Investigating the effectiveness of instructing emotion regulation flexibility to individuals with low and high anxiety.

BACKGROUND AND OBJECTIVES: Psychopathology has been associated with a deficit in emotion regulation (ER) flexibility - the ability to flexibly utilize ER strategies that are appropriate to situational demands. Yet, whether anxious individuals can be taught ER flexibility, or whether ER flexibility is effective in managing negative affect, remains unknown. We investigated the impact of instructed ER flexibility on emotional responding among individuals with differing levels of anxiety. DESIGN AND METHODS: Participants (N = 109) were taught two ER strategies (reappraisal, distraction) and randomized to be instructed in either flexible or inflexible ER while viewing images that differed in negative emotional intensity. RESULTS: When averaged over anxiety, or for participants with low anxiety, negative affect did not differ between conditions. However, among anxious participants, those in the flexible regulatory conditions - those who were instructed to flexibly switch between strategies - reported lower negative affect than those in the inflexible Reappraisal only condition, but not the Distraction only condition. The effectiveness of the two flexible conditions did not significantly differ. CONCLUSIONS: Anxious individuals benefitted from being instructed in either ER flexibility or distraction. This finding supports literature on the adaptiveness of distraction and provides preliminary evidence linking instructed ER flexibility and improved emotional responding.

The mental health effects of changing from insecure to secure visas for refugees.

OBJECTIVE: In response to growing numbers of refugees worldwide, host governments are increasingly implementing temporary protection policies; however, little is known regarding the mental health impact of these policies. This online longitudinal study investigated whether refugees who transitioned from low visa security (e.g. short-term transient visas) to medium (e.g. temporary protection visas) or high visa (e.g. permanent visas) security showed changes in depression symptoms, social difficulties and immigration-related fears. METHODS: Participants were 1,201 refugees and asylum-seekers from Arabic, Farsi, Tamil or English-speaking backgrounds. Study variables were measured prior to and after change in visa status (6 months apart). RESULTS: Refugees who transitioned from low to medium security visas showed reduced immigration-related fear (B = -0.09, 95% confidence interval = -0.29 to -0.06), but no change in depression symptoms or social difficulties compared to those who retained low visa security. Refugees who transitioned from low to high security visas showed reduced depression symptoms (B = -0.02, 95% confidence interval = -0.04 to -0.01), social difficulties (B = -0.04, 95% confidence interval = -0.05 to -0.01) and immigration-related fear (B = -0.03, 95% confidence interval = -0.06 to -0.01) compared to those who retained low visa security. CONCLUSION: Findings indicate that the increased security afforded by temporary protection policies (vs short-term transient visas) did not translate into improved mental health and social outcomes for refugees. In contrast, permanent protection was associated with significant improvements in psychological and social functioning. These results have important policy implications for countries who have committed to protect and facilitate improved mental health among refugees.

An experimental investigation of spontaneous emotion regulation variability, negative affect, and posttraumatic stress disorder among traumatized refugees.

OBJECTIVE: Emotion regulation (ER) may be an important psychological mechanism underpinning the development, and management, of posttraumatic stress disorder (PTSD) in refugees. Despite this, little is known about the ER strategies that refugees spontaneously deploy under stress, nor how effective different approaches may be at reducing distress. This was the first study to identify individual differences in patterns of spontaneous ER among refugees and explore their unique associations with negative affect and PTSD. METHOD: Spontaneous reappraisal and suppression use was measured among 82 refugees following a 5-min exposure to trauma-salient images. Negative affect was indexed before and after the exposure task. Latent profile analysis (LPA) was conducted to identify distinct profiles of participants based on differing levels of ER use. RESULTS: LPA revealed two distinct profiles: a high ER variability profile (37%; high suppression/moderate-high reappraisal) and a low ER variability profile (63%; low suppression/moderate reappraisal). The low ER variability profile was associated with increased negative affect during the experimental paradigm, greater PTSD avoidance symptoms, and greater likelihood of insecure visa status compared with the high ER variability profile. CONCLUSIONS: Our findings suggest that a more variable ER approach in response to trauma-salient stressors results in lower distress and is associated with less severe PTSD symptoms. Better understanding the links between patterns of ER strategy use and psychopathology has important implications for the development of effective treatments for refugees. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Investigating the associations between cognitive appraisals, emotion regulation and symptoms of posttraumatic stress disorder among Asian American and European American trauma survivors.

This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.

Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review.

Despite elevated rates of psychological disorders amongst individuals from a refugee background, levels of mental health help-seeking in these populations are low. There is an urgent need to understand the key barriers that prevent refugees and asylum-seekers from accessing help for psychological symptoms. This review synthesises literature examining perceptions of mental health and barriers to mental health help-seeking in individuals from a refugee background. Our analysis, which complies with PRISMA reporting guidelines, identified 62 relevant studies. Data extraction and thematic analytic techniques were used to synthesise findings from quantitative (n = 26) and qualitative (n = 40) studies. We found that the salient barriers to help-seeking were: (a) cultural barriers, including mental health stigma and knowledge of dominant models of mental health; (b) structural barriers, including financial strain, language proficiency, unstable accommodation, and a lack of understanding of how to access services, and (c) barriers specific to the refugee experience, including immigration status, a lack of trust in authority figures and concerns about confidentiality. We discuss and contextualise these key themes and consider how these findings can inform the development of policies and programs to increase treatment uptake and ultimately reduce the mental health burden amongst refugees and asylum-seekers.

Investigating the relationship between distinctive patterns of emotion regulation, trauma exposure and psychopathology among refugees resettled in Australia: a latent class analysis.

Background: Emotion regulation difficulties are common among individuals from refugee backgrounds. Little is known, however, about whether there are specific patterns relating to the types of emotion regulation strategies commonly employed by refugees, nor how this relates to psychopathology. Moreover, wider literature on emotion regulation has primarily focused on examining specific emotion regulation strategies in isolation, rather than patterns of emotion regulation across multiple strategies. Objective: The current study was the first to identify individual differences in patterns of habitual emotion regulation among refugees, and explore their unique associations with trauma exposure and PTSD symptoms. Method: Levels of trait reappraisal and suppression were measured among 93 refugees, using the Emotion Regulation Questionnaire and the White Bear Suppression Inventory. A latent class analysis was conducted to identify distinct classes of participants based on differing levels of habitual engagement in reappraisal and suppression. The association between class membership and key variables indexing refugee experiences (e.g. trauma exposure) and psychopathology (e.g. PTSD symptoms and emotion dysregulation) were also examined. Results: Latent class analysis revealed three distinct profiles of habitual emotion regulation: a high regulators class (55.7%; high trait reappraisal/high trait suppression), an adaptive regulators class (23.6%; high trait reappraisal/moderate trait suppression), and a maladaptive regulators class (20.6%; low trait reappraisal/high trait suppression). Each class evidenced unique relations with trauma exposure and psychopathology. Compared to adaptive regulators, maladaptive regulators had more PTSD symptoms, experienced greater emotion dysregulation, and were more likely to be female, while high regulators had experienced more types of traumatic events. Conclusions: This study identified distinct patterns of emotion regulation among refugees. Our findings demonstrate the importance of measuring multiple strategies to uncover patterns of emotion regulation and better understand the links between emotion regulation and psychopathology, which has important implications for the development of effective treatment with traumatized refugees.

Antecedentes: Las dificultades en la regulación emocional son frecuentes entre los individuos con historial de ser refugiados. Sin embargo, se sabe poco acerca de si hay patrones específicos relacionados a los tipos de estrategias de regulación emocional comúnmente utilizadas por los refugiados, ni cómo esto se relaciona con psicopatología. Además, la literatura general sobre regulación emocional se ha focalizado principalmente en examinar estrategias específicas de regulación emocional de forma individual, en vez de patrones de regulación emocional a través de múltiples estrategias.Objetivo: El presente estudio fue el primero para identificar las diferencias individuales en los patrones de regulación emocional habituales entre refugiados y explorar sus asociaciones específicas con la exposición al trauma y a síntomas de TEPT.Método: Se midieron los niveles de reevaluación y supresión de rasgos entre 93 refugiados, usando el Cuestionario de Regulación Emocional y el Inventario de Supresión del Oso Blanco. Se condujo un análisis de clase latentes para identificar las clases distintas de participantes basados en diferentes niveles de participación habitual en la reevaluación y supresión. Se examinaron también la asociación entre la pertenencia a clases y las variables claves que indexan las experiencias de los refugiados (ej. Exposición a trauma) y psicopatología (ej. Síntomas de TEPT y des-regulación emocional).Resultados: El análisis de clase latentes reveló tres perfiles distintos de regulación emocional habitual: una clase de altos reguladores (55,7%; rasgos de reevaluación altos/rasgos de supresión altos), una clase de reguladores adaptativos (23,6%; rasgos de reevaluación altos/rasgos de supresión moderados), y una clase de reguladores inadaptados (20,6%; rasgos de reevaluación bajos/rasgos de supresión altos). Cada clase evidenció relaciones únicas con la exposición al trauma y psicopatología. En comparación con los reguladores adaptativos, los reguladores inadaptados tenían más síntomas de TEPT, experimentaron des-regulación emocional más alta y con mayor probabilidad eran mujeres, mientras que los reguladores altos habían experimentado más tipos de eventos traumáticos.Conclusiones: Este estudio identificó patrones distintivos de regulación emocional entre los refugiados. Nuestros hallazgos demuestran la importancia de medir múltiples estrategias para descubrir los patrones de regulación emocional y entender mejor la relación entre regulación emocional y psicopatología, lo que tiene implicancias importantes para el desarrollo de un tratamiento efectivo con refugiados traumatizados.

A factor analytic investigation of DSM-5 PTSD symptoms in a culturally diverse sample of refugees resettled in Australia.

BACKGROUND: Refugees and asylum-seekers are often exposed to multiple types of potentially traumatic events (PTEs) and report elevated rates of psychological disorders, including posttraumatic stress disorder (PTSD). Considering this, refugee populations merit continued research in the field of traumatic stress to better understand the psychological impact of these experiences. The symptom structure of PTSD underwent a major revision in the recent formulation in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and this reformulation has yet to be comprehensively investigated in the context of PTSD arising from traumatic events experienced by refugees. The current study assessed the construct validity of the DSM-5 PTSD structure in a refugee sample from a variety of cultural backgrounds alongside four alternate models commonly identified in western populations, namely the four-factor Dysphoria model, the five-factor Dysphoric Arousal model, and the six-factor Anhedonia and Externalising Behaviours models. METHODS: A total of 246 refugees settled in Australia were assessed using the Harvard Trauma Questionnaire, to measure exposure to potentially traumatic events (PTEs), and the Posttraumatic Diagnostic Scale, to assess symptoms of PTSD based on DSM-5 criteria. All measures were translated into Arabic, Farsi or Tamil using rigorous translation procedures, or provided in English. RESULTS: Findings from five confirmatory factor analyses (CFAs) revealed that all models demonstrated acceptable model fit. However, an examination of relative fit revealed that the DSM-5 model provided the poorest fit overall for our sample. Instead, we found preliminary evidence in support of the six-factor Anhedonia model, comprising the symptom clusters of re-experiencing, avoidance, negative affect, anhedonia, dysphoric arousal and anxious arousal, as the superior model for our data. CONCLUSIONS: Our findings offer preliminary support for the applicability of the Anhedonia model to a culturally diverse refugee sample, and contribute to a growing body of studies which indicate that the DSM-5 model may not best represent the symptom structure of PTSD found across non-western conflict-affected populations.