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Emotion Regulation in Depression and Anxiety: Examining Diagnostic Specificity and Stability of Strategy Use

Cognitive Therapy and Research volume 37, pages 968–980 (2013)Cite this article

Abstract

Many psychological disorders are characterized by difficulties in emotion regulation. It is unclear, however, whether different disorders are associated with the use of specific emotion regulation strategies, and whether these difficulties are stable characteristics that are evident even after recovery. It is also unclear whether the use of specific strategies is problematic across all disorders or whether disorders differ in how strongly strategy use is associated with symptom severity. This study investigated (1) the specificity of use of emotion regulation strategies in individuals diagnosed with current major depressive disorder (MDD), with social anxiety disorder (SAD), and in never-disordered controls (CTL); and (2) the stability of strategy use in formerly depressed participants (i.e., remitted; RMD). Path analysis was conducted to examine the relation between strategy use and symptom severity across diagnostic groups. Compared to the CTL group, participants in both clinical groups endorsed more frequent use of rumination and expressive suppression, and less frequent use of reappraisal. Specific to SAD were even higher levels of expressive suppression relative to MDD, as well as a stronger relation between rumination and anxiety levels. In contrast, specific to MDD were even higher levels of rumination and lower levels of reappraisal. Interestingly, elevated rumination, but not decreased reappraisal, was found to be a stable feature characterizing remitted depressed individuals. These results may provide insight into ways in which emotion regulation strategy use maintains psychological disorders.

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Fig. 1

Notes

  1. We use the term specificity to refer to relative specificity, indicating that use of a particular strategy is more elevated in one group than another, rather than present in one group and absent in another.

  2. The data were collected as the first part of ongoing data collection in our labs. Participants were assigned to participate in additional tasks after completion of the diagnostic interview and the questionnaires, including tasks which were part of various sub- studies of depression and social anxiety. Separate advertisements targeting individuals currently experiencing (1) depression, (2) social anxiety, and (3) individuals with no current or past depression or psychiatric concerns (controls) were posted throughout the community. Individuals in the remitted depressed group were drawn from individuals responding to the depression ads who did not currently meet MDD criteria, but met criteria for a past episode. The ads described the symptoms of each disorder and invited individuals currently experiencing these symptoms to contact the lab if interested in taking part in the study. Throughout the course of enrollment, a greater number of depression ads were posted, reflecting a greater focus of studies in our lab on depression. This contributed to different sample sizes across diagnostic groups. Given the ads were identical with the exception of the symptoms being described, the nature of the ads should not have resulted in differential representativeness of the diagnostic groups.

  3. As data on suppression and reappraisal was not collected until mid-way into enrollment for the study, this resulted in smaller sample sizes for analyses of these variables. Individuals missing this data were included in analyses of diagnostic group differences in rumination frequency, as well as in the SEM analyses, as missing data on these emotion regulation variables was missing at random.

  4. As some prior studies have found different subcomponents of rumination to differ in relation to symptoms of psychopathology, we also examined diagnostic group differences in brooding, a subscale of the RRS assessing more maladaptive rumination, and reflection, the RRS subscale assessing a more adaptive form of rumination. Brooding and reflection were significantly correlated in the present sample, r = .47, p = .00. The MDD and SAD groups were elevated on both the brooding and reflection subscales compared to CTLs. However, the MDD compared to SAD group was elevated only in brooding, t(244) = 3.47, p = .00, not reflection, t(244) = .1.65, p = .10. In addition, compared to the CTL group, t(297) = 5.23, p = .00, only elevated brooding, but not reflection, t(294) = 1.84, p = .07, was seen in the RMD group. Both brooding and reflection showed significant positive correlations with BDI and STAI-T levels for all diagnostic groups, with the exception that only brooding, but not reflection, was correlated with BDI and STAI-T in the RMD group.

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Acknowledgments

This research was supported by NIMH Grants MH059259 and MH080683 awarded to Ian H. Gotlib.

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The authors have no potential conflicts of interest pertaining to this manuscript.

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  1. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33124, USA

    Catherine D’Avanzato, Jutta Joormann & Matthias Siemer

  2. Department of Psychology, Stanford University, Palo Alto, CA, USA

    Ian H. Gotlib

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  1. Catherine D’Avanzato
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D’Avanzato, C., Joormann, J., Siemer, M. et al. Emotion Regulation in Depression and Anxiety: Examining Diagnostic Specificity and Stability of Strategy Use. Cogn Ther Res 37, 968–980 (2013). https://doi.org/10.1007/s10608-013-9537-0

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Keywords

  • Depression
  • Social anxiety
  • Emotion regulation
  • Rumination
  • Suppression
  • Reappraisal