Anxiety sensitivity and affect regulatory strategies: individual and interactive risk factors for anxiety-related symptoms

Find your rhythm and regulate: Breath-synced vibration feedback during breath-focused mindfulness reduces respiration variability in trauma-exposed adults

Stress and anxiety are associated with increased autonomic arousal, including altered respiration. Breath-focused mindfulness meditation can reduce stress and anxiety, but trauma-exposed adults with dissociation have difficulty engaging in this practice. Our ongoing clinical trial examines if vibration-augmented breath-focused mindfulness (VABF) can improve outcomes and increase engagement. Here, we tested if VABF reduces respiration rate (RR) or respiration variability (RV), and examined associations between RR, RV, and emotion ratings. 128 trauma-exposed adults (mean age = 30.21 years) with elevated dissociation volunteered and completed at least 50 % of intervention visits. Participants were randomized to one of four mindfulness meditation interventions: VABF (n = 34); breath-focus only (n = 33); vibration only (n = 34); open awareness (no vibration or breath-focus, n = 27). Results from linear mixed-effects models showed that VABF decreased RV across visits while all the other interventions showed increased RV across visits (p = .008; ηp2 = .014), and RV was positively associated with both anxiety and anger ratings (ps < .001; rs > .125). Findings suggest RV is a meaningful metric for examining regulatory processes in clinical populations with elevated autonomic arousal and negative emotionality. They also show that RV is modifiable through VABF, which holds significant promise as an intervention to improve regulatory processes in trauma-exposed populations.

"Warning-This Content May Trigger Temporary Discomfort, Which Is Expected and Manageable": The Effect of Modified Trigger-Warning Language on Reactions to Emotionally Provocative Content

A growing body of research suggests that trigger warnings do not actually reduce distress in those viewing emotionally provocative stimuli and may at times even worsen it. However, little is known regarding the potential benefits of modifying trigger-warning language so that it employs therapeutically consistent messaging to encourage adaptive coping. The current study explored whether a modified trigger warning might be more effective than a traditional trigger warning in reducing participants' negative affect (NA) when exposed to distressing content. University students (N = 606) participated in an online study and were randomly assigned to one of three conditions: traditional trigger warning, modified trigger warning, or a no-warning control group. NA was measured before and after display of two emotionally provocative stimuli (one article and one video). Anxiety sensitivity (AS) and posttraumatic stress symptoms (PTSS) were also measured to assess whether these preexisting individual vulnerabilities might moderate participants' responses to the different messages. Although the carefully pilot-tested stimuli were successful in increasing NA, there was no significant effect of trigger-warning condition, despite ample statistical power. AS and PTSS were associated with higher overall levels of NA but did not interact with study condition. These results add to the growing body of literature suggesting trigger warnings (whether traditional or modified) do not succeed in their goal of reducing the distress elicited by emotionally provocative content, including among vulnerable individuals. Alternative approaches to traditional trigger warnings are considered that may help individuals cope adaptively with potentially distressing material.

A transdiagnostic approach to investigate of the relationships between anxiety sensitivity and health anxiety: the mediated roles of distress tolerance and emotion regulation

Background

Emotion regulation (ER) and distress tolerance (DT) are considered transdiagnostic risk factors for a range of anxiety disorders. This study investigated the relationship between anxiety sensitivity (AS) and health anxiety (HA) in the general population, focusing on the mediating roles of DT and ER.

Methods

The study was conducted as a cross-sectional survey from October to December 2023 in Tehran Province, Iran. A total of 971 individuals participated in this study (52.8% female; mean age 39.04 years, SD=10.64). Participants completed self-report questionnaires to assess HA (The Short Health Anxiety Inventory), AS (The Anxiety Sensitivity Index-3), DT (The 15-item Distress Tolerance Scale) and ER (The 10-item Emotion Regulation Questionnaire). We used structural equation modeling (SEM) to examine the hypothesis that DT and ER would mediate the relationship between AS and the HA.

Results

AS was modestly related to all measures (r from -0.40 to 0.55). According to the SEM analysis, AS (β = 0.45, 95%CI [0.34, 0.56]) had a significant direct effect on HA. However, the analysis of the indirect effects revealed that both DT (β = 0.10, 95% CI [0.06, 0.16]) and emotion regulation strategies-cognitive reappraisal (β = 0.06, 95% CI [0.01, 0.11]) and expressive suppression (β = 0.11, 95% CI [0.06, 0.18])-act as partial mediators in the relationship between AS and HA.

Conclusions

AS plays a crucial role in predisposing individuals to HA. The mediating roles of DT and ER provide insight into the link between AS and HA. Nevertheless, the study's cross-sectional design and reliance on a non-clinical sample limit the applicability of the results. Further research involving different samples and intervention studies is needed to validate and expand upon these findings.

Fears of positive and negative evaluation and their within-person associations with emotion regulation in adolescence: A longitudinal analysis

Fear of positive evaluation (FPE) has recently emerged as an important aspect of social anxiety, alongside fear of negative evaluation. These evaluation fears peak during adolescence, a developmental stage that is also often accompanied by difficulties in emotion regulation, thereby increasing young individuals' vulnerability to mental disorders, such as social anxiety. We aimed to examine the longitudinal within-person associations between fears of evaluation, social anxiety, and three emotion regulation strategies (i.e., acceptance, suppression, rumination) in adolescents. Data were collected from a sample of 684 adolescents through an online survey three times over the course of 6 months and were analyzed using random intercept cross-lagged panel models. At the between-person level, FPE was linked to all three emotion regulation strategies, whereas fear of negative evaluation and social anxiety were associated with acceptance and rumination. At the within-person level, difficulties in accepting emotions predicted FPE, suppression predicted social anxiety, and social anxiety predicted rumination over time. These findings reveal complex interdependencies between emotion regulation, social anxiety, and evaluation fears, both reflecting individual differences and predicting changes within individuals, and further elucidate the developmental trajectory of social anxiety in adolescence.

Differential effects of mindfulness treatment and mobile neurofeedback on event-related potentials in early posterior negativity in cancer patients: a clinical-experimental parallel group design

Introduction

Cancer frequently leads to psychological challenges, among them emotion regulation problems. These can be alleviated with the help of mindfulness therapies or neurofeedback (NF) interventions. Possible intervention effects on emotion procession can be detected in clinical EEG studies by exploring event-related potentials, e.g., early posterior negativity (EPN), which recently has been established to investigate emotional processing and represents very early attention to affective stimuli. Therefore, this clinical-experimental study investigated the efficacy of mindfulness and NF (10 sessions each) on the EPN in oncology patients.

Method

The study enrolled 42 cancer patients (age: 31-73 years; gender: 28 female, 14 male). The study design was an RCT with a parallel group [NF (n = 21) versus mindfulness (n = 21)] waitlist paradigm. EEG recordings in an oddball task with neutral, rare positive and negative valence and high and low arousal stimuli were performed at three measurement time points (T0 = before waitlist, T1 = before intervention, T2 = after intervention). Following preprocessing, data from electrodes O1, Oz and O2 were analyzed for EPN amplitudes.

Results

Response time did not differ across groups and conditions. Comparing EPN at T1 and T2, there was a significant interaction of time, valence, and intervention (p = 0.042). Descriptive statistics showed increased EPN for negative stimuli after the NF intervention (T1 to T2), while EPN for positive stimuli only slightly increased. For mindfulness, positive stimuli evoked stronger amplitudes after the intervention, while EPN for negative stimuli increased from T1 to T2.

Conclusion

Distinct effects were observed for the EPN for pictures with negative valence. Here, it is presumed that mindfulness treatment led to a refocusing of attention with a focus on positive valence, whereas NF seems to entail a different processing of images with negative valence and is therefore to be seen more in the sense of a confrontational approach. Our results suggest that both interventions are suitable for modulating EPN. However, it is not clear to what extent the effects are due to the interventions alone and how other factors might have affected the amplitudes, which highlights the need for further research in this area.

Self-Critical Perfectionism and Anxious and Depressive Symptoms Over 2 Years: Moderated Mediation Models of Anxiety Sensitivity and Experiential Avoidance

This three-wave longitudinal study of 297 community adults (mean age = 38.66 years, 67% female) examined how anxiety sensitivity and experiential avoidance work together to explain the relation between perfectionism and anxious and depressive symptoms over 2 years. Participants completed measures of self-critical (SC) and personal standards (PS) higher-order dimensions of perfectionism, anxiety sensitivity, experiential avoidance, and anxious and depressive symptoms at Time 1. Participants completed measures of anxiety sensitivity, experiential avoidance, and symptoms again at Time 2 one year later, and symptoms measures again at Time 3 two years after baseline. Moderated mediation analyses showed that for those with higher Time 1 experiential avoidance, Time 1 SC perfectionism was indirectly related to Time 3 anxious arousal symptoms through Time 2 anxiety sensitivity. For those with moderate to higher Time 1 anxiety sensitivity, Time 1 SC perfectionism was indirectly associated with Time 3 general distress and anxious arousal symptoms through Time 2 experiential avoidance. These moderated mediation effects were not found for PS perfectionism. These results support anxiety sensitivity and experiential avoidance as moderating and mediating processes that may be important treatment targets for reducing vulnerability to anxious and depressive symptoms over the longer-term in SC perfectionistic individuals.

Insomnia Severity Predicts Psychiatric Symptoms: A Cross-Sectional Study Investigating the Partial Mediations of Worry and Rumination

OBJECTIVE

Insomnia as a disorder on its own or as a symptom of other mental disorders can lead to significant distress and lower quality of life. By exacerbating negative affect and emotion dysregulation, poor sleep and insomnia can contribute to the initiation and maintenance of mental disorders. The aim of this cross-sectional study was to investigate the relationship between insomnia severity and overall psychiatric symptoms (anxiety, depression, obsessive-compulsive symptoms, somatization, phobic anxiety, hostility, interpersonal sensitivity, paranoid ideation, and psychoticism), and the mediational roles of worry and rumination in this relationship.

METHOD

The data was collected from a community sample of 1444 participants (females 69.39%, Mage = 27.95, SD = 9.37) who completed self-report measures of insomnia severity, worry, rumination, and psychiatric symptoms. The mediational roles of worry and rumination were tested with mediation analysis using the PROCESS Macro.

RESULTS

It was found that insomnia severity (β = 0.20, p < .001) significantly predicted psychiatric symptoms directly and via worry and rumination (β = 0.33, p < .001), meaning that worry and rumination partially mediated the relationship between insomnia severity and psychiatric symptoms. The findings were similar after controlling for smoking status, daily screen time, coffee consumption in the evening, weekly exercise frequency, and pre-sleep screen time.

CONCLUSIONS

Interventions targeting the reduction of insomnia severity and maladaptive emotion regulation strategies (e.g., worry and rumination), as well as the enhancement of adaptive emotion regulation strategies (e.g., positive refocusing and mindfulness), may alleviate the adverse effects of insomnia on psychiatric symptoms.

Clarifying relations of emotion regulation, emotional avoidance and anxiety symptoms in a community-based treatment-seeking sample

OBJECTIVES

Anxiety is a global problem that is readily treatable with psychosocial interventions, though many individuals do not benefit following participation in extant treatment protocols. Accordingly, clarification of process-related variables that may be leveraged to enhance outcomes appears warranted. Emotion regulation (ER) is a robust correlate of anxiety symptoms and is often targeted in behavioural treatments applied to anxiety-related problems. Yet, some evidence suggests ER difficulties may be a proxy variable for emotional avoidance (EA). Clarifying the relative influence of ER and EA on anxiety symptom severity may improve specificity in targeting behavioural processes within psychosocial treatments designed to alleviate anxiety-related suffering. Accordingly, we examined relations of ER and EA to anxiety symptom severity after accounting for anxiety sensitivity and anxiolytic medication use in a community-based treatment-seeking sample.

DESIGN

A four-step hierarchical linear regression analysis of cross-sectional data provided by a community-based treatment-seeking sample.

METHODS

Totally, 120 participants (Mage  = 39.18; Female = 58.3%) completed a questionnaire packet upon intake to an anxiety disorders clinic.

RESULTS

EA and ER were strongly correlated, and each accounted for significant variance over and above model covariates. EA was a dominant risk factor for anxiety symptom severity, as ER was not a significant predictor (p = .073) following the inclusion of EA in the model (p = .006).

CONCLUSIONS

EA appears to be a dominant risk factor, and ER a proxy risk factor, for anxiety symptom severity. EA may be an avenue for greater treatment specificity for those with anxiety symptoms.

Emotion regulation styles and Adolescent adjustment following a COVID-19 lockdown

This study explored the effect of emotion regulation styles - integrative emotion regulation (IER), suppressive emotion regulation, and dysregulation-on adolescents' psychosocial adjustment following a Covid-19-related lockdown. 114 mother-adolescent dyads were surveyed after lockdown and at two additional time points (three and six months later). Adolescents were aged 10-16 years, 50.9% females. Adolescents reported on their emotion regulation styles. Mothers and adolescents reported on adolescents' well-being (depressive symptoms, negative and positive emotions) and social behaviour (aggression and prosocial behaviour). Results of multilevel linear growth models showed IER predicted optimal well-being and social behaviour reported by both mothers and adolescents at baseline and a self-reported reduction in prosocial behaviours over time. Suppressive emotion regulation predicted reduced self-reported well-being after lockdown, evident in higher levels of negative affect and depressive symptoms and reductions in mother-reported prosocial behaviour over time. Dysregulation predicted reduced well-being and impaired social behaviour after lockdown, reported by both mothers and adolescents, and a reduction in self-reported depressive symptoms over time. Results suggest adolescents' adjustment to lockdown was affected by their habitual emotion regulation styles.

Anhedonia as a transdiagnostic symptom across psychological disorders: a network approach

BACKGROUND

Anhedonia is apparent in different mental disorders and is suggested to be related to dysfunctions in the reward system and/or affect regulation. It may hence be a common underlying feature associated with symptom severity of mental disorders.

METHODS

We constructed a cross-sectional graphical Least Absolute Shrinkage and Selection Operator (LASSO) network and a relative importance network to estimate the relationships between anhedonia severity and the severity of symptom clusters of major depressive disorder (MDD), anxiety sensitivity (AS), attention-deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) in a sample of Dutch adult psychiatric patients (N = 557).

RESULTS

Both these networks revealed anhedonia severity and depression symptom severity as central to the network. Results suggest that anhedonia severity may be predictive of the severity of symptom clusters of MDD, AS, ADHD, and ASD. MDD symptom severity may be predictive of AS and ADHD symptom severity.

CONCLUSIONS

The results suggest that anhedonia may serve as a common underlying transdiagnostic psychopathology feature, predictive of the severity of symptom clusters of depression, AS, ADHD, and ASD. Thus, anhedonia may be associated with the high comorbidity between these symptom clusters and disorders. If our results will be replicated in future studies, it is recommended for clinicians to be more vigilant about screening for anhedonia and/or depression severity in individuals diagnosed with an anxiety disorder, ADHD and/or ASD.

Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping

BACKGROUND AND OBJECTIVES

Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, panic disorder is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. The objective of this article is to systematically identify and review the empirical literature on emotional management processes and strategies associated with panic disorder, with the aim of evaluating their role in the development and maintenance of panic disorder, in order to better understand the pathogenesis of the disorder and guide clinicians to improve their current treatments.

METHODS

Four databases were searched for studies which were based on self-reported questionnaires or a methodology based on an experimental procedure.

RESULTS

Of the 1719 articles identified, 61 referred to different aspects of emotional management. People living with PD are characterized by low emotional intelligence levels, excessive use of suppression, impaired cognitive reappraisal, high levels of alexithymia and maladaptive coping strategies.

LIMITATIONS

Most of the reviewed studies used measures of emotional management in cross-sectional models and were based on self-assessment reports.

CONCLUSIONS

Improving emotional intelligence levels is key to increasing emotion regulation flexibility for people living with PD. Automatic cognitive reappraisal impairment in these people indicates low importance of cognitive restructuring in psychotherapeutic treatment.

Associations between Social Support Dimensions and Resilience Factors and Pathways of Influence in Depression and Anxiety Rates in Young Adults

Emerging adulthood is an important developmental period, associated to mental health risk. Resilience research points to both social and personal protective factors against development of psychopathology, but there is paucity with their comprehensive study in young adults. This study provides and initial integrative approach to model multiple dimensions of perceived social support (i.e., from family, friends, significant others) and personal factor of trait resilience (i.e., coping and persistence during stress, tolerance to negative affect, positive appraisals, trust) and their hypothesized contributions to reducing depression and anxiety rates. The study was conducted with a sample of 500 Spanish emerging adults (18 to 29 years old). Regression analyses and multiple mediation models were performed to test our hypotheses. Results showed that social support from family was the dimension with the highest strength relating individual differences in resilience. Furthermore, analyses supported a differential mediating role of specific resilience factors (coping and persistence during stress, tolerance to negative affect, positive appraisals, trust) in partially accounting for the association between higher social support from family and lower depression and anxiety levels in young adults. These results may inform new programs of mental health during emerging adulthood via the promotion of different sources of social support and their related resilience pathways contributing to low emotional symptomatology at this stage of development.

Perceived Discrimination, Experiential Avoidance, and Mental Health among Hispanic Adults in Primary Care

The Hispanic population is the largest minority group in the United States and frequently experiences racial discrimination and mental health difficulties. Prior work suggests that perceived racial discrimination is a significant risk factor for poorer mental health among Hispanic in the United States. However, little work has investigated how perceived racial discrimination relates to anxiety and depression among Hispanic adults. Thus, the current study evaluated the explanatory role of experiential avoidance in the relation between perceived racial discrimination and anxiety/depressive symptoms and disorders among Hispanic adults in primary care. Participants included 202 Spanish-speaking adults (Mage = 38.99, SD = 12.43, 86.1% female) attending a community-based Federally Qualified Health Center. Results were consistent with the hypothesis that perceived racial discrimination had a significant indirect effect on depression, social anxiety, and anxious arousal symptoms as well as the number of mood and anxiety disorders through experiential avoidance. These findings suggest future work should continue to explore experiential avoidance in the association between perceived racial discrimination and other psychiatric and medical problems among the Hispanic population.

Shared and unique affective abnormalities in schizotypy dimensions

Attention to affect is theoretically a precursor to one's ideal affect (i.e., preference for feeling low- and high-arousal positive and negative affect) and emotion regulation (ER). In schizotypy, there have been mixed findings regarding abnormalities in attention to affect. At the same time, little is known about ideal affect in schizotypy or whether differences in ideal affect or ER difficulties in schizotypy are driven by attention to affect. Thus, this study aimed to identify shared and unique abnormalities in attention to affect, ideal affect, and ER difficulties in schizotypy, and to test whether attention to affect underlies differences in ideal affect and ER difficulties. Using groups of individuals with either extreme levels of social anhedonia (SocAnh; n = 181), extreme levels of perceptual aberrations/magical ideation (PerMag; n = 105), or individuals low on both (i.e., controls; n = 531), we tested group differences in attention to affect, ideal affect, and ER difficulties. Our findings suggest both shared and unique affective abnormalities; compared to controls, the SocAnh group paid the least attention to positive affect. Only PerMag had heightened attention to negative affect compared to controls. Additionally, we found unique abnormalities relating to ideal affect but mostly shared difficulties in ER in schizotypy. Abnormalities in ideal affect and ER remain largely consistent after accounting for attention to affect for PerMag, suggesting that attention to affect is not the primary mechanism driving these abnormalities. However, we found evidence that attention to affect underlies some SocAnh-control group differences in ideal affect and ER difficulties. Our work helps to clarify prior work and contributes to the understanding of shared and unique affective abnormalities in schizotypy. Future research may consider longitudinal approaches to test causal mechanisms of affective abnormalities in schizotypy.

Problematic Smartphone Use Influences the Relationship Between Experiential Avoidance and Anxiety

Experiential avoidance (EA), an unwillingness to stay in contact with unwanted inner experiences (e.g., emotions, thoughts, and bodily sensations), has been implicated in the development and maintenance of anxiety. Individuals with high levels of EA are more likely to employ maladaptive coping strategies (i.e., avoidance behaviors), which exacerbates emotional distress and anxious arousal. As smartphone ownership has become increasingly common in recent years, problematic smartphone use (PSU) has been suggested to serve as a "safety behavior" in situations in which individuals believe that they might experience emotional discomfort. That is, individuals experiencing emotional distress and/or anxious arousal may overengage in the use of technology to relieve emotional distress. As such, the purpose of this study was to examine PSU as a moderator of the relationship between EA and anxiety. Adult participants (N = 294) recruited through Amazon's Mechanical Turk (MTurk), an online labor market, completed an online battery of self-reported measures. Results indicated that the relationship between EA and anxiety became significantly stronger as PSU increased, thereby suggesting that PSU may exacerbate the effect of EA on anxiety. These findings are a first step toward the development of risk profiles that incorporate EA and PSU. Such risk profiles may be beneficial for early identification and intervention for individuals at high risk for the development of anxiety.

Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety

Background

To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders.

Methods

Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated.

Results

The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values.

Conclusions

These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.

The Interpersonal Mindfulness in Parenting Scale in Mothers of Children and Infants: Factor Structure and Associations With Child Internalizing Problems

Objectives: Mindful parenting, measured by the Interpersonal Mindfulness in Parenting scale (IMP), is beneficial for parents and children. However, the IMP has not been validated in English-speaking parents. Further, little is known about whether mindful parenting is similar in parents of children vs. infants, or how it reduces child internalizing problems. We sought to validate the IMP in English-speaking mothers of children and infants, and to examine relationships between the facets of mindful parenting, child internalizing problems and parent variables related to internalizing. Methods: Using confirmatory factor analyses, we examined the fit of various models of mindful parenting in English-speaking community-recruited mothers of children aged 3-18 years (n = 396) and infants aged 0-2 years (n = 320). We used regression analyses to investigate relationships between the facets of mindful parenting, child internalizing problems, and parent variables including parental experiential avoidance, unhelpful beliefs about child anxiety and accommodation of child anxiety. Results: Mindful parenting can be measured in English-speaking mothers, using either a 5- or 6-factor, 29-item version of the IMP. These versions of the IMP operate similarly for mothers of children and infants. Child internalizing problems and related parent variables were best predicted by non-judgmental acceptance of parenting in mothers of children, and emotional self-awareness and non-reactivity in mothers of infants. Conclusions: The IMP is a valid measure of mindful parenting in English-speaking mothers of children and infants. Mindful parenting predicts child internalizing problems and related parent variables, suggesting that mindful parenting programs could benefit families of children with internalizing problems, potentially by reducing parental experiential avoidance, unhelpful beliefs about or accommodation of child anxiety.

The Effects of Emotional Working Memory Training on Trait Anxiety

Background

Trait anxiety is a pervasive tendency to attend to and experience fears and worries to a disproportionate degree, across various situations. Decreased vulnerability to trait anxiety has been linked to having higher working memory capacity and better emotion regulation; however, the relationship between these factors has not been well-established.

Objective

This study sought to determine if participants who undergo emotional working memory training will have significantly lower trait anxiety post-training. The study also sought to determine if emotion regulation mediated the relationship between working memory training and trait anxiety.

Method

An experimental group comprising of 49 participants underwent 20 days of computerized emotional working memory training, which involved viewing a continuous stream of emotionally-charged content on a grid, and then remembering the location and color of items presented on the grid. The control group comprised of 51 participants.

Results

Participants of the experimental group had significantly lower trait anxiety compared to controls, post-training. Subsequent mediation analysis determined that working memory training capacity gains were significantly related to anxiety reduction as measured by form Y2 of the Spielberger State-Trait Anxiety Inventory (STAI-Y2). Emotion regulation, as measured by the Emotional Regulation Questionnaire (ERQ), was found not to mediate between working memory capacity gains and trait anxiety reduction.

Conclusion

Working memory capacity gains and reductions in levels of trait anxiety were observed following emotional working memory training. The study may therefore be useful in informing interventions targeted at improving working memory capacity, and reducing levels of trait anxiety. Moreover, it proposes for future research to further look into the mediating role of emotion regulation via the development or utilization of more comprehensive measures of emotion regulation.

Worry during the initial height of the COVID-19 crisis in an Italian sample

In the earliest months of 2020, the COVID-19 emergency reached a pandemic status of international concern. In this situation, people tended to think more about current difficulties and their negative consequences due to the fear of infection and changed daily life during quarantine. The aim of this study was to explore the severity of worry in relation to individual characteristics and emotions during COVID-19 outbreak in the Italian people. Socio-demographic questions and standardized self-report questionnaires were administered online. Results highlighted a moderate level of worry, anxiety and distress. People with higher perceptions of COVID-19 severity exhibited higher levels of worry in contrast to those who perceived a greater control over the possibility of infection. Multiple regression analysis indicated that coping styles, emotion regulation strategies and personality traits significantly contributed to explain the variance in worry scores. Findings supported that cognitive reappraisal, emotion-focused coping and extraversion were protective factors for worry, while expressive suppression, dysfunctional and problem-focused coping, and neuroticism were related to high worry. However, neuroticism and dysfunctional coping were particularly important predictors of worry. This paper also considers possible psychological interventions that might be implemented in order to deal with mental health issues emanating from the COVID-19 pandemic.

Cardiovascular risk as a moderator of associations among anxiety sensitivity, distress tolerance, PTSD and depression symptoms among trauma-exposed firefighters

BACKGROUND

Firefighters experience frequent and severe trauma exposure, which places them at elevated risk for posttraumatic stress disorder (PTSD) and major depression. Cardiovascular issues may exacerbate the effects of mental health risk factors, such as anxiety sensitivity (AS) and distress tolerance (DT), on PTSD and depression. The current study investigated cardiovascular risk as a moderator of associations between risk factors (AS and DT) and psychiatric symptoms (PTSD and depression) among firefighters.

METHODS

Participants were 836 trauma-exposed active duty firefighters (93.90% men; with mean age 38 years, [SD = 9]). Participants endorsing at least one of three cardiovascular risk items-experiencing current high blood pressure, history of heart problems, and experiencing chest pains in the past 2 years-were considered high in cardiovascular risk.

RESULTS

A structural equation model indicated that higher AS was associated with greater PTSD (β = 0.38, p < .01) and depression symptoms (β = 0.32, p < .01); lower DT was associated with greater PTSD (β = -0.18, p < .01) and depression symptoms (β = -0.31, p < .01). Multigroup analyses showed that cardiovascular risk moderated the association between 1) AS and PTSD symptoms, but not 2) AS and depression symptoms, 3) DT and PTSD symptoms, or 4) DT and depression symptoms. For those high in cardiovascular risk, higher AS was associated more strongly with greater PTSD symptoms (high cardiovascular risk group: β = 0.46, p < .01]; low cardiovascular risk group: β = 0.33, p < .01).

CONCLUSIONS

High cardiovascular risk may contribute to PTSD symptoms among trauma-exposed firefighters with high AS. These results highlight the importance of considering physical and mental health vulnerabilities in first responder populations.

Is there a relationship between cannabis use problems, emotion dysregulation, and mental health problems among adults with chronic pain?

Cannabis is often used to manage pain among persons who suffer from chronic pain. Yet, despite much literature suggesting cannabis use problems are associated with mental health problems, little work has examined mechanisms of this relationship among a chronic pain population. Chronic pain is also associated with emotion dysregulation. Individuals with chronic pain who experience cannabis use problems may have less capacity to regulate negative emotions, which could relate to greater anxiety, depression, and suicidal ideation. Thus, the current study explored whether emotion dysregulation explained, in part, the relation between cannabis use problems and anxiety, depression, and suicidal ideation among adults with chronic pain. Participants were 431 opioid-using adults with current moderate to severe chronic pain, 176 were current cannabis users, of which 30.20% reported cannabis use problems. Results indicated a significant indirect relationship between cannabis use problems and anxiety [95% CI (.03, .05)], depression [95% CI (.03, .06)], and suicidal ideation [95% CI (.01, .01)] via emotion dysregulation. Tests of specificity suggested potential for a bi-directional effect for suicidal ideation (p < .001). Initial findings suggest that emotion dysregulation may be an important mechanism in the relationship between cannabis use problems and mental health among adults with chronic pain.

Anxiety sensitivity and emotion regulation as mechanisms of successful CBT outcome for anxiety-related disorders in a naturalistic treatment setting

BACKGROUND

Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction.

METHODS

Participants were treatment-seeking patients (N = 247) at an outpatient anxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses.

RESULTS

Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081).

LIMITATIONS

This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group.

CONCLUSIONS

These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples.

The effects of induced and trait anxiety on the sequential modulation of emotional conflict

The current study aimed to investigate whether induced anxiety, as well as trait anxiety, would lead to the failure of the regulation of emotional conflict. To measure the regulation of emotional conflict, the congruency sequence effect (CSE), which is a reduced effect of task-irrelevant distractor after incongruent trials compared to congruent trials, was observed while participants performed an emotional conflict task. In Experiment 1, participants performed the task in a safe context and a threatening context where a couple of electric shocks were given randomly on two consecutive days. In Experiment 2, participants performed the same task in either a safe or threatening context to avoid a potential carryover effect of the threat. The CSE observed in the safe context disappeared in the threatening context as well as in participants with high-trait anxiety level even without the threat. The findings imply that induced anxiety causes a failure of cognitive control that engenders the CSE in emotional congruency tasks. Moreover, such failure driven by participants' trait anxiety level might be a potential predisposing factor leading to anxiety disorders. Overall, these results suggest that induced anxiety, as well as trait anxiety, has an adverse impact on the sequential modulation of emotional conflict.

Clinical and Cost-Effectiveness of Personalized Tele-Based Coaching for Farmers, Foresters and Gardeners to Prevent Depression: Study Protocol of an 18-Month Follow-Up Pragmatic Randomized Controlled Trial (TEC-A)

Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25-50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.

The Positive Valence Systems Scale: Development and Validation

We present the Positive Valence Systems Scale (PVSS), a measure of the National Institute of Mental Health's Research Domain Criteria Positive Valence Systems domain. An initial long form of the scale (45 items) providing a broad assessment of the domain was distilled into a short form (21 items) measuring responses to a wide range of rewards (Food, Physical Touch, Outdoors, Positive Feedback, Social Interactions, Hobbies, and Goals). Across three diverse samples, the PVSS-21 demonstrated strong internal consistency, retest reliability, and factorial validity. It was more strongly related to reward than punishment sensitivity, positive than negative affect, and depression than anxiety. PVSS-21 scores discriminated depressed from nondepressed individuals and predicted anhedonia severity even when controlling for depression status. Hobbies emerged as the strongest predictor of clinical outcomes and the best differentiator of depressed and nondepressed individuals. Results highlight the potential of the PVSS for advancing understanding of reward-related abnormalities in depression and other disorders.

A signal-detection approach to individual differences in negative feeling

Feeling is an important aspect of core personality traits and affective-style. Here we implemented a new signal-detection-theory based model for feeling generation, involving two parameters: report-criterion (c), the level above which enough emotional evidence has gathered for intense feeling to appear, and evidence-differentiation (d_a), the ability to emotionally differentiate between (negative) triggers of varying intensity. Results indicate that a low c was related to Neuroticism but not to affective-style, yet a low d_a was related to limited access to emotion regulation strategies, but not to personality traits.

Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial

BACKGROUND

Dialectical behavior therapy (DBT) has demonstrated efficacy in treating disorders such as alcohol dependence that are characterized by emotional dysregulation. Preliminary evidence has revealed the feasibility of DBT skills training (ST) as a stand-alone treatment for such disorders. Although emotional dysregulation plays a significant role in alcohol dependence, there are no previous reports of using DBT-ST to treat it.

OBJECTIVES

The aim of this study was to evaluate the duration of abstinence and changes in emotional regulation in a 3-month DBT-ST program for alcohol-dependent patients and to look for relations between abstinence and emotional regulation.

METHODS

We administered the Difficulties in Emotion Regulation Scale (DERS) and used urine toxicology screening to monitor alcohol/substance intake among the 244 subjects admitted to the program.

RESULTS

Among the 157 patients who completed the treatment, 73.2% were abstinent at the end of the program, and their emotional regulation improved. Improvement was independent of the initial severity of both alcohol use and emotional dysregulation. For substance use outcomes, we found a partial mediation role of improved emotional regulation.

CONCLUSIONS

This is the first open trial to show improved alcohol-related behavior and emotional regulation in alcohol-dependent patients treated with DBT-ST and to posit a partial but significant relation between improved emotional regulation and alcohol use outcomes. In the treatment of alcohol dependence, emotional regulation may be a relevant factor for therapists to consider.

The role of emotion regulation difficulties in the relationship between attachment representations and depressive and anxiety symptoms in the postpartum period

BACKGROUND

Insecure attachment representations have been established as a vulnerability factor for postpartum depressive symptoms. However, there is a lack of studies on the effects of attachment (in)security on postpartum anxiety symptoms, and on the mechanisms through which attachment representations may affect women's postpartum adjustment, namely, emotion regulation difficulties.

METHODS

The sample included 450 women in the postpartum period (up to 12 months postpartum), who were recruited both online (advertisements on social media) and in person (study was presented by the researchers during the women's postpartum hospitalization).

RESULTS

Approximately one third of the women with clinically significant symptoms (33.3%) presented comorbid symptoms of anxiety and depression, and these women presented more insecure attachment representations and more emotion regulation difficulties (p < .001) than did women without comorbid symptoms (p < .001). The relationship between more insecure attachment representations and depressive and anxiety symptoms occurred both directly and indirectly through emotional regulation difficulties.

LIMITATIONS

The cross-sectional nature of the study, the use of self-report questionnaires that do not allow the establishment of clinical diagnosis and the self-selected bias in recruitment were study limitations.

CONCLUSIONS

The results underline the need for attention to anxiety symptomatology, which is a condition that co-occurs frequently in this period. Interventions that focus on promoting adaptive strategies of emotional regulation are relevant rather than more intensive interventions to change attachment representations.

Implicit Emotion Regulation Deficits in Trait Anxiety: An ERP Study

According to the framework of emotion regulation (ER), both explicit and implicit forms are essential to our well-being. It is the interaction between these two processes that ensures adaptive emotional responses. Although many studies have focused on explicit ER deficits in anxiety, there is still a lack of awareness about the implicit form and its role in anxiety. To address this issue, we explored the time course of implicit ER processes in individuals with high and low trait anxiety (LTA). To do this, we employed the newly developed Priming-Identify (PI) paradigm, which includes a word-matching task (externally-generated implicit goals) and a facial expression identification task (emotion processing). We aimed to modulate the implicit ER goals of individuals through the application of different priming conditions (ER-related and -unrelated words). In addition to their behavioral effects, we recorded the influence of these priming conditions through event-related potentials (ERPs) during the facial expression identification task. Three ERP components were chosen as indexes of three stages of implicit ER processing: N170, early posterior negativity (EPN) and late positive potential (LPP). In individuals with LTA, the early N170 and the middle EPN were enlarged under the ER-related priming condition, while the LPP was not influenced. However, in individuals with high trait anxiety (HTA), we observed an absence of any significant differences between the ER-related and -unrelated priming conditions across all three ERP components. Furthermore, enlargements of N170 and EPN amplitudes were significantly correlated with a decrease in negative emotion experience scores. Our results suggest that HTA individuals experience implicit ER deficits during the early and middle stages of ER.

Emotion Regulation Difficulties in Relation to Anxiety, Depression, and Functional Impairment Among Treatment-Seeking Smokers

Psychological distress is elevated among smokers and plays a key role in the maintenance of smoking behavior. Although research has implicated emotion regulation (ER) difficulties as a transdiagnostic construct for psychological distress, empirical work has not yet investigated ER difficulties among treatment-seeking smokers. The purpose of the current study was to increase understanding of ER difficulties in relation to depression, anxious arousal, and functional impairment among treatment-seeking smokers. Participants included adult daily treatment-seeking smokers (N = 568; Mage = 37, SD = 13.46; 51.9% male). Results indicated that global ER difficulties were significantly related to depression, anxious arousal, and functional impairment. Analyses focused on the lower-order facets of ER and indicated that limited access to ER strategies, difficulty engaging in goal-directed behavior, and lack of emotional clarity were significantly related to depression; limited access to ER strategies, nonacceptance of emotions, and impulsivity were significantly associated with anxious arousal; and limited access to ER strategies and difficulty engaging in goal-directed behavior were significantly related to functional impairment. The significant ER effects were evident above and beyond the variance accounted for by neuroticism and tobacco dependence. These findings highlight the importance of considering ER difficulties to better understand psychological distress among smokers.

Acculturative stress, emotion regulation, and affective symptomology among Latino/a college students

Although recent work has highlighted the relation of acculturative stress with depression and anxiety symptoms specifically among Latino/a university students, the potential mechanisms underlying these associations remain relatively unknown. The present study aims to examine difficulties in emotion regulation as an explanatory factor in the relation of acculturative stress with symptoms of depression, suicidality, social anxiety, and anxious arousal. A sample of 448 Latino/a college students (Mage = 20.67 years, SD = 1.96; 78.3% female) were recruited from a southwestern public university through an online, self-report survey. Indirect effects of acculturative stress via difficulties in emotion regulation on all outcomes were observed among males and females. Follow-up analyses showed the indirect effect on all dependent variables among Latino men occurred exclusively through lack of access to emotion regulation strategies, whereas the indirect effects among Latina women occurred through a different subfactor of difficulties in emotion regulation for each dependent variable. These findings suggest the potential clinical utility of assessing and targeting acculturative stress and difficulties in emotion regulation in the treatment of depression and anxiety problems among Latino/a college students. (PsycINFO Database Record

Looking at the bigger picture: Young men's sexual health from a psychological perspective

Researchers have seldom compared how various psychological factors relate to men's sexual health. We sought to identify whether and how psychological risk factors (i.e. anxiety sensitivity, emotion regulation, psychological distress) predict men's sexual health (i.e. functioning, sexual quality of life, frequency of sexual activity). Men ( N = 306) completed an online survey measuring emotional, psychological, and sexual outcomes. Comparisons of four path analysis models suggested that psychological risk factors are related to some but not all sexual health markers. We will highlight the factors that may place young men at risk for developing mental and sexual health difficulties.

Adaptive emotion regulation mediates the relationship between self-compassion and depression in individuals with unipolar depression

OBJECTIVES

To identify the mechanisms involved in the association between self-compassion and depression, we examined whether adaptive emotion regulation would mediate the relationship between self-compassion and depression in individuals with unipolar depression. Furthermore, we explored which specific emotion regulation skills would be most important in this relationship.

DESIGN AND METHOD

Sixty-nine individuals with unipolar depression were assessed with the Self-Compassion Scale and the Emotion Regulation Skills Questionnaire at baseline and with the Beck Depression Inventory-II 1 week later.

RESULTS

The results showed that successful application of emotion regulation skills mediates the association between self-compassion and depression. Among eight specific emotion regulation skills, only the ability to tolerate negative emotions was identified as a significant mediator in the self-compassion-depression relationship.

CONCLUSIONS

These findings provide preliminary evidence that systematically fostering self-compassion might help depressed individuals cope with their symptoms by enhancing their abilities to tolerate undesired emotions.

PRACTITIONER POINTS

Systematically fostering self-compassion through specific compassion-focused interventions might facilitate a reduction in depressive symptoms by improving the person's emotion regulation abilities, especially by improving his or her ability to tolerate negative emotions. Hence, compassion-focused interventions might be particularly promising in depressed patients with a tendency to avoid negative emotions and deficits in tolerating them.

Experiential Avoidance and Bordering Psychological Constructs as Predictors of the Onset, Relapse and Maintenance of Anxiety Disorders: One or Many?

To investigate (a) the incremental predictive validity of experiential avoidance over and above bordering psychological constructs (i.e., rumination, worry, neuroticism and anxiety sensitivity) in predicting onset, relapse and maintenance of anxiety disorders; and (b) whether these related constructs can be represented by a single, higher-order latent factor with similar predictive power as the separate psychological constructs while offering a more parsimonious predictive model. Longitudinal cohort study with repeated assessments after 4 years in a sample of 2157 adults aged 18-65, consisting of 1614 persons with past or current anxiety disorder (Panic Disorder with or without Agoraphobia, Social Anxiety Disorder, Generalized Anxiety Disorder, Agoraphobia without panic) according to the Composite Interview Diagnostic Instrument (CIDI) and 543 controls. Experiential avoidance (Acceptance and Action Questionnaire-I) manifested substantial overlap with bordering cognitive constructs. Experiential avoidance and anxiety sensitivity both uniquely predicted maintenance of anxiety disorders and neuroticism uniquely predicted relapse of anxiety disorders, over and above the effect of the other cognitive constructs. Moreover, a latent factor of psychological vulnerability loaded strongly on each of these psychological constructs. This latent factor predicted onset, maintenance and relapse of anxiety disorders. The tendency to frequently experience strong negative emotions, to evaluate these experiences as aversive and to engage in avoidant coping strategies may constitute a transdiagnostic factor predictive of anxiety disorders. Further developing and testing of interventions targeting transdiagnostic construct underlying anxiety and mood disorders seem warranted.

The Role of Experiential Avoidance in the Relation between Anxiety Disorder Diagnoses and Future Physical Health Symptoms in a Community Sample of Young Adult Women

Individuals diagnosed with an anxiety disorder report more physical health problems than those without an anxiety disorder. Few studies have examined the relation of anxiety disorders to later physical health symptoms, or the processes that may explain this relation. One process of interest is experiential avoidance (EA), which is commonly reported in populations characterized by high anxiety and often leads to health-compromising behaviors. The present study examined the relations between anxiety disorder diagnostic status, EA, and physical health symptoms in a community sample of young adult women. Results revealed a significant association between an anxiety disorder diagnosis and physical health problems four months later. Furthermore, levels of EA accounted for this relation. Findings highlight the potential utility of targeting EA as a method for improving health outcomes among individuals with anxiety disorders.

Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: An examination of the role of emotion dysregulation

Hazardous drinking is prevalent among persons living with HIV/AIDS (PLWHA). Anxiety sensitivity is a vulnerability factor that is highly associated with hazardous drinking among seronegatives, but has yet to be tested in PLWHA. Additionally, there is a need to examine potential mechanisms underlying associations of anxiety sensitivity and hazardous drinking. Emotion dysregulation is one potential construct that may explain the association between anxiety sensitivity and hazardous drinking. The current study examined emotion dysregulation as a potential explanatory variable between anxiety sensitivity and four, clinically significant alcohol-related outcomes among PLWHA: hazardous drinking, symptoms of alcohol dependence, number of days consuming alcohol within the past month, and degree of past heavy episodic drinking. The sample included 126 PLWHA (Mage=48.3; SD=7.5; 65.9% male). Results indicated significant indirect effects of anxiety sensitivity via emotion dysregulation in all models. Indirect effects (κ(2)) were of medium effect size. Alternative models were run reversing the predictor with mediator and, separately, reversing the mediator with the proposed outcome(s); alternative models yielded non-significant indirect effects in all but one case. Together, the current results indicate that anxiety sensitivity is associated emotion dysregulation, which, in turn, is associated with hazardous drinking outcomes. Overall, these findings may provide initial empirical evidence that emotion dysregulation may be a clinical intervention target for hazardous drinking.

Exploring the Relationship between Experiential Avoidance, Coping Functions and the Recency and Frequency of Self-Harm

This study investigated the relationship between experiential avoidance, coping and the recency and frequency of self-harm, in a community sample (N = 1332, aged 16–69 years). Participants completed online, self-report measures assessing self-harm, momentary affect, experiential avoidance and coping in response to a recent stressor. Participants who had self-harmed reported significantly higher levels of experiential avoidance and avoidance coping, as well as lower levels of approach, reappraisal and emotional regulation coping, than those with no self-harm history. Moreover, more recent self-harm was associated with lower endorsement of approach, reappraisal and emotion regulation coping, and also higher levels of both avoidance coping and experiential avoidance. Higher experiential avoidance and avoidance coping also predicted increased lifetime frequency of self-harm. Conversely, increased approach and reappraisal coping were associated with a decreased likelihood of high frequency self-harm. Although some of the effects were small, particularly in relation to lifetime frequency of self-harm, overall our results suggest that experiential avoidance tendency may be an important psychological factor underpinning self-harm, regardless of suicidal intent (e.g. including mixed intent, suicidal intent, ambivalence), which is not accounted for in existing models of self-harm.