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Mansueto G, Palmieri S, Sassaroli S, Ruggiero GM, Caselli G, Calligaro D, Manigrasso A, Nikčevic A, Spada MM. Emotion dysregulation in participants with substance use disorders: A metacognitive perspective. J Affect Disord 2024; 363:63-71. [PMID: 39038617 DOI: 10.1016/j.jad.2024.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Using the metacognitive model of emotion dysregulation as a basis, this study explored whether, among participants with substance use disorders (SUDs), metacognitive beliefs and repetitive negative thinking were associated with emotion dysregulation. METHODS 127 participants with SUDs and 127 controls without SUDs were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, and depression were assessed. t-tests, Mann-Whitney tests, logistic regression, correlation, and hierarchal regression analyses were run. RESULTS Participants with SUDs reported significantly higher levels of emotion dysregulation, positive beliefs about worry, beliefs about the need to control thoughts, rumination, and worry, compared to controls without SUDs. Among participants with SUDs negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence, beliefs about the need to control thoughts, rumination, and worry were significantly associated with an increase of emotion dysregulation. LIMITATIONS The cross-sectional design. CONCLUSION Emotion dysregulation, metacognitive beliefs, and repetitive negative thinking may contribute to increase the risk of substance use. Among participants with SUDs emotion dysregulation is associated with the tendency to endorse dysfunctional metacognitive beliefs and report repetitive negative thinking. Metacognitive beliefs and repetitive negative thinking could be a suitable therapeutic target to reduce emotion dysregulation among participants with SUDs.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy; School of Applied Sciences, London South Bank University, London, UK.
| | - Sara Palmieri
- School of Applied Sciences, London South Bank University, London, UK; Department of Psychology, Sigmund Freud University, Milan, Italy; Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - Sandra Sassaroli
- Department of Psychology, Sigmund Freud University, Milan, Italy; Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - Giovanni Maria Ruggiero
- Department of Psychology, Sigmund Freud University, Milan, Italy; Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - Gabriele Caselli
- Department of Psychology, Sigmund Freud University, Milan, Italy; Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - Dalila Calligaro
- Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - Antonella Manigrasso
- Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - Ana Nikčevic
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Kingston upon Thames, UK
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Zou M, Liu B, Ren L, Mu D, He Y, Yin M, Yu H, Liu X, Wu S, Wang H, Wang X. The association between aspects of expressive suppression emotion regulation strategy and rumination traits: a network analysis approach. BMC Psychol 2024; 12:501. [PMID: 39334290 PMCID: PMC11438175 DOI: 10.1186/s40359-024-01993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
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.
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Affiliation(s)
- Mingxuan Zou
- Public Health School, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Bin Liu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Lei Ren
- Military Psychology Section, Logistics University of PAP, Tianjin, 300309, China
- Military Mental Health Services & Research Center, Tianjin, 300309, China
| | - Defang Mu
- Department of Psychology, Tianjin University of Commerce, Tianjin, 300134, China
| | - Yuqing He
- Public Health School, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Mengxin Yin
- Public Health School, Shaanxi University of Chinese Medicine, Xianyang, 712046, China
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Huaihuai Yu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Xufeng Liu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Shengjun Wu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China
| | - Hui Wang
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China.
| | - Xiuchao Wang
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, 710032, China.
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Özkan Y, Öztürk M, Tvrtkovic S, Aydın O, Ünal-Aydın P. Exploring the associations between symptom severity, metacognition, problematic social media use and cyberbullying in treatment naïve adolescents with Attention Deficit and Hyperactivity Disorder. Addict Behav 2024; 160:108169. [PMID: 39348777 DOI: 10.1016/j.addbeh.2024.108169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 10/02/2024]
Abstract
This study investigates the relationship between ADHD symptom severity, metacognition, problematic social media use, and cyberbullying/cybervictimization in treatment-naïve adolescents. Understanding these relationships is vital for enhancing ADHD intervention strategies. Using a cross-sectional design, 97 adolescents meeting DSM-5 criteria for ADHD without any comorbidity and 97 healthy controls were assessed. Measures included the Metacognitions Questionnaire for Children, Social Media Disorder Scale, Revised Cyberbullying Inventory-II, and Revised Conners' Parent Rating Scale-Short. The comparisons were performed with independent samples' t tests and the associations were estimated by using Pearson's bivariate correlations and multiple regression analyses. Results revealed that adolescents with ADHD exhibited higher levels of dysfunctional metacognitions, problematic social media use, cyberbullying, and cybervictimization compared to controls. Regression analysis showed significant positive associations between ADHD symptoms, specific metacognitions (e.g., positive meta-worry, cognitive monitoring), and problematic social media use. This study, the first of its kind among treatment-naïve ADHD adolescents, provides valuable insights into the relationship between ADHD symptoms and particular metacognitions (i.e. positive meta-worry, cognitive monitoring) and problematic social media use. These findings contribute to a deeper understanding of ADHD in adolescence and may inform the development of targeted prevention and treatment strategies, particularly relevant given adolescents' susceptibility to social media's influence and their potential for cognitive flexibility in rehabilitation contexts.
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Affiliation(s)
- Yekta Özkan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey.
| | - Masum Öztürk
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Selma Tvrtkovic
- Department of Psychology, Faculty of Arts and Science, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Orkun Aydın
- Department of Psychology, Faculty of Arts and Science, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Pınar Ünal-Aydın
- Department of Psychology, Faculty of Arts and Science, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Inostroza C, Bustos C, Bühring V, González L, Cova F. Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study. Front Psychol 2024; 15:1400013. [PMID: 39100565 PMCID: PMC11295934 DOI: 10.3389/fpsyg.2024.1400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/24/2024] [Indexed: 08/06/2024] Open
Abstract
Background Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students' difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days. Method Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms. Results When comparing models, adding baseline symptoms increased the models' predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms. Discussion The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students' mental health. Targeting RNT would also benefit selective preventive interventions.
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Affiliation(s)
- Carolina Inostroza
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
| | - Claudio Bustos
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
| | - Vasily Bühring
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
| | - Lorena González
- Programa de Magíster en Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
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Mansueto G, Sassaroli S, Ruggiero GM, Caselli G, Nocita R, Spada MM, Palmieri S. The Mediating Role of Emotion Dysregulation in the Association Between Perfectionism and Eating Psychopathology Symptoms. Clin Psychol Psychother 2024; 31:e3020. [PMID: 38948954 DOI: 10.1002/cpp.3020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION This study explored the possible mediating role of emotion dysregulation in the association between perfectionism and eating psychopathology symptoms. METHOD One hundred forty-two outpatients with eating disorders (EDs) were enrolled. Perfectionism, emotion dysregulation, ED psychopathology, anxious and depressive symptoms were assessed. Correlation, mediation and 95% bias corrected and accelerated (BCa CI) bootstrapped analyses were run. RESULTS Emotion dysregulation was found to mediate the association between concern over mistakes perfectionism and restraint (indirect effect: 0.093, BCa CI: 0.001-0.02, adjusted R2 = 0.3324, p < 0.001), shape concern (indirect effect: 0.0130, BCa CI: 0.004-0.03, adjusted R2 = p < 0.001) and weight concern (indirect effect: 0.0142, BCa CI: 0.004-0.03, adjusted R2 = 0.2986, p < 0.001). CONCLUSION Among ED outpatients, emotion dysregulation may be involved in the association between concern over mistakes perfectionism and persistence of eating psychopathology symptoms. Emotion dysregulation could be considered as possible therapeutic target to reduce the persistence, and severity, of eating psychopathology symptoms among ED patients with concern over mistakes perfectionism.
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Affiliation(s)
- G Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - S Sassaroli
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
- Eating Disorders Unit, Italian Psychotherapy Clinics, Milan, Italy
| | - G M Ruggiero
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - G Caselli
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
| | - R Nocita
- Eating Disorders Unit, Italian Psychotherapy Clinics, Milan, Italy
| | - M M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - S Palmieri
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Psychotherapy School and Research Center, Studi Cognitivi, Milan, Italy
- Eating Disorders Unit, Italian Psychotherapy Clinics, Milan, Italy
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Kroener J, Eickholt ML, Sosic-Vasic Z. Group based metacognitive therapy for alcohol use disorder: a pilot study. Front Psychiatry 2024; 15:1375960. [PMID: 39015882 PMCID: PMC11249785 DOI: 10.3389/fpsyt.2024.1375960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/12/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Alcohol use disorder (AUD) is a severe clinical disorder, which has been associated with 5.3% of death worldwide. Although several treatments have been developed to improve AUD symptomatology, treatment effects were moderate, with a certain amount of patients displaying symptom deterioration after treatment termination. Moreover, outpatient treatment placements become increasingly scarce, thus necessitating more efficient treatment options. Therefore, the aim of the present study was to investigate the efficacy, feasibility, and acceptability of a newly invented, short, group based metacognitive therapy (MCT) for patients diagnosed with AUD. Method Seven patients were treated with eight sessions of group based MCT using a single case series design with an A-B replication across patients. Patients were assessed one month and one week before treatment, as well as one week and three months after treatment termination. Results Patients improved significantly and with large effect sizes regarding dysfunctional metacognitive beliefs, desire thinking/craving and depressive symptoms up to three months after treatment termination. AUD symptomatology as well as positive and negative metacognitive beliefs improved at post-treatment, but improvements could not be maintained at follow-up. All included patients completed the treatment and were highly satisfied. Conclusion The presented findings show preliminary evidence for the efficacy, feasibility, and acceptability of the implemented group based MCT treatment. Large scale randomized controlled trials (RCTs) are needed to confirm the effectiveness of the developed program for patients diagnosed with AUD.
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Goeppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Maja Lara Eickholt
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Goeppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Goeppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
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Van Bogart K, Harrington EE, Witzel DD, Kang JE, Sliwinski MJ, Engeland CG, Graham-Engeland JE. Momentary loneliness and intrusive thoughts among older adults: the interactive roles of mild cognitive impairment and marital status. Aging Ment Health 2024:1-8. [PMID: 38907581 DOI: 10.1080/13607863.2024.2368643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES Loneliness is associated with maladaptive cognitions, yet little is known about the association between loneliness and intrusive thinking during older adulthood. Links between loneliness and intrusive thoughts may be particularly strong among individuals with mild cognitive impairment (MCI), who may have greater difficulty regulating emotion and intrusive thoughts. In contrast, having close relationships (e.g. being married) may serve as a protective factor as marital status is associated with better overall well-being. METHOD Participants were 316 older adults (recruited from the Bronx, NY, as part of a larger study) without dementia at study intake (40% Black; 13% Hispanic, Mage = 77.45 years, 67% women) who completed ecological momentary assessments five times daily for 14 consecutive days (13,957 EMAs total). Multilevel modeling was used to examine the association between momentary loneliness and intrusive thoughts and whether MCI and marital status interacted to moderate this association. RESULTS There was a significant three-way interaction (β = -0.17, p < 0.05), such that lagged momentary loneliness was positively associated with intrusive thoughts (3-4 h later) for those with MCI who were not married. CONCLUSION Findings suggest that among older adults with MCI, being married may be a protective factor and being unmarried may be a risk factor for experiencing loneliness and subsequent intrusive thoughts.
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Affiliation(s)
- Karina Van Bogart
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | | | - Dakota D Witzel
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Jee Eun Kang
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Martin J Sliwinski
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Christopher G Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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Coutinho BDMC, Pariz CG, Krahe TE, Mograbi DC. Are you how you eat? Aspects of self-awareness in eating disorders. PERSONALITY NEUROSCIENCE 2024; 7:e9. [PMID: 38826820 PMCID: PMC11140494 DOI: 10.1017/pen.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/15/2024] [Accepted: 04/13/2024] [Indexed: 06/04/2024]
Abstract
Eating disorders (ED) are severe psychiatric disorders characterized by dysfunctional behaviors related to eating or weight control, with profound impacts on health, quality of life, and the financial burden of affected individuals and society at large. Given that these disorders involve disturbances in self-perception, it is crucial to comprehend the role of self-awareness in their prevalence and maintenance. This literature review presents different self-awareness processes, discussing their functioning across different levels of complexity. By deconstructing this concept, we can gain a better understanding of how each facet of self and personality relates to the symptoms of these disorders. Understanding the absence or impairment of self-awareness in ED holds significant implications for diagnosis, treatment, and overall management. By recognizing and comprehending the characteristics of self-awareness, clinicians can develop tailored interventions and evidence-based treatments for individuals with ED. Furthermore, this narrative review underscores the importance of considering temperament and personality factors in the context of ED, as temperament traits and personality characteristics may interact with self-awareness processes, influencing the development and maintenance of ED. Ultimately, the results highlight the pressing need for further research on the development of effective interventions and support strategies grounded in the aspects of self-awareness mechanisms for individuals affected by these disorders.
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Affiliation(s)
- Bruna de Moura Cortes Coutinho
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro. Rua Marquês de São Vicente 225 Gávea, Rio de Janeiro, RJ CEP 22451-900, Brazil
| | - Caio Gomes Pariz
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro. Rua Marquês de São Vicente 225 Gávea, Rio de Janeiro, RJ CEP 22451-900, Brazil
| | - Thomas E. Krahe
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro. Rua Marquês de São Vicente 225 Gávea, Rio de Janeiro, RJ CEP 22451-900, Brazil
| | - Daniel C. Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro. Rua Marquês de São Vicente 225 Gávea, Rio de Janeiro, RJ CEP 22451-900, Brazil
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, Psychology & Neuroscience, KCL, PO Box 078, De Crespigny Park, SE5 8AF, London, UK
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Neshat Z, Farah Bijari A, Dehshiri G. The relationship between perfectionism and interpersonal sensitivity with self-compassion in university students: the mediation of repetitive negative thinking. Cogn Process 2024; 25:107-120. [PMID: 37803210 DOI: 10.1007/s10339-023-01163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
Self-compassion is a construct of positive psychology related to personality and cognitive factors. Perfectionism and interpersonal sensitivity are prevalent personality traits among university students and are associated with low self-compassion. Further research is required to comprehend how these mechanisms work in creating self-compassion. Consequently, the current study investigated the direct and indirect relationship between perfectionism and interpersonal sensitivity with self-compassion via repetitive negative thinking. To this end, a sample of 450 students studying in Tehran during the 2022 academic year was selected as the study sample. The results indicated that perfectionism and interpersonal sensitivity demonstrate a negative direct relationship with self-compassion, while perfectionism and interpersonal sensitivity exhibit an indirect relationship with self-compassion via repetitive negative thinking. Based on the findings, it can be concluded that the relationship between perfectionism and interpersonal sensitivity with self-compassion is not straightforward and that repetitive negative thinking can mediate this relationship. The results can be used to improve methods for increasing self-compassion and paying attention to personality, and cognitive factors can be an important step toward more effective self-compassion interventions.
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Affiliation(s)
- Zahra Neshat
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran.
| | - Azam Farah Bijari
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Gholamreza Dehshiri
- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
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Pozzato I, Tran Y, Gopinath B, Cameron ID, Craig A. The importance of self-regulation and mental health for effective recovery after traffic injuries: A comprehensive network analysis approach. J Psychosom Res 2024; 177:111560. [PMID: 38118203 DOI: 10.1016/j.jpsychores.2023.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Traffic injuries significantly impact people's psychological, physical and social wellbeing, and involve complex self-regulation responses. Psychological impacts are seldom recognized and addressed holistically. This study employs network analysis to investigate the interconnectedness between different dimensions that influence mental health vulnerability and recovery after traffic injuries. METHODS 120 adults with mild-to-moderate traffic injuries and 112 non-injured controls were recruited. The network investigation employed two main approaches. Four cross-sectional networks examined the interrelationships between self-regulation responses (cognitive and autonomic) and various health dimensions (psychological, physical, social) over time (1, 3, 6, 12 months). Three predictive networks explored influences of acute self-regulation responses (1 month) on long-term outcomes. Network analyses focused on between-group differences in overall connectivity and centrality measures (nodal strength). RESULTS An overall measure of psychological wellbeing consistently emerged as the most central (strongest) node in both groups' networks. Injured individuals showed higher overall connectivity and differences in the centrality of self-regulation nodes compared to controls, at 1-month and 12-months post-injury. These patterns were similarly observed in the predictive networks, including differences in cognitive and autonomic self-regulation influences. CONCLUSIONS Network analyses highlighted the crucial role of psychological health and self-regulation, in promoting optimal wellbeing and effective recovery. Post-traffic injury, increased connectivity indicated prolonged vulnerability for at least a year, underscoring the need of ongoing support beyond the initial improvements. A comprehensive approach that prioritizes psychological health and self-regulation through psychologically informed services, early psychological screening, and interventions promoting cognitive and autonomic self-regulation is crucial for mitigating morbidity and facilitating recovery. TRIAL REGISTRATION IMPRINT study, ACTRN 12616001445460.
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Affiliation(s)
- Ilaria Pozzato
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Yvonne Tran
- Macquarie University, Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Australia
| | - Bamini Gopinath
- Macquarie University, Hearing Research Centre, Faculty of Medicine, Health and Human Sciences, Australia
| | - Ian D Cameron
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ashley Craig
- John Walsh Centre Rehabilitation Research, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Mansueto G, Jarach A, Caselli G, Ruggiero GM, Sassaroli S, Nikčević A, Spada MM, Palmieri S. A systematic review of the relationship between generic and specific metacognitive beliefs and emotion dysregulation: A metacognitive model of emotion dysregulation. Clin Psychol Psychother 2024; 31:e2961. [PMID: 38357852 DOI: 10.1002/cpp.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Although a probable association between metacognitive beliefs (also termed 'metacognitions') and emotion dysregulation has been suggested in the literature, the evidence is still sparse and inconclusive. The current study aims to present a comprehensive evaluation of the literature examining the association between metacognitive beliefs and emotion dysregulation. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'metacognitions/metacognitive beliefs/positive metacognitive beliefs/negative metacognitive beliefs/cognitive self-consciousness/beliefs about the need to control thoughts/cognitive confidence/negative beliefs about thoughts concerning uncontrollability and danger/AND difficulties emotion regulation/emotion dysregulation'. A total of 19 studies met the inclusion criteria. In both non-clinical and clinical populations, a higher endorsement of dysfunctional metacognitive beliefs was found to be associated with emotion dysregulation and vice versa. A higher endorsement of metacognitive beliefs may be associated, either directly or via maladaptive forms of mental control (e.g., worry, rumination and suppression) to emotion dysregulation. Metacognitive beliefs could be the potential therapeutic target in clinical interventions aimed at reducing emotion regulation difficulties.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
- School of Applied Sciences, London South Bank University, London, UK
| | | | - Gabriele Caselli
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - Giovanni Maria Ruggiero
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - Sandra Sassaroli
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - Ana Nikčević
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, London, UK
| | | | - Sara Palmieri
- School of Applied Sciences, London South Bank University, London, UK
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Cognitive Studies, Cognitive Psychotherapy School and Research Center, Milan, Italy
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Belmans E, De Vuyst HJ, Takano K, Raes F. Reducing the stickiness of negative memory retrieval through positive memory training in adolescents. J Behav Ther Exp Psychiatry 2023; 81:101881. [PMID: 37348168 DOI: 10.1016/j.jbtep.2023.101881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals at risk for depression exhibit a decreased ability to disengage from negative memory retrieval during times of mental distress, partly because they have difficulty retrieving positive memories to repair sad mood. In this study, we tested whether this persistent tendency for negative memory retrieval could be reduced in adolescents through repeated practice to retrieve positive autobiographical memories, namely Positive Memory Specificity Training (PMST). Further, we examined the impact of this intervention on secondary outcomes, including depressive symptoms, emotion regulation strategies, and fear of positive emotions. METHODS Adolescents (n = 68) between 16 and 18 years old were randomly allocated to either PMST or bogus control training. Persistent negative memory retrieval was assessed following the training using a behavioral decision-making task (Emotional Reversal Learning Task). Additionally, participants completed self-report measurements (e.g., depressive symptoms) before and two weeks after the training. RESULTS We found preliminary supportive evidence for a significant training effect such that adolescents following PMST showed less persistence in negative memory retrieval compared to those in the control group. Only for anhedonia a significant training effect was found, indicating a possible adverse effect of the intervention. LIMITATIONS The primary outcome was assessed only at post-intervention to prevent a potential learning effect due to repeated measurements. We cannot exclude the possibility that baseline individual differences contaminated our results. To examine possible adverse effects of PMST, larger sample are needed. CONCLUSIONS PMST may help to reduce persistent negative memory retrieval in adolescents. Recommendations for future studies are addressed.
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Affiliation(s)
- Eline Belmans
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Child & Youth Institute, KU Leuven, Leuven, Belgium.
| | - Hendrik-Jan De Vuyst
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Neuromodulation Laboratory, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Leuven 3001, Belgium.
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Leopoldstraße 13, Munich, Germany; Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8560, Japan.
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Child & Youth Institute, KU Leuven, Leuven, Belgium.
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Palmieri S, Mansueto G, Marchant AP, Sassaroli S, Caselli G, Ruggiero GM, Spada MM. The Metacognitions about Binge Eating Questionnaire: Investigation of the association between specific metacognitions and Binge Eating Disorder. Clin Psychol Psychother 2023; 30:780-794. [PMID: 36754777 DOI: 10.1002/cpp.2839] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
Literature suggested that metacognitions are involved in eating problems and may be relevant to the understanding of Binge Eating Disorder (BED). The goal of the current studies was to develop the first self-report instrument on metacognitions about binge eating. In Study 1, a community sample completed the Metacognitions about Binge Eating Questionnaire (MBEQ); an Exploratory Factor Analysis (EFA) was performed. In study 2, a community sample completed the MBEQ and measures assessing severity of binge eating, irrational food beliefs, anxiety, depression, impulsiveness. A Confirmatory Factor Analysis (CFA) was performed. Concurrent and incremental validity were assessed. In study 3, a clinical sample of participants with a diagnosis of BED completed the MBEQ and other measures. Bivariate correlational analysis and hierarchical linear regression were performed. Participants from the general population and participants with a diagnosis of BED were compared. EFA and CFA supported a two-factor solution consisting of positive and negative metacognitions about binge eating. Concurrent and incremental validity were acceptable. The metacognitions factors correlated positively with anxiety, depression, irrational food beliefs, impulsiveness in the community sample, and anxiety, irrational food beliefs, impulsiveness in clinical sample. The metacognitions factors contributed to the prediction of BEDs symptoms, in community and clinical samples, over and above age, gender, impulsiveness, anxiety, depression, irrational food beliefs. The MBEQ possesses good psychometric properties and appears a reliable and valid measure of positive and negative metacognitions about binge eating. Metacognitions about binge eating could be a therapeutic target to reduce the severity of binge eating episodes.
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Affiliation(s)
- S Palmieri
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - G Mansueto
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - A P Marchant
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - S Sassaroli
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - G Caselli
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - G M Ruggiero
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
| | - M M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
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Zhang MX, Yu SM, Demetrovics Z, Wu AMS. Metacognitive beliefs and anxiety symptoms could serve as mediators between fear of missing out and gaming disorder in adolescents. Addict Behav 2023; 145:107775. [PMID: 37336094 DOI: 10.1016/j.addbeh.2023.107775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
Given the vulnerability to and prevalence of emotional problems and Internet gaming disorder (IGD) in adolescents, this study aimed to test the effects of fear of missing out (FoMO) on IGD and the mediating roles of metacognitive beliefs and anxiety symptoms based on the self-regulatory executive function (S-REF) model. At a Chinese high school, 283 participants (Mage = 16.89 years old; girls = 42.0%) with past-year gaming experience voluntarily completed an anonymous paper-and-pencil questionnaire. FoMO showed significant, positive associations with IGD, anxiety symptoms, and metacognitive beliefs. Results of path analysis showed a significant direct effect of FoMO on IGD, whereas anxiety symptoms mediated the relationship between FoMO and IGD. The indirect effects of FoMO on IGD via serial mediations of three negative metacognitive beliefs (i.e., negative beliefs about worry, low cognitive confidence, and beliefs regarding need for control) and anxiety symptoms were also statistically significant. These findings demonstrated that maladaptive metacognitive beliefs and anxiety are risk-enhancing mediators in the relationship between FoMO and IGD. Therefore, metacognitive therapy, particularly for regulating those three specific significant metacognitive beliefs, is recommended for treating IGD and anxiety, especially for those with higher levels of FoMO.
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Affiliation(s)
- Meng Xuan Zhang
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, Jiangsu, China; Psychological Research & Education Center, School of Humanities, Southeast University, Nanjing, Jiangsu, China
| | - Shu M Yu
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Anise M S Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.
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Efrati Y, Spada MM. "I have no control over how much time I play" the metacognitions about online gaming scale: Evidence from a cross-cultural validation among Israeli adolescents. Addict Behav 2023; 141:107638. [PMID: 36746106 DOI: 10.1016/j.addbeh.2023.107638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
In the current study we evaluated the psychometric properties of the Metacognitions about Online Gaming Scale (MOGS), including its factor structure, reliability, and predictive validity among Israeli adolescents in a six-month prospective study. We also examined the usefulness of the MOGS as a mediator of the effect of attachment patterns on Internet Gaming Disorder (IGD), the preference for online social interactions, and the motives for online gaming. The study population included 1,056 Israeli adolescents (610 males and 446 females, M = 15.77, standard deviation (SD) = 1.43) with an age range of 13-18 years. The participants completed the translated Hebrew version of the MOGS and measures on attachment style, IGD, preference for online social interactions, emotion regulation, and motives for online gaming. The analyses indicated that the factorial structure of the Hebrew MOGS comprised the expected two factors at T1 and T2 (a six-month follow-up). We also found that positive and negative metacognitions significantly mediated the effect of attachment styles on IGD, the preference for online social interactions, and the motives for online gaming. The findings provide evidence that the Hebrew MOGS among Israeli adolescents appears psychometrically appropriate for use by researchers and practitioners dealing with the prevention and treatment of IGD.
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Affiliation(s)
- Yaniv Efrati
- Bar-Ilan University, Faculty of Education, Ramat Gan, Israel.
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Impact of Metacognition on Health-Related Behavior: A Mediation Model Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2023; 2023:6547804. [PMID: 36761241 PMCID: PMC9904901 DOI: 10.1155/2023/6547804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/16/2022] [Accepted: 10/22/2022] [Indexed: 02/03/2023]
Abstract
Objective The study aims to explore the correlation mechanism among metacognition, attitude toward physical exercise, and health-related behavior in high school students. Methods A total of 869 students (17 ± 1.70) from Anhui, Zhejiang, Shandong, and Fujian provinces were selected by stratified sampling to complete the Metacognition Questionnaire, Health-Related Behavior Self-Rating Scale, Attitude Toward Physical Exercise Scale, and Depression-Anxiety-Stress Scale (Simplified Chinese version, DASS-21). Results (1) Metacognition was negatively predictive of attitude toward physical exercise and health-related behavior (β = -0.236, P < 0.01; β = -0.239, P < 0.01) but positively predictive of negative emotion (β = 0.496, P < 0.01); (2) attitude toward physical exercise was positively predictive of health-related behavior (β = 0.533, P < 0.01) but negatively predictive of negative emotion (β = -0.336, P < 0.01); and (3) negative emotion was negatively predictive of health-related behavior (β = -0.389, P < 0.01). Conclusions Metacognition not only has a directly predictive effect on health-related behavior but also predicts it through attitude toward physical exercise. Negative emotion also mediates the relationship between metacognition and attitude toward physical exercise.
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Effect of a Nursing Comprehensive Skill Training Course (NCST-C) on Nursing Students' Metacognitive Awareness: A Quasi-experimental Study. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:275-281. [PMID: 36332792 DOI: 10.1016/j.anr.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE This study explored the effect of a nursing comprehensive skill training course (NCST-C) on the metacognitive awareness of nursing students to provide a scientific foundation for improving metacognitive awareness. METHODS This study used a quasi-experimental two-group matched pretest, post-test, and follow-up test. Ninety-six junior nursing students were recruited using convenience sampling and assigned to two groups by drawing lots with odd and even numbers in a nursing school at Huzhou University. The control group received a traditional skill-training course. The intervention group received NCST-C. Nursing students' metacognitive awareness inventory (MAI) was evaluated at the baseline, 16-week, and 20-week follow-up points. A repeated-measures analysis of variance and a simple effect test was used to compare each outcome measure of the two groups three times. RESULTS The NCST-C resulted in greater benefits for nursing students' metacognitive awareness as well as various dimensions (knowledge of cognition and regulation of cognition) in the intervention group. Combined with a simple effects test, the MAI and dimension scores of those in the intervention group significantly improved at 16 weeks after the baseline (F = 9.78-44.03; all ps < .01). The sustainable effect of NCST-C lasted 1 month after the intervention (F = 14.24-62.36; ps < .01), reaching statistical significance (p < .05). CONCLUSIONS The NCST-C effectively developed metacognitive awareness among nursing students. Its design provides a new type of experimental course for improving metacognitive awareness. TRIAL REGISTRATION chictr.org.cn: ChiCTR2200057910. First registration date: 1/11/2020.
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Noda S, Masaki M, Kishimoto T, Kaiya H. Effect of rejection sensitivity on the development of anxious-depressive attack in Japanese outpatients: The mediating roles of rumination, social anxiety, and depressive symptoms. Front Psychol 2022; 13:1016879. [PMID: 36532964 PMCID: PMC9749812 DOI: 10.3389/fpsyg.2022.1016879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE Anxious-depressive attack (ADA) is a cluster of symptoms, including sudden and intense anxiety or depression, intrusive rumination about negative memories or future worries, prominent agitation, impatient behavior, and/or loneliness; in some cases, symptoms include a wide range of violent coping behaviors to manage emotional distress. Four characteristics-rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms-are thought to be associated with the development of ADA. However, the complex relationships among these factors have not been clarified. In this study, we aimed to examine the mechanism by which these four characteristics influence the development of ADA. METHODS We conducted a structured interview about ADA with 332 outpatients, who completed several self-report measures, to assess rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms. RESULTS A structural equation model showed goodness-of-fit with the data. These findings suggest that rejection sensitivity may demonstrate a direct effect on the occurrence of ADA. Furthermore, rejection sensitivity might affect depressive symptoms through rumination and social anxiety symptoms and consequently contribute to the development of ADA. CONCLUSION These results provide preliminary evidence that rejection sensitivity contributes to the development of ADA.
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Affiliation(s)
- Shota Noda
- Panic Disorder Research Center, Warakukai Medical Corporation, Tokyo, Japan
- Tokyo Mindfulness Center, Tokyo, Japan
| | - Mina Masaki
- Nagoya Mental Clinic, Warakukai Medical Corporation, Aichi, Japan
| | | | - Hisanobu Kaiya
- Panic Disorder Research Center, Warakukai Medical Corporation, Tokyo, Japan
- Tokyo Mindfulness Center, Tokyo, Japan
- Nagoya Mental Clinic, Warakukai Medical Corporation, Aichi, Japan
- Department of Psychiatry, Kyoto Prefectural University of Medicine, Kyoto, Japan
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