Emotion Differentiation and Emotion Regulation in High and Low Socially Anxious Individuals: An Experience-Sampling Study

The association between negative emotion differentiation and emotion regulation flexibility in daily life

Emotion differentiation emphasises labelling emotional experiences in a precise and context-sensitive way. Negative emotion differentiation (NED) has been found to be associated with mental health, where emotion regulation (ER) may act as a pathway. The current study aims to explore the association between NED and flexible ER implementation in daily life. Specifically, we examined how NED was associated with two aspects of ER flexibility: contextual synchrony and temporal ER variability. 101 college students (54% female; Mage = 20.24 years) reported their momentary emotions via a 7-day experience sampling protocol, and the intraclass correlation coefficients were calculated to reflect NED. In 10-day daily diaries, they also reported information about the most negative event during the day (i.e. event type, event intensity and ER goal) and how they regulated their emotions. The results revealed that individuals with high NED showed higher levels of synchrony between change in ER use and change in event type and ER goal. In addition, NED was positively associated with both within- and between-strategy variability in ER use. The results demonstrated that the ability to differentiate between negative emotions was related to higher ER flexibility, which shed new light on understanding the role of emotion differentiation in well-being.

How do "words poorly expressed emotion" affect mental health? The mediating role of affect labelling effect

Previous studies have found that people with high negative emotional granularity(NEG) tend to have better health levels. It is generally believed that this is due to the selection and application of explicit emotion regulation strategies that affect mental health. However, no research has yet examined a more fundamental process, the role of affect labelling, an implicit emotion regulation strategy. This study focuses on the aforementioned issues and uses the experience sampling method to categorise participants into groups with high and low NEG. Using an affect labelling paradigm with ERP(event-related potential) technology, the study measures the effects of affect labelling in participants. Furthermore, it assesses the mental health levels of the participants through questionnaires to explore whether the affect labelling effect serves as a mediator between NEG and mental health. The results show that: (1) The high-NEG group exhibited significantly lower LPP wave amplitudes under affect labelling compared to under non-affect labelling, whereas the low-NEG group did not show significant differences. The results indicate that only the high-NEG group can produce the affect labelling effect. (2) The affect labelling effect mediates the relationship between NEG and mental health, meaning that NEG predicts mental health through the affect labelling effect.

Are vaccination uptake and non-uptake influenced by our emotions? An experimental study on the role of emotional processes and compassion

OBJECTIVE

This study examined the effects of emotional arousal, emotional competence, emotion regulation (ER), and compassion on COVID-19 and flu vaccination intentions (VI) among the French population.

DESIGN

Data were collected online from October to December 2020. Altogether, 451 participants (Mage = 35.8, SD = 16.4) were allocated to four groups. High positive (n = 104) or negative (n = 103) emotional arousal were induced into two groups using pictures and music, and compared against a control group (flu group; n = 116) and a reference group (COVID-19 group; n = 114). All groups completed questionnaires on emotional arousal, ER, emotional competence, compassion, and VI.

RESULTS

The findings indicated a significant effect of group on VI, h2=.023, 95% CI [-.002, .09]. The Group*Gender interaction on emotional arousal was non-significant, η p 2 =.015, 95%CI [.000, .041]. However, emotional arousal was observed to have a significant main effect on VI, η p 2 =.09, 95% CI [.043, .238]. The ER type*Emotional arousal*Gender interaction on ER use was trend, η p 2 = .002, 95% CI [.000, .005]. The emotional competence*ER type interaction on ER use was significant, η p 2 = .028, 95% CI [.011, .049]. Only experiential avoidance mediated the relationship between emotional arousal and VI, p < .018, 95% CI [.015, .18].

CONCLUSION

Emotional arousal impacts VI. High emotional competence only reduces the use of dysfunctional ER strategies.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review

BACKGROUND

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet.

OBJECTIVE

This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science.

RESULTS

A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics.

CONCLUSIONS

AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Feasibility and Acceptability of a Mobile App for Prolonged Grief Disorder Symptoms

Background

Mobile apps provide a unique platform for mental health assessment and monitoring. They can provide real time, accessible data on symptoms of mental disorders that may yield rich data for detailed clinical assessment and help individuals gain insight into their current mental state. We developed one of the first apps for tracking symptoms of prolonged grief disorder.

Method

In this pilot feasibility study, we assess the feasibility and acceptability of a new mobile app mGAGE for use once a day for 3 weeks. 27 participants completed mental health assessments at t1 and t2.

Results

Adherence to the app protocol was very high with 100% for the first two weeks of use. A surprising finding was the improvement of grief symptoms at t2. Debriefing interviews revealed general qualitative categories including positive feedback, negative feedback and specific recommendations. Overall, the app was found to be feasible for use for the first two weeks and acceptable for bereaved individuals.

Conclusions

This app could provide valuable data for in depth clinical assessment, may support individuals to gain greater insight into their symptoms and may have a therapeutic effect in terms of improved grief symptoms. Implications for future studies including use in larger intervention studies are discussed.

Social anxiety and emotion regulation flexibility: a daily diary approach

Previous research suggests that social anxiety symptoms are maintained and intensified by inflexible emotion regulation (ER). Therefore, we examined whether trait-level social anxiety moderates ER flexibility operationalised at both between-person (covariation between variability in emotional intensity and variability in strategy use across occasions) and within-person (associations between emotional intensity and strategy use on a given day) levels. In a sample of healthy college-aged adults (N = 185, Mage = 21.89), we examined overall and emotion-specific intensities (shame, guilt, anxiety, anger, sadness) and regulatory strategies (i.e. experiential avoidance, expressive suppression, and rumination) in response to each day's most emotionally intense event over 6 days. During the study period, we found a positive association between variability in emotional intensity and variability of experiential avoidance in individuals with lower, rather than higher, levels of trait social anxiety after controlling for key covariates (i.e. gender, personality traits, and stress exposure). However, we did not find evidence for the moderating role of trait social anxiety in ER flexibility assessed at within-person levels. Our findings highlight the need to delineate dynamic ER flexibility across everyday events.

Examining the Role of Emotion Differentiation on Emotion and Cardiovascular Physiological Activity During Acute Stress

Emotion differentiation (ED) - the tendency to experience one's emotions with specificity - is a well-established predictor of adaptive responses to daily life stress. Yet, there is little research testing the role of ED in self-reported and physiological responses to an acute stressor. In the current study, we investigate the effects of negative emotion differentiation (NED) and positive emotion differentiation (PED) on participants' self-reported emotions and cardiac-mediated sympathetic nervous system reactivity (i.e., pre-ejection period) in response to a stressful task. Healthy young adults enrolled in a two-session study. At an initial session, participants completed a modified experience sampling procedure (i.e., the Day Reconstruction Method). At session 2, 195 completed the Trier Social Stress Test while cardiac impedance was acquired throughout. Linear regressions demonstrated that higher NED, but not PED, was associated with experiencing less intense self-reported negative, high arousal emotions (e.g., irritated, panicky) during the stressor (β =  - .15, p < .05) although people with higher NED also exhibited greater sympathetic reactivity (β = .16, p < .05). In exploratory analyses, we tested whether the effect of NED on self-reported stress was mediated by the tendency to make internally focus (or self-focused) attributions about performance on the task but did not find a significant indirect effect (p = .085). These results both complement prior work and provide a more complex picture of the role of NED in adaptive responses to stressful life events, suggesting that people with higher NED may experience their emotions as more manageable regardless of their level of physiological arousal.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00189-y.

Emotions in social anxiety disorder: A review

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed.

Psychological Resilience: An Affect-Regulation Framework

Exposure to adversity (e.g., poverty, bereavement) is a robust predictor of disruptions in psychological functioning. However, people vary greatly in their responses to adversity; some experience severe long-term disruptions, others experience minimal disruptions or even improvements. We refer to the latter outcomes-faring better than expected given adversity-as psychological resilience. Understanding what processes explain resilience has critical theoretical and practical implications. Yet, psychology's understanding of resilience is incomplete, for two reasons: (a) We lack conceptual clarity, and (b) two major approaches to resilience-the stress and coping approach and the emotion and emotion-regulation approach-have limitations and are relatively isolated from one another. To address these two obstacles,we first discuss conceptual questions about resilience. Next, we offer an integrative affect-regulation framework that capitalizes on complementary strengths of both approaches. This framework advances our understanding of resilience by integrating existing findings, highlighting gaps in knowledge, and guiding future research.

The Influence of Emotion Regulation on Estimation Strategy Execution in Individuals with Trait Anxiety

Previous studies have shown that some negative emotions hinder estimation strategy execution. However, these studies rarely investigate the influence of negative emotions on the estimation strategy execution in individuals with trait anxiety. The present study examines the relationship between negative emotions and trait anxiety in individuals’ estimation strategy execution. Moreover, it looks into the influence of different emotion regulation strategies on their estimation strategy execution. In October 2010, 803 college students were evaluated using the Trait Anxiety Scale. From these participants, individuals with high and low trait anxiety were selected to complete the double-digit multiplication estimation task. The results showed that the estimation strategy’s execution speed in individuals with high trait anxiety was slower than those with low trait anxiety under negative emotions (t (113) = −2.269, p = 0.025, d = 0.427). Both expression inhibition and cognitive reappraisal could significantly improve the execution speed of the estimation strategy in low trait anxiety (p < 0.001). For individuals with high trait anxiety, cognitive reappraisal regulating negative emotions can promote the estimation strategy’s execution speed (p = 0.031). However, the use of expression inhibition has no significant effect on estimation strategy execution (p = 0.101). In summary, the present study revealed that different emotion regulation strategies moderated the arithmetic strategy execution of individuals with trait anxiety, and cognitive reappraisal had a better effect in individuals with high trait anxiety.

The roles of negative emotion intensity, negative emotion differentiation, and self-compassion in loss of control eating

OBJECTIVE

Negative affect intensity is robustly related to binge eating, but the relationship between negative emotion differentiation (i.e., the ability to differentiate negatively-valenced emotions) and binge eating is unclear. Further, little is known about factors that might reduce emotion intensity and/or enhance emotion differentiation, thereby reducing binge eating. Self-compassion is consistently linked to less binge eating, which may be due to decreased negative affect and/or an enhanced ability to differentiate emotions. The current study examined the roles of negative emotion intensity, negative emotion differentiation, and self-compassion in binge eating using ecological momentary assessment.

METHOD

Participants were 201 university students (52.2% female) who completed questionnaires assessing affect seven times a day, and engagement in loss of control (LOC) eating episodes at the end of each day, for 10 days. The average of sadness, fear, guilt, and hostility subscales represented negative emotion intensity; intraclass correlations across negative affect subscales defined negative emotion differentiation. Both daily (i.e., within-person) and trait (i.e., between-person) emotion variables were examined as predictors.

RESULTS

Between-person negative emotion intensity, but not negative emotion differentiation, significantly predicted LOC eating occurrence. Self-compassion had a significant effect on LOC eating frequency, and this relationship was partially mediated via negative emotion intensity, but not via negative emotion differentiation.

DISCUSSION

Lower levels of negative emotion intensity partially account for the relationship between greater self-compassion and less frequent LOC eating. These findings highlight the importance of cultivating self-compassion to down-regulate negative emotions and to reduce LOC eating.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that university students who approach their limitations compassionately experience fewer negative emotions in daily life and engage in less loss of control eating. Lower levels of negative affect partially explain this relationship between self-compassion and loss of control eating. These results highlight the importance of cultivating an understanding and a compassionate attitude toward oneself for reducing eating pathology.

Cognitive risk factors and the experience of acute anxiety following social stressors: An ecological momentary assessment study

To better understand how social anxiety develops, it is crucial to identify mechanisms that influence anxiety following social stressors. Anxiety sensitivity social concerns (ASSC; fear of publicly observable anxiety symptoms) and fear of negative evaluation (FNE; distress arising from concerns about negative judgment) are constructs that amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal and anxious apprehension following stressors was examined in community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day for two-weeks. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict both forms of anxiety, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.

Emotion regulation patterns: Capturing variability and flexibility in emotion regulation in an experience sampling study

Variability and flexibility in emotion regulation (ER) are considered important ingredients in adaptive ER. Few attempts at operationalizing variability and flexibility in ER have been made. In two 10‐day experience sampling studies (N = 51 and 39), healthy participants rated their momentary emotions and their ER efforts in response to those emotions. We evaluated the association between ER (i.e., between and within ER strategy variability and ER flexibility, operationalized as putatively adaptive, putatively maladaptive and total strategies) and measures of well‐being (psychological distress, satisfaction with life) in general (person‐level) and in everyday life (day‐level). Higher within‐variability indicated that a strategy was used more at some occasions and less at others. Higher between‐variability indicated variation in the extent to which different strategies were engaged at the same time point. Overall, results were mixed, but in some instances, indicators of ER variability and ER flexibility were related to each other and measures of well‐being differently. Total within ER variability was negatively associated with well‐being at the person and day level. Putatively adaptive between and within ER variability were associated with less well‐being at the person level. At the day level, putatively adaptive and maladaptive between ER variability and maladaptive within ER variability were negatively associated with well‐being. Putatively adaptive ER flexibility was negatively associated with satisfaction with life. This study adds to the literature on indicators of variability and flexibility in ER and their potential adaptiveness. The results indicate that variability in ER could be a maladaptive property, but more research is needed to understand this in terms of putatively adaptive and maladaptive strategies. Future studies on the adaptiveness of these indicators should obtain more contextual information.

Transactional links between children daily emotions and internalizing symptoms: a six-wave ecological momentary assessment study

BACKGROUND

This study explored the cross-sectional and longitudinal associations between everyday emotion dimensions and internalizing symptoms during the transition to early adolescence. We tested associations between children's intensity and instability of daily negative emotions (NE), positive emotions (PE), and daily NE differentiation (NED) with children's self-reported and their mothers' report of children's internalizing symptoms, across six waves, each wave separated by six months.

METHODS

The sample included 199 ethnically diverse mother [M_age at baseline = 40.1 years (SD = 6.1] and child [M_age at baseline = 10.1 (SD = 0.90), 51% girls] dyads, who participated in six 7-day waves of ecological momentary assessment (EMA). During each wave, children reported on PE (i.e. happy and joyful) and NE (i.e. mad, sad, and stressed) up to eight random times per day through smartphone-based EMA. Children and mothers reported on children's internalizing symptoms at each wave. We used random-intercept cross-lagged panel models (RI-CLPMs) to test within- and between-person effects.

RESULTS

At the within-person level, increased NE and decreased PE intensity, more unstable NE and PE, and decreased NED at any given wave were positively associated with children's self-reported internalizing symptoms but not with mother-reported child symptoms. However, emotion dimensions did not predict child-reported nor mother-reported child symptoms at the next wave. At the between-person level, higher average NE, more unstable PE and NE, and lower NED were positively associated with average child-reported and mother-reported child internalizing symptoms.

CONCLUSIONS

This study suggests that emotional intensity, instability, and differentiation could be conceptualized as manifestations of internalizing symptoms but not as risk factors for its progression, or residual manifestations of it, among typical children.

Modeling Skin Conductance Response Time Series during Consecutive Rapid Decision-Making under Concurrent Temporal Pressure and Information Ambiguity

Emergency situations promote risk-taking behaviors associated with anxiety reactivity. A previous study using the Iowa Gambling Task (IGT) has demonstrated that prespecified state anxiety predicts moderate risk-taking (middle-risk/high-return) after salient penalty events under temporal pressure and information ambiguity. Such moderate risk-taking can be used as a behavioral background in the case of fraud damage. We conducted two psychophysiological experiments using the IGT and used a psychophysiological modeling approach to examine how moderate risk-taking under temporal pressure and information ambiguity is associated with automatic physiological responses, such as a skin conductance response (SCR). The first experiment created template SCR functions under concurrent temporal pressure and information ambiguity. The second experiment produced a convolution model using the SCR functions and fitted the model to the SCR time series recorded under temporal pressure and no temporal pressure, respectively. We also collected the participants’ anxiety profiles before the IGT experiment. The first finding indicated that participants with higher state anxiety scores yielded better model fitting (that is, event-related physiological responses) under temporal pressure. The second finding demonstrated that participants with better model fitting made consecutive Deck A selections under temporal pressure more frequently. In summary, a psychophysiological modeling approach is effective for capturing overlapping SCRs and moderate risk-taking under concurrent temporal pressure and information ambiguity is associated with automatic physiological and emotional reactivity.

Is Negative Emotion Differentiation Associated With Emotion Regulation Choice? Investigations at the Person and Day Level

Negative emotion differentiation (ED) has been suggested to be important for adaptive emotion regulation (ER). However, knowledge concerning how ED may impact specific ER strategy choice remains surprisingly sparse. We therefore investigated (1) if person-level negative ED was associated with habitual use of individual ER strategies, (2) how person-level negative ED was associated with daily use of individual ER strategies, and finally (3) how within-person daily fluctuations in negative ED were associated with daily use of individual ER strategies. During a 10-day experience sampling study, 90 healthy participants rated their momentary emotions and their ER efforts in response to those emotions. ER strategies included four putatively adaptive strategies (reflection, distancing, non-reactivity, reappraisal) and four putatively maladaptive strategies (rumination, experiential avoidance, expressive suppression, worry). Results revealed that negative ED at the person level was neither associated with habitual nor daily ER strategy endorsement when controlling for negative emotions. Likewise, associations between within-individual daily variation in negative ED and daily ER did not remain statistically significant after controlling for negative emotions. The results thus point to no or weak associations between negative ED and ER choice above and beyond negative emotions. Future experimental studies addressing ED at the momentary level and teasing out the ED-ER causal timeline are needed to further evaluate ED-ER associations. Findings from such research may represent an important step toward refining psychotherapeutic interventions aimed at improving emotional problems.

Measuring Negative Emotion Differentiation Via Coded Descriptions of Emotional Experience

Emotion differentiation (ED) has been defined in terms of two abilities: (a) making fine-grained distinctions between emotional experiences, and (b) describing individual emotional experiences with a high degree of nuance and specificity. Research to date has almost exclusively focused on the former, with little attention paid to the latter. The current study sought to address this discrepant focus by testing two novel measures of negative ED (i.e., based on negatively valenced emotions only) via coded open-ended descriptions of individual emotional experiences, both past and present. As part of a larger study, 307 participants completed written descriptions of two negative emotional experiences, as well as a measure of emotion regulation difficulties and indices of psychopathological symptom severity. Negative ED ability, as measured via consistency between emotional experiences, was found to be unrelated to negative ED ability exhibited via coding of language within experiences. Within-experience negative ED may offer an incrementally adaptive function to that of ED between emotional experiences. Implications for ED theory are discussed.

Development of a Novel Method of Emotion Differentiation That Uses Open-Ended Descriptions of Momentary Affective States

Emotion differentiation (ED) has been conceptualized as a trait that facilitates emotion regulation and increases well-being. Yet basic questions remain unanswered about how best to assess it and whether favorable outcomes can be observed only during times of stress. The goal of the present research was to develop a novel behavioral (specificity) index of ED. We conducted two daily diary studies (N = 111-190) in which we included different measures of ED, well-being, and emotion regulation. The different ED measures were largely unrelated to each other. In both studies, the specificity index of ED showed a positive association with daily well-being, but in Study 2, this association held only on days with a negative event. Results regarding ED and the use of emotion-regulation strategies were inconsistent across strategies and studies. Possible reasons for these mixed results (e.g., sample selection, context sensitivity of regulation strategies) are discussed.

Is more emotional clarity always better? An examination of curvilinear and moderated associations between emotional clarity and internalising symptoms

Low emotional clarity has been a target for psychological interventions due to its association with increased internalising symptoms. However, theory suggests that very high emotional clarity may also lead to increased symptoms, particularly in combination with high levels of neuroticism. As an initial empirical test of this hypothesis, the present study examined curvilinear associations of emotional clarity with internalising symptoms (i.e. dysphoria, social anxiety, panic, traumatic intrusions) and a moderating role of neuroticism/negative affect in the association across two student samples and two clinical samples (total N = 920). Evidence of curvilinear associations and moderation varied across samples, with some supporting evidence in three samples. Specifically, neuroticism/negative affect moderated the curvilinear association of emotional clarity with traumatic intrusions in Clinical Sample 2 as well as the linear association between emotional clarity and dysphoria in Student Sample 2 and Clinical Sample 1. Simple slope analyses indicated that high emotional clarity was not consistently associated with lower symptoms. Also, the hypothesised quadratic effects of emotional clarity were found in Student Sample 2 and Clinical Sample 1 for panic, and in Clinical Sample 1 for dysphoria. Implications and limitations of these findings for conceptualisations of emotional clarity and current treatments were discussed.

Mood Monitoring Over One Year for People With Chronic Obstructive Pulmonary Disease Using a Mobile Health System: Retrospective Analysis of a Randomized Controlled Trial

Background

Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment.

Objective

We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring.

Methods

A total of 107 men and women with a clinical diagnosis of COPD, aged ≥40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ≥5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression.

Results

Overall, 94 (87.9%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ≥2 responses each month. Of all the participants, 47 (50%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P<.001) and increased depression symptoms (P<.001). Videos were viewed by 64 (68%) people over 12 months. Of the 220 viewing visualizations, 70 (34.7%) began after being signposted. Participants signposted to the stress management video (100%; IQR 23.3-100%) watched a greater proportion of it compared to those not signposted (38.4%; IQR 16.0-68.1%; P=.03), whereas duration of viewing was not significantly different for the mood management video.

Conclusions

Monitoring of anxiety and depression symptoms for people with COPD is feasible. More than half of trial participants reported scores indicating a mood disturbance during the study. Signposting participants to an advisory video when reporting increased symptoms of a mood disturbance resulted in a longer view-time for the stress management video. The opportunity to elicit measures of mood regularly as part of a health monitoring system could contribute to better care for people with COPD.

A Systematic Review and Meta-Analysis of the Association Between Complexity of Emotion Experience and Behavioral Adaptation

This article systematically reviews studies investigating the effect of three operationalizations of complexity in emotion experience (i.e., differentiation, covariation, and variability) on situational behavioral adaptation (i.e., physiological, cognitive, and overt action responses), and quantifies the results with meta-analyses. Twenty-seven studies of emotion complexity were identified and divided into four categories: (a) trait and (b) state studies within clinical samples, and (c) trait and (d) state studies within nonclinical samples. Most studies investigated trait emotion differentiation, revealing negligible to small effects ( r range: .06 to .15). Only 4 studies in total assessed indicators of state emotion complexity. The theoretical assumptions behind the indicators of emotion complexity as well as the conceptualization of behavioral adaptiveness are critically discussed, and a number of future avenues for this type of research are proposed.

Ambulatory Assessment of Adolescent Coping: It's a Complicated Process

Scholars have long-called for researchers to treat coping as a process that is measured over an arc of time. Ambulatory assessment (AA) offers an appealing tool for capturing the dynamic process of adolescent coping. However, challenges in capturing the coping process are not altogether circumvented with AA designs. We conducted a scoping review of the AA literature on adolescent coping and draw from 60 studies to provide an overview of the field. We provide critiques of different AA approaches and highlight benefits and costs associated with various types of measurement within AA. We also speak to considerations of participant burden and compliance. We conclude with recommendations for developmental scholars seeking to deploy AA to capture this quintessential process among adolescents.

Implicit Emotion Regulation Deficits in Trait Anxiety: An ERP Study

According to the framework of emotion regulation (ER), both explicit and implicit forms are essential to our well-being. It is the interaction between these two processes that ensures adaptive emotional responses. Although many studies have focused on explicit ER deficits in anxiety, there is still a lack of awareness about the implicit form and its role in anxiety. To address this issue, we explored the time course of implicit ER processes in individuals with high and low trait anxiety (LTA). To do this, we employed the newly developed Priming-Identify (PI) paradigm, which includes a word-matching task (externally-generated implicit goals) and a facial expression identification task (emotion processing). We aimed to modulate the implicit ER goals of individuals through the application of different priming conditions (ER-related and -unrelated words). In addition to their behavioral effects, we recorded the influence of these priming conditions through event-related potentials (ERPs) during the facial expression identification task. Three ERP components were chosen as indexes of three stages of implicit ER processing: N170, early posterior negativity (EPN) and late positive potential (LPP). In individuals with LTA, the early N170 and the middle EPN were enlarged under the ER-related priming condition, while the LPP was not influenced. However, in individuals with high trait anxiety (HTA), we observed an absence of any significant differences between the ER-related and -unrelated priming conditions across all three ERP components. Furthermore, enlargements of N170 and EPN amplitudes were significantly correlated with a decrease in negative emotion experience scores. Our results suggest that HTA individuals experience implicit ER deficits during the early and middle stages of ER.

A randomized controlled trial of three smartphone apps for enhancing public mental health

Many smartphone applications (apps) for mental health (MHapps) are available to the public. However, few have been the subject of a randomized controlled trial (RCT), and the change processes that are hypothesized to mediate claimed effects have not been previously studied. This RCT compared the efficacy of three publicly available MHapps to a waitlist control condition in a community sample, in which no MHapp was provided. The three MHapps included cognitive behavioural therapy (CBT) toolkit app MoodKit, mood tracking app MoodPrism, and CBT strategy app MoodMission. Participants were randomly allocated to each condition, completed a baseline assessment, downloaded their allocated MHapp, and completed a second assessment 30 days later, with n = 226 included in final analyses (81% female; M age = 34 years). Compared to the control condition, all MHapp groups experienced increases in mental wellbeing, MoodKit and MoodMission groups experienced decreases in depression, and no groups experienced effects on anxiety. Mediated regressions revealed that increasing coping self-efficacy, rather than emotional self-awareness or mental health literacy, was the underlying process contributing to effects on mental health for all three MHapps. MHapps appear to be an effective solution for improving public mental health, notably by improving users' confidence in their ability to cope.

Emotion Regulation of Events Central to Identity and Their Relationship With Concurrent and Prospective Depressive Symptoms

Dispositional emotion regulation is related to the severity and maintenance of depressive symptoms. However, whether emotion regulation specific to an event highly central for an individual's identity is predictive of depressive symptoms has not been examined. Nonclinical participants (N = 220) reported the extent to which they employed a selection of emotion regulation strategies when recalling low- and high-centrality events. Dispositional emotion regulation and depressive symptoms were also assessed. A 7-week follow-up was conducted. High-centrality events were associated with more emotion regulation efforts. Greater brooding and expressive suppression in relation to high-centrality memories predicted concurrent depressive symptoms after controlling for event valence and dispostional emotion regulation. Effects were absent for low-centrality memories. Emotion regulation in response to high-centrality memories did not predict depressive symptoms at follow-up beyond baseline depressive symptoms. Overall, the findings showed that maladaptive emotion regulation in response to memories of high-centrality events is important for explaining depressive symptomatology.

Engagement in mobile phone app for self-monitoring of emotional wellbeing predicts changes in mental health: MoodPrism

BACKGROUND

Mobile apps are being used increasingly for mental health purposes, but evidence of their efficacy remains limited. The mechanisms underlying any effects of such apps are also unclear. This study examined the effectiveness of a self-monitoring mobile phone app by investigating the relationships between app engagement and mental health outcomes.

METHOD

Participants downloaded the MoodPrism app from the iOS and Android app stores, completing in-app assessments at start of use and again 30days later. The app prompted participants daily to complete a short mood questionnaire and formulated their responses into a mood diary. Data from 234 assessment completers (73% female; M age = 34.8 years) were analysed via hierarchical and mediation regressions.

RESULTS

In this community sample, app engagement ratings predicted decreases in depression and anxiety, and increases in mental well-being. These effects were mediated by increases in emotional self-awareness, but only for participants who were clinically depressed or anxious at the time of the baseline assessment. Mental health literacy and coping self-efficacy did not play mediating roles.

LIMITATIONS

Findings suggest that other influential mediators may have not been measured, and future studies could verify the findings by using alternative methodologies, such as comparison with a control group.

CONCLUSIONS

Engaging with an emotional wellbeing self-monitoring app may reduce depressive and anxious symptoms, and increase mental well-being. Increases in emotional self-awareness may mediate these changes in clinical populations, and further research is needed to reveal other mechanisms that mental health apps can utilize.

Emotion dysregulation and negative affect: Laboratory and EMA investigations in smokers

Introduction

Difficulties in emotion regulation are associated with addictive behaviors, including smoking. Difficulties in emotion regulation may underlie large, rapid changes in negative affect that can increase likelihood of relapse. We investigated the association between emotion regulation ability and negative affect in smokers assessed both in the laboratory and in the field using Ecological Momentary Assessment.

Methods

Adult community smokers (N = 44) carried a personal digital assistant (PDA) for two weeks and were instructed to complete assessments of negative affect multiple times per day. Participants were instructed that they could smoke as much or as little as they liked. The Difficulties in Emotion Regulation Scale (DERS) and the Positive and Negative Affect Schedule (PANAS) were completed at three lab visits.

Results

Participants with higher average DERS scores reported greater negative affect at lab visits. When a participant reported a DERS score at a lab visit higher than their individual average, they also reported higher negative affect at that lab visit. Participants with higher baseline DERS scores reported more labile negative affect during EMA than those with lower baseline DERS scores, and they also reported a higher maximum level of negative affect during EMA.

Discussion and conclusions

Overall, the findings suggest that changes in emotion regulation are associated with negative affect and that emotion regulation ability is related to both the intensity and lability of negative affect. A better understanding of momentary changes in emotion regulation and negative affect may lead to improved interventions for preventing substance use relapse.

•

Emotion regulation show variability, and changes in emotion regulation are associated with changes in negative affect

•

Emotion regulation ability is associated with the intensity of negative affect assessed using EMA

•

Emotion regulation ability is associated with the lability of negative affect assessed using EMA

Positive and Negative Affect as Links Between Social Anxiety and Depression: Predicting Concurrent and Prospective Mood Symptoms in Unipolar and Bipolar Mood Disorders

The co-occurrence of social anxiety and depression is associated with increased functional impairment and a more severe course of illness. Social anxiety disorder is unique among the anxiety disorders in sharing an affective profile with depression, characterized by low levels of positive affect (PA) and high levels of negative affect (NA). Yet it remains unclear how this shared affective profile contributes to the covariation of social anxiety and depressive symptoms. We examined whether self-reported PA and NA accounted for unique variance in the association between social anxiety and depressive symptoms across three groups (individuals with remitted bipolar disorder, type I [BD; n = 32], individuals with remitted major depressive disorder [MDD; n = 31], and nonpsychiatric controls [n = 30]) at baseline and follow-ups of 6 and 12 months. Low levels of PA, but not NA, accounted for unique variance in both concurrent and prospective associations between social anxiety and depression in the BD group; in contrast, high levels of NA, but not PA, accounted for unique variance in concurrent and prospective associations between social anxiety and depression in the MDD group. Limitations include that social anxiety and PA/NA were assessed concurrently and all measurement was self-report. Few individuals with MDD/BD met current diagnostic criteria for social anxiety disorder. There was some attrition at follow-up assessments. Results suggest that affective mechanisms may contribute to the high rates of co-occurrence of social anxiety and depression in both MDD and BD. Implications of the differential role of PA and NA in the relationship between social anxiety and depression in MDD and BD and considerations for treatment are discussed.

Social anxiety and emotion regulation flexibility: considering emotion intensity and type as contextual factors

BACKGROUND AND OBJECTIVES

Individuals with social anxiety disorder have often been considered inflexible in their emotion regulation. The aim of this study was to investigate emotion regulation flexibility in socially anxious individuals in response to two contextual factors, namely different levels of emotion intensity and emotion type.

METHODS

A daily diary approach was employed, investigating emotion regulation (i.e., experiential avoidance, expressive suppression and cognitive reappraisal) in college students scoring high (N = 62; HSA) and low (N = 52; LSA) on social anxiety.

RESULTS

Results revealed that HSAs were found to use more experiential avoidance than LSAs, especially at higher levels of negative intensity. The use of this emotion regulation strategy appeared to be driven by guilt, nervousness, and sadness. There were no between-group differences concerning the other strategies in response to varying levels of emotional intensity.

CONCLUSIONS

Together, the results provide evidence for inflexible emotion regulation in HSAs, reflected in an unwillingness to experience negative emotions.

Craving for cigarette smoking among male adolescents in Isfahan based on mindfulness and emotional self-regulation

Background Cigarette smoking among adolescents and its consequences are categorized as serious health problems. Cigarette craving is influenced by various psycho-social factors. Objective This study aimed to investigate desire and intention to smoke based on mindfulness and emotional self-regulation in adolescents. Methods In this correlational study conducted based on structural equation modeling, a sample of 350 male students was randomly selected from different schools of education districts in Isfahan. Three questionnaires, including Hooked on Nicotine Checklist, emotional regulation inventory, and Mindful Attention Awareness Scale were employed. Data were analyzed using χ2, correlation coefficient and structural modeling tests. In this regard, SPSS and AMOS software were used. Results The results showed that 62% of male students had experienced cigarette smoking at least once. There was a significant inverse correlation between cigarette craving and emotional reappraisal (r = -0.48), expressive suppression (r = -0.58) and mindfulness (r = -0.55), respectively (p < 0.01). In addition to the direct effect, mindfulness through emotional self-regulation had indirect effects on nicotine craving. A total of 58% of the variance in nicotine craving was explained by the study variables. Conclusion The results showed that the high percentage of male students hooked on smoking is an important issue. In this regard, students' psychological issues such as efficient mechanisms of emotional regulation and their knowledge of the risks of smoking must be addressed by authorities and families.

Development and Validation of a State-Based Measure of Emotion Dysregulation

Existing measures of emotion dysregulation typically assess dispositional tendencies and are therefore not well suited for study designs that require repeated assessments over brief intervals. The aim of this study was to develop and validate a state-based multidimensional measure of emotion dysregulation. Psychometric properties of the State Difficulties in Emotion Regulation Scale (S-DERS) were examined in a large representative community sample of young adult women drawn from four sites ( N = 484). Exploratory factor analysis suggested a four-factor solution, with results supporting the internal consistency, construct validity, and predictive validity of the total scale and the four subscales: Nonacceptance (i.e., nonacceptance of current emotions), Modulate (i.e., difficulties modulating emotional and behavioral responses in the moment), Awareness (i.e., limited awareness of current emotions), and Clarity (i.e., limited clarity about current emotions). S-DERS scores were significantly associated with trait-based measures of emotion dysregulation, affect intensity/reactivity, experiential avoidance, and mindfulness, as well as measures of substance use problems. Moreover, significant associations were found between the S-DERS and state-based laboratory measures of emotional reactivity, even when controlling for the corresponding original DERS scales. Results provide preliminary support for the reliability and validity of the S-DERS as a state-based measure of emotion regulation difficulties.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.

OBJECTIVE

To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.

METHODS

A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.

RESULTS

Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.

CONCLUSIONS

Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

Emotion differentiation and intensity during acute tobacco abstinence: A comparison of heavy and light smokers

The ability to recognize and label discrete emotions, termed emotion differentiation, is particularly pertinent to overall emotion regulation abilities. Patterns of deficient emotion differentiation have been associated with mood and anxiety disorders but have yet to be examined in relation to nicotine dependence. This study employed ecological momentary assessment to examine smokers' subjective experience of discrete emotions during 24-h of forced tobacco abstinence. Thirty daily smokers rated their emotions up to 23 times over the 24-hour period, and smoking abstinence was biologically verified. From these data, we computed individual difference measures of emotion differentiation, overall emotion intensity, and emotional variability. As hypothesized, heavy smokers reported poorer negative emotion differentiation than light smokers (d=0.55), along with more intense negative emotion (d=0.97) and greater negative emotion variability (d=0.97). No differences were observed in positive emotion differentiation. Across the sample, poorer negative emotion differentiation was associated with greater endorsement of psychological motives to smoke, including negative and positive reinforcement motives, while positive emotion differentiation was not.