نقص تنظیم احساسات در اختلال اضطراب منتشر، اختلال اضطراب اجتماعی و هم رخدادی آنها

Abstract Preliminary evidence supports the role of emotion-related deficits in generalized anxiety disorder (GAD), including heightened emotional intensity, poor understanding of emotion, negative cognitive reactivity to emotions, and maladaptive emotion management. However, questions remain concerning the specificity of these emotion-related deficits compared to highly comorbid conditions such as social anxiety disorder (SAD). In the current study, 113 undergraduate students were administered measures of GAD, SAD, and emotion-related factors in order to clarify relationships among these variables. In univariate analyses, presence of SAD did not significantly impact the association between GAD and the emotion-related measures. Further, a discriminant function analysis revealed that emotional intensity and impaired regulation strategies provided the greatest discrimination between groups and best predicted a diagnosis of GAD (regardless of SAD comorbidity). Although their discriminatory ability was weaker, poor emotional understanding best predicted a diagnosis of SAD (regardless of GAD comorbidity), and non-acceptance of emotions best predicted comorbid GAD and SAD.

2. Results Correlations for the emotion-related outcome measures are displayed in Table 1. The AIM-NI, DERS non-acceptance, and DERS strategies subscales demonstrated strong relationships with each other (r's > .50). With the exception of the AIM-NI and DERS awareness subscale which were highly inversely correlated, the DERS clarity and DERS awareness demonstrated weaker relationships with the other study variables but correlated highly with each other. Table 1. Pearson correlations among emotion measures. 1 2 3 4 5 1. AIM-NI – 2. DERS clarity .16 – 3. DERS awareness −.79 .59** – 4. DERS non-acceptance .40** .34** .28* – 5. DERS strategies .57** .27* .13 .52** – Note: AIM-NI denotes the Affect Intensity Measure, Negative Intensity Subscale; DERS denotes the Difficulties in Emotion Regulation Scale. * p < .01. ** p < .001. Table options Emotion measure subscale scores for each group are displayed in Table 2. Table 2. Means and standard deviations on emotion measures for GAD (with and without SAD), SAD only, and control participants. Measure GAD + SAD GAD–SAD SAD CONTROL AIM-NI 3.99 (.15) 3.92 (.11) 3.48 (.14) 3.01 (.10) DERS Clarity 2.59 (.17) 2.28 (.13) 2.31 (.16) 1.94 (.11) Awareness 2.48 (.18) 2.32 (.14) 2.30 (.17) 2.20 (.12) Acceptance 2.83 (.21) 2.35 (.16) 1.94 (.20) 1.83 (.13) Strategies 2.53 (.10) 2.29 (.13) 2.00 (.16) 1.62 (.11) Note: GAD + SAD denotes participants with both generalized anxiety disorder and social anxiety disorder, GAD–SAD denotes participants with generalized anxiety disorder but not social anxiety disorder, SAD denotes participants with only SAD, control denotes control participants. Higher scores on the DERS reflect greater emotion dysregulation. Table options 2.1. Emotion intensity Group differences were found on the AIM-NI subscale (F [3, 109] = 17.07, p < 0.001, η2 = 0.32). Using non-orthogonal contrasts, we first compared GAD with SAD and GAD without SAD and did not find a significant difference (CI: [−0.438, 0.304], p = .72, L = −.067). We then compared both GAD groups to the SAD and control groups. GAD with SAD participants reported higher scores on the AIM-NI subscale than SAD only (CI: [−0.914, −1.00], p < .05, L = −.507), or control participants (CI: [0.630, 1.331], p < .001, L = .980). GAD participants without SAD reported more intense negative emotions when compared with participants with SAD alone (CI: [0.081, 0.799], p < .05, L = .440), or the control group (CI [0.619, 1.207], p < .001, L = .913). Finally, individuals with only SAD also reported significantly greater intensity of negative emotions than control individuals (CI: [0.136, 0.811], p < .01, L = .473). 2.2. Emotion understanding Differences were found between groups for the DERS clarity of emotions subscale, an index of poor emotional understanding (F [3, 109] = 4.02, p < 0.01, η2 = .01; Table 2). Non-orthogonal contrasts demonstrated that GAD with SAD and GAD without SAD groups did not differ on the DERS clarity of emotions subscale (CI: [−0.723, 0.113], p = .151, L = −0.305). GAD + SAD participants did not differ in DERS clarity scores compared to SAD only participants (CI: [−0.737, 0.179], p = .23, L = −.279) but demonstrated higher scores in comparison to controls [CI: (0.252, 1.042), p < .01, L = .647]. Similarly, GAD participants without SAD did not display poorer understanding of emotions than SAD only participants [CI: (−0.431, 0.378), p = .90, L = −.026] but did have significantly greater deficits in this index compared to controls (CI: [0.011, 0.673], p < .05, L = .342). Finally, the comparison between SAD only and control participants on DERS clarity scores did not reach significance (CI: [−.012, .748], p = .058, L = .368). 2.3. Emotion awareness and acceptance No differences among the groups were found for scores on the DERS awareness of emotion subscale (F [3, 109] = 0.58, p = 0.631, η2 = .016). However, group differences emerged for DERS non-acceptance scores (F [3, 109] = 6.504, p < .001, η2 = 0.152; Table 2). Using non-orthogonal contrasts, the comparison between GAD with SAD and GAD without SAD participants on the DERS non-acceptance subscale did not reach significance (CI: [−0.992, 0.004], p = 0.067, L = −0.478). GAD with SAD participants reported greater DERS non-acceptance scores than SAD only participants, CI: (−1.451, −0.325), p < .01, L = −0.888) and control individuals (CI: [0.514, 1.483], p < .001, L = 0.998). In contrast, the GAD participants without SAD did not differ from SAD only participants on this measure (CI: [−0.087, 0.906], p < .01, L = 0.409) but did differ from controls (CI: [0.114, 0.926], p < .05, L = 0.520). The SAD only group, however, did not differ from controls on DERS non-acceptance subscales scores, CI: (−0.357, 0.578), p = .640, L = 0.110. 2.4. Emotion management Differences among the groups were found for the DERS subscale, access to effective emotion regulation strategies (F (3, 109) = 9.611, p < .001, η2 = 0.209; Table 2). Using non-orthogonal contrasts, GAD with SAD and GAD without SAD participants did not differ on the ability to access to effective emotion regulation strategies (CI: [−0.643, 0.176], p = .262, L = −0.233). The GAD with SAD group displayed higher DERS strategies scores than SAD only (CI: [−0.977, −0.078], p < .05, L = −.528) or control (CI: [0.521, 1.295], p < .001, L = .908) participants. GAD without SAD participants did not significantly differ from SAD only participants (CI: [−0.102, 0.691], p = .14, L = .294) but did display higher DERS strategies subscales scores than control individuals (CI: [0.351, 0.999], p < .001, L = .675). Participants with only SAD also displayed higher DERS strategy scores than controls (CI: [0.008, 0.754], p < .05, L = .381). 2.5. Discriminant function analysis Using, discriminant function analysis, three canonical discriminant functions containing the AIM-NI and the DERS subscales significantly discriminated the four diagnostic groups, Wilk's Λ = .589, χ2 (15, N = 113) = 56.94, p < .001. The first canonical function demonstrated the strongest discrimination among groups accounting for 91% of the variance (eigenvalue = .606, canonical r = .61) and had the highest absolute correlations (as determined by r's > .50) with the AIM negative intensity subscale (r = .83) and the DERS strategies subscale (r = .63). Only the DERS non-acceptance scale (r = .60) scale was highly correlated with the second canonical function, which accounted for 6% of the variance in discriminating among groups (eigenvalue = .037; canonical r = .19). Finally, only the DERS clarity scale displayed a strong correlation (r = −.61) with the third canonical function, which accounted for 3% of the variance in discriminating among groups (eigenvalue = .020; canonical r = .14). Fig. 1 demonstrates the relationship of the four diagnostic groups with these functions by plotting the unstandardized canonical discriminant functions for each group in a discriminant space. The first function is plotted against the second function in Fig. 1a and the third function in Fig. 1b. As shown in Fig. 1a, the first function (vertical axis) best discriminates between those with and without GAD (regardless of SAD). Additionally, the second discriminant function (horizontal axis) is shown in Fig. 1a to be the primary contributor to the separation of the comorbid GAD with SAD group from the single anxiety disorder groups (i.e., GAD without SAD, SAD only). Finally, the third function (horizontal axis) displayed in Fig. 1b distinguishes those with SAD from those without SAD (regardless of GAD). The mean scores of the two unstandardized canonical discriminant functions for ... Fig. 1. The mean scores of the two unstandardized canonical discriminant functions for the GAD groups with and without SAD, the SAD only group, and normal control group plotted in discriminant spaces of (a) Function 1 (vertical axis) × Function 2 (horizontal axis) and (b) Function 1 (vertical axis) × Function 3 (horizontal axis).