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