Edited by: Roberto Viviani, University of Innsbruck, Austria
Reviewed by: Marta Walentynowicz, University of Southern California, United States; Bertus F. Jeronimus, University of Groningen, Netherlands
This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology
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The identification of distinctive and overlapping features of anxiety and depression remains an important scientific problem. Currently, the literature does not allow to determine stable similarities and differences in the use of cognitive emotion regulation strategies (CERS) in anxiety and depression, especially concerning the adaptive strategies. Consequently, the aim of this study was to identify the overlapping and distinctive patterns of CERS use in the recently proposed types of anxiety and depression in a general population. In this dimensional approach, types of anxiety and depression are considered as personality types and distinguished based on their specific structural composition and functional role (reactive or regulative) in stimulation processing. 1,632 participants from a representative sample completed the Anxiety and Depression Questionnaire (measuring the Arousal and Apprehension Types of anxiety and the Valence and Anhedonic Types of depression) and the Cognitive Emotion Regulation Questionnaire. Regression analyses were conducted with the affective types as predictors. The co-occurrence of the types was accounted for in order to examine their independent relationships with the CERS. We found that reactive arousal anxiety was not related to any strategies, while regulative apprehension anxiety primarily predicted the use of rumination, which is presumably related to the type's cognitive structural components. The strategy specific to reactive valence depression was other-blame (as predicted by the high negative affect in its structure), and the regulative, most structurally complex anhedonic depression predicted the use of the largest number of strategies, including the adaptive ones. The relationships between the types of depression and self-blame and refocus on planning were moderated by sex but the effects were small. These findings fit into the current trend of exploring the shared and specific features of anxiety and depression, which might facilitate their differentiation by identifying CERS that are characteristic for the specific types. This information can be used for supporting diagnosis and targeting selected strategies in therapy both in clinical and non-clinical populations.
The aim of this study is to determine the specific and common patterns in the use of cognitive emotion regulation strategies in the recently proposed types of anxiety and depression (Fajkowska,
Here, cognitive emotion regulation is understood as “an individual's thoughts after having experienced a negative event” (Garnefski et al.,
Definitions of the adaptive and maladaptive Cognitive Emotion Regulation Strategies (Garnefski et al.,
Self-blame | Blaming oneself for the negative event |
Rumination | Repetitive thinking about the thoughts and feelings about the event |
Catastrophizing | Focusing on how terrible the event was |
Other-blame | Blaming others for what happened |
Acceptance | Resigning to what happened |
Positive refocusing | Directing thoughts to pleasant matters |
Refocus on planning | Thinking about actions that can help deal with the negative event |
Putting into perspective | Diminishing the meaning of the event |
Positive reappraisal | Finding a positive side of the negative event |
The strategies most frequently described as being related to anxiety are catastrophizing (Garnefski et al.,
Most authors agree that depression is related to rumination (Garnefski et al.,
Apparently, the pattern of the relationship between CERS and anxiety and depression does not allow for a clear differentiation of these phenomena, as most data suggests an overlap in the reported strategies. One study showed that six out of nine strategies correlated with both anxiety and depression, including at a retest after over a year (Garnefski et al.,
We decided to use an alternative approach to anxiety and depression for a few reasons. A review of the vast literature might suggest that the cognitive emotion regulation strategies are transdiagnostic processes, related to a variety of psychopathological units. However, we suggest that the most commonly used diagnostic classifications (DSM-5, American Psychiatric Association,
Fajkowska (
According to Fajkowska (
The organization of anxiety types according to the three-level compositional hierarchy. Adapted from Fajkowska (
Structural composition of the anxiety and depression types and their functions in stimulation processing (Fajkowska et al.,
Arousal anxiety | Somatic reactivity | Elevated autonomic reactivity, psychophysiological arousal, and somatic tension—e.g., trembling hands, heart pounding—resulting from the occurrence of negative and threatening stimuli | Reactive |
Panic/phobia | Panic symptoms, distress, phobias | ||
Attentional vigilance/avoidance | “Early” vigilance to threat, usually in the clinical form of anxiety, and “late” attentional avoidance of threat, usually in the non-clinical form | ||
Apprehension anxiety | Worrisome thoughts | Concerning physical, emotional or symbolic threat to the self; connected with the social appraisal of one's behavior or competence, real or anticipated physical threat, or general problems of the world | Regulative |
Attentional control | Problems in attention switching and concentration, inability to disengage attention from negative experiences, giving in to distracting thoughts, impaired inhibition, especially in processing negative emotional material connected with failure or a negative event | ||
Somatic reactivity | Elevated reactivity of the autonomous nervous system while facing threat, or as a result of worrisome thoughts | ||
Valence depression | Negative affect | Elevated level of anxiety, tension, hostility, anger, sadness, high sensitivity to the self, and social avoidance | Reactive |
Attentional avoidance | Insensitivity to the valence of the emotional material and insensitivity to social stimuli | ||
Anhedonic depression | Emotional-motivational deficits | Inability to experience pleasure and a lowered reactivity to pleasurable events, difficulties in goal pursuit and taking up activity in order to attain them, inability to attain pleasure or reward oneself by appetitive behaviors | Regulative |
Positive affect | Very low level of positive feelings, such as self-confidence, happiness, or hope | ||
Negative affect | Very high level of negative feelings and emotions, such as sadness, guilt, disappointment or anxiety | ||
Attentional control | Inability to sustain attention on emotional material, slower and inaccurate reactions to emotional material, lowered ability to sustain effort in processing emotional material regardless of its valence, problems with concentration of attention |
Further, Fajkowska (
The organization of depression types according to the three-level compositional hierarchy. Adapted from Fajkowska (
This categorization (Fajkowska,
Considering the possibility of “grouping” the types of anxiety and depression according to their functional role in processing stimulation (see Table
We also hypothesized that the use of CERS will be related to the structural composition of the affective types. The domination of the cognitive component in apprehension anxiety (especially worrisome thoughts and reduced attentional control) may be related to more frequent use of rumination and less of positive refocusing. We expect that anhedonic depression will be connected with more frequent use of self-blame, rumination, and catastrophizing, as it is by definition characterized by reduced attentional control, very low positive affect, and high negative affect. Valence depression should be related to a more frequent use of other-blame, since it is connected to a high negative affect, manifesting itself in hostility, tension, anger, anxiety, and sensitivity to the “self.” Moreover, all types of anxiety and depression should be related to more frequent use of non-adaptive strategies (Aldao et al.,
In accord with the presented theoretical framework of affective types, these types are located at a lower level of the personality system than the behavioral markers (e.g., strategies, placed at the highest level of personality; Fajkowska,
Sex differences in the use of CERS are rarely considered or show weak effects (Garnefski and Kraaij,
One thousand six hundred and thirty-two participants (52% females) aged 18–65 (
This study was carried out in accordance with the recommendations of the Ethics Committee of the Institute of Psychology, Polish Academy of Sciences. The protocol was approved by the Ethics Committee of the Institute of Psychology, Polish Academy of Sciences. After providing informed consent, participants filled out the Anxiety and Depression Questionnaire (Fajkowska et al.,
The ADQ (Fajkowska et al.,
Arousal Anxiety — (45 items, including 4 fillers):
Somatic Reactivity (22 items): e.g., When I am scared, I feel pain in my chest.
Panic/Phobia (14 items): e.g., I often get sudden anxiety attacks.
Attentional Vigilance/Avoidance (5 items): e.g., When I notice a potential threat, I automatically withdraw from the given situation.
Apprehension Anxiety — (48 items):
Worrisome Thoughts (14 items): e.g., When I start to worry, I cannot stop.
Attentional Control (23 items): e.g., I cannot concentrate on a difficult task if there are noises around.
Somatic Reactivity (11 items): e.g., My body reacts intensively to sudden stress.
Valence Depression — (40 items, including 4 fillers):
Negative Affect (21 items): e.g., I am very often tense.
Attentional Avoidance (15 items): e.g., It is difficult for me to notice anger in others.
Anhedonic Depression — (64 items):
Emotional-Motivational Deficits (31 items): e.g., I feel completely bored.
Positive Affect (13 items): e.g., I often smile honestly and joke.
Negative Affect (12 items): e.g., I feel worthless.
Attentional Control (8 items): e.g., Emotional events distract me so much that I later have trouble concentrating.
Empirical data collected during the construction and validation stages provide evidence that the ADQ is a reliable and valid self-rating measure of the anxiety and depression types (Fajkowska et al.,
The Cognitive Emotion Regulation Questionnaire (Garnefski et al.,
In order to filter out those who “clicked through” the questionnaires, participants with extremely low variance of raw scores on any of the questionnaires (
Means, standard deviations, and Cronbach's Alphas of the Anxiety and Depression Questionnaire (
Arousal anxiety | 15.00 | 10.71 | 0.94 |
Apprehension anxiety | 23.24 | 12.77 | 0.95 |
Valence depression | 10.82 | 8.80 | 0.93 |
Anhedonic depression | 18.08 | 16.07 | 0.97 |
Means, standard deviations, and Cronbach's Alphas of the Cognitive Emotion Regulation Questionnaire in the total sample and in the women and men subgroups.
Self-Blame | 11.26 | 2.64 | 11.23 | 2.82 | 11.29 | 2.43 | 0.70 |
Acceptance | 13.07 | 2.31 | 13.24 | 2.29 | 12.86 | 2.33 | 0.61 |
Rumination | 12.22 | 2.70 | 12.46 | 2.80 | 11.94 | 2.56 | 0.75 |
Positive refocusing | 12.89 | 2.55 | 12.98 | 2.57 | 12.78 | 2.53 | 0.73 |
Refocus on planning | 14.13 | 2.47 | 14.20 | 2.46 | 14.05 | 2.47 | 0.76 |
Positive reappraisal | 13.72 | 2.72 | 13.79 | 2.72 | 13.65 | 2.71 | 0.78 |
Putting into perspective | 13.05 | 2.46 | 13.24 | 2.51 | 12.84 | 2.39 | 0.70 |
Catastrophizing | 10.75 | 3.02 | 10.81 | 3.11 | 10.67 | 2.92 | 0.78 |
Other-blame | 10.56 | 2.80 | 10.36 | 2.89 | 10.78 | 2.65 | 0.80 |
All strategies (mean) | 12.40 | 1.41 | 12.48 | 1.45 | 12.32 | 1.36 | 0.85 |
Independent samples
Subsequently, nine hierarchical regression analyses were run. In each of them a different CERS was the predicted variable, and the types of anxiety and depression, age, sex, and the remaining eight CERS were entered as predictors in the first step. In order to assess sex differences, in the second step the interaction between types and sex were entered as predictors. A dummy variable was created where men were coded as 0 and women as 1. The variables were centered at their means for the interaction analyses. Similar analyses were run for the aggregated adaptive and maladaptive strategies.
Table
Results of hierarchical regression analyses (standardized Betas) for each of the predicted cognitive emotion regulation strategies (CERS) with types of anxiety and depression, age, sex, and the remaining CERS as predictors (
Arousal anxiety | 0.070 |
−0.033 | −0.056 | 0.068 | −0.037 | −0.014 | 0.024 | −0.008 | 0.085 |
Apprehension anxiety | −0.039 | −0.004 | 0.170 |
−0.112 |
0.065 | −0.042 | −0.009 | 0.037 | −0.098 |
Valence depression | 0.104 |
−0.047 | −0.031 | 0.082 |
−0.159 |
0.037 | 0.038 | 0.028 | 0.201 |
Anhedonic depression | 0.156 |
0.093 |
0.075 |
−0.164 |
0.073 |
−0.171 |
−0.127 |
0.121 |
−0.089 |
Age | 0.000 | 0.037 | −0.026 | 0.016 | 0.037 | −0.015 | 0.032 | 0.038 |
−0.048 |
Sex | −0.078 |
0.045 | 0.064 |
0.021 | −0.016 | −0.011 | 0.049 |
0.024 | −0.112 |
Self–blame | 0.205 |
0.246 |
−0.143 |
0.086 |
0.019 | 0.065 |
0.197 |
−0.196 |
|
Acceptance | 0.171 |
0.199 |
0.080 |
0.144 |
0.018 | 0.141 |
−0.012 | 0.014 | |
Rumination | 0.292 |
0.283 |
−0.063 | 0.198 |
0.018 | −0.016 | 0.300 |
0.175 |
|
Positive refocusing | −0.115 |
0.078 |
−0.043 | 0.142 |
0.139 |
0.122 |
0.042 | 0.060 |
|
Refocus on planning | 0.090 |
0.181 |
0.175 |
0.185 |
0.351 |
0.007 | −0.128 |
0.029 | |
Positive reappraisal | 0.026 | 0.029 | 0.021 | 0.233 |
0.453 |
0.490 |
−0.117 |
0.004 | |
Putting into perspective | 0.062 |
0.161 |
−0.013 | 0.144 |
0.007 | 0.346 |
0.025 | 0.009 | |
Catastrophizing | 0.229 |
−0.017 | 0.294 |
0.061 | −0.143 |
−0.100 |
0.030 | 0.473 |
|
Other-blame | −0.155 |
0.013 | 0.117 |
0.059 |
0.022 | 0.002 | 0.007 | 0.321 |
|
0.459 | 0.351 | 0.543 | 0.327 | 0.488 | 0.599 | 0.432 | 0.535 | 0.315 | |
Model parameters | |||||||||
Arousal anxiety | 0.057 | −0.052 | −0.059 | 0.114 |
−0.050 | 0.003 | 0.025 | −0.033 | 0.086 |
Apprehension anxiety | −0.063 | 0.030 | 0.183 |
−0.117 |
0.079 | −0.047 | −0.020 | 0.042 | −0.109 |
Valence depression | 0.026 | −0.052 | 0.020 | 0.063 | −0.135 |
0.021 | 0.047 | 0.031 | 0.121 |
Anhedonic depression | 0.233 |
0.116 |
0.009 | −0.113 |
−0.012 | −0.162 |
−0.080 | 0.112 |
−0.016 |
Age | 0.000 | 0.038 | −0.027 | 0.020 | 0.032 | −0.014 | 0.035 | 0.036 | −0.047 |
Sex | −0.077 |
0.045 | 0.064 |
0.019 | −0.016 | −0.012 | 0.049 |
0.025 | −0.112 |
Self-blame | 0.206 |
0.249 |
−0.141 |
0.086 |
0.018 | 0.066 |
0.196 |
−0.202 |
|
Acceptance | 0.170 |
0.199 |
0.078 |
0.145 |
0.018 | 0.139 |
−0.012 | 0.014 | |
Rumination | 0.294 |
0.283 |
−0.060 | 0.193 |
0.019 | −0.014 | 0.299 |
0.179 |
|
Positive refocusing | −0.113 |
0.075 |
−0.041 | 0.146 |
0.138 |
0.118 |
0.044 | 0.059 |
|
Refocus on planning | 0.090 |
0.183 |
0.171 |
0.190 |
0.351 |
0.012 | −0.130 |
0.030 | |
Positive reappraisal | 0.025 | 0.029 | 0.022 | 0.231 |
0.450 |
0.488 |
−0.116 |
0.003 | |
Putting into perspective | 0.063 |
0.159 |
−0.011 | 0.140 |
0.011 | 0.346 |
0.026 | 0.009 | |
Catastrophizing | 0.226 |
−0.016 | 0.293 |
0.063 | −0.144 |
−0.100 |
0.031 | 0.471 |
|
Other-blame | −0.159 |
0.013 | 0.119 |
0.058 |
0.023 | 0.002 | 0.008 | 0.321 |
|
Arousal anxiety * sex | 0.017 | 0.034 | 0.001 | −0.054 | 0.008 | −0.023 | 0.003 | 0.031 | 0.001 |
Apprehension anxiety * sex | 0.029 | −0.053 | −0.013 | 0.001 | −0.009 | 0.006 | 0.009 | −0.006 | 0.011 |
Valence depression * sex | 0.114 |
0.005 | −0.071 | 0.019 | −0.026 | 0.022 | −0.017 | −0.001 | 0.114 |
Anhedonic depression * sex | −0.105 |
−0.033 | 0.089 |
−0.068 | 0.113 |
−0.012 | −0.060 | 0.011 | −0.099 |
0.004 | 0.001 | 0.002 | 0.004 | 0.004 | 0.000 | 0.002 | 0.000 | 0.003 | |
0.040 | 0.665 | 0.336 | 0.133 | 0.039 | 0.965 | 0.301 | 0.860 | 0.200 |
Results of regression analyses (standardized Betas) for the predicted aggregated adaptive and maladaptive cognitive emotion regulation strategies (CERS) with types of anxiety and depression, age, sex, and the aggregated maladaptive and adaptive CERS (respectively) as predictors (
Arousal anxiety | 0.008 | 0.025 |
Apprehension anxiety | −0.070 | 0.158 |
Valence depression | −0.056 | 0.186 |
Anhedonic depression | −0.422 |
0.356 |
Age | 0.075 |
0.001 |
Sex | 0.059 |
−0.022 |
Adaptive strategies | 0.177 |
|
Maladaptive strategies | 0.212 |
|
0.202 | 0.333 | |
Model parameters |
Arousal anxiety did not significantly predict any of the CERS, neither by itself or in interaction with sex. Also, this type did not predict the use of adaptive or maladaptive aggregated strategies.
Apprehension anxiety significantly predicted the use of rumination and positive refocusing (as predicted, the latter one was an inverse relationship). It did not interact with sex. When aggregated strategies were analyzed, only the maladaptive ones were predicted by apprehension anxiety.
Valence depression turned out to be a significant predictor of other-blame (positive relationship) and refocus on planning (negative). Additionally, a significant interaction indicated that the relationship between valence depression and self-blame is moderated by sex in such a way that valence depression is a significantly stronger predictor of self-blame in women than in men. When aggregated strategies were analyzed, only the maladaptive ones were predicted by valence depression.
Anhedonic depression significantly predicted the use of self-blame, rumination, positive refocusing, positive reappraisal, putting into perspective, and catastrophizing. The relationship with positive refocusing, positive reappraisal, and putting into perspective was positive and with the remaining three strategies—negative. The significant interactions additionally showed that anhedonic depression is a stronger predictor of self-blame in men than in women and a significant predictor of refocus on planning in women. This type was the only significant (and the strongest of all types) predictor of both the aggregated adaptive and maladaptive strategies.
In this study, we analyzed the relationships between types of anxiety and depression on one side and cognitive emotion regulation strategies on the other. We based our approach on the model developed by Fajkowska (
Consistently with previous studies (Garnefski et al.,
We hypothesized that regulative apprehension anxiety, with its dominating cognitive component (worrisome thoughts, reduced attentional control), will predict the more frequent use of rumination. The results confirmed this hypothesis. Regulative anhedonic depression (which is also characterized by reduced attentional control) predicted the use of rumination as well. Studies usually show that rumination is related to depression (Garnefski et al.,
Concerning the functional role of the types of anxiety and depression, we previously reported that the regulative types correlated more strongly with the use of aggregated strategies than the reactive types (Fajkowska et al.,
Previous results (Garnefski et al.,
To sum up, our study showed that the proposed types of anxiety and depression predict different patterns of the cognitive emotion regulation strategies use, and that these strategies are related to the proposed structural and functional characteristic of the types. We controlled for the effects of co-occurrence, as it allows to study the effects and characteristics of “pure” types of anxiety and depression, which enables us to better understand their mechanisms. Age did not turn out to be a significant predictor of any of the strategies. The contribution of the affective types to the prediction of the cognitive emotion regulation strategies use is small to moderate, which is not surprising, given that the affective types can be characterized by various behavioral markers. This issue needs to be addressed in future studies. For example, so-called overt emotion regulation strategies, such as drinking alcohol, eating, or seeking advice have been shown to be related to anxiety and depression symptoms (Aldao and Dixon-Gordon,
Nevertheless, these results further validate the proposed classification of anxiety and depression, and at the same time allow for a better understanding of their underlying mechanisms. Research suggests that the use of cognitive emotion regulation strategies influences emotional responding (for a review see: Cisler and Olatunji,
Interestingly, according to our results, types of anxiety are related to a less frequent use of the CERS than types of depression. Theoretically, it seems that cognitive regulation of emotion is less mentally available to anxious than depressive individuals. For some reasons they might not be able to use them. Although the latter ones rather use maladaptive and ineffective cognitive strategies of emotion regulation, it still suggests that cognitive control over emotional states seems to be crucial in depression. Therefore, the transformation from negative to positive strategies should be recommended as very important in the therapeutic protocol of curing depression. However, the question arises about what kinds of strategies are more available/typical to anxious people. Behavioral strategies are one possible answer. These issues can be the focus of further studies and speculations related to therapy of anxiety (e.g., how to regulate the level of anxiety: by building adaptive cognitive strategies of emotion regulation or by incorporating behavioral ones?).
The gender differences should also be considered in therapy, as our results show possible, however small, differences between men and women in typical patterns of CERS use in types of depression. Therefore, a greater focus on strategies typical for each gender could turn out a useful approach. However, research on clinical samples might bring different effects, as the present study was conducted on a general population.
The dataset generated for this study can be found in the Mendeley Data repository (
MF and ED: contributed to the study design and supervised data collection; ED: analyzed the data and drafted the manuscript; MF: provided critical revisions; ED and MF: approved the final version of the manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
This work was supported by the National Science Center, Poland under grant 2012/07/E/HS6/04071. ED has obtained funding under a scholarship from the National Science Center, Poland, grant number 2016/20/T/HS6/00598.