The Relation Between Emotional Dysregulation and Anxiety and Depressive Symptoms, Pain-Related Anxiety, and HIV-Symptom Distress Among Adults with HIV/AIDS

Brief transdiagnostic group intervention for people living with HIV and emotional disorders: feasibility and clinical utility

Emotional regulation-based transdiagnostic interventions provide positive but limited evidence regarding efficacy with people living with human immunodeficiency virus (HIV). In the present study, 10 participants living with HIV with emotional disorders completed a five-session transdiagnostic group intervention to improve their emotional regulation skills (Unified Protocol). Changes at pre-treatment, post-treatment and three-month follow-up were explored at the population (mean-rank) and the individual level (reliable change index). Compared to pre-treatment, participants improved significantly in anxiety, depression, negative affect and quality of life. Changes were maintained at the three-month follow-up. Emotion regulation, particularly the confusion factor, improved when comparing pre-treatment with the three-month follow-up. At the three-month follow-up, the percentage of normalized scores was the largest in maladjustment (70%), followed by depression, negative affect, and lack of control (50%). All participants indicated high treatment satisfaction and perceived benefits. These promising results suggest that brief emotion regulation interventions might be feasible and effective in the public health settings for people living with HIV suffering emotional disorders.

A meta-analysis of gray matter volume abnormalities in HIV patients

HIV infection is known to have significant effects on central nervous system. This study conducted a meta-analysis of whole voxel-based morphometry (VBM) in HIV patients (N = 435) and HIV-uninfected controls (N = 397). This study observed a reduction of limbic lobe, cingulate gyrus, frontal lobe, middle frontal gyrus, sub-lobar, insula, inferior frontal gyrus and superior frontal gyrus volume in HIV patients. These morphological differences may be responsible for cognitive decline in HIV patients, as these brain regions are closely related to motor and memory functions. These results contribute to a better understanding of the neural mechanisms underlying brain injury in HIV patients and could help develop targeted brain targets, provide more personalized treatment and predict neurodevelopmental outcomes.

Emotion Regulation Difficulties and Depression Among Individuals With Dermatological and Body Dysmorphic Concerns

ABSTRACT

Existing literature demonstrates strong links between emotion regulation (ER) difficulties and depression. Although high rates of depression are observed among individuals with body dysmorphic disorder and skin disease, little is known about these co-occurring syndromes. To advance our understanding of a vulnerable population, this study examined facets of ER difficulties in relation to depression among adults with skin disease symptoms and body dysmorphic concerns (N = 97). Participants were recruited online and completed self-report measures. The overall hierarchical regression model accounted for 61.6% of the variance in depression. After controlling for anxiety and stress, ER difficulties added 9.9% unique variance. In particular, limited access to ER strategies was the only ER dimension significantly associated with depression. This study integrates divergent literatures and suggests the important role of ER difficulties in depression in this unique sample, thereby highlighting directions for future investigation.

Investigating how individual differences influence responses to the COVID-19 crisis: The role of maladaptive and five-factor personality traits

INTRODUCTION

Coronavirus disease (COVID-19) pandemic impacted both the physical and psychological aspects of people's lives. Personality traits are one of the factors that explain the diverse responses to stressful situations. This study aimed to investigate whether five-factor and maladaptive personality traits are associated with depressive and anxiety symptoms, suicide risk, self-reported COVID-19 symptoms, and preventive behaviors during the COVID-19 pandemic, comprehensively.

METHODS

We conducted an online survey among a representative sample of 1000 Koreans between May 8 to 13, 2020. Participants' five-factor and maladaptive personality traits were measured using the multidimensional personality inventory, the Bright and Dark Personality Inventory. COVID-19 symptoms, depressive and anxiety symptoms, suicide risk, and preventive behaviors were also measured.

RESULTS

The results revealed that maladaptive personality traits (e.g., negative affectivity, detachment) had positive correlations with depressive and anxiety symptoms, suicide risk, and COVID-19 symptoms, and the five-factor personality traits (e.g., agreeableness, conscientiousness) had positive correlations with preventive behaviors.

CONCLUSION

Our findings extend the current understanding of the relationship between five-factor and maladaptive personality traits and responses to the COVID-19 pandemic. Longitudinal follow-up should further investigate the influence of personality traits on an individual's response to the COVID-19 pandemic.

Coping styles as predictors of negative affective conditions in Asian Indians: does being optimistic still make a difference?

The present study examined the role of optimism, as measured by the Life Orientation Test-Revised, and coping styles, as measured by the COPE scale, in predicting negative affective conditions (viz., depressive symptoms, stress, and negative affect) among 386 Asian Indian young adults (197 females and 189 males). Results from our hierarchical regression analyses indicated that coping styles accounted for a medium-large amount of variance in negative affective conditions, after controlling for demographic factors (i.e. age, gender, parent's education, and monthly income). Five coping styles were significant in predicting negative affective conditions across all three indices; mental disengagement, denial, and venting emotions were found to be maladaptive, while positive reinterpretation and humor were found to be adaptive among Asian Indian young adults. Furthermore, when optimism was included in the prediction model, optimism consistently accounted for additional variance in negative affective conditions, beyond coping styles. Due to the additional variance among negative affective conditions accounted for by optimism when compared to coping, we advise that mental health professionals consider prioritizing the reinforcement of positive expectancy in addition to enhancing adaptive coping styles and reducing the use of maladaptive coping among Asian Indians.

Emotion dysregulation in the experience of pain among persons living with HIV/AIDS

Persons living with HIV and AIDS (PLWHA) report disproportionally high rates of pain. Pain among PLWHA has been associated with poor medication adherence and anxiety and depressive symptoms. This relationship may be primarily driven by elevated negative affect, and one factor that may be important to understanding elevated negative affect is emotion dysregulation. Therefore, the current study sought to examine emotion dysregulation (Difficulties in Emotion Regulation Scale) in terms of multi-dimensional pain experience (pain severity, pain interference, pain affective distress, pain life control; Multidimensional Pain Inventory; Turk and Rudy (1988) among a sample of 162 HIV+ individuals (M_age = 47.65, SD = 8.59, 35.2% female). Two-step hierarchical regression analyses revealed that emotion dysregulation total score was significantly associated with each of the pain variables. These results may suggest PLWHA who demonstrate greater emotion dysregulation struggle to effectively manage negative affect associated with their pain experience, exacerbating the severity of pain symptoms across numerous clinically-relevant domains. The novel findings may provide important assessment and intervention targets for PLWHA living with pain.

The association between perceived distress tolerance and cannabis use problems, cannabis withdrawal symptoms, and self-efficacy for quitting cannabis: The explanatory role of pain-related affective distress

Rates of cannabis use and related problems continue to rise, ranking as the third most common substance use disorder in the United States, behind tobacco and alcohol use. Past work suggests that perceived distress tolerance is related to several clinically significant features of cannabis use (e.g., coping-oriented use). However, there has been little exploration of the mechanisms that may underlie relations between perceived distress tolerance and cannabis use problems, withdrawal severity, and self-efficacy for quitting. The current study sought to examine the experience of pain, which frequently co-occurs with cannabis use (Ashrafioun, Bohnert, Jannausch, & Ilgen, 2015), as an underlying factor in the relation between perceived distress tolerance and cannabis related problems among 203 current cannabis-using adults (29.2% female, M = 37.7 years, SD = 10.2, 63% African American). Results indicated that perceived distress tolerance via pain related affective distress significantly predicted the severity of cannabis use problems (Pm = 0.60), degree of cannabis withdrawal (Pm = 0.39), and lower self-efficacy for quitting cannabis (Pm = 0.36). Future work may usefully explore the role of pain-related affective distress as a mechanistic factor in the context of perceived distress tolerance-cannabis relations.

Exploring Distress Tolerance as an Underlying Mechanism in the Relation Between Negative Affectivity and Anxiety/Depression Among Persons Living with HIV/AIDS

Persons living with HIV/AIDS (PLHIV) suffer disproportionately from a variety of mood disorders relative to the general population, yet, there is little understanding of the underlying nature behind this. The present study explored the indirect effect of perceived distress tolerance in relation between negative affectivity and anxiety/depressive symptoms and disorders among PLHIV. Participants included 97 PLHIV (60.8% male; 66% Minority; M age = 48.5 years, SE = 7.7). Results revealed indirect effects of negative affectivity via perceived distress tolerance in relation to social anxiety, depression symptoms, as well as the existence of any anxiety disorder; findings were evident after controlling for covariates. Perceived distress tolerance may serve as a construct to aid understanding in the relation between negative affectivity and the expression of anxiety/depressive symptoms and disorders among PLHIV. Future work may consider addressing distress tolerance in efforts to offset the severity of the expression of anxiety/depressive symptoms among PLHIV.

Distress tolerance and pain experience among young adults

Pain and pain related problems affect a significant proportion of the United States population. Past research suggests that emotional distress is associated with more severe and disabling pain experience. Yet, it is less clear how individual reactions to distress are related to pain experience. Distress tolerance, defined as the perceived ability to withstand cognitive, affective, or physical distress, is an individual difference factor that may be particularly important to understanding the experience of pain. The current study examined the association of distress tolerance with pain severity, pain disability, and frequency of pain disability in a sample of young adults (N = 1577, M _age = 22.17) with mild to severe pain. Results indicated that, after controlling for gender, past 30-day opiate use, and perceived health status, lower distress tolerance was significantly associated with more severe and disabling pain. These novel empirical findings suggest distress tolerance may be a useful construct in need of further study among young adults with pain complaints.

Examining HIV-Related stigma in relation to pain interference and psychological inflexibility among persons living with HIV/AIDS: The role of anxiety sensitivity

Pain is highly prevalent among people living with HIV (PLHIV). Although the association between stigma and pain among stigmatized individuals has been well-established in the non- HIV chronic pain literature, little is known about the association between stigma and pain among PLHIV and the mechanisms that underlie this association. The present study examined the indirect effect of HIV stigma and pain via anxiety sensitivity (fear of anxiety symptoms). The sample included 97 PLHIV (60.2% male, M_age = 48.40, SD = 7.75). Results indicated significant and medium-sized indirect effects of HIV stigma on pain severity, pain interference, and psychological inflexibility in pain via anxiety sensitivity. Alternative models did not yield significant indirect effects. The results suggest anxiety sensitivity may explain the association between stigma and pain among PLHIV. These findings provide novel empirical insight into the nature of stigma-pain relation among PLHIV and could be used to guide pain-based intervention development for this population.

Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV

Persons living with HIV (PLHIV) are a health disparity subgroup of the overall population for mental and physical health problems. HIV-related stigma has been shown to increase anxiety symptoms and HIV symptoms among PLHIV. However, little is known about factors that may impact the relations between HIV-related stigma and anxiety symptoms and HIV symptoms among PLHIV. To address this gap in the literature, the current study examined anxiety sensitivity (i.e., the extent to which individuals believe anxiety and anxiety-related sensations) in the relation between HIV-related stigma, social anxiety, anxious arousal, and HIV symptoms among a sample of 87 PLHIV (60.9% cis gender male, 52.9% Black, non-Hispanic). Results indicated that anxiety sensitivity mediated the relations between HIV-related stigma and the dependent variables, with effect sizes indicating moderate to large effects of anxiety sensitivity on these relations. Findings suggest that anxiety sensitivity be a mechanistic factor in the relations between HIV-related stigma and social anxiety, anxious arousal, and HIV symptoms, and therefore, be important element in efforts to reduce mental/physical health disparity among this population.

Extending the Minority Stress Model to Incorporate HIV-Positive Gay and Bisexual Men's Experiences: a Longitudinal Examination of Mental Health and Sexual Risk Behavior

BACKGROUND

Minority stress theory represents the most plausible conceptual framework for explaining health disparities for gay and bisexual men (GBM). However, little focus has been given to including the unique stressors experienced by HIV-positive GBM.

PURPOSE

We explored the role of HIV-related stress within a minority stress model of mental health and condomless anal sex.

METHODS

Longitudinal data were collected on a diverse convenience sample of 138 highly sexually active, HIV-positive GBM in NYC regarding sexual minority (internalized homonegativity and gay-related rejection sensitivity) and HIV-related stressors (internalized HIV stigma and HIV-related rejection sensitivity), emotion dysregulation, mental health (symptoms of depression, anxiety, sexual compulsivity, and hypersexuality), and sexual behavior (condomless anal sex with all male partners and with serodiscordant male partners).

RESULTS

Across both sexual minority and HIV-related stressors, internalized stigma was significantly associated with mental health and sexual behavior outcomes while rejection sensitivity was not. Moreover, path analyses revealed that emotion dysregulation mediated the influence of both forms of internalized stigma on symptoms of depression/anxiety and sexual compulsivity/hypersexuality as well as serodiscordant condomless anal sex.

CONCLUSIONS

We identified two targets of behavioral interventions that may lead to improvements in mental health and reductions in sexual transmission risk behaviors-maladaptive cognitions underlying negative self-schemas and difficulties with emotion regulation. Techniques for cognitive restructuring and emotion regulation may be particularly useful in the development of interventions that are sensitive to the needs of this population while also highlighting the important role that structural interventions can have in preventing these disparities for future generations.

Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature

There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning.

Emotional nonacceptance within the context of traumatic event exposure: The explanatory role of anxiety sensitivity for traumatic stress symptoms and disability among Latinos in a primary care setting

OBJECTIVE

Research has found that Latinos (versus non-Latino Whites) evince higher rates of posttraumatic stress symptoms (PTS) and posttraumatic stress disorder (PTSD), yet little attention has been given to intra-individual, emotion-related processes to explicate the higher incidence of these symptoms among Latinos.

METHOD

Participants included 183 trauma-exposed adult Latinos (88.5% female; Mage=37.7, SD=10.7 and 93.4% reported Spanish as their first language) who attended a community-based primary healthcare clinic in Houston. It was hypothesized that anxiety sensitivity would explain the relation between emotional nonacceptance and traumatic stress symptoms, namely re-experiencing, avoidance, and arousal difficulties as well as overall disability. Additionally, it was expected that the observed effects would be evident above and beyond the variance accounted for by number of traumas reported, gender, age, marital status, educational status, years living in the U.S., and negative affectivity.

RESULTS

Consistent with our hypotheses, difficulties accepting negative emotions were associated with increased trauma-related re-experiencing, avoidance, and arousal difficulties. Additionally, anxiety sensitivity was an underlying mechanism in the association between emotional nonacceptance and all but one facet of traumatic stress symptoms (i.e., re-experiencing symptoms) and disability. Alternative models yielded no significant effects, providing greater confidence in the direction of the hypothesized effects.

CONCLUSION

Findings are discussed in the context of their significance for informing the development of specialized intervention strategies that target anxiety sensitivity for Latinos in primary care with elevated risk for PTS and PTSD by their heightened levels of emotional nonacceptance.

Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: An examination of the role of emotion dysregulation

Hazardous drinking is prevalent among persons living with HIV/AIDS (PLWHA). Anxiety sensitivity is a vulnerability factor that is highly associated with hazardous drinking among seronegatives, but has yet to be tested in PLWHA. Additionally, there is a need to examine potential mechanisms underlying associations of anxiety sensitivity and hazardous drinking. Emotion dysregulation is one potential construct that may explain the association between anxiety sensitivity and hazardous drinking. The current study examined emotion dysregulation as a potential explanatory variable between anxiety sensitivity and four, clinically significant alcohol-related outcomes among PLWHA: hazardous drinking, symptoms of alcohol dependence, number of days consuming alcohol within the past month, and degree of past heavy episodic drinking. The sample included 126 PLWHA (Mage=48.3; SD=7.5; 65.9% male). Results indicated significant indirect effects of anxiety sensitivity via emotion dysregulation in all models. Indirect effects (κ(2)) were of medium effect size. Alternative models were run reversing the predictor with mediator and, separately, reversing the mediator with the proposed outcome(s); alternative models yielded non-significant indirect effects in all but one case. Together, the current results indicate that anxiety sensitivity is associated emotion dysregulation, which, in turn, is associated with hazardous drinking outcomes. Overall, these findings may provide initial empirical evidence that emotion dysregulation may be a clinical intervention target for hazardous drinking.

Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS

HIV symptoms are associated with a poorer quality of life (QOL) among persons living with HIV/AIDS (PLWHA). Yet, there is little understanding of emotional factors that impact the relation between HIV symptom severity and QOL. The present study examined the main and interactive effects of emotion dysregulation and HIV symptom severity on multiple indices of QOL, including physical (impact of physical problems related to HIV), psychological (frequency of negative feelings), independence (necessity of medical treatment to function in daily life), social (feelings of acceptance), environmental (satisfaction with living conditions and medical care), and spiritual (fear of the future and death) among a sample of 74 PLWHA. Participants (72.9% male; mean age = 48.24, SD = 7.85) were recruited from AIDS Service Organizations in the United States. Results indicated that higher HIV symptom severity is significantly associated with lower physical and independence QOL, whereas higher emotion dysregulation is significantly associated with lower scores on all measured aspects of QOL. Additionally, results indicated that the interaction of emotion dysregulation and HIV symptom severity was significantly associated with both physical and environmental QOL. The form of the observed significant interactions indicated that HIV symptom severity was related to poorer QOL among those with lower (versus higher) emotion dysregulation. The present findings indicate that emotion dysregulation is related to QOL among PLWHA and may interact with HIV symptom severity to negatively impact certain aspects of QOL. Given the profound impact that HIV has on QOL, this finding is important in understanding these relations mechanistically, and may be important in the development of novel psychological treatment strategies.

Stigma and disease disclosure among HIV+ individuals: the moderating role of emotion dysregulation

Increased disclosure of HIV status has been shown to reduce disease transmission among persons living with HIV (PLHIV). HIV-related stigma has been shown to reduce HIV disclosure; however, little is known about factors that may underlie the relation between HIV-related stigma and HIV disclosure. The current study examined emotion dysregulation (i.e., maladaptive generation, processing, and modulation of one's emotions) in the relation between HIV-related stigma, sub-facets of HIV-related stigma, and HIV disclosure among PLHIV seeking psychological treatment (n = 80; 61.3% male; 56.3% African-American (non-Hispanic); M_age = 48.25, SD = 7.39). Results indicated past experiences of rejection due to one's HIV status (i.e., enacted stigma), as well as subjective beliefs regarding how PLHIV are evaluated by others (i.e., public attitudes stigma), are significantly related to HIV disclosure. Additionally, these relations are moderated by emotion dysregulation. Specifically, greater HIV-related stigma is associated with reduced HIV disclosure for individuals with greater emotion dysregulation. However, emotion dysregulation did not moderate the relations between negative self-image (e.g., shame, guilt) or disclosure concerns and HIV disclosure. Findings suggest emotion dysregulation may play a moderating role for certain types of HIV disclosure.

The examination of emotion dysregulation as a moderator of depression and HIV-relevant outcome relations among an HIV+sample

The present study examined whether emotion dysregulation moderated the relations between depressive symptoms and HIV symptoms, HIV medication adherence due to medication side effects, avoidant coping, and distress tolerance among people living with HIV/AIDS (PLHA). Participants included 115 PLHA (16.8% female; Mage = 49.70, SD = 8.57). Results indicated that there was a significant interaction between depressive symptoms and emotion dysregulation in relation to HIV symptoms, HIV medication adherence due to medication side effects, avoidant coping, and distress tolerance. The form of the interaction indicated that PLHA experiencing higher depressive symptoms and higher levels of emotion dysregulation reported the highest levels of HIV symptoms and lowest levels of distress tolerance. Additionally, results indicated that at lower levels of depressive symptoms, very high levels of emotion dysregulation predicted higher rates of medication nonadherence, whereas at higher levels of depressive symptoms, very high levels of emotion dysregulation predicted the lowest rates of medication nonadherence. Moreover, those experiencing lower levels of depressive symptoms and higher levels of emotion dysregulation reported the greatest rates of avoidant coping. In total, the present results suggest a complex interplay between emotion dysregulation and depressive symptoms with regard to HIV symptoms, medication nonadherence, and self-regulatory processes (e.g., avoidant coping, distress tolerance) among PLHA.

Anxiety, depression, and HIV symptoms among persons living with HIV/AIDS: the role of hazardous drinking

Hazardous drinking is common among persons living with HIV/AIDS (PLWHA) and associated with numerous negative health consequences. Despite the well-established negative effects of hazardous drinking among PLWHA, scholarly work has neglected to explore the role of such drinking in regard to anxiety/depressive symptoms and HIV symptom expression. The current study investigated associations between hazardous drinking and anxiety/depressive symptoms and HIV symptoms among PLWHA. Participants (n = 94; 88.3% male; Mage = 48.55; SD = 9.15) included PLWHA recruited from AIDS service organizations in the northeast. Hazardous drinking was significantly associated with anxiety/depressive symptoms and HIV symptom expression above and beyond the variance accounted for by sex, race, recruitment site, and CD4 T-Cell count, as well as other cognitive-affective variables (emotion dysregulation, distress intolerance, and anxiety sensitivity). The present results provide empirical support that hazardous drinking is indeed related to depressive and anxiety symptoms as well as HIV symptom distress and that this effect is not attributable to other factors commonly related to both alcohol use problems and emotional distress among PLWHA. Results highlight the importance of alcohol interventions for excessive drinking specifically tailored for PLWHA to facilitate better mental and physical health adjustment.