Emotion Regulation in Depression, Anxiety and Stress

331 Pages·2017·4.86 MB·English

by  David Angell

Emotion Regulation in Depression, Anxiety
and Stress: A focus on Catastrophising

Thesis submitted for the degree of Doctor of
Philosophy

School of Psychology and Clinical Language
Sciences

University of Reading

David Jack Angell

December 2016
Declaration of Original Authorship

I confirm that this is my own work and the use of all
material from other sources has been properly and
fully acknowledged

Signature:
Contents
1 Chapter One: Literature Review ......................................................................................... 11
1.1 Emotion Regulation ..................................................................................................... 12
1.2 The Modal Model of Emotion ..................................................................................... 13
1.3 Process Model of Emotion Regulation ........................................................................ 14
1.4 Problems in Definition ................................................................................................ 17
1.5 Measuring Emotion Regulation................................................................................... 18
1.6 Emotion Regulation: Experimental Design ................................................................. 20
1.7 Emotion Regulation in Psychopathology .................................................................... 22
1.8 Factors of Emotion Regulation .................................................................................... 26
1.9 Emotion regulation strategies ..................................................................................... 28
1.10 Catastrophising ........................................................................................................... 28
1.11 Rumination .................................................................................................................. 30
1.12 Suppression ................................................................................................................. 32
1.13 Reappraisal .................................................................................................................. 34
1.14 Therapeutic Approaches to Emotion Regulation ........................................................ 35
1.15 Affect Regulation Training (ART) ................................................................................. 36
1.16 Emotion Regulation Therapy (ERT) ............................................................................. 40
1.17 Conclusion ................................................................................................................... 44
1.18 Overview of Thesis content ......................................................................................... 45
2 Chapter Two: Profiling Emotion Regulation Strategies Against Mental Health Indicators 47
2.1 Introduction ................................................................................................................ 47
2.2 Method ........................................................................................................................ 52
2.2.1 Participants ......................................................................................................... 52
2.2.2 Design .................................................................................................................. 53
2.2.3 Materials ............................................................................................................. 53
2.2.4 Procedure ............................................................................................................ 56
2.2.5 Statistical Analyses .............................................................................................. 57
2.3 Results ......................................................................................................................... 58
2.3.1 Sample Characteristics ........................................................................................ 58
2.3.2 Comparisons with validation scores ................................................................... 59
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2.3.3 Relationships between emotion regulation strategies and mood measures ..... 63
2.3.4 Age comparisons ................................................................................................. 65
2.3.5 Inter-correlations between trait measures ......................................................... 67
2.3.6 Emotion Regulation profiles ................................................................................ 67
2.4 Discussion .................................................................................................................... 73
2.4.1 Emotion Regulation Profiles ................................................................................ 77
2.4.2 Limitations ........................................................................................................... 79
2.4.3 Future Studies ..................................................................................................... 80
2.4.4 Conclusion ........................................................................................................... 81
3 Chapter Three: Developing a State-Trait Emotion Regulation Questionnaire .................... 82
3.1 Introduction ................................................................................................................ 82
3.2 Method ........................................................................................................................ 84
3.2.1 Phase One ........................................................................................................... 84
3.2.2 Phase Two ........................................................................................................... 88
3.3 Results ......................................................................................................................... 91
3.3.1 Phase One ........................................................................................................... 91
3.3.2 Phase Two ......................................................................................................... 103
3.4 Discussion .................................................................................................................. 116
3.4.1 Future Studies ................................................................................................... 118
3.4.2 Conclusion ......................................................................................................... 119
4 Chapter Four: Inducing Catastrophising ........................................................................... 120
4.1 Introduction .............................................................................................................. 120
4.2 Method ...................................................................................................................... 124
4.2.1 Participants ....................................................................................................... 124
4.2.2 Design ................................................................................................................ 124
4.2.3 Measures ........................................................................................................... 125
4.2.4 Procedure .......................................................................................................... 126
4.2.5 Statistical Analysis ............................................................................................. 127
4.3 Results ....................................................................................................................... 129
4.3.1 Normality Checks .............................................................................................. 129
4.3.2 Mood Induction ................................................................................................. 130
4.3.3 Baseline Mood Condition Comparison ............................................................. 130
4.3.4 Catastrophising and Mood Change ................................................................... 131
4.3.5 CERQ Catastrophising and DASS subscales ....................................................... 132
4.3.6 Post Experimental Questions and Task Compliance ......................................... 133
4.4 Discussion .................................................................................................................. 134
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4.4.1 Conclusion ......................................................................................................... 137
5 Chapter Five: Developing the Catastrophising Questionnaire (CQ) .................................. 139
5.1 Introduction .............................................................................................................. 139
5.2 Method ...................................................................................................................... 143
5.2.1 Participants ....................................................................................................... 143
5.2.2 Design ................................................................................................................ 143
5.2.3 Measures ........................................................................................................... 144
5.2.4 Convergent Validity ........................................................................................... 144
5.2.5 Procedure .......................................................................................................... 145
5.2.6 Statistical Analysis ............................................................................................. 145
5.3 Results ....................................................................................................................... 146
5.3.1 Item generation ................................................................................................. 146
5.3.2 Competing models ............................................................................................ 146
5.3.3 Two Factor Validation ....................................................................................... 150
5.4 Discussion .................................................................................................................. 151
5.4.1 Conclusion ......................................................................................................... 154
6 Chapter Six: A Catastrophising Intervention ..................................................................... 155
6.1 Introduction .............................................................................................................. 155
6.1.1 Interventions as Smartphone Applications ....................................................... 156
6.1.2 Aim .................................................................................................................... 160
6.2 Method ...................................................................................................................... 161
6.2.1 Participants ....................................................................................................... 161
6.2.2 Design ................................................................................................................ 162
6.2.3 Materials and Apparatus ................................................................................... 162
6.2.4 Procedure .......................................................................................................... 168
6.2.5 Statistical Analysis ............................................................................................. 169
6.3 Results ....................................................................................................................... 170
6.3.1 Normality Checks .............................................................................................. 170
6.3.2 Impact of UoR:C on Catastrophising ................................................................. 172
6.3.3 Impact of UoR:C on Depression, Anxiety & Stress Symptoms .......................... 175
6.3.4 DASS Stress Scores Between Groups over Time ............................................... 177
6.3.5 Impact of UoR:C on Mood ................................................................................. 178
6.4 Discussion .................................................................................................................. 180
6.4.1 Limitations ......................................................................................................... 181
6.4.2 Future Study ...................................................................................................... 184
6.4.3 Conclusion ......................................................................................................... 185
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7 Chapter Seven: General Discussion................................................................................... 188
7.1 The origin of this thesis ............................................................................................. 188
7.2 Understanding catastrophizing ................................................................................. 189
7.2.1 Limitations ......................................................................................................... 193
7.2.2 Further Studies .................................................................................................. 196
7.2.3 Clinical potential ................................................................................................ 199
7.2.4 Final Summary ................................................................................................... 201
8 References ......................................................................................................................... 202
9 Appendix ........................................................................................................................... 228
9.1 Appendix 1 ................................................................................................................ 228
9.2 Appendix 2 ................................................................................................................ 230
9.3 Appendix 3 ................................................................................................................ 232
9.4 Appendix 4 ................................................................................................................ 233
9.5 Appendix 5 ................................................................................................................ 235
9.6 Appendix 6 ................................................................................................................ 237
9.7 Appendix 7 ................................................................................................................ 238
9.8 Appendix 8 ................................................................................................................ 240
9.9 Appendix 9 ................................................................................................................ 241
9.10 Appendix 10 .............................................................................................................. 242
9.11 Appendix 11 .............................................................................................................. 246
9.12 Appendix 12 .............................................................................................................. 250
9.13 Appendix 13 .............................................................................................................. 252
9.14 Appendix 14 .............................................................................................................. 254
9.15 Appendix 15 .............................................................................................................. 255
9.16 Appendix 16 .............................................................................................................. 256
9.17 Appendix 17 .............................................................................................................. 258
9.18 Appendix 18 .............................................................................................................. 260
9.19 Appendix 19 .............................................................................................................. 262
9.20 Appendix 20 .............................................................................................................. 263
9.21 Appendix 21 .............................................................................................................. 264
9.22 Appendix 22 .............................................................................................................. 265
9.23 Appendix 23 .............................................................................................................. 266
9.24 Appendix 24 .............................................................................................................. 268
9.25 Appendix 25 .............................................................................................................. 269
9.26 Appendix 26 .............................................................................................................. 270
9.27 Appendix 27 .............................................................................................................. 271
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9.28 Appendix 28 .............................................................................................................. 272
9.29 Appendix 29 .............................................................................................................. 274
9.30 Appendix 30 .............................................................................................................. 276
9.31 Appendix 31 .............................................................................................................. 278
9.32 Appendix 32 .............................................................................................................. 280
9.33 Appendix 33 .............................................................................................................. 281
9.34 Appendix 35 .............................................................................................................. 283
9.35 Appendix 36 .............................................................................................................. 284
9.36 Appendix 37 .............................................................................................................. 285
9.37 Appendix 38 .............................................................................................................. 286
9.38 Appendix 39 .............................................................................................................. 288
9.39 Appendix 40 .............................................................................................................. 289
9.40 Appendix 41 .............................................................................................................. 291
9.41 Appendix 42 .............................................................................................................. 297
9.42 Appendix 43 .............................................................................................................. 303
9.43 Appendix 44 .............................................................................................................. 304
9.44 Appendix 45 .............................................................................................................. 305
9.45 Appendix 46 .............................................................................................................. 306
9.46 Appendix 47 .............................................................................................................. 307
9.47 Appendix 48 .............................................................................................................. 308
9.48 Appendix 49 .............................................................................................................. 309
9.49 Appendix 50 .............................................................................................................. 310
9.50 Appendix 51 .............................................................................................................. 325
9.51 Appendix 52 .............................................................................................................. 326
9.52 Appendix 53 .............................................................................................................. 327
9.53 Appendix 54 .............................................................................................................. 329

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FIGURE 1.1 THE MODAL MODEL OF EMOTION BY JAMES J GROSS, 2014, HANDBOOK OF EMOTION REGULATION SECOND
EDITION, P. 5. COPYRIGHT 2014 BY THE GUILDFORD PRESS. .......................................................................... 13
FIGURE 1.2 A PROCESS MODEL OF EMOTION REGULATION. REPRINTED FROM “EMOTION REGULATION: AFFECTIVE,
COGNITIVE, AND SOCIAL CONSEQUENCES” BY JAMES J GROSS, 2002, PSYCHOPHYSIOLOGY, P. 282. COPYRIGHT 2002
BY THE SOCIETY FOR PSYCHOPHYSIOLOGICAL RESEARCH. ................................................................................ 14
FIGURE 1.3 THE ART MODEL OF ADAPTIVE AFFECT REGULATION. REPRINTED FROM “AFFECT REGULATION TRAINING” BY
MATTHIAS BERKING & JEANINE SCHWARZ, 2014, HANDBOOK OF EMOTION REGULATION SECOND EDITION, P. 532.
COPYRIGHT 2014 BY THE GUILDFORD PRESS. .............................................................................................. 37
FIGURE 1.4 THE CONCEPTUAL MODEL OF TARGET MECHANISMS, CHANGE PRINCIPLES, AND THERAPEUTIC PROCESSES IN
EMOTION REGULATION THERAPY. REPRINTED FROM “EMOTION REGULATION THERAPY” BY DOUGLAS S. MENNIN &
DAVID M. FRESCO, 2014, HANDBOOK OF EMOTION REGULATION SECOND EDITION, P. 532. COPYRIGHT 2014 BY THE
GUILDFORD PRESS. ................................................................................................................................. 42
FIGURE 2.1 DISTRIBUTION OF PARTICIPANTS BY AGE AND GENDER ............................................................................ 58
FIGURE 3.1 DISTRIBUTION OF PARTICIPANTS BY AGE AND GENDER ............................................................................ 92
FIGURE 3.2 A SCREE PLOT DISPLAYING THE EIGENVALUES FOR DIFFERING NUMBERS OF FACTORS FOR THE TRAIT POSITIVE SCALE
.......................................................................................................................................................... 94
FIGURE 3.3 A SCREE PLOT DISPLAYING THE EIGENVALUES FOR DIFFERING NUMBERS OF FACTORS FOR THE STATE POSITIVE SCALE
.......................................................................................................................................................... 95
FIGURE 3.4 DISTRIBUTION OF PARTICIPANTS BY AGE AND GENDER ............................................................................ 96
FIGURE 3.5 A SCREE PLOT DISPLAYING THE EIGENVALUES FOR DIFFERING NUMBERS OF FACTORS FOR THE TRAIT NEGATIVE
SCALE ................................................................................................................................................... 98
FIGURE 3.6 A SCREE PLOT DISPLAYING THE EIGENVALUES FOR DIFFERING NUMBERS OF FACTORS FOR THE STATE NEGATIVE
SCALE ................................................................................................................................................... 98
FIGURE 3.7 DISTRIBUTION OF PARTICIPANTS BY AGE AND GENDER .......................................................................... 104
FIGURE 3.8 STRUCTURAL EQUATION MODEL OF THE TRAIT POSITIVE ITEMS AND FACTORS ............................................ 107
FIGURE 3.9 STRUCTURAL EQUATION MODEL OF THE STATE POSITIVE ITEMS AND FACTORS ........................................... 109
FIGURE 3.10 DISTRIBUTION OF PARTICIPANTS BY AGE AND GENDER ........................................................................ 110
FIGURE 3.11 STRUCTURAL EQUATION MODEL OF THE TRAIT NEGATIVE ITEMS AND FACTORS ........................................ 113
FIGURE 3.12 STRUCTURAL EQUATION MODEL OF THE STATE NEGATIVE ITEMS AND FACTORS ........................................ 115
FIGURE 4.1 BASELINE AND POST NEGATIVE MOOD SCORES BETWEEN GROUPS ........................................................... 131
FIGURE 4.2 BASELINE AND POST POSITIVE MOOD SCORES BETWEEN GROUPS ............................................................ 132
FIGURE 5.1 STRUCTURAL EQUATION MODEL OF THE ONE FACTOR MODEL. N=143 .................................................... 148
FIGURE 5.2 STRUCTURAL EQUATION MODEL OF THE TWO FACTOR MODEL. N=143 ................................................... 149
FIGURE 6.1 MAIN MENU OF THE UOR:C, WHERE !’S MARK ITEMS TO BE COMPLETED BY THE USER ............................... 164
FIGURE 6.2 BELOW IS THE INTRODUCTION SCREEN AND BELOW RIGHT ARE THE FOUR SUBSECTIONS. ALL ARE THE SAME
ACROSS GROUPS, EXCEPT FOR SOME DETAILS IN 1 ABOUT THIS APP. .............................................................. 165
FIGURE 6.3 BELOW IS THE TASKS SCREEN AND BELOW RIGHT ARE THE FOUR SUBSECTIONS FOR THE CATASTROPHISING
CONDITION. FOR THE CONTROL CONDITION SEE APPENDIX 50. ...................................................................... 167
FIGURE 6.4 EXAMPLE DATA ON PROGRESS GRAPH OF POSITIVE AND NEGATIVE AFFECT PANAS SCORES. ........................ 168
FIGURE 6.5 TOTAL CQ SCORES BY GROUP AND TIME ............................................................................................ 173
FIGURE 6.6 CQ HEALTH & SAFETY SCORES BY GROUP AND TIME ............................................................................ 174
FIGURE 6.7 CQ GENERAL SCORES BY GROUP AND TIME ........................................................................................ 175
FIGURE 6.8 DASS DEPRESSION SCORES BY GROUP AND TIME FOLLOWING RECIPROCAL TRANSFORMATION (Y-AXIS), WHERE
HIGHER SCORES INDICATE A LOWER INITIAL DASS SCORE .............................................................................. 176
FIGURE 6.9 DASS ANXIETY SCORES BY GROUP AND TIME FOLLOWING RECIPROCAL TRANSFORMATION, WHERE HIGHER SCORES
INDICATE A LOWER INITIAL DASS SCORE ................................................................................................... 177
FIGURE 6.10 DASS STRESS SCORES BY GROUP AND TIME FOLLOWING RECIPROCAL TRANSFORMATION, WHERE HIGHER SCORES
INDICATE A LOWER INITIAL DASS SCORE ................................................................................................... 178
FIGURE 6.11 MEAN POSITIVE PANAS SCORES PER DAY ....................................................................................... 179
FIGURE 6.12 MEAN NEGATIVE PANAS SCORES PER DAY ...................................................................................... 179
FIGURE 7.1 PROPOSED MEDIATED MODEL FOR CATASTROPHISING’S EFFECT ON MENTAL HEALTH TRAITS ........................ 192

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TABLE 2.1 SCALE MEANS AND STANDARD DEVIATIONS FOR ALL QUESTIONNAIRES, EXCLUDING THE CERQ AND ART-Q ...... 59
TABLE 2.2 SCALE MEANS AND STANDARD DEVIATIONS FOR THE CERQ-SHORT RESULTS FOUND IN THIS STUDY AND THE
ORIGINAL VALIDATION OF THE QUESTIONNAIRE ............................................................................................. 61
TABLE 2.3 SCALE MEANS AND STANDARD DEVIATIONS FOR THE ART-Q RESULTS FOUND IN THIS STUDY AND THE ORIGINAL
VALIDATION OF THE QUESTIONNAIRE .......................................................................................................... 62
TABLE 2.4 PARTIAL SPEARMAN CORRELATIONS OF THE CERQ WITH MEASURES OF MOOD, IMPULSIVENESS, ANXIETY AND
HYPOMANIA USING A BONFERRONI ADJUSTED SIGNIFICANCE LEVEL OF 0.001(.05/54) WHERE AGE IS PARTIALLED OUT.
.......................................................................................................................................................... 63
TABLE 2.5 PARTIAL SPEARMAN CORRELATIONS OF THE ART-Q WITH MEASURES OF MOOD, IMPULSIVENESS, ANXIETY AND
HYPOMANIA WHERE AGE IS PARTIALLED OUT USING A BONFERRONI ADJUSTED SIGNIFICANCE LEVEL OF 0.001(.05/54)
.......................................................................................................................................................... 64
TABLE 2.6 PARTIAL SPEARMAN CORRELATIONS OF THE NMR WITH MEASURES OF MOOD, IMPULSIVENESS, ANXIETY AND
HYPOMANIA WHERE AGE IS PARTIALLED OUT USING A BONFERRONI ADJUSTED SIGNIFICANCE LEVEL OF 0.001(.05/6).
.......................................................................................................................................................... 65
TABLE 2.7 MEANS AND STANDARD DEVIATIONS FOR THE 17 AND BELOW AGE GROUP AS WELL AS THE 18 AND ABOVE AGE
GROUP WITH INDEPENDENT T-TEST COMPARISONS AND EFFECT SIZE (R) ACROSS CERQ SUBSCALES. USING A
BONFERRONI ADJUSTED SIGNIFICANCE LEVEL OF 0.006(.05/9) NO TESTS REMAINED SIGNIFICANT. ........................ 65
TABLE 2.8 MEANS AND STANDARD DEVIATIONS FOR THE 17 AND BELOW AGE GROUP AS WELL AS THE 18 AND ABOVE AGE
GROUP WITH INDEPENDENT T-TEST COMPARISONS AND EFFECT SIZE (R) ACROSS ART-Q SUBSCALES. USING A
BONFERRONI ADJUSTED SIGNIFICANCE LEVEL OF 0.006(.05/9) NO TESTS WERE SIGNIFICANT. ............................... 66
TABLE 2.9 SPEARMAN CORRELATIONS BETWEEN MEASURES OF MOOD, IMPULSIVENESS, ANXIETY AND HYPOMANIA AND
HYPOMANIC ATTITUDES USING A BONFERRONI ADJUSTED SIGNIFICANCE LEVEL OF 0.01(.05/5). ............................ 67
TABLE 2.10 MULTIPLE REGRESSION ANALYSIS PREDICTING DEPRESSION AS MEASURED BY THE CES-DC THROUGH EMOTION
REGULATION STRATEGIES, CONTROLLING FOR VARIANCE EXPLAINED BY CORRELATED TRAIT AND PERSONALITY FACTORS
.......................................................................................................................................................... 68
TABLE 2.11 MULTIPLE REGRESSION ANALYSIS PREDICTING RELATIONSHIPS BETWEEN ANXIETY AS MEASURED BY THE ANXIETY
SUBSCALE OF THE DASS THROUGH EMOTION REGULATION STRATEGIES, CONTROLLING FOR VARIANCE EXPLAINED BY
CORRELATED TRAIT AND PERSONALITY FACTORS ............................................................................................ 69
TABLE 2.12 MULTIPLE REGRESSION ANALYSIS PREDICTING RELATIONSHIPS BETWEEN STRESS AS MEASURED BY THE STRESS
SUBSCALE OF THE DASS THROUGH EMOTION REGULATION STRATEGIES, CONTROLLING FOR VARIANCE EXPLAINED BY
CORRELATED TRAIT AND PERSONALITY FACTORS ............................................................................................ 70
TABLE 2.13 MULTIPLE REGRESSION ANALYSIS PREDICTING RELATIONSHIPS BETWEEN HYPOMANIC ATTITUDES AS MEASURED BY
THE HAPPI THROUGH EMOTION REGULATION STRATEGIES, CONTROLLING FOR VARIANCE EXPLAINED BY CORRELATED
TRAIT AND PERSONALITY FACTORS .............................................................................................................. 71
TABLE 3.1 PARTICIPANTS EXCLUDED FROM PHASE ONE .......................................................................................... 85
TABLE 3.2 PARTICIPANTS EXCLUDED FROM PHASE TWO .......................................................................................... 89
TABLE 3.3 MEANS AND STANDARD DEVIATIONS OF PRE- AND POST-MOOD INDUCTION SCORES ....................................... 92
TABLE 3.4 MEANS AND STANDARD DEVIATIONS OF PRE- AND POST-MOOD INDUCTION SCORES ....................................... 96
TABLE 3.5 RELIABILITY AND INTER-ITEM CORRELATIONS FOR TRAIT POSITIVE FACTORS POST ITEM REDUCTION ................. 99
TABLE 3.6 RELIABILITY FOR STATE POSITIVE FACTORS POST ITEM REDUCTION .......................................................... 100
TABLE 3.7 RELIABILITY FOR TRAIT NEGATIVE FACTORS POST ITEM REDUCTION ......................................................... 101
TABLE 3.8 RELIABILITY FOR STATE NEGATIVE FACTORS POST ITEM REDUCTION ......................................................... 101
TABLE 3.9 MEANS AND STANDARD DEVIATIONS OF PRE- AND POST-MOOD INDUCTION SCORES ..................................... 105
TABLE 3.10 RELIABILITY FOR TRAIT POSITIVE FACTORS ......................................................................................... 105
TABLE 3.11 RELIABILITY FOR STATE POSITIVE FACTORS ........................................................................................ 108
TABLE 3.12 MEANS AND STANDARD DEVIATIONS OF PRE- AND POST-MOOD INDUCTION SCORES ................................... 111
TABLE 3.13 RELIABILITY FOR TRAIT NEGATIVE FACTORS ....................................................................................... 112
TABLE 3.14 RELIABILITY FOR STATE NEGATIVE FACTORS....................................................................................... 114
TABLE 4.1 Z-SCORED KURTOSIS AND SKEWNESS FOR PANAS ................................................................................ 129
TABLE 4.2 TESTS OF NORMALITY ON PANAS SCORES USING SHAPIRO-WILK METHOD ................................................ 129
TABLE 4.3 AVERAGE (MEAN AND MEDIAN) AND RANGE (STANDARD DEVIATION AND INTERQUARTILE RANGE) OF PRE- AND
POST-MOOD INDUCTION SCORES ............................................................................................................. 130
TABLE 4.4 Z-SCORED KURTOSIS AND SKEWNESS FOR DASS SUBSCALES AND CERQ CATASTROPHISING .......................... 132
TABLE 5.1 PEARSON CORRELATIONS OF THE CQ (AND ITS SUBSCALES) WITH OTHER SCALES (N=243) ........................... 151
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TABLE 5.2 PEARSON PARTIAL CORRELATIONS OF THE CQ SUBSCALES WITH OTHER SCALES (N=243) ............................. 151
TABLE 6.1 Z-SCORED KURTOSIS AND SKEWNESS FOR CQ (TOTAL AND BOTH SUBSCALES) AND DASS (SUBSCALES ONLY). ALL Z-
SCORES BETWEEN -1.96 AND 1.96 ARE CONSIDERED NORMAL ...................................................................... 171
TABLE 6.2 Z-SCORED KURTOSIS AND SKEWNESS FOR DASS FOLLOWING RECIPROCAL TRANSFORMATION (SUBSCALES ONLY)
........................................................................................................................................................ 172

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