An integrative model of emotion regulation and associations with positive and negative affectivity across four Arabic speaking countries and the USA

Impact of resilience-based intervention on emotional regulation, grit and life satisfaction among female Egyptian and Saudi nursing students: A randomized controlled trial

AIM

Evaluate and compare the impact of a resilience-based intervention on emotional regulation, grit and life satisfaction among female Egyptian and Saudi nursing students.

BACKGROUND

Nursing students should experience a comprehensive learning environment since they are mind-body-spirit creatures. Therefore, nursing education should emphasize growing students' physical, social, emotional and spiritual well-being in addition to their knowledge, skills and attitudes.

DESIGN

This study followed a parallel arm randomized controlled trial design. Study participants were randomly assigned to the intervention or control groups in a (1:1) ratio. It was conducted between January 2023 and the end of April 2023.

METHOD

Students were randomly allocated to the eight-week resilience intervention (n= 60) or a control (n= 60) group (half of the students in each group were from each country). The intervention group received a pamphlet and attended eight weekly 15-person sessions on resilience, grit (perseverance), emotional regulation and self-care. The Emotion Regulation Questionnaire, the Short Grit Scale and the Satisfaction with Life Scales were administered pre- and immediately post-intervention.

RESULTS

Between pre- and post-intervention, there were significant improvements in grit (from 41.374.27 to 51.235.22 among Egyptian students with an effect size of 0.663 and from 42.974.30 to 54.103.87 among Saudi students with an effect size of 0.800), as well as mean emotional regulation (from 36.635.11 to 55.707.51 among Egyptian students with an effect size of 0.818 and from 44.606.87 to 61. With a substantial effect size of 0.850 (p0.001), Egyptian nursing students experienced a more significant rise in mean life satisfaction than Saudi nursing students (18.336.54 to 29.305.14).

CONCLUSION

Resilience-based interventions enhanced emotional regulation, grit and life satisfaction in Egyptian and Saudi female nursing students. Grit, resilience and emotional regulation should be incorporated into nurse training to equip female students with the necessary values and protective factors to succeed in their studies. Given the unique challenges and stressors that female nursing students may face, nursing programs and institutions must provide resources and support services to help students manage stress and build resilience.

Psychometric properties of an Arabic translation of the brief version of the difficulty in emotion regulation scale (DERS-16)

BACKGROUND

The current study aimed to examine the psychometric properties of an Arabic translation of the short form of the Difficulty in Emotion Regulation Scale (DERS-16) in an Arabic-speaking population-based adult sample in Lebanon. In particular, the factorial structure, composite reliability, convergent validity and gender invariance were investigated.

METHODS

A total of 411 Lebanese adult participants (mean age of 32.86 ± 11.98 years, 75.4% females) took part of this cross-sectional web-based study. The forward and backward translation method was applied.

RESULTS

Findings revealed good internal consistency of the Arabic DERS-16 total scale and five subscales (McDonald's ω ranging from 0.81 to 0.95). Confirmatory factor analyses confirmed the five-factor solution of the scale and demonstrated strong measurement invariance across gender at the configural, metric, and scalar levels. No significant differences were found in all DERS-16 domains between men and women participants. Finally, the DERS-16 scores and sub-scores showed strong correlations with the Borderline Personality Questionnaire (r > .40), thus indicating its convergent validity.

CONCLUSION

Overall, the present findings suggest that the Arabic version of the DERS-16 may be a reliable and valid self-report measure that assesses ER difficulties as a multidimensional construct. Making the Arabic version of the DERS-16 available will hopefully strengthen its utilization for clinical and research purposes to benefit the millions of Arabic-speaking people worldwide.

Cognitive Emotion Regulation Questionnaire-Short: Reliability, Validity, and Measurement Invariance of the Italian Version

OBJECTIVE

The Cognitive Emotion Regulation Questionnaire (CERQ) is a widely used instrument to assess cognitive emotion regulation strategies. The study aimed to test the psychometric properties of the Italian short version of the CERQ (CERQ-IS).

METHODS

Two separate samples of 442 young adults (M_age = 21.12; SD = 3.69) and 256 adolescents (M_age = 14.81; SD = 0.59) completed the CERQ, the Emotional Regulation Questionnaire (ERQ) and the Multidimensional Perfectionism Scale (MPS). A confirmatory factor analysis (CFA) was performed to evaluate the dimensionality of the CERQ-IS. Internal consistency was analysed by calculating model-based composite reliability coefficients. Criterion and discriminant validity were gathered through the correlations with the ERQ and the MPS, respectively. Factorial invariances tests across gender and age were computed by means of multiple-group CFA.

RESULTS

CFA confirmed the nine-factor structure showing an excellent fit to the data. Except for rumination which was minimally acceptable, all subscales had an acceptable to good reliability. Criterion validity was supported by significant correlations between CERQ-IS and ERQ subscales. Discriminant validity was confirmed by meaningless correlations with the MPS facets. Configural, metric and scalar invariance were established across both grouping variables.

CONCLUSIONS

The brevity of this tool and its good psychometric properties suggest that CERQ-IS could be a useful screening tool in both clinical and research practice in adolescence and young adulthood.

Supporting Youth and Families in Gaza: A Randomized Controlled Trial of a Family-Based Intervention Program

Background: A total of 450 million children are now living in active conflict zones. The negative consequences for children are significant and long lasting. In response to the urgent need for sustainable interventions for children and families, the current study evaluated a brief (12 hr, 8 session) family-based coping and support program, Promoting Positive Family Futures (PPFF), in Gaza. Methods: Families (n = 68, mother/father/adolescent triads) were randomized into the PPFF intervention or another lengthier (50 hr, 25 session) locally well-established psychosocial support program (treatment as usual; TAU). Results: Improvements were found for both conditions for paternal and maternal depression, emotion regulation using cognitive reappraisal, family-wide emotional security, and adolescent adjustment. Effect sizes were medium to large (d = 0.35–1.27). Fathers in the PPFF condition reported lower depression and higher emotion regulation using cognitive reappraisal at post-test than did fathers in the TAU condition. Mothers in the PPFF condition reported higher levels of emotion regulation using cognitive reappraisal at post-test than did mothers in the TAU condition. PPFF was also indirectly associated with improved depression at post-test for both mothers and fathers via improvements in emotion regulation using cognitive reappraisal and with adolescent adjustment at six months via improvements in maternal emotion regulation using cognitive reappraisal. Conclusions: These findings suggest that the PPFF intervention has many benefits comparable with a longer and locally well-established program. PPFF was also associated with unique positive implications for family-wide adjustment over time. Support was also identified for transdiagnostic processes of improvement associated with the PPPF intervention consistent with the theoretical models informing the approach.

The Depression Anxiety Stress Scale 8-Items Expresses Robust Psychometric Properties as an Ideal Shorter Version of the Depression Anxiety Stress Scale 21 Among Healthy Respondents From Three Continents

To examine the cultural limitations and implications in the applicability of the Depression Anxiety Stress Scale 8-items (DASS-8)-a shortened version of the DASS-21 recently introduced in an Arab sample-this study evaluated its psychometric properties, including measurement invariance, among healthy subjects from the United States, Australia, and Ghana. Confirmatory factor analysis revealed good fit of the DASS-8 relative to a 12-item version (DASS-12). Both the DASS-8 and the DASS-12 were invariant at all levels across genders, employment status, and students vs. non-students. The DASS-8/DASS-12 also expressed invariance at the configural and metric levels across all countries, albeit scalar invariance was not maintained due to misspecification of the factor loadings in the Ghanian sample. Mann-Whitney U test revealed significantly lower levels of mental symptomatology on the DASS measures among Ghanian students than in English-speaking respondents (both students and non-students). The DASS-8 expressed excellent internal consistency (coefficient alpha = 0.89), good convergent validity-noted by high values of item-total correlations (r = 0.87 to 0.88), good predictive validity-indicated by significantly strong correlation with the DASS-21 and its subscales (r = 0.95 to 0.80), and adequate discriminant validity-indicated by heterotrait-monotrait ratio of correlations <0.85. The DASS-8 correlated with the Internet Gaming Disorder-9, the Adult attention-deficit/hyperactivity disorder Self-Report Scale, and the Individualism and Collectivism Scale/Culture Orientation Scale at the same level as the DASS-21 and the DASS-12, denoting its adequate criterion validity. The DASS-8 can be used as a brief alternative to the DASS-21 to screen for mental symptomatology in English-speaking and African cultures. However, the same scores on the DASS-8 and the DASS-12 may not always indicate the same level of symptom severity in subjects from different countries. Further inter-cultural evaluations of the DASS-8 are needed.

The Association Between Trauma Centrality and Posttraumatic Stress Among Syrian Refugees: The Impact of Cognitive Distortions and Trauma-Coping Self-Efficacy

While research suggests that the war in Syria has led to a drastic re-evaluation of oneself and elevated psychiatric symptoms among Syrian refugees, little is known whether these psychological reactions might be influenced by maladaptive beliefs about oneself and the world and their ability to cope with the effect of the trauma. This study aimed to provide further evidence on the association between trauma centrality, posttraumatic stress, and psychiatric comorbidity, and examine whether cognitive distortions and trauma-coping self-efficacy would mediate the impact of trauma centrality on distress among Syrian refugees residing in Sweden. Four-hundred seventy-five Syrian refugees completed a demographic page, the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Cognitive Distortion Scales, and trauma-coping self-efficacy. Results showed that trauma centrality was significantly correlated with posttraumatic stress disorder (PTSD) and psychiatric comorbidity after adjusting the effects of trauma exposure characteristics. Cognitive distortions mediated the impact of trauma centrality on the two distress outcomes; trauma-coping self-efficacy did not but was negatively correlated with outcomes. To conclude, the war in Syria changed self-perception, outlook on life, and identity among Syrian refugees. These changes were related to increased psychological symptoms especially for those who had distorted beliefs about themselves and the world. Refugees' belief in the lack of ability to cope with the effect of the trauma impacted psychological distress independently of changes in self-perception.

The COVID-19-Related Lockdown in Qatar: Associations Among Demographics, Social Distancing, Mood Changes, and Quality of Life

The worldwide spread of the coronavirus disease (COVID-19), the absence of medical treatment and vaccination, the delayed onset of symptoms, and the rapid human-to-human transmission have led the vast majority of countries to impose strict social distancing procedures. Whereas it appears that social distancing is an effective strategy for mitigating spread, it may also result in a variety of unintended negative consequences to individuals' psychological well-being and mental health. During the peak of the COVID-19 pandemic, the present study examined associations among some demographic variables (gender, age, marital and working statuses, and having a family member or a friend infected with COVID-19), acceptance of social distancing, mood changes, and quality of life (QoL) in Qatar, a high-income Middle Eastern Arabic-speaking country. Older, married, and working participants were more accepting of social distancing than younger, unmarried, and non-working participants, respectively. Participants indicated that, during this time, they became more distressed, upset, scared, irritable, nervous, and afraid, and less inspired and determined. In a stark contrast, more individuals indicated that they became more interested, alert, and attentive, whereas higher percentages of participants reported feeling less guilty, hostile, and ashamed. Social distancing correlated positively with negative affect, whereas social avoidances correlated positively with positive affect and with physical, psychological, social, and environmental QoL. Finally, positive affect correlated positively, and negative affect correlated negatively, with these four domains of QoL. These results highlight the need for public health and clinical providers to consider peoples' psychological well-being and mental health during the COVID-19 pandemic.

Psychometric Properties and Factor Structures of the CERQ, DERS, and RESE Measures: A Bifactor Approach

This study aims to simultaneously compare the psychometric properties and examine the factor structures of 3 emotion regulation (ER) strategy scales using a bifactor approach. Due to good reliability and validity, extensive use, and the same scoring method, the Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, and Regulatory Emotional Self-Efficacy Scale were used to assess ER strategies in 1,036 Chinese respondents. A bifactor confirmatory factor analysis was designed to address the multidimensionality of the factor structure, and the corresponding bifactor structures were then applied in a subsequent bifactor multidimensional item response theory (MIRT) analysis. Finally, bifactor MIRT was used to compare the psychometric properties of the 3 measures. The results indicated that bifactor structures were appropriate for the 3 ER strategy measures, which performed well overall. Different measures provide the highest accuracy for specific groups and designs. Some strengths and limitations of this article are discussed.

Development of Computerized Adaptive Testing for Emotion Regulation

Emotion regulation (ER) plays a vital role in individuals’ well-being and successful functioning. In this study, we attempted to develop a computerized adaptive testing (CAT) to efficiently evaluate ER, namely the CAT-ER. The initial CAT-ER item bank comprised 154 items from six commonly used ER scales, which were completed by 887 participants recruited in China. We conducted unidimensionality testing, item response theory (IRT) model comparison and selection, and IRT item analysis including local independence, item fit, differential item functioning, and item discrimination. Sixty-three items with good psychometric properties were retained in the final CAT-ER. Then, two CAT simulation studies were implemented to assess the CAT-ER, which revealed that the CAT-ER developed in this study performed reasonably well, considering that it greatly lessened the test items and time without losing measurement accuracy.

Individual differences in emotion regulation and face recognition

Face recognition ability is highly variable among neurologically intact populations. Across three experiments, this study examined for the first time associations between individual differences in a range of adaptive versus maladaptive emotion regulation strategies and face recognition. Using an immediate face-memory paradigm, in which observers had to identify a self-paced learned unfamiliar face from a 10-face target-present/ target-absent line-up, Experiment 1 (N = 42) found high levels of expressive suppression (the ongoing efforts to inhibit emotion-expressive behaviors), but not cognitive reappraisal (the cognitive re-evaluation of emotional events to change their emotional consequences), were associated with a lower level of overall face-memory accuracy and higher rates of misidentifications and false positives. Experiment 2 (N = 53) replicated these finding using a range of face-matching tasks, where observers were asked to match pairs of same-race or different-race face images taken on the same day or during different times. Once again, high levels of expressive suppression were associated with a lower level of overall face-matching performance and higher rates of false positives, but cognitive reappraisal did not correlate with any face-matching measure. Finally, Experiment 3 (N = 52) revealed that the higher use of maladaptive cognitive emotion regulation strategies, especially catastrophizing, was associated with lower levels of overall face-matching performances and higher rates of false positives. All told, the current research provides new evidence concerning the important associations between emotion and cognition.

Posttraumatic stress disorder and psychiatric co-morbidity among Syrian refugees: the role of trauma exposure, trauma centrality, self-efficacy and emotional suppression

Background: The devastation of the Syrian war can lead to a drastic re-evaluation of oneself and alteration in self-capacities. Yet, little is known regarding its impact on these domains among Syrian refugees.Aims: To investigate the inter-relationship between trauma characteristics, trauma centrality, self-efficacy, emotional suppression, PTSD and psychiatric co-morbidity among Syrian refugees.Methods: 1197 refugees from Turkey and Sweden completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Generalized Self-Efficacy Scale and Courtauld Emotional Control Scale.Results: Using the DSM-IV criteria for PTSD from the Harvard Trauma Questionnaire, 43% met the criteria. The PTSD group reported significantly higher levels of trauma characteristics, trauma centrality and psychiatric co-morbidity but a lower level of self-efficacy than the non-PTSD group. Trauma characteristics were positively associated with trauma centrality; trauma centrality was negatively correlated with self-efficacy. Contrary to hypothesis, self-efficacy was positively correlated with emotional suppression which was positively correlated with psychiatric co-morbidity but not PTSD.Conclusions: The experience of war can lead to the emergence of PTSD among Syrian refugees. Exposure to war can alter self-perception, belief of personal mastery over one's future and the way emotion is expressed, all of which can have specific effects on general psychological symptoms.

Investigating the relationship between distinctive patterns of emotion regulation, trauma exposure and psychopathology among refugees resettled in Australia: a latent class analysis

Background: Emotion regulation difficulties are common among individuals from refugee backgrounds. Little is known, however, about whether there are specific patterns relating to the types of emotion regulation strategies commonly employed by refugees, nor how this relates to psychopathology. Moreover, wider literature on emotion regulation has primarily focused on examining specific emotion regulation strategies in isolation, rather than patterns of emotion regulation across multiple strategies. Objective: The current study was the first to identify individual differences in patterns of habitual emotion regulation among refugees, and explore their unique associations with trauma exposure and PTSD symptoms. Method: Levels of trait reappraisal and suppression were measured among 93 refugees, using the Emotion Regulation Questionnaire and the White Bear Suppression Inventory. A latent class analysis was conducted to identify distinct classes of participants based on differing levels of habitual engagement in reappraisal and suppression. The association between class membership and key variables indexing refugee experiences (e.g. trauma exposure) and psychopathology (e.g. PTSD symptoms and emotion dysregulation) were also examined. Results: Latent class analysis revealed three distinct profiles of habitual emotion regulation: a high regulators class (55.7%; high trait reappraisal/high trait suppression), an adaptive regulators class (23.6%; high trait reappraisal/moderate trait suppression), and a maladaptive regulators class (20.6%; low trait reappraisal/high trait suppression). Each class evidenced unique relations with trauma exposure and psychopathology. Compared to adaptive regulators, maladaptive regulators had more PTSD symptoms, experienced greater emotion dysregulation, and were more likely to be female, while high regulators had experienced more types of traumatic events. Conclusions: This study identified distinct patterns of emotion regulation among refugees. Our findings demonstrate the importance of measuring multiple strategies to uncover patterns of emotion regulation and better understand the links between emotion regulation and psychopathology, which has important implications for the development of effective treatment with traumatized refugees.