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      Emotion regulation moderates the association between COVID-19 stress and mental distress: findings on buffering, exacerbation, and gender differences in a cross-sectional study from Norway

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          Translated abstract

          Background

          Maintaining good mental health is important during a crisis. However, little attention has been given to how people achieve this, or how they evaluate emotions associated with stressors, such as the COVID-19 pandemic. This study aims to (1) investigate whether emotion regulation, in particular cognitive reappraisal and suppression, moderates the relationship between COVID-19 stress and general mental distress and (2) examine gender differences in the interrelations between COVID-19 stress, emotion regulation, and mental distress.

          Methods

          Data from a population in Norway ( n = 1.225) were collected using a cross-sectional survey during the early months of the COVID-19 pandemic. Emotion regulation was measured using the Emotion Regulation Questionnaire Scale (ERQ), COVID-19 stress with the COVID-19 Stress Scale, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS.

          Results

          There was a strong association between COVID-19 stress and general mental distress ( r = 0.61). The moderation analyses showed substantial moderation effects of cognitive reappraisal and suppression on the relationship between COVID-19 stress and mental distress. Cognitive reappraisal served as a buffer ( p = 0.001) and suppression ( p = 0.002) exacerbated the relation between COVID-19 stress and mental distress. Men had higher scores of suppression ( p < 0.001), and women had higher scores of cognitive reappraisal ( p = 0.025). The buffering effect of cognitive reappraisal presented itself only in women ( p < 0.001), while the exacerbation effect of suppression appeared only in men ( p < 0.001).

          Conclusion

          The current study suggests that COVID-19 pandemic-related stress is easier to deal with for those who have the tendency to cognitively reappraise. In contrast, suppression is associated with symptoms of depression and anxiety. The prevention of mental distress can be supported by guiding people about the importance of using healthy emotion regulation strategies, as well as helping them to become more aware of the way they interpret and regulate their emotions. Gender differences in emotion regulation suggest gender awareness, e.g., tailored programs for men and women.

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          Most cited references127

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          The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.

          Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization. Copyright 2010. Published by Elsevier Inc.
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            Emotion-regulation strategies across psychopathology: A meta-analytic review.

            We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that examined the relationships between dispositional emotion regulation and psychopathology. We focused on dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we examined the relationship between each regulatory strategy and psychopathology across the four disorders. We found a large effect size for rumination, medium to large for avoidance, problem solving, and suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory strategy and each of the four psychopathology groups. We found that internalizing disorders were more consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses showed that whether the sample came from a clinical or normative population significantly moderated the relationships. This finding underscores the importance of adopting a multi-sample approach to the study of psychopathology. Copyright 2009 Elsevier B.V. All rights reserved.
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              The emerging field of emotion regulation: An integrative review.

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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                22 June 2023
                2023
                22 June 2023
                : 14
                : 1121986
                Affiliations
                [1] 1Faculty of Social Sciences, Norwegian School of Hotel Management, University of Stavanger , Stavanger, Norway
                [2] 2School of Psychology, Faculty of the Arts, Social Sciences, and Humanities, University of Wollongong , Wollongong, NSW, Australia
                [3] 3Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin, Germany
                [4] 4MF Norwegian School of Theology, Religion and Society , Majorstuen, Oslo, Norway
                [5] 5Centre for Psychology of Religion, Innlandet Hospital Trust , Brumunddal, Norway
                [6] 6Modum Bad Psychiatric Center , Vikersund, Norway
                [7] 7Existential Psychology Lab, Institute of Psychology, University of Innsbruck , Innsbruck, Tyrol, Austria
                Author notes

                Edited by: Changiz Mohiyeddini, Oakland University William Beaumont School of Medicine, United States

                Reviewed by: Xihui Chen, Zhejiang University of Technology, China; Naresh Poondla, Icahn School of Medicine at Mount Sinai, United States; Brahmi Mohsen, University of Sfax, Tunisia

                *Correspondence: Annie Haver, annie.haver@ 123456uis.no
                Article
                10.3389/fpsyg.2023.1121986
                10325689
                efc2aa24-b70a-4063-8c3b-9a2e8bbf7c5e
                Copyright © 2023 Haver, Krampe, Danbolt, Stålsett and Schnell.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 12 December 2022
                : 15 May 2023
                Page count
                Figures: 4, Tables: 5, Equations: 0, References: 134, Pages: 15, Words: 11972
                Categories
                Psychology
                Hypothesis and Theory
                Custom metadata
                Health Psychology

                Clinical Psychology & Psychiatry
                covid-19,anxiety,depression,emotion regulation,moderator analysis,public mental health,reappraisal,suppression

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