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Cited by 222Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPersonality Disorders and Psychopathology

Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder

Open access
Aldao, Amelia, Jazaieri, Hooria, Goldin, Philippe R., Gross, James J.·2014·Journal of Anxiety Disorders
DOI 10.1016/j.janxdis.2014.03.005PMC PMC4089517
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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. © 2014 Elsevier Ltd.

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Crossref · 10.1016/j.janxdis.2014.03.005

Cites

82 of 82 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 31 cited sources checked · 4 supported · 0 flagged

  • Premisecitation

    The capacity to flexibly choose and apply strategies from one's repertoire according to changing contextual demands is linked to better mental health.

    “Doing so is particularly important in light of a growing understanding that people’s ability to flexibility select and implement various strategies from their repertoires in response to varying contextual demands is associated with good mental health outcomes (e.g., Aldao, 2013; Bonanno & Burton, 2013; Kashdan & Rottenberg, 2010; Kashdan et al., 2014; Sheppes et al., 2014).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Aldao, 2013 source
    • cites Bonanno & Burton, 2013 source
    • cites Kashdan & Rottenberg, 2010 source
  • Premisecitation

    Compared with SAD patients on a waitlist, those receiving CBT reported greater self-efficacy in using reappraisal.

    “Goldin et al. (2012) have found that, relative to patients with SAD in a wait list control condition, those who underwent CBT showed increased self-efficacy in the use of reappraisal.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Goldin et al. (2012) source
  • Findingown data

    Study phase significantly interacted with weekly changes in maladaptive avoidance strategy use.

    “the use of mal-adaptive avoidance strategies, Wald’s χ2 = 11.03, p < .001, b = .45, SE (.13), (CI .18; .71)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.
  • Findingown data

    During the follow-up phase, social anxiety symptoms did not change from week to week.

    “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)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.
  • Findingown data

    During the cognitive phase, social anxiety symptoms decreased significantly from week to week.

    “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)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.
  • Classified as probably not a substantial claim. 14
  • May combine two claims. 13
  • The quote only partly states this claim. 3

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    All therapists reached CBT proficiency before treating participants and met adherence criteria.

    “All treating therapists achieved proficiency in implementing CBT prior to treating study participants and met treatment adherence criteria (for details see Goldin et al., 2012)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Goldin et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The interpretation that adaptive engagement is most beneficial when strategy use levels are similar aligns with work on emotion regulation flexibility.

    “Such an interpretation is in line with current work underscoring the importance of regulating one’s emotions with flexibility (e.g., Bonanno & Burton, 2013; Kashdan & Rottenberg, 2010).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Bonanno & Burton, 2013 source
    • cites Kashdan & Rottenberg, 2010 source
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.

  • The quote only partly states this claim.

    Findingown data

    In the follow-up phase, the interaction between maladaptive avoidance and adaptive engagement was significant.

    “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).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.

  • The quote only partly states this claim.

    Findingown data

    In the cognitive plus behavioral exposures phase, the interaction between maladaptive avoidance and adaptive engagement was significant.

    “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).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.

  • The quote only partly states this claim.

    Findingown data

    In 71 participants receiving CBT for SAD, putatively adaptive and maladaptive emotion regulation strategies interacted in predicting social anxiety symptoms.

    “We found that strategies interacted with each other”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Patients with SAD who responded to CBT increased their habitual reappraisal from pre- to mid-treatment, while suppression did not increase.

    “Moscovitch et al. (2012) have found that patients who responded to CBT exhibited an increase in their habitual use of the putatively adaptive strategy of reappraisal from pre- to mid-treatment assessments (this was not the case for suppression).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Moscovitch et al. (2012) source

  • May combine two claims.

    Premisecitation

    Avoidance and expressive suppression are ineffective at changing affect in experiments and appear linked to more psychological symptoms; they are labeled putatively maladaptive.

    “some emotion regulation strategies (e.g., avoidance, expressive suppression) are ineffective at modifying affect in experimental studies, and seem to be associated with greater levels of psychological symptoms. These strategies have been conceptualized as putatively maladaptive (e.g., Aldao, Nolen-Hoeksema, & Schweizer, 2010; Webb, Miles, & Sheeran, 2012).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Aldao, Nolen-Hoeksema, & Schweizer, 2010 source
    • cites Webb, Miles, & Sheeran, 2012 source

  • May combine two claims.

    Premisecitation

    In clinical groups, people diagnosed with SAD tend to report more expressive suppression, rumination, and experiential avoidance and less reappraisal than healthy controls.

    “In clinical samples, participants diagnosed with SAD have tended to report making greater use of the putatively maladaptive strategies of expressive suppression, rumination, and experiential avoidance and lesser use of the putatively adaptive strategy of reappraisal than healthy controls (e.g., D’Avanzato, Joormann, Siemer, & Gotlib, 2013; Kashdan et al., 2013).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites D’Avanzato, Joormann, Siemer, & Gotlib, 2013 source
    • cites Kashdan et al., 2013 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Participants completed single-item measures of strategies, which may not capture the complexity of psychological processes.

    “In addition, participants completed single-item measures of strategies, which can be problematic because such measures might not capture the complexity of psychological processes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Generalized estimating equations assume correlated dependent-variable observations and are fairly robust to missing data and covariance-matrix misspecification.

    “We used generalized estimating equations (GEE), which is an extension of the general linear model (GLM) that assumes correlated observations of dependent variables and are fairly robust to missing data and to misspecifications of the covariance matrix (e.g., Ghisletta & Spini, 2004; Liang & Zeger, 1986).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Ghisletta & Spini, 2004 source
    • cites Liang & Zeger, 1986 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    During the follow-up phase, data were collected from 51 of the original 71 participants.

    “A final limitation stems from the fact that during the follow-up phase, we collected data from 51 out of the original 71 participants.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    In a large community sample, habitual putatively adaptive strategies (acceptance, positive reframing) interacted with habitual putatively maladaptive strategies (behavioral disengagement, denial) in predicting a composite of anxiety, depression, and alcohol abuse symptoms.

    “Aldao and Nolen-Hoeksema (2012) examined the relationship between emotion regulation strategies and mental health in a large community sample and found that the habitual use of putatively adaptive strategies (acceptance, positive reframing) interacted with the habitual use of putatively maladaptive strategies (behavioral disengagement, denial) in the prediction of a composite scores of symptoms of”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aldao and Nolen-Hoeksema (2012) source

  • May combine two claims.

    Premisecitation

    In Aldao et al.'s meta-analysis, acceptance had a mean effect size of −.19 and reappraisal −.14, with overlapping confidence intervals.

    “In the meta-analysis by Aldao et al. (2010), acceptance had a mean effect size of −.19 and reappraisal had a mean effect size of −.14. Their confidence intervals overlapped (acceptance: −.40 to .05; reappraisal: −.20 to −.07), thus suggesting that these effect sizes are not statistically significant from each other.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aldao et al. (2010) source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Reappraisal and acceptance are effective at changing affect in laboratory settings and appear negatively linked to clinical symptoms; they are labeled putatively adaptive.

    “Conversely, other emotion regulation strategies (e.g., reappraisal, acceptance) are effective at modifying affect in laboratory settings, and seem to have negative associations with clinical symptoms. These strategies have been conceptualized as putatively adaptive (Aldao et al., 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aldao et al., 2010 source

  • May combine two claims.

    Interpretationown data

    In the cognitive phase, adaptive engagement was negatively associated with social anxiety symptoms when maladaptive avoidance was low; in the cognitive plus behavioral exposures and follow-up phases, adaptive engagement was negatively associated with symptoms when maladaptive avoidance was high.

    “Whereas in the cognitive phase, the use of adaptive engagement strategies had negative associations with social anxiety symptoms when the use of maladaptive avoidance strategies was low, in the cognitive + behavioral exposures and follow-up phases, their use had negative associations with symptoms when the use of maladaptive avoidance strategies was high.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Because the treatment phases differed in how much emotion regulation they demanded, the weekly links between regulation and anxiety symptoms should not be assumed constant across phase.

    “Given the heterogeneity in emotion regulation demands across the various study phases, we thought it unwise to assume that the associations between weekly emotion regulation and anxiety symptoms would be invariant across study phase.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the Emotion Regulation Questionnaire validation study, depressive symptoms correlated .25 with habitual expressive suppression and −.23 with habitual reappraisal.

    “For example, in the validation paper for the emotion regulation questionnaire, the correlation between depressive symptoms and the habitual use of expressive suppression was .25, and the correlation between depressive symptoms and habitual use of reappraisal was −.23 (Gross & John, 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gross & John, 2003 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    An autoregressive (AR1) covariance structure was specified because observations were expected to correlate over time within participants.

    “We specified an autoregressive (AR1) covariance structure because we expected observations to be correlated over time within each participant.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The four maladaptive avoidance items were averaged into a composite with α = .69.

    “We averaged these four strategies into a composite score called “maladaptive avoidance strategies” (α = .69).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    When participants reported high maladaptive strategy use, adaptive strategies had the expected negative association with the symptom composite; when maladaptive use was low, the adaptive-strategy association was non-significant.

    “Specifically, for participants who reported using high levels of putatively maladaptive strategies, the use of putatively adaptive strategies had the expected negative association with the composite score of symptoms. However, for participants who reported using low levels of putatively maladaptive strategies, the association between putatively adaptive strategies and psychopathology was non-sign”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aldao and Nolen-Hoeksema (2012) source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The six social anxiety facets were averaged into a composite with α = .91.

    “We averaged these items into a composite “social anxiety” score (α = .91).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Participants were assigned to immediate CBT or waitlist by Efron's biased coin randomization.

    “We randomly assigned them to either immediate CBT or to a wait list (WL) group using Efron’s biased coin randomization procedure (Efron, 1971), which results in approximately equal sample sizes throughout the duration of a clinical trial.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Efron, 1971 source

  • May combine two claims.

    Premisecitation

    Affective states, how they are regulated, and symptom levels change markedly across time.

    “This is particularly important because emotions, their regulation, and symptoms of psychopathology fluctuate substantially over time (e.g., Aldao, 2013; Barrett, Gross, Christensen, & Benvenuto, 2001; Bylsma & Rottenberg, 2011; Ebner-Priemer & Trull, 2009; Robinson & Clore, 2002; Srivastava, Tamir, McGonigal, John, & Gross, 2009).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Aldao, 2013 source
    • cites Barrett, Gross, Christensen, & Benvenuto, 2001 source
    • cites Bylsma & Rottenberg, 2011 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In that validation study, putatively adaptive and maladaptive strategies did not interact in predicting symptoms, suggesting additive effects.

    “Further, these putatively adaptive and maladaptive strategies did not interact with each other in the prediction of symptoms (Gross & John, 2003), suggesting that their effects might be additive.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gross & John, 2003 source
24 of 24

  • The paper relies on this without support.

    The weekly self-report measures adequately capture social anxiety symptoms and the use of adaptive engagement and maladaptive avoidance strategies.

    “participants completed single-item measures of strategies, which can be problematic because such measures might not capture the complexity of psychological processes.”
1 of 1

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Each contradiction between two passages listed here was confirmed by an independent check.

  • Follow-up sample size is 51 in one place and 53 in another

    Minor

    The paper gives two different participant counts for the follow-up phase. One results paragraph reports 51 participants, while another preliminary-analyses paragraph reports 53 participants for the same follow-up phase.

  • Follow-up participant counts conflict

    Minor

    The follow-up trend analysis reports data from 53 participants, but the limitations section says follow-up data were collected from only 51 of the original participants. The text does not reconcile these counts.

2 of 2

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Authors
Aldao, A., Jazaieri, H., Goldin, P. R., & Gross, J. J.
Affiliations
  • The Ohio State University (US)
  • University of California, Berkeley (US)
  • Stanford University (US)
Corresponding author
Aldao, Amelia
ORCID
Venue
Journal of Anxiety Disorders
Publisher
Elsevier BV
Published
2014-05
Volume
28
Issue
4
Pages
382-389
ISSN
0887-6185 (ISSN-L)
DOI
10.1016/j.janxdis.2014.03.005
PMC
PMC4089517
OpenAlex
W2149676985
Semantic Scholar
ad6d6761bd08985fa2a01980f15946a5a92f3d69
Cited by
222
References
90
Citations by year
2026: 16 · 2025: 23 · 2024: 24 · 2023: 21 · 2022: 24 · 2021: 29 · 2020: 13 · 2019: 18 · 2018: 21 · 2017: 10 · 2016: 10 · 2015: 10 · 2014: 3
FWCI
15.27
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Anxiety Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Mental Health (R01MH076074)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
emotion regulation strategies, social anxiety disorder, cognitive behavioral therapy, interaction effects, contextual factors, social anxiety symptoms, cognitive flexibility
MeSH terms
Adaptation, Psychological, Adult, Emotions, Female, Follow-Up Studies, Humans, Male, Middle Aged, Phobic Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult

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