The mediating role of emotion regulation strategies in the relationship between rumination and aggression in bipolar patients

Document Type : Original Article

Authors

1 Master of Clinical Psychology, Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran

2 Assistant Professor, Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran

Abstract

Introduction: The aim of this study was to determine the mediating role of emotion regulation strategies between rumination and aggression in bipolar patients.
Methods: The research method was descriptive-correlational, and the statistical population of the study consisted of all patients with bipolar disorder, referred and hospitalized in Tehran's maintenance and rehabilitation centers in 2018-2019, of which 200 were selected by targeted sampling. Research tools include Ruminative Response Scale, Emotion Regulation Questionnaire and Aggression Questionnaire. Structural equation modeling was used to analyze the data.
Results: The results showed that the suppression (p < 0.01, Z=2.71, β=0.75) and reappraisal (p < 0.05, Z=2.47, β=0.074) emotion regulation strategies mediate the relationship between rumination and aggression in bipolar patients.
Conclusion: Based on the results of the present study, it is recommended to evaluate the level of rumination and emotional regulation strategies of bipolar patients in the treatment process and provide appropriate therapies to reduce rumination and suppression emotional regulation strategy in these patients.

Keywords


منابع
1. Arici C, Cremaschi L, Dobrea C, Vismara M, Grancini B, Benatti B, et al. Differentiating multiple vs single lifetime suicide attempters with bipolar disorders: A retrospective study. Comprehensive psychiatry. 2018;80:214-22.
2. Luu B, Rodway G. Lithium Therapy for Bipolar Disorder. The Journal for Nurse Practitioners. 2018;14(2):93-9.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. Arlington, VA: American Psychiatric Association; 2013.
4. Peters EM, Bowen R. Irritability in a mixed sample of patients with unipolar and bipolar II depression predicts responsiveness to lamotrigine. Personalized Medicine in Psychiatry. 2018;7-8:27-30.
5. Garno JL, Gunawardane N, Goldberg JF. Predictors of trait aggression in bipolar disorder. Bipolar disorders. 2008;10(2):285-92.
6. Van Meter A, Youngstrom E, Freeman A, Feeny N, Youngstrom JK, Findling RL. Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder. Journal of child and adolescent psychopharmacology. 2016;26(1):26-37.
7. Hunt J, Birmaher B, Leonard H, Strober M, Axelson D, Ryan N, et al. Irritability without elation in a large bipolar youth sample: frequency and clinical description. Journal of the American Academy of Child and Adolescent Psychiatry. 2009;48(7):730-9.
8. Yuen LD, Miller S, Wang PW, Hooshmand F, Holtzman JN, Goffin KC, et al. Current irritability robustly related to current and prior anxiety in bipolar disorder. Journal of psychiatric research. 2016;79:101-7.
9. Stanford MS, Greve KW, Dickens TJ. Irritability and impulsiveness: relationship to self-reported impulsive aggression. Personality and Individual Differences. 1995;19(5):757-60.
10. Johnson SL, Haase CM, Beermann U, Sanchez AH, Tharp JA, Lwi SJ, et al. Positive urgency and emotional reactivity: Evidence for altered responding to positive stimuli. Emotion (Washington, DC). 2017;17(3):442-9.
11. Conner KR, Meldrum S, Wieczorek WF, Duberstein PR, Welte JW. The association of irritability and impulsivity with suicidal ideation among 15- to 20-year-old males. Suicide & life-threatening behavior. 2004;34(4):363-73.
12. Etain B, Mathieu F, Liquet S, Raust A, Cochet B, Richard JR, et al. Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients. Journal of affective disorders. 2013;144(3):240-7.
13. Ozten M, Erol A, Karayilan S, Kapudan H, Orsel ES, Kumsar NA. Impulsivity in bipolar and substance use disorders. Comprehensive psychiatry. 2015;59:28-32.
14. Feki I, Moalla M, Baati I, Trigui D, Sellami R, Masmoudi J. Impulsivity in bipolar disorders in a Tunisian sample. Asian journal of psychiatry. 2016;22:77-80.
15. Lijffijt M, Lane SD, Moeller FG, Steinberg JL, Swann AC. Trait impulsivity and increased pre-attentional sensitivity to intense stimuli in bipolar disorder and controls. Journal of psychiatric research. 2015;60:73-80.
16. Maser JD, Akiskal HS, Schettler P, Scheftner W, Mueller T, Endicott J, et al. Can temperament identify affectively ill patients who engage in lethal or near-lethal suicidal behavior? A 14-year prospective study. Suicide & life-threatening behavior. 2002;32(1):10-32.
17. Dour HJ, Cha CB, Nock MK. Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behaviour research and therapy. 2011;49(4):294-8.
18. Najmi S, Wegner DM, Nock MK. Thought suppression and self-injurious thoughts and behaviors. Behaviour research and therapy. 2007;45(8):1957-65.
19. Gruber J, Harvey AG, Purcell A. What goes up can come down? A preliminary investigation of emotion reactivity and emotion recovery in bipolar disorder. Journal of affective disorders. 2011;133(3):457-66.
20. M'Bailara K, Chevrier F, Dutertre T, Demotes-Mainard J, Swendsen J, Henry C. [Emotional reactivity in euthymic bipolar patients]. L'Encephale. 2009;35(5):484-90.
21. Mathieu F, Etain B, Dizier MH, Lajnef M, Lathrop M, Cabon C, et al. Genetics of emotional reactivity in bipolar disorders. Journal of Affective Disorders. 2015;188:101-6.
22. Gross JJ. Emotion regulation in adulthood: Timing is everything. Current Directions in Psychological Science. 2001;10(6):214-9.
23. Kobylińska D, Kusev P. Flexible Emotion Regulation: How Situational Demands and Individual Differences Influence the Effectiveness of Regulatory Strategies. Frontiers in Psychology. 2019;10:72.
24. Borjali, A, Aazami, Y., Chopan, H. The Effectiveness of Emotion Regulation Strategies Training on Reducing of Sensation Seeking in Drug-Dependent Persons. Journal of Clinical Psychology. 2016;8(2):33-42.
25. Gross JJ, Barrett LF. Emotion Generation and Emotion Regulation: One or Two Depends on Your Point of View. Emot Rev. 2011;3(1):8-16.
26. Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):281-91.
27. Henry C, M'Bailara K, Lepine JP, Lajnef M, Leboyer M. Defining bipolar mood states with quantitative measurement of inhibition/activation and emotional reactivity. J Affect Disord. 2010;127(1-3):300-4.
28. Silveira Ede M, Jr., Kauer-Sant'Anna M. Rumination in bipolar disorder: a systematic review. Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999). 2015;37(3):256-63.
29. Querstret D, Cropley M. Assessing treatments used to reduce rumination and/or worry: A systematic review. Clinical Psychology Review. 2013;33(8):996-1009.
30. Rusting CL, Nolen-Hoeksema S. Regulating responses to anger: effects of rumination and distraction on angry mood. J Pers Soc Psychol. 1998;74(3):790-803.
31. Bushman BJ. Does Venting Anger Feed or Extinguish the Flame? Catharsis, Rumination, Distraction, Anger, and Aggressive Responding. Personality and Social Psychology Bulletin. 2002;28(6):724-31.
32. Aftab R, Karbalaee Mohammad Meigouni A, Taghiloo S. The mediating role of emotion regulation strategies in relationship between borderline personality and conjugal violence. Journal of Applied Psychology. 2015;8(32):7-27.
33. Murphy ER, Barch DM, Pagliaccio D, Luby JL, Belden AC. Functional connectivity of the amygdala and subgenual cingulate during cognitive reappraisal of emotions in children with MDD history is associated with rumination. Developmental Cognitive Neuroscience. 2016;18:89-100.
34. Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York: Guilford press; 2011.
35. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of personality and social psychology. 1991;61(1):115-21.
36. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85(2):348-62.
37. Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol. 1992;63(3):452-9.
38. Dozois DJA, Beck AT. Cognitive Schemas, Beliefs and assumptions. Oxford, Uk: Elsevier Academic Press; 2008.
39. Kirkegaard Thomsen D. The association between rumination and negative affect: A review. Cognition and Emotion. 2006;20(8):1216-35.
40. Donaldson C, Lam D. Rumination, mood and social problem-solving in major depression. Psychological medicine. 2004;34(7):1309-18.
41. Wilkowski BM, Robinson MD. The cognitive basis of trait anger and reactive aggression: an integrative analysis. Personality and social psychology review: an official journal of the Society for Personality and Social Psychology, Inc. 2008;12(1):3-21.
42. Wilkowski BM, Robinson MD. The anatomy of anger: an integrative cognitive model of trait anger and reactive aggression. Journal of personality. 2010;78(1):9-38.
43. Anestis MD, Anestis JC, Selby EA, Joiner TE. Anger rumination across forms of aggression. Personality and Individual Differences. 2009;46(2):192-6.
44. Roemer L, Borkovec TD. Effects of suppressing thoughts about emotional material. Journal of abnormal psychology. 1994;103(3):467-74.
45. Szasz PL, Szentagotai A, Hofmann SG. The effect of emotion regulation strategies on anger. Behaviour research and therapy. 2011;49(2):114-9.
46. Denson TF, Creswell JD, Terides MD, Blundell K. Cognitive reappraisal increases neuroendocrine reactivity to acute social stress and physical pain. Psychoneuroendocrinology. 2014;49:69-78.
47. Ghasemi Gojani M, Kordi M, Asgharipur N, Amirian M, Esmaeli H, Eskandarnia E. Comparing the Effect of Positive Reappraisal CopingIntervention on Anxiety of Waiting Period in IUI TreatmentUsing Problem-solving Skills Training. Journal of Mazandaran University of Medical Sciences. 2017;27(149):111-23.
48. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences. 2001;30(8):1311-27.
49. Sharifibastan F, Yazdi S, Zahraei S. The role of cognitive emotion regulation and positive and negative affect in resiliency of women with breast cancer. Journal of Nursing Education. 2016;4(2):38-49.
50. Hilt LM, Aldao A, Fischer K. Rumination and multi-modal emotional reactivity. Cognition & emotion. 2015;29(8):1486-95.
51. Magee JC, Harden KP, Teachman BA. Psychopathology and thought suppression: a quantitative review. Clinical psychology review. 2012;32(3):189-201.
52. Bryan JL, Young CM, Lucas S, Quist MC. Should I say thank you? Gratitude encourages cognitive reappraisal and buffers the negative impact of ambivalence over emotional expression on depression. Personality and Individual Differences. 2018;120:253-8.