Skip to main content

The Impact of Negative Emotions on Drinking Among Individuals with Social Anxiety Disorder in Daily Life: The Moderating Effect of Maladaptive Emotion Regulation Strategies

Cognitive Therapy and Research volume 44, pages 345–359 (2020)Cite this article

Abstract

Emerging evidence suggests that increased negative emotions and maladaptive emotion regulation (ER) strategies underlie social anxiety disorder (SAD) and alcohol related problems, but little is known about how specific negative emotions and maladaptive ER strategies interact with one another in predicting drinking in daily life. This study aimed to investigate (1) the impact of within-person level negative emotions and maladaptive ER strategies on drinking among individuals with SAD, and (2) the moderating effect of specific maladaptive ER strategies (avoidance, rumination, suppression) on the relationship between negative emotions and alcohol craving in daily life via an ecological momentary assessment (EMA). Results revealed that the SAD group (n = 66) showed a higher increase rate in alcohol craving when they were socially anxious, tense and lonely than the non-SAD group (n = 53). In moderation analyses, maladaptive ER strategies interacted with negative emotions in predicting alcohol craving and different patterns were observed between groups: rumination was a significant moderator for the SAD group, while avoidance was for the non-SAD group in both concurrent and lagged effect analyses. Implications for the future research and interventions on daily negative emotions and maladaptive ER strategies are discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

Notes

  1. In group-difference analyses, SAD group showed lower levels of positive emotions including excitement and relaxation and less frequent use in adaptive ER strategies including social support seeking and acceptance, all ps < .05. However, there were no significant group differences in calm and positive reinterpretation. Results from multilevel modeling analyses on the positive emotion experiences and adaptive ER strategies are available upon request.

References

  • Abrams, K., & Kushner, M. G. (2004). The moderating effects of tension-reduction alcohol outcome expectancies on placebo responding in individuals with social phobia. Addictive Behaviors,29(6), 1221–1224.

    Article  PubMed  Google Scholar 

  • Abrams, K., Kushner, M., Medina, K. L., & Voight, A. (2001). The pharmacologic and expectancy effects of alcohol on social anxiety in individuals with social phobia. Drug and Alcohol Dependence,64(2), 219–231.

    Article  CAS  PubMed  Google Scholar 

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review,30(2), 217–237.

    Article  PubMed  Google Scholar 

  • Arpin, S. N., Mohr, C. D., & Brannan, D. (2015). Having friends and feeling loney: A daily process examination of transient loneliness, socialization, and drinking behavior. Personality and Social Psychology Bulletin,41(4), 615–628.

    Article  PubMed  Google Scholar 

  • Babor, T. F., Berglas, S., Mendelson, J. H., Ellingboe, J., & Miller, K. (1983). Alcohol, affect, and the disinhibition of verbal behavior. Psychopharmacology (Berl),80(1), 53–60.

    Article  CAS  Google Scholar 

  • Babor, T. F., De la Fuente, J. R., Saunders, J., & Grant, M. (1989). AUDIT-the alcohol use disorders identification test: Guidlines for use in primary health care. Geneva: World Health Organization.

    Google Scholar 

  • Bonn-Miller, M. O., Vujanovic, A. A., & Zvolensky, M. J. (2008). Emotional dysregulation: Association with coping-oriented marijuana use motives among current marijuana users. Substance Use and Misuse,43(11), 1653–1665.

    Article  PubMed  Google Scholar 

  • Bradizza, C. M., Brown, W. C., Ruszczyk, M. U., Dermen, K. H., Lucke, J. F., & Stasiewicz, P. R. (2018). Difficulties in emotion regulation in treatment-seeking alcoholics with and without co-occurring mood and anxiety disorders. Addictive Behaviors,80, 6–13.

    Article  PubMed  Google Scholar 

  • Buckner, J. D., Heimber, R. G., Ecker, A. H., & Vinci, C. (2013). A biopsychosocial model of social anxiety and substance use. Depression and Anxiety,30(3), 276–284.

    Article  PubMed  Google Scholar 

  • Buckner, J. D., Schmidt, N. B., Lang, A. R., Small, J. W., Schlauch, R. C., & Lewinsohn, P. M. (2008a). Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research,42(3), 230–239.

    Article  PubMed  Google Scholar 

  • Buckner, J. D., & Terlecki, M. A. (2016). Social anxiety and alcohol-related impairment: The mediational impact of solitary drinking. Addictive Behaviors,58, 7–11.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buckner, J. D., Timpano, K. R., Zvolensky, M. J., Sachs-Ericsson, N., & Schmidt, N. B. (2008b). Implications of comorbid alcohol dependence among individuals with social anxiety disorder. Depression and Anxiety,25(12), 1028–1037.

    Article  PubMed  PubMed Central  Google Scholar 

  • Butler, T. R., Karkhanis, A. N., Jones, S. R., & Weiner, J. L. (2016). Adolescent social isolation as a model of heightened vulnerability to comorbid alcoholism and anxiety disorders. Alcoholism, Clinical and Experimental Research,40(6), 1202–1214.

    Article  PubMed  PubMed Central  Google Scholar 

  • Campbell-Sills, L., Ellard, K., & Barlow, D. (2013). Emotion regulation in anxiety disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (2nd ed., pp. 393–412). New York: Guilford Press.

    Google Scholar 

  • Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology,56(2), 267–283.

    Article  CAS  PubMed  Google Scholar 

  • Chandley, R. B., Luebbe, A. M., Messman-Moore, T. L., & Ward, R. M. (2014). Anxiety sensitivity, coping motives, emotion dysregulation, and alcohol-related outcomes in college women: A moderated-mediation model. Journal of Studies on Alcohol and Drugs,75(1), 83–92.

    Article  PubMed  Google Scholar 

  • Cho, Y. (2007). Assessing emotion dysregulation: Psychometric properties of the Korean version of the Difficulties in Emotion Regulation Scale. Korean Journal of Clinical Psychology.,26, 1015–1038.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral science (2nd ed.). London: Psychology Press.

    Google Scholar 

  • Collins, J. L., Sherry, S. B., McKee, K., Thompson, K., & Stewart, S. H. (2019). Do drinking motives and drinking contexts mediate the relationship between social avoidance and alcohol problems? Evidence from two studies of undergraduate drinkers. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-019-00092-3.

    Article  Google Scholar 

  • Conger, J. J. (1956). Reinforcement theory and the dynamics of alcoholism. Quarterly Journal of Studies on Alcohol,17, 296–305.

    CAS  PubMed  Google Scholar 

  • Earleywine, M., & Erblich, J. (1996). A confirmed factor structure for the biphasic alcohol effects scale. Experimental and Clinical Psychopharmacology,4(1), 107.

    Article  Google Scholar 

  • Eggleston, A. M., Woolaway-Bickel, K., & Schmidt, N. B. (2004). Social anxiety and alcohol use: Evaluation of the moderating and mediating effects of alcohol expectancies. Journal of Anxiety Disorders,18(1), 33–49.

    Article  Google Scholar 

  • Falk, D. E., Yi, H. Y., & Hilton, M. E. (2008). Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders. Drug and Alcohol Dependence,94(1–3), 234–245.

    Article  PubMed  PubMed Central  Google Scholar 

  • Farmer, A. S., & Kashdan, T. B. (2012). Social anxiety and emotion regulation in daily life: Spillover effects on positive and negative social events. Cognitive Behaviour Therapy,41(2), 152–162.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fox, H. C., Hong, K. A., & Sinha, R. (2008). Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers. Addictive Behaviors,33(2), 388–394.

    Article  CAS  PubMed  Google Scholar 

  • Goldin, P. R., Manber-Ball, T., Werner, K., Heimberg, R., & Gross, J. J. (2009). Neural mechanisms of cognitive reappraisal of negative self-beliefs in social anxiety disorder. Biological Psychiatry,66(12), 1091–1099.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., Goldstein, R. B.,… & Huang, B. (2005). The epidemiology of social anxiety disorder in the United States: Results from the national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 66(11), 1351–1361

  • Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W.,… & Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independentmood and anxiety disorders: Results from the national epidemiologic survey on alcohol and relatedconditions. Archives of General Psychiatry, 61(8), 807–816

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment,26(1), 41–54.

    Article  Google Scholar 

  • Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology,85(2), 348–362.

    Article  PubMed  Google Scholar 

  • Ham, L. S., & Hope, D. A. (2005). Incorporating social anxiety into a model of college student problematic drinking. Addictive Behaviors,30(1), 127–150.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: Understanding and treating human suffering. New York: Guilford.

    Google Scholar 

  • Hodgins, D. C., el-Guebaly, N., & Armstrong, S. (1995). Prospective and retrospective reports of mood states before relapse to substance use. Journal of Consulting and Clinical Psychology,63(3), 400–407.

    Article  CAS  PubMed  Google Scholar 

  • Kashdan, T. B., & Collins, R. L. (2010). Social anxiety and the experience of positive emotion and anger in everyday life: An ecological momentary assessment approach. Anxiety Stress and Coping,23(3), 259–272.

    Article  PubMed  Google Scholar 

  • Kashdan, T. B., Weeks, J. W., & Savostyanova, A. A. (2011). Whether, how, and when social anxiety shapes positive experiences and events: A self-regulatory framework and treatment implications. Clinical Psychology Review,31(5), 786–799.

    Article  PubMed  Google Scholar 

  • Keough, M. T., Battista, S. R., O’Connor, R. M., Sherry, S. B., & Stewart, S. H. (2016). Getting the party started—Alone: Solitary predrinking mediates the effect of social anxiety on alcohol-related problems. Addictive Behaviors,55, 19–24.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry,62(6), 593–602.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine,27(5), 1101–1119.

    Article  CAS  PubMed  Google Scholar 

  • Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S.,… & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8–19

  • Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry,4(5), 231–244.

    Article  CAS  PubMed  Google Scholar 

  • Khosravani, V., Bastan, F. S., Ghorbani, F., & Kamali, Z. (2017). Difficulties in emotion regulation mediate negative and positive affects and craving in alcoholic patients. Addictive Behaviors,71, 75–81.

    Article  PubMed  Google Scholar 

  • Kidorf, M., & Lang, A. R. (1999). Effects of social anxiety and alcohol expectancies on stress-induced drinking. Psychology of Addictive Behaviors,13(2), 134–142.

    Article  Google Scholar 

  • Kim, H. S. (2001). Memory bias in subtypes of social phobia. (Master’s Degree), Seoul University, Seoul, Korea.

  • Kim, S., Yoon, H. Y., & Kwon, J. H. (2013). Validation of the short form of the Korean Social Interaction Anxiety Scale (K-SIAS) and the Korean Social Phobia Scale (K-SPS). Cognitive Behavior Therapy in Korea,13(3), 511–535.

    Google Scholar 

  • Koval, P., Kuppens, P., Allen, N. B., & Sheeber, L. (2012). Getting stuck in depression: The roles of rumination and emotional inertia. Cognition and Emotion,26(8), 1412–1427.

    Article  PubMed  Google Scholar 

  • Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., ··· Dunbar, G. C. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231.

  • Lee, B. O., Lee, C. H., Lee, P. G., Choi, M. J., & Namkoong, K. (2000). Development of Korean version of Alcohol Use Disorders Identification Test (AUDIT-K): Its reliability and validity. Journal of Korean Academy of Addiction Psychiatry,4(2), 83–92.

    Google Scholar 

  • Lewis, M. A., Hove, M. C., Whiteside, U., Lee, C. M., Kirkeby, B. S., Oster-Aaland, L., et al. (2008). Fitting in and feeling fine: Conformity and coping motives as mediators of the relationship between social anxiety and problematic drinking. Psychology of Addictive Behaviors,22(1), 58–67.

    Article  PubMed  Google Scholar 

  • Magee, W. J., Eaton, W. W., Wittchen, H. U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry,53(2), 159–168.

    Article  CAS  PubMed  Google Scholar 

  • Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy,36(4), 455–470.

    Article  CAS  PubMed  Google Scholar 

  • McMahon, T. P., & Naragon-Gainey, K. (2018). The moderating effect of maladaptive emotion regulation strategies on reappraisal: A daily diary study. Cognitive Therapy and Research,42(5), 552–564.

    Article  Google Scholar 

  • Morris, E., Stewart, S., Theakston, J., & Mellings, T. (2004). Relations of social anxiety variables to drinking motives, levels, and problems in young adult drinkers. Paper presented at the 24th Annual Meeting of the Anxiety Disorders Association of America, Miami, FL, March.

  • Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology,61(1), 115–121.

    Article  CAS  PubMed  Google Scholar 

  • Norberg, M. M., Norton, A. R., Olivier, J., & Zvolensky, M. J. (2010). Social anxiety, reasons for drinking, and college students. Behavior Therapy,41(4), 555–566.

    Article  PubMed  Google Scholar 

  • O’Toole, M. S., Jensen, M. B., Fentz, H. N., Zachariae, R., & Hougaard, E. (2014). Emotion differentiation and emotion regulation in high and low socially anxious individuals: An experience sampling study. Cognitve Therapy and Resarch,38, 428–438.

    Article  Google Scholar 

  • Pe, M. L., Raes, F., Koval, P., Brans, K., Verduyn, P., & Kuppens, P. (2013). Interference resolution moderates the impact of rumination and reappraisal on affective experiences in daily life. Cognition and Emotion,27(3), 492–501.

    Article  PubMed  Google Scholar 

  • Posner, J., Russell, J. A., & Peterson, B. S. (2005). The circumplex model of affect: An integrative approach to affective neuroscience, cognitive development, and psychopathology. Development and Psychopathology,17(03), 715–734.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rodriguez, B. F., Bruce, S. E., Pagano, M. E., Spencer, M. A., & Keller, M. B. (2004). Factor structure and stability of the Anxiety Sensitivity Index in a longitudinal study of anxiety disorder patients. Behaviour Research and Therapy,42(1), 79–91.

    Article  PubMed  PubMed Central  Google Scholar 

  • Russell, J. A. (1980). A circumplex model of affect. Journal of Personality and Social Psychology,39, 1161–1178.

    Article  Google Scholar 

  • Saunders, J. B., Aasland, O. G., Amundsen, A., & Grant, M. (1993a). Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption—I. Addiction,88(3), 349–362.

    Article  CAS  PubMed  Google Scholar 

  • Saunders, J. B., Aasland, O. G., Babor, T. F., De la Fuente, J. R., & Grant, M. (1993b). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction,88(6), 791–804.

    Article  CAS  PubMed  Google Scholar 

  • Schneier, F. R., Foose, T. E., Hasin, D. S., Heimberg, R. G., Liu, S.-M., Grant, B. F., et al. (2010). Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine,40(6), 977–988.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schneier, F. R., Martin, L. Y., Liebowitz, M. R., Gorman, J. M., & Fyer, A. J. (1989). Alcohol abuse in social phobia. Journal of Anxiety Disorders,3(1), 15–23.

    Article  Google Scholar 

  • Schry, A. R., & White, S. W. (2013). Understanding the relationship between social anxiety and alcohol use in college students: A meta-analysis. Addictive Behaviors,38(11), 2690–2706.

    Article  PubMed  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry,59, 22–33.

    PubMed  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., et al. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry,12(5), 232–241.

    Article  Google Scholar 

  • Sher, K. J., & Levenson, R. W. (1982). Risk for alcoholism and individual differences in the stress-response-dampening effect of alcohol. Journal of Abnormal Psychology,91(5), 350–367.

    Article  CAS  PubMed  Google Scholar 

  • Stewart, S. H., Morris, E., Mellings, T., & Komar, J. (2006). Relations of social anxiety variables to drinking motives, drinking quantity and frequency, and alcohol-related problems in undergraduates. Journal of Mental Health,15(6), 671–682.

    Article  Google Scholar 

  • Swendsen, J. D., Tennen, H., Carney, M. A., Affleck, G., Willard, A., & Hromi, A. (2000). Mood and alcohol consumption: an experience sampling test of the self-medication hypothesis. Journal of Abnormal Psychology,109(2), 198–204.

    Article  CAS  PubMed  Google Scholar 

  • Terlecki, M. A., Ecker, A. H., & Buckner, J. D. (2014). College drinking problems and social anxiety: The importance of drinking context. Psychology of Addictive Behaviors,28(2), 545–552.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thomas, S. E., Randall, C. L., & Carrigan, M. H. (2003). Drinking to cope in socially anxious individuals: A controlled study. Alcoholism, Clinical and Experimental Research,27(12), 1937–1943.

    Article  PubMed  Google Scholar 

  • Wenzel, A., & Jager-Hyman, S. (2014). Social anxiety disorder and its relation to clinical syndromes in adulthood. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety clinical, developmental, and social perspectives (pp. 227–251). London: Academic Press.

    Google Scholar 

  • Willinger, U., Lenzinger, E., Hornik, K., Fischer, G., Schönbeck, G., Aschauer, H. N., et al. (2002). Anxiety as a predictor of relapse in detoxified alcohol-dependent patients. Alcohol and Alcoholism,37(6), 609–612.

    Article  PubMed  Google Scholar 

  • Wong, Q. J., McEvoy, P. M., & Rapee, R. M. (2019). Repetitive thinking in social anxiety disorder: Are anticipatory processing and post-event processing facets of an underlying unidimensional construct? Behavior Therapy,50(3), 571–581.

    Article  PubMed  Google Scholar 

  • Yoo, S. W., Kim, Y. S., Noh, J. S., Oh, K. S., Kim, C. H., Namkoong, K., et al. (2006). Validation of Korean version of the mini-international neuropsychiatric interview. Anxiety and Mood,2(1), 50–55.

    Google Scholar 

  • Zinbarg, R. E., Barlow, D. H., & Brown, T. A. (1997). Hierarchical structure and general factor saturation of the anxiety sensitivity index: Evidence and implications. Psychological Assessment,9(3), 277–284.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Korea University, 145, Anam-Ro Sungbuk-Gu, Seoul, 02841, Republic of Korea

    Sojung Kim & Jung-Hye Kwon

  2. Department of Psychiatry, Hanyang University Seoul Hospital, Seoul, Republic of Korea

    Sojung Kim

Authors
  1. Sojung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung-Hye Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung-Hye Kwon.

Ethics declarations

Conflict of Interest

Sojung Kim and Jung-Hye Kwon declare that they have no conflict of interest.

Informed Consent

All procedures were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants gave informed consent.

Animal Rights

No animal studies were carried out by the authors for this article.

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

Verify currency and authenticity via CrossMark

Cite this article

Kim, S., Kwon, JH. The Impact of Negative Emotions on Drinking Among Individuals with Social Anxiety Disorder in Daily Life: The Moderating Effect of Maladaptive Emotion Regulation Strategies. Cogn Ther Res 44, 345–359 (2020). https://doi.org/10.1007/s10608-019-10045-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-019-10045-8

Keywords

  • Social anxiety disorder (SAD)
  • Drinking
  • Negative emotions
  • Emotion regulation (ER)
  • Ecological momentary assessment (EMA)