Relationship between Experience Avoidance and Difficulties in Emotion Regulation with Suicidal Ideation: Mediating Role of Interpersonal Difficulties

Document Type : Research Paper

Authors

1 M.A. in General Psychology, Shahr-e-Qods Branch Islamic Azad University, Shahr-e-Qods, Iran

2 Ph.D in Psychology, Karaj Branch Islamic Azad University, Karaj, Iran

Abstract

The purpose of this study was to determine the mediating role of interpersonal difficulties in the relationship between experiential avoidance and difficulties in emotion regulation with suicidal ideation. The research method was descriptive-correlative and based on the purpose, practice and statistical population of this study, which included all citizens of Karaj in the fall of 2019 with a total of 124688 people selected by them using a two-stage random sampling method with reference to Karaj urban area, districts 3 and 7 in the first stage and the second stage two Hamoon Boostan in district 3 and Nabovvat Boostan in district 7 and finally 270 people (125 men, 143 women and 2 unknowns). The study instruments included the Emotion Regulation Difficulty Scale by Gratz & Roemer (2004) (ERDS); the Multidimensional Experiential Avoidance Questionnaire by Gámez, Chmielewski, Kotov, Ruggero & Watson (2011) (MEAQ); the Inventory of Interpersonal Problems-47 by Pilkonis, Kim, Proietti & Barkham (1996) (IIP) and the Suicide Cognitions Scale by Rudd et al. (2010) (SCS). Structural equation modeling was used to analyze the data. In the present study, the indirect path coefficient between experience avoidance and suicidal ideation (β=0.066, P=0.003) and difficulty in emotion regulation and suicidal ideation (β=0.086, P=0.006) was positive and significant at the 0.01 level. Overall, the present study showed that interpersonal difficulties mediated the association between experience avoidance and difficulties in emotion regulation with suicidal ideation.

Keywords


اصلانی، س.، اسکندری، ح.، و برجعلی، ا. (1398). پیش‌بینی مشکلات بین شخصی افراد براساس سبک‌های دلبستگی با توجه به نقش واسطه‌ای شفقت خود در زوجین شهر تهران. فصلنامۀ اندیشه و رفتار در روان‌شناسی بالینی. 14(52)، 46-37.
افروز، غ.، قاسم‌زاده، س.، تازیکی، ط.، و دلگشاد، ئ. (1393). اثربخشی آموزش مهارت‌های تنظیم خلق بر خودپنداره و کفایت اجتماعی دانش آموزان با ناتوانی یادگیری. مجلۀ ناتوانی‌های یادگیری. 3(3)، 24-6.
آفتاب، ر. (1395). نقش میانجی‌گر دشواری‌های بین‌فردی در رابطۀ بین اجتناب تجربی با افسردگی و اضطراب. فصلنامۀ روان‌شناسی کاربردی. 10(40)، 540-521.
آفتاب، ر.، برماس، ح.، و ابوالمعالی الحسینی، خ. (1398). پیش‌بینی اندیشه‌پردازی خودکشی براساس صفات پنج‌عاملی شخصیت با واسطه‌گری سازوکارهای دفاعی. مجلۀ روان‌شناسی بالینی. 11(43)، 24-11.
آفتاب، ر.، کربلایی محمد میگونی، ا.، و تقی‌لو، ص. (1393). نقش میانجی‌گر راهبردهای تنظیم هیجانی در رابطۀ بین شخصیت مرزی و خشونت زناشویی. فصلنامۀ روان‌شناسی کاربردی. 8(32)، 27-7.
بشارت، م.، افقی، ز.، آقایی ثابت، س.، حبیب‌نژاد، م.، پورنقدعلی، ع.، و گرانمایه‌پور، ش. (1392). نقش تعدیل‌کنندۀ راهبردهای تنظیم شناختی هیجان در رابطۀ بین ناگویی هیجانی و مشکلات بین‌شخصی. تازه‌های علوم شناختی. 15(4)، 52-43.
بگیان کوله‌مرز، م.، کرمی، ج.، مؤمنی، خ.، و الهی، ع. (1398). اثربخشی یکپارچه‌سازی رفتاردرمانی دیالکتیکی مبتنی بر ذهن شفقت‌ورز بر کاهش واکنش‌پذیری شناختی و انگیزه‌های اقدام به خودکشی در افراد اقدام‌کننده. مجلۀ دستاوردهای روان‌شناختی. 26(22)، 26-1.
خانزاده، م.، سعیدیان، م.، حسین‌چاری، م.، و ادریسی، ف. (1391). ساختار عاملی و ویژگی‌های روان‌سنجی مقیاس دشواری در نظم‌بخشی هیجانی. مجلۀ علوم رفتاری. 6(1)، 96-87.
زال‌پور، خ.، شهیدی، ش.، زرانی، ف.، مظاهری، م.، و حیدری، م. (1395). مقایسۀ مشکلات بین‌فردی و پرخاشگری در دانشجویان دارای رگه‌های خودشیفتگی بیمارگون خودبزرگ‌بین، آسیب‌پذیر و افراد فاقد این رگه‌ها. فصلنامۀ مطالعات روان‌شناسی بالینی. 6(22)، 18-1.
زمستانی، م.، یوسفی، ن.، و کشاورزی، س. (1394). اثربخشی درمان شناختی-رفتاری گروهی همراه با آموزش خانواده بر مؤلفه‌های مرتبط با خودکشی در دختران اقدام‌کننده به خودکشی. مشاوره و روان‌درمانی خانواده. 5(19)، 120-107.
سپهری‌نژاد، م.، و حاتمیان، پ. (1397). پیش‌بینی افکار خودکشی براساس دشواری تنظیم هیجان و اجتناب تجربی در پرستاران. پژوهش پرستاری، 13(4)، 44-39.
محمودنژاد، م.، کربلایی محمد میگونی، ا.، و ثابت، م. (1397). پیش‌بینی ایده‌پردازی خودکشی و خشونت بین‌فردی در کودکان کار براساس آسیب کودکی، دشواری‌های تنظیم هیجان و صفات سنگدلی- فقدان همدلی. مجلۀ دستاوردهای روان‌شناختی. 25(1)، 22-1.
نجفی، م.، حسینی امام، س.، مکوند حسینی، ش.، صلواتی، م.، و محمدرضایی، ع. م. (1398). مقایسۀ اثربخشی آموزش مهارت تنظیم هیجان مبتنی بر مدل گراس و مدل لینهان بر افکار خودکشی در نوجوانان دارای نشانگان بالینی شخصیت مرزی. فصلنامۀ مطالعات روان‌شناختی. 15(54)، 146-131.
Baumeister, R. F. (1990). Suicide as Escape from Self. Psychological review, 97(1). 90-113.
Brodie, Z. P., Goodall, K., Darling, S., & McVittie, C. (2019). Attachment Insecurity and Dispositional Aggression: The Mediating Role of Maladaptive Anger Regulation. Journal of Social and Personal Relationships36(6), 1831-1852.
Brook, C. A., & Schmidt, L. A. (2020). Lifespan Trends in Sociability: Measurement Invariance and Mean-Level Differences in Ages 3 to 86 Years. Personality and Individual Differences, 152(1), 109579.
Butler, R. M., Boden, M. T., Olino, T. M., Morrison, A. S., Goldin, P. R., Gross, J. J., & Heimberg, R. G. (2018). Emotional Clarity and Attention to Emotions in Cognitive Behavioral Group Therapy and Mindfulness-Based Stress Reduction for Social Anxiety Disorder. Journal of Anxiety Disorders55(1), 31-38.
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A Biosocial Developmental Model of Borderline Personality: Elaborating and Extending Linehan's Theory. Psychological Bulletin135(3), 495-510.
Dollar, J. M., & Calkins, S. D. (2020). Emotion Regulation and Its Development. In J. B. Benson (Ed.), Encyclopedia of Infant and Early Childhood Development (Second Edition) (pp. 546-559). Amsterdam, Netherlands, United States: Elsevier.
Dworsky, C. K. O., Pargament, K. I., Wong, S., & Exline, J. J. (2016). Suppressing Spiritual Struggles: The Role of Experiential Avoidance in Mental Health. Journal of Contextual Behavioral Science, 5(4), 258-265.
Dykas, M. J., & Cassidy, J. (2011). Attachment and the processing of social information across the life span: theory and evidence. Psychological Bulletin, 137(1), 19-46.
Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, E., Keller, M., & Langer, D. (2009). Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol. Cognitive and Behavioral Practice, 16(4), 368-385.
Ellis, T. E., & Rufino, K. A. (2015). A Psychometric Study of the Suicide Cognitions Scale with Psychiatric Inpatients. Psychological Assessment, 27(1), 82-89.
Ellis, T. E., & Rufino, K. A. (2016). Change in Experiential Avoidance Is Associated with Reduced Suicidal Ideation over the Course of Psychiatric Hospitalization. Archives of Suicide Research, 20(3), 426-437.
Fraley, R. C., & Roisman, G. I. (2019). The Development of Adult Attachment Styles: Four Lessons. Current Opinion in Psychology, 25(1), 26-30.
Gamez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011). Development of a Measure of Experiential Avoidance: The Multidimensional Experiential Avoidance Questionnaire. Psychological Assessment, 23(3), 692-713.
Garofalo, C., Velotti, P., Zavattini, G. C., & Kosson, D. S. (2017). Emotion Dysregulation and Interpersonal Problems: The Role of Defensiveness. Personality and Individual Differences, 119(1), 96-105.
Gerhart, J. I., Baker, C. N., Hoerger, M., & Ronan, G. F. (2014). Experiential Avoidance and Interpersonal Problems: A Moderated Mediation Model. Journal of Contextual Behavioral Science, 3(4), 291-298.
Gillath, O., Karantzas, G. C., & Fraley, R. C. (2016). Adult Attachment: A Concise Introduction to Theory and Research (1st Ed.). Cambridge, Massachusetts, United States: Academic Press.
Gratz, K. L., & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 55-41.
Hagger, M. S., Wood, C., Stiff, C., & Chatzisarantis, N. L. (2010). Ego Depletion and the Strength Model of Self-Control: A Meta-Analysis. Psychological Bulletin, 136(4), 495-525.
Herr, N. R., Rosenthal, M. Z., Geiger, P., & Erikson, K. (2013). Difficulties with Emotion Regulation Mediate the Relationship between Borderline Personality Disorder Symptom Severity and Interpersonal Problems. Personality and Mental Health, 7(3), 191-202.
Hilt, L. M., Hanson, J. L., & Pollak, S. D. (2011). Emotion Dysregulation. In B. B. Brown & M. J. Prinstein (Eds.), Encyclopedia of Adolescence (pp. 160-169). Cambridge, Massachusetts, United States: Academic Press.
Jonbeshi, A., & Abolmaali, Alhoseini, K. (2017). Confirmatory Factor Analysis of the Experiential Avoidance Questionnaire in High School Students. International Journal of Behavioral Sciences, 11(1), 1-4.
Karreman, A., & Vingerhoets, A. (2012). Attachment and Well-Being: The Mediating Role of Emotion Regulation and Resilience. Personality and Individual Differences, 53(7), 821-826.
Kernberg, O. F. (2004). Borderline Personality Disorder and Borderline Personality Organization: Psychopathology and Psychotherapy. In J. J. Magnavita (Ed.), Handbook of Personality Disorders: Theory and Practice (pp. 92-119). Hoboken, NJ, US: John Wiley & Sons Inc.
Kulkarni, M., Porter, K. E., & Rauch, S. A. (2012). Anger, Dissociation, and Ptsd Among Male Veterans Entering into Ptsd Treatment. Journal of Anxiety Disorders, 26(2), 271-278.
Kun, B., Balazs, H., Kapitany, M., Urban, R., & Demetrovics, Z. (2010). Confirmation of the Three-Factor Model of the Assessing Emotions Scale (Aes): Verification of the Theoretical Starting Point. Behavior Research Methods, 42(2), 596-606.
Levi-Belz, Y., Gvion, Y., Levi, U., & Apter, A. (2019). Beyond the Mental Pain: A Case-Control Study on the Contribution of Schizoid Personality Disorder Symptoms to Medically Serious Suicide Attempts. Comprehensive Psychiatry, 90(1), 102-109.
Li, E. T., Carracher, E., & Bird, T. (2020). Linking Childhood Emotional Abuse and Adult Depressive Symptoms: The Role of Mentalizing Incapacity. Child Abuse & Neglect, 99(1), 104253.
Lindsay, E. K., Young, S., Brown, K. W., Smyth, J. M., & Creswell, J. D. (2019). Mindfulness Training Reduces Loneliness and Increases Social Contact in a Randomized Controlled Trial. Proceedings of the National Academy of Sciences, 116(9), 3488.
Marc, B., & Lorin, A. S. (2016). Suicide: Etiology, Methods, and Statistics. In J. Payne-James & R. W. Byard (Eds.), Encyclopedia of Forensic and Legal Medicine (Second Edition) (pp. 488-497). Elsevier.
McCrae, R. R., & Costa, P. T. (2003). Personality in Adulthood: A Five-Factor Theory Perspective. New York, NY: Guilford Press.
McLean, J. (2007). Psychotherapy with a Narcissistic Patient Using Kohut's Self-Psychology Model. Psychiatry (Edgmont), 4(10), 40-47.
Meyers, L. S., Gamst, G., & Guarino, A. J. (2016). Applied Multivariate Research: Design and Interpretation (3rd Ed.). Sage publication.
Mikulincer, M., & Shaver, P. R. (2019). Attachment Orientations and Emotion Regulation. Current Opinion in Psychology, 25(1), 6-10.
Mohammadkhani, P., Abasi, I., Pourshahbaz, A., Mohammadi, A., & Fatehi, M. (2016). The Role of Neuroticism and Experiential Avoidance in Predicting Anxiety and Depression Symptoms: Mediating Effect of Emotion Regulation. Iranian journal of psychiatry and behavioral sciences, 10(3), e5047.
Moore, S. D., Brody, L. R., & Dierberger, A. E. (2009). Mindfulness and Experiential Avoidance as Predictors and Outcomes of the Narrative Emotional Disclosure Task. Journal of Clinical Psychology65(9), 971-988.
Natoli, A., Nelson, S., Lengu, K., & Huprich, S. (2016). Sensitivity to Criticism Differentially Mediates the Relationship between Interpersonal Problems and State and Trait Depression. Personality and Mental Health, 10(4), 293-304.
Neacsiu, A. D., Fang, C. M., Rodriguez, M., & Rosenthal, M. Z. (2018). Suicidal Behavior and Problems with Emotion Regulation. Suicide and Life-Threatening Behavior, 48(1), 52-74.
Pearlman, L. A. (1997). Trauma and the Self. Journal of Emotional Abuse, 1(1), 7-25.
Pilkonis, P. A., Kim, Y., Proietti, J. M., & Barkham, M. (1996). Scales for Personality Disorders Developed From the Inventory of Interpersonal Problems. Journal of Personality Disorders, 10(4), 355-369.
Predatu, R., David, D. O., & Maffei, A. (2020). The Effects of Irrational, Rational, and Acceptance Beliefs about Emotions on the Emotional Response and Perceived Control of Emotions. Personality and Individual Differences. 155(1), 109712.
Quinlan, E., Deane, F. P., Crowe, T., & Caputi, P. (2018). Do Attachment Anxiety and Hostility Mediate the Relationship Between Experiential Avoidance and Interpersonal Problems in Mental Health Carers? Journal of Contextual Behavioral Science, 7(1), 63-71.
Rajappa, K., Gallagher, M., & Miranda, R. (2012). Emotion Dysregulation and Vulnerability to Suicidal Ideation and Attempts. Cognitive Therapy and Research, 36(6), 833-839.
Rice, T. R., & Hoffman, L. (2014). Defense Mechanisms and Implicit Emotion Regulation: A Comparison of a Psychodynamic Construct with One from Contemporary Neuroscience. Journal of the American Psychoanalytic Association, 62(4), 693-708.
Rogers, M. L., Ringer, F. B., & Joiner, T. E. (2018). The Association Between Suicidal Ideation and Lifetime Suicide Attempts Is Strongest at Low Levels of Depression. Psychiatry Research, 270(1), 324-328.
Roush, J. F., Brown, S. L., Mitchell, S. M., & Cukrowicz, K. C. (2019). Experiential Avoidance, Cognitive Fusion, and Suicide Ideation among Psychiatric Inpatients: The Role of Thwarted Interpersonal Needs. Psychotherapy Research, 29(4), 514-523.
Rubenstein, L. M., Hamilton, J. L., Stange, J. P., Flynn, M., Abramson, L. Y., & Alloy, L. B. (2015). The Cyclical Nature of Depressed Mood and Future Risk: Depression, Rumination, and Deficits in Emotional Clarity in Adolescent Girls. Journal of Adolescence, 42(1), 68-76.
Rudd, M. D., Schmitz, B., McClenen, R., Joiner, T., Elkins, G., & Claassen, C. A. (2010). The Suicide Cognitions Scale: A Suicide-Specific Measure of Hopelessness. Manuscript in preparation.
Set, Z. (2019). Potential Regulatory Elements between Attachment Styles and Psychopathology: Rejection Sensitivity and Self-Esteem. Archives of Neuropsychiatry, 56(3), 205-212.
Stepp, S. D., Morse, J. Q., Yaggi, K. E., Reynolds, S. K., Reed, L. I., & Pilkonis, P. A. (2008). The Role of Attachment Styles and Interpersonal Problems in Suicide-Related Behaviors. Suicide & Life-Threatening Behavior, 38(5), 592-607.
Stucke, T., & Sporer, S. (2002). When a Grandiose Self-Image Is Threatened: Narcissism and Self-Concept Clarity as Predictors of Negative Emotions and Aggression Following Ego-Threat. Journal of Personality, 70(4), 509-532.
Szczygieł, D., Buczny, J., & Bazińska, R. (2012). Emotion Regulation and Emotional Information Processing: The Moderating Effect of Emotional Awareness. Personality and Individual Differences, 52(3), 433-437.
Tang, A., & Schmidt, L. A. (2017). Shyness and Sociability. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of Personality and Individual Differences (pp. 1-5). Berlin, Germany: Springer International Publishing.
Tasca, G. A. (2014). Attachment and Group Psychotherapy: Introduction to a Special Section. Psychotherapy, 51(1), 53-56.
Vanwoerden, S., Kalpakci, A. H., & Sharp, C. (2015). Experiential Avoidance Mediates the Link between Maternal Attachment Style and Theory of Mind. Comprehensive Psychiatry, 57(1), 117-124.
Weiss, N. H., Gratz, K. L., & Lavender, J. M. (2015). Factor Structure and Initial Validation of a Multidimensional Measure of Difficulties in the Regulation of Positive Emotions: The DERS-Positive. Behavior Modification, 39(3), 431-453.