Direct and indirect associations of cognitive reappraisal and suppression with disease biomarkers

Objective: Habitual use of emotion regulation strategies may influence physical health. We examined whether the tendencies to employ cognitive reappraisal and suppression were associated with health biomarkers, and whether stress and sleep quality mediated these associations. Design & main outcome measures: Using data from the Biomarkers substudy (n?=?1255) of the national Midlife in the U.S. Study, we tested the hypothesis that there would be indirect, but not direct, associations of cognitive reappraisal and suppression to biomarker indicators of multisystem physiological dysregulation, that is, allostatic load (AL). We computed the proportion of biomarkers in the highest risk quartile within seven biological systems, and summed these scores to compute AL. Associations with the biological systems were also examined separately.Results: Neither reappraisal nor suppression was directly associated with AL or biomarker function in the seven biological systems. Suppression was indirectly associated with higher AL and greater dysregulation in the inflammatory, metabolic, and hypothalamic-pituitary-adrenal systems via its relations to stress and sleep, p?<?0.05. Reappraisal was indirectly associated with lower AL and less metabolic and inflammatory dysregulation, ps<0.05.Conclusions: Suppression and reappraisal may have different downstream health effects via stress, sleep, and biomarker expression, suggesting malleable emotion regulation strategies may be an important intervention target.     

Emotion regulation and biological stress responding: associations with worry,rumination, and reappraisal

ABSTRACT

Individual differences in the habitual use of emotion regulation strategies may play a critical role in understanding psychological and biological stress reactivity and recovery in depression and anxiety. This study investigated the relation between the habitual use of different emotion regulation strategies and cortisol reactivity and recovery in healthy control individuals (CTL; n?=?33) and in individuals diagnosed with social anxiety disorder (SAD; n?=?41). The tendency to worry was associated with increased cortisol reactivity to a stressor across the full sample. Rumination was not associated with cortisol reactivity, despite its oft-reported similarities to worry. Worry and rumination, however, were associated with increased cortisol during recovery from the stressor. The only difference between CTL and SAD participants was observed for reappraisal. In the CTL but not in the SAD group, reappraisal predicted recovery, such that an increased tendency to reappraise was associated with greater cortisol recovery. These results suggest an important role of the habitual use of emotion regulation strategies in understanding biological stress reactivity and recovery.     

Emotion Regulation and Middle School Adjustment in Japanese Girls: Mediation by Perceived Social Support

Prior research has stated that successful emotion regulation (ER) contributes to psychological health and favorable interpersonal relationships. However, few studies have explored adaptive ER strategies in a school setting. The present study targeted Japanese female adolescents and examined the relationship between two specific ER strategies (reappraisal and suppression) and school adjustment, with social support as a mediating variable. Two hundred and seventy Japanese middle school girls completed measures of ER, perceived social support, and subjective school adjustment. The results showed that school adjustment was highest among reappraisers, followed by a balanced group who used both strategies with equal frequency, then suppressors. In addition, reappraisal showed both direct and indirect effects on school adjustment, while suppression showed only a negative indirect effect on school adjustment. Our findings suggest that reappraisal is an effective strategy that promotes receiving social support and consequently enhances school adjustment. Suppression, on the other hand, has neither favorable nor harmful impacts on school adjustment, but may, in the long run, result in poorer adjustment by impairing social relationships among adolescent girls.     

The effects of emotion regulation strategies on positive and negative affect in early adolescents

Recent research suggests that impaired emotion regulation (ER) may play an important role in the development of youth psychopathology. However, little research has explored the effects of ER strategies on affect in early adolescents. In Study 1 (n?=?76), we examined if early adolescents are able to use distraction and whether the effects of this strategy are similar to talking to one’s mother. In Study 2 (n?=?184), we compared the effects of distraction, cognitive reappraisal, acceptance, and rumination. In both studies, participants received instructions on how to regulate their emotions after a standardised negative mood induction. In general, the results indicated that distraction, but also cognitive reappraisal and acceptance, had promising short-term effects on positive and negative affect in early adolescents. These findings suggest that targeting adaptive ER skills, such as distraction, acceptance, and cognitive reappraisal, may be an important strategy to prevent or treat psychological problems in early adolescents.     

A longitudinal analysis of the relationship between self-compassion and the psychological effects of perceived stress

ABSTRACT

Self-compassion is consistently associated with psychological well-being, but most research has examined their relationship at only a single point in time. This study employed a longitudinal design to investigate the relationship between baseline self-compassion, perceived stress, and psychological outcomes in college students (n = 462) when the outcomes were measured both concurrently with perceived stress and after a lag of six months. Self-compassion moderated the effects of perceived stress such that stress was less strongly related to depression, anxiety, and negative affect among participants who scored high rather than low in self-compassion. Self-compassion also moderated the effects of perceived stress on depression and anxiety prospectively after six months. Self-compassion predicted positive affect but moderated the effects of perceived stress on positive affect in only one analysis. This study suggests that high self-compassion provides emotional benefits over time, partly by weakening the link between stress and negative outcomes.     

Compassionate reappraisal and emotion suppression as alternatives to offense-focused rumination: Implications for forgiveness and psychophysiological well-being

This within subjects experiment (28 females, 26 males) examined three responses to a past interpersonal offender. We contrasted offense-focused rumination with two subsequent, counterbalanced coping strategies: compassionate reappraisal and emotion suppression. Compassionate reappraisal emphasized the offender's human qualities and need for positive change. Emotion suppression inhibited the experience and expression of negative offense-related emotions. Offense rumination was associated with negative emotion, faster heartbeats (i.e., shortened electrocardiogram R-R intervals), and lower heart rate variability (HRV; i.e., the high-frequency component of the R-R power spectrum). By contrast, both compassionate reappraisal and emotion suppression decreased negative emotion in ratings and linguistic analyses, calmed eye muscle tension (orbicularis oculi EMG, electromyography), and maintained HRV at baseline levels. Suppression inhibited negative emotion expression at the brow (corrugator EMG) and slowed cardiac R-R intervals, but without forgiveness effects. Only compassionate reappraisal significantly increased positive emotions, smiling (zygomatic EMG), and social language along with forgiveness.     

Divergent effects of instructed and reported emotion regulation strategies on children’s memory for emotional information

ABSTRACT

Distraction can reduce adults’ memory for emotion-eliciting information, whereas reappraisal can preserve or enhance it. Yet, when given instructions to use specific emotion regulation (ER) strategies, adults report using other strategies too. The consequences of non-instructed strategy use within instructed ER paradigms are rarely examined. We investigated how both instructed and non-instructed but reported strategies related to memory for emotional information in childhood. Older (N?=?69; 8- to 10-year-olds; 24 girls) and younger (N?=?65; 5- to 7-year-olds; 35 girls) children received instructions to use cognitive distraction, reappraisal, or do nothing (control) before and after viewing a negative emotional film clip. Children were later interviewed about what they remembered about the film, and reported the ER strategies they used during it. Memory did not vary across instructed ER strategy conditions, and reported strategies did not relate to memory differently for older and younger children. Consistent with adult work, reported cognitive distraction related to poorer memory. Different reappraisal types were reported, but only situation-focused reappraisal was linked to better memory. In sum, children’s reported cognitive distraction and reappraisal strategies related to memory for emotional information differently. Thus, ER strategies divergently relate to what children remember about their emotional experiences.     

Impact of negative cognitions about body image on inflammatory status in relation to health

Objective: Evidence suggests that body dissatisfaction may relate to biological processes and that negative cognitions can influence physical health through the complex pathways linking psychological and biological factors.

Design: The present study investigates the relationships between body image satisfaction, inflammation (cytokine levels), aerobic fitness level and obesity in 96 middle-aged men and women (48 normal and 48 overweight). All participants underwent measurements of body satisfaction, body composition, serological measurements of inflammation and aerobic capabilities assessment.

Results: Body image dissatisfaction uniquely predicted inflammation biomarkers, C-reactive protein and tumour necrosis factor-α, even when controlled for obesity indicators. Thus, body image dissatisfaction is strongly linked to inflammation processes and may promote the increase in cytokines, representing a relative metabolic risk, independent of most traditional risk factors, such as gender, body mass index and intra-abdominal (waist to hip ratio) adiposity.

Conclusion: Results highlight the fact that person’s negative cognitions need to be considered in psychologically based interventions and strategies in treatment of obesity, including strategies for health promotion. Results contribute to the knowledge base of the complex pathways in the association between psychological factors and physical illness and some important attempts were made to explain the psychological pathways linking cognitions with inflammation.     

Effects of daily maladaptive coping on nightly sleep in mothers

Objective: We examined effects of daily rumination and suppression in response to stressors on objective and subjective sleep among mothers.

Design: Participants were 183 mothers, including chronically stressed mothers of children with an autism spectrum disorder (M-ASD; n = 92) and age-matched mothers of neurotypical children (M-NT; n = 91). In an intensive longitudinal design, participants provided reports of daily rumination and suppression, nightly objective actigraphy-defined sleep and nightly subjective sleep quality for seven consecutive days at baseline, 9 months and 18 months.

Main Outcome Measures: Total sleep time, sleep fragmentation, sleep onset latency, and subjective sleep quality.

Results: Among M-NT with above average depressive symptoms, higher daily rumination was associated with shorter total sleep time. Rumination was associated with more sleep fragmentation among M-NT at the trend level. Rumination was not associated with sleep onset latency among M-NT, or with any sleep outcomes among M-ASD. Suppression was not associated with any sleep outcomes.

Conclusion: We provide novel evidence of the effect of rumination on objectively measured sleep duration among M-NT. Coping was not related to sleep among M-ASD. Given the prevalence of poor sleep among mothers, future work should examine modifiable factors perpetuating sleep disturbance.     

The relation between emotion regulation choice and posttraumatic growth

ABSTRACT

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.     

Effects of emotion regulation strategies on anxiety during job interviews in Chinese college students

Background and objectives: Few studies related to the impact of different emotion regulation strategies on anxiety have used externally and ecologically valid emotion-eliciting stimuli or Eastern populations. The present study compares the effects of reappraisal, suppression, and acceptance on anxiety induced by a simulated job interview in a Chinese sample. Methods: Eighty-two subjects were randomly assigned to one of four instructions: reappraisal, suppression, acceptance, or no-regulation strategies during a simulated job interview. Anxiety was assessed with an observer-based behavior rating scale during the interview and the State Anxiety Inventory before, during, and after the interview. Results: A repeated-measures MANOVA indicated a significantly greater reduction in anxiety in the reappraisal and acceptance groups compared to the control group during the interview (reappraisal: d = 1.42; acceptance: d = 1.30; each p < .001), but not during the recovery stage. The suppression and control group did not differ in any stage. Suppression led to a higher (p_max < .04) anxiety than reappraisal/acceptance in the anticipation (d = 0.65/0.68), interview (d = 0.87/0.79), and recovery stages (d = 0.94/1.03). No significant differences were found between reappraisal and acceptance. Conclusions: In Chinese students reappraisal and acceptance seem to be more effective anxiety regulation strategies than suppression.     

Roles of Leisure in Coping with Stress Among University Students: A Repeated-Assessment Field Study

This article reports findings of a study to examine the effects of leisure coping on various stress coping outcomes including: immediate outcomes (perceived coping effectiveness, perceived satisfaction with coping outcomes, and perceived stress reduction) and distal or long-term outcomes (physical and mental ill-health and psychological well-being), above and beyond the contributions of general coping - coping not directly associated with leisure. A repeated-assessment field design was used to examine ways in which university students cope with stressors in their daily lives. The study found that leisure coping beliefs (leisure-generated dispositional coping resources) significantly predicted lower levels of mental and physical ill-health and greater levels of psychological well-being above and beyond the effects of general coping. Also, the use of leisure coping strategies (situation-specific stress coping strategies through leisure) was significantly associated with higher levels of perceived coping effectiveness and stress reduction when the effects of general coping were taken into account. Significant contributions of specific leisure coping dimensions were found as well.     

Emotion regulation mediates the relationship between personality and sleep quality

Objective: Despite a long history of interest in personality as well as in the mechanisms that regulate sleep, the relationship between personality and sleep is not yet well understood. The purpose of this study was to explore how personality affects sleep.

Design: The present cross-sectional study, based on a sample of 1291 participants with a mean age of 31.16 years (SD = 12.77), investigates the impact of personality styles, assessed by the Personality Adjectives Checklist (PACL), on subjective sleep quality, as well as the possible mediation of this relationship by dispositional emotion regulation (ER) styles.

Results: The dispositional use of suppression was a quite consistent predictor of poor subjective sleep quality for individuals scoring high on Confident, Cooperative or Introversive personality traits, but low on Respectful personality traits. Although a positive relationship between reappraisal and subjective sleep quality was found, there was only little evidence for a relationship between the assessed personality styles and the use of cognitive reappraisal.

Conclusion: The present results indicate that in the evaluation of subjective sleep, the impact of personality and ER processes, such as emotion suppression, should be taken into account.     

Rumination in migraine: Mediating effects of brooding and reflection between migraine and psychological distress

Objective: The relationship between migraine and psychological distress has been consistently reported in cross-sectional and longitudinal studies. We hypothesised that a stable tendency to perseverative thoughts such as rumination would mediate the relationship between migraine and psychological distress.

Design and Main Outcomes Measures: Self-report questionnaires measuring depressive rumination, current psychological distress and migraine symptoms in two independent European population cohorts, recruited from Budapest (N = 1139) and Manchester (N = 2004), were used. Structural regression analysis within structural equation modelling was applied to test the mediational role of brooding and reflection, the components of rumination, between migraine and psychological distress. Sex, age and lifetime depression were controlled for in the analysis.

Results: Migraine predicted higher brooding and reflection scores, and brooding proved to be a mediator between migraine and psychological distress in both samples, while reflection mediated the relationship significantly only in the Budapest sample.

Conclusions: Elevated psychological distress in migraine is partially attributed to ruminative response style. Further studies are needed to expand our findings to clinical samples and to examine how rumination links to the adjustment to migraine.     

Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community Over Five Years

This study evaluated the effectiveness, change mechanisms, and sustainability of a brief mindfulness intervention for people with multiple sclerosis (PwMS) delivered in the community through a frontline service over five years. Participants were 126 PwMS. A single intervention condition design was used with pre-intervention, post-intervention and 2-month follow-up assessments. The primary outcome was distress. Secondary outcomes were perceived stress, quality of life (QoL) and fatigue, and the proposed change mechanisms: mindfulness, self-compassion, psychological inflexibility. Intention-to-treat analyses showed the primary outcome, distress (Cohen’s d = .25), and all secondary outcomes improved: perceived stress (d = .38), mental health QoL (d = .39), physical health QoL (d = .47), fatigue (d = .30), mindfulness (d = .29), self-compassion (d = .37), psychological flexibility (d = .44). Distress, stress and perceived stress continued to improve post-intervention to follow-up. Mindfulness emerged as a temporal mediator of perceived stress (BCa 95% CI). Self-compassion mediated concurrent improvements in distress, perceived stress, fatigue and physical health QoL, while greater psychological flexibility mediated concurrent reductions in distress (BCa 95% CI). Mindfulness home practice was unrelated to improvements on all outcomes except a marginal association with mindfulness. Of the socio-demographic and illness factors, lower disease severity predicted improvements in physical health QoL (p = .046). Improvements in outcomes were supported by qualitative feedback and participant satisfaction ratings. Twenty-one groups were offered with good participant engagement and wide geographical reach, suggesting sustained feasibility of the Mindfulness for MS program over five years. Findings support the delivery of the Mindfulness for MS program through a community-based service in partnership with a local university.

     

Fitting In and Feeling Good

Abstract

This study examined self-evaluation (self-esteem, perceived physical attractiveness, and perceived social competence) and indicators of psychological stress (physical and somatic symptoms of depression and substance use) among 463 adolescent biracial girls from three different backgrounds: Black-White, Hispanic-White, and Asian-White. Patterns of self-evaluation and psychological stress were examined as a function of both parentage and self-identification as either White or non-White. Biracial girls were compared with nonbiracial girls on all variables. Results indicated that outcomes vary as a function of parentage and ethnic self-identification and that there is broad variability among biracial girls from different backgrounds.     

Reappraisal inventiveness: impact of appropriate brain activation during efforts to generate alternative appraisals on the perception of chronic stress in women*

Background and objectives: Previous research indicated that more left-lateralized prefrontal activation during cognitive reappraisal efforts was linked to a greater capacity for generating reappraisals, which is a prerequisite for the effective implementation of cognitive reappraisal in everyday life. The present study examined whether the supposedly appropriate brain activation is relevant in terms of more distal outcomes, i.e., chronic stress perception.

Design and methods: Prefrontal EEG alpha asymmetry was recorded while female participants were generating reappraisals for stressful events and was correlated with their self-reported chronic stress levels in everyday life (n?=?80).

Results: Women showing less left-lateralized brain activity in the ventrolateral prefrontal cortex during cognitive reappraisal efforts reported experiencing more stress in their daily lives. This effect was independent of self-efficacy beliefs in managing negative emotions.

Conclusion: These findings underline the practical relevance of individual differences in appropriate brain activation during emotion regulation efforts and the assumedly related basic capacity for the generation of cognitive reappraisals to the feeling of being stressed. Implications include the selection of interventions for the improvement of coping with stress in women in whom the capability for appropriate brain activation during reappraisal efforts may be impaired, e.g., due to depression or old age.     

Associations between heart rate,perceived heart rate,and anxiety during acute psychological stress

ABSTRACT

Background: Acute psychological stress elicits increases in heart rate (HR) and anxiety. Theories propose associations between HR, perceived HR, and anxiety during stress. However, anxiety is often measured as a unidimensional construct which limits a comprehensive understanding of these relationships.

Objectives: This research explored whether HR reactivity or perceived HR change was more closely associated with cognitive and somatic anxiety during acute psychological stress.

Design: Two laboratory-based studies were conducted.

Methods: In a single laboratory session, healthy male (N?=?71; study 1) and female (N?=?70; study 2) university students completed three laboratory psychological stress tasks (counterbalanced), each with a preceding baseline. Heart rate, perceived HR change, and cognitive and somatic anxiety intensity and interpretation of anxiety symptoms were assessed immediately following each task. Data were aggregated across tasks.

Results: Actual HR change was unrelated to anxiety intensity, but was associated with more debilitative interpretations of anxiety (study 2). Perceptions of HR change were consistently associated with greater intensity of cognitive (study 1) and somatic (study 1 and 2) anxiety.

Conclusions: Perceived HR rather than actual HR is more closely associated with anxiety intensity during psychological stress. The findings have implications for stress management and the clinical treatment of anxiety symptoms.     

Should we suppress or reappraise our stress?: the moderating role of reappraisal on cortisol reactivity and recovery in healthy adults

Background: People differ in their ability to regulate their physiological stress response. Individual differences in emotion regulation strategies such as suppression and reappraisal may explain this differential response to stress.

Objective: The aim of the current study was to assess whether daily use of suppression and reappraisal as well as their interaction predicted physiological stress reactivity and/or recovery, as assessed by variations in cortisol levels.

Method: Thirty-eight healthy young adults (13 men) completed the Emotion Regulation Questionnaire and were exposed to a psychosocial stressor, throughout which salivary cortisol was measured.

Results: Linear regressions showed main effects of reappraisal and suppression on cortisol reactivity and a main effect of suppression on cortisol recovery, where both strategies were positively associated with stress phases. Moreover, results showed a significant interaction of suppression by reappraisal in predicting both cortisol reactivity and recovery. Simple slope tests revealed that reappraisal moderated the association between suppression and both phases of cortisol responsivity.

Conclusion: Our results suggest that reappraisal represents a protective factor against the deleterious effects of suppression on stress responsivity. This study underlines the importance of investigating emotion regulation strategies as a means to understand individual differences in vulnerability to stress-related psychopathologies such as anxiety and depression.     

Interference resolution moderates the impact of rumination and reappraisal on affective experiences in daily life

Research has shown that cognitive control processes play a central role in emotion regulation. While most research has examined whether individual differences in such processes are related to the use of these strategies, a crucial next step involves examining whether such differences influence their impact on people's feelings, especially in normal daily life. The present study examined whether impairments in cognitive control (measured using an affective interference resolution task) moderate the impact of using rumination and reappraisal on affective experiences in everyday life (assessed using experience sampling methods). Multilevel analyses revealed that difficulties removing previously relevant negative information from working memory were associated with a larger increase in negative affect following rumination, and smaller increase and decrease in positive and negative affect, respectively, following reappraisal. These findings show that impaired interference resolution for negative information aggravates the deleterious effects of rumination and curbs the benefits of reappraisal in daily life.