Predicting anger in social anxiety: The mediating role of rumination

Anger and emotion regulation strategies: a meta-analysis

The hypothesis that maladaptive emotion regulation plays a central role in anger problems has driven the development of cognitive-behavioral interventions for anger and has stimulated a wealth of studies. However, this work is heterogeneous, drawing on multiple theories from clinical psychology and affective science, and focusing on multiple dimensions of emotion regulation. In addition, previous findings have not always been consistent. The present meta-analysis aimed to characterize associations between anger and emotion regulation strategies (i.e., avoidance, acceptance, distraction, reappraisal, rumination, suppression). A systematic search was conducted, and 81 studies (115 effect sizes) were included in the analysis. The results indicated consistent positive associations between anger and avoidance, rumination, and suppression, and consistent negative associations between anger and acceptance, and reappraisal. The relation between anger and distraction could not be analyzed. Heterogeneity was large in all analyses, and multiple differences between studies, including type of anger, clinical status, criminal status, type of culture, study quality, and sample sex distribution, influenced the effect sizes. Overall, the present findings support the view that anger is consistently associated with the differential use of multiple emotion regulation strategies and suggest methodological improvements for future studies.

Adverse Childhood Experiences and Symptom Severity in Social Anxiety Disorder: The Role of Emotion Regulation

In this study, the relationship was examined of adverse childhood experiences (ACEs) with difficulties in emotion regulation and symptom severity in individuals with social anxiety disorder (SAD). The study included 71 patients diagnosed with SAD and a healthy control group of 73 subjects. Data for all the participants were collected using a sociodemographic data form, the Liebowitz Social Anxiety Scale, the Adverse Childhood Experiences-Turkish Form scale, and the Difficulties in Emotion Regulation Scale-16. The study results showed a higher probability of ACEs and difficulties in emotion regulation in the SAD group than in the control group. The difficulties in emotion regulation in the SAD group were correlated with symptom severity and these difficulties were found to play a mediating role between trauma and symptom severity. It was emphasized that emotion regulation skills were an important factor in the treatment of SAD patients. It can be suggested that therapies and interventions to develop emotion regulation skills could be effective in the management of SAD symptoms. It was thus concluded that ACEs and difficulties in emotion regulation are associated with SAD symptoms and should be taken into consideration in treatment. This study emphasizes the importance of emotion regulation skills for SAD treatment and can be considered to be of guidance for future studies.

Mediating Role of Rumination Between Anger and Anxious-Depressive Symptomatology in Family Members of People with Gambling Disorder

Gambling disorder is characterized by a behavioural pattern of dysfunctional gambling that persists despite its negative implications in different areas of people's daily life. One of the most negatively affected areas is the one related to family members. This study aimed, firstly, to study the differences between family members of people with gambling disorder and a general population sample in anger (state, trait, expression-out, expression-in. control-out and control-in), rumination (brooding, reflection and total), and anxiety and depression. The second aim was to analyse the correlation between these variables in the family members of people with gambling disorder, and thirdly, to analyse the mediating role of rumination between anger, anxiety and depression. This study consisted of 170 people, of whom 87 were family members of people with a gambling disorder, and 83 were from the general population. Instruments measuring anger, anxiety, depression, and ruminative responses were administered. Results showed that family members had significantly higher scores in anger (state), depression, anxiety, rumination (total and brooding). Also, results showed that anger correlated positively and significantly with rumination, depression and anxiety, which also correlated positively and significantly with each other. Third, rumination mediated the relationship between the following variables: anger (state) and depression; anger (trait) and anxiety and depression; anger (external expression) and anxiety and depression. A complete mediating effect was found in the latter case and a partial mediating effect in the first two cases. In conclusion, it is found that having a family member with a gambling disorder may increase levels of anger, anxiety, depression and rumination. Furthermore, it is shown that working on rumination may reduce depression and anxiety in family members of gamblers.

Emotions in social anxiety disorder: A review

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed.

Decoding individual differences in expressing and suppressing anger from structural brain networks: A supervised machine learning approach

Anger can be broken down into different elements: a transitory state (state anger), a stable personality feature (trait anger), a tendency to express it (anger-out), or to suppress it (anger-in), and the ability to regulate it (anger control). These elements are characterized by individual differences that vary across a continuum. Among them, the abilities to express and suppress anger are of particular relevance as they determine outcomes and enable successful anger management in daily situations. The aim of this study was to demonstrate that anger suppression and expression can be decoded by patterns of grey matter of specific well-known brain networks. To this aim, a supervised machine learning technique, known as Kernel Ridge Regression, was used to predict anger expression and suppression scores of 212 healthy subjects from the grey matter concentration. Results show that individual differences in anger suppression were predicted by two grey matter patterns associated with the Default-Mode Network and the Salience Network. Additionally, individual differences in anger expression were predicted by a circuit mainly involving subcortical and fronto-temporal regions when considering whole brain grey matter features. These results expand previous findings regarding the neural bases of anger by showing that individual differences in specific anger-related components can be predicted by the grey matter features of specific networks.

The moderating effects of anger suppression and anger expression on cognitive behavioral group therapy and mindfulness-based stress reduction among individuals with social anxiety disorder

BACKGROUND

. Cognitive-behavioral therapy and mindfulness-based stress reduction (MBSR) are two prominent evidence-based treatments for social anxiety disorder (SAD). It is not clear, however, whether outcomes of these two treatments are moderated by similar factors. For example, whereas anger suppression and anger expression each predict outcomes in cognitive- behavioral group therapy (CBGT), it is unknown whether they differentially influence outcomes in CBGT versus MBSR.

METHODS

. One hundred eight participants with SAD were randomized to CBGT, MBSR or Waitlist (WL). WL participants were later randomized to CBGT or MBSR, and their data were combined with data from those originally randomized to CBGT or MBSR. Anger suppression and anger expression were assessed at pre-treatment, and social anxiety was assessed at pre-treatment, post-treatment, and every 3 months throughout a 12-month follow-up period.

RESULTS

. From pre- to post-treatment, higher anger suppression was associated with significantly greater reduction in social anxiety in CBGT compared with MBSR. From post-treatment through follow-up, higher anger expression was associated lesser reduction in social anxiety in MBSR but not in CBGT.

LIMITATIONS

. Data are limited by sole reliance on self-report and it is unclear whether these findings generalize beyond group-based interventions.

CONCLUSIONS

. Individuals with SAD who are higher in anger suppression and/or expression might be better suited to CBGT than MBSR.

Latent Profiles of Anxious Children and Their Differences in Aggressive Behavior

Children tend to develop forms of anxiety that can be associated with school violence. However, the previous scientific literature on anxiety and aggression is scarce. In addition, it has only focused on examining differential relationships between both variables. This study aimed to analyze the relationships between three forms of anxiety (anticipatory anxiety, school-based performance anxiety, and generalized anxiety) and the components of aggression (physical and verbal aggression, anger, and hostility) by adopting a person-centered approach. The sample consisted of 1161 Spanish students from 8 to 11 years old (M = 9.72, SD = 1.14); 46.2% were boys. Informed written consent from the parents or legal guardians was obtained. The Visual Analogue Scale for Anxiety—Revised and the Aggression Questionnaire were used. The latent profile analysis technique identified three profiles of anxious children: Low Anxiety, High School-based Performance Anxiety, and High Anxiety. The High Anxiety group scored significantly higher than the Low Anxiety group in all components of aggression, with effect sizes ranging from moderate to large (d = 0.59 to 0.99). The High Anxiety profile showed significantly higher scores than the high school-based performance anxiety profile only in anger (d = 0.56) and hostility (d = 0.44). The results have relevant implications for practice, since there is evidence that different intervention strategies should be applied according to the risk profile.

Mediational role of rumination and reflection on irrational beliefs and distress

BACKGROUND

The cognitive restructuring of maladaptive beliefs within many cognitive behavioural psychotherapies typically encourages the client to undertake self-reflection. However, whilst self-consciousness can aid self-regulation, it is also implicated in a broad Grange of psychopathologies. The extent to which self-consciousness is associated with psychological distress is yet to be fully determined, but recent literature suggests that irrational beliefs, as proposed within rational emotive behaviour theory (REBT) may play an important role.

AIMS

The aim of the study was to test the mediational effects of self-consciousness, specifically reflection and rumination, on the relationship between irrational beliefs and psychological distress. Based on past research, it was hypothesized that reflection and rumination would mediate the positive relationship between irrational beliefs and psychological distress. We expected irrational beliefs to interact with rumination to positively predict psychological distress, and irrational beliefs to interact with reflection to negatively predict psychological distress.

METHOD

The present research tested a structural equation model (SEM) in which rumination and reflection mediated the relationship between irrational beliefs and psychological distress.

RESULTS

Results indicated that rumination mediates the positive relationship between irrational beliefs and psychological distress. However, in contrast to our hypotheses, significant mediation did not emerge for reflection.

CONCLUSIONS

This study is the first to show how irrational beliefs and rumination interact to predict psychopathology using advanced statistical techniques. However, future research is needed to determine whether similar mediational effects are evident with rational beliefs as opposed to irrational beliefs.

Anger Rumination is not Uniquely Characteristic of Obsessive-Compulsive Disorder

Although anger has been observed in obsessive-compulsive disorder (OCD), it remains unclear if rumination about anger is characteristic and/or unique to OCD. The present study examines whether types of anger rumination are endorsed more strongly by OCD patients compared to clinical and nonclinical controls. Patients with OCD (n = 30), generalized anxiety disorder (GAD; n = 29), and non-clinical controls (NCC; n = 30) completed measures of OCD symptoms, anger rumination, and trait anxiety. Patients with OCD and GAD significantly differed from NCC's (all ps < .001), but not each other (all ps > .10), in anger afterthoughts, thoughts of revenge, angry memories, and understanding causes of anger. However, the group differences were no longer significant when controlling for trait anxiety. A dimensional approach revealed that OCD symptoms were correlated with anger rumination domains overall. However, these associations were also no longer significant after controlling for trait anxiety. These findings suggest that anger rumination may emerge in OCD largely as an artifact of trait anxiety/negative affect that is associated with but not unique to the disorder. The implications of these findings for conceptualizing emotion and its regulation in OCD are discussed.

Exploring the process of change in emotion-focused therapy for social anxiety

Objective: This study examined purported change mechanisms in emotion-focused therapy for social anxiety disorder. Methods: The sample included nine clients who had participated in a multiple-baseline case study trial examining the efficacy of emotion-focused therapy for social anxiety disorder (SAD). Multilevel analyses were conducted to examine the trajectories of emotions over the course of treatment, and whether primary adaptive emotions in a given session predicted levels of SAD symptoms, self-criticism, and self-reassurance over the course of the following week. Results: Findings showed a significant decrease in shame, and a marginally significant increase in assertive anger, over the course of treatment. Adaptive sadness/grief in a given session predicted less fear of negative evaluation over the course of the following week. Shame in a given session predicted higher levels of inadequate-self over the course of the following week. Finally, shame, and to a lesser degree assertive anger, in a given session predicted reassurance of self over the course of the following week. Neither assertive anger nor adaptive sadness/grief in a given session predicted levels of self-criticism over the course of the following week. Conclusions: These findings lend partial preliminary support for the therapeutic role of evoking and processing adaptive sadness/grief and assertive anger in the treatment of SAD.

The Role of Emotion-Driven Impulse Control Difficulties in the Relation Between Social Anxiety and Aggression

OBJECTIVES

To enhance our understanding of the factors that may account for increased aggression in socially anxious individuals, this study examined associations among emotion-driven impulse control difficulties, social anxiety, and dimensions of aggression (i.e., hostility, anger, physical aggression, verbal aggression).

METHOD

Individuals (N = 107; 73.8% male; M_age = 40.8 years) receiving residential substance abuse treatment participated in this cross-sectional study.

RESULTS

Social anxiety symptoms were significantly positively correlated with emotion-driven impulse control difficulties, anger, and hostility, but not verbal or physical aggression. Separate models for each aggression facet were examined to test the direct and indirect paths. Bootstrapped mediation analyses indicated a significant indirect path from social anxiety symptoms to each facet of aggression through emotion-driven impulse control difficulties (ps < .05).

CONCLUSION

Results highlight the potential utility of targeting emotion-driven impulse control difficulties to decrease aggression among socially anxious individuals.

The effect of rumination and reappraisal on social anxiety symptoms during cognitive-behavioral therapy for social anxiety disorder

OBJECTIVE

There is growing interest in the role of transdiagnostic processes in the onset, maintenance, and treatment of mental disorders (Nolen-Hoeksema & Watkins, 2011). Two such transdiagnostic processes-rumination and reappraisal-are the focus of the present study. The main objective was to examine the roles of rumination (thought to be harmful) and reappraisal (thought to be helpful) in adults with social anxiety disorder (SAD).

METHOD

We conducted a randomized controlled trial of cognitive-behavioral therapy (CBT) with 75 adults with SAD and examined pre- to post-CBT changes as well as weekly fluctuations in rumination, reappraisal, and social anxiety symptoms.

RESULTS

Socially anxious individuals' baseline rumination (brooding) scores predicted weekly levels of social anxiety, rumination, and reappraisal, whereas baseline reappraisal scores did not. Greater weekly rumination was associated with greater weekly social anxiety, but reappraisal was not related to social anxiety.

CONCLUSION

These findings suggest that rumination may have a more significant role than reappraisal in understanding fluctuations in social anxiety during CBT for SAD.

Anticipatory and Post-Event Rumination in Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature

Social anxiety disorder (SAD) is a psychological disorder characterised by an excessive and persistent fear of social or performance situations, which interferes with daily functioning. Cognitive models of SAD (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the importance of negative pre- and post-event rumination as a maintaining factor in the cycle of SAD. While the link between negative rumination and SAD is well supported by empirical research, little is understood about this cognitively important process; thus, research investigating the predictors of negative rumination in SAD is important to consider. Within the current literature, performance appraisal appears to be the most likely unique cognitive predictor of post-event rumination. There is limited research into cognitive predictors of pre-event rumination. Treatments targeting this maintaining factor are important to consider. Suggestions for future research examining the cognitive models of SAD by experimentally manipulating perceived social standards in order to examine the impact of high and low perceived social standard on appraisal processes (i.e., threat appraisal and performance appraisal), state social anxiety, and negative pre-event and post-event rumination, are proposed. Implications for theoretical models and efficacious treatments for SAD are discussed.

Hostility/anger as a mediator between college students' emotion regulation abilities and symptoms of depression, social anxiety, and generalized anxiety

Internalizing problems are common among college students and have been linked consistently to deficits in emotion regulation (ER). Also, hostility/anger (animosity toward others, phenomenological aspect of anger) is an important feature of internalizing problems, but has received limited attention as a mediator between ER and outcomes. Results (N = 160) indicated that although college students' ER abilities corresponded with all three types of internalizing symptoms, hostility/anger mediated fully the relationship for symptoms of depression and social anxiety, but not generalized anxiety (GAD). The stronger interpersonal aspect inherent in depression and social anxiety relative to GAD may in part explain findings, but findings must be viewed in lieu of limitations, which include self-report, a non-clinical sample, and a cross-sectional design. Overall, hostility/anger may be important to address in interventions and programs aimed at reducing internalizing problems, especially among those who demonstrate ER deficits and are prone to depression and social anxiety.

Gender differences in rumination: A meta-analysis

Starting in adolescence and continuing through adulthood, women are twice as likely as men to experience depression. According to the response styles theory (RST), gender differences in depression result, in part, from women's tendency to ruminate more than men. A meta-analysis was performed to evaluate gender differences in rumination in adults (k = 59; N = 14,321); additionally, an analysis of subtypes of rumination - brooding and reflection - was conducted (k = 23). Fixed effects analyses indicated that women scored higher than men in rumination (d = .24, p < .01, SEd = .02), brooding (d = .19, p < .01, SEd = .03) and reflection (d = .17, p < .01, SEd = .03); there was no evidence of heterogeneity or publication bias across studies for these effect sizes. Although statistically significant, the effect sizes for gender differences in rumination were small in magnitude. Results are discussed with respect to the RST and gender differences in depression.

Experiential avoidance as an emotion regulatory function: an empirical analysis of experiential avoidance in relation to behavioral avoidance, cognitive reappraisal, and response suppression

The purpose of the present study was to empirically test the suggestion that experiential avoidance in an emotion regulation context is best understood as an emotion regulatory function of topographically distinct strategies. To do this we examined whether a measure of experiential avoidance could statistically account for the effects of emotion regulation strategies intervening at different points of the emotion-generative process as conceptualized by Gross' (1998) process model of emotion regulation. The strategies under examination were behavioral avoidance, cognitive reappraisal, and response suppression. The specific hypotheses to be tested were (1) that behavioral avoidance, cognitive reappraisal, and response suppression would statistically mediate the differences in measures of psychological well-being between a clinical and nonclinical sample, but that (2) these indirect effects would be reduced to nonsignificant levels when controlling for differences in experiential avoidance. The results provide clear support for the first hypothesis with regard to all the studied strategies. In contrast to the second hypothesis, the results showed the predicted outcome pattern only for the response-focused strategy "response suppression" and not for cognitive reappraisal or behavioral avoidance. The results are interpreted and discussed in relation to theories on experiential avoidance and emotion regulation.

Mental health correlates of anger in the general population: findings from the 2007 National Survey of Mental Health and Wellbeing

OBJECTIVE

The aim of the present study is to examine the mental health correlates of anger in the general population using data collected as part of the 2007 Australian National Survey of Mental Health and Wellbeing (2007 NSMHWB).

METHOD

The 2007 NSMHWB was a nationally representative household survey of 8841 Australians aged between 16 and 85 years. The survey assessed for 30-day DSM-IV mental health disorders and 30-day anger symptoms.

RESULTS

A range of mood, anxiety and substance use disorders were found to be independently associated with symptoms of anger after controlling for demographics and comorbidity. These included major depressive disorder, bipolar disorder, social phobia, generalised anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and alcohol and drug use disorders.

CONCLUSIONS

This study is the first epidemiological investigation of the mental health correlates of anger in the Australian general population. Anger can have extremely maladaptive effects on behaviour and can lead to serious consequences for the individual and for the community. The findings of the present study denote the importance of assessing anger symptoms among individuals presenting with these common mental health disorders.

Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer

Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.