Overview
·
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
Results
·
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
Conclusions
·
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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