1 - (SYM 36) Emotion Regulation Flexibility in Depression and Anxiety: Validation and Replication in Community and Clinical Samples Across Cultures

The effectiveness of discrete emotion regulation (ER) strategies is shaped by context such that a strategy may be adaptive in one context and maladaptive in another. Therefore, it is increasingly important to consider flexibility, which is the process of matching emotion regulation to dynamic contexts. To date, ER flexibility has been conceptualized as a process involving flexibility in the evaluation, implementation, and monitoring stages of ER. A few questions remain: How can we capture ER flexibility in daily life? How are these three ER flexibility components associated with affective outcomes? Are these links consistent across cultures, and are they transdiagnostic or symptom-specific?

In four independent samples (US community, Chinese community, US Veterans with Criterion A trauma exposure, US clinical samples with MDD, GAD, or comorbidity; Total N = 489, momentary N > 40,000) completing 4X/day, 21-day ecological momentary assessment (EMA), we developed and validated momentary measures of evaluation, implementation, and monitoring flexibility, and then linked them to momentary depressed and anxious mood. We examined whether these patterns differed across cultures and symptom severity. Participants reported situational features, ER uses and effectiveness, and momentary affect.

Consistent across samples, increased evaluation and implementation flexibility were associated with decreased anxious and depressed mood. For monitoring flexibility, when initial strategies were relatively effective, strategy switching was linked to increased anxious mood; when initial strategies were less effective, strategy switching was associated with decreased depressed mood. These findings were largely consistent across four samples with some nuanced differences: First, US participants benefited less from strategy switching than Chinese, which may reflect Chinese culture’s strong emphasis on adaptation. Second, for Veterans meeting the criteria for PTSD, the benefit of implementation flexibility was smaller, driven by lower ER endorsement in this group. Third, strategy switching was particularly beneficial for people with MDD.

In sum, we replicated the independent affective benefits of three flexibility components in community and clinical samples across cultures while showing cultural differences and the differential benefits of strategy maintenance and switching for anxiety and depression. These findings suggest that the importance of stability and variability in the ER may depend on clinical presentations and cultures.