Further Examining Positive Affect in Relation to Worry: A Synergistic Effect Between Positive Affect Expressivity and Proneness to Positive Affect.

There is emerging interest in understanding positive affect dysfunction in relation to anxiety, including worry. This set of two studies examined the association between the inhibition of affect expression (general affect expressivity in Study 1, positive affect expressivity in Study 2) and worry, with a particular interest in the moderating role of proneness to experience positive affect. Subjects were US-residing adults (Study 1 N = 502, Study 2 N = 250) who were recruited through a crowdsourcing website and completed self-report measures of study variables. Moderated regression was used to examine study predictions that affect expression would negatively correlate with worry when coupled with diminished positive affect. Proneness toward negative affect was included as a covariate within multivariate analyses. An interactive effect between affect expressivity and positive affect was supported in Study 2 (positive affect expressivity) but not Study 1 (general affect expressivity) in relation to worry. A diminished tendency to express positive affect was associated with greater worry when coupled with less positive affect. Study results and future directions are discussed in terms of the potential emotion-regulatory functions of positive affect expressivity as it relates to worry.

Development and Validation of the Ease of Imagery Questionnaire.

The present series of studies aimed to develop and provide initial validation of the Ease of Imagery Questionnaire (EIQ)-a measure assessing ease of imaging different positive and negative imagery content reflective of valence and engaging or disengaging in adverse situations. Five studies were conducted to collectively examine the questionnaire's factor structure and concurrent validity. Study 1 (N = 336) and Study 2 (N = 207) informed the development of 16 items of the EIQ, with a four-factor structure supported in Studies 3 (N = 219), 4 (N = 135), and 5 (N = 184) using confirmatory factor analysis. Study 3 also supported concurrent validity with significant bivariate correlations (p < .05) with the similar Sport Imagery Ability Questionnaire subscales, while studies 4 and 5 demonstrated criterion validity in the EIQ's prediction of challenge and threat appraisal tendencies, perceived stress, stress mindset, and anxiety and depressive symptoms. Overall, the EIQ demonstrates a replicable four-factor structure and appears to assess ability to image content associated with positive and negative emotions as well as demanding stress-evoking situations.

Emotion suppression and acute physiological responses to stress in healthy populations: a quantitative review of experimental and correlational investigations.

Emotion suppression may be linked to poor health outcomes through elevated stress-related physiology. The current meta-analyses investigate the magnitude of the association between suppression and physiological responses to active psychological stress tasks administered in the laboratory. Relevant articles were identified through Medline, PsychINFO, PubMed, and ProQuest. Studies were eligible if they (a) used a sample of healthy, human subjects; (b) assessed physiology during a resting baseline and active psychological stress task; and (c) measured self-report or experimentally manipulated suppression. Twenty-four studies were identified and grouped within two separate random effects meta-analyses based on study methodology, namely, manipulated suppression (k = 12) and/or self-report (k = 14). Experimentally manipulated suppression was associated with greater physiological stress reactivity compared to controls (Hg = 0.20, 95% CI [0.08, 0.33]), primarily driven by cardiac, hemodynamic, and neuroendocrine parameters. Self-report trait suppression was not associated with overall physiological stress reactivity but was associated with greater neuroendocrine reactivity (r = 0.08, 95% CI [0.01, 0.14]). Significant moderator variables were identified (i.e., type/duration of stress task, nature of control instructions, type of physiology, and gender). This review suggests that suppression may exacerbate stress-induced physiological arousal; however, this may differ based upon the chosen methodological assessment of suppression.

Examining Associations Between Metacognitive Beliefs and Type II Worry: The Specificity of Negative Metacognitive Beliefs to State Type II Worry During a Worry Episode.

The metacognitive model of generalized anxiety disorder (GAD) considers Type II worry, which represents one's tendency to negatively appraise worry, as a defining feature of GAD, and negative metacognitive beliefs are central to eliciting Type II worry during worry episodes. Extant research has found that individuals experiencing GAD report elevated Type II worry, and that negative metacognitive beliefs correlate with Type II worry. However, because of how Type II worry was assessed in existing studies, it remains unclear if negative metacognitive beliefs relate to state Type II worry specifically during a worry episode. This study sought to fill that gap in the existing literature among a sample of individuals experiencing elevated GAD symptom severity (N = 106). Participants completed an assessment of GAD symptom severity and metacognitive beliefs, while later attending an in-person study session where they completed a worry induction and state Type II worry, as conceptualized as the strength of negative appraisals of worry, which was then assessed. Metacognitive beliefs generally positively correlated with state Type II worry, with negative metacognitive beliefs being the only metacognitive belief domain that correlated with state Type II worry in multivariate analyses. Implications for how these results support the metacognitive model of GAD and treatment implications are discussed.

Metacognitive beliefs about uncontrollability relate most strongly to health anxiety among US-based non-Latinx White primary care patients: Comparing strength of relations with US-based non-Latinx Black and Latinx primary care patients.

Metacognitive beliefs have emerged as important to health anxiety, particularly beliefs that health-related thoughts are uncontrollable. Preliminary research examining generalized worry indicates uncontrollability beliefs relate more strongly to anxiety among US-based self-identifying White relative to Black college students. The present study sought to extend that line of research by examining if metacognitive beliefs about the uncontrollability of health-related thoughts differentially relate to health anxiety among self-identifying non-Latinx Black (n = 123), Latinx (n = 104) and non-Latinx White (n = 80) US-based primary care patients. As predicted, although positive associations were seen across all three groups, beliefs that health-related thoughts are uncontrollable more strongly related to health anxiety among White patients compared to both Black and Latinx patients. Those differential relations held in multivariate analyses while statistically controlling for positive depression screening status, generalized anxiety symptom severity and medical morbidity. Although the effect size surrounding the differential relations was small in magnitude, the present results further support the notion that metacognitive beliefs about uncontrollability relate less strongly to anxiety among US-based ethnoracial minorities compared to White individuals. Potential reasons for the differential relations are discussed, along with additional areas for future research.

I am Worried: Do the PSWQ and PSWQ-A Display Measurement Invariance Across Four Racial Groups?

The issue of race within the context of psychological assessment is important, but often overlooked. Many self-report measures of psychopathology have been developed and validated using primarily White samples. Research regarding the Penn State Worry Questionnaire (PSWQ) and race has produced mixed results, which in turn may present challenges when comparing scores across racial groups. The current article sought to investigate the measurement invariance of the PSWQ and PSWQ-A (an abbreviated version) across four racial groups (White, Black, Asian, and Hispanic) in a sample of 2,489 undergraduate students. Confirmatory factor analysis of a one-factor structure illustrated poor fit across all racial groups for the full-length PSWQ. Two-factor and one-factor with method effects models of the full-length PSWQ each improved on the previous model fit, although the one-factor method effects model was limited by nonsalient factor loadings. Additionally, a separate confirmatory factor analysis indicated good fit for the PSWQ-A. Further analysis of the PSWQ-A suggested measurement invariance across all racial groups, as well as configural, metric, and scalar invariance. These findings advance the literature on the relationship between worry and race, suggesting that direct comparisons on the PSWQ-A between racial groups is appropriate.

Associations between self-absorption and working memory capacity: A preliminary examination of a transdiagnostic process spanning across emotional disorders.

Considered a transdiagnostic process spanning across emotional disorders, self-absorption reflects self-focused processing that is excessive, sustained, and inflexible. Working memory capacity is critical for self-regulation, inclusive of mitigating perseverative thinking. Providing the first known examination of associations between self-absorption and working memory capacity, a negative association was expected. A sample of adults (N = 63; 70 % experiencing an anxiety or depressive disorder) completed the study protocol, which included completing a structured diagnostic interview, self-report measures, and a working memory capacity task. Self-absorption, as predicted, negatively correlated with working memory capacity, with an association found for the private, but not public, aspect of self-absorption. The association between private self-absorption and working memory capacity was not attributable to shared variance with public self-absorption or negative affectivity. Diagnostic status (anxiety disorder, depressive disorder, or either disorder) did not moderate the association. The results provide evidence that self-absorption relates to impairments in working memory capacity. Implications and future directions for how these results advance our understanding and treatment efforts of self-absorption are discussed.

Individual differences in emotion regulation prospectively predict early COVID-19 related acute stress.

Preliminary prospective research suggests emotion dysregulation may confer vulnerability to poor stress responses. The present prospective study extends this research by examining both specific emotion regulation strategies and global emotion regulation difficulties in the context of acute stress following onset of the COVID-19 global pandemic in 119 young adults. As part of a larger study, emotion regulation was assessed prior to pandemic onset (January 2019 - February 2020) using two standard measures (Emotion Regulation Questionnaire, ERQ, Gross & John, 2003; Difficulties in Emotion Regulation Scale, DERS, Gratz & Roemer, 2004). A self-report assessment of acute stress was conducted 2-3½ weeks after the COVID-19 pandemic declaration. Results demonstrated cognitive reappraisal and expressive suppression (i.e., ERQ) were not individually predictive of acute stress; however, there was a significant interaction of suppression by reappraisal. Simple effects indicated suppression was negatively associated with acute stress only when reappraisal levels were high. Greater global emotion regulation difficulties (i.e., DERS), particularly nonacceptance of emotions and limited access to emotion regulation strategies, significantly predicted greater acute stress. These results provide further evidence of the temporal relationship between emotion dysregulation and stress reactions, and also suggest the expected effects of emotion regulation strategies may differ across contexts.

Development and validation of the Multidimensional Cognitive Attentional Syndrome Scale (MCASS).

The cognitive attentional syndrome (CAS), a multidimensional construct that consists of maladaptive forms of self-regulation, is central to the metacognitive model. Despite the CAS's central importance to the metacognitive model, as well as evidence that components of the CAS are risk factors for the development of emotional disorders, a psychometrically sound self-report measure that accounts for the multidimensional nature of the CAS has yet to be developed. The present set of studies details the development and initial validation of the Multidimensional Cognitive Attentional Syndrome Scale (MCASS). In study 1, a pool of 69 items, assessing the seven self-regulation strategies of the CAS, was administered to U.S. adults recruited through a crowd-sourcing website (N = 323). Structural analyses supported the proposed 7-factor solution and three items with the highest loadings on each factor, without salient cross-loadings, were retained. In Study 2, adult participants (N = 389) completed a battery of self-report measures, including the retained 21 MCASS items. The reduced item pool was examined using both first- and second-order measurement models. The 7-factor first-order measurement model and the second-order measurement model, with each of the first-order factors loading on a higher-order construct (i.e., CAS), provided adequate model fit. Each of the seven, first-order factors exhibited significant loadings on the second-order construct. Convergent, discriminant, and concurrent validity analyses further supported the construct validity of the MCASS scale scores. The MCASS may be particularly useful for examining the theoretical underpinnings of the metacognitive model, as well as for more comprehensive clinical monitoring of the CAS. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Metacognitive beliefs and emotional eating in adolescents.

PURPOSE: Metacognition refers to how people think about their own thoughts. Existing studies have found that compared to healthy controls, individuals with eating disorders manifest elevated levels of dysfunctional metacognitive beliefs. No studies to date have investigated what role metacognitive beliefs play in the manifestation of emotional eating, a well-known risk factor for the development of eating disorders. The purpose of the current study was to assess the associations between metacognitive beliefs and emotional eating in a community sample of adolescents. METHODS: Participants were 135 middle school students (Mean age = 13.62 years; SD = 0.57) who completed the Emotional Eating Scale Adapted for Children and Adolescents-Short-Form, Metacognition Questionnaire for Children, Positive and Negative Affect Schedule for Children, and a demographic questionnaire. RESULTS: Participants classified as high emotional eaters reported statistically significant higher negative metacognitive beliefs (Mean = 15.56; SD = 4.22) compared to participants classified as low emotional eaters (Mean = 12.85; SD = 4.31; p ≤ 0.001; t = - 3.69). There was a significant positive association between emotional eating and negative metacognitive beliefs in the hierarchical multiple linear regression analysis (standardized beta coefficient = 0.25; p < 0.05) after controlling for socio-demographic variables and negative affect. CONCLUSIONS: The current findings provide preliminary evidence that negative metacognitive beliefs may play a role in the manifestation of emotional eating in adolescents. Future prospective studies are needed to elucidate the temporal associations between emotional eating and negative metacognitive beliefs in this population. LEVEL OF EVIDENCE: Level III, case-control analytic study.

COVID stress syndrome: Concept, structure, and correlates.

BACKGROUND: Research shows that the COVID Stress Scales have a robust multifactorial structure, representing five correlated facets of COVID-19-related distress: (a) Fear of the dangerousness of COVID-19, which includes fear of coming into contact with fomites potentially contaminated with SARSCoV2, (b) worry about socioeconomic costs of COVID-19 (e.g., worry about personal finances and disruption in the supply chain), (c) xenophobic fears that foreigners are spreading SARSCoV2, (d) traumatic stress symptoms associated with direct or vicarious traumatic exposure to COVID-19 (nightmares, intrusive thoughts, or images related to COVID-19), and (e) COVID-19-related compulsive checking and reassurance seeking. These factors cohere to form a COVID stress syndrome, which we sought to further delineate in the present study. METHODS: A population-representative sample of 6,854 American and Canadian adults completed a self-report survey comprising questions about current mental health and COVID-19-related experiences, distress, and coping. RESULTS: Network analysis revealed that worry about the dangerousness of COVID-19 is the central feature of the syndrome. Latent class analysis indicated that the syndrome is quasi-dimensional, comprising five classes differing in syndrome severity. Sixteen percent of participants were in the most severe class and possibly needing mental health services. Syndrome severity was correlated with preexisting psychopathology and with excessive COVID-19-related avoidance, panic buying, and coping difficulties during self-isolation. CONCLUSION: The findings provide new information about the structure and correlates of COVID stress syndrome. Further research is needed to determine whether the syndrome will abate once the pandemic has passed or whether, for some individuals, it becomes a chronic condition.

Intolerance of Uncertainty Moderates the Relation Between the Choice to Access Health Information and Post-Choice Distress Among Individuals Prone to Health Anxiety.

Access to health information has steeply grown, mainly through the availability of online health information. Associated with a number of potential benefits, accessing health information can be non-adaptive and particularly for individuals prone to health anxiety. For those individuals, accessing health information often serves as reassurance seeking to assuage health concerns. However, accessing health information can prompt distress for individuals prone to health anxiety. The present study sought to further understand when accessing health information prompts distress by examining the moderating role of intolerance of uncertainty (IU). Individuals prone to health anxiety (N = 98), as indicated by an elevated score on a self-report measure rather than through formal assessment of meeting criteria for disorders marked by elevated health anxiety (e.g., illness anxiety disorder), participated in a lab-based session where they viewed a provocation of health concerns and were given the choice to either access or avoid further health information. As predicted, participants with high, but not low, IU reported significantly greater distress when they chose to access versus avoid health information. Study results further highlight IU as potentially important for understanding when accessing health information relates to greater negative emotionality. Future directions are discussed.

Development and initial validation of the COVID Stress Scales.

Research and clinical observations suggest that during times of pandemic many people exhibit stress- or anxiety-related responses that include fear of becoming infected, fear of coming into contact with possibly contaminated objects or surfaces, fear of foreigners who might be carrying infection (i.e., disease-related xenophobia), fear of the socio-economic consequences of the pandemic, compulsive checking and reassurance-seeking regarding possible pandemic-related threats, and traumatic stress symptoms about the pandemic (e.g., nightmares, intrusive thoughts). We developed the 36-item COVID Stress Scales (CSS) to measure these features, as they pertain to COVID-19. The CSS were developed to better understand and assess COVID-19-related distress. The scales were intentionally designed so they could be readily adapted for future pandemics. The CSS were developed and initially validated in population-representative samples from Canada (N = 3479) and the United States (N = 3375). A stable 5-factor solution was identified, corresponding to scales assessing COVID-related stress and anxiety symptoms: (1) Danger and contamination fears, (2) fears about economic consequences, (3) xenophobia, (4) compulsive checking and reassurance seeking, and (5) traumatic stress symptoms about COVID-19. The scales performed well on various indices of reliability and validity. The scales were intercorrelated, providing evidence of a COVID Stress Syndrome. The scales offer promise as tools for better understanding the distress associated with COVID-19 and for identifying people in need of mental health services.

The closed response style and posttraumatic stress: Examining the interaction between experiential avoidance and cognitive fusion among women experiencing sexual trauma.

OBJECTIVE: Experiential avoidance and cognitive fusion synergistically form what is known as the closed response style. Prior study findings indicate that the closed response style, examined as an interaction between experiential avoidance and cognitive fusion, relates to posttraumatic stress symptom severity among a heterogeneous sample of trauma survivors. The present study sought to extend those findings by examining the association between the closed response style and posttraumatic stress symptom severity specifically among women who survived a Criterion A sexual trauma. METHOD: The sample was 136 women attending a southern U.S. university who reported Criterion A sexual trauma exposure. Participants completed self-report measures assessing the study variables. RESULTS: The predicted interaction between experiential avoidance and cognitive fusion accounted for unique variance in posttraumatic stress symptom severity (total symptom severity, along with hyperarousal and alterations in cognitions and mood). Simple effects indicated that experiential avoidance and cognitive fusion only shared associations with posttraumatic stress symptom severity when coupled with high levels of the other process (i.e., cognitive fusion or experiential avoidance, respectively). CONCLUSIONS: Results provide further support for the potential relevance of the closed response style to posttraumatic stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria.

Cyberchondria refers to the tendency to excessively and compulsively search for online medical information despite the distress experienced, with consequent impairment of daily-life activities. The current two studies sought to explore (i) the factor structure of the Italian version of the Cyberchondria Severity Scale (CSS) and (ii) a metacognitive model of cyberchondria. Participants were Italian community adults who reported using the Internet to search for health-related information (Study 1: N = 374, Study 2: N = 717). Results from Study 1 supported the Italian version of the CSS exhibiting a five-factor structure, with the resulting scales demonstrating good internal consistency, 5-week test-retest reliability, and generally strong correlations with indices of health anxiety. In Study 2, results of a path analysis showed that the negative metacognitive belief domain ("thoughts are uncontrollable") shared the strongest direct association with each of the five dimensions of cyberchondria, followed by beliefs about rituals. Consistently, the strongest indirect associations were found between "thoughts are uncontrollable" and all the five cyberchondria dimensions via beliefs about rituals. These results provide support for an Italian version of the CSS and the metacognitive conceptualization of cyberchondria.

Multidimensional Inventory of Hypochondriacal Traits: An Examination of a Bifactor Model and Measurement Invariance Between Those With and Without a Self-Reported Medical Condition.

The Multidimensional Inventory of Hypochondriacal Traits (MIHT) is a self-report measure that assesses four interrelated domains of health anxiety (i.e., Cognitive, Behavioral, Perceptual, Affective). Prior research has supported a correlated four-factor model, as well as a hierarchical model, in which each of the four factors load onto the higher order health anxiety construct. However, a bifactor modeling approach has yet to be used to examine the factor structure of the MIHT. Results supported a bifactor model of the MIHT in three different samples (i.e., unselected based on current medical status [n = 824], and those with [n = 348] and without [n = 354] a self-reported medical condition). The MIHT appears to be strongly multidimensional, with three of the four subscales providing substantive value. Confirmatory factor analysis supported the configural and metric/scalar invariance of the bifactor model between those with and without a self-reported medical condition. Results provide support for a bifactor conceptualization of the MIHT and the invariance of that model across levels of current health status.

Factor Structure and Incremental Utility of the Distress Tolerance Scale: A Bifactor Analysis.

The Distress Tolerance Scale (DTS) is a self-report measure of perceived capacity to withstand aversive emotions. Initial factor analysis of this measure suggested a structure comprising one higher-order factor and four lower-order domain-specific factors. However, there is limited evidence in support of the DTS's purported multidimensionality, and despite use of the DTS subscales, research has yet to assess their incremental utility. The current investigation sought to rectify the paucity of evidence in support of the DTS's factor structure and independent use of DTS subscales via bifactor analysis. In the present study (N = 826 community adults), a bifactor model of the DTS provided the best fit to the data. However, an examination of statistical indices associated with bifactor modeling, as well as results from an examination of incremental utility, suggest that the domain-specific factors are largely redundant with the general factor and do not provide incremental utility in predicting relevant clinical constructs beyond the general factor. Measurement invariance between sexes was confirmed. Taken together, results support use of a DTS total score, but not subscale scores.

Emotion regulation self-efficacy mediates the relation between happiness emotion goals and depressive symptoms: A cross-lagged panel design.

The present study was designed to test the hypothesis that unrealistically high happiness emotion goals lead to decreased emotion regulation self-efficacy, which in turn, leads to depressive symptoms. A cross-lagged panel design with data collection at three time points was used to allow for causal inferences of directionality among study variables. Participants (N = 181) completed a battery of self-report questionnaires at a baseline assessment session (T1). The same measures were completed again at 6- (T2) and 12-month (T3) follow-up sessions. Results of a cross-lagged path analysis indicated that emotion regulation self-efficacy at T2 mediated the relation between happiness emotion goals at T1 and depressive symptoms at T3, thus confirming the primary study hypothesis. To decrease the likelihood that one will experience depressive symptoms, vulnerable individuals may benefit from preemptive efforts that help recalibrate emotion goals in a realistic manner or shift attention toward end-state goals that are not emotion related. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Examining the Whiteley Index-6 as a screener for DSM-5 presentations of severe health anxiety in primary care.

Psychological screening is essential within primary care settings, with growing evidence that health anxiety could be important to screen for in such settings. Brief screeners in primary care settings are considered most viable for routine use. This study provided the first known examination of a version of the Whiteley Index (WI; Pilowksy, 1967) as a screener for primary care patients who are experiencing DSM-5 presentations of severe health anxiety (i.e., somatic symptom disorder, illness anxiety disorder). A six-item short form of the WI (i.e., WI-6), with item responses made using an ordered-category response option, was examined. Consecutively enrolled U.S. patients presenting for treatment at a community health center (N = 202) completed the WI-6 and a semi-structured interview assessing clinically severe health anxiety in the form of somatic symptom disorder and illness anxiety disorder. A total of 61 participants met criteria for clinically severe health anxiety and were compared to patients who did not meet criteria for clinically severe health anxiety. Results from a receiver operating characteristic (ROC) analysis indicated that a cutoff score of 18 on the WI-6 adequately balanced sensitivity (75%) and specificity (77%). The area under the curve (AUC) indicated the WI-6 did a reasonable job discriminating between the two groups (AUC = 0.83, p < .001, 95% confidence interval = 0.77-0.89). Study results offer preliminary support for the WI-6 as a practical screener for identifying cases of severe health anxiety in U.S. primary care settings that may warrant further evaluation.

Reducing Test Anxiety in School Settings: A Controlled Pilot Study Examining a Group Format Delivery of the Attention Training Technique Among Adolescent Students.

Researchers have called for the examination of test anxiety interventions that extend beyond the delivery of individual services by a trained professional. Following from conceptual models and research findings underscoring the importance of metacognitive beliefs to test anxiety, a controlled pilot study examined whether a group format delivery of the attention training technique (ATT) component of metacognitive therapy reduces test anxiety among eighth-grade students. Students completed baseline study measures and were allocated based upon class period to five sessions of ATT (n = 39) or a music listening control (n = 34) delivered within a group format during a school week. Students completed postintervention study measures on the final day of the intervention and completed follow-up study measures approximately 3 weeks following the intervention. As predicted, students receiving ATT reported less postintervention test anxiety than the control when they held stronger baseline metacognitive beliefs about worry. The patterns of findings held at the follow-up and when specifically examining the cognitive (i.e., worry) dimension of test anxiety. Study results suggest that ATT may be a viable test anxiety intervention for students holding heightened metacognitive beliefs about worry. Future directions are discussed.