دانلود مقاله ISI انگلیسی شماره 39250
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کد مقاله سال انتشار مقاله انگلیسی ترجمه فارسی تعداد کلمات
39250 2014 8 صفحه PDF سفارش دهید محاسبه نشده
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عنوان انگلیسی
Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder
منبع

Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)

Journal : Journal of Anxiety Disorders, Volume 28, Issue 4, May 2014, Pages 382–389

کلمات کلیدی
Emotion regulation - Adaptive regulation strategies - Maladaptive regulation strategies - Social anxiety - Cognitive behavioral therapy
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چکیده انگلیسی

Abstract There has been a increasing interest in understanding emotion regulation deficits in social anxiety disorder (SAD; e.g., Hofmann, Sawyer, Fang, & Asnaani, 2012). However, much remains to be understood about the patterns of associations among regulation strategies in the repertoire. Doing so is important in light of the growing recognition that people's ability to flexibly implement strategies is associated with better mental health (e.g., Kashdan et al., 2014). Based on previous work (Aldao & Nolen-Hoeksema, 2012), we examined whether putatively adaptive and maladaptive emotion regulation strategies interacted with each other in the prediction of social anxiety symptoms in a sample of 71 participants undergoing CBT for SAD. We found that strategies interacted with each other and that this interaction was qualified by a three-way interaction with a contextual factor, namely treatment study phase. Consequently, these findings underscore the importance of modeling contextual factors when seeking to understand emotion regulation deficits in SAD.

نتیجه گیری انگلیسی

Results 3.1. Preliminary analyses Before conducting our main analyses, we examined how the measures of interest changed over time by running 3 GEE models, predicting weekly changes in social anxiety symptoms, use of maladaptive avoidance strategies, or use of adaptive engagement strategies by treatment study phase (N = 71 participants, n = 1088 observations). We found a significant two-way interaction between study phase and weekly changes in social anxiety symptoms, Wald's χ2 = 9.11, p < .001, b = .39, SE (.13), CI (.14; .65), the use of maladaptive avoidance strategies, Wald's χ2 = 11.03, p < .001, b = .45, SE (.13), (CI .18; .71), and the use of adaptive engagement strategies, Wald's χ2 = 16.49, p < .001, b = −.71, SE (.17), CI (−1.05; −.37). Consequently, we examined weekly changes in the experience of social anxiety symptoms and the use of maladaptive avoidance and adaptive engagement strategies separately for each treatment study phase. During the cognitive phase (N = 71, participants, n = 477 observations), the experience of social anxiety symptoms and the use of maladaptive avoidance strategies declined significantly every week, Wald's χ2 = 48.78, p < .001, b = −2.09, SE (.30), CI (−2.67; −1.50), Wald's χ2 = 12.73, p < .001, b = −.90, SE (.25), CI (−1.39; −.40), respectively. The use of adaptive engagement strategies increased every week, Wald's χ2 = 18.90 p < .001, b = 1.57, SE (.36), CI (.86; 2.28). We observed a similar pattern during the cognitive + behavioral exposures phase (N = 60 participants, n = 436 observations), Wald's χ2 = 35.88, p < .001, b = −1.85, SE (.31), CI (−2.45; −1.24), Wald's χ2 = 31.37, p < .001, b = −1.44, SE (.26), CI (−1.95; −.94), Wald's χ2 = 4.98, p < .03, b = .69, SE (.31), CI (.08; 1.29), respectively. On the other hand, during the follow-up phase (N = 53 participants, n = 175 observations), there were no changes in the experience of social anxiety symptoms or in the use of maladaptive avoidance or adaptive engagement strategies, Wald's χ2 = .57, ns, b = .66, SE (.87), CI (−1.05; 2.37), Wald's χ2 = 1.17, ns, b = .85, SE (.79), CI (−.69; 2.39), Wald's χ2 = .03, ns, b = .13, SE (.81), CI (−1.46; 1.71), respectively. This suggests that the changes in the experience of social anxiety symptoms and in the use regulation strategies that took place during treatment were maintained during the 1-year follow-up. Table 2 contains the means and standard deviations for the average social anxiety symptoms and use of adaptive engagement and maladaptive avoidance strategies in each treatment study phase. Table 2. Means and standard deviations for anxiety and regulation strategies in each phase of treatment. Phase Social anxiety symptoms Maladaptive strategies Adaptive strategies Cognitive 59.01 (17.41)** 47.90 (17.03)** 33.22 (19.69)** Cognitive + behavioral exposures 46.82 (16.62)** 38.42 (16.90)** 43.99 (16.84)** Follow-up 42.24 (21.68) 37.89 (19.90) 42.91 (20.84) ** p < .01 for changes in each variable over time within that phase. Table options 3.2. Predicting weekly social anxiety symptoms with regulation strategies We first ran an omnibus GEE model, in which we predicted weekly social anxiety symptoms with the weekly use of maladaptive avoidance and adaptive engagement strategies as well as with treatment study phase (N = 71 participants; n = 1088 observations). This analysis yielded a three-way interaction between treatment study phase, maladaptive avoidance, and adaptive engagement strategies, Wald's χ2 = 17.15, p < .001, b = −.007, SE (.002), CI (−.01; −.003). Consequently, we examined the association between strategies and social anxiety symptoms separately in each treatment study phase. 3.2.1. Cognitive phase We predicted weekly social anxiety symptoms with the weekly use of maladaptive avoidance and adaptive engagement strategies and their interaction (N = 71 participants; n = 477 observations). The weekly use of maladaptive avoidance strategies was positively associated with weekly social anxiety symptoms, Wald's χ2 = 68.99, p < .001, b = .49, SE (.06), CI (.37; .60) and the weekly use of adaptive engagement strategies was marginally associated with lower weekly social anxiety symptoms, Wald's χ2 = 2.93, p = .09, b = −.09, SE (.05), CI (−.20; .01). We compared the magnitude of the coefficients for adaptive engagement and maladaptive avoidance strategies by examining whether their confidence intervals overlapped. Because these coefficients were in opposite directions, we re-ran the model with a reversed coefficient for adaptive engagement strategies. Its confidence interval then became (−.01; .20). Given that the confidence intervals for maladaptive avoidance (.37; .60) and reversed adaptive engagement strategies (−.01; .20) did not overlap, we can conclude that the coefficients significantly differed from each other. Importantly, the interaction between the weekly use of adaptive engagement and maladaptive avoidance strategies was significant, Wald's χ2 = 4.90, p < .03, b = .004, SE (.002), CI (.001; .008). We probed this interaction with simple slope analyses. Results revealed that, on weeks when participants used maladaptive avoidance strategies with low frequency (1 SD below the mean), adaptive engagement strategies were associated with lower weekly social anxiety symptoms, Wald's χ2 = 5.37, p < .02, b = −.16, SE (.07), CI (−.30; −.03). Conversely, on weeks when participants utilized maladaptive avoidance strategies with greater frequency (1 SD above the mean), the use of adaptive engagement strategies was not associated with weekly social anxiety symptoms, Wald's χ2 = .21, ns, b = −.03, SE (.05), CI (−.13; .08). See Fig. 1. 3.2.2. Cognitive + behavioral exposures phase We predicted weekly social anxiety symptoms with the weekly use of maladaptive avoidance and adaptive engagement strategies and their interaction (N = 60 participants; n = 436 observations). The weekly use of maladaptive avoidance strategies was positively associated with weekly social anxiety symptoms, Wald's χ2 = 58.39, p < .001, b = .54, SE (.07), CI (.40; .68), but the use of adaptive engagement strategies was not associated with weekly social anxiety symptoms, Wald's χ2 = .92, ns, b = −.08, SE (.09), CI (−.25; .09). Given that the confidence intervals for maladaptive avoidance (.40; .68) and reversed adaptive engagement strategies (−.09; .25) did not overlap, we can conclude that the coefficients significantly differed from each other. Importantly, the interaction between the use of maladaptive avoidance and adaptive strategies was significant, Wald's χ2 = 7.71, p < .005, b = −.009, SE (.003), CI (−.015; −.003). We probed this interaction with simple slope analyses. Results reveal that, on weeks when participants used maladaptive avoidance strategies with low frequency (1 SD below the mean), adaptive engagement strategies were not associated with weekly social anxiety symptoms, Wald's χ2 = .43, ns, b = .07, SE (.11), CI (−.14; .28). Conversely, on weeks when participants utilized maladaptive avoidance strategies with greater frequency (1 SD above the mean), the use of adaptive engagement strategies had the expected negative association with weekly social anxiety symptoms, Wald's χ2 = 5.89, p < .02, b = −.24, SE (.10), CI (−.43; −.05). See Fig. 1. 3.2.3. Follow-up phase We predicted weekly social anxiety symptoms with the weekly (i.e., past week at months 3, 6, 9, and 12) use of maladaptive avoidance and adaptive engagement strategies and their interaction (N = 51 participants; n = 175 observations). The weekly use of maladaptive avoidance strategies was positively associated with weekly social anxiety symptoms, Wald's χ2 = 84.50, p < .001, b = .72, SE (.08), CI (.57; .88) and the use of adaptive engagement strategies was associated with lower weekly social anxiety symptoms, Wald's χ2 = 8.12, p < .004, b = −.20, SE (.07), CI (−.34; −.06). Given that the confidence intervals for maladaptive avoidance (.57; .88) and reversed adaptive engagement strategies (.06; .34) did not overlap, we can conclude that the coefficients significantly differed from each other. Importantly, the interaction between the use of maladaptive avoidance and adaptive strategies was significant, Wald's χ2 = 5.78, p < .02, b = −.007, SE (.003), CI (−.013; −.001). We probed this interaction with simple slope analyses. Results reveal that, on weeks when participants used maladaptive avoidance strategies with low frequency (1 SD below the mean), adaptive engagement strategies were not associated with weekly social anxiety symptoms, Wald's χ2 = .34, ns, b = −.05, SE (.09), CI (−.24; .13). Conversely, on weeks when participants utilized maladaptive avoidance strategies with greater frequency (1 SD above the mean), the use of adaptive engagement strategies had the expected negative association with weekly social anxiety symptoms, Wald's χ2 = 13.49, p < .001, b = −.35, SE (.10), CI (−.54; −.16). See Fig. 1. 5

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