Elsevier

Psychiatry Research

Volume 256, October 2017, Pages 71-78
Psychiatry Research

Relationship between cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers: Exploring multiple mediation model

https://doi.org/10.1016/j.psychres.2017.06.018Get rights and content

Highlights

  • This study explored the association of CER, social support, resilience and acute stress responses in 1477 Chinese soldiers.

  • Military acute stress was significantly associated with cognitive emotion regulation, social support and resilience.

  • Social support and resilience have multiple mediation effects on the relationship between emotion regulation and stress.

Abstract

The current study aimed to explore the association of cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers and to understand the multiple mediation effects of social support and resilience on the relationship between cognitive emotion regulation and acute stress responses. A total of 1477 male soldiers completed mental scales, including the cognitive emotion regulation questionnaire-Chinese version, the perceived social support scale, the Chinese version of the Connor-Davidson resilience scale, and the military acute stress scale. As hypothesized, physiological responses, psychological responses, and acute stress were associated with negative-focused cognitive emotion regulation, and negatively associated with positive-focused cognitive emotion regulation, social supports and resilience. Besides, positive-focused cognitive emotion regulation, social support, and resilience were significantly associated with one another, and negative-focused cognitive emotion regulation was negatively associated with social support. Regression analysis and bootstrap analysis showed that social support and resilience had partly mediating effects on negative strategies and acute stress, and fully mediating effects on positive strategies and acute stress. These results thus indicate that military acute stress is significantly associated with cognitive emotion regulation, social support, and resilience, and that social support and resilience have multiple mediation effects on the relationship between cognitive emotion regulation and acute stress responses.

Introduction

Acute stress response (ASR), generally considered the fight-or-flight response, occurs under psychologically or physically terrifying circumstances. Clinically, ASR refers to clusters of traumatic stress symptoms characterized by disassociation, avoidance, and arousal that occur in the first month after exposure to a traumatic event (Bryant et al., 2011). Although low to moderate levels of acute stress can be adaptive, the accumulated effects of chronic exposure to stress still lead to negative outcomes, including exhaustion, cognitive decline, poor health behaviors, depressive symptoms, avoidance behavior, and negative social relationships (Juster et al., 2010). Currently, the majority of soldiers are not engaged in wars or conflicts, but they have to face many other types of stressors, such as training exercises, heavy workloads, and family separation (Bartone et al., 1998; Castro et al., 1999). These inevitable stressors could give rise to anxiety, depression, posttraumatic stress disorder (Hoge et al., 2004; Kutz et al., 2006), and even suicidal behaviors (Kuehn, 2009, Anglemyer et al., 2016), which might seriously impair their functions in social and occupational areas, as well as other significant fields (Sharp et al., 2012). There is evidence that ASR is relatively frequent in military personnel (Huang et al., 2014, Speckhard, 2002), and exposure to acute stress for a long time can compromise an individual's task effectiveness. Several protective factors (Israel-Cohen et al., 2016) and successful stress management strategies (Cruess et al., 2015) may be effective at reducing acute distress and also at buffering physiological response. In this instance, many researchers have examined military acute stress and potential related factors (Hu et al., 2012, Huang et al., 2014).

Emerging research suggests that emotion regulation strategies are predictive of stress-related symptoms (Vanderhasselt et al., 2014). According to Garnefski et al. (2001), the general concept of emotion regulation can be regarded as a cognitive style of managing the intake of emotionally arousing information, which encompasses a broad range of cognitive, behavioral, emotional, and physiological responses. This concept is assumed to be an understanding of the behavioral and emotional connection between affective states and stress (Rudolph et al., 2007). Importantly, cognitive emotion regulation strategies are reported to affect the initial emotional response and its subsequent course when individuals confront stressful life events (Garnefski et al., 2006; Jinyao et al., 2012). Given the differential effects on mental health and behaviors, cognitive emotion regulation strategies are divided into adaptive and maladaptive strategies. Reappraisal, regarded as an adaptive strategy, involves altering how to think about an emotion by eliciting the situation to change its emotional impact. Suppression, considered a maladaptive strategy, involves inhibiting emotional expression in response to an emotion-eliciting event (Appleton et al., 2013). Adaptive cognitive emotion regulation strategies are of importance for well-being and successful functioning and are essential for the initiation, motivation, and task effectiveness, whereas maladaptive strategies might result in maladaptive behaviors, not favorable for individual rehabilitation (Wang et al., 2014, Garnefski et al., 2001). Several researchers suggested that emotion regulation is a critical factor for military performance (e.g., emotion/attention interactions, and motor task performance, etc., Janelle et al., 2008; Tenenbaum et al., 2008; Wallenius et al., 2004). Both military and non-military operations are stressful events for soldiers, but few studies have explored the relationship between cognitive emotion regulation strategies and military acute stress, which is one of the current study's objectives.

Even though some people undergo negative physical and mental health effects following stressful life events, some others show high resilience to stress (Bartone, 2006). It's on account of the potential effects on well-being, health, and quality of life that resilience becomes a fruitful focus of research (Friedli, 2009, Jr, 2011). Resilience is assumed to be an important factor that protects individuals from the negative impact of stress (Newman, 2005), increases the ability to cope with considerable challenges (Rutter, 1985) and to promptly pick up from negative emotional experiences (Tugade et al., 2004). Schaubroeck et al. (2011) explored resilience to traumatic exposure among soldiers deployed in combat areas and suggested resilience might play a substantial role in differentiating those who prove to be more or less adaptive to extremely stressful environments. Then, several researchers demonstrated that resilience contributed to success at military academies (Bartone et al., 2013, Bezdjian et al., 2016, Maddi et al., 2012). Besides, emotion regulation processes prove to be the key to resilience and mental well-being (Gross et al., 2003; Hu et al., 2014; Kalisch et al., 2015). For example, Min et al. (2013) showed that the cognitive emotion regulation strategies of refocus on planning, positive reappraisal, and less rumination contributed to resilience in patients with depression and anxiety disorders. It might provide potential targets for psychotherapeutic intervention to improve resilience in these patients. Therefore it is also important to help soldiers survive and thrive when dealing with negative events and to investigate the correlations among resilience, emotion regulation, and military acute stress.

Another potential factor is social support, which is considered the perceived availability of support, affection, and instrumental aid from significant social partners, such as family members, intimate friends, and workmates (Larocca et al., 2015). Several studies have found that good social support is associated positive health effects (Berkman et al., 2000, Cohen, 2004), and poor social support leads to negative outcomes (Skarupski et al., 2015). Additionally, a longitudinal study successfully showed that entity theorists of emotion had lower emotion regulation and received less social support from new friends (Tamir et al., 2007). Due to strict management, family separations, and heavy workloads, social support turns out to be more important for soldiers’ mental health. On the one hand, social supports are able to promote soldiers’ combat motivation during deployment (Grant-Vallone et al., 2001; Greene et al., 2010; Kamphuis et al., 2012). On the other hand, a supportive family can provide service members with emotional resources, such as understanding and comfort, which enable individuals to perceive the experience as less threatening and to help them process through the situation (House et al., 1985; Schaefer et al., 1998). A recent research in otherwise healthy navy personnel suggested that greater resilience, greater post-deployment social support, and less stressful deployment environments could predict greater post-deployment adjustment (Cunningham et al., 2014). Also, adaptive emotion regulation skills and social relationships could have significant protective effects on the lives of recently returning combat veterans (Williston, 2013).

In the current study, social support was expected to mediate the relationship between emotion regulation and acute stress response. The positive effects of social support might be especially beneficial for those military personnel with maladaptive emotion regulation strategies, because they used to experience more distress when exposed to the threat. Additionally, there is mounting evidence suggesting that social support interacts with interpersonal variables to confer resilience (Lee et al., 2011, Russell et al., 2016), which is also one of the relationships this research aims to explore in military personnel.

Generally speaking, cognitive emotion regulation strategies, resilience, social support, and military acute stress are closely linked with one another. To our knowledge, the current study is the first report on a model examining the relationships among these four constructs in a large Chinese military sample. Specifically, we sought to (1) explore the associations among cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers; and (2) more importantly, understand the multiple mediation effects of social support and resilience on the relationship between cognitive emotion regulation and acute stress responses, supporting references for the improvement of acute stress responses in military personnel.

Section snippets

Participants

Fifteen hundred forty-eight male soldiers of the Chinese People's Liberation Army from the same barracks were recruited for the current study. All the participants took part in the annual military examination, which was closely connected to their promotion and other incentives. They were informed in advance that participation was completely voluntary and that their command would not receive any respondent data. They also read the informed consent on the first page of the questionnaires. The

Demographic variables

Table 1 shows some demographic information for all participants in addition to descriptive statistics for study measures.

Correlation analysis of cognitive emotion regulation, social support, resilience and acute stress responses

Table 2 shows descriptive statistics and Pearson correlations among the study variables. All the measuring instruments demonstrated acceptable internal consistency in the current sample. Physiological responses, psychological responses, and acute stress were positively associated with both positively focused cognitive emotion regulation and negatively focused cognitive

Discussion

The present study was undertaken to investigate the relationships among cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers. As hypothesized, military acute stress was significantly associated with cognitive emotion regulation, social support, and resilience. Although the effect sizes were relatively small in the current results, the observed effects were obvious above and beyond the statistical variance accounted for by the covariates of

Conclusions

Above all, the current study is the first to simultaneously examine multiple mediation in one model to disentangle the complex mechanisms by which three key factors (cognitive emotion regulation strategy, social support, and resilience) interact with one another to predict military acute stress responses among Chinese soldiers. These results suggest the potential great value of resilience training in reducing negative stress responses, but further research is needed to replicate the findings

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

We thank all the participants for volunteering in this study and give our sincere gratitude to Prof. Nadia Garnefski (Leiden University), Su Zhou & Xiuqin Zhang (Nanjing University of Chinese Medicine), Jun Gao (Shanghai Jiao Tong University) who gave us great help when we revised the article. This study was funded by the Major Program of the “12th Five-Year Plan” for Medical Development of PLA (14CXZ002), the General Program of the “12th Five-Year Plan” for Medical Development of PLA (CWS12J015

References (96)

  • A.J. Lamond et al.

    Measurement and predictors of resilience among community-dwelling older women

    Psychiatr. Res.

    (2008)
  • J. Li et al.

    Does psychological resilience mediate the impact of social support on geriatric depression? An exploratory study among Chinese older adults in Singapore

    Asian Psychiatr.

    (2015)
  • M.K. Malhotra et al.

    An assessment of survey research in POM: from constructs to theory

    Oper. Manag.

    (1998)
  • R.C. Martin et al.

    Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger

    Pers. Individ. Dif.

    (2005)
  • J.A. Min et al.

    Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders

    Compr. Psychiatry

    (2013)
  • S.A. Stansfeld et al.

    Work and psychiatric disorder in the Whitehall II Study

    Psychosom. Res.

    (1997)
  • M.A. Vanderhasselt et al.

    Adaptive cognitive emotion regulation moderates the relationship between dysfunctional attitudes and depressive symptoms during a stressful life period: a prospective study

    Behav. Ther. Exp. Psychiatry

    (2014)
  • Q. Zhang et al.

    Relationship between acute stress and sleep disorder in grass-root military personnel: mediating effect of social support

    Mil. Med. Res.

    (2014)
  • A.B. Adler et al.

    Resilience training with soldiers during basic combat training: randomisation by platoon

    Appl. Psychol. Health Well Being

    (2015)
  • A. Aldao et al.

    Emotion regulation flexibility

    Cogn. Ther. Res.

    (2015)
  • A. Anglemyer et al.

    Suicide rates and methods in active duty military personnel, 2005 to 2011: a cohort study

    Ann. Intern. Med.

    (2016)
  • A.A. Appleton et al.

    Divergent associations of adaptive and maladaptive emotion regulation strategies with inflammation

    Health Psychol.

    (2013)
  • B.B. Arnetz et al.

    Assessment of a prevention program for work-related stress among urban police officers

    Int. Arch. Occ. Environ. Health

    (2013)
  • M.J. Azur et al.

    Multiple imputation by chained equations: what is it and how does it work?

    Int. J. Methods Psychiatr Res.

    (2011)
  • P.T. Bartone

    Resilience under military operational stress: can leaders influence hardiness?

    Mil. Psychol.

    (2006)
  • P.T. Bartone et al.

    Dimensions of psychological stress in peacekeeping operations

    Mil. Med.

    (1998)
  • P.T. Bartone et al.

    Psychological hardiness predicts adaptability in military leaders: a prospective study

    Int. Sel. Assess.

    (2013)
  • S. Bezdjian et al.

    Resilience in the united states air force: psychometric properties of the connor-davidson resilience scale (CD-RISC)

    Psychol. Assess.

    (2016)
  • J.A. Blumenthal et al.

    Social support, type A behavior, and coronary artery disease

    Psychosom. Med.

    (1987)
  • G. Bouchard et al.

    Situational and dispositional coping: an examination of their relation to personality, cognitive appraisals, and psychological distress

    Eur. Psychol. Assess.

    (2004)
  • R.A. Bryant et al.

    A review of acute stress disorder in DSM-5

    Depress. Anxiety

    (2011)
  • C.A. Castro et al.

    OPTEMPO: effects on soldier and unit readiness

    Parameters U. S. Army War Coll.

    (1999)
  • S. Cohen

    Social relationships and health

    Am. Psychol.

    (2004)
  • S. Cohen et al.

    Stress, social support, and the buffering hypothesis

    Psychol. Bull.

    (1985)
  • B.E. Compas et al.

    Coping and emotion regulation from childhood to early adulthood: points of convergence and divergence

    Aust. Psychol.

    (2014)
  • D.G. Cruess et al.

    Brief stress management reduces acute distress and buffers physiological response to a social stress test

    Int. Stress. Manag.

    (2015)
  • C.A. Cunningham et al.

    The role of resilience and social support in predicting postdeployment adjustment in otherwise healthy navy personnel

    Mil. Med.

    (2014)
  • Y. Dai et al.

    Prevalence and predisposing factors for fepressive status in Chinese patients with obstructive sleep apnoea: a large-sample survey

    PLoS One

    (2016)
  • L. Friedli

    Mental Health, Resilience and Inequalities

    (2009)
  • N. Garnefski et al.

    The relationship between cognitive emotion regulation strategies and emotional problems: comparison between a clinical and a non‐clinical sample

    Eur. Pers.

    (2002)
  • N. Garnefski et al.

    Manual for the use of the Cognitive Emotion Regulation Questionnaire

    (2002)
  • E.J. Grant-Vallone et al.

    Consequences of work-family conflict on employee well-being over time

    Work Stress

    (2001)
  • T. Greene et al.

    How communication with families can both help and hinder service members' mental health and occupational effectiveness on deployment

    Mil. Med.

    (2010)
  • J.J. Gross et al.

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

    Pers. Soc. Psychol.

    (2003)
  • D.A. Hien et al.

    Emotion-focused coping as a mediator of maternal cocaine abuse and antisocial behavior

    Psychol. Addict. Behav.

    (2003)
  • C.W. Hoge et al.

    Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care

    N. Engl. Med.

    (2004)
  • J.S. House et al.

    Measures and concepts of social support

  • G. Hu et al.

    Psychological stress of Chinese armyman under diversified military tasks

    Rev. Int. Serv. Sante Forces Armees

    (2012)
  • Cited by (0)

    View full text