Emotion Dysregulation and Military Suicidality Since 2001: A Review of the Literature

Policy makers and researchers have worked to explain the perplexing rise in U.S. military suicides since 2001, with little progress in explaining this widespread phenomenon. This article synthesizes several literatures to highlight the role of emotion dysregulation in military suicidality. After considering advances in suicidal ideation‐to‐action frameworks and the factors that contribute to the prevalence of emotion dysregulation in the modern U.S. military, it explores how military service provides for two distinct circumstances in which such emotion dysregulation may facilitate the transition from suicidal ideation to behavior. The first circumstance is high distress tolerance, wherein the effects of disproportionately high rates of adverse childhood experiences (ACEs) among service‐members may increase vulnerability to suicidal behavior. The second circumstance is preexisting acquired capability with lethal means paired with executive functioning degradation. Empirically associated with military environments, such degradation may undermine the effectiveness of top‐down emotion regulation strategies—thereby allowing acquired familiarity with lethal means to assist the transition from suicidal ideation to action. Thus, emotion dysregulation’s unique relationship with the U.S. military may help to explain the powerful correlation between service and suicide since 2001—suggesting that enhancing emotion regulation skills may present a key leverage point for effectively addressing the issue.     

The Nature of the Association between Anxiety Sensitivity and Pain-Related Anxiety: Evidence from Correlational and Intervention Studies

High anxiety sensitivity (AS) has been associated with elevated pain-related anxiety in anxiety and pain samples. The present study investigated (a) the associations among the lower order dimensions of AS and pain-related anxiety, using a robust measure of AS, and (b) the pain-related anxiety outcomes of a telephone-delivered cognitive behavioural treatment (CBT) designed to reduce high AS. Participants were 80 anxiety treatment-seeking participants with high AS (M age = 36 years; 79% women). After providing baseline data on AS and pain-related anxiety, participants were randomly assigned to an eight-week telephone CBT or a waiting list control. At baseline, bivariate correlations showed AS physical and cognitive, but not social, concerns were significantly associated with pain-related fear and arousal but not escape/avoidance behaviours. Multiple regression revealed that after accounting for emotional distress symptoms, AS physical, but not cognitive or social, concerns uniquely predicted pain-related anxiety. Multilevel modelling showed that the AS-targeted CBT reduced pain-related anxiety and treatment-related changes in global AS and AS physical concerns mediated changes in pain-related anxiety. Results suggest that an AS-targeted intervention may have implications for reducing pain-related anxiety. Further research is needed in a chronic pain sample.     

The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity

Poor distress tolerance (DT) is considered an underlying facet of anxiety, depression, and a number of other psychological disorders. Mindfulness may help to increase DT by fostering an attitude of acceptance or nonjudgment toward distressing experiences. Accordingly, the present study examined the effects of a brief mindfulness training on tolerance of different types of distress, and tested whether trait mindfulness moderates the effect of such training. Undergraduates (n = 107) naïve to mindfulness completed a measure of trait mindfulness and underwent a series of stress tasks (cold pressor, hyperventilation challenge, neutralization task) before and after completing a 15-minute mindfulness training or a no-instruction control in which participants listened to relaxing music. Participants in the mindfulness condition demonstrated greater task persistence on the hyperventilation task compared to the control group, as well as a decreased urge to neutralize the effects of writing an upsetting sentence. No effect on distress ratings during the tasks were found. Overall trait mindfulness did not significantly moderate task persistence, but those with lower scores on the act with awareness facet of mindfulness demonstrated greater relative benefit of mindfulness training on the hyperventilation challenge. Mediation analyses revealed significant indirect effects of mindfulness training on cold pressor task persistence and urges to neutralize through the use of the nonjudge and nonreact facets of mindfulness. These results suggest that a brief mindfulness training can increase DT without affecting the subjective experience of distress.     

Self-Criticism,Neediness, and Distress in the Prediction of Suicide Ideation: Results from Cross-Sectional and Longitudinal Studies

The aim of the present study was to test whether the maladaptive personality traits of self-criticism and neediness predict suicide ideation when controlling for general distress. Further, potential interactive effects on suicide ideation of the two traits and distress were also evaluated. Two studies with nonclinical samples were conducted. The first investigation was cross-sectional and involved a final sample of 202 community adults while the second study was longitudinal with a final sample of 207 college students. Results of Study 1 demonstrated that self-criticism, but not neediness, associated with suicide ideation and, in doing so, also interacted with distress. Neediness also tended to interact with self-criticism in the prediction of suicide ideation. Results from Study 2 were similar and confirmed the Study 1 results. Changes in self-criticism, but not changes in neediness, predicted changes in suicide ideation after statistically controlling for changes in distress. Changes in the interaction between self-criticism and distress predicted changes in suicide ideation and changes in the interaction between self-criticism and neediness tended to predict changes in suicide ideation. Results are discussed with regard to their implications for psychological intervention.     

Clarifying the Relationship of Dissociative Experiences to Suicide Ideation and Attempts: A Multimethod Examination in Two Samples

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one’s body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (M_age = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (M_age = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to “third variables” associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.     

The Interaction of Extraversion and Anxiety Sensitivity on Social Anxiety: Evidence of Specificity Relative to Depression

Neuroticism and extraversion have been linked to the etiologies and course of anxiety and mood disorders, such that neuroticism is broadly associated with numerous disorders and extraversion is most strongly associated with social anxiety and depression. While previous research has established the broad associations between temperament and emotional disorders, less is known about the specific, proximal factors that are associated with them, and very few studies have situated these risk factors into a larger etiological model that specifies how they may relate to one another. The current study examined the interaction of extraversion and anxiety sensitivity (AS) in predicting social anxiety symptoms in a large, diagnostically diverse clinical sample (N = 826). Symptoms were assessed with self-report and dimensional interview measures, and regression analyses were performed examining the main effects and interaction of extraversion and AS (examining both total and lower-order components) on social anxiety. Results showed that at higher levels of AS, the inverse relationship between extraversion and social anxiety was stronger, and the social concerns component of AS is responsible for this effect. This interaction was also observed with regard to depression symptoms, but the interaction was not present after accounting for shared variance (i.e., comorbidity) between depression and social anxiety symptoms. Clinical and theoretical implications of the results are discussed.     

父母教养方式对子女焦虑的影响：认知情绪调节策略与男性化特质的中介作用

本研究通过对269名在校大学生进行父母教养方式、情绪调节策略的使用、男性化特质和焦虑水平的测查,探讨了父母教养方式对子女焦虑产生影响的可能机制。结果发现,研究建构的模型对焦虑的整体解释率为26%。父母教养方式主要通过三种途径影响子女焦虑：（1）直接对子女焦虑产生影响;（2）以灾难化和积极重评这两种情绪调节策略为中介,间接影响子女焦虑;（3）促成子女男性化特质的形成,该特质通过积极重评策略的完全中介作用,间接影响子女焦虑。     

Evaluating the Etiology of Anxiety Sensitivity: Relation to Cardiovascular Perception and Reactivity

A large body of research has suggested that anxiety sensitivity (AS) acts as a specific vulnerability factor in the development of anxiety pathology. More recently, attention has turned to the etiology of AS per se. The present study tested several related etiological hypotheses derived from Expectancy theory. S. Reiss and R. J. McNally (1985) originally proposed that greater physiological reactivity would increase risk for developing heightened AS. Reactive individuals are believed to have greater opportunity to perceive unpleasant bodily perturbations, thereby increasing the likelihood that concerns and fears could be attached to the sensations. Nonclinical participants (N = 86) completed physical (e.g., orthostatic) and biological (e.g., 35% CO₂) challenges and a heart beat perception task. AS was not related to heart beat perception but was related to greater tonic heart rate and greater diastolic blood pressure (DBP) reactivity to both the challenges. Higher DBP and higher heart beat accuracy interacted to predict higher AS.     

中学生不同焦虑水平与认知策略研究

使用测试方式对中学生的焦虑水平和认知策略之间的关系进行了研究。结果发现,在7钟认知策略中能力认识、失败归因、命运控制和社会关系4种认知策略在三个级别的焦虑组之间存在显著差异,焦虑水平高的人倾向于使用否定自身能力、选取失败、悲惨宿命论和消极社会关系认知策略。除成就认识外．其他认知策略不存在性别差异,女性倾向于产生低成就认知。     

焦虑调节：接受策略与表达抑制、认知重评策略之比较

情绪调节策略研究已经成为近年来心理学研究的热点课题。回顾近十年来关于焦虑的情绪调节策略研究,重点介绍了其中有着新理念、新视角的情绪调节策略——接受策略,并将其与表达抑制和认知重评两种情绪调节策略进行对比,发现接受策略对于焦虑而言是一种有效的调节策略,而且初步得出其作用效果优于表达抑制策略,但可能不及认知重评策略。最后从情绪调节策略的研究趋势、情绪调节策略对心理治疗和心理健康教育等的潜在价值三个方面进行了探讨。     

Firearms Matter: The Moderating Role of Firearm Storage in the Association Between Current Suicidal Ideation and Likelihood of Future Suicide Attempts Among United States Military Personnel

The relationship between firearm ownership and suicide is well documented. This study hypothesized that how soldiers store their firearms would moderate the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, and that this relationship would be explained by fearlessness about death. There were 432 military personnel (91.3% men, 74.2% White, M_age = 27.60) who endorsed current ownership of a private firearm and who were recruited from a military base in the southeastern United States (94.5% National Guard). Firearm storage moderated the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, but this relationship was not explained by fearlessness about death. Individuals who reported keeping their firearms loaded and stored in an unsecure location exhibited higher mean levels of fearlessness about death. Findings highlight the need for research examining contributors to suicide risk in the context of firearm storage, and provide support for suicide prevention efforts involving restricting means.     

Assessing the Relationship Between Cold Pressor Pain Responses and Dimensions of the Anxiety Sensitivity Profile in Healthy Men and Women

Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS; (ii) examining whether different coping instructions affect pain reports; and (iii) investigating potential differences between men and women. Participants were 50 healthy adults (23 males, 27 females) who were required to complete 2 versions of the cold pressor pain task; one version required the use of control instructions, whereas the other made use of acceptance‐based instructions. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds), a similar pattern of correlations were found between the pain indexes and AS under both conditions. Of the ASP subscales, the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. When the analysis was conducted separately for each sex, the ASP scales were related to the self‐report measures of pain in women, whereas they were related to the behavioural measures of pain in men. These results not only confirm that AS is associated with experimental pain, but that there may be sex differences in this relationship.     

The Emotional Foundation of Political Cognition: The Impact of Extrinsic Anxiety on the Formation of Political Tolerance Judgments

Common sense recognizes emotion's ability to influence judgments. We argue that affective processes, in addition to generating feeling states, also influence how political cognition is manifested. Drawing on the theory of affective intelligence, we examine the role that anxiety plays in how and when people rely on predispositions and when they rely on contemporaneous information in making political tolerance judgments. We report on two experimental studies to test our arguments. In the first study we find that extrinsic anxiety generates a resistance response among subjects who hold a strong predisposition and a receptive response among those who do not. In the second study we present subjects with explicit "frames" exposing them to a pro- or anti-free speech message. We find that extrinsic anxiety enhances responsiveness to frames while an absence of anxiety diminishes the impact of these frames. Taken together these results show that affective processes shape how people make political judgments.     

The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder

Distress tolerance (DT) and intolerance of uncertainty (IU) have been identified as transdiagnostic processes that predict symptom severity across a range of distinct anxiety disorders. However, the joint effect of these two variables on therapeutic outcome has not yet been examined. It is possible that DT and IU may both impact on treatment response to cognitive-behavioural therapy (CBT) in clients with anxiety, as clients with weak DT and strong IU may be less likely to engage in exposure and cognitive restructuring tasks across treatment due to their associated distress. The purpose of this study was to examine the interaction of DT and IU as predictors of post-treatment symptom severity and treatment response to group CBT in participants with primary DSM-IV-TR diagnosed social anxiety disorder (SAD). Participants (N = 95) with SAD completed 12 weeks of manualized group CBT. Results of multilevel longitudinal analysis demonstrated an interaction effect, such that lower DT and higher IU predicted higher SAD symptom severity across the course of therapy. The findings are discussed in terms of clinical implications for the disorder-specific and transdiagnostic treatment of anxiety disorders.     

Disentangling the Impact of Resistance and Ambivalence on Therapy Outcomes in Cognitive Behavioural Therapy for Generalized Anxiety Disorder

Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients’ arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.     

The Existential Function of Intrinsic Religiousness: Moderation of Effects of Priming Religion on Intercultural Tolerance and Afterlife Anxiety

Managing existential concerns is theorized to be a key function of religion. We posit that priming religion should be related to greater existential security for those high in intrinsic religiosity. In Experiment 1, priming religion increased intercultural tolerance among individuals who were highly intrinsically religious but decreased it for those low in intrinsic religiousness. In Experiment 2, intrinsic religiousness again moderated the effects of the prime, suggesting that priming religion resulted in attenuated afterlife anxiety for intrinsically religious individuals but greater anxiety for individuals low in intrinsic religiousness. Religious reminders appeared to provide existential security—evidenced by tolerance and reduced death anxiety—only to those high in intrinsic religiousness and can be threatening to those low in intrinsic religiousness. Existential outcomes are a specific case in which intrinsic religiousness can moderate the effects of religious primes, suggesting that religion plays a different existential role for different people.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

Gut interpretations: how difficulties in emotion regulation may help explain the relation of visceral sensitivity with depression and anxiety among young adults with gastrointestinal symptoms

It is widely recognized that abdominal pain and discomfort are common problems in the United States and are often associated with negative quality of life. The prevalence of anxiety/depression elevations and disorders among persons with gastrointestinal disturbances (GI) is estimated to be at least two to three times the rate in the general population. Visceral sensitivity reflects anxiety about GI sensations and its accompanying contexts and often leads to worsening of sensations (e.g. bloating, upset stomach, diarrhea). Among individuals with GI symptoms, visceral sensitivity may be associated with interpreting common sensations as catastrophic which may be related to greater difficulties with emotion dysregulation (e.g. severe anxiety and depression). The current study evaluated the indirect association of visceral sensitivity via emotion dysregulation in relation to depression, anxious arousal, and social anxiety symptoms among 344 young adults with a current history of GI symptoms and problems. Results indicated an indirect effect of visceral sensitivity via emotion dysregulation. These findings provide novel empirical support for the association of visceral sensitivity with emotional distress symptoms among young adults with GI symptoms. Based on the results, targeting emotion dysregulation may be a promising health promotion tactic among young adults with GI symptoms and disorders.     

领悟社会支持对社交焦虑的影响:反刍思维的中介作用和社会阻抑的调节作用

本研究旨在探索领悟社会支持对社交焦虑的影响,深入探讨社会阻抑和反刍思维对该影响的作用。方法:采用问卷法,以471名职员为被试进行调查,数据结果分析采用Bootstrap分析方法。结果显示:(1)反刍思维在领悟社会支持和社交焦虑之间起中介作用。领悟社会支持通过降低反刍思维的水平,减轻社交焦虑。(2)社会阻抑调节领悟社会支持→反刍思维→社交焦虑中介模型的前半路径,社会阻抑改变了领悟社会支持对反刍思维作用的大小。     

Anxiety sensitivity and its impact on pain experiences and conditions: A state of the art

This paper serves as an introduction to the special issue of Cognitive Behaviour Therapy devoted to the topic of anxiety sensitivity (AS) and its impact on pain experiences and conditions. We provide a historical overview of relevant cognitive behavioural models of chronic pain, summarize recent models incorporating the AS construct, and introduce the papers in the special issue. These papers are organized into two sets – basic laboratory‐based investigations and relatively more applied studies. We attempt to highlight some of the most important findings from each of these investigations and studies, in turn. Then, we consider several important conclusions derived from the set of special issue papers and the implications of these for the practice of cognitive‐behavioural interventions with pain populations. Finally, we make several suggestions for directions for future investigations in this burgeoning area of cognitive behavioural research and practice.