Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder

doi:10.1016/j.brat.2011.12.004

Behaviour Research and Therapy

Volume 50, Issue 2, February 2012, Pages 122-130

https://doi.org/10.1016/j.brat.2011.12.004 Get rights and content

Abstract

Recent models of generalized anxiety disorder (GAD) have expanded on Borkovec’s avoidance theory by delineating emotion regulation deficits associated with the excessive worry characteristic of this disorder (see Behar, DiMarco, Hekler, Mohlman, & Staples, 2009). However, it has been difficult to determine whether emotion regulation is simply a useful heuristic for the avoidant properties of worry or an important extension to conceptualizations of GAD. Some of this difficulty may arise from a focus on purported maladaptive regulation strategies, which may be confounded with symptomatic distress components of the disorder (such as worry). We examined the implementation of adaptive regulation strategies by participants with and without a diagnosis of GAD while watching emotion-eliciting film clips. In a between-subjects design, participants were randomly assigned to accept, reappraise, or were not given specific regulation instructions. Implementation of adaptive regulation strategies produced differential effects in the physiological (but not subjective) domain across diagnostic groups. Whereas participants with GAD demonstrated lower cardiac flexibility when implementing adaptive regulation strategies than when not given specific instructions on how to regulate, healthy controls showed the opposite pattern, suggesting they benefited from the use of adaptive regulation strategies. We discuss the implications of these findings for the delineation of emotion regulation deficits in psychopathology.

Highlights

► Acceptance (and No Regulation Instruction) led to higher subjective negative affect than Reappraisal in both groups. ► In the GAD group, Acceptance and Reappraisal led to lower HRV than No Regulation (opposite than in controls). ► Findings are interpreted in light of emotion regulation framework and recent findings on physiological feedback loops.

Section snippets

Background

Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry (APA, 2000). According to Borkovec’s avoidance theory, worry is a verbal/linguistic process that, although associated with heightened subjective distress, is negatively reinforced through the facilitated avoidance of unpleasant somatic activation and imagery (Borkovec, Alcaine, & Behar, 2004). Recent theories have expanded upon the avoidance perspective by detailing the role of emotional components that

Participants

Participants were recruited from an urban community surrounding a large private university in the northeast United States. In order to qualify for the study, they had to be between the ages of 21 and 65, not be college students, be fluent in English, and have no history of heart conditions or diabetes. In addition, participants were excluded if they reported current substance use or abuse (with the exception of nicotine), pertinent medical conditions (e.g., heart condition, epilepsy) and use of

Group characteristics

The following demographic variables did not differ across diagnostic group or regulation condition: age, gender, ethnicity, alcohol quantity, caffeine quantity, exercise status, smoking status, and antidepressant status (p’s > .05). In addition, there were no differences in terms of comorbid depression across regulation conditions within the GAD group, χ² (2) = 1.08, ns. Lastly, given documented gender difference in HRV (e.g., Kosinken et al., 2009, Snieder et al., 2007, Sztajzel et al., 2008),

Discussion

Despite recent advances in the delineation of emotion regulation deficits in GAD, our understanding of the process of implementation of strategies beyond worry is still in its infancy. Specifically, very little is known about the actual sources of difficulties that individuals with this disorder encounter when seeking to deploy adaptive regulation strategies, such as cognitive reappraisal or acceptance. Given that adaptive regulation strategies are seldom compared to one another in experimental

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Citation Excerpt :
Although we found differences at the subjective level and in terms of greater PFC left side activation for the FR group, we did not find any differences at the level of autonomic reactions and flexibility. The lack of differences in autonomic effects obtained in this study for between groups can be related to various paradoxical effects documented in the literature (see Aldao & Mennin, 2012) in terms of the lower cardiac flexibility for individuals with generalized anxiety disorder while using adaptive ER strategies, compared to healthy participants. In terms of the potential mechanisms explaining our results, we obtained a marginally significant moderating effect of the severity of social anxiety only for the lateral prefrontal asymmetries after the ER statement in the FR group compared to the control condition.
It is known that social anxiety disorder (SAD) interferes in a great deal of life areas, ranging from social and private relationships to work related environments. We aimed to investigate the comparative efficacy of three emotion-regulation strategies in a job interview task for individuals with SAD. We considered both different categories of emotion-regulation strategies (reappraisal vs. suppression) but also different types of the same strategy (functional vs. positive reappraisal).
92 participants diagnosed with SAD were randomly assigned to one of the three experimental groups and a no strategy control group. Participants were required to present themselves in front of external observers who would rate their performance and decide if they are suited for the job. We measured subjective mood, rated performance, EEG asymmetries, and autonomic flexibility at three different phases: while anticipating the discourse, after the statement (when emotion regulation strategy was offered), and when recovering.
The functional reappraisal strategy was found to be superior to no strategy for anxiety, confidence, and coded performance. We found a higher level of left side PFC activity for the functional reappraisal group at the statement phase, with a moderation effect for PFC asymmetry of SAD severity.

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Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder

Abstract

Highlights

Section snippets

Background

Participants

Group characteristics

Discussion

Behaviour Research & Therapy

Clinical Psychology Review

Biological Psychology

Brain & Cognition

Journal of Anxiety Disorders

Behaviour Research & Therapy

Neuroimage

Behaviour Research & Therapy

Behaviour Research & Therapy

Journal of Behavior Therapy & Experimental Psychiatry

Behavior Therapy

Biological Psychology

Clinical Psychology Review

Behaviour Research & Therapy

Behavior Therapy

Behavior Therapy

Behaviour Research & Therapy

Behaviour Research & Therapy

Behaviour Therapy

Behaviour Research & Therapy

Biological Psychology

Clinical Psychology Review

Behavior Therapy

Psychiatry Research

Biological Psychology

Journal of Anxiety Disorders

Biological Psychiatry

Personality & Individual Differences

Diagnostic and statistical manual of mental disorders

Fear, anxiety, and theories of emotion

Cognitive therapy of depression

Manual for the Beck depression inventory-II

The development of the unified protocol for the transdiagnostic treatment of emotional disorders: a case study

Cognitive & Behavioral Practice

Avoidance theory of worry and generalized anxiety disorder