How do people with social anxiety disorder manage daily stressors? Deconstructing emotion regulation flexibility in daily life

Adverse Childhood Experiences and Symptom Severity in Social Anxiety Disorder: The Role of Emotion Regulation

In this study, the relationship was examined of adverse childhood experiences (ACEs) with difficulties in emotion regulation and symptom severity in individuals with social anxiety disorder (SAD). The study included 71 patients diagnosed with SAD and a healthy control group of 73 subjects. Data for all the participants were collected using a sociodemographic data form, the Liebowitz Social Anxiety Scale, the Adverse Childhood Experiences-Turkish Form scale, and the Difficulties in Emotion Regulation Scale-16. The study results showed a higher probability of ACEs and difficulties in emotion regulation in the SAD group than in the control group. The difficulties in emotion regulation in the SAD group were correlated with symptom severity and these difficulties were found to play a mediating role between trauma and symptom severity. It was emphasized that emotion regulation skills were an important factor in the treatment of SAD patients. It can be suggested that therapies and interventions to develop emotion regulation skills could be effective in the management of SAD symptoms. It was thus concluded that ACEs and difficulties in emotion regulation are associated with SAD symptoms and should be taken into consideration in treatment. This study emphasizes the importance of emotion regulation skills for SAD treatment and can be considered to be of guidance for future studies.

Daily stress and emotions in relation to fear of negative and positive evaluation

Fear of negative (FNE) and positive (FPE) evaluation constitute distinct components of social anxiety and relate to altered affectivity. It is unclear whether individuals with strong FNE/FPE overreact to social stressors only or to more unspecific ones as well. The present set of three studies (n = 109 and n = 97 healthy individuals in study 1/2, n = 49 patients with social anxiety disorder in study 3) assessed whether reactivity to various daily stressors and non-specific momentary stress/emotions assessed through ecological momentary assessment depend on individuals' level of FPE/FNE. Almost all relationships with FPE/FNE were explained by depressive symptoms, except for a unique association of FNE with reactivity to stressors from the distant social network. Relationships of FNE with momentary global stress and emotions were mixed, but again explained by depressive symptoms. More depressive symptoms were associated with higher stress, negative affect, and most stressor types as well as lower positive affect in all studies. These results show that for social stressors from the distant social network, FNE has explanatory power. They further document the role of depressive affect for reactivity to a wide range of everyday stressors and question the need for specific instruments assessing FPE/FNE unless stressors are explicitly social-evaluative in nature.

Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review

BACKGROUND

There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet.

OBJECTIVE

This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science.

RESULTS

A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics.

CONCLUSIONS

AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

Interactions among stress, behavioral inhibition, and delta-beta coupling predict adolescent anxiety during the COVID-19 pandemic

The COVID-19 pandemic brought about unprecedented changes and uncertainty to the daily lives of youth. The range of adjustment in light of a near-universal experience of COVID restrictions highlights the importance of identifying factors that may render some individuals more susceptible to heightened levels of anxiety during stressful life events than others. Two risk factors to consider are temperamental behavioral inhibition (BI) and difficulties in emotion regulation (ER). As such, the current paper focused on BI examined prior to COVID, because of its developmental link to anxiety and ER, as difficulties may be associated with differences in anxiety. We examined a neurocognitive marker of ER processes, delta-beta coupling (DBC). The current paper had two goals: (1) to examine BI in relation to COVID-related worry and social anxiety experienced during the pandemic, and (2) to explore the role of individual differences in early DBC in the relationship between BI and anxiety outcomes 6 months apart during COVID-19 (n = 86; T1 Mage  = 15.95, SD = 1.73; T6 Mage  = 16.43, SD = 1.73). We found support for the moderating role of DBC in the relationship between BI levels and social anxiety disorder (SAD) symptom severity during the pandemic. Here, high BI was predictive of increased SAD symptom levels in adolescents with stronger DBC.

Social anxiety and emotion regulation flexibility: a daily diary approach

Previous research suggests that social anxiety symptoms are maintained and intensified by inflexible emotion regulation (ER). Therefore, we examined whether trait-level social anxiety moderates ER flexibility operationalised at both between-person (covariation between variability in emotional intensity and variability in strategy use across occasions) and within-person (associations between emotional intensity and strategy use on a given day) levels. In a sample of healthy college-aged adults (N = 185, Mage = 21.89), we examined overall and emotion-specific intensities (shame, guilt, anxiety, anger, sadness) and regulatory strategies (i.e. experiential avoidance, expressive suppression, and rumination) in response to each day's most emotionally intense event over 6 days. During the study period, we found a positive association between variability in emotional intensity and variability of experiential avoidance in individuals with lower, rather than higher, levels of trait social anxiety after controlling for key covariates (i.e. gender, personality traits, and stress exposure). However, we did not find evidence for the moderating role of trait social anxiety in ER flexibility assessed at within-person levels. Our findings highlight the need to delineate dynamic ER flexibility across everyday events.

Emotion regulation in daily life in early psychosis: The role of contextual appraisals

BACKGROUND

Little is known about whether and how contextual appraisals relate to emotion regulation (ER) strategy use across the ultra-high risk and first episode stages of psychosis. The present study extends previous research by investigating the extent to which different appraisal dimensions of the most negative and positive events of the day are associated with ER strategy use in individuals with ultra-high risk (UHR) and first-episode psychosis (FEP).

METHOD

Sixty-eight UHR individuals and fifty-five FEP individuals filled out an experience sampling evening questionnaire for six consecutive days, in which their appraisal of intensity, importance and perceived control concerning the most negative or positive event of the day, and the ER strategies they deploy in response to these events were measured.

RESULTS

Multilevel mixed effect models showed that intensity appraisal was most closely associated with ER strategy use, as opposed to importance and controllability appraisals. Higher intense negative events were associated with more rumination and social sharing, while less intense negative events were associated with more reappraisal. Higher intense positive events were associated with a greater number of deployed strategies and more efforts in using savoring, expression and social sharing. The UHR and FEP individuals did not significantly differ regarding effects of above-mentioned appraisal dimensions on ER.

CONCLUSIONS

These results provide evidence supporting ER flexibility in early psychosis, and event intensity emerged as the dimension most strongly associated with ER. Future research should better account for other situational factors (such as social context) that might affect ER use in psychosis.

Reconceptualizing emotion regulation and coping strategy usage in eating disorders research: The utility of a regulatory flexibility framework

Emotion regulation and coping strategies are often conceptualized in eating disorder (ED) research as inherently adaptive or maladaptive, and successful regulation is often defined as greater overall use of adaptive strategies. However, recent empirical work outside of the field of EDs challenges this categorical conceptualization of strategies, demonstrating that adaptiveness is determined by the ability to flexibly implement and adjust strategies based on contextual demands (i.e., regulatory flexibility). Despite evidence that emotion regulation and coping strategies are best conceptualized in terms of flexibility in the broader literature, few ED studies have adopted this model. We review the current conceptual framework of emotion regulation and coping strategies used in ED research and present regulatory flexibility as an alternative approach to conceptualizing these strategies. The lack of research on regulatory flexibility among individuals with EDs limits our understanding of the role of emotion regulation and coping difficulties in ED risk and maintenance. Adopting a regulatory flexibility model of strategies in EDs may extend knowledge of the role of emotion regulation difficulties in the development and maintenance of EDs. We highlight the potential utility of investigating regulatory flexibility and present recommendations for future research on regulatory flexibility in EDs. PUBLIC SIGNIFICANCE STATEMENT: Research on emotion regulation and coping strategy usage in eating disorders often view regulatory strategies as inherently adaptive or maladaptive. However, recent studies support defining strategies in terms of flexibility. Adopting a regulatory flexibility model of strategies in eating disorders research may advance knowledge of the role of emotion regulation difficulties in the development and maintenance of eating disorders, ultimately enhancing prevention and treatment efforts.

State and Trait Emotion Regulation Diversity in Social Anxiety

Emotion regulation (ER) diversity, defined as the variety, frequency, and evenness of ER strategies used, may predict social anxiety (SA) severity. In a sample of individuals with high (n=113) or low (n=42) SA severity, we tested whether four trait ER diversity metrics predicted group membership. We generalized existing trait ER diversity calculations to repeated-measures data to test if state-level metrics (using two weeks of EMA data) predicted SA severity within the higher severity group. As hypothesized (osf.io/xadyp), higher trait ER diversity within avoidance-oriented strategies predicted greater likelihood of belonging to the higher severity group. At the state-level, higher diversity across all ER strategies, and within and between avoidance- and approach-oriented strategies, predicted higher SA severity (but only after controlling for number of submitted EMAs). Only diversity within avoidance-oriented strategies was significantly correlated across trait and state levels. Findings suggest that high avoidance-oriented ER diversity may co-occur with higher SA severity.

Emotions in social anxiety disorder: A review

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed.

Interoceptive attention facilitates emotion regulation strategy use

Background

Method

Results

Conclusions

Moment-to-Moment Interplay Among Stress Appraisals and Emotion Regulation Flexibility in Daily Life

Flexible use of emotion regulation (ER) strategies in daily life is theorized to depend on appraisals of occurring stressful events. Yet, to date, little is known about (a) how appraisals of the current situation modulate the use of ER strategies in daily life and (b) how individual differences in affective symptoms impact these relations among appraisals and ER strategy use. This study attempted to address these two limitations using a 5-day experience sampling protocol, with three surveys administered per day in a sample of 97 participants. Each survey measured momentary appraisals of stress intensity and controllability as well as ER strategy use (i.e., rumination, reappraisal, avoidance, and active coping). Results showed that, in situations of low-stress intensity, higher stress controllability was related to greater use of reappraisal and rumination. In situations of high-stress intensity, higher controllability was related to reduced use of rumination. This pattern of flexible use of ER strategies depending on momentary stress appraisals was found for both rumination and avoidance and occurred specifically in individuals reporting lower levels of depression and/or anxiety levels. These findings provide new insight into how flexible use of ER strategies in daily life is modulated by interactions between stress intensity and controllability appraisals at varying levels of affective symptoms.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42761-022-00122-9.

The Association of Emotion Regulation Flexibility and Negative and Positive Affect in Daily Life

In contrast to traditional classifications of emotion regulation (ER) strategies as either uniformly maladaptive or adaptive, recent theoretical models emphasize that adaptability is determined by greater ER flexibility (i.e., the ability to flexibly implement and adjust ER strategies based on the context). This study is the first to empirically test the two central perspectives of ER flexibility on affect. A sample of 384 adults (M age=38.58 years, SD=13.82) residing predominantly in North America completed daily diaries for 14 days. We found evidence that theoretical components of ER flexibility, as defined by greater context sensitivity in the selection of ER strategies, greater ER strategy repertoire, enhanced responsivity to affective feedback, and ER-environmental covariation, were associated with adaptive affective outcomes (i.e., reduced negative affect and/or increased positive affect). This study highlights the importance of examining ER flexibility and its consequences as a critical component of ER.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00132-7.

Cognitive risk factors and the experience of acute anxiety following social stressors: An ecological momentary assessment study

To better understand how social anxiety develops, it is crucial to identify mechanisms that influence anxiety following social stressors. Anxiety sensitivity social concerns (ASSC; fear of publicly observable anxiety symptoms) and fear of negative evaluation (FNE; distress arising from concerns about negative judgment) are constructs that amplify anxiety following social stressors. However, it is unclear how ASSC and FNE influence acute anxiety following stressors in naturalistic settings. In the current study, the impact of ASSC and FNE on anxious arousal and anxious apprehension following stressors was examined in community adults (N = 83; M age = 29.66 years, SD = 12.49, 59.0% female) who completed questionnaires five times per day for two-weeks. Dynamic structural equation modeling was used to examine predictors of overall levels of anxiety as well as anxiety following social and nonsocial stressors. ASSC interacted with the presence of social stressors, such that ASSC positively predicted anxious arousal following social stressors. FNE interacted with the presence of nonsocial stressors to predict both forms of anxiety, such that FNE positively predicted anxiety following nonsocial stressors. These findings suggest ASSC may specifically amplify anxious arousal following social stressors, whereas FNE may broadly amplify anxiety following nonsocial stressors.