Expressive flexibility: Enhancement and suppression abilities differentially predict life satisfaction and psychopathology symptoms

Translating theoretical insights into an emotion regulation flexibility intervention: assessing effectiveness

ABSTRACTObjective: Traditional research often categorizes emotion regulation strategies as adaptive or maladaptive, overlooking crucial situational and individual differences that dictate their efficacy. The literature highlights the need for a more nuanced approach, like the role of emotion regulation flexibility. Despite its importance, research on developing and testing interventions that promote this flexibility is scarce. Addressing this gap, our study designed and tested an "Emotion Regulation Flexibility Booster Program" (ERFBP). We aimed to assess its efficacy in improving emotion regulation flexibility (ERF) and its impact on various mental health indicators. Method: We recruited 153 participants with low emotion regulation flexibility, randomly assigning them to experimental, control, and no-treatment groups. The experimental group was provided with an intervention based on an ERF model. The control group received sessions on study habits, whereas no-treatment group received no training. Results: The analysis indicated that participants in the ERFBP group exhibited significant changes in ERF, subjective wellbeing, and emotion regulation goals and psychological distress compared to baseline measurements and post-intervention scores of other two groups. Conclusion: These findings support the effectiveness of the ERFBP in enhancing ERF and wellbeing. However, further research must confirm these findings across diverse contexts and populations.

The role of caregiver emotion regulation in youth mental health during the COVID-19 pandemic: A longitudinal study

The COVID-19 pandemic has presented youth and families with a broad spectrum of unique stressors. Given that adolescents are at increased risk for mental health and emotional difficulties, it is critical to explore family processes that confer resilience for youth in the face of stress. The current study investigated caregiver emotion regulation (ER) as a familial factor contributing to youth ER and risk for psychopathology following stressful life events. In a longitudinal sample of 224 youth (M age = 12.65 years) and their caregivers, we examined whether caregiver and youth engagement in ER strategies early in the pandemic mediated the associations of pandemic-related stress with youth internalizing and externalizing symptoms six months later. Leveraging serial mediation analysis, we demonstrated that caregiver and youth rumination, but not expressive suppression or cognitive reappraisal, mediated the prospective associations of pandemic-related stress with youth internalizing and externalizing symptoms. Greater exposure to pandemic-related stressors was associated with greater caregiver rumination, which, in turn, related to greater rumination in youth, and higher levels of youth internalizing and externalizing symptoms thereafter. Family interventions that target caregiver ER, specifically rumination, may buffer against the consequences of stress on youth engagement in maladaptive ER strategies and risk for psychopathology.

Flexible Regulation of Positive and Negative Emotion Expression: Reexamining the Factor Structure of the Flexible Regulation of Emotional Expression Scale (FREE) Based on Emotion Valence

The Flexible Regulation of Emotional Expression (FREE) Scale assesses individuals' ability to enhance and suppress their emotional expressions across different situations. This study investigates the optimal factor structure of the FREE and emphasizes the importance of distinguishing between the regulation abilities for positive and negative expressions. A sample of 607 undergraduates (Mage = 19.02, SD = 1.02, 72.2% female) from Mainland China completed the questionnaire survey. Confirmatory factor analyses tested eight competing models of the FREE structure. Results indicated that the second-order model, featuring two higher-order factors (expressive enhancement and suppression abilities), fit the data well. An alternative second-order model, with two different higher-order factors (positive and negative emotion expressive abilities) and the same four first-order factors, demonstrated an even better fit. Various types of expressive ability scores showed predictive validity regarding emotion regulation self-efficacy, mental health outcomes, and relationship stress. Regulation of emotional expression can be represented by either regulation type or emotion valence, with the latter providing more informative insights. Flexible regulation of positive and negative emotion expression predicted fewer symptoms of depression, anxiety, stress, and relationship stress beyond emotion regulation self-efficacy. These findings highlight the importance of considering emotional valence in understanding flexibility in expression regulation.

Emotion Regulation Flexibility in Adolescents: A Systematic Review from Conceptualization to Methodology

Considerable attention has been devoted to the concept of flexible emotion regulation, which de-emphasizes the importance of any specific regulatory strategy in favor of the flexible deployment of strategies in response to specific situational challenges. The bulk of research in this area has been conducted on adult samples. Research on emotion regulation flexibility (ERF) in youth has been documented in only a limited number of studies and using various definitions. This systematic review aims to gather and summarize different conceptualizations and methodological approaches of adolescent ERF. We incorporate these findings into a general framework to understand ERF and its role in adolescents' emotional, behavioral and social functioning. Adhering to the PRISMA guidelines, 11 studies were included in the review. While ERF has been defined in various and inconsistent ways, the included studies utilized conceptualizations from two overarching domains: the regulation of expressed emotion and the repertoire of emotion regulation strategies. Promising approaches and future directions will be highlighted.

A meta-analysis of cognitive reappraisal and personal resilience

Cognitive reappraisal, an adaptive emotion regulation strategy that involves subjectively reinterpreting stressful and adverse experiences in a more positive manner, can enhance personal resilience. Personal resilience is a constellation of attributes that facilitate successful coping and an expeditious return to adaptive functioning after exposure to stress or adversity. This meta-analysis evaluated the association between cognitive reappraisal and personal resilience. A systematic and exhaustive search identified 64 independent samples from 55 studies (N = 29,824) that examined the correlation between cognitive reappraisal and personal resilience. A random-effects model revealed a positive summary effect (r = 0.47, p < .001), indicating that higher cognitive reappraisal was associated with higher personal resilience. Six potential meta-moderators were tested: culture, age, name of the cognitive reappraisal measure, name of the personal resilience measure, study design, and publication period. After two extreme effect size outliers were omitted, tests of publication bias did not reveal any publication bias in this line of research. This quantitative synthesis offers compelling evidence showing that cognitive reappraisal skills operate as a protective strategy against stress and adversity and, therefore, enhance personal resilience. The protective benefits of cognitive reappraisal in relation to personal resilience are relatively robust, as the correlations were statistically significant for all subgroups in the meta-moderation analyses.

Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat

Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.

The Phenotype of Recovery X: Associations between delay discounting, regulatory flexibility, and remission from substance use disorder

INTRODUCTION

Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations among DD, RF, and remission from SUDs among individuals in recovery.

METHODS

Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an $1000 hypothetical reward Adjusting Amount Delay Discounting Task. The study considered individuals to be in remission from SUD if they did not endorse any SUD DSM-5 symptom other than craving (except tobacco use disorder) in the past three months. The study team used t-tests to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship among DD, RF, and remission status.

RESULTS

Remitted individuals (n = 82) had significantly lower DD (i.e., greater preference for larger, later rewards) rates (p < .001) and higher context sensitivity (p < .001) and coping flexibility (p < .001). The study found significant negative associations between DD and context sensitivity (p = .008), coping flexibility (p = .002), and emotion regulation flexibility (p < .001). Finally, context sensitivity (p = .023) and coping flexibility (p = .009) mediated the relationship between DD and SUD remission.

CONCLUSIONS

Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes.

The Role of Emotion Regulation for General Self-Efficacy in Adolescents Assessed Through Both Neurophysiological and Self-Reported Measures

Background

Self-efficacy, the belief in one's ability and capacity to organize and execute actions required to achieve desired results, is associated with adolescent academic achievement and reduced risk for psychopathology. Adolescent emotion regulation represents an important component in the relationship between self-efficacy and developmental outcomes, but the underlying neurophysiological mechanisms are poorly understood. It is unclear how emotion regulation strategies, which change with experience, and emotion regulation capacity, which is largely determined by genetics, contribute to the development of self-efficacy.

Aim

The present study aims to explore the relationship between emotion regulation and self-efficacy in adolescents. We hypothesize that neurophysiological emotion regulation capacity moderates the relationship between emotion regulation strategies and self-efficacy.

Methods

The present study applied a cross-sectional design. A sample of high-school students (N = 45, nfemale = 31, age = 17-18) provided answers on the General Self-Efficacy Questionnaire and the Emotion Regulation Questionnaire. Vagal tone was used as an indicator for emotion regulation capacity.

Results

In the initial correlational analysis, reappraisal, but not expressive suppression nor vagal tone was associated with self-efficacy. Vagal tone was not associated with any self-report measures of emotion regulation or self-efficacy. Contrary to our hypothesis, vagal tone did not moderate the relationship between emotion regulation and self-efficacy.

Conclusion

This is the first study assessing the relationship between neurophysiological indicators of emotion regulation and self-efficacy. Our results do not indicate that vagal tone moderates the relationship between emotion regulation strategies and general self-efficacy. Future studies should also assess the possible influence of metacognition and interoception on relationships.

Cultural differences in the relations between expressive flexibility and life satisfaction over time

Background

Expressive flexibility refers to the ability to assess situational demands and adjust one's emotion expressions via enhancement or suppression. It has been associated with lower levels of depressive and anxiety symptoms and greater social acceptance. These relationships, however, have not yet been examined across cultures-where prior research has found cultural differences in norms on emotion displays and their associations with mental health. This study examined expressive flexibility across three cultural groups and their associations with life satisfaction and depressive symptoms over time.

Methods

276 first-year college students (146 Asian American, 71 European Americans, and 62 Latinx Americans) completed two online surveys during the first (T1) and thirteenth week (T2) of the Fall 2020 academic semester.

Results

Results revealed no significant cultural group differences in the ability to enhance or suppress emotions. However, we found a significant ethnicity x enhancement ability interaction in predicting T2 life satisfaction, controlling for T1 life satisfaction, age, gender, and emotion regulation frequency. Specifically, greater ability to enhance one's emotions was significantly associated with higher life satisfaction over time among Asian Americans, but not for European Americans and Latinx Americans.

Discussion

Our findings illustrate the importance of not looking just at cultural group differences in the levels of expressive flexibility, but also at the associations between expressive flexibility and mental health.

Greater resting frontal alpha asymmetry associated with higher emotional expressive flexibility

Emotional expressive flexibility (EEF) is an important social ability that has prompted scholars to examine its benefits to human mental health. However, the neural underpinnings of individual differences in the EEF remain unclear. In neuroscience, frontal alpha asymmetry (FAA) is regarded as a sensitive indicator of certain emotional modalities and affective styles. To the best of our knowledge, no study has linked FAA with EEF to examine whether FAA could be a potential neural indicator of EEF. In the present study, 47 participants (Mage = 22.38 years, 55.3% women) underwent a resting electroencephalogram and completed the flexible regulation of emotional expression scale (FREE). The results revealed that after controlling for gender, resting FAA scores positively predicted EEF, with relative left frontal activity associated with higher EEF. Additionally, this prediction was reflected in both the enhancement and suppression dimensions of EEF. Furthermore, individuals with relative left frontal activity reported greater enhancement and EEF than individuals with relative right frontal activity. The present study indicated that FAA may be a neural marker of EEF. In the future, more empirical studies are needed to provide causal evidence that the improvement in FAA can enhance EEF.

The Flexible Regulation of Emotional Expression Scale for Youth (FREE-Y): Adaptation and Validation Across a Varied Sample of Children and Adolescents

Flexible self-regulation has been shown to be an adaptive ability. This study adapted and validated the adult Flexible Regulation of Emotional Expression (FREE) Scale for use with youth (FREE-Y) in community and maltreatment samples. The FREE-Y measures the ability to flexibly enhance and suppress emotion expression across an array of hypothetical social scenarios. Participants (N = 654, 8-19 years) were included from three studies. Confirmatory factor analysis (CFA) confirmed a theoretically appropriate higher order factor structure. Using multiple-group CFAs, measurement invariance was achieved across maltreatment status, age, and gender. Reliabilities were adequate and construct validity was demonstrated through associations with measures of emotion regulation, psychopathology, IQ, and executive functioning. Group comparisons indicated lower Suppression and Flexibility scores for maltreated versus comparison participants. Findings suggest that the FREE-Y is a valid measure of expressive regulation ability in youth that can be applied across a range of populations.

Understanding Rumor Sharing Behavior During COVID-19: The Dominant Motivation and the Potential Consequences for Life Satisfaction

During the COVID-19 pandemic, rumors were shared widely and quickly, leading to unfortunate consequences. To explore the dominant motivation underlying such rumor sharing behavior and the potential consequences for sharers' life satisfaction, two studies were conducted. Study 1 was based on representative popular rumors that circulated throughout Chinese society during the pandemic to examine the dominant motivation underlying rumor sharing behavior. Study 2 employed a longitudinal design to further test the dominant motivation underlying rumor sharing behavior and its effects on life satisfaction. The results of these two studies generally supported our hypotheses that people chose to share rumors during the pandemic mainly for the purpose of fact-finding. Regarding the effects of rumor sharing behavior on life satisfaction, although sharing wish rumors (i.e., rumors expressing hopes) had no effect on sharers' life satisfaction, sharing dread rumors (i.e., rumors reflecting fears) and aggression rumors (i.e., rumors implying aggression and hatred) reduced sharers' life satisfaction. This research lends support to the integrative model of rumor and provides practical implications for mitigating the spread of rumors.

Childhood maltreatment and emotion regulation in everyday life: an experience sampling study

Childhood maltreatment is a major risk factor for psychopathology, and increasing evidence suggests that emotion regulation is one of the underlying mechanisms. However, most of this evidence comes from single assessments of habitual emotion regulation, which may not overlap with spontaneous emotion regulation in daily life and which fail to account for within-individual variability in emotion regulation across multiple contexts. In the present study, we investigated the relation between history of childhood maltreatment, positive and negative affect, and multiple dimensions of spontaneous emotion regulation (strategy use, emotion regulation goals, emotion regulation success and effort) in everyday life, using experience sampling method (3 assessments/day, for 10 consecutive days), in a sample of healthy volunteers (N = 118). Multilevel modeling results indicated that childhood maltreatment was associated with lower positive affect and higher negative affect. Childhood maltreatment was also related to lower use of reappraisal and savoring (but not suppression, rumination and distraction), reduced emotion regulation success (but not effort), as well as lower levels of and higher within-individual variability of hedonic (but not instrumental) emotion regulation goals. These results provide ecological evidence for multiple differences in emotion regulation in individuals with a history of childhood maltreatment.

Age and gender differences in expressive flexibility and the association with depressive symptoms in adolescents

Objective

This study investigated age and gender differences in the ability to flexibly enhance and suppress facial expressions according to situational demands, known as expressive flexibility (EF), as well as its relationship with depressive symptoms in adolescents.

Methods

The participants included 766 Chinese high school students aged between 12 and 18 years (mean age = 14.96 years, standard deviation = 2.04; 52.2% female). Data on EF and depressive symptoms were collected using self-report questionnaires.

Results

Girls scored higher on enhancement abilities than boys, but with no significant gender difference in suppression abilities. There were also no significant age-related differences in enhancement and suppression abilities. Only enhancement ability was negatively associated with depressive symptoms.

Conclusion

The development of EF abilities was stable among adolescents, with varying effects in terms of gender, and the importance of EF and enhancement abilities in reducing depressive symptoms in adolescents was highlighted.

Longitudinal links between expressive flexibility and friendship quality in adolescence: The moderating effect of social anxiety

INTRODUCTION

Expressive flexibility, or the ability to both up- and down-regulate emotional expressions in social interactions, is thought as an indicator and a consequence of healthy interpersonal relationships. The present longitudinal study examined bidirectional associations between expressive flexibility and friendship quality in early adolescence. Since prior research found inconsistent results regarding the adaptiveness of expressive flexibility, which indicated the necessity to consider individual variability in the process, we further tested the potential moderating effect of social anxiety in the links from expressive flexibility to friendship quality.

METHODS

Participants from two junior high schools in eastern China (N = 274; 50.4% female; M_age  = 13.56) were surveyed at three time points with 6-month intervals. Expressive flexibility, friendship quality, and social anxiety were all assessed via self-reported scales.

RESULTS

According to the cross-lagged model results, friendship quality significantly predicted increased expressive flexibility over time. Conversely, the longitudinal association from expressive flexibility to friendship quality was not significant, but the interaction between expressive flexibility and social anxiety significantly predicted later friendship quality. Further analyses via the Johnson-Neyman technique revealed that expressive flexibility only positively predicted friendship quality for adolescents with lower levels of social anxiety.

CONCLUSION

Our results suggest that expressive flexibility is not always socially adaptive, so practical interventions that aim to improve youths' social adjustment via expressive flexibility training might need to consider the role of individual characteristics.

Exploring two models of emotion regulation: how strategy use, abilities, and flexibility relate to well-being and mental illness

BACKGROUND AND OBJECTIVES

The process model of emotion regulation (ER) focuses on strategies used to manage emotions, while the abilities model emphasizes the extent one adaptively responds to negative emotions. We sought to clarify the relationships between components of ER based on both of the abilities (i.e., dysregulation) and process (i.e., strategy use) models, as well as ER flexibility (i.e., choosing the optimal strategy for a given situation) with well-being (happiness, flourishing), internalizing symptoms (depression, anxiety), and disordered eating. Gender differences were explored.

DESIGN AND METHOD

Participants included 612 undergraduate students (M_age = 20.24) who completed questionnaires measuring ER, well-being, and mental illness. Structural equation modeling was used on cross-sectional data to explore the associations between ER and psychological outcomes.

RESULTS

Dysregulation was associated with reduced well-being and greater psychopathology. In terms of strategy use, reappraisal was related to greater well-being and fewer internalizing symptoms, while the opposite relationships were found for suppression. Suppression was also linked to disordered eating. ER flexibility was related to well-being for men only. Further, dysregulation had the largest association with all outcomes.

CONCLUSIONS

Findings suggest that ER abilities may underlie other components of ER and are most central to mental health and illness.

Social Support Predicts Differential Use, but not Differential Effectiveness, of Expressive Suppression and Social Sharing in Daily Life

While emotion regulation often happens in the presence of others, little is known about how social context shapes regulatory efforts and outcomes. One key element of the social context is social support. In two experience sampling studies (Ns = 179 and 123), we examined how the use and affective consequences of two fundamentally social emotion-regulation strategies-social sharing and expressive suppression-vary as a function of perceived social support. Across both studies, we found evidence that social support was associated with variation in people's use of these strategies, such that when people perceived their environments as being higher (vs. lower) in social support, they engaged in more sharing and less suppression. However, we found only limited and inconsistent support for context-dependent affective outcomes of suppression and sharing: suppression was associated with better affective consequences in the context of higher perceived social support in Study 1, but this effect did not replicate in Study 2. Taken together, these findings suggest that the use of social emotion-regulation strategies may depend on contextual variability in social support, whereas their effectiveness does not. Future research is needed to better understand the circumstances in which context-dependent use of emotion regulation may have emotional benefits, accounting for personal, situational, and cultural factors.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42761-022-00123-8.

Time Spent on Daily Activities and Its Association with Life Satisfaction among Czech Adolescents from 1992 to 2019

Life satisfaction, an important precursor of adolescents’ well-being, is linked to daily activities. Substantial changes have been noted in adolescents’ daily activities over the years, raising the question of possible consequences for life satisfaction. This study aimed to explore changes in adolescents’ life satisfaction and their time spent on daily activities (sleeping, engaging in sports, online gaming, school commuting, time spent at school) and further investigate the associations between adolescents’ life satisfaction and these daily activities. The sample comprised 2715 adolescents from birth cohorts surveyed at four time points between 1992 and 2019. Participants were administered the Daily Activities Inventory and the Berne Questionnaire on Adolescents’ Well-Being. Robust ANOVA with post hoc tests and spline regression were employed. We found cohort differences in sleep duration (8.6 h a day on average in 1992 and 7.5 in 2019). Sleep duration of 8 h and 1 h of sports activities had a beneficial effect on life satisfaction, while more than 1 h of online gaming had a negative impact. Neither school attendance nor commuting to school was associated with adolescents’ life satisfaction. The results of this study can inform public-health policies to promote sleeping and sports habits in adolescence.

Resilience to suicidal behavior in young adults: a cross-sectional study

Despite decades of research on suicide risk factors in young people, there has been no significant improvement in our understanding of this phenomenon. This study adopts a positive deviance approach to identify individuals with suicide resilience and to describe their associated psychological and sociodemographic profiles. Australian young adults aged 18–25 years with suicidal thoughts (N = 557) completed an online survey covering sociodemographic, mental health status, emotion regulatory and suicide-related domains. Latent class analysis was used to identify the individuals with suicide resilience. The predictors of suicide resilience were assessed using logistic regression models. The results suggested that one in ten (n = 55) met the criteria for suicide resilience. Factors that had a significant association with suicide resilience included greater cognitive flexibility, greater self-efficacy in expressing positive affect, reduced use of digital technology and less self-harm and substance use as a response to emotional distress. This study identified the factors that may protect young adults with suicidal thoughts from progressing to suicide attempts. Suicide prevention programs might be optimised by shifting from a deficit-based to a strength-based approach through promoting cognitive flexibility, self-efficacy and reducing maladaptive coping.

Associating Flexible Regulation of Emotional Expression With Psychopathological Symptoms

Background: Stressful situations and psychopathology symptoms (e.g., depression and anxiety) shape how individuals regulate and respond to others’ emotions. However, how emotional expressions influence mental health and impact intrapersonal and interpersonal experiences is still unclear.

Objective: Here, we used the Flexible Regulation of Emotional Expression (FREE) scale to explore the relationship between emotional expression abilities with affective symptoms and mental health markers.

Methods: From a sample of 351 participants, we firstly validate a German version of the FREE scale on a final sample of 222 participants located in Germany, recruited through an online platform. Following this, we performed confirmatory factor analyses to assess the model structure of the FREE-scale. We then utilize a LASSO regression to determine which indicators of psychopathology symptoms and mental health are related to emotional expressive regulation and determine their particular interactions through the general linear model.

Results: We replicated the FREE scale’s four latent factors (i.e., ability to enhance and suppress positive as well as negative emotional expressions). After the selection of relevant instruments through LASSO regression, the suppress ability showed specific negative associations with depression (r = 0.2) and stress symptoms (r = 0.16) and positive associations with readiness to confront distressing situations (r = 0.25), self-support (r = 0.2), and tolerance of emotions (r = 0.2). Both, emotional expressions enhance and suppress abilities positively associated with coping markers (resilience) and emotion regulation skills. Finally, the interaction effects between emotional flexibility abilities and stress, depression, and anxiety symptoms evidenced that consistent with the flexibility theory, enhancing and suppressing abilities may predict psychopathological symptoms.

Conclusions: These findings emphasize the importance of considering the flexibility to express emotions as a relevant factor for preserved mental health or the development of psychopathological symptoms and indicate that online surveys may serve as a reliable indicator of mental health.

Expressive flexibility and health-related quality of life: The predictive role of enhancement and suppression abilities and relationships with trait emotional intelligence

This study aims to examine the ability to flexibly enhance and suppress emotional expression, known as expressive flexibility, in relation to physical and psychological health, as well as trait emotional intelligence (EI). A sample of 503 Italian (M_age  = 28.65 ± 9.26 years, 85.1% females) participants completed the Italian version of Flexible Regulation of Emotional Expression (FREE) Scale, the TEIQue-SF, and the Short Form-12 Health Survey. Confirmatory factor analysis indicated that the Italian version of FREE showed adequate psychometric properties. In both genders, results of correlational analyses indicated that enhancement ability was associated with well-being, emotionality, and sociability, whereas suppression ability was associated with self-control. Regression analyses, controlling for age and gender, indicated that suppression and inversely enhancement abilities, predicted the perceived psychological but not physical health. Well-being, self-control, and sociability also contributed to explaining variance in the model. The interaction effect of enhancement and suppression was not significantly associated with either physical or psychological health. Overall, these results suggest that enhancement and suppression abilities differentially contribute to psychological health when trait EI is accounted for. Clinical implications and future directions for research on expressive flexibility are discussed.

Post-traumatic Growth and Psychological Resilience During the COVID-19 Pandemic: A Serial Mediation Model

Although the World Health Organization (WHO) has issued guidelines for managing to contain, mitigate, and limit of the COVID-19. However, it is more essential to highlight the urgency and importance of evaluating social functioning and mental health status during the pandemic. College students have experienced serious problems and have had to overcome many negative situations brought about by the pandemic. Accordingly, the present study intended to use Chinese college students as sample to examine the positive adoption and changes during the ongoing COVID-19. Guided by literatures in this filed, we explored the internal mechanism of post-traumatic growth affecting psychological resilience, and considered about mediation roles of positive coping styles and cognitive reappraisal. A total of 463 college students from universities in China effectively completed online questionnaires. The result indicated that these four variables were positively correlated with each other (ps < 0.001). More importantly, our findings proved a direct and positive effect on psychological resilience. Positive coping styles and cognitive reappraisal, respectively, mediated the relationship between post-traumatic growth and psychological resilience. Over all, the hypothesized serial model conclusively fits the data: students with high-level post-traumatic growth tended to report increased use of positive coping strategies, which further facilitated their cognitive reappraisal, and subsequently, promoted their psychological resilience. The findings obtained in this study will provide a theoretical basis and possible viable strategies for both targeted crisis intervention and psychological trauma recovery plans.

Expressive Flexibility and Mental Health: The Mediating Role of Social Support and Gender Differences

Recent research has emphasized the crucial role of expressive flexibility in mental health. This study extended prior studies by further exploring the mediating mechanism and possible gender differences underlying the association between expressive flexibility and mental health indexed by depression and life satisfaction based on the dual-factor model of mental health. Specifically, we explored whether social support mediated the association between expressive flexibility and depression as well as life satisfaction, and whether there were gender differences in these relationships. A total of 711 voluntary college students (mean age = 20.98 years, SD = 2.28; 55.70% women) completed a set of scales assessing expressive flexibility, perceived social support, depression, and life satisfaction. Results showed that expressive flexibility had a positive direct effect on life satisfaction and social support mediated this association. Social support also mediated the relationship between expressive flexibility and depression. The mediation effect of social support was robust and consistent in men and women whereas expressive flexibility had a stronger direct effect on depression in women compared to men. The present study contributes to clarifying the relationship between expressive flexibility and mental health from a more comprehensive perspective. Last, the strengths and limitations of this study were discussed.

Psychometric evaluation of the Adjustment Disorder New Module-20 (ADNM-20): A multi-study analysis

The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.

The Tension Between Cognitive and Regulatory Flexibility and Their Associations With Current and Lifetime PTSD Symptoms

In recent years, researchers have tried to unpack the meaning of the term flexibility and test how different constructs of flexibility are associated with various psychopathologies. For example, it is apparent that high levels of flexibility allow individuals to adaptively cope and avoid psychopathology following traumatic events, but the precise nature of this flexibility is ambiguous. In this study we focus on two central constructs: cognitive flexibility - the ability to recognize and implement possible responses to a situation- and regulatory flexibility - the ability to modulate emotional expression and experience across situations. We aim to explore the connection between cognitive and regulatory flexibility and evaluate their relative effect on PTSD symptoms. Trauma-exposed college students (N = 109, M age = 25.31, SD = 4.59) were assessed for cognitive and regulatory flexibility and current and lifetime PTSD symptoms. We predicted and found a relatively weak, yet significant, overlap between participants' cognitive and regulatory flexibility. Importantly, while both cognitive and regulatory flexibility were associated with lifetime PTSD symptoms, only cognitive flexibility was associated with current PTSD symptoms. The findings illuminate the possible value of differentiating between constructs of flexibility in predicting short and long-term effects of traumatic exposure and may pave the ground for developing personalized intervention methods.

Flexibility in using self-regulatory strategies to manage self-control conflicts: The role of metacognitive knowledge, strategy repertoire, and feedback monitoring

For regulating emotion, it has been shown that people benefit from being flexible in their use of emotion regulation strategies. In the current study, we built on research focused on regulatory flexibility with respect to emotions to investigate flexibility in the use of self-regulatory strategies to resolve daily self-control conflicts. We investigated three components of flexibility: (1) metacognitive knowledge, (2) strategy repertoire, and (3) feedback monitoring. In a 10-day experience sampling study, 226 participants reported whether they had, within the past hour, experienced a self-control conflict of initiating an aversive activity, persisting in it, or inhibiting an unwanted impulse in response to a temptation. Results support the hypothesis that higher levels of all three components of flexibility are associated with higher levels of success in managing daily self-control conflicts, except for strategy repertoire and feedback monitoring in conflicts of persistence. Results also support the hypothesis that higher levels of trait self-control are associated with higher levels of metacognitive knowledge and feedback monitoring for conflicts of initiation, but not for conflicts of persistence and inhibition. We found no evidence of an association between trait self-control and strategy repertoire. These findings demonstrate the importance of flexible strategy use during daily self-control conflicts.

Depression, Anxiety, and Stress Among Healthcare Workers During the COVID-19 Outbreak and Relationships With Expressive Flexibility and Context Sensitivity

This study aimed at investigating depression, anxiety, and stress symptoms among healthcare workers and examine the role of expressive flexibility and context sensitivity as key components of resilience in understanding reported symptoms. We hypothesized a significant and different contribution of resilience components in explaining depression, anxiety, and stress. A total sample of 218 Italian healthcare workers participated in this study through an online survey during the lockdown, consequently to the COVID-19. The Depression Anxiety Stress Scales-21 (DASS-21) was used to measure depression, anxiety, and stress; the Flexible Regulation of Emotional Expression (FREE) scale was used to measure the ability to enhance and suppress emotional expression; the Context Sensitivity Index (CSI) was used to measure the ability to accurately perceive contextual cues and determine cue absence. Demographic and work-related data were also collected. DASS-21 cut-off scores were used to verify the mental status among the respondents. Correlational analyses examined relationships between DASS-21, FREE, and CSI, followed by three regression analyses with depression, anxiety, and stress as dependent variables, controlling for age, gender, and work experience. Enhancement and suppression abilities, cue presence, and cue absence served as independent variables. The results showed a prevalence of moderate to extremely severe symptoms of 8% for depression, 9.8% for anxiety, and 8.9% for stress. Results of correlational analysis highlighted that enhance ability was inversely associated with depression and stress. Suppression ability was inversely associated with depression, anxiety, and stress. The ability to perceive contextual cues was inversely associated with depression and anxiety. The regression analysis showed that the ability to enhance emotional expression was statistically significant to explain depression among healthcare workers. In predicting anxiety, age, and the ability to accurately perceive contextual cues and determine cue absence made substantial contributions as predictors. In the last regression model, age, work experience, and the ability to suppress emotional expression were significant predictors of stress. This study’s findings can help understand the specific contributions of enhancement and suppression abilities and sensitivity to stressor context cues in predicting depression, anxiety, and stress among healthcare workers. Psychological interventions to prevent burnout should consider these relationships.

The relationships between resilience and student personal factors in an undergraduate medical program

BACKGROUND

Resilience is an essential aspect of wellbeing that plays a major role in undergraduate medical education. Various personal and social factors are known to affect resilience. Empirical evidence remains limited regarding resilience and the personal factors that affect it among undergraduate medical students in an Asian setting. Therefore, this study aims to identify undergraduate medical students' level of resilience and its relationships to personal factors in Indonesia.

METHODS

This cross-sectional study was conducted among undergraduate medical students in years 1-6. Respondents were asked to complete three validated questionnaires: the Connor-Davidson Resilience Scale (CD-RISC) to measure resilience, the Brief-COPE to assess coping mechanisms, and the Big Five Personality Test to measure five personality dimensions. Descriptive and Pearson's correlation analyses were completed to explore relationships between each variable. Regression analysis was completed to analyze the extent to which coping mechanisms, personality, and academic achievement explained the variation in resilience scores.

RESULTS

A total of 1040 respondents completed the questionnaires (a 75.42% response rate). Students in both preclinical and clinical stages had quite good levels of resilience and higher scores on adaptive coping mechanisms than on maladaptive coping mechanisms. Adaptive and maladaptive coping mechanisms, Big Five Personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and students' academic achievement explained 46.9% of students' resilience scores.

CONCLUSIONS

Although the resilience scores in this study were comparable to resilience scores among undergraduate medical students in other settings, we found that coping mechanisms, personality traits, and academic performance may predict resilience among medical students.

Expressive Flexibility and Dispositional Optimism Contribute to the Elderly's Resilience and Health-Related Quality of Life during the COVID-19 Pandemic

The COVID-19 outbreak had a negative impact on psychological status among elderly subjects, negatively affecting their health-related quality of life (HRQoL). Psychological factors that promote resilience might beneficially contribute also to promoting a better HRQoL among elderly subjects. The main purpose of the present study was to investigate the contribution of dispositional optimism and expressive flexibility on the HRQoL of elderly outpatients during the COVID-19 outbreak. The outpatients were recruited from October 2018 to October 2019, and then followed-up during April 2020, by evaluating their HRQoL. The baseline sample consisted of 141 elderly outpatients (mean age 80.31 ± 6.84 years); the final number of outpatients included in the follow-up evaluation was 104 (mean age 80.26 ± 6.39). Univariate and multivariate linear regressions were developed to explore significant associations with the physical and mental component of HRQoL. Baseline dispositional optimism was a predictor of the mental component of HRQoL at follow-up; the flexible suppression of emotional expression was a predictor of the physical component of HRQoL at follow-up. From a psychogeriatric perspective, the accurate assessment of psychological factors, such as dispositional optimism and expressive flexibility, might help physicians and psychologists to recognize additional patients' vulnerabilities during the current emergency.

The Suppression Paradox: A Cross-Cultural Comparison of Suppression Frequency, Suppression Ability, and Depression

The habitual use of expressive suppression (suppression frequency) is consistently associated with a number of negative outcomes, but paradoxically, the ability to suppress when there is a situational need (suppression ability) is usually linked to positive outcomes. The two sides of the paradox, suppression frequency and suppression ability, have been found to be unrelated. Given that these findings have emerged in largely western samples, the present studies examined whether the coupling of suppression frequency and ability depends on cultural contexts, and whether this can explain the previously established cultural difference in the costs of suppression frequency. In an initial study, we examined the relations among suppression frequency, suppression ability, and depression in a Chinese sample (Study 1; N = 310), and then, using two new samples, we compared these relations between Chinese and the US samples (Study 2; N = 392). Results showed that suppression frequency was related to depression in two distinct ways. In both cultures, suppression frequency had a direct, positive association with depression. In Chinese culture only, however, suppression frequency also had an indirect association, such that higher suppression frequency was related to higher suppression ability and in turn related to fewer depressive symptoms. Our findings show that suppression frequency is related to suppression ability only among Chinese participants, and can serve as a potential explanation for why suppression frequency is less related to depression in Chinese culture.

Bidirectional effects between expressive regulatory abilities and peer acceptance among Chinese adolescents

The current study examined potential bidirectional effects between adolescents' expressive regulation (the ability to enhance and suppress overt emotional behavior in line with situational demands) and peer interactions via two experiments. Experiment 1 tested the hypothesis that adolescents' expressive regulation affects their social acceptance from peers. Participants (N = 147) were randomly divided into three conditions and watched video clips in which a same-sex partner differed in his or her levels of expressive enhancement and suppression abilities. Results showed that participants reported greater liking of the partner when he or she was able to flexibly enhance and suppress emotional expressions in line with situational demands compared with when either one of these abilities was impaired. Experiment 2 then examined whether peer rejection reduced participants' enhancement and suppression abilities. We manipulated participants' feelings of rejection through a virtual Cyberball game. Following this manipulation (N = 100; Inclusion vs. Exclusion), we tested participants' expressive enhancement and suppression abilities, as well as their natural expressivity, via an observational task. Peer exclusion resulted in lower levels of enhancement ability and natural expressive behaviors but did not impair suppression ability. The results of these experiments suggest that both expressive enhancement and expressive suppression are important for adolescents to obtain higher peer acceptance. In addition, peer exclusion also caused impairments in expressive regulation, specifically reduced enhancement abilities. In summary, these results evidenced the bidirectional effects between expressive regulation and peer acceptance.

Anger and Sadness Regulation in Refugee Children: The Roles of Pre- and Post-migratory Factors

Pre- and post-migratory factors have been implicated in refugee children's mental health. However, findings regarding their unique and joint roles are inconsistent or nonexistent. We examined the main and interactive relations of pre-migratory life stressors and post-migratory daily hassles and routines to emotion regulation-a key marker of mental health-in 5- to 13-year-old Syrian refugee children (N = 103) resettling in Canada. Mothers and children completed questionnaires assessing pre-migratory life stressors and post-migratory daily hassles. Mothers also reported their children's adherence to family routines and emotion regulation abilities (i.e., anger and sadness regulation) via questionnaire. Overall, children who more frequently engaged in family routines showed better anger regulation. Pre- and post-migratory factors also interacted, such that greater post-migratory daily hassles were associated with worse sadness regulation for children with lower levels of pre-migratory life stressors, but were unassociated with the sadness regulation of children who experienced higher levels of pre-migratory life stressors. Results suggest that pre- and post-migratory factors play unique and joint roles in refugee children's emotion regulation during resettlement.

Using automated computer vision and machine learning to code facial expressions of affect and arousal: Implications for emotion dysregulation research

As early as infancy, caregivers' facial expressions shape children's behaviors, help them regulate their emotions, and encourage or dissuade their interpersonal agency. In childhood and adolescence, proficiencies in producing and decoding facial expressions promote social competence, whereas deficiencies characterize several forms of psychopathology. To date, however, studying facial expressions has been hampered by the labor-intensive, time-consuming nature of human coding. We describe a partial solution: automated facial expression coding (AFEC), which combines computer vision and machine learning to code facial expressions in real time. Although AFEC cannot capture the full complexity of human emotion, it codes positive affect, negative affect, and arousal-core Research Domain Criteria constructs-as accurately as humans, and it characterizes emotion dysregulation with greater specificity than other objective measures such as autonomic responding. We provide an example in which we use AFEC to evaluate emotion dynamics in mother-daughter dyads engaged in conflict. Among other findings, AFEC (a) shows convergent validity with a validated human coding scheme, (b) distinguishes among risk groups, and (c) detects developmental increases in positive dyadic affect correspondence as teen daughters age. Although more research is needed to realize the full potential of AFEC, findings demonstrate its current utility in research on emotion dysregulation.

The Context Sensitivity Index (CSI): Measuring the Ability to Identify the Presence and Absence of Stressor Context Cues

The ability to accurately perceive cues to contextual demands across different situations has been identified as a crucial component of successful self-regulation. However, previous attempts to measure context sensitivity have suffered from serious methodological limitations, most notably the possibility that respondents may not possess sufficient knowledge of their own abilities, the confounding of perception of context with response to context, the use of only one or two contextual variations, and the failure to consider the abilities to both accurately detect contextual cues and accurately determine cue absence. This article reports a new, easy-to-administer scenario-based questionnaire measure, the Context Sensitivity Index (CSI), that addressed each of these limitations. The 20-item CSI was iteratively developed and normed using data from five studies to create separate indices to capture sensitivity to the presence of contextual cues (Cue Presence index) and to the relative absence of cues (Cue Absence index). We validated these indices against measures of flexibility, psychopathology, and other scales. Results are discussed in terms of the CSI's implications, limitations, and future applications.