(PS2-B40) Emotion Regulation Moderates the Relationship Between Anxiety Symptoms and Avoidance Behavior

In cognitive behavior therapy, emotion regulation is often explored as a means of managing anxiety. A predominant feature shared across anxiety disorders is avoidance behavior. Past research has shown that the perceived efficacy of emotion regulation moderates the relationship between anxiety and avoidance behavior (Fergus, T. A. et al., 2013). However, to our knowledge, there is a gap in the literature on how utilizing emotion regulation directly moderates anxiety and avoidance behavior. This present study examined whether trait emotion regulation moderates the relationship between state anxiety symptoms and avoidance behaviors within (N = 134) subjects over time.

Given that the emotion regulation strategy suppression has elicited a greater physiological and self-report anxiety response than the cognitive reappraisal strategy (Hoffman et al., 2009), we hypothesized that among individuals who are more likely to use suppression, state anxiety symptoms and avoidance behaviors will be more strongly associated; whereas, among those who are more likely to use cognitive reappraisal, state anxiety symptoms and avoidance behaviors will be less strongly associated. Trait suppression and cognitive reappraisal were both measured by the Emotion Regulation Questionnaire (Gross, J.J., & John, O.P., 2003) during a baseline assessment.

State anxiety symptoms and avoidance behavior were captured using ecological momentary assessment (EMA) surveys sent 8 times a day for up to 21 days. State anxiety symptoms were assessed using EMA survey items addressing how anxious, irritable, and restless the participant was currently feeling in that moment on a continuous scale of 0-100. Avoidance behavior was assessed via EMA survey items addressing whether the participant avoided people, activities, or thoughts, and if yes, to what degree on a continuous scale of 0-100.

To account for the nested structure of the EMA, we constructed a random intercept, cross-level interaction multilevel model using the NLME package in R. State level variables were person-mean centered, and all the available data was analyzed without exclusion to avoid potential analytic biases (Jacobson, 2020). Results showed that for those with high trait suppression, the association between state anxiety and avoidance behaviors was amplified (b = 0.029, SE = 0.013, t = 2.203, p = 0.028, d = 0.041); and for those with high trait reappraisal, the association between state anxiety and avoidance behaviors was dampened (b = -0.023, SE = 0.011, t = -2.089, p = 0.037, d = -0.039). These results support evidence-based treatments that target emotion regulation strategies to help individuals experiencing anxiety symptoms reduce habitual avoidance.