Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder

https://doi.org/10.1016/j.janxdis.2014.03.005Get rights and content

Highlights

  • Emotion regulation strategies have asymmetric relationships with social anxiety.

  • Adaptive and maladaptive strategies interact when predicting social anxiety.

  • These relationships are moderated by CBT treatment phase.

  • Results underscore the importance of context in emotion regulation in anxiety.

Abstract

There has been a increasing interest in understanding emotion regulation deficits in social anxiety disorder (SAD; e.g., Hofmann, Sawyer, Fang, & Asnaani, 2012). However, much remains to be understood about the patterns of associations among regulation strategies in the repertoire. Doing so is important in light of the growing recognition that people's ability to flexibly implement strategies is associated with better mental health (e.g., Kashdan et al., 2014). Based on previous work (Aldao & Nolen-Hoeksema, 2012), we examined whether putatively adaptive and maladaptive emotion regulation strategies interacted with each other in the prediction of social anxiety symptoms in a sample of 71 participants undergoing CBT for SAD. We found that strategies interacted with each other and that this interaction was qualified by a three-way interaction with a contextual factor, namely treatment study phase. Consequently, these findings underscore the importance of modeling contextual factors when seeking to understand emotion regulation deficits in SAD.

Section snippets

Background

In the past decade, there has been growing interest in understanding emotion regulation difficulties in social anxiety disorder (SAD; e.g., Hofmann, 2010, Hofmann et al., 2012, Kashdan et al., 2014, Kashdan and Steger, 2006, Moscovitch et al., 2010, Turk et al., 2005). In non-clinical samples, symptoms of social anxiety have been associated with the use of the putatively maladaptive strategies of suppression (e.g., Kashdan and Breen, 2008, McLean et al., 2007, Perini et al., 2006), experiential

Participants

As part of a larger neuroimaging study examining CBT for SAD, participants were recruited through referrals, community flyers, and web listings advertising a free treatment at Stanford University (see Goldin et al., 2014) for detailed methods. We screened 436 individuals over the telephone to obtain preliminary eligibility information based upon the study inclusion/exclusion criteria (described in detail in the next section). Individuals who met these criteria (N = 110) were invited to

Preliminary analyses

Before conducting our main analyses, we examined how the measures of interest changed over time by running 3 GEE models, predicting weekly changes in social anxiety symptoms, use of maladaptive avoidance strategies, or use of adaptive engagement strategies by treatment study phase (N = 71 participants, n = 1088 observations). We found a significant two-way interaction between study phase and weekly changes in social anxiety symptoms, Wald's χ2 = 9.11, p < .001, b = .39, SE (.13), CI (.14; .65), the use

Discussion

In this study, we sought to expand upon the growing literature on emotion regulation deficits in SAD by adopting a contextual framework emphasizing the examination of interactions among strategies in the repertoire (e.g., Aldao & Nolen-Hoeksema, 2012). First, we found support for the presence of an asymmetry in the relationship between social anxiety symptoms and the use of adaptive engagement/maladaptive avoidance strategies, whereby the use of adaptive engagement strategies had a weaker

Authorship note

A. A., H. J., and J.G. developed the study concept. H. J., P. G., and J. G. contributed to the study design and data collection. A. A. conducted data analysis. All four authors wrote the manuscript and approved the final version for submission.

Funding

This research was supported by a National Institute of Mental Health Grant R01 MH076074 awarded to James J. Gross.

References (67)

  • P.L. Szasz et al.

    The effect of emotion regulation strategies on anger

    Behaviour Research & Therapy

    (2011)
  • M. Wolgast et al.

    Cognitive reappraisal and acceptance: an experimental comparison of two emotion regulation strategies

    Behaviour Research & Therapy

    (2011)
  • L.S. Aiken et al.

    Multiple regression: testing and interpreting interactions

    (1991)
  • A. Aldao

    The future of emotion regulation research: capturing context

    Perspectives on Psychological Science

    (2013)
  • A. Aldao et al.

    Broadening the scope of research on emotion regulation strategies and psychopathology

    Cognitive Behaviour Therapy

    (2014)
  • A. Aldao et al.

    . When are adaptive strategies most predictive of psychopathology?

    Journal of Abnormal Psychology

    (2012)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (1994)
  • L.F. Barrett et al.

    Knowing what you’re feeling and knowing what to do about it: mapping the relation between emotion differentiation and emotion regulation

    Cognition & Emotion

    (2001)
  • D. Berle et al.

    Preliminary validation of an ultra-brief version of the Penn State Worry Questionnaire

    Clinical Psychology & Psychotherapy

    (2011)
  • G.A. Bonanno et al.

    Regulatory flexibility: an individual differences perspective on coping and emotion regulation

    Perspectives on Psychological Science

    (2013)
  • L.M. Bylsma et al.

    Uncovering the dynamics of emotion regulation and dysfunction in daily life with ecological momentary assessment

  • P.A. DiNardo et al.

    Anxiety disorders interview schedule for DSM-IV (ADIS-IV)

    (1994)
  • C. D’Avanzato et al.

    Emotion regulation in depression and anxiety: examining diagnostic specificity and stability of strategy use

    Cognitive Therapy and Research

    (2013)
  • U.W. Ebner-Priemer et al.

    Ecological momentary assessment of mood disorders and mood dysregulation

    Psychological Assessment

    (2009)
  • B. Efron

    Forcing a sequential experiment to be balanced

    Biometrika

    (1971)
  • N.A. Farb et al.

    Mindfulness interventions and emotion regulation

  • H.N. Fentz et al.

    Mechanisms of change in cognitive behaviour therapy for panic disorder: the role of panic self-efficacy and catastrophic misinterpretations

    Behaviour Research and Therapy

    (2013)
  • P. Ghisletta et al.

    An introduction to generalized estimating equations and an application to assess selectivity effects in a longitudinal study on very old individuals

    Journal of Educational and Behavioral Statistics

    (2004)
  • A.T. Gloster et al.

    Timing matters: change depends on the stage of treatment in cognitive behavioral therapy for panic disorder with agoraphobia

    Journal of Consulting and Clinical Psychology

    (2013)
  • P.R. Goldin et al.

    Trajectories of change in emotion regulation and social anxiety during cognitive-behavioral therapy for social anxiety disorder

    Behaviour Research and Therapy

    (2014)
  • P.R. Goldin et al.

    Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder

    Journal of Consulting and Clinical Psychology

    (2012)
  • J.J. Gross et al.

    Emotion regulation and psychopathology: an affective science perspective

    Clinical Psychological Science

    (2014)
  • J.J. Gross et al.

    Individual differences in two emotion regulation processes: implications for affect, relationships, and well being

    Journal of Personality and Social Psychology

    (2003)
  • Cited by (129)

    • Interoceptive attention facilitates emotion regulation strategy use

      2023, International Journal of Clinical and Health Psychology
    • Interactive Technologies for Emotion Regulation Training: A Scoping Review

      2022, International Journal of Human Computer Studies
    View all citing articles on Scopus
    1

    Tel.: +1 408 462 1447.

    2

    Tel.: +1 415 503 1606.

    3

    Tel.: +1 650 723 1281.

    View full text