Emotion regulation strategies in bipolar disorder: A systematic and critical review

Theoretical frameworks emphasise associations between interpretations and responses to affect and bipolar disorder (BD). This review (PROSPERO CRD42016043801) investigated which emotion regulation (ER) strategies have been applied to BD, are elevated in BD compared to clinical and non-clinical controls, and are associated with clinical and functional outcomes in BD METHODS: Search terms relating to emotion regulation, coping and bipolar disorder were entered into Embase, MedLine and PsycInfo. Quantitative studies investigating relationships between ER strategies and BD were eligible for this narrative synthesis RESULTS: A large volume of research (n = 47) investigated specific ER strategies in BD. Maladaptive strategies such as rumination and dampening were elevated in BD compared to controls and these particular strategies had a detrimental impact on outcomes such as mood symptoms. BD had a similar profile of ER strategies to unipolar depression, but there was limited comparison to other clinical groups. People with BD did not generally have deficits in using adaptive strategies, as evidenced by comparisons with controls and experimental studies LIMITATIONS: Methodological heterogeneity and a lack of ecologically valid ER assessments CONCLUSIONS: Empirical literature is critiqued in line with contemporary theories of BD and of emotion regulation more generally, in order to inform future research recommendations. This includes investigation of the importance of context in the impact of ER strategies, and discrepancies between trait and state use of ER strategies, particularly through experience sampling.

A two-year longitudinal study of gender differences in responses to positive affect and depressive symptoms during middle adolescence

This study aimed to analyze the prospective associations during adolescence between depressive symptoms and response styles to positive affect and to examine gender differences. A longitudinal study was conducted with three waves separated by 1 year each to assess a non-clinical sample of 622 Spanish adolescents who were 13 and 14 years old (50.2% boys, 49.8% girls). The participants completed self-report measures of depressive symptoms and responses to positive affect (emotion-focused positive rumination, self-focused positive rumination and dampening of positive emotion). The results showed that the increase in depressive symptoms was associated with an increase in dampening and decreases in emotion-focused and self-focused positive rumination. Furthermore, girls presented more depressive symptoms, as well as higher dampening and lower self-focused positive rumination, than boys. The conclusions highlight the need to consider responses to positive affect in explaining gender differences in depressive symptoms during mid-adolescence, as well as in designing prevention programs.

General mixture item response models with different item response structures: Exposition with an application to Likert scales

This article proposes a general mixture item response theory (IRT) framework that allows for classes of persons to differ with respect to the type of processes underlying the item responses. Through the use of mixture models, nonnested IRT models with different structures can be estimated for different classes, and class membership can be estimated for each person in the sample. If researchers are able to provide competing measurement models, this mixture IRT framework may help them deal with some violations of measurement invariance. To illustrate this approach, we consider a two-class mixture model, where a person's responses to Likert-scale items containing a neutral middle category are either modeled using a generalized partial credit model, or through an IRTree model. In the first model, the middle category ("neither agree nor disagree") is taken to be qualitatively similar to the other categories, and is taken to provide information about the person's endorsement. In the second model, the middle category is taken to be qualitatively different and to reflect a nonresponse choice, which is modeled using an additional latent variable that captures a person's willingness to respond. The mixture model is studied using simulation studies and is applied to an empirical example.

Combining agreement and frequency rating scales to optimize psychometrics in measuring behavioral health functioning

OBJECTIVE

The goal of this article was to investigate optimal functioning of using frequency vs. agreement rating scales in two subdomains of the newly developed Work Disability Functional Assessment Battery: the Mood & Emotions and Behavioral Control scales.

STUDY DESIGN AND SETTING

A psychometric study comparing rating scale performance embedded in a cross-sectional survey used for developing a new instrument to measure behavioral health functioning among adults applying for disability benefits in the United States was performed.

RESULTS

Within the sample of 1,017 respondents, the range of response category endorsement was similar for both frequency and agreement item types for both scales. There were fewer missing values in the frequency items than the agreement items. Both frequency and agreement items showed acceptable reliability. The frequency items demonstrated optimal effectiveness around the mean ± 1-2 standard deviation score range; the agreement items performed better at the extreme score ranges.

CONCLUSION

Findings suggest an optimal response format requires a mix of both agreement-based and frequency-based items. Frequency items perform better in the normal range of responses, capturing specific behaviors, reactions, or situations that may elicit a specific response. Agreement items do better for those whose scores are more extreme and capture subjective content related to general attitudes, behaviors, or feelings of work-related behavioral health functioning.

Moving beyond Likert and Traditional Forced-Choice Scales: A Comprehensive Investigation of the Graded Forced-Choice Format

The graded forced-choice (FC) format has recently emerged as an alternative that may preserve the advantages and overcome the issues of the dichotomous FC measures. The current study presented the first large-scale evaluation of the performance of three types of FC measures (FC2, FC4 and FC5 with 2, 4 and 5 response options, respectively) and compared their performance to their Likert (LK) counterparts (LK2, LK4, and LK5) on (1) psychometric properties, (2) respondent reactions, and (3) susceptibility to response styles. Results showed that, compared to LK measures with the same number of response options, the three FC scales provided better support for the hypothesized factor structure, were perceived as more faking-resistant and cognitive demanding, and were less susceptible to response styles. FC4/5 and LK4/5 demonstrated similarly good reliability, while LK2 provided more reliable scores than FC2. When compared across the three FC measures, FC4 and FC5 displayed comparable psychometric performance and respondent reactions. FC4 exhibited a moderate presence of extreme response style, while FC5 had a weak presence of both extreme and middle response styles. Based on these findings, the study recommends the use of graded FC over dichotomous FC and LK, particularly FC5 when extreme response style is a concern.

Beck's cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability

AIM

This study tests the validity of Beck's cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID.

METHODS

The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression.

RESULTS

The cognitive error 'underestimation of the ability to cope' was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups.

CONCLUSION

The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. WHAT THIS PAPER ADDS?: Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID.

Do response styles affect the predictive validity of self-rated health among Chinese older men and women?

PURPOSE

This study intended to examine whether correcting for response styles of the widely used self-rated health (SRH) question would affect its predictive validity in estimating respondents' mortality risks.

METHODS

We used data on a sample of 3319 men and 3250 women aged 60 and above from a nationally representative survey in China. Response styles were estimated with both ratings on two health anchoring vignettes and self-rated items in domains unrelated to health. Gender-stratified logistic regressions were used to estimate the effects of SRH on 4-year mortality risks. We compared the results before and after adjusting for response styles.

RESULTS

In the unconditional model, the effects of the five-point SRH on 4-year mortality risks were significant in both older women and men, and stronger among Chinese older men based on discrete change in probabilities of mortality at means. Gender difference was observed in response styles. Men assigned lower ratings to the vignettes than women, reflecting their higher standards in defining good health. Women presented higher proportions of extreme responses and lower proportions of midpoint responses. Correcting for response styles had no effect on the predictive validity of SRH for Chinese older men, but had some positive effects for Chinese older women when no other covariates were included.

CONCLUSION

Adjusting for response styles contributed to a small improvement in predicting mortality risks only among Chinese older women under restricted conditions, but not men.

Neurocognitive Correlates of Rumination Risk in Children: Comparing Competing Model Predictions in a Clinically Heterogeneous Sample

The current study examined associations between rumination and executive function difficulties in preadolescent youth, using predictions outlined in the attentional scope and multiple systems models of rumination. This study aimed to (a) extend current conceptual models of rumination to youth, (b) clarify disparate model predictions regarding working memory updating ("updating"), inhibition, and shifting abilities, and (c) examine differential neurocognitive predictions between two forms of rumination, sadness and anger. One hundred and fifty-nine youths oversampled for ADHD and other forms of child psychopathology associated with executive dysfunction (aged 8-13; 53.5% male; 59.1% Caucasian) completed a battery of assessments, including self-report measures of rumination and computerized neurocognitive tasks. Multiple regression analyses were conducted assessing relations between rumination and each executive function, controlling for both sadness and anger rumination to assess their unique associations. Sadness rumination was associated with poorer updating (β = -0.18, p = 0.046) and shifting abilities (β = 0.20, p = 0.03) but not inhibition (β = -0.04, p = 0.62), offering partial support to the attentional scope and multiple systems models. In contrast, anger rumination was associated with better updating abilities (β = 0.20, p = 0.03) but not shifting (β = -0.15, p = 0.11) or inhibition (β = 0.08, p = 0.35). Together, these results suggest (a) developmental differences in the neurocognitive correlates associated with rumination risk in youth compared to findings from the adult literature, and (b) that the executive function correlates of children's responses to negative emotions are affect-specific, such that sadness rumination is associated with difficulties replacing negative thoughts and shifting between mental sets, while anger rumination is associated with a better ability to maintain negative thoughts.

Psychometric benefits of self-chosen rating scales over given rating scales

Rating scales are susceptible to response styles that undermine the scale quality. Optimizing a rating scale can tailor it to individuals' cognitive abilities, thereby preventing the occurrence of response styles related to a suboptimal response format. However, the discrimination ability of individuals in a sample may vary, suggesting that different rating scales may be appropriate for different individuals. This study aims to examine (1) whether response styles can be avoided when individuals are allowed to choose a rating scale and (2) whether the psychometric properties of self-chosen rating scales improve compared to given rating scales. To address these objectives, data from the flourishing scale were used as an illustrative example. MTurk workers from Amazon's Mechanical Turk platform (N = 7042) completed an eight-item flourishing scale twice: (1) using a randomly assigned four-, six-, or 11-point rating scale, and (2) using a self-chosen rating scale. Applying the restrictive mixed generalized partial credit model (rmGPCM) allowed examination of category use across the conditions. Correlations with external variables were calculated to assess the effects of the rating scales on criterion validity. The results revealed consistent use of self-chosen rating scales, with approximately equal proportions of the three response styles. Ordinary response behavior was observed in 55-58% of individuals, which was an increase of 12-15% compared to assigned rating scales. The self-chosen rating scales also exhibited superior psychometric properties. The implications of these findings are discussed.

Pathways to Depressive Symptoms in a Digital Environment: The Role of Trait Affectivity and Mediation of Media Response Styles in Adolescence

Trait negative affectivity and trait extraversion/positive affectivity are predictive of both responses to affect and depressive symptoms in adolescence. Furthermore, differences in the use of responses to affect are associated with different levels of depressive symptoms. Despite the central role of media content in adolescents' daily lives, responses to affect have not yet been extended to affect in this media content. It is thus unclear whether trait affectivity is predictive of responses to affective media content, and whether such media response styles are predictive of depressive symptoms. A 3-wave longitudinal panel study with 3-month intervals among 318 adolescents (Mage = 16.5 years, SDage = 1.11, 72.5% boys) investigated the mediating role of media response styles in associations between trait affectivity and depressive symptoms. Trait negative affectivity predicted media rumination and media dampening, yet only media rumination predicted greater levels of depressive symptoms over time. Trait positive affectivity was associated with concurrent media distraction and media-enhancing. The media response styles did not mediate the associations between trait affectivity and depressive symptoms over time. These findings suggest that individuals higher in trait negative affectivity tend to engage in maladaptive emotion regulation strategies during sad media content consumption, whereas adolescents higher in trait positive affectivity turn to more adaptive strategies during sad or happy media content consumption. Yet, media response styles are not robustly associated with depressive symptoms over time.

Co-occurring dominance and ideal point processes: A general IRTree framework for multidimensional item responding

Responding to rating scale items is a multidimensional process, since not only the substantive trait being measured but also additional personal characteristics can affect the respondents' category choices. A flexible model class for analyzing such multidimensional responses are IRTree models, in which rating responses are decomposed into a sequence of sub-decisions. Different response processes can be involved in item responding both sequentially across those sub-decisions and as co-occurring processes within sub-decisions. In the previous literature, modeling co-occurring processes has been exclusively limited to dominance models, where higher trait levels are associated with higher expected scores. However, some response processes may rather follow an ideal point rationale, where the expected score depends on the proximity of a person's trait level to the item's location. Therefore, we propose a new multidimensional IRT model of co-occurring dominance and ideal point processes (DI-MIRT model) as a flexible framework for parameterizing IRTree sub-decisions with multiple dominance processes, multiple ideal point processes, and combinations of both. The DI-MIRT parameterization opens up new application areas for the IRTree model class and allows the specification of a wide range of theoretical assumptions regarding the cognitive processing of item responding. A simulation study shows that IRTree models with DI-MIRT parameterization provide excellent parameter recovery and accurately reflect co-occurring dominance and ideal point processes. In addition, a clear advantage over traditional IRTree models with purely sequential processes is demonstrated. Two application examples from the field of response style analysis highlight the benefits of the general IRTree framework under real-world conditions.

A Stan tutorial on Bayesian IRTree models: Conventional models and explanatory extension

IRTree models have been receiving increasing attention. However, to date, there are limited sources that provide a systematic introduction to Bayesian modeling techniques using modern probabilistic programming frameworks for the implementation of IRTree models. To facilitate the research and application of IRTree models, this paper introduces how to perform two families of Bayesian IRTree models (i.e., response tree models and latent tree models) in Stan and how to extend them in an explanatory way. Some suggestions on executing Stan codes and checking convergence are also provided. An empirical study based on the Oxford Achieving Resilience during COVID-19 data was conducted as an example to further illustrate how to apply Bayesian IRTree models to address research questions. Finally, strengths and future directions are discussed.

Predicting response time on self-report rating scale assessments of noncognitive constructs

Methodological studies of response time on noncognitive assessments have separately demonstrated the relevance of content trait level and response styles as predictive factors. In this paper we examine the simultaneous relevance of both factors as well as the potential for omitted predictor bias when ignoring either factor. Using response time data from several different noncognitive assessments, we demonstrate how a multilevel regression model that attends simultaneously to content and response style factors leads to consistent findings that support the simultaneous relevance of both factors. The average effects of response style consistently emerge as stronger, although also show greater respondent-level variability, possibly due to the multiple different underlying causes of response style behavior. Some implications for the use of response times in noncognitive measurement are considered.