Schereretal.BMCPsychiatry2013,13:16 http://www.biomedcentral.com/1471-244X/13/16 RESEARCH ARTICLE Open Access The negative affect repair questionnaire: factor analysis and psychometric evaluation in three samples Anne Scherer1*, Nicole Eberle1, Maren Boecker1, Claus Vögele2, Siegfried Gauggel1 and Thomas Forkmann1 Abstract Background: Negative affect and difficultiesin itsregulation have been connected to several adversepsychological consequences. While severalquestionnaires exist,it would be important to have a theory-based measure that includes clinically relevantitems and shows good psychometric properties in healthy and patient samples. This study aims atdeveloping such a questionnaire, combining thetwo Gross[1]scales Reappraisal and Suppression withan additional response-focused scale calledExternalizing Behavioral Strategiescovering clinically relevant items. Methods: The samples consisted of684 students (meanage=23.3,SD=3.5; 53.6% female) and 369 persons with mixedmentaldisorders(meanage=36.0 SD=14.6; 71.2%female).Items for thequestionnaire were derived from existing questionnaires and additional items were formulated based onsuggestions by clinical experts.Allitems start with “When I don’t feelwell, inorder to feel better...”.Participantsrated how frequently they used each strategy ona 5-point Likert scale. Confirmatory Factor Analyses were conducted to verify the factor structure in two separate student samples and a clinical sample. Group comparisons and correlations with other questionnaires were calculated to ensure validity. Results: After modification, theCFA showed goodmodel fit inall threesamples. Reliability scores (Cronbach’s α) for thethreeNARQ scales ranged between .71 and .80. Comparisons between students and persons with mental disorders showed thepostulated relationships, as did comparisons between male and female students and persons withor without Borderline Personality Disorder. Correlations with other questionnaires suggest the NARQ’s construct validity. Conclusions: The results indicate that theNARQis a psychometrically sound and reliable measure with practical usefor therapy planning and trackingof treatment outcome across time. We advocate theintegrationof the new response-focused strategyin theGross’s model of emotion regulation. Keywords: Affect regulation, Emotionregulation, Mood regulation, Psychometric quality Background several adverse consequences, from ordinary unhappi- Negative affect has profound effect on the quality of so- ness to outright psychopathology [6,7], such as mood cial interactions, social functioning, and well-being [1-4]. disorders [8], generalized anxiety disorder [9], personal- Consequently, people try to regulate negative affect itydisorders[10]andsubstance abuse [11,12]. using various strategies, with some strategies apparently Nonetheless, some problems come to light when dis- being more successful than others [4,5]. Difficulties in cussing affect regulation. For example, the terms affect, affect regulation are considered to be connected to emotion, and mood are used inconsistently, often inter- changeably. In order to avoid this confusion, we use the term “affect regulation” in the sense of a superordinate *Correspondence:ascherer@ukaachen.de category for all valenced states. Consequently, negative 1InstituteofMedicalPsychologyandMedicalSociology,UniversityHospital ofRWTHAachen,Pauwelsstraße19,Aachen52074,Germany affect regulation describes the tendency to actively and Fulllistofauthorinformationisavailableattheendofthearticle ©2013Schereretal.;ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense (http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium, providedtheoriginalworkisproperlycited. Schereretal.BMCPsychiatry2013,13:16 Page2of10 http://www.biomedcentral.com/1471-244X/13/16 positively influence negative affect with various strategies. thewaytheyapproachanemotion-elicitingsituation.The Thisincludestheregulationofemotionsandmoods. sequence starts with Situation Selection and Situation Another problem concerns the available instruments to Modification. After these two steps follows Attentional measure affect regulation. Many instruments are purely Deployment and finally, Cognitive Reappraisal of the empiricallyderived(byuseofexploratoryfactoranalyses), emotion-elicitingsituation. i.e.,withoutcleartheoreticalfoundationorwithouttesting In contrast, response-focused strategies are employed the appropriateness of the theoretical model used. This to change an already existing emotion in certain ways. mayleadtouncertaintiesaboutthenumberandinterpret- Theonlystrategyoftheresponse-focusedstageexplicitly ation of the empirically derived factors [13,14]. Some of stated in Gross’s model is “Expressive Suppression”. This these instruments includeThayer et al’s questionnaire [5] strategy is defined by attempting to keep emotions in or Garnefeski at al’s Cognitive Emotion Regulation Ques- check by not showing them, especially toward other tionnaire (CERQ), where a principal component analysis people. Reappraisal, unlike Suppression, is supposed to was used [15]. Other measurement instruments assess ameliorate the effects that negative emotions have on affectregulationasoneaspectembeddedinabroaderthe- the person. Suppression, in fact, may even be detrimen- oretical construct, for example emotional intelligence or tal to well-being by making people feel inauthentic [27] generalized expectancies of negative mood regulation andcausing disruptionsinsocial situations[28]. [16-18]. Several more instruments to assess emotion or Over the past fifteen years, much evidence has been mood regulation strategies exist, especially in the context presented supporting the general validity of the model ofcertaintherapeutic outcomes, for example,the Accept- (e.g., [28,29]), while on the other hand, there is so far lit- ance and Action Questionnaire (AAQ) [19], which was tle evidence concerning the sequence of different time developed in connection with Acceptance and Commit- stages, the allocation of the strategies to a certain stage ment Therapy (ACT) [20], or the Emotion Regulation and the question if antecedent-focused strategies are Skills Questionnaire [21] which asks participants about generally more beneficial than response-focused strat- theirviewondifferentcompetenciesinrelationwithemo- egies. For a more in-depth discussion on these issues, tion regulation and which is connected to an emotion see[26]. regulationtraining[22].Diversecopingscalesalsoinclude Nevertheless, a close link of the postulated emotion itemssimilartothosefoundinaffectregulationliterature. regulation strategies Reappraisal and Suppression to per- Despite its extensive use in clinical application, most sonal well-being and the development and maintenance available assessment tools of affect regulation strategies ofmentaldisordershasbeenshown(e.g., [15,27,30-32]). were developed exclusively with student populations. Starting from Gross’ model, Gross and John developed This is probably a critical point, making their use poten- the Emotion Regulation Questionnaire (ERQ; [27]), which tially difficultforclinicalgroups(NegativeMoodRegulation was designed to measure Reappraisal and Suppression - (NMR) [16]; Difficulties in Emotion Regulation Scale the two emotion regulation strategies the authors consid- (DERS) [17]). Inthecloselyrelatedfieldofcopingassess- ered to be most typical. In their original study, Gross and ment,Parkeretal.[23]couldnotreplicatethefactorstruc- John found internal consistencies ranging from .68 to .82 ture of a well-established coping questionnaire in different withnocross-loadingsonthetwofactors[27].Egloffetal. student samples, proving the complexity of developing an [33] reported good internal consistencies (mean α=.81) assessmenttoolwithstablepsychometricpropertiesacross for a German adaptation of the ERQ in a sample of 82 differentsamples. psychology students. While the ERQ includes regulation Witha plethoraofdifferent instruments usedin empir- of positive and negative emotions, no separation is made ical studies, it is not surprising that the last years saw a between regulation of positive and negative emotion in rise of different taxonomies of affect regulation. For a the sum score, assumingthatthe valence ofthe regulated comprehensive overview, see the recent meta-analyses by emotionisoflessimportancethanthestrategyingeneral. Webb et al. [24] and Aldao et al. [25] and the recent re- The wording of the items are very similar, asking for Re- view by Berking and Wupperman [26]. Of the theories appraisal and Suppression on an abstract level and with available in the field of affect regulation, Gross’s Emotion seven answer options, which might be difficult to answer RegulationTheoryisprobablyoneofthemostintensively and to interpret, especially for people with mental disor- investigated and most widely accepted [1]. Gross's model ders [34]. Additionally, the factor structure of the ERQ includes five distinct emotion regulation stages, which couldnotbereplicatedbyStadelmaier[35]. occur in sequence over time. The strategies of the first From a clinical perspective, it might be surprising that four stages are summed up under the term “antecedent- otherstrategiestoreduceunpleasantfeelingsarestillab- focused strategies”, because they are assumed to be used sent from Gross’s model and thus also from the ERQ. before the emotion takes (full) hold. So antecedent- Self-harm, aggression or substance abuse should also be focused emotion regulation means people try to change countedamongtheresponse-focused emotionregulation Schereretal.BMCPsychiatry2013,13:16 Page3of10 http://www.biomedcentral.com/1471-244X/13/16 strategies because they are usually used when the nega- assumed the questionnaire to have a three-dimensional tive affect already took hold. These strategies could be structure. Furthermore, we expected Reappraisal to be taken together as “Externalizing Behavioral Strategies” related to psychological well-being and Suppression and should be added as additional response-focused and Externalizing Behavior to be related to symptoms strategy to Gross’s model, especially because knowing of mental illness. We also expected general differences about strategies which are harmful to the person’s health in the emotion regulation strategies between men and at the beginning of treatment can be crucial to its suc- women as found by Gross and John in their original cess [36].A typical patient sample expected toshow sev- work on the ERQ [27] as well as Nolen-Hoeksema & eral harmful externalizing behavioral strategies are Rusting [43] and differences in Externalizing Behavior people diagnosed with Borderline Personality Disorder between patients with and without a diagnosis of Bor- (BPD). In BPD, potentially self-damaging impulsivity in derline Personality Disorder. at least two areas and inappropriate anger are diagnostic criteria according to DSM-IV [37]. Patients suffering Methods from BPD are likely to drop out of inpatient [38] or out- Participants patient treatment [39] and have a high risk of completed The study included 684 students, most of whom studied suicide [40]. But of course, externalizing behavior is also medicine,psychologyorengineering,and369personswho common in other mental disorders without a necessary were treated at a local psychotherapeutic hospital. Stu- comorbidityofapersonalitydisorder [41]. dents’ mean age was 23.3 years (SD=3.5), 53.6% were fe- Externalizing behavioral strategies of affect regulation male.Meanageofpeoplediagnosedwithmentaldisorders arenotusuallycoveredbyaffectregulationquestionnaires. was 36.0 years (SD =14.6), 71.2% were female. The most The questionnaire developed by Thayer et al. [5] assesses common primary diagnoses were Major Depressive Dis- the use of drugs and alcohol with two items. Another order (40.4%) and Eating Disorders (29.3%). Diagnoses questionnairewasdevelopedbyPhillipsandPower[42]to were verified in a two step procedure: First, the diagnoses monitor functional and dysfunctional emotion regulation were assessed by the responsible therapist using a clinical strategies in adolescents and single items concerning interview in which the International Diagnostic Checklists externalizing behavior exist in several affect regulation (IDCL) [44] were applied. The IDCL are checklists that and coping questionnaires. Nevertheless, to our know- canbeused to make acareful evaluationofthe symptoms ledge, no other questionnaire assesses the strategies of andclassificationcriteria,andthushelptoarriveatprecise self-harm,aggression,substanceabuseorotherexternaliz- diagnoses according to ICD-10 criteria. Results of this as- ing behavioral strategies to regulate negative affect in a sessmentwerediscussedwithasupervisingseniorpsycho- systematicmanner. therapist.Incasethatambiguityaboutmainandcomorbid To sum up, there is extensive evidence suggesting that diagnosespersistedafterthisitwasdecidedthatafullform affect regulation may play an important role in the devel- oftheGermanVersionoftheStructuredClinicalInterview opmentandmaintenanceofmentaldisordersandthatthe for DSM-IV (SKID) [45] was conducted in addition. The two extensively investigated regulation strategies Cogni- clinical interviews were conducted by clinical psycholo- tiveReappraisalandExpressiveSuppressionarerelatedto gists. In the second step, diagnoses were verified through personal well-being. However, from a clinical perspective, clinical conferences including senior psychotherapists and it appears promising to extend Gross’s model of emotion psychiatrists.Table1showsdetaileddemographicandclin- regulation by a second response-focused strategy called ical characteristics of the samples. The students were ran- “Externalizing Behavioral Strategies” which appears to be domly divided into two subsamples to allow for cross of major importance in clinical populations and thus also validation. The two random groups did not differ in age promises important practical benefits. To our knowledge (t=1.34, p=.184) or sex (χ2 =1.42, p=.251). Students thereisnoinstrumentthatcombinesthetwoGrossscales volunteered to participate after class meetings. Persons with an assessment of Externalizing Behavioral Strategies. seeking treatment for mental disorders were tested during This provided the rationale for the current study which admissionaspartofastandarddiagnosticassessment.They aimedatdevelopingtheNegativeAffectRepairQuestion- gavewritteninformedconsentfortheirdatatobeincluded naire (NARQ) including those three scales, measuring in research. Ethical approval was given by the local ethics them with more palpable, behavior-related items that committee of the Medical Faculty of the RWTH Aachen measure different aspects of Reappraisal and Suppression University.Noneoftheparticipantswaspaid. andensuringtheirstabilityacrossclinicalandnon-clinical groups. The focus on negative affect allows us to exclude Instruments confounding effects that could arise from differences in Itempool regulation of positive and negative emotions. Consistent Items designed to assess strategies that people might use with previous results and Gross’s theoretical model, we to repair negative affect were collected. The item pool Schereretal.BMCPsychiatry2013,13:16 Page4of10 http://www.biomedcentral.com/1471-244X/13/16 Table1Demographicandclinicalcharacteristicsofthestudentandclinicalgroupsandthetotalsample N Age Female% Primarydiagnoses M SD Range Depression Eatingdisorder Other Totalsample 1053 27.7 11.0 15-81 59.8 StudentsI 341 23.4 3.7 19-45 51.3 StudentsII 343 23.0 3.4 18-50 55.8 Clinical 369 36.0 14.6 15-81 71.2 40.4% 29.3% 30.3% was constructed as follows: questionnaires related to Dataanalysis affect regulation were screened to select relevant items, Confirmatoryfactoranalysis some of which were revised or rephrased to standardize Confirmatory factor analysis (CFA) was conducted to wording and answer options. Additional items related to corroborate the postulated factor structure of the NARQ behavior and relevant for clinical populations were con- and to determine its reliability. Ordinal scale CFA with structed. For the second step, clinicians (i.e., senior psy- weighted least square means and variance adjusted was chotherapists) were asked to suggest further relevant performed using the software MPlus 4.1. The appropri- regulation strategies, especially those they rated as clin- ateness of a specific CFA model was assessed using ab- ically relevant. The final item pool consisted of 55 items. solute and incremental measures of global model fit. All items start with “When I don’t feel well, in order to Measures of global fit indicate whether the empirical feel better...”. Test subjects rated how frequently they associations among the manifest variables are appropri- used each of the strategies on a 5-point Likert scale ran- ately reproducedinthe model [48,49]. ging from 0(never) to4(always). Absolute fit was tested with two measures: χ2 is used Consistent with previous results and Gross’s theoret- to measure the differences between the observed and ical model, we assumed the questionnaire to have a the expected covariance matrix. Butbecause χ2 is known three-dimensional structure. Items were allocated to one to be sensitive to sample size, additional measures were of the three scales—Reappraisal, Suppression, or Exter- included[50,51]. nalizing Behavioral Strategies. Items that could not be Therootmeansquareerrorofapproximation(RMSEA) allocated to one of the three categories were excluded. is interpreted as the amount of information within the Thus,analyseswereperformedusing32items. empirical covariance matrix that cannot be explained by the proposed model. The model may be classified as ac- Emotionregulationquestionnaire ceptableifonly8percentorlessoftheinformationisnot The Emotion Regulation Questionnaire. (ERQ, [27]) accountedforbythemodel(RMSEA≤0.08;[51]). consists of 10 items (e.g., I keep positive emotions to Measures of incremental fit show the improvement of myself;Icontrolmynegativeemotionsbynotexpressing the proposed model compared with a baseline model. them.). Six of them are included on the “Cognitive Re- Two different measures of incremental fit were employed appraisal” scale, four on the “Expressive Suppression” inthisstudy:TheTucker-Lewisindex(TLI)andtheCom- scale. Answers are given on a scale that ranges from 1 parative Fit Index (CFI) [52]. TLI and CFI values of≥.95 “strongly disagree” to 7 “strongly agree”, which adds up indicateagoodmodelfit[53]. to a minimum score of 6 (Reappraisal) and 4 (Suppres- To improve fit, (1) items were eliminated if item-scale sion) and a maximum score of 42 (Reappraisal) and 28 correlations were low (<.32; [53]) and the elimination of (Suppression). TheERQwascompleted by thesampleof the item would not reduce the internal consistency of persons withmentaldisordersonly. the scale, or (2) modification indices were allowed when they suggested that residual correlations between error Beckdepressioninventory terms would entail a substantial improvement in fit, a The Beck Depression Inventory (BDI, [46,47]) was used residual correlation was in line with theoretical consid- to measure depression. It contains 21 items answered on erations and the modification could be replicated in the a 0-to-3 scale. Participants were asked to choose one or cross-validation[49,54]. more statements per item that best represented their All analyses were first conducted using one of the stu- mental state during the last week. A total score of ≥11 dent samples and then cross-validated on the second indicates mild-to-moderate depression, and a total score student sample and the sample of persons with mental of ≥18 indicates moderate-to-severe depression. The disorders. BDI was completed by the sample of persons with men- Additionally, the factor structure of the ERQ was tal disorders only. Internal consistency (Cronbach’s α) tested in the clinical sample to compare its factor struc- forthe BDIwas.90inoursample. turewith ournewlydevelopedquestionnaire. Schereretal.BMCPsychiatry2013,13:16 Page5of10 http://www.biomedcentral.com/1471-244X/13/16 Reliabilityandvalidity TLI=.96, CFI=.96) that was confirmed in all three sam- Reliability (internal consistency) of the three scales of ples(seeTable2). the NARQ was assessed by calculating Cronbach’s α. Theitem-scale correlations for each item and the scale Validity was assessed by using Multivariate Analysis of structure of the modified CFA model are displayed in Variance (MANOVA) and effect sizes to compare mean Figure 1, means and standard deviations for students values for subgroups that were expected to differ in andclinicalsubgroups aredisplayed inTable3.Allitems affect regulation. Effect sizes d were calculated using of the final version of the NARQ scales can be found in Hedges and Olkin’s corrected factor [55]. According to theAdditionalfile1. Cohen’s guidelines, effect sizes of .20.05 ≥.90 ≥.90 ≤.08 guidelines(seeMethods).Inaddition,modificationindices FirstVersion indicated that several items that loaded on the same fac- StudentsI 1697.0 99 <.001 .72 .72 .112 tors should be allowed to have correlated error terms. ModifiedVersion Thus residual correlations that were in line with theoret- StudentsI 1598.9 46 <.001 .96 .96 .064 ical considerations were allowed. The modified CFA StudentsII 1122.7 43 <.001 .93 .94 .067 model thatresulted contained 17items and yielded abet- ter fit of the data (χ2=1598.9, p<.001, RMSEA=.064, Clinical 1915.2 38 <.001 .96 .95 .074 Schereretal.BMCPsychiatry2013,13:16 Page6of10 http://www.biomedcentral.com/1471-244X/13/16 Figure1StructureoftheCFAmodel.Note:Boldnumbers=Firststudentsample,normalnumbers=Secondstudentsample,italicnumbers= Clinicalsample. Table3Meansandstandarddeviationsofstudentsampleandclinicalsubgroups N Reappraisal Suppression ExternalizingBehaviorStrategies M SD Range M SD Range M SD Range Students 684 11.4 3.0 1–20 8.6 3.7 0–20 3.9 3.2 0–19 Clinical:Depression 147 9.1 3.5 0–17 10.7 4.0 1–20 4.6 3.7 0–14 Clinical:EatingDisorders 107 8.7 3.5 1–18 10.9 3.6 2–17 5.6 3.8 0–18 Clinical:Other 115 10.0 3.0 3–20 10.8 3.6 1–18 4.8 4.1 0–18 Note:Clinicalsamplesortedbyfirstdiagnosis.Furthercomorbiddisordersmayexist. Schereretal.BMCPsychiatry2013,13:16 Page7of10 http://www.biomedcentral.com/1471-244X/13/16 In both subgroups (students and patients), Reappraisal Correlations of the NARQ scales with the ERQ scales and Suppression were the most commonly used strat- could also only be obtained from the clinical sample and egies. Calculating effect sizes between the two samples, were calculated to estimate how closely the NARQ students use more Reappraisal (F=101.46 p<.001; scales match the original scales by Gross and John [15]. d=.68 CI=.55 to .81), but less Suppression (F=81.19 The results show moderate correlations between the Re- p<0.001; d=−.59 CI=−.46 to -.72) and Externalizing appraisal scales (r=.52, p<.001) and the Suppression Behavioral Strategies (F=17.10 p<.001; d=−.29 CI= scales (r=.72, p<.001). Weaker but significant correla- −.16 to -.42) than patients. Comparing male and female tions were also found between the ERQ scale Re- students, male students showed slightly less Re- appraisal and the NARQ scale Suppression r=−.18, appraisal (F=9.94 p=.002; d=.25 CI=.09 to .40), but p=.006 and between the ERQ scale Suppression and the markedly more Suppression and Externalizing Behav- NARQ scales Reappraisal r=−.29, p<.001 and External- ioral Strategies (F=101.46 p<.001; d=−.81 CI=−.65 izingBehavioral Strategies r=−.22,p=.001. to -.97, F=31.00 p<.001; d=−.44 CI=−.29 to -.60) Summing up, the results show acceptable fit for the than female students. modified model and indicate good internal consistency Persons diagnosed with Borderline Personality Dis- andconstructvalidity ofthenewquestionnaire. order showed Reappraisal and Suppression no different from persons with other mental disorders (F=.39 Discussion p=.561; d=.13 CI -.19 to .45; F=2.60 p=.108; The aim of the current study was to develop a theoretic- d=−.31 CI .01 to -.63). On Externalizing Behavioral ally derived and reliable instrument for the measurement Strategies, on the other hand, persons with BPD reached of negative affect repair strategies, applicable in clinical twicetherawscoreofotherpeople,resultinginalargeef- groups and assessing the well established scales Re- fect size (F=65.76 p<.001; d=−1.33 CI −1.00 to −1.66). appraisalandSuppressioninadditiontoascalemeasuring SeeTable4fordetailsonmeansandstandarddeviations. Externalizing Behavioral Strategies that may endanger the In order to explore construct validity, correlations be- therapeutic process. The psychometric properties of the tween the NARQ scales and BDI scores were assessed newly developed NARQ were examined in two student for the clinical subgroup. The results revealed a weak samplesandaclinicalsample. but significant negative correlation between the BDI and The a-priori, theoretically derived scale structure was NARQ scale Reappraisal (r=−.35, p<.001), indicating tested using CFA. After modification and shortening the that an increased score on the Reappraisal scale of the scale to 17 items, the three-dimensional structure could NARQ isassociatedwith fewerdepressivesymptoms. befoundinthestudent sampleandconfirmedinthesec- Incontrast,thecorrelationsbetweenthescalesSuppres- ond student sample and the clinical sample. The results sion and Externalizing Behavioral Strategies and the BDI areinlinewiththehypothesizedthree-dimensionalfactor score were positive (r=.36, p<.001 and r=.49, p<.001) structure of the NARQ and confirm the general multidi- suggesting that with an increased score in Suppression mensionality of the construct negative affect regulation and Externalizing Behavioral Strategies, the depression [5,17,27,60]. score also increased. Comparing the correlations to the Reliability was found to be acceptable, especially in re- correlationsbetweentheBDIandtheoriginalERQscales, gard to other published affect regulation questionnaires, we found an identical correlation for the Suppression for example the ERQ (α=.68 - .82), the questionnaire Scale (r=.36, p<.001), but a lower correlation for the published by Thayer [5] (α=.54 to .81) or Phillips’s and ERQReappraisalScale(r=.20,p=.004). Power’squestionnaire[42](α=.66-.76). Table4Meansandstandarddeviationsforthedifferentsubgroups Reappraisal Suppression Externalizing N Mean(SD) d(CI) N Mean(SD) d(CI) N Mean(SD) d(CI) AllPersonswithMental 364 9.3(3.4) 364 10.7(3.8) 350 4.9(3.9) Disorders 0.68(0.55-0.81) −0.59(−0.46−-0.72) −0.29(−0.16-−0.42) AllStudents 670 11.4(3.0) 675 8.6(3.6) 673 3.9(3.2) MaleStudents 314 11.0(3.2) 312 10.0(3.3) 312 4.7(3.5) 0.25(0.09-0.40) −0.81(−0.65−-0.97) −0.44(−0.29−-0.60) FemaleStudents 356 11.8(2.8) 363 7.3(3.4) 361 3.3(2.8) BPD 43 8.9(3.4) 43 11.8(3.7) 44 9.0(3.7) 0.13(−0.19-0.45) −0.31(0.01−-0.63) −1.33(−1.00−-1.66) OtherMentalDisorders 318 9.3(3.4) 319 10.6(3.8) 304 4.3(3.5) Note:AllcomparisonsexceptforReappraisalandSuppressionbetweenBPDandotherpatientsweresignificant(p<.001). Schereretal.BMCPsychiatry2013,13:16 Page8of10 http://www.biomedcentral.com/1471-244X/13/16 Comparisons between clinical and student samples, because they showed the best psychometric fit and reli- between male and female students and between persons ability. Since the item formulations are less abstract it with BPD and persons with other mental disorders can be expected that they are easier to understand. Fur- showed results that are in line with the theoretical thermore, redundancy of item contents can be seen as expectations and thus can be counted as evidence for potential shortcoming of the ERQ so that greater item the NARQ’s validity. The comparably small difference diversity was an explicit aim in the development of the between the clinical and the student sample in average NARQ. This also applies to the NARQ Suppression use of externalizing strategies is not unexpected: Only a scale, which includes items that cover aspects of (not) few patients show aggressive behavior (towards them- sharing feelings in addition to hiding them from others. selves or others) or drug abuse. Comparing persons with While it has recently been argued that Suppression and without a diagnosis of BPD, larger differences came might not be used solely as an affect regulation strategy tolight. The correlationswith related anddiverging con- but also as a way to prevent negative evaluation of structs(BDI, ERQ) also supported the NARQ’s construct others [26], this potential problem was avoided by the validity. instruction which asks specifically for things to do to Some limitations of the present study should be noted. make oneselffeel better. Due to the nature of self-reports, it cannot be ruled out Some potentially harmful strategies (e.g., smoking or that social desirability could have had an influence on eating) had to be deleted from the final version of the the rating of strategies that might have been considered NARQ due to insufficient fit. It is important to note socially undesirable (e.g., hurt others, hit things). How- that of course no questionnaire can replace a thorough ever, socially undesirable strategies were reported in all case history to identify more idiosyncratic ways of ag- samples. A further potential methodological shortcom- gression towards self and others (sexual behavior, binge ing was the significant χ2 of the CFA models which eating, etc.). might be interpreted as indicating insufficient fit of the Students were not screened for symptoms of mental model. However, it is a well-known statistical effect that disorder, so it must be assumed that a small part of the the χ2-statistic becomes hypersensitive for small misspe- student populations suffers from mental illness. None- cifications of the model in large samples resulting in sig- theless, the NARQ was able to differentiate between stu- nificant results [50,51]. Since the entire study sample dents and persons with mental disorders on the group- consisted of N=1053 individuals this was likely the case level. Differences between age groups could not yet be in the present study. In this case, it is recommended to calculated because of the small age range of the current examine further fit indices to identify real serious misfit. samples. Because of this and since students tend to be a Since all further measures of model fit (RMSEA, CFI, fairly homogeneous group, it would be advisable to val- TLI) indicated very good model fit, the significant χ2- idate the factor structure in an additional representative, statistic canbeneglected. non clinical sample from the general population as well The deletion of items and the inclusion of correlated as compare other, larger groups of people with mental error terms are two empirical strategies to improve fit disorders. to the model in CFA that might be interpreted as a A future aim should be to determine retest reliability contradiction towards a theory-driven approach. How- and predictive validity of the inventory, for example the ever, in this study, we followed an a-priori protocol and associations of NARQ scales with clinically relevant be- only allowed correlated error terms if there was a good havioral outcomes, to further corroborate the instru- theoretical explanation for both items to have a com- ments validity and practical utility. Further analyses of mon variance beyond the scale to which they were allo- convergent validity in comparison to other measures of cated and remained within the framework of Gross’s affect regulation would also be useful. Most importantly, theory. None of the residual correlations allowed threa- norms have to be developed for both sexes and maybe tened the theoretically assumed dimensionality of the also for different age groups to permit standardized developed instrument. Since the identified factor struc- comparisons. ture could be replicated across all three samples it can be considered to be stable despite of the application of Conclusion modifications [54]. With the NARQ, clinicians have a new, psychometrically The items included in the Reappraisal scale indicate a sound and reliable measure for the assessment of affect wider understanding of the construct “Reappraisal” than regulation strategies. Initial validation of the instrument the Reappraisal subscale used by Gross and John [27], indicated promising results. The NARQ covers both which probably also causes the smaller correlation be- Gross’s scales Reappraisal and Suppression which were tween those two scales in contrast to the Suppression operationalized in a more behavior-related manner. It scales. These more diverse cognitive items were retained also includes a new scale called Externalizing Behavioral Schereretal.BMCPsychiatry2013,13:16 Page9of10 http://www.biomedcentral.com/1471-244X/13/16 Strategies. The reported differences between samples of References persons with different mental disorders indicate that this 1. GrossJJ:Theemergingfieldofemotionregulation:anintegrativereview. RevGenPsychol1998,2(Suppl3):271–299.doi:10.1037/1089-2680.2.3.271. scale might be of practical use for therapy planning and 2. EisenbergN,FabesR,GuthrieI,ReiserM:Dispositionalemotionalityand tracking of treatment outcome across time. We advocate regulation:theirroleinpredictingqualityofsocialfunctioning.JPersSoc for the integration of this new response-focused strategy Psychol2000,78(Suppl1):136–157.doi:10.1037/0022-3514.78.1.136. in the Gross’s model of emotion regulation. In regard to 3. 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The negative affect repair questionnaire: factor analysis and psychometric evaluation in three samples.

Similar The negative affect repair questionnaire: factor analysis and psychometric evaluation in three samples.