Expressive suppression and cognitive reappraisal in veterans with PTSD: Results from the mind your heart study

The association between aspects of expressive suppression emotion regulation strategy and rumination traits: a network analysis approach

Expressive suppression is an abnormal emotion regulation strategy, and its relationship with rumination traits is unclear. In this study with 395 participants in China (33.9% female, Mean age = 21.22, SD = 2.11), we estimated the association between expressive suppression and rumination traits, using the Rumination Response Scale (RRS) and the Emotion Regulation Questionnaire (ERQ) respectively. Considering there may be complex correlations between different behavioral symptoms of expressive suppression ("Keeping emotions to myself", "Inhibiting positive emotion responses", "Controlling emotions by not expressing them", "Inhibiting negative emotion responses") and different subtypes of rumination traits, this study employed a symptom-based network analysis method to uncover the differential association between rumination traits and expressive suppression, and the key symptoms linking the two. The study found the S3 node (Controlling emotions by not expressing them) had significant positive correlations with symptom rumination, brooding, and reflective pondering. Among the network, the S3 node acts as a bridge between two variables. This suggests that interventions targeting the S3 symptom may improve rumination traits. The present study was a cross-sectional study with limitations in revealing the causal relationships between expression suppression and rumination traits. Future studies could employ longitudinal tracing methods to explore the relationship between them.

Emotion regulation profiles in Syrian refugees and migrants in Germany: self-efficacy, resilience and well-being comparisons

BACKGROUND

Emotion regulation (ER) plays a central role in psychopathology. Understanding person-centred patterns of ER strategies is crucial for prevention and intervention strategies. However, there is a paucity of research on ER profiles and their psychological correlates in forcibly displaced people (FDP).

OBJECTIVE

This study aimed to identify habitual ER profiles and to examine the predictive role of different psychological variables on these profiles in Syrian FDP in Germany.

METHOD

In a sample of 991 individuals, we conducted a latent profile analysis (LPA) to assess habitual reappraisal and suppression of emotion as ER strategies, as well as self-efficacy, resilience, well-being comparisons, trauma exposure and International Classification of Diseases 11th Revision post-traumatic stress disorder (PTSD) symptoms as potential predictors of ER profile membership.

RESULTS

LPA identified four distinct ER profiles: high regulators (12.8%), low regulators (20.6%), reappraisal regulators (25.1%) and suppressive regulators (41.5%). In multinomial regression analysis, self-efficacy, resilience, appetitive well-being comparisons and trauma exposure were significantly associated with profile membership, while PTSD and aversive well-being comparisons showed no significant association. High regulators exhibited the highest levels of self-efficacy, resilience and appetitive well-being comparisons, followed by reappraisal, suppressive and low regulators. Additionally, high regulators reported the highest number of traumatic events, followed by suppressive and low regulators.

CONCLUSIONS

Our results indicate a higher adaptiveness in high regulation ER profiles as opposed to low regulation ER profiles.

CLINICAL IMPLICATIONS

Given that most FDP in our sample relied predominantly on one ER strategy, developing interventions that focus on cultivating a broad repertoire of ER strategies may be beneficial.

Navigating the battlefield within: Exploring the interplay of political armed conflict, mental health, and emotion regulation

The study explored the intricate relationship between political armed conflict, mental health outcomes, and emotion regulation strategies, focusing on cognitive reappraisal and emotion suppression. Drawing on extensive literature, we examined the impact of the Israel-Hamas war on mental health, particularly post-traumatic stress symptoms (PTSS) and anxiety. Using data from a nationally representative sample of 517 Israeli adults surveyed four weeks after the October 7 war began, we conducted path analysis to examine the direct and indirect effects of conflict exposure on mental health outcomes mediated by emotion regulation. Cognitive reappraisal was positively associated with well-being, while emotion suppression was linked to higher levels of PTSS and anxiety and lower levels of well-being. Subjective exposure to war events was associated with higher levels of anxiety and PTSS, and cognitive reappraisal served as a protective factor for overall well-being. We also observed ethnicity, age, and gender differences in exposure levels and mental health outcomes. Emotion regulation emerges as a crucial factor in navigating the psychological challenges posed by war exposure, with cognitive reappraisal associated with positive mental health outcomes and emotion suppression linked to adverse effects.

The role of objective sleep in implicit and explicit affect regulation: A comprehensive review

Impairments in sleep and affect regulation are evident across a wide range of mental disorders. Understanding the sleep factors that relate to affect regulatory difficulties will inform mechanistic understanding and aid in treatment. Despite rising interest, some research challenges in this area include integrating across different clinical and non-clinical literatures investigating the role of sleep architecture (measured with polysomnography) and experimentally manipulated sleep, as well as integrating more explicit versus implicit affect regulation processes. In this comprehensive review, we use a unifying framework to examine sleep's relationship with implicit-automatic regulation and explicit-controlled regulation, both of which are relevant to mental health (e.g., PTSD and depression). Many studies of implicit-automatic regulation (e.g., fear extinction and safety learning) demonstrate the importance of sleep, and REM sleep specifically. Studies of explicit-controlled regulation (e.g., cognitive reappraisal and expressive suppression) are less consistent in their findings, with results differing depending on the type of affect regulation and/or way that sleep was measured or manipulated. There is a clear relationship between objective sleep and affect regulation processes. However, there is a need for 1) more studies focusing on sleep and explicit-controlled affect regulation; 2) replication with the same types of regulation strategies; 3) more studies experimentally manipulating sleep to examine its impact on affect regulation and vice versa in order to infer cause and effect; and 4) more studies looking at sleep's impact on next-day affect regulation (not just overnight change in affect reactivity).

Post-traumatic Stress Disorder in Veterans: A Concept Analysis

Post-traumatic stress disorder (PTSD) occurs when an individual experiences a traumatic event that exceeds the limits of psychological endurance. Many veterans experience PTSD. PTSD can negatively impact veterans' quality of life, functioning, life satisfaction, and overall well-being. It is important to analyze the concept of PTSD in the veteran population. This concept analysis aimed to investigate the defining attributes, a model case, antecedents, consequences, and empirical referents related to the concept of PTSD among veterans. Walker and Avant's method was used to guide this concept analysis of PTSD. The results showed that three attributes were determined from the analysis: intrusive memories of traumatic events, feelings of isolation and estrangement, and negative cognitions. PTSD is conceptualized as a collection of symptoms that arise from highly traumatic experiences. The military environment predisposes veterans to traumatic events that should be identified or acknowledged. A better understanding of the concept of PTSD can facilitate the development of effective interventions for the veteran population and enhance their mental health.

Szabo Y. Childhood Adversity and Adult Inflammation: Exploring the Mediating Role of Emotion Regulation in the MIDUS II Study

The present study furthers understanding of how childhood adversity connects to inflammation and, in turn, poor health. Using the publicly available Midlife in the United States II (MIDUS II) dataset, we test a recent theoretical model that suggests emotion regulation is a potential mechanism of associations between adversity and inflammation. We examined the indirect effects of various types of adversity (e.g., stressful events, maltreatment, threat, and deprivation) on inflammation via two emotion regulation strategies (i.e., expressive suppression and reappraisal). Participants included 1096 adults without a history of cancer or HIV/AIDS who had completed the initial MIDUS II follow up and a sub-study examining biomarkers. Participants completed self-report measures inquiring about psychosocial factors including stressful life events, childhood trauma, and emotion regulation as well as provided blood samples. Bivariate correlation indicated that multiple forms of childhood adversity were associated with both C-reactive protein and fibrinogen. Deprivation, as measured by a stressful life events scale, was positively associated with both reappraisal and suppression. Tests of indirect effects indicated that deprivation was positively associated with fibrinogen through both emotion regulation strategies, particularly for female participants. Our findings partially support recent theory positing emotion regulation as a pathway through which childhood adversity may impact inflammation in adulthood. Further, deprivation may be particularly critical in understanding how adversity is connected to maladaptive emotion regulation and inflammation. Emotion regulation may be an important treatment target to mitigate the negative impact of childhood adversity on health and well-being.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-023-00594-2.

Investigating the Role of Anger and Cognitive Malfunction in Mental Health: A Cross-Sectional Exploration Paving the Way for a Subsequent Experiment

The functional outcomes associated with subjective well-being (SWB) and the detrimental aspects of psychological distress (PD) make it essential to explore contributing factors. The present study investigated a model about the existing gap in the determining role of trait anger (TA), state anger (SA), cognitive reappraisal (CR), rumination and cognitive failure (CF) as predictors of SWB and PD. The study contributes by exploring the interaction of dispositional, situation factors and emotional regulation strategies in shaping SWB and PD in the Indian Sample. A cross-sectional survey design was employed wherein 600 young adults aged 18-40 (Mage = 22.13, SDage = 4.06) were recruited from Uttar Pradesh, India using a multi-level cluster sampling method. The data were collected using questionnaires in the field setting during August-December 2021. Regression and path analysis revealed that the proposed predictors explained significant variance in SWB and PD, i.e., R2 = 0.24, F (5, 594) = 38.03, p < 0.01, Cohen f2 =0.31 and R2 = 0.35, F (5, 594) = 66.40, p < 0.01, Cohen f2 = 0.53, respectively. The models also fit well with the statistical indices. Except CR, all predictors emerged as significant risk factors. The findings suggest that the interventions to reduce PD and enhance SWB may consider inculcating CR and reducing higher levels of TA, SA, rumination and CF to enhance an individual's adaptive functioning. The findings pave the way for conducting a pre-planned experiment to study the outcomes of various levels of TA in regulating incidental anger (SA) employing CR and rumination.

On the relationship between emotion regulation difficulties and posttraumatic stress symptoms during treatment: A test of reciprocity

Positive associations between difficulties in emotion regulation and PTSD symptom severity have been consistently found in the literature. Little is known whether these associations are the result of reciprocal effects between the two constructs. This study investigated the reciprocal relationship between post-traumatic stress symptoms and emotion regulation difficulties. The study used a longitudinal design with two time points. The sample consisted of 293 patients who were all in treatment for PTSD. We estimated the cross-lagged panel model with latent variables. The results showed a significant cross-lagged effect of emotion regulation difficulties on post-traumatic stress symptoms. This finding highlights that emotion regulation difficulties play a pivotal role in the development and maintenance of post-traumatic stress. Therefore, exploring emotion regulation difficulties early on in treatment may support the effectiveness of trauma-focused interventions.

Cognitive reappraisal moderates the effect of combat or other exposures on negative behavioral health symptoms

Understanding the individual differences that can buffer the impact of combat and other adverse exposures on deleterious behavioral health outcomes could lead to more targeted prevention and intervention efforts. Cognitive reappraisal, an antecedent-focused emotion regulation strategy, is linked to positive health outcomes such as lower levels of post-traumatic stress disorder, anxiety, and depression. This study examined the moderating effect of individual differences in cognitive reappraisal use on the association between combat exposure and behavioral health outcomes in active-duty U.S. Soldiers (N = 2,290). This study utilized survey data collected approximately 18 months following a combat deployment to Afghanistan in 2014. Results showed that individual differences in cognitive reappraisal use significantly moderated the effect of combat exposure on anxiety and post-traumatic stress symptoms but not depressive symptoms. Specifically, increasing combat exposures predicted a steeper increase in negative behavioral health symptoms for Soldiers reporting lesser (versus greater) cognitive reappraisal use. These findings highlight a role for cognitive reappraisal as a targetable factor that can mitigate the behavioral health consequences of exposure to combat stressors.

Effortful control and depression in school-age children: The chain mediating role of emotion regulation ability and cognitive reappraisal strategy

BACKGROUND

Depression is one of the main mental health problems facing primary school students. Temperamental effortful control (EC) has received much attention as a protective factor to depression. The present study aimed to verify the association of effortful control and children's depression and explore the mediating roles of emotion regulation ability (ERA) and strategies (ERSs) in the relationship.

METHODS

A total of 449 valid primary school students in grades 3 to 6 were included in the study. Self-report and parent-report questionnaires were used to collect data on key variables, including EC, depression, ERA and ERSs.

RESULTS

Gender and whether-native-or-not had significant effects on children's depression. EC was significantly and negatively correlated with children's depression; EC and depression were significantly correlated with Emotion Regulation dimension of ERA and cognitive reappraisal; but there was no correlation between EC and Lability/Negativity, as well as between expression suppression and depression. EmotionRegulation and cognitive reappraisal played mediating effects in the relationship between EC and depression parallelly and sequentially.

LIMITATIONS

The study used cross-sectional design and the sample was restricted to Chinese primary school students. Additionally, the types and research perspectives of ERSs can be further expanded.

CONCLUSIONS

EC can reduce the level of children's depression by improving the abilities of Emotion Regulation and the use of cognitive reappraisal strategy, as well as the chain mediating effects of the two.

A latent profile analysis of emotional expression among patients with unintentional injuries

BACKGROUND

Emotional expression has been suggested to affect the well-being of individuals with unintentional injuries. However, few studies have investigated it as a heterogeneous phenomenon. The purpose of this study was to characterize the patterns of emotional expression among patients with unintentional injuries using latent profile analysis, and to examine the relationship among these latent profiles and cognitive processing, posttraumatic growth, and posttraumatic stress disorder.

METHODS

A cross-sectional study was carried out at two general hospitals in Wenzhou, China. In total, 352 patients with unintentional injuries completed the socio-demographic questionnaire, Berkeley Expressivity Questionnaire, Ambivalence Over Emotional Expression Questionnaire, Event-Related Rumination Inventory, the Posttraumatic Growth Inventory, and PTSD Checklist-Civilian Version.  RESULTS: Three unique profiles were identified: high emotional expressivity (n = 238, 67.6%), moderate emotional expressivity (n = 45, 12.8%), and low emotional expressivity (n = 69, 19.6%). The ANOVA and chi-square tests demonstrated significant differences among the three groups concerning deliberate rumination and posttraumatic growth. Multinomial logistic regression analysis indicated that monthly income and time since injury significantly predicted profile membership.

CONCLUSIONS

Most patients showed high emotional expressivity after an unintentional injury. Emotional expression profiles were associated with deliberate rumination and posttraumatic growth. Emotional expression interventions tailored for different profiles are warranted after an unintentional injury.

The neural bases of expressive suppression: A systematic review of functional neuroimaging studies

Expressive suppression refers to the inhibition of emotion-expressive behavior (e.g., facial expressions of emotion). Although it is a commonly used emotion regulation strategy with well-documented consequences for well-being, little is known about its underlying mechanisms. In this systematic review, we for the first time synthesize functional neuroimaging studies on the neural bases of expressive suppression in non-clinical populations. The 12 studies included in this review contrasted the use of expressive suppression to simply watching emotional stimuli. Results showed that expressive suppression consistently increased activation of frontoparietal regions, especially the dorsolateral and ventrolateral prefrontal cortices and inferior parietal cortex, but decreased activation in temporo-occipital areas. Results regarding the involvement of the insula and amygdala were inconsistent with studies showing increased, decreased, or no changes in activation. These mixed findings underscore the importance of distinguishing expressive suppression from other forms of suppression and highlight the need to pay more attention to experimental design and neuroimaging data analysis procedures. We discuss these conceptual and methodological issues and provide suggestions for future research.

Laboratory models of post-traumatic stress disorder: The elusive bridge to translation

Post-traumatic stress disorder (PTSD) is a debilitating mental illness composed of a heterogeneous collection of symptom clusters. The unique nature of PTSD as arising from a precipitating traumatic event helps simplify cross-species translational research modeling the neurobehavioral effects of stress and fear. However, the neurobiological progress on these complex neural circuits informed by animal models has yet to produce novel, evidence-based clinical treatment for PTSD. Here, we provide a comprehensive overview of popular laboratory models of PTSD and provide concrete ideas for improving the validity and clinical translational value of basic research efforts in humans. We detail modifications to simplified animal paradigms to account for myriad cognitive factors affected in PTSD, which may contribute to abnormalities in regulating fear. We further describe new avenues for integrating different areas of psychological research underserved by animal models of PTSD. This includes incorporating emerging trends in the cognitive neuroscience of episodic memory, emotion regulation, social-emotional processes, and PTSD subtyping to provide a more comprehensive recapitulation of the human experience to trauma in laboratory research.

The influence of dispositional cognitive reappraisal and expressive suppression on post-retrieval and standard extinction

Individual differences in the ability to habitually regulate emotion may impact the efficacy of fear memory extinction. The aim of this study was to assess the relationship between dispositional cognitive reappraisal and expressive suppression with post-retrieval and standard extinction. Fear memory and extinction were measured with the recovery of skin conductance responses. We also examined the relationship between a temporal feature of electrodermal responding (half-recovery time) and each of the emotion regulation strategies. University students (N = 80) underwent a three-day fear conditioning procedure using a within-subject design consisting of acquisition on day one, post-retrieval extinction and standard extinction on day two, and recovery test on day three. Individual difference data on self-reported levels of cognitive reappraisal, expressive suppression, trait anxiety, and depression were collected. We did not detect a relationship between the two emotion regulation strategies measured in this study and acquisition or extinction. We found, however, that increased dispositional use of cognitive reappraisal was associated with lower spontaneous recovery to both the post-retrieval extinction and standard extinction stimulus after controlling for age, trait anxiety, and depression. There were no associations between expressive suppression and conditioned responses. We also observed patterns of faster dissipation of arousal for reappraisal and slower for suppression to the conditioned stimulus during extinction training, which may represent the unique influence of each emotion strategy on the regulation of fear. We conclude greater daily use of cognitive reappraisal, but not expressive suppression, associates with extinction retention after receiving both standard and post-retrieval extinction.

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.