Trait and Daily Emotion Regulation in Social Anxiety Disorder

Fears of positive and negative evaluation and their within-person associations with emotion regulation in adolescence: A longitudinal analysis

Fear of positive evaluation (FPE) has recently emerged as an important aspect of social anxiety, alongside fear of negative evaluation. These evaluation fears peak during adolescence, a developmental stage that is also often accompanied by difficulties in emotion regulation, thereby increasing young individuals' vulnerability to mental disorders, such as social anxiety. We aimed to examine the longitudinal within-person associations between fears of evaluation, social anxiety, and three emotion regulation strategies (i.e., acceptance, suppression, rumination) in adolescents. Data were collected from a sample of 684 adolescents through an online survey three times over the course of 6 months and were analyzed using random intercept cross-lagged panel models. At the between-person level, FPE was linked to all three emotion regulation strategies, whereas fear of negative evaluation and social anxiety were associated with acceptance and rumination. At the within-person level, difficulties in accepting emotions predicted FPE, suppression predicted social anxiety, and social anxiety predicted rumination over time. These findings reveal complex interdependencies between emotion regulation, social anxiety, and evaluation fears, both reflecting individual differences and predicting changes within individuals, and further elucidate the developmental trajectory of social anxiety in adolescence.

Adverse Childhood Experiences and Symptom Severity in Social Anxiety Disorder: The Role of Emotion Regulation

In this study, the relationship was examined of adverse childhood experiences (ACEs) with difficulties in emotion regulation and symptom severity in individuals with social anxiety disorder (SAD). The study included 71 patients diagnosed with SAD and a healthy control group of 73 subjects. Data for all the participants were collected using a sociodemographic data form, the Liebowitz Social Anxiety Scale, the Adverse Childhood Experiences-Turkish Form scale, and the Difficulties in Emotion Regulation Scale-16. The study results showed a higher probability of ACEs and difficulties in emotion regulation in the SAD group than in the control group. The difficulties in emotion regulation in the SAD group were correlated with symptom severity and these difficulties were found to play a mediating role between trauma and symptom severity. It was emphasized that emotion regulation skills were an important factor in the treatment of SAD patients. It can be suggested that therapies and interventions to develop emotion regulation skills could be effective in the management of SAD symptoms. It was thus concluded that ACEs and difficulties in emotion regulation are associated with SAD symptoms and should be taken into consideration in treatment. This study emphasizes the importance of emotion regulation skills for SAD treatment and can be considered to be of guidance for future studies.

Anger in social anxiety disorder

The present study focused on the emotional experience of anger among individuals with and without social anxiety disorder (SAD). Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling measurement (ESM) in which they reported on daily social interactions and emotions. Using multilevel linear modeling we found that individuals with SAD experienced more anger compared to individuals without SAD. We also found a Diagnosis × Social Context interaction such that interactions with distant others were associated with elevated anger compared to interactions with close others for individuals with SAD but not for individuals without SAD. Finally, we found that for individuals with SAD (but not those without SAD) anger on a given day (day t) was associated with elevated anxiety on the following day (day t + 1), above and beyond previous anxiety, sadness and guilt (i.e. anxiety, sadness and guilt reported on day t). This suggests that anger may play a unique role in maintaining or exacerbating anxiety among individuals with SAD. Additional implications of our findings for models of psychopathology and for treatment of SAD are discussed.

Linking a latent variable trait-state-occasion model of emotion regulation to cognitive control

Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed the Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β  = -.62) were significant and larger than those for the TV factor (average β  = -.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component.

Safety behaviors and positive emotions in social anxiety disorder

The present study examined contextual factors that affect safety behavior use as well as positive emotions when using safety behaviors among individuals with SAD. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling methodology (ESM) measurement in which they reported on daily social interactions, safety behavior use, and emotions. Using multilevel linear modeling we found that both individuals with and without SAD used more safety behaviors when interacting with distant others compared to close others, but this effect was greater for individuals with SAD compared to individuals without SAD. We also found that social anxiety significantly moderated the relationship between safety behaviors in social interactions and positive emotions. Specifically, our findings indicated that individuals with higher levels of social anxiety reported lower levels of positive emotions when using safety behaviors. Implications of our findings for models of psychopathology and for treatment of SAD are discussed.

Daily-life reactivity and emotion regulation in children with social anxiety disorder

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.

Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

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.

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.

Pride in social anxiety disorder

The present study examined differences in the experience of pride between individuals with and without social anxiety disorder (SAD), and is the first to examine both the effects of context on pride and the temporal relationship between pride and anxiety in participants' daily lives. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not. Both groups completed an experience sampling measurement (ESM) to assess the levels of pride and anxiety and the nature of interpersonal contexts in which these emotions were experienced every day for 21 consecutive days. Using multilevel linear modeling, our findings suggest that pride is diminished among individuals with SAD, that situations percieved as highly neagative and positive, or as highly meaningful and positive are associated with the highest levels of pride, and that the experience of pride is associated with subsequent reductions in anxiety among individuals with SAD. These findings point to the role of pride in the disorder and can be used to inform and enhance therapeutic interventions for SAD.

State and Trait Emotion Regulation Diversity in Social Anxiety

Emotion regulation (ER) diversity, defined as the variety, frequency, and evenness of ER strategies used, may predict social anxiety (SA) severity. In a sample of individuals with high (n=113) or low (n=42) SA severity, we tested whether four trait ER diversity metrics predicted group membership. We generalized existing trait ER diversity calculations to repeated-measures data to test if state-level metrics (using two weeks of EMA data) predicted SA severity within the higher severity group. As hypothesized (osf.io/xadyp), higher trait ER diversity within avoidance-oriented strategies predicted greater likelihood of belonging to the higher severity group. At the state-level, higher diversity across all ER strategies, and within and between avoidance- and approach-oriented strategies, predicted higher SA severity (but only after controlling for number of submitted EMAs). Only diversity within avoidance-oriented strategies was significantly correlated across trait and state levels. Findings suggest that high avoidance-oriented ER diversity may co-occur with higher SA severity.

Fear of Positive Evaluation and Loneliness: Mediating Role of Social Anxiety and Suppression

Loneliness is a commonly observed problem that is associated with several mental and physical health outcomes. Although research shows that fear of negative evaluation is related to loneliness, no study has examined the role of fear of positive evaluation (FPE) on loneliness. This study investigated the mediator role of social anxiety and suppression in the relationship between FPE and loneliness using an undergraduate sample (N = 467). The results show that FPE is positively associated with loneliness and that this relationship is mediated by social anxiety and suppression. This study highlights the importance of the FPE in understanding loneliness and can guide intervention programs for loneliness.

The relations between real-time use of emotion regulation strategies and anxiety and depression symptoms

OBJECTIVE

How individuals differentially implement specific emotion regulation (ER) strategies is a critical indicator of the progression of depressive and anxiety disorders. Symptoms of anxiety and depression may be associated with differences in ER, but little evidence to date had examined whether anxiety and depression were associated with individual differences in the real-time use of ER strategies.

METHODS

This study used ecological momentary assessment (EMA) in two samples (n = 276) of undergraduate students from a single university who were assessed for 8-10 days. Baseline surveys captured participant self-reported anxiety symptoms and depressive symptoms using the PROMIS-Anxiety scale and the PROMIS-Depression scale, respectively. We measured ER through EMA-adapted prompts from the Cognitive Emotion Regulation Questionnaire (CERQ), which participants received on their internet-enabled cell phones. In pre-registered analyses, we tested the associations between anxiety symptoms with the use of discrete ER strategies in EMA using generalized estimating equations with a log-link function to account for nesting of EMA observations within participants, and further tested whether the findings generalized to depression (not pre-registered).

RESULTS

Symptoms of anxiety and depression were associated with greater odds of using both maladaptive and adaptive ER strategy use during the EMA period, and with lower odds of reporting no strategy use. Moreover, associations were generally stronger for maladaptive than adaptive ER strategies.

CONCLUSION

Anxiety and depressive symptoms are related to increased regulatory efforts overall, and results suggest that individuals with anxiety and depressive symptoms may be especially prone to use maladaptive ER strategies. Tracking ER strategies in a natural environment can further inform our understanding of how anxious and depressed individuals attempt to regulate emotions.

Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety

In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.

Spontaneous suppression in dating couples: Social and physiological correlates of suppressing negative and positive emotions during negative and positive conversations

Suppression (i.e., inhibiting one's emotional expression) has typically been associated with social and physiological costs. However, recent theorizing calls into question the inevitability of these costs. The present study takes a more nuanced approach and examines the social and physiological correlates of spontaneous (i.e., uninstructed) suppression when considering two potentially critical factors: the valence of the suppressed emotions (i.e., negative vs. positive) and the valence of the emotional context in which emotions are suppressed (i.e., negative conversation vs. positive conversation). Specifically, dating couples (N = 196 couples) completed both a negatively-valenced and a positively-valenced conversation in the laboratory while their autonomic-physiological responses were recorded. After each conversation, participants rated 1) the extent to which they had suppressed their negative and positive emotions, 2) the quality of the conversation, and 3) how connected they felt with their partner. We used Actor-Partner Interdependence Models to estimate actor effects (e.g., association of one's own suppression and one's own connectedness) and partner effects (e.g., association of one's partner's suppression and one's own connectedness). Suppression was associated with lower conversation quality and connectedness for the actors but largely not for the partners, regardless of the valence of the suppressed emotions and of the context, even when adjusting for felt emotion. Additionally, suppression was consistently not associated with physiological responses of actors or partners. Together, these findings suggest that, during emotional conversations with one's romantic partner, spontaneous (unlike instructed) suppression is associated with social but not physiological costs for the self but not one's partner.

When and Where Do People Regulate Their Emotions? Patterns of Emotion Regulation in Unselected and Socially Anxious Young Adults

Introduction: The current studies examined how smartphone-assessed contextual features (i.e., location, time-of-day, social situation, and affect) contribute to the relative likelihood of emotion regulation strategy endorsement in daily life. Methods: Emotion regulation strategy endorsement and concurrent contextual features were assessed either passively (e.g., via GPS coordinates) or via self-report among unselected (Study 1: N = 112; duration = 2 weeks) and socially anxious (Study 2: N = 106; duration = 5 weeks) young adults. Results: An analysis of 2,891 (Study 1) and 12,289 (Study 2) mobile phone survey responses indicated small differences in rates of emotion regulation strategy endorsement across location (e.g., home vs. work/education settings), time-of-day (e.g., afternoon vs. evening), time-of-week (i.e., weekdays vs. weekends) and social context (e.g., with others vs. alone). However, emotion regulation patterns differed markedly depending on the set of emotion regulation strategies examined, which likely partly explains some inconsistent results across the studies. Also, many observed effects were no longer significant after accounting for state affect in the models. Discussion: Results demonstrate how contextual information collected with relatively low (or no) participant burden can add to our understanding of emotion regulation in daily life, yet it is important to consider state affect alongside other contextual features when drawing conclusions about how people regulate their emotions.

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.

Psychometric Properties of the Korean version of the Emotion Regulation Questionnaire (K-ERQ) in a Clinical Sample

OBJECTIVE

The Emotion Regulation Questionnaire (ERQ) is one of the widely used instruments to assess emotion regulation skills in many countries, including Korea. However, its psychometric properties have not been validated within this population. Also, the ERQ has increasingly been used in studies with psychiatric patients despite a general lack of validation in clinical settings. Therefore, the present study aimed to investigate the psychometric properties of the Korean version of the ERQ (K-ERQ) using a clinical sample in Korea.

METHODS

One hundred and ninety-three psychiatric patients completed a packet of self-report measures, including K-ERQ, K-BDI-II, K-ASI-3, PCL-5-K, AUDIT-K. Confirmatory factor analysis (CFA) was administered to investigate the factor structure of the K-ERQ, and internal reliability and validity were examined.

RESULTS

Results of the CFA supported the two-factor structure, but only after the removal of one item. The K-ERQ showed good internal consistency reliability, and its concurrent validity was also confirmed. Cognitive reappraisal was negatively correlated with depression and alcohol use disorder-related symptoms, and expressive suppression was positively correlated with depression, anxiety sensitivity, posttraumatic stress disorder (PTSD)-related symptoms and alcohol use disorder-related symptoms. Significant group differences were found in the use of emotion regulation strategies; patients with PTSD reported the higher level of cognitive reappraisal than patients with depressive disorders, bipolar disorders, and attention-deficit hyperactivity disorder.

CONCLUSION

The 9-itemed K-ERQ is a reliable and valid tool to assess the emotion regulation strategies in a Korean clinical sample. Our study also adds preliminary evidence on the usefulness of the ERQ in clinical settings.

The Use of Rumination and Reappraisal in Adolescents Daily Life: Links to Affect and Emotion Regulation Style

This study explored the association between temperament-i.e., positive affect (PA) and negative affect (NA)-and emotion regulation (ER), and what momentary factors influence the selection of rumination or reappraisal during adolescents' daily life. The type of social situation in which negative events occurred, the self-rated degrees of discomfort, the types of predominant emotions experienced, and the use of reappraisal and rumination were assessed at 24 different times with an ecological momentary assessment approach given to 71 adolescents. PA, NA, and ER style were evaluated using self-reports. Bivariate Pearson correlations analysis revealed that NA and negative ER style correlated positively with the rumination use whereas PA correlated negatively with the rumination use. Negative ER style moderated the relationship between NA and the frequency with which rumination was used. The moderated function of positive ER style could not be tested due to its lack of association with the rumination use. Adolescents selected rumination more often during family-related events and when experiencing depression-like emotions. No interaction effects were shown between negative ER style and the momentary factors related with the type of social situation and the type of prevailing emotion during negative event. No associations between study variables and reappraisal were found. This study provides a better understanding of ER patterns in adolescence.

The Medium is the Message: Effects of Mediums of Communication on Perceptions and Emotions in Social Anxiety Disorder

We examined the use of voice/text and visual mediums and their effects on perceptions and emotions in social anxiety disorder (SAD). Our sample included 88 individuals: 44 individuals with SAD and 44 non-socially-anxious (NSA) individuals. We used an experience sampling methodology (ESM) in which participants received daily links to online measures at random times during the day, for 21 days and reported on social interactions, emotions and perceptions. Results indicated that individuals with SAD used voice/text mediums to a greater extent and used visual mediums to a lesser extent compared to NSA individuals. However, despite preferring voice/text mediums, use of visual mediums resulted in immediate increases in positive perceptions and emotions for individuals with SAD. These findings were above and beyond the effect of depressive symptoms and remained when social anxiety was represented as a continuum of severity. This has important implications for exposure interventions in the treatment of SAD.

The grass is always greener: Envy in social anxiety disorder

In the present study we examined envy in social anxiety disorder (SAD) and its potential role in maintaining the disorder. In addition, we examined social contexts and modes of communication that may serve as moderators of envy in SAD, and the temporal relationship between envy and anxiety in the disorder. Our sample included 88 individuals (44 with SAD and 44 without SAD) who underwent an experience sampling procedure in which participants received daily measures of emotions for 21 days. Using multilevel linear modeling we found that individuals with SAD experienced elevated envy compared to individuals without SAD and this was enhanced in social (compared to non-social) contexts. For individuals with SAD, visual modes of communication were associated with elevated envy compared to voice/text communication. Finally, envy predicted subsequent anxiety above and beyond previous anxiety and additional negative emotions. The role of envy in the psychopathology and maintenance of SAD, as well as clinical implications are discussed.

A systematic review and meta-analysis of the association between expressive suppression and positive affect

People differ in their self-reported propensities to experience positive affect (PA). Even those prone to internalizing symptoms show varied proclivities to PA; social anxiety (SA), for instance, unlike other types of anxiety, shows a strong negative association with PA that cannot be explained by diminished reward sensitivity. Heightened reliance on suppression of emotional displays (expressive suppression; ES) may be an alternate contributor to attenuated PA among people with elevated SA, relative to people with other types of anxiety. A first step toward testing this hypothesis is clarifying the ES-PA association and examining whether it varies as a function of anxiety type (social anxiety vs. other types of anxiety). This meta-analysis (k = 41; n = 11,010) revealed a significant, negative association between ES and PA (r = -0.158); however, this relationship was not significant for individuals with social or other anxiety disorders. Moreover, two moderators (sample culture-Western: r = -0.16; Eastern: r = 0.003; type of emotion suppressed-Negative: r = 0.18; Positive: r = -0.12) accounted for significant heterogeneity in effect sizes. This review synthesizes the literature on ES and PA in healthy and anxious samples; findings suggest moderating variables merit closer attention in future studies.

Facets of Emotion Regulation and Emotional Disorder Symptom Dimensions: Differential Associations and Incremental Validity in a Large Clinical Sample

A growing literature suggests robust associations between dimensions of emotion regulation and emotional disorder psychopathology. However, limited research has investigated associations of emotion regulation dimensions across several emotional disorders (transdiagnostic associations), or the incremental validity of emotion regulation versus the higher-order construct of neuroticism. The current study used exploratory structural equation modeling and a large clinical sample (N = 1,138) to: (a) develop a multidimensional emotion regulation measurement model, (b) evaluate the differential associations between latent emotion regulation dimensions and five latent emotional disorder symptom dimensions (social anxiety, depression, agoraphobia/panic, obsessions/compulsions, generalized worry), and (c) determine the incremental contribution of emotion regulation in predicting symptom dimensions beyond neuroticism. The best-fitting measurement model of emotion regulation included four dimensions: Problematic Responses, Poor Recognition/Clarity, Negative Thinking, and Emotional Inhibition/Suppression. Although many zero-order associations between the four latent emotion regulation dimensions and five latent symptom dimensions were significant, few associations remained significant in a structural regression model that included neuroticism. Specifically, Negative Thinking and Problematic Responses incrementally predicted depression symptoms, while Emotional Inhibition/Suppression predicted both social anxiety and depression symptoms. Associations between neuroticism and the emotional disorder dimensions were similar regardless of whether the emotion regulation dimensions were held constant. These results suggest that self-reported emotion regulation dimensions are associated with the severity and expression of a range of emotional disorder symptoms, but that some emotion regulation dimensions have limited incremental validity after accounting for general emotional reactivity. Studies of emotion regulation should assess neuroticism as a key covariate.

Virtual reality for the enhancement of emotion regulation

In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.

Emotion regulation in response to daily negative and positive events in youth: The role of event intensity and psychopathology

Environmental and individual contextual factors profoundly influence how people regulate their emotions. The current article addresses the role of event intensity and psychopathology (an admixture of depression, anxiety, and psychoticism) on emotion regulation in response to naturally occurring events. For six days each evening, a youth sample (aged 15-25, N = 713) recorded the intensity of the most positive and most negative event of the day and their subsequent emotion regulation. The intensity of negative events was positively associated with summed total emotion regulation effort, strategy diversity, engaging in rumination, situation modification, emotion expression, and sharing and negatively associated with reappraisal and acceptance. The intensity of positive events was positively associated with strategy diversity, savoring, emotion expression, and sharing. Higher psychopathology symptoms were only related to ruminating more about negative events. We interpret these findings as support for the role of context in the degree of effort and type of emotion regulation that young people engage in.

The role of frontal-subcortical connectivity in the relation between coping styles and reactivity and downregulation of negative emotion

Coping styles (CS) reflect individuals' habitual use of strategies for coping with negative events in daily life. Although research into coping has not reached consistent agreement about classifying coping strategies as either inherently adaptive or maladaptive, the influence of maladaptive CS on mental health is noticeable. CS might also be related to emotion regulation and associated brain systems. Participants (N = 165) completed measurements of CS, trait emotions including trait anxiety, depressive symptoms and happiness and then performed an emotion regulation task, in conjunction with functional MRI. Individual differences in maladaptive CS use were associated with higher trait negative emotionality and higher state reactivity of negative emotion. Concurrent bilateral amygdala-right middle frontal gyrus (MFG) connectivity during passive negative stimulus processing mediated the relation between maladaptive CS and negative emotion ratings. Psychophysiological interaction analyses showed that maladaptive and adaptive CS were linked to patterns of frontal-subcortical connectivity during state emotion regulation. These results suggest that maladaptive CS might be related to negative emotion processing and weaker spontaneous regulation and indicate that maladaptive CS is a risk factor in individual mental health.

Emotion regulation deficits mediate childhood sexual abuse effects on stress sensitization and depression outcomes

Child sexual abuse (CSA) is a notable risk factor for depressive disorders. Though multiply determined, increased sensitivity to stress (stress sensitization) and difficulty managing distress (emotion regulation) may reflect two pathways by which CSA confers depression risk. However, it remains unclear whether stress sensitization and emotion regulation deficits contribute to depression risk independently or in a sequential manner. That is, the frequent use of maladaptive emotion regulation responses and insufficient use of those that attenuate distress (adaptive emotion regulation) may lead to stress sensitization. We tested competing models of CSA, stress sensitization, and emotion regulation to predict depression symptoms and depressive affects in daily life among adults with and without histories of CSA. Results supported a sequential mediation: CSA predicted greater maladaptive repertoires that, in turn, exacerbated the effects of stress on depression symptoms. Maladaptive responses also exacerbated the effects of daily life stress on contemporaneous negative affect (NA) levels and their increase over time. Independent of stress sensitization, emotion regulation deficits also mediated CSA effects on both depressive outcomes, though the effect of maladaptive strategies was specific to NA, and adaptive responses to positive affect. Our findings suggest that emotion regulation deficits and stress sensitization play key intervening roles between CSA and risk for depression.

Involuntary autobiographical memories and future projections in social anxiety

Intrusive involuntary memories and images are a cardinal phenomenon in a range of psychological disorders, but not systematically examined in social anxiety. We examined potential biases upon generating involuntary versus voluntary memories and future projections in individuals with high and low levels of social anxiety. Participants recorded involuntary and voluntary autobiographical events, and their associated emotional response in a structured mental time travel diary. High social anxiety was associated with more intense anxiety and embarrassment and greater use of a range of emotion regulation strategies upon generating all types of autobiographical events. Involuntary (versus voluntary) memories and future events were associated with a heightened emotional response independent of social anxiety, and memories were associated with more embarrassment than imagined future events. The effects of high versus low social anxiety and involuntary versus voluntary generation process were independent from each other. The findings have implications for affective and cognitive models of involuntary memories and future projections in emotional disorders.

The most important life goals of people with and without social anxiety disorder: Focusing on emotional interference and uncovering meaning in life

People with social anxiety disorder (SAD) display maladaptive attitudes towards emotions. In this experience-sampling study, we explored the extent to which people with SAD viewed anxiety and pain as an impediment to pursuing personal strivings and deriving meaning in life. Participants were adults diagnosed with SAD and a control comparison group who completed baseline questionnaires and daily surveys for 14 consecutive days. People with SAD perceived anxiety and pain as interfering with progress towards their strivings to a greater degree than healthy controls. Perception of emotion-related goal interference was inversely associated with daily meaning. This relationship was moderated by diagnostic group such that there was a strong, inverse association with daily meaning in life for people with SAD; for controls, no association was found. Results suggest that negative beliefs about the value of anxiety and pain are pronounced in people with SAD and may impede derivation of meaning in life.

Dimensionality, Reliability, Invariance, and Validity of the Multidimensional Social Anxiety Response Inventory-21 (MSARI-21)

Research shows that social anxiety disorder (SAD) is prevalent in the United States, and could interfere with many aspects of a person's life. Although numerous psychological instruments have been developed to measure presence and intensity levels of social anxiety, these instruments fail to capture the range of responses individuals use to mitigate the negative affect associated with the anxiety, namely alcohol use and anger distress. Recently, the Multidimensional Social Anxiety Response Inventory-21 (MSARI-21) was developed to address this limitation and increase our understanding of the complexity of social anxiety. We expand on this work by evaluating the psychometric properties of the instrument, using a combination of exploratory structural equation and bifactor modeling, and item response techniques. Across 2 studies, data indicated the presence of a strong, 3-factor structure (i.e., anger distress, alcohol reliance, and social avoidance), strong internal consistency, and evidence of both convergent and discriminant validity. In addition, results showed that the MSARI-21 multidimensional structure was invariant across gender. We conclude that the MSARI-21 is a valid and valuable tool for assessing individuals' responses to social anxiety, and that future research should evaluate the instrument within other samples to ensure its utility across clinical and subclinical populations.

Momentary experiential avoidance: Within-person correlates, antecedents, and consequences and between-person moderators

We used ecological momentary assessment to investigate momentary correlates, antecedents, and consequences of experiential avoidance (EA), and to explore whether depression and anxiety moderate these within-person relationships. Participants recorded their mood, thoughts, stress, and EA four times daily for one week. Baseline depression and anxiety were associated with EA. EA was lower when participants reported more positive mood and thoughts, and higher when participants reported more negative mood, negative thoughts, and stress. The EA-stress relationship was stronger for participants with higher depression. Lag analyses showed that negative mood, negative thoughts, and stress predicted subsequent EA. In turn, EA predicted subsequent negative mood, negative thoughts, and stress. The relationship between EA and subsequent negative thoughts was stronger for participants with higher anxiety. Participants with higher depression and anxiety had a less negative association between positive thoughts and subsequent EA. This study adds to a growing body of literature on the process of EA as it unfolds in vivo, in real-time. Findings highlight links between momentary negative internal experiences and EA (which may be especially strong for people with depression or anxiety) and suggest that certain positive subjective experiences may buffer against EA. Clinical implications and future research directions are discussed.

High risk, high reward: Daily perceptions of social challenge and performance in social anxiety disorder

Individuals with Social Anxiety Disorder (SAD) have difficulty engaging in social situations because their actions are predicated on minimizing the subjectively biased high potential for rejection. That is, individuals with SAD frequently perceive social situations as challenging, and their performance as subpar. Yet when individuals perceive themselves as succeeding in challenging situations, they typically report these situations as enjoyable and rewarding. This subjective experience of succeeding in a challenging situation has been studied as flow (Csikszentmihalyi, 1975; 2000). Thirty-three adults with SAD and 34 matched healthy controls completed a baseline assessment, along with daily and experience sampling entries for 14 days. Results were analyzed using three-level generalized linear mixed effects models, with observations nested within days, nested within participants. Although individuals with and without SAD experienced the same frequency of flow in daily life, social situations led to proportionally more flow in participants with SAD than healthy controls. Both results were unexpected, and reasons for them are explored at length. Several experiential variables (positive emotions during and importance ascribed to the event) predicted the probability of flow during each situation. These results offer intervention-relevant suggestions for how individuals may benefit from seeking out challenging situations that offer maximal rewards.

Emotion regulation in action: Use, selection, and success of emotion regulation in adolescents' daily lives

Successful emotion regulation (ER) is a central aspect of psychosocial functioning and mental health and is thought to improve and be refined in adolescence. Past research on ER has mainly focused on one-time measurements of habitual ER. Linking regulatory strategies to emotions in daily lives is key to understanding adolescents’ emotional lives. Using an Experience Sampling Method with 78 adolescents (M_age = 13.91, SD_age = .95, 66% girls), we investigated the use, selection, and success in down-regulating negative emotions of eight ER strategies across 44 assessments. Acceptance was the strategy employed most often followed by problem-solving, rumination, distraction, avoidance, reappraisal, social support, and suppression. Interestingly, negativity of the event influenced the use of ER strategies: With low intensity negative emotions, acceptance was more likely to be used, and with high intensity negative emotions, suppression, problem-solving, distraction, avoidance, social support, and rumination were more likely to be used. With regard to success, multilevel models revealed that problem-solving, reappraisal, and acceptance were more successful in down-regulating negative emotions than rumination. Further, among girls, no relations between the momentary use of ER strategies and depressive symptoms was found. Among boys, a negative relation between acceptance and depressive symptoms emerged. Results from this study suggest that there is a reciprocal relationship between the intensity of negative emotions and ER strategies and that gender differences may exist. Taken together, this study showed which ER strategies are used by a healthy adolescent sample, and these results are discussed with regard to their theoretical and practical importance.

Affective predictors of the severity and change in eating psychopathology in residential eating disorder treatment: The role of social anxiety

Despite evidence documenting relationships between eating disorder (ED) psychopathology, depression, and anxiety, little is known regarding how social anxiety is related to ED symptoms in treatment. Therefore this study examined associations between depression, general anxiety, social anxiety, and ED psychopathology at the beginning and end of treatment (EOT) among patients (N = 380) treated in a residential ED program. Participants completed measures of ED psychopathology and affective variables. Higher depression and general anxiety, but not social anxiety, were related to higher ED psychopathology at baseline. However, social anxiety emerged as a unique predictor of ED psychopathology at EOT such that participants with higher social anxiety evidenced less improvement in ED psychopathology. Findings suggest that social anxiety has specific relevance to treatment in EDs, which may reflect shared mechanisms and underlying deficits in emotion regulation.

Dispositional and Situational Emotion Regulation in Younger and Older Adults

Abstract. Younger and older adults (N = 207) viewed a film scene eliciting strong negative emotions and then indicated how they had regulated their emotions. Dispositional emotion regulation was measured prior to stimulus presentation. Older adults showed higher levels of dispositional suppression than younger adults. Furthermore, individual differences in dispositional expressive suppression were predictive of reappraisal and suppression in the given situation. However, dispositional suppression was more strongly related to situational suppression among older adults than among younger adults. Future directions concerning the importance of and possible implications for age differences in coping with stressful situations 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.

Emotion regulation strategy selection in daily life: The role of social context and goals

Recent studies have begun to document the diversity of ways people regulate their emotions. However, one unanswered question is why people regulate their emotions as they do in everyday life. In the present research, we examined how social context and goals influence strategy selection in daily high points and low points. As expected, suppression was particularly tied to social features of context: it was used more when others were present, especially non-close partners, and when people had instrumental goals, especially more interpersonal ones (e.g., avoid conflict). Distraction and reappraisal were used more when regulating for hedonic reasons (e.g., to feel better), but these strategies were also linked to certain instrumental goals (e.g., getting work done). When contra-hedonic regulation occurred, it primarily took the form of dampening positive emotion during high points. Suppression was more likely to be used for contra-hedonic regulation, whereas reappraisal and distraction were used more for pro-hedonic regulation. Overall, these findings highlight the social nature of emotion regulation and underscore the importance of examining regulation in both positive and negative contexts.