Amanda J. Shallcross

A Person-by-Situation Approach to Emotion Regulation Cognitive Reappraisal Can Either Help or Hurt, Depending on the Context

Emotion regulation is central to psychological health. For instance, cognitive reappraisal (reframing an emotional situation) is generally an adaptive emotion-regulation strategy (i.e., it is associated with increased psychological health). However, a person-by-situation approach suggests that the adaptiveness of different emotion-regulation strategies depends on the context in which they are used. Specifically, reappraisal may be adaptive when stressors are uncontrollable (when the person can regulate only the self) but maladaptive when stressors can be controlled (when the person can change the situation). To test this prediction, we measured cognitive-reappraisal ability, the severity of recent life stressors, stressor controllability, and level of depression in 170 participants. For participants with uncontrollable stress, higher cognitive-reappraisal ability was associated with lower levels of depression. In contrast, for participants with controllable stress, higher cognitive-reappraisal ability was associated with greater levels of depression. These findings support a theoretical model in which particular emotion-regulation strategies are not adaptive or maladaptive per se; rather, their adaptiveness depends on the context.

Getting better with age: the relationship between age, acceptance, and negative affect.

Although aging involves cognitive and physical declines, it is also associated with improved emotional well-being, particularly lower negative affect. However, the relationship between age and global negative affect, versus discrete negative emotions, and the pathways that link age to lower negative affect are not well understood. We hypothesize that 1 important link between age and lower negative affect may be acceptance of negative emotional experiences. The present study examined this hypothesis in a community sample of 21- to 73-year-olds (N = 340) by measuring acceptance and multiple indices of negative affect: trait negative affect, negative experiential and physiological reactivity to a laboratory stress induction, daily experience of negative affect, and trait negative affect 6 months after the initial assessment. Negative affect was measured using a discrete emotions approach whereby anger, anxiety, and sadness were assessed at each time point. Age was associated with increased acceptance as well as lower anger and anxiety (but not sadness) across measurement modalities and time points. Further, acceptance statistically mediated the relationship between age on the one hand and anger and anxiety on the other hand. These results are consistent with the idea that acceptance may be an important pathway in the link between age and lower negative affect. Implications of these results for understanding the nature of age-related decreases in discrete negative emotions are discussed.

Too Much of a Good Thing? Cardiac Vagal Tone's Nonlinear Relationship With Well-Being

Parasympathetic regulation of heart rate through the vagus nerve--often measured as resting respiratory sinus arrhythmia or cardiac vagal tone (CVT)--is a key biological correlate of psychological well-being. However, recent theorizing has suggested that many biological and psychological processes can become maladaptive when they reach extreme levels. This raises the possibility that CVT might not have an unmitigated positive relationship with well-being. In line with this reasoning, across 231 adult participants (Mage = 40.02 years; 52% female), we found that CVT was quadratically related to multiple measures of well-being, including life satisfaction and depressive symptoms. Individuals with moderate CVT had higher well-being than those with low or high CVT. These results provide the first direct evidence of a nonlinear relationship between CVT and well-being, adding to a growing body of research that has suggested some biological processes may cease being adaptive when they reach extreme levels.

Relapse Prevention in Major Depressive Disorder: Mindfulness-Based Cognitive Therapy Versus an Active Control Condition

OBJECTIVE We evaluated the comparative effectiveness of mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. METHOD Ninety-two participants in remission from major depressive disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for nonspecific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. RESULTS Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (Group × Time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction postintervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. CONCLUSIONS MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions.

Illness perceptions mediate the relationship between depression and quality of life in patients with epilepsy

The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self‐report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = −.72, lower limit = −1.7, upper limit = −.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low‐income, racially/ethnically diverse patients with epilepsy.

Emotional reactivity and emotion regulation among adults with a history of self-harm: laboratory self-report and functional MRI evidence.

Intentionally hurting ones body (deliberate self-harm; DSH) is theorized to be associated with high negative emotional reactivity and poor emotion regulation ability. However, little research has assessed the relationship between these potential risk factors and DSH using laboratory measures. Therefore, we conducted 2 studies using laboratory measures of negative emotional reactivity and emotion regulation ability. Study 1 assessed self-reported negative emotions during a sad film clip (reactivity) and during a sad film clip for which participants were instructed to use reappraisal (regulation). Those with a history of DSH were compared with 2 control groups without a history of DSH matched on key demographics: 1 healthy group low in depression and anxiety symptoms and 1 group matched to the DSH group on depression and anxiety symptoms. Study 2 extended Study 1 by assessing neural responding to negative images (reactivity) and negative images for which participants were instructed to use reappraisal (regulation). Those with a history of DSH were compared with a control group matched to the DSH group on demographics, depression, and anxiety symptoms. Compared with control groups, participants with a history of DSH did not exhibit greater negative emotional reactivity but did exhibit lower ability to regulate emotion with reappraisal (greater self-reported negative emotions in Study 1 and greater amygdala activation in Study 2 during regulation). These results suggest that poor emotion regulation ability, but not necessarily greater negative emotional reactivity, is a correlate of and may be a risk factor for DSH, even when controlling for mood disorder symptoms.

Psychosocial factors associated with medication adherence in ethnically and socioeconomically diverse patients with epilepsy

The current study examined psychosocial correlates of medication adherence in a socioeconomically and racially diverse sample of patients with epilepsy. Fifty-five patients with epilepsy completed standardized self-report questionnaires measuring depression, stress, social support, and medication and illness beliefs. Antiepileptic drug (AED) adherence was measured using the 8-item Morisky Medication Adherence Scale 36% reported poor adherence. We tested which psychosocial factors were independently and most strongly associated with AED adherence. Stress and depression were negatively correlated with adherence, while perceived social support was positively correlated with adherence (Ps<.05). When all three of these variables and relevant covariates in a multiple regression model were included, only perceived social support remained a significant predictor of adherence (P=.015). This study is one of the first to suggest the importance of targeting social support in screening and intervention approaches in order to improve AED adherence among low-income, racially/ethnically diverse patients with epilepsy.

Thresholds for Ambulatory Blood Pressure Among African Americans in the Jackson Heart Study

Background: Ambulatory blood pressure (BP) monitoring is the reference standard for out-of-clinic BP measurement. Thresholds for identifying ambulatory hypertension (daytime systolic BP [SBP]/diastolic BP [DBP] ≥135/85 mm Hg, 24-hour SBP/DBP ≥130/80 mm Hg, and nighttime SBP/DBP ≥120/70 mm Hg) have been derived from European, Asian, and South American populations. We determined BP thresholds for ambulatory hypertension in a US population-based sample of African American adults. Methods: We analyzed data from the Jackson Heart Study, a population-based cohort study comprised exclusively of African American adults (n=5306). Analyses were restricted to 1016 participants who completed ambulatory BP monitoring at baseline in 2000 to 2004. Mean SBP and DBP levels were calculated for daytime (10:00 am–8:00 pm), 24-hour (all available readings), and nighttime (midnight–6:00 am) periods, separately. Daytime, 24-hour, and nighttime BP thresholds for ambulatory hypertension were identified using regression- and outcome-derived approaches. The composite of a cardiovascular disease or an all-cause mortality event was used in the outcome-derived approach. For this latter approach, BP thresholds were identified only for SBP because clinic DBP was not associated with the outcome. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 134/85 mm Hg, 130/81 mm Hg, and 123/73 mm Hg, respectively. The outcome-derived thresholds for daytime, 24-hour, and nighttime SBP corresponding to a clinic SBP ≥140 mm Hg were 138 mm Hg, 134 mm Hg, and 129 mm Hg, respectively. Among participants taking antihypertensive medication, the regression-derived thresholds for daytime, 24-hour, and nighttime SBP/DBP corresponding to clinic SBP/DBP of 140/90 mm Hg were 135/85 mm Hg, 133/82 mm Hg, and 128/76 mm Hg, respectively. The corresponding outcome-derived thresholds for daytime, 24-hour, and nighttime SBP were 140 mm Hg, 137 mm Hg, and 133 mm Hg, respectively, among those taking antihypertensive medication. Conclusions: On the basis of the outcome-derived approach for SBP and regression-derived approach for DBP, the following definitions for daytime, 24-hour, and nighttime hypertension corresponding to clinic SBP/DBP ≥140/90 mm Hg are proposed for African American adults: daytime SBP/DBP ≥140/85 mm Hg, 24-hour SBP/DBP ≥135/80 mm Hg, and nighttime SBP/DBP ≥130/75 mm Hg, respectively.

Psychosocial Correlates of Nocturnal Blood Pressure Dipping in African Americans: The Jackson Heart Study

BACKGROUND African Americans exhibit a lower degree of nocturnal blood pressure (BP) dipping compared with Whites, but the reasons for reduced BP dipping in this group are not fully understood. The aim of this study was to identify psychosocial factors associated with BP dipping in a population-based cohort of African Americans. METHODS This cross-sectional study included 668 Jackson Heart Study (JHS) participants with valid 24-hour ambulatory BP data and complete data on psychosocial factors of interest including stress, negative emotions, and psychosocial resources (e.g., perceived support). The association of each psychosocial factor with BP dipping percentage and nondipping status (defined as <10% BP dipping) was assessed using linear and Poisson regression models, respectively, with progressive adjustment for demographic, socioeconomic, biomedical, and behavioral factors. RESULTS The prevalence of nondipping was 64%. Higher depressive symptoms, higher hostility, and lower perceived social support were associated with a lower BP dipping percentage in unadjusted models and after adjustment for age, sex, body mass index, and mean 24-hour systolic BP (P < 0.05). Only perceived support was associated with BP dipping percentage in fully adjusted models. Also, after full multivariable adjustment, the prevalence ratio for nondipping BP associated with 1 SD (7.1 unit) increase in perceived support was 0.93 (95% CI: 0.88-0.99). No other psychosocial factors were associated with nondipping status. CONCLUSIONS Lower perceived support was associated with reduced BP dipping in this study. The role of social support as a potentially modifiable determinant of nocturnal BP dipping warrants further investigation.

Race/ethnicity moderates the relationship between chronic life stress and quality of life in type 2 diabetes.

AIMS To determine whether chronic life stress is differentially associated with quality of life (QoL) for Blacks vs. Hispanics with type 2 diabetes. METHODS We assessed self-reported chronic stress and QoL in 125 patients with type 2 diabetes who self-identified as either non-Hispanic Black or Hispanic. Separate cross-sectional two-way interaction models (stress × race/ethnicity) with physical and mental health as outcomes were examined. RESULTS The two-way interaction predicted mental (b=3.12, P=.04) but not physical health. Simple slopes analyses indicated that under conditions of high stress, Blacks (b=-4.4, P<.001), but not Hispanics, experienced significantly lower levels of mental health. In exploratory analyses, we examined a three-way interaction (stress × race/ethnicity × social support) with physical and mental health as outcomes. Results indicated the three-way interaction predicted mental (b=.62, P=.01) but not physical health. Simple slopes analyses indicated that under conditions of high stress, high levels of social support improved mental health for Hispanics (b=1.2, P<.001), but not for Blacks. CONCLUSIONS Black patients with type 2 diabetes may be particularly vulnerable to the deleterious effects of high chronic stress. Social support buffers effects of stress on mental health in Hispanics but not Blacks, which suggests differences in the use and/or quality of social support between Hispanics and Blacks. Longitudinal investigations that examine race/ethnicity, stress, social support, and QoL should help clarify the processes that underlie these observed relations.