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.
Similar content being viewed by others
Notes
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.
Akaike, H. (1974). A new look at the statistical model identification. Automatic Control, IEEE Transactions on Automatic Control, 19, 716–723.
Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy, 48(10), 974–983.
Aldao, A., & Nolen-Hoeksema, S. (2012). The influence of context on the implementation of adaptive emotion regulation strategies. Behaviour Research and Therapy, 50, 493.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion regulation strategies across psychopathology: A meta-analysis. Clinical Psychology Review, 30, 217–237.
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.
Aldao, A., Sheppes, G., & Gross, J. J. (2015). Emotion regulation flexibility. Cognitive Therapy and Research, 39(3), 263–278.
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.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation.
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.
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.
Bradley, M. M., & Lang, P. J. (2000). Emotion and motivation. Handbook of Psychophysiology, 2, 602–642.
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.
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.
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.
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.
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.
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.
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.
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.
Craske, M. G., & Waters, A. M. (2005). Panic disorder, phobias, and generalized anxiety disorder. Annual Review of Clinical Psychology, 1(1), 197–225.
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.
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.
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.
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.
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.
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.
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.
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26.
Gupta, S., & Bonanno, G. A. (2011). Complicated grief and deficits in emotional expressive flexibility. Journal of Abnormal Psychology, 120(3), 635–643.
Hofmann, S. G. (2014). Interpersonal emotion regulation model of mood and anxiety disorders. Cognitive Therapy and Research, 38(5), 483–492.
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.
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.
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.
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.
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878.
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.
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.
Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88, 767–778.
Marroquín, B. (2011). Interpersonal emotion regulation as a mechanism of social support in depression. Clinical Psychology Review, 31(8), 1276–1290.
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.
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.
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.
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.
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.
Sclove, S. L. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52(3), 333–343.
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.
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.
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.
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.
Vuong, Q. H. (1989). Likelihood ratio tests for model selection and non-nested hypotheses (pp. 307–333). Econometrica: Journal of the Econometric Society.
Westphal, M., Seivert, N. H., & Bonanno, G. A. (2010). Expressive flexibility. Emotion, 10(1), 92–100.
WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558.
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.
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
Corresponding author
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
About this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10862-019-09773-8