Skip to main content

Advertisement

Log in

Emotion Regulation Flexibility in Generalized Anxiety Disorder

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

People differ in their affective styles, which refers to habitual use of emotion regulation (ER) strategies. Previous research has shown that mental health is associated with an individual’s adaptive flexibility of emotion regulation strategies rather than any one particular ER strategy. Methods: The present study employed a person-centered approach using latent profile analyses to distinguish patients with generalized anxiety disorder (GAD) based on their responses on an affective styles measure. Results: Results of the latent profile analysis supported a three-class solution. Class 1 (26% of participants) identified individuals with the lowest scores of each affective style; class 2 (10%) included individuals with the highest scores of each style; and class 3 (64%) consisted of individuals who scored in the mid-range of each affective style. Greater ER flexibility was associated with better emotional functioning and quality of life. Conclusions: Patients with GAD differ in ER flexibility. The vast majority of patients appear to have only moderate or low ER flexibility. Those individuals with high ER flexibility show a greater quality of life and less emotional distress.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Notes

  1. Diagnostic criteria of GAD is identical in the SCID-IV and ADIS-5.

References

  • Akaike, H. (1973). Information theory and an extension of the maximum likelihood principle. In B. N. Petrov & F. Casaki (Eds.), Second international symposium on information theory (pp. 267–281). Academiai Kiado: Budapest.

    Google Scholar 

  • Akaike, H. (1974). A new look at the statistical model identification. Automatic Control, IEEE Transactions on Automatic Control, 19, 716–723.

    Article  Google Scholar 

  • Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy, 48(10), 974–983.

    Article  PubMed  Google Scholar 

  • Aldao, A., & Nolen-Hoeksema, S. (2012). The influence of context on the implementation of adaptive emotion regulation strategies. Behaviour Research and Therapy, 50, 493.

    Article  PubMed  Google Scholar 

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion regulation strategies across psychopathology: A meta-analysis. Clinical Psychology Review, 30, 217–237.

    Article  PubMed  Google Scholar 

  • Aldao, A., Jazaieri, H., Goldin, P. R., & Gross, J. J. (2014). Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder. Journal of Anxiety Disorders, 28(4), 382–389.

    Article  PubMed  PubMed Central  Google Scholar 

  • Aldao, A., Sheppes, G., & Gross, J. J. (2015). Emotion regulation flexibility. Cognitive Therapy and Research, 39(3), 263–278.

    Article  Google Scholar 

  • Barthel, A. L., Hay, A., Doan, S. N., & Hofmann, S. G. (2018). Interpersonal emotion regulation: A review of social and developmental components. Behaviour Change, 1–14.

  • Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591–612.

    Article  PubMed  Google Scholar 

  • Bonanno, G. A., Papa, A., O’Neill, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15, 482e487.

    Article  Google Scholar 

  • Bradley, M. M., & Lang, P. J. (2000). Emotion and motivation. Handbook of Psychophysiology, 2, 602–642.

    Google Scholar 

  • Brawman-Mintzer, O., Lydiard, R. B., Emmanuel, N., Payeur, R., Johnson, M., Roberts, J., Jarrell, M. P., & Ballenger, J. C. (1993). Psychiatric comorbidity in patients with generalized anxiety disorder. The American Journal of Psychiatry, 150(8), 1216–1218.

    Article  PubMed  Google Scholar 

  • Brown, T. A., & Barlow, D. H. (2014). Anxiety and related disorders interview schedule for DSM-5 (ADIS-5L) - adult and lifetime version. Oxford: Oxford University Press.

    Google Scholar 

  • Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599.

    Article  PubMed  Google Scholar 

  • Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., Shea, M. T., & Keller, M. B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162(6), 1179–1187.

    Article  Google Scholar 

  • Buhle, J. T., Silvers, J. A., Wager, T. D., Lopez, R., Onyemekwu, C., Kober, H., Weber, J., & Ochsner, K. N. (2014). Cognitive reappraisal of emotion: A meta-analysis of human neuroimaging studies. Cerebral Cortex, 24(11), 2981–2990.

    Article  PubMed  Google Scholar 

  • Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of Psychopathology and Behavioral Assessment, 32(1), 68–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Clark, S. L., & Muthén, B. (2009). Relating latent class analysis results to variables not included in the analysis.

  • Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy, 36(2), 119–124.

    Article  Google Scholar 

  • Comer, J. S., Blanco, C., Hasin, D. S., Liu, S. M., Grant, B. F., Turner, J. B., & Olfson, M. (2011). Health-related quality of life across the anxiety disorders. The Journal of Clinical Psychiatry, 72(1), 43–50.

    Article  PubMed  Google Scholar 

  • Craske, M. G., & Waters, A. M. (2005). Panic disorder, phobias, and generalized anxiety disorder. Annual Review of Clinical Psychology, 1(1), 197–225.

    Article  PubMed  Google Scholar 

  • Curtiss, J., & Klemanski, D. H. (2015). Identifying individuals with generalised anxiety disorder: A receiver operator characteristic analysis of theoretically relevant measures. Behaviour Change, 32(4), 255–272.

    Article  Google Scholar 

  • Curtiss, J., & Klemanski, D. H. (2016). Taxonicity and network structure of generalized anxiety disorder and major depressive disorder: An admixture analysis and complex network analysis. Journal of Affective Disorders, 199, 99–105.

    Article  PubMed  Google Scholar 

  • Dingle, G. A., Neves, D. D. C., Alhadad, S. S., & Hides, L. (2018). Individual and interpersonal emotion regulation among adults with substance use disorders and matched controls. British Journal of Clinical Psychology, 57(2), 186–202.

    Article  Google Scholar 

  • Dixon-Gordon, K. L., Haliczer, L. A., Conkey, L. C., & Whalen, D. J. (2018). Difficulties in interpersonal emotion regulation: Initial development and validation of a self-report measure. Journal of Psychopathology and Behavioral Assessment, 40(3), 528–549.

    Article  Google Scholar 

  • Dugas, M. J., & Charette, C. A. (2018). Generalized anxiety disorder. In J. Hunsley & E. J. Mash (Eds.), A guide to assessments that work (Second ed., pp. 293–310). New York, NY, US: Oxford University Press.

  • Dziak, J. J., Bray, B. C., Zhang, J., Zhang, M., & Lanza, S. T. (2016). Comparing the performance of improved classify-analyze approaches for distal outcomes in latent profile analysis. Methodology.

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition with psychotic Screen (SCID-I/PW/PSY SCREEN). New York: Biometrics Research, New York State Psychiatric Institute.

    Google Scholar 

  • Fisher, A. J. (2015). Toward a dynamic model of psychological assessment: Implications for personalized care. Journal of Consulting and Clinical Psychology, 83(4), 825–836.

    Article  PubMed  Google Scholar 

  • Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Ruan, W. J., Goldstein, R. B., et al. (2005). Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the National Epidemiologic Survey on alcohol and related conditions. Psychological Medicine, 35(12), 1747–1759.

    Article  PubMed  Google Scholar 

  • Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26.

    Article  Google Scholar 

  • Gupta, S., & Bonanno, G. A. (2011). Complicated grief and deficits in emotional expressive flexibility. Journal of Abnormal Psychology, 120(3), 635–643.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G. (2014). Interpersonal emotion regulation model of mood and anxiety disorders. Cognitive Therapy and Research, 38(5), 483–492.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hofmann, S. G., & Kashdan, T. B. (2010). The affective style questionnaire: Development and psychometric properties. Journal of Psychopathology and Behavioral Assessment, 32(2), 255–263.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409–416.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G., Carpenter, J. K., & Curtiss, J. (2016). Interpersonal emotion regulation questionnaire (IERQ): Scale development and psychometric characteristics. Cognitive Therapy and Research, 40(3), 341–356.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hunt, C., Issakidis, C., & Andrews, G. (2002). DSM-IV generalized anxiety disorder in the Australian National Survey of mental health and well-being. Psychological Medicine, 32(4), 649–659.

    Article  PubMed  Google Scholar 

  • Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., Walters, E. E., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169–184.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88, 767–778.

    Article  Google Scholar 

  • Marroquín, B. (2011). Interpersonal emotion regulation as a mechanism of social support in depression. Clinical Psychology Review, 31(8), 1276–1290.

    Article  PubMed  Google Scholar 

  • McLaughlin, K. A., Mennin, D. S., & Farach, F. J. (2007). The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder. Behaviour Research and Therapy, 45(8), 1735–1752.

    Article  PubMed  Google Scholar 

  • Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43(10), 1281–1310.

    Article  PubMed  Google Scholar 

  • Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302.

    Article  PubMed  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998-2017). Mplus User’s Guide. Eighth Edition. Los Angeles, CA: Muthén & Muthén.

  • Schneider, R. L., Arch, J. J., & Wolitzky-Taylor, K. B. (2015). The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators. Clinical Psychology Review, 38, 39–54.

    Article  PubMed  Google Scholar 

  • Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.

    Article  Google Scholar 

  • Sclove, S. L. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52(3), 333–343.

    Article  Google Scholar 

  • Seedat, S., Scott, K. M., Angermeyer, M. C., Berglund, P., Bromet, E. J., Brugha, T. S., et al. (2009). Cross-national associations between gender and mental disorders in the World Health Organization world mental health surveys. Archives of General Psychiatry, 66(7), 785–795.

    Article  PubMed  PubMed Central  Google Scholar 

  • Totzeck, C., Teismann, T., Hofmann, S. G., von Brachel, R., Zhang, X. C., Pflug, V., & Margraf, J. (2018). Affective styles in mood and anxiety disorders– Clinical validation of the “affective style questionnaire” (ASQ). Journal of Affective Disorders, 238, 392–398.

    Article  PubMed  Google Scholar 

  • Turpyn, C. C., Chaplin, T. M., Cook, E. C., & Martelli, A. M. (2015). A person-centered approach to adolescent emotion regulation: Associations with psychopathology and parenting. Journal of Experimental Child Psychology, 136, 1–16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vesga-López, O., Schneier, F., Wang, S., Heimberg, R., Liu, S. M., Hasin, D. S., & Blanco, C. (2008). Gender differences in generalized anxiety disorder: Results from the National Epidemiologic Survey on alcohol and related conditions (NESARC). The Journal of Clinical Psychiatry, 69(10), 1606–1616.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vuong, Q. H. (1989). Likelihood ratio tests for model selection and non-nested hypotheses (pp. 307–333). Econometrica: Journal of the Econometric Society.

    Google Scholar 

  • Westphal, M., Seivert, N. H., & Bonanno, G. A. (2010). Expressive flexibility. Emotion, 10(1), 92–100.

    Article  PubMed  Google Scholar 

  • WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558.

    Article  Google Scholar 

  • Yonkers, K. A., Bruce, S. E., Dyck, I. R., & Keller, M. B. (2003). Chronicity, relapse, and illness—Course of panic disorder, social phobia, and generalized anxiety disorder: Findings in men and women from 8 years of follow-up. Depression and Anxiety, 17(3), 173–117.

    Article  PubMed  Google Scholar 

Download references

Contributors

Authors KC and JEC conceptualized the idea for this research and developed the methodological approach. Authors KC and ALB conducted the literature review. Author KC ran the analyses and wrote the first draft of the manuscript, with contributions and editing from JEC, ALB, SW, RL. Authors SGH, NMS, EB oversaw study design and management, data collection, and provided guidance on major methodological and conceptual decisions and provided revision of the manuscript. All authors have contributed to and approved the final manuscript.

Funding

This work was supported by the National Institute of Health/National Center for Complementary and Integrative Health (R01AT007257: PIs Simon and Hofmann).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stefan G. Hofmann.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (this study was approved by the Institutional Review Boards at three academic institutions: Boston University, Massachusetts General Hospital and New York University Langone Health) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. Hofmann receives support from the Alexander von Humboldt Foundation (as part of the Humboldt Prize), NIH/NCCIH (R01AT007257), NIH/NIMH (R01MH099021, U01MH108168), and the James S. McDonnell Foundation twenty-first Century Science Initiative in Understanding Human Cognition – Special Initiative, and the Department of the Army for work unrelated to the studies reported in this article. He receives compensation for his work as editor from SpringerNature and the Association for Psychological Science, and as an advisor from the Palo Alto Health Sciences and for his work as a Subject Matter Expert from John Wiley & Sons, Inc. and SilverCloud Health, Inc. He also receives royalties and payments for his editorial work from various publishers. Dr. Simon receives funding from the Patient Centered Outcomes Research Institute, Department of Defense, NIH, Highland Street Foundation, American Foundation for Suicide Prevention, and Janssen. She also receives compensation for her work as a speaker for the Massachusetts General Hospital Psychiatry Academy and her role as a consultant with Axovant Sciences, Springworks, Praxis Therapeutics, and Aptinyx. Her spouse has an equity stake in G1 Therapeutics. Dr. Bui receives royalties from Springer Nature for a textbook on Grief Reactions. Dr. Bui receives grant funding from the Elizabeth Dole Foundation, Patient Centered Outcomes Research Institute, NIH, and the Department of Defense.

All other authors declare they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Conroy, K., Curtiss, J.E., Barthel, A.L. et al. Emotion Regulation Flexibility in Generalized Anxiety Disorder. J Psychopathol Behav Assess 42, 93–100 (2020). https://doi.org/10.1007/s10862-019-09773-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-019-09773-8

Keywords

Navigation