سطح هشیاری عاطفی به عنوان یک متغیر تمایز بین افراد با و بدون اختلال اضطراب فراگیر

Using Mennin, Heimberg, Turk, and Fresco’s [Emotion regulation deficits as a key feature of generalized anxiety disorder: Testing a theoretical model, submitted for publication] conceptualization of generalized anxiety disorder (GAD) as a syndrome involving emotion dysregulation and an overuse of cognitive control strategies, this study sought to differentiate individuals with GAD from controls by offering differences in emotional awareness as one of the central distinctions between these groups. This study employs the Levels of Emotional Awareness Scale (LEAS) [Lane et al., 1990Lane, R. D., Quinlan, D. M., Schwartz, G. E., Walker, P. A., & Zeitlin, S. B. (1990). The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion. Journal of Personality Assessment, 55, 124–134] a rater-coded measure, to assess level of emotional awareness, a methodological improvement over previous tests of the model, which relied upon self-report. Individuals with GAD scored significantly higher than controls on emotional awareness. These findings are discussed in light of the theoretical implications for GAD.

Borkovec, Alcaine, and Behar (2004) assert that worry, the central feature of generalized anxiety disorder (GAD), functions to allow the individual to avoid uncomfortable emotional experiences. By processing emotional stimuli cognitively through worry, the experience of intense emotions is avoided, thereby negatively reinforcing worry (Borkovec et al., 2004). However, in utilizing worry as an avoidance response, individuals prevent themselves from effectively processing all situationally relevant information, including emotions. Given that emotions provide information about how one should respond to situations (e.g., Gross, 1998a and Gross, 1998b) and are important in initiating, motivating, and organizing behavior (e.g., Cicchetti, Ackerman, & Izard, 1995), individuals with GAD may not be able to respond in the most adaptive way to their environment. Using this perspective as a foundation, Mennin, Heimberg, Turk, and Fresco (2002) and Mennin, Turk, Heimberg, and Carmin (2004) propose that understanding the role of emotions and emotion regulation processes in GAD is critical to adequately conceptualizing the disorder. Emotion regulation refers to “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions” (Gross, 1998a, p. 275). This definition encompasses both positive and negative emotions as well as emotion reduction, enhancement, and maintenance (Cicchetti et al., 1995; Gross, 1998a). In this way, emotion regulation is different from coping, which typically is limited to reducing negative emotional states (Gross, 1998a). Emotion regulation processes range from ones that may be automatic (e.g., an infant averting his gaze from his mother’s frown) to ones that are conscious, controlled, and effortful (e.g., purposefully avoiding a disliked coworker; Gross, 1998a). Some theorists do not attempt to make value judgments on emotion regulation processes as good or bad or adaptive or maladaptive (e.g., Gross, 1998a). However, other theorists have suggested that certain emotion skills and activities are important to adaptive emotion regulation (e.g., Mayer & Salovey, 1993; Saarni, 1990). For example, Mayer and Salovey (1997) have introduced the construct of emotional intelligence, which they define as “the ability to perceive accurately, appraise, and express emotion; the ability to access and/or generate feelings when they facilitate thought; the ability to understand emotion and emotional knowledge; and the ability to regulate emotions to promote emotional and intellectual growth” (p. 10). Recent studies have linked emotion skills such as these to good functioning. For example, one emotion skill that has been cited as conducive to positive emotion regulation is the ability to identify discrete emotional experiences. Theoretically, knowing how one feels provides important information about the current situation, clarifies the best options for what to do next, and suggests specific strategies for modifying that emotion if desired (Feldman-Barrett, Gross, Conner-Christensen, & Benvenuto, 2001). Indeed, this ability has been shown to be associated with recovery from an induced negative mood (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995) and increased regulation of negative emotions using a wide range of strategies (Feldman-Barrett et al., 2001). It is argued that emotion skills deficits (e.g., difficulty understanding emotions, difficulty using emotions to facilitate thought, difficulty changing how one feels) will be related to poor functioning and, in many cases, psychopathology. Particular patterns of emotion skills deficits may be related to different forms of psychopathology (e.g., Turk, Heimberg, Luterek, Mennin, & Fresco, in press). Poor emotion skills are thought to hamper positive emotion regulation (i.e., the ability to influence the experience and expression of emotions as appropriate for the given environmental context). Among individuals with emotion skills deficits, emotions may become dysregulated. Emotionally dysregulated individuals have difficulty influencing the latency, magnitude, duration, and expression of their emotions as appropriate to the current situation. Emotion dysregulation may be associated with a variety of activities detrimental to adaptive functioning (e.g., binge eating, worrying, substance abuse). According to their recently proposed theoretical model, Mennin et al. (2002) and Mennin et al. (2004) assert that individuals with GAD avoid processing emotional stimuli through use of worry because these individuals experience emotion skills deficits and emotion dysregulation as core problems. According to this model, GAD is best conceptualized as a syndrome involving four components which interact to maintain symptoms: (1) intense experience of emotions, (2) difficulty understanding emotions, (3) negative reactions to the experience of emotions, and (4) poor emotion management (Mennin et al., 2004). Specifically, individuals with GAD are conceptualized as being emotionally sensitive individuals who experience emotions more easily and intensely than most other people do. Being emotionally sensitive is not necessarily problematic. However, for individuals with GAD, this emotional sensitivity is combined with difficulty understanding emotions and difficulty using them as a source of information to guide adaptive behavior. Thus, emotions are experienced as intense and confusing—leading individuals with GAD to fear their emotions. With few skills to modulate their emotions, individuals with GAD often attempt to manage their emotions in maladaptive ways. The most obvious maladaptive strategy is worry, although other strategies are used, such as avoiding emotionally evocative interpersonal situations or inappropriately seeking reassurance. Empirical investigations of this model have shown that individuals with GAD report greater intensity of emotions than control participants and have few skills to identify, describe, or modulate negative emotional reactions (Mennin, Heimberg, Turk, & Fresco, submitted for publication; Turk et al., in press). Individuals with GAD may also be more expressive of negative emotion than individuals without GAD (Mennin et al., in press). Furthermore, individuals with GAD have greater difficulty accepting an induced negative mood than controls and deem themselves less able to influence their induced negative mood than controls (Mennin et al., in press). The current study sought to provide additional support for the aspect of the emotion dysregulation model that proposes that individuals with GAD have a poor understanding of emotions. Emotional understanding or awareness is defined by Lane and Schwartz (1987) as the ability to recognize emotions in oneself and others, the development of which occurs from progressive differentiation and integration of emotion information (Conway, 2000 and Lane and Schwartz, 1987). It is different than simply the ability to perceive emotions (Lundh, Johnsson, Sundqvist, & Olsson, 2002). Rather, emotional awareness involves the knowledge or recognition that an emotion is present, which is different than emotional expression and emotional experiencing (Croyle & Waltz, 2002). Emotional expression involves an outward display, such as a facial expression or a verbalization, and does not require awareness of emotion (Croyle & Waltz, 2002). Emotional awareness, however, includes experiencing, but more than mere experience of emotion, it also involves contemplation of the emotion experience (Croyle & Waltz, 2002). Previous tests of the emotional understanding aspect of the emotion dysregulation model of GAD have relied on self-report measures that directly ask participants to rate the extent to which they are able to identify and describe how they are feeling. As previously stated, assessed in this manner, individuals with GAD report less emotional clarity and more difficulty identifying and describing emotions (Mennin et al., in press and Turk et al., in press). Exclusive reliance on self-report methodologies is problematic, however, in that individuals who are hypothesized to have difficulty assessing their emotion states are asked to report or rate these states. Moreover, self-report methodologies are most problematic when used to assess emotion regulation issues because many aspects of emotion regulation are difficult to access by conscious self-report (Westen, Muderrisoglu, Fowler, Shedler, & Koren, 1997). This study is an improvement over previous tests of the emotional awareness aspect of the emotion dysregulation model in that the Levels of Emotional Awareness Scale (LEAS; Lane, Quinlan, Schwartz, Walker, & Zeitlin, 1990) was used. The LEAS requires participants to respond to emotional scenarios, which are then coded for level of emotional awareness by an objective observer. In this way, individuals with GAD are not asked to assess their own emotion skills. The LEAS conceptualizes emotional awareness through a Piagetian cognitive-developmental framework (Lane & Pollermann, 2002; Lane & Schwartz, 1987). This conceptualization views emotional understanding as becoming progressively more complex with development and undergoing a “structural transformation in a hierarchical developmental sequence of progressive differentiation and integration. Five levels of emotional awareness are described: bodily sensations, action tendencies, single emotions, blends of emotion, and combinations of blends” (Lane et al., 1990, p. 125). Higher or more complex levels of emotional awareness provide individuals with the ability to understand their environment and its relevance to their well-being (Greenberg, 2002) and enables individuals to cope better with stressors (Stanton, Kirk, Cameron, & Danoff-Burg, 2000). Indeed, if individuals with GAD are understood as having poor emotion skills, it seems likely that the ability to integrate and differentiate various increasingly complex levels of emotional experience will be a problem for this group. It is hypothesized that individuals with GAD will operate at a lower level of emotional awareness than controls