Skip to main content
SpringerLink
Log in

Divergent Associations of Antecedent- and Response-Focused Emotion Regulation Strategies with Midlife Cardiovascular Disease Risk

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

It is not known whether various forms of emotion regulation are differentially related to cardiovascular disease risk.

Purpose

The purpose of this study is to assess whether antecedent and response-focused emotion regulation would have divergent associations with likelihood of developing cardiovascular disease.

Methods

Two emotion regulation strategies were examined: reappraisal (antecedent-focused) and suppression (response-focused). Cardiovascular disease risk was assessed with a validated Framingham algorithm that estimates the likelihood of developing CVD in 10 years. Associations were assessed among 373 adults via multiple linear regression. Pathways and gender-specific associations were also considered.

Results

One standard deviation increases in reappraisal and suppression were associated with 5.9 % lower and 10.0 % higher 10-year cardiovascular disease risk, respectively, in adjusted analyses.

Conclusions

Divergent associations of antecedent and response-focused emotion regulation with cardiovascular disease risk were observed. Effective emotion regulation may promote cardiovascular health.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update: A report from the American Heart Association. Circulation. 2011; 123: e18-e209.

    Article  PubMed  Google Scholar 

  2. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics-2010 update: A report from the American Heart Association. Circulation. 2010; 121: e46-e215.

    Article  PubMed  Google Scholar 

  3. Miller G, Chen E, Cole SW. Health psychology: Developing biologically plausible models linking the social world to physical health. Annu Rev Psychol. 2009; 60: 501-524.

    Article  PubMed  Google Scholar 

  4. Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular disease. Annu Rev Public Health. 2005; 26: 469-500.

    Article  PubMed  Google Scholar 

  5. Kobau R, Seligman MEP, Peterson C, et al. Mental health promotion in public health: Perspectives and strategies from positive psychology. Am J Public Health. 2011; 101: e1-e9.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Boehm JK, Kubzansky LD. The heart’s content: The association between positive psychological well-being and cardiovascular health. Psychol Bull. 2012. doi:10.1037/a0027448.

    PubMed  Google Scholar 

  7. Gross JJ, John OP. Individual differences in two emotion regulation processes: Implications for affect, relationships and well-being. J Pers Soc Psychol. 2003; 85: 348-362.

    Article  PubMed  Google Scholar 

  8. John OP, Gross JJ. Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. J Pers. 2004; 72: 1301-1334.

    Article  PubMed  Google Scholar 

  9. Gross JJ. Emotion regulation in adulthood: Timing is everything. Curr Dir Psychol Sci. 2001; 10: 214-219.

    Article  Google Scholar 

  10. Appleton AA, Kubzansky LD. Emotion regulation and cardiovascular disease risk. In: Gross JJ, ed. Hanbook of Emotion Regulation. 2nd ed. New York: The Guilford Press; 2014.

    Google Scholar 

  11. Consedine NS, Magai C, Bonanno GA. Moderators of the emotion inhibition-health relationship: A review and research agenda. Rev Gen Psychol. 2002; 6: 204-228.

    Article  Google Scholar 

  12. Appleton AA, Buka SL, Loucks EB, Gilman SE, Kubzansky LD. Divergent associations of adaptive and maladaptive emotion regulation strategies with inflammation. Health Psychol. 2013; 13: 748-756.

    Article  Google Scholar 

  13. Rozanski A, Kubzansky LD. Psychologic functioning and physical health: A paradigm of flexibility. Psychosom Med. 2005; 67: S47-S53.

    Article  PubMed  Google Scholar 

  14. Kubzansky LD, Park N, Peterson C, Vokonas P, Sparrow D. Healthy psychological functioning and incident coronary heart disease: The importance of self-regulation. Arch Gen Psychiatr. 2011; 68: 400-408.

    Article  PubMed  Google Scholar 

  15. Kinnunen M, Kokkonen M, Kaprio J, Pulkkinen L. The associations of emotion regulation and dysregulation with the metabolic syndrome factor. J Psychosom Res. 2005; 58: 513-521.

    Article  PubMed  Google Scholar 

  16. C Reactive Protein Coronary Heart Disease Genetics Collaboration. Association between C reactive protein and coronary heart disease: Mendelian randomisation analysis based on individual participant data. BMJ. 2011; 342: 1-8.

    Article  Google Scholar 

  17. Danesh D, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. New Engl J Med. 2004; 350: 1387-1397.

    Article  CAS  PubMed  Google Scholar 

  18. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice. A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003; 107: 499-511.

    Article  PubMed  Google Scholar 

  19. Elliott P, Chambers JC, Zhang W, et al. Genetic loci associated with c-reactive protein levels and risk of coronary heart disease. JAMA. 2009; 302: 37-48.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Appleton AA, Loucks EB, Buka SL, Rimm E, Kubzansky LD. Childhood emotional functioning and the developmental origins of cardiovascular disease risk. J Epidemiol Community Health. 2013; 67: 405-411.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Thurston RC, Kubzansky LD. Multiple sources of psychosocial disadvantage and risk of coronary heart disease. Psychosom Med. 2007; 69: 748-755.

    Article  PubMed  Google Scholar 

  22. Moller-Leimkuhler A. Higher comorbidity of depression and cardiovascular disease in women: A biopsychosocial perspective. World J Biol Psychiatry. 2010; 11: 922-933.

    Article  PubMed  Google Scholar 

  23. Lazarus RS. Emotion and Adaptation. New York: Oxford University Press; 1991.

    Google Scholar 

  24. Calkins SD, Hill A. Caregiver influences on emerging emotion regulation: Biological and environmental transactions in early development. In: Gross JJ, ed. Handbook of Emotion Regulation. New York: The Guilford Press; 2007: 229-248.

    Google Scholar 

  25. Thompson R. Family influences on emotion regulation. In: Gross JJ, ed. Handbook of Emotion Regulation. 2nd ed. New York: The Guilford Press; 2014.

    Google Scholar 

  26. Rothbart M, Posner M. Temperament and emotion regulation. In: Gross JJ, ed. Handbook of Emotion Regulation. 2nd ed. New York: The Guilford Press; 2014.

    Google Scholar 

  27. Shonkoff JP, Phillips DA, eds. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  28. Hart CL, Taylor MD, Davey Smith G, et al. Childhood IQ and cardiovascular disease in adulthood: Prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies. Soc Sci Med. 2004; 59: 2131-2138.

    Article  CAS  PubMed  Google Scholar 

  29. Pollitt RA, Rose KM, Kaufman JS. Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: A systematic review. BMC Public Health. 2005; 5: 7.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Berenson GS, Srnivasan SR. Cardiovascular risk factors in youth with implications for aging: The Bogalusa heart study. Neurobiol Aging. 2005; 26: 303-307.

    Article  CAS  PubMed  Google Scholar 

  31. D’Agostino RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: The Framingham Heart Study. Circulation. 2008; 117: 742-753.

    Google Scholar 

  32. Broman SH, Nichols PI, Kennedy WA. Preschool IQ: Prenatal and Early Developmental Correlates. New York: Hallstead Press; 1975.

    Google Scholar 

  33. Niswander KR, Gordon M. The Women and Their Pregnancies. Washington, DC: US Government Printing Office; 1972.

    Google Scholar 

  34. Almeida ND, Loucks EB, Kubzansky LD, et al. Quality of parental emotional care and calculated risk for coronary heart disease. Psychosom Med. 2010; 72: 148-155.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Allain CC, Poon LS, Chan CS, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974; 20: 470-475.

    CAS  PubMed  Google Scholar 

  36. Rafai N, Cole TG, Iannotti E, et al. Assessment of interlaboratory performance in external proficiency testing programs with a direct HDL-cholesterol assay. Clin Chem. 1998; 44: 1452-1458.

    Google Scholar 

  37. Mattu GS, Heran BS, Wright JM. Overall accuracy of the BpTRU - an automated electronic blood pressure device. Blood Press Monit. 2004; 9: 47-52.

    Article  PubMed  Google Scholar 

  38. Wechsler D. Wechsler Intelligence Scale for Children. New York: The Psychological Corporation; 1949.

    Google Scholar 

  39. Myrianthopoulos N, French K. An application of the U.S. Bureau of the Census socioeconomic index to a large, diversified patient population. Soc Sci Med. 1968; 2: 283-299.

    Article  CAS  PubMed  Google Scholar 

  40. CDC: Fact Sheets - Alcohol Use and Health. Retrieved 9/12/13, 2013 from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm.

  41. Willett WC. Nutritional Epidemiology. 2nd ed. New York: Oxford University Press; 1998.

    Book  Google Scholar 

  42. Michaud DS, Skinner HG, Wu K, et al. Dietary patterns and pancreatic cancer risk in men and women. J Natl Cancer Inst. 2005; 97: 518-524.

    Article  PubMed  Google Scholar 

  43. UCLA Academic Technology Services Statistical Consulting Group: Introduction to SAS. 2011.

  44. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51: 1173-1182.

    Article  CAS  PubMed  Google Scholar 

  45. Kramer HC, Kiernan M, Essex M. How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approachs. Health Psychol. 2008; 27: S101-S108.

    Article  Google Scholar 

  46. Gross JJ, Levenson RW. Emotion suppression: Physiology, self-report, and expressive behavior. J Pers Soc Psychol. 1993; 64: 970-986.

    Article  CAS  PubMed  Google Scholar 

  47. Gross JJ, Levenson RW. Hiding feelings: The acute effects of inhibiting negative and positive emotion. J Abnorm Psychol. 1997; 106: 95-103.

    Article  CAS  PubMed  Google Scholar 

  48. Black PH, Garbutt LD. Stress, inflammation and cardiovascular disease. J Psychosom Res. 2002; 52: 1-23.

    Article  PubMed  Google Scholar 

  49. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: The problems and implications of overlapping affective dispositions. Psychol Bull. 2005; 131: 260-300.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by National Institute of Aging grant AG023397, National Institutes of Health Transdisciplinary Tobacco Use Research Center (TTURC) Award (P50 CA084719) by the National Cancer Institute, the National Institute on Drug Abuse, and the Robert Wood Johnson Foundation. Dr. Appleton was supported by the National Heart Lung and Blood Institute Training Grant at the Harvard School of Public Health (T32 HL098048), and the Quantitative Biomedical Sciences training program at Geisel School of Medicine at Dartmouth (R25 CA134286).

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Appleton, Loucks, Buka, and Kubzansky declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Author information

Authors and Affiliations

  1. School of Public Health, Department of Epidemiology and Biostatistics, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144-3456, USA

    Allison A. Appleton ScD, MPH

  2. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Eric B. Loucks PhD & Stephen L. Buka ScD

  3. Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

    Laura D. Kubzansky PhD, MPH

Authors
  1. Allison A. Appleton ScD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric B. Loucks PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen L. Buka ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura D. Kubzansky PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allison A. Appleton ScD, MPH.

About this article

Cite this article

Appleton, A.A., Loucks, E.B., Buka, S.L. et al. Divergent Associations of Antecedent- and Response-Focused Emotion Regulation Strategies with Midlife Cardiovascular Disease Risk. ann. behav. med. 48, 246–255 (2014). https://doi.org/10.1007/s12160-014-9600-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-014-9600-4

Keywords

Search

Navigation