Amelia Aldao

Emotion-regulation strategies across psychopathology: A meta-analytic review.

We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that examined the relationships between dispositional emotion regulation and psychopathology. We focused on dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we examined the relationship between each regulatory strategy and psychopathology across the four disorders. We found a large effect size for rumination, medium to large for avoidance, problem solving, and suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory strategy and each of the four psychopathology groups. We found that internalizing disorders were more consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses showed that whether the sample came from a clinical or normative population significantly moderated the relationships. This finding underscores the importance of adopting a multi-sample approach to the study of psychopathology.

Specificity of cognitive emotion regulation strategies: A transdiagnostic examination

Despite growing interest in the role of regulatory processes in clinical disorders, it is not clear whether certain cognitive emotion regulation strategies play a more central role in psychopathology than others. Similarly, little is known about whether these strategies have effects transdiagnostically. We examined the relationship between four cognitive emotion regulation strategies (rumination, thought suppression, reappraisal, and problem-solving) and symptoms of three psychopathologies (depression, anxiety, and eating disorders) in an undergraduate sample (N=252). Maladaptive strategies (rumination, suppression), compared to adaptive strategies (reappraisal, problem-solving), were more strongly associated with psychopathology and loaded more highly on a latent factor of cognitive emotion regulation. In addition, this latent factor of cognitive emotion regulation was significantly associated with symptoms of all three disorders. Overall, these results suggest that the use of maladaptive strategies might play a more central role in psychopathology than the non-use of adaptive strategies and provide support of a transdiagnostic view of cognitive emotion regulation.

When are adaptive strategies most predictive of psychopathology

In recent work, we showed that putatively adaptive emotion regulation strategies, such as reappraisal and acceptance, have a weaker association with psychopathology than putatively maladaptive strategies, such as rumination, suppression, and avoidance (e.g., Aldao & Nolen-Hoeksema, 2010; Aldao, Nolen-Hoeksema, & Schweizer, 2010). In this investigation, we examined the interaction between adaptive and maladaptive emotion regulation strategies in the prediction of psychopathology symptoms (depression, anxiety, and alcohol problems) concurrently and prospectively. We assessed trait emotion regulation and psychopathology symptoms in a sample of community residents at Time 1 (N = 1,317) and then reassessed psychopathology at Time 2 (N = 1,132). Cross-sectionally, we found that the relationship between adaptive strategies and psychopathology symptoms was moderated by levels of maladaptive strategies: adaptive strategies had a negative association with psychopathology symptoms only at high levels of maladaptive strategies. In contrast, adaptive strategies showed no prospective relationship to psychopathology symptoms either alone or in interaction with maladaptive strategies. We discuss the implications of this investigation for future work on the contextual factors surrounding the deployment of emotion regulation strategies.

The influence of context on the implementation of adaptive emotion regulation strategies

Putatively adaptive emotion regulation strategies (e.g., acceptance, problem solving, reappraisal) show weaker associations with psychopathology than putatively maladaptive strategies (e.g., avoidance, self-criticism, hiding expression, suppression of experience, worry, rumination). This is puzzling, given the central role that adaptive strategies play in a wide range of psychotherapeutic approaches. We explored this asymmetry by examining the effects of context (i.e., emotion intensity, type of emotion, social vs. academic circumstances) on the implementation of adaptive and maladaptive strategies. We asked 111 participants to describe 8 emotion-eliciting situations and identify which strategies they used in order to regulate their affect. We found support for a contextual model of emotion regulation, in which adaptive strategies were implemented with more cross-situational variability than maladaptive strategies. In addition, the variability in implementation of two adaptive strategies (acceptance, problem solving) predicted lower levels of psychopathology, suggesting that flexible implementation of such strategies in line with contextual demands is associated with better mental health. We discuss these findings by underscoring the importance of adopting a functional approach to the delineation of contextual factors that influence the implementation of emotion regulation strategies.

Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder

Recent models of generalized anxiety disorder (GAD) have expanded on Borkovecs avoidance theory by delineating emotion regulation deficits associated with the excessive worry characteristic of this disorder (see Behar, DiMarco, Hekler, Mohlman, & Staples, 2009). However, it has been difficult to determine whether emotion regulation is simply a useful heuristic for the avoidant properties of worry or an important extension to conceptualizations of GAD. Some of this difficulty may arise from a focus on purported maladaptive regulation strategies, which may be confounded with symptomatic distress components of the disorder (such as worry). We examined the implementation of adaptive regulation strategies by participants with and without a diagnosis of GAD while watching emotion-eliciting film clips. In a between-subjects design, participants were randomly assigned to accept, reappraise, or were not given specific regulation instructions. Implementation of adaptive regulation strategies produced differential effects in the physiological (but not subjective) domain across diagnostic groups. Whereas participants with GAD demonstrated lower cardiac flexibility when implementing adaptive regulation strategies than when not given specific instructions on how to regulate, healthy controls showed the opposite pattern, suggesting they benefited from the use of adaptive regulation strategies. We discuss the implications of these findings for the delineation of emotion regulation deficits in psychopathology.

Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions.

In response to rapidly growing rates of comorbidity among psychiatric disorders, clinical scientists have become interested in identifying transdiagnostic processes that can help explain dysfunction across diagnostic categories (e.g., Kring & Sloan, 2009). One factor that has received a great deal of attention is that of emotion regulation, namely, the ability to modulate the intensity and/or duration of emotional states (e.g., Cicchetti, Ackerman, & Izard, 1995; Gross, 1998). Recent theoretical and empirical work has begun to emphasize the role that emotion regulation plays in the temporal comorbidity between internalizing and externalizing conditions (e.g., Aldao & De Los Reyes, 2015; De Los Reyes & Aldao, 2015; Drabick & Kendall, 2010; Jarrett & Ollendick, 2008; Patrick & Hajcak, 2016). However, close inspection of this work reveals two very pertinent areas of growth: (a) this literature is characterized by mixed findings that are likely explained, in part, by methodological heterogeneity; and (b) emotion regulation tends to be studied in relatively narrow terms. To address these issues, we provide a series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework. We hope that our perspective can enhance the organization and growth of this very important area of inquiry, and ultimately result in more effective prevention and treatment programs.

Compromised Decision Making and the Effects of Manipulating Physical States on Human Judgments

OBJECTIVESnNonmorally based decision making between two equitable objects often involves degrading the unchosen object and promoting the chosen object (postdecisional dissonance). One can extinguish these thought processes with the physical act of hand-washing (clean slate effects; [Lee & Schwarz (2010). Washing away postdecisional dissonance. Science, 328, 709.]). However, clean slate effects might not characterize all nonmorally based decision making, particularly for people who mentally get stuck making decisions (i.e., compromised decision making).nnnDESIGNnWe administered a clean slate task to 48 undergraduates (64.6% females; mean = 21.34 years, standard deviation = 4.06 years; 75% Caucasian), and identified individuals reporting relatively high-compromised versus low-compromised decision making (e.g., self-reported repetitive thought processes and generalized anxiety symptoms).nnnRESULTSnOnly individuals reporting relatively high-compromised decision making continued to express postdecisional dissonance even after hand-washing.nnnCONCLUSIONSnBehavioral markers of clean slate effects might result in identifying phenotypes associated with psychological concerns typified by compromised decision making.