August 23, 2015

SSCP Journal Club Week 8 - Emotion-regulation strategies across psychopathology: A meta-analytic review

This week's article is entitled Emotion-regulation strategies across psychopathology: A meta-analytic review.  The article can be found here.

·         examine the relationships between dispositional (patterns over time) emotion-regulation strategies  - acceptance, avoidance, problem solving, reappraisal, rumination and suppression - and psychopathology - anxiety, depression, eating and substance use disorder
o   effect size of relationship across disorders (sensitivity)
§  large: rumination; medium – large: avoidance, problem solving and suppression; small – medium: reappraisal, acceptance
o   effect size of relationship between each strategy and disorder (specificity)
§  internalizing disorders more consistently associated with regulatory strategies than externalizing
o   moderation effect of sample (normative vs. clinical)
§  multi-sample approach is very important

Models of Emotion Regulation
·         emotion regulation – “processes through which individuals modulate their emotions consciously and unconsciously to appropriately respond to environmental demands”
·         many disorders are viewed as a result of difficulty managing emotion – leads to more severe periods of distress (anxiety/depression) or using substances to regulate (eating/substance)
·         as such many therapeutic approaches incorporate emotion regulation training (DBT, EMFT, ACT, ERT)
·         strategies hypothesized to be protective against psychopathology
·         reappraisal  - generating benign or positive interpretations or perspectives on a stressful situation to reduce distress (CBT)
·         problem solving – conscious attempts to change a stressful situation or its consequences (brainstorming, planning course of action, etc...) – indirect attempt to regulate emotions by reducing stressors
·         acceptance – mindfulness as non-elaborative, non-judgmental, present-centered awareness in which thoughts, feelings and sensations are accepted as they are
·         strategies hypothesized to be risk factors for psychopathology
·         suppression
o   suppression of emotional expression - reduce outward expression and subjective experience in short term but not emotion or physiological arousal over the long term
o   suppression of unwanted thoughts – attempts to suppress result in increased accessibility and physiological arousal
o   chronic suppression prevents habituation and leads to hypersensitivity to depression and anxiety-related thoughts/symptoms
·         avoidance - two-stage theory of fear (Mowrer 1947) – fear acquired through classical conditioning, avoidance precludes extinction, fear maintained via operant conditioning
·         rumination – repetitively focus on experience of emotion and its causes/consequences, reduces problem solving  and immobilizes in indecision, binging as an attempt to escape from aversive self-awareness maintained by rumination

Measuring Emotion Regulation – this meta-analysis  includes self report only
·         many self report scales – measure dispositional tendencies (supposedly assess what people do across time and context) but may require a level of insight and meta-cognition that not everyone is capable of, confound experience of emotion with its regulation and overlap with criterion measures
·         some observational methods – can test hypotheses about short term effects of strategies but do not assess tendencies; usually focus on one or two at a time; heterogeneous in design and outcome variables

·         random-effect model of the correlation coefficients for each strategy collapsed across disorders
o   avoidance: r = .38*                                  problem solving: r = -.31*
o   suppression: r = .34*                                              reappraisal: r = -.14*
o   rumination: r = .49*                                                acceptance : r = -.19 (NS)
·         moderation analyses – collapsed
o   sample type (clinical pop had larger effect size)
§  significant - rumination, suppression
§  marginally significant – avoidance, problem solving
o   age group (adults had stronger relationship than children/adolescents)
§  significant - problem solving & suppression
§  not significant – rumination
·         random-effect model of the correlation coefficients for each combination of strategy and disorder
o   avoidance – anxiety (r = .37*), depression (r = .48*) & eating (r = .18*)
o   rumination – anxiety (r = .42*), depression (r = .55*),  eating (r = .26*) & substance (r = .21*)
o   suppression - anxiety (r = .29*), depression (r = .36*) & eating (r = .36*)
o   problem solving – anxiety (r = -.27*), depression (r = -.33*) & eating (r = -.29*)
o   reappraisal – anxiety (r = -.13 marginal), depression (r = -.17*) & eating (r = -.05 MS)
o   acceptance – anxiety (r = -.25 NS) & depression (-.20 NS)
·         moderation analyses – each combination
o   sample type (clinical pop had larger effect size)
§  significant – rumination + anxiety, avoidance + depression, rumination + depression, suppression + eating
§  marginally significant – problem solving + depression, avoidance + eating
o   age group (adults had stronger relationship than children/adolescents)
§  significant - problem solving + depression & suppression + depression
§  not significant – rumination + depression

·         each strategy was associated with overall psychopathology in the predicted direction
o   some more strongly related to overall psychopathology than others and maladaptive ones were more strongly related than adaptive ones – the presence of a maladaptive strategy is more deleterious than absence of particularly adaptive strategies
·         some strategies were more closely related to depression/anxiety (mood) than substance/eating (externalizing)  – rumination, avoidance and reappraisal
o   likely the relationships are more complex in externalizing disorders - might be moderated by reward sensitivity and/or eating and substance use may be strategies in their own right or used as part of a cluster of strategies
o   effect sizes may also be less reliability in this analysis
·         strength of relationships are likely a function of clinical severity and underscore the importance of using a multi-sample approach
·         children and adults reported similar relationships with psychopathology + rumination only – rumination may be a more primitive, automatic response; children may be less likely to report on use of problem solving and suppression bc require executive control and meta-cognition
·         the small relationships between psychopathology and acceptance and reappraisal are surprising given they are incorporated into major treatments (ACT, CBT) – but the data doesn’t allow clarification of the relationship between avoidance and reappraisal
·         future research
o   model relationships between strategies + psychopathology using latent factors (personality traits, attention)
o   examine strategies temporally
o   examine relationship between strategies + psychopathology at the dispositional and state levels simultaneously (measured spontaneously and in an ecologically valid environment)
·         limitations of the literature
o   number of effect sizes for combos of strategies and disorders is small

o   very few studies examine context-specificity and flexibility hypotheses

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