Appraising reappraisal: Exploring its role in the context of behavioral exposure for contamination fears.

OBJECTIVES: A large body of work suggests that cognitive reappraisal is an effective strategy for modifying emotional intensity. In addition, its habitual use has been linked to adaptive psychological functioning, operationalized as low levels of symptoms of psychopathology. However, little is known about the impact of cognitive reappraisal on behavioral aspects of mental disorders. For example, the experience of fear is often accompanied by the behavioral urge to avoid the feared stimuli. Although there is evidence to suggest that cognitive reappraisal reduces fear in the moment, there is less information about the impact on behavioral correlates. METHOD: To that end, we recruited 90 participants who experienced substantial contamination concerns (i.e., obsessive-compulsive disorder symptoms) and asked them to participate in exposure tasks that consisted of gradually coming into contact with contaminated objects (i.e., approach behavior). We randomly assigned participants to one of three conditions: (1) reappraise the emotion-eliciting stimulus, (2) reappraise their emotional response, or (3) no specific emotion regulation instructions. RESULTS: Reappraising the stimulus, but not reappraising the emotional response, led to significantly greater behavioral approach (p = .02) than the no-instruction condition during exposure. There were no significant differences in subjective state anxiety between any of the conditions. CONCLUSION: These findings suggest that certain types of reappraisal may lead to greater approach behavior during exposure even in the absence of subjective emotional changes. More broadly, they underscore the importance of examining the role of emotion regulation strategies (including different types of reappraisal) on the behavioral aspects of mental disorders.

Mindfulness and emotion regulation in older and young adults.

OBJECTIVES: Research shows that dispositional mindfulness is associated with metrics of overall well-being, with enhanced emotion regulation potentially underlying these salutary effects. However, the role of regulation strategy use remains poorly understood. In this study, we examined age-variant associations between dispositional mindfulness, emotion regulation strategies, and emotion dysregulation. METHOD: Self-report data were collected from 50 older and 50 young adults on mindfulness, emotion dysregulation, and recent strategy use. For the current study, we examined if cognitive reappraisal, experiential suppression, and thought avoidance use mediated the association between mindfulness and emotion dysregulation. RESULTS: Thought avoidance, but not reappraisal or suppression strategies, partially mediated the association between mindfulness and emotion dysregulation. Age group moderated the observed mediation, such that for young adults, lower mindfulness was associated with greater use of thought avoidance, and in turn with greater emotion dysregulation (e.g., difficulties engaging in goal-directed behavior in the face of strong emotions). CONCLUSION: The current cross-sectional study suggests that reduced avoidance of thoughts may partially explain the relationship between trait mindfulness and enhanced emotion regulation, with this mediational pathway being stronger for young compared with older adults.

Habitual reappraisal in context: peer victimisation moderates its association with physiological reactivity to social stress.

Although the emotion regulation strategy of reappraisal has been associated with adaptive outcomes, there is a growing evidence that it may not be adaptive in all contexts. In the present study, adolescents reported their use of habitual reappraisal and their experiences with peer victimisation, a chronic stressor that is associated with reduced well-being in this population. We examined how these variables predicted physiological reactivity (vagal withdrawal and changes in pre-ejection period) during a social stressor (i.e., Trier Social Stress Task). In line with previous research, at high levels of victimisation, habitual reappraisal predicted adaptive physiological reactivity (i.e., greater vagal withdrawal). Conversely, at low levels of victimisation, habitual reappraisal predicted maladaptive physiological reactivity (i.e., blunted vagal withdrawal). These findings were specific to parasympathetic reactivity. They suggest that habitual reappraisal may exert different effects on parasympathetic reactivity depending on the presence of stressors, and highlight the importance of examining the role of contextual factors in determining the adaptiveness of emotion regulation strategies.

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

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

Individual differences in physiological flexibility predict spontaneous avoidance.

People often regulate their emotions by resorting to avoidance, a putatively maladaptive strategy. Prior work suggests that increased psychopathology symptoms predict greater spontaneous utilisation of this strategy. Extending this work, we examined whether heightened resting cardiac vagal tone (which reflects a general ability to regulate emotions in line with contextual demands) predicts decreased spontaneous avoidance. In Study 1, greater resting vagal tone was associated with reduced spontaneous avoidance in response to disgust-eliciting pictures, beyond anxiety and depression symptoms and emotional reactivity. In Study 2, resting vagal tone interacted with anxiety and depression symptoms to predict spontaneous avoidance in response to disgust-eliciting film clips. The positive association between symptoms and spontaneous avoidance was more pronounced among participants with reduced resting vagal tone. Thus, increased resting vagal tone might protect against the use of avoidance. Our findings highlight the importance of assessing both subjective and biological processes when studying individual differences in emotion regulation.

Introduction to the special issue: toward implementing physiological measures in clinical child and adolescent assessments.

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). The RDoC is an initiative to improve classification of mental health concerns by promoting research on the brain mechanisms underlying these concerns, with the ultimate goal of developing interventions that target these brain mechanisms. A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures. The RDoC presents unique challenges to mental health professionals who work with children and adolescents. Indeed, mental health professionals rarely integrate biological measures into clinical assessments. Thus, RDoC's ability to improve patient care rests, in part, on the development of strategies for implementing biological measures within mental health assessments. Further, mental health professionals already carry out comprehensive assessments that frequently yield inconsistent findings. These inconsistencies have historically posed challenges to interpreting research findings as well as assessment outcomes in practice settings. In this introductory article, we review key issues that informed the development of a special issue of articles demonstrating methods for implementing low-cost measures of physiological functioning in clinical child and adolescent assessments. We also outline a conceptual framework, informed by theoretical work on using and interpreting multiple informants' clinical reports (De Los Reyes, Thomas, Goodman, & Kundey, 2013 ), to guide hypothesis testing when using physiological measures within clinical child and adolescent assessments. This special issue and the conceptual model described in this article may open up new lines of research testing paradigms for implementing clinically feasible physiological measures in clinical child and adolescent assessments.

Commentary: a practical guide for translating basic research on affective science to implementing physiology in clinical child and adolescent assessments.

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). RDoC is a framework that facilitates the dimensional assessment and classification of processes relevant to mental health (e.g., affect, regulation, cognition, social affiliation), as reflected in measurements across multiple units of analysis (e.g., physiology, circuitry, genes, self-reports). A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures, with the key goal of developing new therapeutic techniques that effectively target mechanisms of mental disorders. Yet applied researchers and practitioners rarely use biological measures within mental health assessments, which may present challenges in translating RDoC-guided research into improvements in patient care. Thus, if RDoC is to result in research that yields clinical tools that reduce the burden of mental illness and improve public health, we ought to develop strategies for effectively implementing biological measures in the context of clinical assessments. In this special issue, we sought to provide an initial step in this direction by assembling a collection of articles from leading research teams carrying out pioneering work on implementing multimodal assessments (biological, subjective, behavioral) of affective processes in applied settings. In this commentary, we expand upon the work presented in this special issue by making a series of suggestions for how to most parsimoniously conduct multimodal assessments of affective processes in applied research and clinical settings. We hope that this approach will facilitate translations of the RDoC framework into applied research and clinic settings.

Implementing psychophysiology in clinical assessments of adolescent social anxiety: use of rater judgments based on graphical representations of psychophysiology.

Social stressor tasks induce adolescents' social distress as indexed by low-cost psychophysiological methods. Unknown is how to incorporate these methods within clinical assessments. Having assessors judge graphical depictions of psychophysiological data may facilitate detections of data patterns that may be difficult to identify using judgments about numerical depictions of psychophysiological data. Specifically, the Chernoff Face method involves graphically representing data using features on the human face (eyes, nose, mouth, and face shape). This method capitalizes on humans' abilities to discern subtle variations in facial features. Using adolescent heart rate norms and Chernoff Faces, we illustrated a method for implementing psychophysiology within clinical assessments of adolescent social anxiety. Twenty-two clinic-referred adolescents completed a social anxiety self-report and provided psychophysiological data using wireless heart rate monitors during a social stressor task. We graphically represented participants' psychophysiological data and normative adolescent heart rates. For each participant, two undergraduate coders made comparative judgments between the dimensions (eyes, nose, mouth, and face shape) of two Chernoff Faces. One Chernoff Face represented a participant's heart rate within a context (baseline, speech preparation, or speech-giving). The second Chernoff Face represented normative heart rate data matched to the participant's age. Using Chernoff Faces, coders reliably and accurately identified contextual variation in participants' heart rate responses to social stress. Further, adolescents' self-reported social anxiety symptoms predicted Chernoff Face judgments, and judgments could be differentiated by social stress context. Our findings have important implications for implementing psychophysiology within clinical assessments of adolescent social anxiety.

Repertoires of emotion regulation: A person-centered approach to assessing emotion regulation strategies and links to psychopathology.

Despite growing research on emotion regulation (ER) strategies and psychopathology, research has primarily focused on identifying one-to-one associations between ER strategies and symptoms. Thus, little is known about how patterns in the repertoires of ER strategies are associated with different mental disorders. We utilised latent class analysis to identify distinct repertoires of ER strategies, and their links with various psychopathology domains (i.e., anxiety, depression, disordered eating, borderline personality). Participants (N = 531) reported on their use of seven ER strategies in six recalled stressful contexts, as well as on their symptoms of psychopathology. We identified five classes of ER strategies: Low Regulators (n = 168), High Regulators (n = 140), Adaptive Regulators (n = 99), Worriers/Ruminators (n = 96) and Avoiders (n = 28). Generally, High Regulators and Worriers/Ruminators endorsed greater levels of psychopathology, relative to Low and Adaptive Regulators. Our findings underscore the importance of characterising the dynamics of ER repertoires when seeking to understand links between ER strategies and psychopathology.

Rumination and multi-modal emotional reactivity.

Rumination, a cognitive process that involves passively and repetitively focusing on negative feelings and their consequences, has been linked to negative emotional outcomes. Previous research suggests that rumination may lead to deleterious outcomes through prolonging emotional reactivity; however, evidence supporting the link between rumination and reactivity has been mixed. In the present study, we examined the relationship between state and trait rumination and multi-modal emotional reactivity (i.e., hypothalamic-pituitary-adrenal axis, autonomic nervous system, subjective experience). Fifty undergraduates participated in a social evaluative laboratory stressor. They also reported on their general tendency to ruminate and their use of rumination in response to this particular laboratory stressor. State, but not trait, rumination was associated with increases in cortisol and negative affect. Findings underscore the importance of multi-modal assessment of emotional reactivity and suggest important implications for rumination following a stressor.

Broadening the scope of research on emotion regulation strategies and psychopathology.

Despite the increasing interest in the study of emotion regulation strategies and psychopathology, researchers have predominantly focused on covert emotion regulation strategies-that is, those strategies that occur within the individual (e.g., cognitive reappraisal, suppression). Conversely, less attention has been devoted to the examination of the relationship between psychopathology and overt emotion regulation strategies (e.g., drinking alcohol, seeking advice). This has resulted in a limited understanding of the complex repertoire of emotion regulation strategies that individuals possess, and how patterns in the use of strategies might relate to psychopathology. We asked 218 undergraduates to report on their habitual use of 15 covert and overt emotion regulation strategies and symptoms of seven different mental disorders. Overt strategies were associated with symptoms and, at times, they predicted psychopathology above and beyond the more frequently studied covert strategies. These findings have implications for developing a more sophisticated understanding of patterns of adaptive and maladaptive emotion regulation.

One versus many: capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus.

The past decade and a half has witnessed a renewed interest in the study of affective processes. James Gross' process model of emotion regulation has provided a theoretical framework for this approach. This model stipulates that individuals have a repertoire of emotion regulation strategies they use in order to modify their affect and/or the situations eliciting such affect. However, empirical investigations of the use of emotion regulation strategies have largely oversimplified this model by assuming that individuals use only one regulation strategy to manage the affect elicited by a given emotion-eliciting stimulus or situation. This is problematic because it has resulted in a limited understanding of the complex process by which individuals select and implement regulation strategies. In this brief report, we present findings suggesting that people spontaneously use multiple emotion regulation strategies in response to a brief disgust-eliciting film clip. We discuss implications for future empirical work on emotion regulation strategies.

Compromised decision making and the effects of manipulating physical states on human judgments.

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

Coming out under fire: The role of minority stress and emotion regulation in sexual orientation disclosure.

Minority stress is hypothesized to interfere with sexual orientation disclosure and sexual minority wellbeing. In this study, we investigated whether minority stress is causally linked to reduced disclosure in sexual minorities, and whether emotion regulation, a potentially adaptive form of stigma coping, can intervene to promote disclosure even following exposure to minority stress. Sexual minority adults in the US (N = 168) were recruited online and randomized to a 2 x 2 between-subjects experimental design, where they: 1) received either emotion regulation instructions that asked them to either distance themselves from an emotionally evocative film clip or immerse themselves in the clip, and then 2) viewed either an affirming or a minority stress film clip. Following the film clip, participants completed a written reflection task in which they reflected on the film clip they viewed, which allowed research assistants to subsequently code for participants' spontaneous disclosures of sexual orientation. Participants who viewed the minority stress clip were significantly less likely to spontaneously disclose their sexual orientation in the written task compared to those who viewed the affirming film clip, OR = 3.21, 95% CI [1.14, 9.05], p = .03. Although the emotion regulation manipulation was successful, there was no effect on sexual orientation disclosure. To our knowledge, this is the first study to demonstrate a causal link between minority stress and disclosure in sexual minorities, and thus highlights an important mechanism underlying minority stress's effects on sexual minority wellbeing. Results demonstrate the importance of interventions that affirm marginalized identities and promote safe sexual orientation disclosure. Future research is needed to determine the circumstances under which effective emotion regulation can buffer against the negative emotional effects of minority stress to promote healthy approach behaviors like disclosure in safe contexts.

Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect.

Vagally mediated heart rate variability (vmHRV), a measure of the parasympathetic nervous system's control over the heart, is often negatively related to maladaptive emotional outcomes. Recent work suggests that quadratic relationships involving these factors may be present; however, research has not investigated gender differences in these nonlinear functions. To address this gap, the current study tested for quadratic relationships between resting vmHRV and depression and positive affect while investigating gender differences in these relationships. Significant quadratic effects were found between resting vmHRV and reports of both depression symptoms and positive affect in women but not men. Specifically, the lowest levels of depression and the highest levels of positive affect were found at moderate vmHRV in women. These results suggest that examinations of vmHRV's nonlinear associations require the consideration of gender. Our findings are interpreted based on proposed differential neuropsychological mechanisms of vmHRV in men versus women.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Moderated mediation of the link between parent-adolescent conflict and adolescent risk-taking: The role of physiological regulation and hostile behavior in an experimentally controlled investigation.

Compared to childhood and adulthood, adolescence is a time of greater risk-taking behavior, potentially resulting in serious consequences. Theories of adolescent brain development highlight the imbalance between neural circuitry for reward vs. regulation. Although this imbalance may make adolescents more vulnerable to impaired decision-making in the context of heightened arousal, not all adolescents exhibit problematic risk behavior, suggesting other factors are involved. Relatedly, parent-adolescent conflict increases in mid-adolescence, and is linked to negative outcomes like substance use related risk-taking. However, the mechanism by which parent-adolescent conflict and risk-taking are linked is still unknown. Therefore, we investigated this association using a multi-method experimental design. Parent-adolescent dyads were randomly assigned to complete a discussion task together on the topic of either the adolescent's dream vacation or an adolescent-identified conflict topic. During the task, adolescent peripheral psychophysiology was measured for later calculation of heart rate variability (HRV), an index of self-regulation. Immediately after the discussion task, adolescents completed a performance-based measure of risk-taking propensity that indexes real-world risk behaviors. We hypothesized that parent-adolescent conflict would predict greater adolescent risk-taking propensity, and that increased behavioral arousal in the context of conflict, coupled with impaired self-regulation, would explain this link. Results indicated no direct effect of parent-adolescent conflict on adolescent risk-taking propensity. However, there was a significant conditional indirect effect: lower HRV, indexing worse regulatory ability, mediated the relation between conflict and risk-taking propensity but only for adolescents exhibiting behavioral arousal during the discussion task. We discuss implications for understanding adolescent risk-taking behavior.

Multi-Informant Assessments of Adolescent Social Anxiety: Adding Clarity by Leveraging Reports from Unfamiliar Peer Confederates.

Adolescent social anxiety (SA) assessments often include adolescent and parent reports, and low reporting correspondence results in uncertainties in clinical decision-making. Adolescents display SA within non-home contexts such as peer interactions. Yet, current methods for collecting peer reports raise confidentiality concerns, though adolescent SA assessments nonetheless would benefit from context-specific reports relevant to adolescent SA (i.e., interactions with unfamiliar peers). In a sample of 89 adolescents (30 Evaluation-Seeking; 59 Community Control), we collected SA reports from adolescents and their parents, and SA reports from unfamiliar peer confederates who interacted with adolescents during 20-minute mock social interactions. Adolescents and parents completed reports on trait measures of adolescent SA and related concerns (e.g., depressive symptoms), and adolescents completed self-reports of state arousal within mock social interactions. Adolescents' SA reports correlated with reports on parallel measures from parents in the .30s and with peer confederates in the .40s to .50s, whereas reports from parent-confederate dyads correlated in the .07 to .22 range. Adolescent, parent, and peer confederate SA reports related to reports on trait measures of adolescent SA and depressive symptoms, and distinguished Evaluation-Seeking from Community Control Adolescents. Confederates' SA reports incrementally predicted adolescents' self-reported SA over and above parent reports, and vice versa, with combined Rs ranging from .51 to .60. These combined Rs approximate typical correspondence levels between informants who observe adolescents in the same context (e.g., mother-father). Adolescent and peer confederate (but not parent) SA reports predicted adolescents' state arousal in social interactions. These findings have implications for clarifying patterns of reporting correspondence in clinical assessments of adolescent SA.

The Indirect Effect of Emotion Regulation on Minority Stress and Problematic Substance Use in Lesbian, Gay, and Bisexual Individuals.

Lesbian, gay, and bisexual (LGB) individuals report higher levels of problematic alcohol and substance use than their heterosexual peers. This disparity is linked to the experience of LGB-specific stressors, termed minority stress. Additionally, bisexual individuals show increased rates of psychopathology, including problematic alcohol and substance use, above and beyond lesbian and gay individuals. However, not everyone experiencing minority stress reports increased rates of alcohol and substance misuse. Emotion regulation (ER), which plays a critical role in psychopathology in general, is theorized to modulate the link between minority stress and psychopathology. However, it remains largely unknown whether ER plays a role in linking instances of minority stress with substance and alcohol use outcomes. To address the gap, the current study assessed 305 LGB individuals' instances of minority stress, ER, and substance and alcohol use outcomes. We assessed the role of ER in problematic alcohol and substance use among LGB individuals using moderated mediation, where sexual minority status was entered as the moderator, and ER difficulties was entered as the mediator. The results indicated significant indirect effects of minority stress, through ER difficulties, on both problematic alcohol and substance use. However, there was no significant interaction with sexual orientation status, suggesting that ER may be important for all LGB individuals in predicting problematic alcohol and substance use. These results highlight the important role that ER plays between instances of minority stress and substance and alcohol use in LGB individuals, suggesting that ER skills may serve as a novel target for intervention.

Graphical representations of adolescents' psychophysiological reactivity to social stressor tasks: Reliability and validity of the Chernoff Face approach and person-centered profiles for clinical use.

Low-cost methods exist for measuring physiology when clinically assessing adolescent social anxiety. Two barriers to widespread use involve lack of (a) physiological expertise among mental health professionals, and (b) techniques for modeling individual-level physiological profiles. We require a "bridge approach" for interpreting physiology that does not require users to have a physiological background to make judgments, and is amenable to developing individual-level physiological profiles. One method-Chernoff Faces-involves graphically representing data using human facial features (eyes, nose, mouth, face shape), thus capitalizing on humans' abilities to detect even subtle variations among facial features. We examined 327 adolescents from the Tracking Adolescents' Individual Lives Survey (TRAILS) study who completed baseline social anxiety self-reports and physiological assessments within the social scenarios of the Groningen Social Stressor Task (GSST). Using heart rate (HR) norms and Chernoff Faces, 2 naïve coders made judgments about graphically represented HR data and HR norms. For each adolescent, coders made 4 judgments about the features of 2 Chernoff Faces: (a) HR within the GSST and (b) aged-matched HR norms. Coders' judgments reliably and accurately identified elevated HR relative to norms. Using latent class analyses, we identified 3 profiles of Chernoff Face judgments: (a) consistently below HR norms across scenarios (n = 193); (b) above HR norms mainly when speech making (n = 35); or (c) consistently above HR norms across scenarios (n = 99). Chernoff Face judgments displayed validity evidence in relation to self-reported social anxiety and resting HR variability. This study has important implications for implementing physiology within adolescent social anxiety assessments. (PsycINFO Database Record