Maladaptive Strategies Research Articles

Adaptive emotion regulation might prevent burnout in emergency healthcare professionals: an exploratory study.

Emergency department (ED) professionals face a high risk of physical, mental, and emotional strain, which can lead to burnout. Burnout arises from chronic work-related stress, which negatively impacts ED professionals, the healthcare system, as well as patient outcomes. Effective adaptive emotion regulation strategies (ERS) are crucial for handling stress in healthcare workplaces and mitigating the risk of burnout. High-quality patient-professional relationships, including empathy, significantly improve patient compliance and disease outcomes. This cross-sectional exploratory study aims to investigate the relationship between mental distress, burnout, adaptive and maladaptive ERS among healthcare professionals in an ED. A total of 159 ED workers participated in an online survey. Emotion regulation was assessed using the Cognitive Emotion Regulation Questionnaire, while burnout and mental distress were measured using the Maslach Burnout Inventory and the Depression, Anxiety, and Stress Scale. The findings revealed that more than 20% of participants displayed severe symptoms of stress (N = 35), anxiety (N = 36), and depression (N = 31), and only 10.7% (N = 27) had no signs of burnout. Despite these findings, it appears that the majority of ED professionals primarily utilise adaptive ERS (91.8%, N = 146). However, as burnout levels increased, the use of adaptive ERS declined compared to maladaptive strategies. Regression analysis identified several significant predictors of Emotional Exhaustion, Depersonalisation, and reduced Personal Accomplishment, including gender, age, physical exercise, smoking, sedative usage, stress, depression, maladaptive strategies and adaptive strategies such as positive reappraisal. These study results highlight the urgent need to address workplace stress, burnout, and mental distress among healthcare professionals in EDs. Implementing effective strategies for adaptive emotion regulation and promoting a supportive work environment can help mitigate burnout and enhance the well-being of ED workers, ultimately benefiting patient care and outcomes.

The effect of alexithymia on self-perceived aging among community-dwelling older adults with multiple chronic conditions: the mediating role of maladaptive cognitive emotion regulation strategies

ObjectivesThis study investigated the mediating role of maladaptive cognitive emotion regulation strategies in the relationship between alexithymia and self-perceived aging among older adults.MethodsWe surveyed 478 Chinese community-dwelling older adults from November 2022 to May 2023. The Toronto Alexithymia Scale (TAS-20), Cognitive Emotion Regulation Questionnaire (CERQ), and Brief Aging Perceptions Questionnaire (B-APQ) were used. Correlation analyses, multiple linear regression analysis, and structural equation modeling were performed.ResultsThe average age of participants was 71.52 ± 7.80 years, and the number of chronic diseases was distributed as follows: 270 (56.49%) had 2 disease conditions, 156 (32.64%) had 3 disease conditions, and 52 (10.88%) had 4 disease conditions or more. Scores for alexithymia 57.83 ± 10.19; maladaptive cognitive emotion regulation strategies 49.63 ± 10.65; and self-perceived aging 58.74 ± 10.23. Alexithymia and maladaptive cognitive emotion regulation strategies were positively correlated with negative self-perceived aging (r=0.665 and r=0.673, respectively), explaining 51.8% of the variance in self-perceived aging. Structural equation modeling results showed that alexithymia had a direct effect (of 0.368) on self-perceived aging, accounting for 44.1% of the total effect. Maladaptive cognitive emotion regulation strategies partially mediated the relationship, with a mediation effect of 0.386, accounting for 51.8% of the total effect.ConclusionThese findings suggest that addressing maladaptive cognitive emotion regulation strategies can help reduce negative self-perceived aging in elderly individuals with multiple chronic conditions, particularly among those with alexithymia.

The effect of cognitive emotion regulation on direct-acting antivirals adherence in patients with hepatitis C

IntroductionAdherence to direct-acting antivirals (DAAs) could be a predictor of chronic viral hepatitis C (HCV) therapeutic failure. We examined the perceptions of patients receiving DAAs to determine how cognitive factors influence their decision to maintain adherence. Also, we explored the threshold of DAAs adherence for obtaining sustained virologic response (SVR) among patients with HCV, in order to better implement a strategy that improves the DAAs adherence in the future clinical practice.MethodsA single-arm prospective study was performed. Patients with HCV that started and completed DAAs treatment in the County Hospital of Craiova, Dolj, Romania, were enrolled. Patients’ medication adherence was assessed using the HCV-AD10 questionnaire, and the cognitive emotion regulation was measured with CERQ questionnaire (five positive/adaptive cognitive emotion-regulation domains and four negative/maladaptive domains). Spearman correlation analysis was conducted to explore the relationships between adherence and different factors. ROC-curves were used to evaluate the adherence threshold to achieve SVR. A linear regression model was performed to analyze the primary outcome (DAAs adherence) to be the target variable based on given independent variables (age, treatment duration, severity of HCV, the nine adaptive and maladaptive strategies).Results368 patients (mean age: 61 years) with HCV diagnosed 4.05 ± 6.38 (average) years ago were enrolled. Mean (±SD) adherence via HCV-AD10 was 91.51 ± 8.34, and the proportion of the participants achieving SVR was 96%. Patients with an adherence less than 84% (5 patients, 1.36%) was considered nonadherent and they have a high probability of not achieving response (sensitivity and specificity of 83% and 80%, respectively). We obtained significantly higher values of three adaptive strategies between adherent and nonadherent patients following DAAs treatment: in positive refocusing (p-value = 0.044), refocus on planning (p-value = 0.037), and positive reappraisal (p-value = 0.047).DiscussionThe interplay between the three adaptive strategies of the cognitive emotion regulation and the enhancement of DAAs adherence contributes to a more holistic comprehension of patient behavior in the context of HCV treatment. Increasing refocusing and planning using goal setting and assisting patients in establishing specific, achievable goals can be crucial strategies for clinicians aiming to improve adherence among their patients.

Differential effects of trait-like emotion regulation use and situational emotion regulation ability across the affective and anxiety disorders spectrum: a transdiagnostic examination

Here, we investigated the association of different emotion regulation (ER) indices with symptom severity across a large transdiagnostic sample of patients with emotional disorders (cross-sectional approach) and the predictive validity these ER indices have for the outcome of routine care CBT (longitudinal approach). We assessed the trait-like use of adaptive (reappraisal) and maladaptive (suppression, externalizing behaviors) ER strategies via questionnaire as well as the situational ability to regulate emotions with an experimental ER paradigm. Psychopathology was assessed dimensionally using the depression, anxiety, and stress scale. Cross-sectionally symptom severity was predicted by less trait-like use of adaptive and more trait-like use of maladaptive ER strategies, but no associations were found for situational ER ability. This association was more pronounced for depression and stress symptoms rather than anxiety symptoms. In a striking dissociation, the longitudinal analyses revealed the reverse picture: Better situational ER ability, but not trait-like use of ER strategies was associated with less symptom severity after the CBT treatment. Our data argues in favor of a distinction between trait-like and situational ER abilities in individuals with emotional disorders, highlighting challenges in applying adaptive ER strategies in daily life despite demonstrating intact ER skills in experimental settings. Our findings also inform transdiagnostic models of psychopathology and suggest that distress/depression rather than anxiety symptomatology to be driving forces for the occurrence of ER deficits across the depression/anxiety disorders spectrum.

Emotion processes in voice-hearers: Understanding differences in emotional reactivity, emotion regulation and alexithymia.

Disrupted emotion processes are commonly linked to the onset and maintenance of auditory verbal hallucinations. However, a comprehensive approach using an extended emotion model has not previously been applied to voice-hearers to distinguish impairments in emotion processes from non-clinical populations. The present study hypothesised voice-hearers, as compared to controls, would have (1) higher reactivity to negative emotions and lower reactivity to positive emotions, (2) more difficulties regulating negative and positive emotions, (3) more maladaptive strategy use, and (4) higher alexithymia. T-tests tested these hypotheses, comparing self-report measures of emotional reactivity, emotion regulation and alexithymia in voice-hearers(n = 50) to controls (n = 53). There were no group differences in emotional reactivity to positive or negative emotions. Compared to controls, voice-hearers showed difficulties in both positive and negative emotion regulation, were more likely to use expressive suppression, and were more likely to be alexithymic. These findings may help researchers and clinicians identify difficulties in voice-hearers' emotion processing, providing better direction for case formulation and treatment.

Is development and persistence of multiple physical symptoms associated with coping? A longitudinal study over a decade

ObjectiveTo examine the development and persistence of multiple physical symptoms (MPS) over a decade including the associations with sociodemographics and coping strategies. MethodA longitudinal study of 16,405 individuals aged 20–64 years participating in the Danish Symptom Cohort (DaSC) was conducted in 2012 with follow-up data in 2022 (DaSC II). MPS were assessed according to the unifying diagnostic construct of bodily distress syndrome, and coping was measured with the Brief Approach/Avoidance Coping Questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed. ResultsAmong individuals not having MPS in 2012, 17 % had developed MPS in 2022. Among individuals having MPS in 2012, 57 % had persistence of MPS in 2022. Individuals who developed or had persistence of MPS at follow-up were more likely to be female, have lower educational level, be immigrant, redeem antidepressants, have lower approach scores as well as higher diversion and resignation scores. ConclusionsIndividuals responding to stressful situations with low approach, high diversion, and high resignation may be at higher risk of developing MPS and have persistence of MPS. As coping can be targeted through psychotherapy, it is important to focus on maladaptive strategies, especially in high-risk groups for developing and maintaining MPS.

How to judge emotions? Measuring moral emotions of lawyers in a retrospective situation

This study examined legal practitioners' emotion regulation strategies and subjective moral emotions related to legal cases they handle. Forty-two participants recalled a civil law case and the emotions they experienced while handling the case. They completed the Cognitive Emotion Regulation Questionnaire to identify emotion regulation strategies they usually use. Results showed that attorneys often experienced anger and empathy and used strategies that tend to be adaptive across a wide range of contexts. There was a moderate positive correlation between Anger and Positive Refocusing, Contempt and Other-Blame, Guilt and Maladaptive emotion regulation strategies, and the Difference between parties’ agreeableness (understood as how sympathetic they seemed) and Anger. As the experience of negative emotions paired with maladaptive emotion regulation techniques might be associated with negative consequences both for the self and for the relationship with clients, the present study suggests that adding emotion regulation into legal curricula is crucial.

Emotion regulation mediates the relation between intolerance of uncertainty and emotion difficulties: A longitudinal investigation.

Intolerance of uncertainty has been proposed as a transdiagnostic factor in emotional disorders. Despite comprehensive empirical evidence demonstrating the association between intolerance of uncertainty and emotional disorders, the underlying mechanism remains elusive. Drawing on theoretical frameworks and empirical studies, the current study proposed that emotion regulation emerges as a potential mechanism. We explored the connections among intolerance of uncertainty, eight emotion regulation strategies (both adaptive and maladaptive), and emotional difficulties (specifically anxiety and depression) using a three-wave longitudinal approach (N = 341). Our findings revealed that heightened intolerance of uncertainty predicted increased anxiety but not depression over time. Greater intolerance of uncertainty significantly predicted elevated levels of maladaptive emotion regulation strategies including experiential avoidance, thought suppression, rumination, and reassurance-seeking. Adaptive strategies (i.e., mindfulness, cognitive reappraisal, problem-solving) predicted lower anxiety and/or depression whereas maladaptive emotion regulation strategy rumination predicted greater levels of anxiety and depression. Surprisingly, thought suppression predicted lower levels of anxiety and depression. More importantly, our analysis showed that both rumination and thought suppression served as significant mediators in the relationship between intolerance of uncertainty and both anxiety and depression. These results hold implications for future interventions, emphasising rumination and thought suppression as potential targets for interventions aimed at alleviating emotional difficulties in individuals with intolerance of uncertainty.

Caregiver burden, attachment and cognitive emotion among the family caregivers of severe mental illness patients

BackgroundSerious mental illness (SMI) is a debilitating medical condition that causes stress and challenges for the family caregivers (FCs) of affected patients, increasing their caregiver burden (CB). This situation can activate attachment styles (AS) and trigger negative emotions, further contributing to CB. Given that AS and cognitive-emotional regulation (CER) can affect the CB of FCs of patients with SMI, the aim of this study was to evaluate the relationship between CB with AS, and CER among the FCs.MethodsThis cross-sectional descriptive-correlational study was carried out in May–November 2022. Participants were 278 FCs of patients with SMI consecutively recruited from Roozbeh leading psychiatric hospital, Tehran, Iran. Data were collected using a patients’ demographic and clinical characteristics questionnaire, an FCs’ demographic characteristics questionnaire, the Attachment Style Questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Burden Scale for Family Caregivers, and were analyzed using the SPSS software (v. 16.0).ResultsCB had significant inverse relationship with secure AS (r = − 0.262) and significant positive relationship with fearful AS (r = 0.194) and dismissive AS (r = 0.242) (P < 0.01). Moreover, CB had significant inverse relationship with adaptive CER strategies and significant positive relationship with maladaptive CER strategies (P < 0.001). Regression analysis also showed that CB had significant relationship with secure AS and catastrophizing, rumination, self-blame, and positive refocusing CER strategies (P < 0.05).ConclusionThis study concludes that AS and CER can impact CB. There is a negative relationship between secure AS and CB, as well as between adaptive CER strategies and CB. Conversely, there is a positive relationship between avoidant AS and increased CB, as well as between maladaptive CER strategies and CB. It is recommended to adopt strategies that promote the use of secure AS and adaptive CER among the FCs of patients with SMI.

Sexual Victimization History and Emotion Regulation in Daily Life: A Role for Stress Sensitization.

Relative to other types of traumatic experiences, a lifetime history of sexual violence (SV) has been linked with more persistent and severe mental health outcomes, but the reasons for this discrepancy have not been clearly established. Stress sensitization, or the amplification of responses to daily stressors as a function of trauma history, offers one possible explanation. Using ecological momentary assessment, the current study tested stress sensitization effects in daily life for individuals with a history of SV, focusing on emotion regulation as an outcome. Smartphone surveys were delivered four times per day over a 2-week period to assess relationships between prior SV exposure, daily stressors, and emotion regulation in an undergraduate sample (N = 122). As expected, individuals with lifetime exposure to SV evidenced increased emotion dysregulation and maladaptive emotion regulation in response to daily stressors relative to nonexposed peers, even after accounting for cumulative trauma. However, the SV and non-SV groups did not differ significantly on state adaptive emotion regulation. Instead, experiencing daily stressors was associated with increased adaptive emotion regulation for individuals in both groups. Broadly, results suggest that SV is uniquely associated with increased sensitivity to daily stressors, manifested as emotion dysregulation and use of maladaptive emotion regulation strategies to regulate emotions. These findings are consistent with emerging research on the neurobiology of trauma and with an emphasis on emotion regulation skills in leading interventions for SV-exposed individuals. Stress sensitization warrants additional attention as a factor linking SV and mental health problems.

An adjunctive multi‐family intervention based on non‐verbal techniques in a day hospital for parents and toddlers with feeding problems

AbstractFeeding problems in early childhood are common and affect parental behaviour with more use of maladaptive feeding strategies. Although multi‐family therapy is well known as an effective intervention for adolescents and adults with eating disorders/problems, the use of multi‐family therapy for toddlers with feeding problems is rather rare. In this paper we describe how we adapted the evidence‐based goals of multi‐family therapy to a specific format for parents and toddlers and how we used it in our clinical work. We explain the importance of creating a supportive culture in which parents may develop effective feeding strategies. We describe how we used non‐verbal techniques in multi‐family therapy as a tool for growth for both toddlers and parents. We end with some retrospective reflections and directions for future therapy and research.

Exploring the Relationship between Decision-Making Styles and Emotion Regulation: A Study of Police Officials in Portuguese Public Security

In public security policing, where pressure is constant, effective decision-making and emotion regulation are critical, especially for leaders. These processes significantly impact upon work results, performance, officials’ health, employee well-being, and the organizational environment. This study aims to broaden the understanding of decision-making styles and emotion-regulation strategies used by police officials in the Portuguese Public Security Police (PSP). We surveyed 138 Portuguese high-ranking police officials using two self-response questionnaires, namely the Emotion Regulation in the Workplace (ReTrab) and the Melbourne Decision Making Questionnaire (MDMQ), both translated, adapted, and validated for the Portuguese police context. A confirmatory factor analysis was conducted, followed by correlations to explore the relationship between emotion-regulation strategies and decision-making styles. Finally, through a regression analysis, the potential impact of this relationship was assessed. The results reveal that specific emotion-regulation strategies, except for adaptive ones, significantly influence and modify the decision-making styles of PSP officials. Dysfunctional and maladaptive emotion-regulation strategies lead to less adaptive decision-making styles, while functional strategies promote more adaptive styles. These findings have theoretical and practical implications, offering valuable insights for targeted training programs and interventions in the law-enforcement sector, benefiting the police personnel, the communities they serve, and public perceptions about police.

The role of caregiver emotion regulation in youth mental health during the COVID-19 pandemic: A longitudinal study.

The COVID-19 pandemic has presented youth and families with a broad spectrum of unique stressors. Given that adolescents are at increased risk for mental health and emotional difficulties, it is critical to explore family processes that confer resilience for youth in the face of stress. The current study investigated caregiver emotion regulation (ER) as a familial factor contributing to youth ER and risk for psychopathology following stressful life events. In a longitudinal sample of 224 youth (M age = 12.65 years) and their caregivers, we examined whether caregiver and youth engagement in ER strategies early in the pandemic mediated the associations of pandemic-related stress with youth internalizing and externalizing symptoms six months later. Leveraging serial mediation analysis, we demonstrated that caregiver and youth rumination, but not expressive suppression or cognitive reappraisal, mediated the prospective associations of pandemic-related stress with youth internalizing and externalizing symptoms. Greater exposure to pandemic-related stressors was associated with greater caregiver rumination, which, in turn, related to greater rumination in youth, and higher levels of youth internalizing and externalizing symptoms thereafter. Family interventions that target caregiver ER, specifically rumination, may buffer against the consequences of stress on youth engagement in maladaptive ER strategies and risk for psychopathology.

Suicidal Ideation as a Maladaptive Emotion Regulation Strategy: Implications for Treatment in Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a leading psychotherapy for the reduction of suicidal and self-injurious behaviors (SIBs). However, evidence shows that DBT may be comparably less effective at reducing suicidal ideation (SI) than SIBs. Improving the effectiveness of DBT for SI is critical, given that SI poses risk for SIBs and presents a substantial clinical burden. In the following theoretical paper, we first review evidence surrounding the effectiveness of DBT for SI reduction and explore why DBT may be comparably less effective at reducing SI than SIBs. We argue that DBT’s effectiveness for treating SI may be enhanced by a functional understanding of SI as a maladaptive form of affect regulation, as put forth by recent empirical research. Finally, we discuss implications of this model for treatment in DBT and provide clinical recommendations for how to target SI more effectively using DBT’s existing repertoire for behavior change.

Discovery of cybervictimization-associated factors among adolescents: Using machine learning and network analysis

The issue of cybervictimization among adolescents is escalating, presenting a significant public concern. Recent research has turned to use a more robust method, machine learning, to explore important predictors for adolescent cybervictimization. The current study tested an extreme gradient boosting (XGBoost) machine learning algorithm to detect cybervictimization-associated factors among adolescents and used network analysis to explore associations between these factors for future targeted interventions. By combining a 6-month longitudinal design, a total of 1181 Chinese adolescents (the average age was 15.78 ± 1.67 years, 55.9% girls) participated in the study. The XGBoost model with satisfactory performance selected the top 10 features from 22 variables associated with cybervictimization by using SHAP value. The network analysis results indicated that maladaptive cognitive emotion regulation strategy is a central node and it has positive correlations with negative self-schema and depression. The XGBoost model and network analysis were useful methods for discovering and understanding cybervictimization-related factors among adolescents. Moreover, these essential factors could offer insights into future interventions for cybervictimization.

Teacher-written feedback in L2 writing education: Insights into student tensions and responses

This study aimed to investigate the perceptions and experiences of six undergraduate students enrolled in two writing courses within an L2 teacher education programme. The focus was on understanding the tensions these students experienced when engaging with their tutors' written feedback and the impact of these tensions on their responses. Adopting a qualitative methodology, the research involved semi-structured background interviews and stimulated recall interviews. Key findings reveal multiple dimensions of tensions, including emotional, interpersonal, academic, and institutional. Students employed various adaptive and maladaptive strategies to navigate these tensions, ranging from proactive engagement and peer support to avoidance and selective feedback engagement. The study also identified five characteristics of the interaction between tensions and responses: dynamic, context-dependent, idiosyncratic, cumulative, and interconnected. These insights emphasise the need for educators to provide clear, specific, and constructive feedback, and foster a supportive environment that mitigates negative impacts and promotes adaptive strategies. The findings have significant implications for research and practice, advocating for the development of feedback literacy among educators and students to enhance the effectiveness of written feedback in L2 writing education.

Attention control mediates the relationship between mental imagery vividness and emotion regulation

Contradictory findings suggest mental imagery may both exacerbate and protect against negative affect. We aimed to reconcile these contradictory findings by considering individual differences (N=989) in imagery vividness, attention control, resilience, emotion regulation strategy, and negative affect (depressive, anxious, and posttraumatic stress symptomology). We hypothesized that attention control would mediate relationships between imagery vividness and emotion regulation strategy use, and psychopathology symptomology. Results revealed that imagery vividness, as mediated by attention control, predicted greater levels of healthy reappraisal and deleterious rumination. Attention control also mediated negative relationships between imagery vividness and catastrophizing, self-blame, and psychopathology symptomology. An exploratory latent structural equation model revealed that imagery vividness and attention control aggregated positively with reappraisal and resilience scores. The present investigation suggests an adaptive function of imagery vividness via the indirect effects of attention control, facilitating adaptive emotion regulation and limiting maladaptive strategy use, thereby protecting against negative affect.

Interplay Cognitive Emotion Regulation and Health-Promoting Lifestyle Profile on Poor Sleep Quality in Adolescents

Background and Objective Adolescence is an important period of development, the main goal of this research was to investigate whether lifestyle can mediate the relationship between cognitive emotion regulation strategies and sleep quality.Methods This multicenter study was conducted between December 2023 and March 2024. The target population was adolescent girls between 12–18 years old. A total of 318 adolescents participated in this study in person. Pearson’s correlation coefficient was first used to check the relationships between research variables. Next, linear regression was used to draw predictive relationships based on independent and dependent variables. To investigate the mediator variable, path analysis was used and the result of the Sobel test was used.Results The R2 showed that 22% of the variance of poor sleep quality was explained by the predictor variables. Among of predictor variables in the model, health-promoting lifestyle profile and maladaptive strategies were significant and predicted poor sleep quality. The mediation role of a health-promoting lifestyle in the relationship between adaptive emotion regulation strategies and poor sleep quality was significant, the coefficient of the indirect path was equal to -0.18 and the Sobel test was equal to -4.68.Conclusions Current research has shown that cognitive emotion regulation strategies are related to poor sleep quality and this effect is mediated by a healthy lifestyle.

Verbal Weight-Related Abuse and Binge Eating Behavior: The Mediating Role of Attentional Bias to Threat Cues and Difficulties in Emotion Regulation.

Previous studies investigated the impact of weight-related abuse (WRA) on eating pathology. However, the circumstances of such an effect are still unclear. Our study aimed to examine the relationship between verbal WRA and binge eating (BE) behavior via attentional bias (AB) to threat cues and difficulties in emotion regulation. We conducted a parallel mediation model. On the basis of the purposive sampling method, 183 individuals with obesity and overweight (70.5% female and 28.4% male; Meanage=32.78), from February to June 2019, were recruited from a nutrition clinic in Tehran. The participants completed the BE scale (BES), the weight-related abuse questionnaire (WRAQ), the difficulties in emotion regulation scale (DERS), and the dot probe task (DPT). AB to threat cues had a significantly negative association with verbal WRA and BE. Difficulties in emotion regulation showed a significant positive association with verbal WRA and BE. The parallel mediation model showed a direct effect of verbal WRA on BE. Moreover, the bootstrap analysis revealed that difficulties in emotion regulation could mediate the association between verbal WRA and BE. Our findings suggest that experiences of verbal WRA can contribute to cognitive bias to negative emotion, maladaptive emotion regulation strategies, and behavioral problems like BE.

The Sequential Mediating Effects of Executive Function Deficits and Maladaptive Cognitive Emotion Regulation Strategies between Emotional Clarity and Depression : Focused on 20s Adults

The Sequential Mediating Effects of Executive Function Deficits and Maladaptive Cognitive Emotion Regulation Strategies between Emotional Clarity and Depression : Focused on 20s Adults