Interactive Effects of Anxiety Sensitivity and Emotion Regulation on Anxiety Symptoms

Attentional Control Accounts for the Association Between Anxiety Sensitivity and Sleep Efficiency in Clinic-Referred Youth

Youth with anxiety disorders report difficulty falling asleep and returning to sleep after sleep onset (i.e., poor sleep efficiency). Anxiety sensitivity, the excessive attention to physical symptoms of anxiety and their threatening interpretations, has been linked to poor sleep efficiency. We tested a conceptual model wherein attentional control, attentional focusing and attentional shifting would account for the relationship between anxiety sensitivity and poor sleep efficiency. 255 youths (6-17 years old, 78% Hispanic/Latino) who presented to a university-based research clinic completed measures on anxiety sensitivity, sleep, and attentional control. Poorer sleep efficiency was significantly correlated with higher anxiety sensitivity and lower attentional control, attentional focusing, and attentional shifting. Higher anxiety sensitivity was significantly correlated with lower attentional control and attentional focusing. Attentional control and attentional focusing, not attentional shifting, accounted for the relationship between anxiety sensitivity and poor sleep efficiency. These findings identify attentional control and attentional focusing as variables that may explain the association between anxiety sensitivity and sleep efficiency in youth.

Emotion regulation tendencies and cardiovascular responses to repeated acute psychological stress

Poor emotion regulation has been associated with cardiovascular disease (CVD) through maladaptive cardiovascular responses to psychological stress. However, there has been scant research examining the relationship between emotion regulation and habituation of cardiovascular responses to recurrent stress, which may be more directly applicable to the experience of stress in everyday life. The aims of the current study were to examine the associations between emotion regulation tendencies and cardiovascular stress reactivity, as well as habituation of cardiovascular reactivity across repeated stressors. A sample of 453 participants (mean (SD) age = 19.5 (1.3) years; 62 % women) completed a repeated stress paradigm, which consisted of two 10-minute baselines and two identical 4-minute stress tasks, separated by a 10-minute recovery period. Heart rate (HR) was measured continuously; systolic/diastolic blood pressures (SBP/DBP) were measured every 2 min. At the end of the visit, participants completed the Emotion Regulation Questionnaire (ERQ) and Difficulties in Emotion Regulation Scale (DERS). Results indicate that impulse control difficulties when distressed (a DERS subscale) were significantly associated with blunted SBP, DBP, and HR reactivity to both stressors, as well as impaired HR habituation across the stressors. None of the ERQ subscales (cognitive reappraisal, expressive suppression) were found to be associated with cardiovascular stress reactivity or habituation. The outcomes of this study demonstrate a potential underlying physiological pathway through which impulse control difficulties when distressed may contribute to CVD risk. This study also reveals the importance of extending traditional cardiovascular stress reactivity protocols to include multiple exposures of the same stress task.

Attentional Control Moderates the Relations between Intolerance of Uncertainty and Generalized Anxiety Disorder and Symptoms

BACKGROUND

Intolerance of uncertainty (IU), perceived attentional control (AC), and poor cognitive control abilities are risk factors for anxiety; however, few studies have examined their interactive effects in relation to anxiety. A more complete understanding of interplay between IU, perceived AC, and cognitive control could inform intervention efforts.

METHODS

The current study examined the direct and interactive effects of IU and AC on anxiety in a sample of 280 community outpatients (M age = 36.01 years, SD = 16.17). Perceived AC was measured using self-report and cognitive control abilities were measured using a Go/No-Go task.

RESULTS

Findings indicated a significant IU by perceived AC interaction predicting worry and GAD diagnoses. There was a positive relation between IU and worry/GAD diagnoses that was strongest among those with high perceived AC. Perceived AC was unrelated to cognitive control abilities, and cognitive control abilities did not interact significantly with IU. Cognitive control abilities were related to worry symptoms but not to GAD diagnoses.

CONCLUSIONS

These results indicate that at high levels of perceived AC, individuals with elevated IU report higher levels of worry, potentially due to the conscious use of worry as an emotion regulation strategy. Clinical implications and future directions are discussed.

Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress

Preliminary prospective research suggests emotion dysregulation may confer vulnerability to poor stress responses. The present prospective study extends this research by examining both specific emotion regulation strategies and global emotion regulation difficulties in the context of acute stress following onset of the COVID-19 global pandemic in 119 young adults. As part of a larger study, emotion regulation was assessed prior to pandemic onset (January 2019 - February 2020) using two standard measures (Emotion Regulation Questionnaire, ERQ, Gross & John, 2003; Difficulties in Emotion Regulation Scale, DERS, Gratz & Roemer, 2004). A self-report assessment of acute stress was conducted 2-3½ weeks after the COVID-19 pandemic declaration. Results demonstrated cognitive reappraisal and expressive suppression (i.e., ERQ) were not individually predictive of acute stress; however, there was a significant interaction of suppression by reappraisal. Simple effects indicated suppression was negatively associated with acute stress only when reappraisal levels were high. Greater global emotion regulation difficulties (i.e., DERS), particularly nonacceptance of emotions and limited access to emotion regulation strategies, significantly predicted greater acute stress. These results provide further evidence of the temporal relationship between emotion dysregulation and stress reactions, and also suggest the expected effects of emotion regulation strategies may differ across contexts.

Niacin biological challenge: A paradigm to evaluate social concerns

BACKGROUND AND OBJECTIVES

Anxiety sensitivity (AS) social concerns, the fear of observable anxiety symptoms is posited as a risk factor for social anxiety by increasing fear reactivity in social situations when observable anxiety symptoms are present. Experimental evaluation of AS social concerns is limited. The current study utilized several manipulations designed to be relevant to AS social concerns or fear of negative evaluation (FNE), a distinct social anxiety risk factor. The effects of these manipulations on fear reactivity to a speech were examined.

METHODS

Participants (N = 124 students; M age = 19.44, SD = 2.45; 64.5% female) were randomized to one of four conditions in a 2 (100 mg niacin vs 100 mg sugar pill) X 2 (instructional set) design. For the instructional set manipulation, participants were told their speech performance would be evaluated by a judge based on their performance (i.e., FNE-relevant) or their observable anxiety symptoms (i.e., AS social concerns-relevant).

RESULTS

There was a main effect for vitamin condition with participants in the niacin condition reporting higher panic symptoms post-speech relative to those in the placebo condition. There was no main effect for speech instructions. As hypothesized, these effects were qualified by an interaction indicating that AS social concerns significantly predicted panic symptoms for those receiving niacin.

LIMITATIONS

Limitations include the reliance on self-reports of outcome variables and the use of an undergraduate student sample.

CONCLUSIONS

These findings highlight a distinct role of AS social concerns in fear responding to socially evaluative situations in the context of physically observable arousal.

The unique and interactive effects of anxiety sensitivity and emotion dysregulation in relation to posttraumatic stress, depressive, and anxiety symptoms among trauma-exposed firefighters

BACKGROUND

Firefighters are chronically exposed to traumatic events. Relatedly, past work has documented high rates of psychiatric problems, such as posttraumatic stress symptoms and depression, among firefighters. Less is known regarding anxiety symptoms among firefighters. Moreover, little work has examined risk/maintenance factors related to these symptoms among firefighters. Doing so may be important to developing interventions tailored to trauma-exposed firefighters. The current study examined symptoms of posttraumatic stress, depression, panic disorder, and social anxiety among trauma-exposed firefighters.

PROCEDURE

Using structural equation modeling, the main and interactive effects of anxiety sensitivity and emotion dysregulation were examined in relation to these symptom outcomes. Participants included 787 male urban firefighters reporting at least one past traumatic event.

RESULTS

There was a statistically significant main effect of anxiety sensitivity on each outcome. Emotion dysregulation exerted a statistically significant main effect on posttraumatic stress, depression, and social anxiety symptoms. Interactive effects of anxiety sensitivity and emotion dysregulation did not reach statistical significance but examination of effect sizes suggests that interactive effects may be present for posttraumatic stress symptoms (R² = 0.011), depression (R² = 0.008), and panic (R² = 0.016) such that emotion dysregulation is more strongly related to outcomes when anxiety sensitivity levels are relatively lower. All effects were evident after controlling for trauma severity and history of armed forces service.

CONCLUSION

Overall, results suggest that anxiety sensitivity and emotion dysregulation represent unique risk/maintenance factors related to a broad range of emotional symptoms among trauma-exposed firefighters. These findings replicate patterns found among the general population and extend the findings to potentially vulnerable firefighters.

The Association between Self-Reported Difficulties in Emotion Regulation and Heart Rate Variability: The Salient Role of Not Accepting Negative Emotions

Difficulties in emotion regulation are associated with development and maintenance of psychopathology. Typically, features of emotion regulation are assessed with self-report questionnaires. Heart rate variability (HRV) is an objective measure proposed as an index of emotional regulation capacity. A limited number of studies have shown that self-reported difficulties in emotion regulation are associated with HRV. However, results from prior studies are inconclusive, and an ecological validation of the association has not yet been tested. Therefore, further exploration of the relation between self-report questionnaires and psychophysiological measures of emotional regulation is needed. The present study investigated the contribution of self-reported emotion regulation difficulties on HRV in a student sample. We expected higher scores on emotion regulation difficulties to be associated with lower vagus-mediated HRV (vmHRV). Sixty-three participants filled out the Difficulties in Emotion Regulation Scale and their resting HRV was assessed. In addition, a subsample of participants provided ambulatory 24-h HRV data, in order to ecologically validate the resting data. Correlation analyses indicated that self-reported difficulties in emotion regulation was negatively associated with vmHRV in both resting HRV and 24-h HRV. Specifically, when exploring the contribution of the different facets of emotion dysregulation, the inability to accept negative emotions showed the strongest association with HRV. The results are discussed and need for future research is described.

Emotional Nonacceptance and Anxiety Sensitivity in Relation to Anxious Arousal, Social Anxiety, and Depressive Symptoms Among African American Young Adults

Past work suggests African American college students may be a segment of the college population at heightened risk for anxiety and depressive symptoms; however, there remains an overarching need to broaden our understanding of individual difference variables that may be related to adverse emotional states. The purpose of the present study was to test a theoretically driven interactive model of two individual difference variables (anxiety sensitivity and emotional nonacceptance) in relation to anxiety and depressive symptoms among 133 African American undergraduate students (76.7% female, Mage = 20.9, SD = 5.6; age range = 18-53 years). Results indicated that anxiety sensitivity was positively associated with anxious arousal symptoms at higher levels of emotional nonacceptance (β = 2.1), and more strongly associated with depressive symptoms among individuals endorsing low levels of emotional nonacceptance (β = 3.8). The present data provide novel evidence suggesting there is clinically relevant interplay between anxiety sensitivity and emotional nonacceptance. These findings aid in better understanding the expression of anxiety and depressive symptoms among this population and may represent transdiagnostic constructs of relevance for early intervention.

Conducting Clinical Research Using Crowdsourced Convenience Samples

Crowdsourcing has had a dramatic impact on the speed and scale at which scientific research can be conducted. Clinical scientists have particularly benefited from readily available research study participants and streamlined recruiting and payment systems afforded by Amazon Mechanical Turk (MTurk), a popular labor market for crowdsourcing workers. MTurk has been used in this capacity for more than five years. The popularity and novelty of the platform have spurred numerous methodological investigations, making it the most studied nonprobability sample available to researchers. This article summarizes what is known about MTurk sample composition and data quality with an emphasis on findings relevant to clinical psychological research. It then addresses methodological issues with using MTurk--many of which are common to other nonprobability samples but unfamiliar to clinical science researchers--and suggests concrete steps to avoid these issues or minimize their impact.