Psychological well-being and distress in patients with generalized anxiety disorder: The roles of positive and negative functioning

English version

Autoři: Luca Iani ^aff001; Rossella Mattea Quinto ^aff001; Marco Lauriola ^aff002; Maria Luigia Crosta ^aff003; Gino Pozzi ^aff003
Působiště autorů: Department of Human Sciences, European University of Rome, Rome, Italy ^aff001; Department of Social and Developmental Psychology, Sapienza, University of Rome, Rome, Italy ^aff002; U.O.C. Psichiatria, Fondazione Policlinico Universitario A. Gemelli IRCCS - Istituto di Psichiatria e Psicologia, Università Cattolica del Sacro Cuore, Rome, Italy ^aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225646

Souhrn

Background

Whether mindfulness and emotional intelligence may counteract psychological symptoms and whether brooding and worry may be linked to decreased psychological well-being (PWB) in individuals with generalized anxiety disorder (GAD) is still an issue.

Methods

The study used a cross-sectional design on a sample of 66 consecutive individuals with a diagnosis of GAD. Two hierarchical multiple regressions were conducted to determine whether PWB and anxiety symptoms were accounted for by mindfulness and emotional intelligence skills, brooding, and worry.

Results

Worry was negatively related to PWB and showed a tendency to be positively associated with anxiety symptoms after controlling for the other variables. Brooding was uniquely and positively related to anxiety symptoms. Different mindfulness (i.e., describing and nonjudging) and emotional intelligence (i.e., attention and repair) skills were particularly important for PWB. Repair was also negatively related to anxiety symptoms.

Conclusions

Repair was the variable that played a key role in the association with both PWB and GAD symptoms. Worry was the second most important variable, although it approached significance in the relationship with anxiety symptoms. Brooding was more strongly positively associated with anxiety than worry. In sum, the results suggest that an integrated and balanced focus on both positive and negative functioning will be useful in future clinical psychology research to predict, understand, and treat anxiety as well as to examine the antecedents and characteristics of positivity in individuals with GAD and promote their PWB.

Klíčová slova:

Mental health and psychiatry – Emotions – Anxiety – Depression – Attention – Intelligence – Anxiety disorders – Clinical psychology

Zdroje

1. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 2008;3: 400–424. doi: 10.1111/j.1745-6924.2008.00088.x 26158958

2. Keller MB. The long-term clinical course of generalized anxiety disorder. J Clin Psychiatry. 2002;63: 11–16.

3. Joseph S, Patterson TG. A Practical Guide to Positive Functioning Assessment in Clinical Psychology. In: Wood AM, Johnson J, editors. The Wiley Handbook of Positive Clinical Psychology. Chichester, UK: John Wiley & Sons Ltd; 2016. pp. 47–56.

4. Wood AM, Johnson J. Positive Clinical Psychology: An Introduction. In: Wood AM, Johnson J, editors. The Wiley Handbook of Positive Clinical Psychology. Chichester, UK: John Wiley & Sons Ltd; 2016. pp. 1–17.

5. Kelly RE, Wood AM, Mansell W. Flexible and tenacious goal pursuit lead to improving well-being in an aging population: a ten-year cohort study. Int Psychogeriatrics. 2013;25: 16–24.

6. Borkovec TD, Ray WJ, Stöber J. Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognit Ther Res. 1998;22: 561–576.

7. Wells A. A metacognitive model and therapy for generalized anxiety disorder. Clin Psychol Psychother. 1999;6: 86–95.

8. Fakouri C, Lyon B. Perceived Health and Life Satisfaction Among Older Adults: The Effects of Worry and Personal Variables. J Gerontol Nurs. 2005;31: 17–24.

9. Hoyer J, Gloster AT, Herzberg PY. Is worry different from rumination? Yes, it is more predictive of psychopathology! Psychosoc Med. 2009;6: Doc06. doi: 10.3205/psm000062 19949448

10. McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. 2011;49: 186–193. doi: 10.1016/j.brat.2010.12.006 21238951

11. McEvoy PM, Watson H, Watkins ER, Nathan P. The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. J Affect Disord. 2013;151: 313–320. doi: 10.1016/j.jad.2013.06.014 23866301

12. Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull. 2008;134: 163–206. doi: 10.1037/0033-2909.134.2.163 18298268

13. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognit Ther Res. 2003;27: 247–259.

14. Segerstrom SC, Stanton AL, Alden LE, Shortridge BE. A Multidimensional Structure for Repetitive Thought: What’s on Your Mind, and How, and How Much? J Pers Soc Psychol. 2003;85: 909–921. doi: 10.1037/0022-3514.85.5.909 14599253

15. Ciarrochi J, Scott G. The link between emotional competence and well-being: A longitudinal study. Br J Guid Couns. 2006;34: 231–243.

16. Moberly NJ, Watkins ER. Ruminative Self-Focus and Negative Affect: An Experience Sampling Study. J Abnorm Psychol. 2008;117: 314–323. doi: 10.1037/0021-843X.117.2.314 18489207

17. Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of rumination in anxiety and depression: A multimodal meta-analysis. Clin Psychol Sci Pract. 2013;20: 225–257.

18. Mennin DS, Heimberg RG, Turk CL, Fresco DM. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther. 2005;43: 1281–1310. doi: 10.1016/j.brat.2004.08.008 16086981

19. Salovey P, Mayer JD, Goldman SL, Turvey C, Palfai TP. Emotional attention, clarity, and repair: Exploring emotional intelligence using the Trait Meta-Mood Scale. In: Pennebaker JW, editor. Emotion, disclosure, & health. Washington, DC: American Psychological Association; 1995. pp. 125–154. doi: 10.1179/2295333714Y.0000000013

20. Fernández-Berrocal P, Alcaide R, Extremera N, Pizarro D. The role of emotional intelligence in anxiety and depression among adolescents. Individ Differ Res. 2006;4: 16–27.

21. Szczygieł D, Mikolajczak M. Why are people high in emotional intelligence happier? They make the most of their positive emotions. Pers Individ Dif. 2017;117: 177–181.

22. Schutte NS, Malouff JM. Emotional intelligence mediates the relationship between mindfulness and subjective well-being. Pers Individ Dif. 2011;50: 1116–1119.

23. Góngora VC, Casullo MM. Factores protectores de la salud mental: Un estudio comparativo sobre valores, autoestima e inteligencia emocional en población clínica y población general. Interdisciplinaria. 2009;26: 183–205. Spanish.

24. Lizeretti NP, Extremera N. Emotional Intelligence and Clinical Symptoms in Outpatients with Generalized Anxiety Disorder (GAD). Psychiatr Q. 2011;82: 253–260. doi: 10.1007/s11126-011-9167-1 21279686

25. Bohlmeijer E, ten Klooster PM, Fledderus M, Veehof M, Baer R. Psychometric Properties of the Five Facet Mindfulness Questionnaire in Depressed Adults and Development of a Short Form. Assessment. 2011;18: 308–320. doi: 10.1177/1073191111408231 21586480

26. Didonna F, Rossi R, Ferrari C, Iani L, Pedrini L, Rossi N, et al. Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive–compulsive disorder, major depressive disorder, or borderline personality disorder. Psychol Psychother Theory, Res Pract. 2019;92: 112–130.

27. Iani L, Didonna EF. Mindfulness e benessere psicologico: Il ruolo della regolazione delle emozioni. Giornale Italiano di Psicologia. 2017;44: 317–322. Italian.

28. Iani L, Lauriola M, Cafaro V, Didonna F. Dimensions of Mindfulness and Their Relations with Psychological Well-Being and Neuroticism. Mindfulness. 2017;8: 664–676. doi: 10.1007/s12671-016-0645-2 28515800

29. Wood AM, Tarrier N. Positive Clinical Psychology: A new vision and strategy for integrated research and practice. Clin Psychol Rev. 2010;30: 819–829. doi: 10.1016/j.cpr.2010.06.003 20655136

30. Iani L, Lauriola M, Cafaro V. The assessment of mindfulness skills: the “what” and the “how.” J Ment Heal. 2017; 1–8. doi: 10.1080/09638237.2017.1385738 28984499

31. Ziegler M, Kemper CJ, Kruyen P. Short scales - Five misunderstandings andways to overcome them. J Individ Differ. 2014;35: 185–189.

32. Bagozzi RP, Yi Y. On the evaluation of structural equation models. J Acad Mark Sci. 1988;16: 74–94.

33. Fernandez-Berrocal P, Extremera N, Ramos N. Validity and reliability of the Spanish modified version of the Trait Meta-Mood Scale. Psychol Rep. 2004;94: 751–755. doi: 10.2466/pr0.94.3.751-755 15217021

34. Sirigatti S, Penzo I, Iani L, Mazzeschi A, Hatalskaja H, Giannetti E, et al. Measurement Invariance of Ryff’s Psychological Well-being Scales Across Italian and Belarusian Students. Soc Indic Res. 2013;113: 67–80.

35. Hopko DR, Stanley M a, Reas DL, Wetherell JL, Beck JG, Novy DM, et al. Assessing worry in older adults: confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychol Assess. 2003;15: 173–183. doi: 10.1037/1040-3590.15.2.173 12847777

36. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006;166: 1092–1097. doi: 10.1001/archinte.166.10.1092 16717171

37. Cohen J, Cohen P, West SG, Aiken LS. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2003.

38. Sifneos PE. The prevalence of “Alexithymic” characteristics in psychosomatic patients. Psychother Psychosom. 1973;22: 255–262. doi: 10.1159/000286529 4770536

39. Parker JDA, Taylor GJ, Bagby RM. The relationship between emotional intelligence and alexithymia. Pers Individ Dif. 2001;30: 107–115.

40. Paniccia MF, Gaudio S, Puddu A, Di Trani M, Dakanalis A, Gentile S, et al. Alexithymia in parents and adolescents with generalised anxiety disorder. Clin Psychol. 2018;22: 336–343.

41. Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, et al. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15: 329–342. doi: 10.1177/1073191107313003 18310597

42. Josefsson T, Larsman P, Broberg AG, Lundh LG. Self-Reported Mindfulness Mediates the Relation Between Meditation Experience and Psychological Well-Being. Mindfulness. 2011;2: 49–58.

43. Iani L, Lauriola M, Chiesa A, Cafaro V. Associations Between Mindfulness and Emotion Regulation: the Key Role of Describing and Nonreactivity. Mindfulness. 2019;10: 366–375.

44. Extremera N, Fernández-Berrocal P. Emotional intelligence as predictor of mental, social, and physical health in university students. Span J Psychol. 2006;9: 45–51. doi: 10.1017/s1138741600005965 16673622

45. Borkovec TD, Alcaine O, Behar E. Avoidance theory of worry and generalized anxiety disorder. Generalized Anxiety Disorder: Advances in Research and Practice. New York: Guilford Press; 2004. pp. 77–108.

46. Fava GA, Rafanelli C, Ottolini F, Ruini C, Cazzaro M, Grandi S. Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia. J Affect Disord. 2001;65: 185–190. doi: 10.1016/s0165-0327(00)00267-6 11356243

47. Watkins PC, Pereira A. Don’t Worry, Be Happy: Toward a Positive Clinical Psychology for Anxiety Disorders. In: Wood AM, Johnson J, editors. The Wiley Handbook of Positive Clinical Psychology. Chichester, UK: John Wiley & Sons Ltd; 2016. pp. 205–221.

48. Verstraeten K, Bijttebier P, Vasey MW, Raes F. Specificity of worry and rumination in the development of anxiety and depressive symptoms in children. Br J Clin Psychol. 2011;50: 364–378. doi: 10.1348/014466510X532715 22003947

49. Muris P, Roelofs J, Meesters C, Boomsma P. Rumination and worry in nonclinical adolescents. Cognit Ther Res. 2004;28: 539–554.

50. McEvoy PM, Brans S. Common versus unique variance across measures of worry and rumination: Predictive utility and mediational models for anxiety and depression. Cognit Ther Res. 2013;37: 183–196.

51. Hong RY. Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behav Res Ther. 2007;45: 277–290. doi: 10.1016/j.brat.2006.03.006 16635479

52. Ciarrochi J, Blackledge J, Bilich L, Bayliss V. Improving Emotional Intelligence: A Guide to Mindfulness-Based Emotional Intelligence Training. In: Ciarrochi J, Mayer J, editors. Applying emotional intelligence: A practitioner’s guide. New York: Psychology Press; 2007. pp. 89–124.

53. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017;40: 739–749. doi: 10.1016/j.psc.2017.08.008 29080597

54. Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37: 1–12. doi: 10.1016/j.cpr.2015.01.006 25689576

55. Baer RA, Lykins ELB, Peters JR. Mindfulness and self-compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators. J Posit Psychol. 2012;7: 230–238.

56. Strege M V., Swain D, Bochicchio L, Valdespino A, Richey JA. A pilot study of the effects of mindfulness-based cognitive therapy on positive affect and social anxiety symptoms. Front Psychol. 2018;9: 866. doi: 10.3389/fpsyg.2018.00866 29910759

57. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al. Mindfulness-based therapy: A comprehensive meta-analysis. Clin Psychol Rev. 2013;33: 763–771. doi: 10.1016/j.cpr.2013.05.005 23796855

58. Nyklicek I, Kuijpers KF. Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: Is increased mindfulness indeed the mechanism? Ann Behav Med. 2008;35: 331–340. doi: 10.1007/s12160-008-9030-2 18535870

59. Hoge EA, Bui E, Marques L, Metcalf CA, Morris LK, Robinaugh DJ, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: Effects on anxiety and stress reactivity. J Clin Psychiatry. 2013;74: 786–792. doi: 10.4088/JCP.12m08083 23541163