The Role of Emotion Regulation in the Relationship Between Social Anxiety and Depression: A Daily Diary Study

Abstract

Social anxiety and depression are commonly comorbid, and together they result in greater functional impairment and a poorer prognosis than when either condition occurs alone. Although the onset of social anxiety precedes the development of depression in the large majority of comorbid cases, little research has directly examined factors that contribute to the occurrence of depression in individuals with social anxiety. Theoretical models implicate emotion and emotion regulation in the development and maintenance of internalizing disorders. Emotion regulation research has predominantly focused on expressive suppression (ES), the suppression of outward emotion, and cognitive reappraisal (CR), the modification of cognitions to manage emotion. Social anxiety and depression are both characterized by maladaptive patterns of emotion regulation, exhibiting an overreliance on ES and an underutilization of CR. The present study investigated the role of emotion regulation, specifically ES and CR, in the relationship between social anxiety and depression over time. Our primary aim was to evaluate ES and CR, separately, as mediators of the relationship between social anxiety and depression. Our secondary aim was to evaluate additional mediating and/or moderating effects of related variables (i.e., relationship quality, positive and negative affect, and reward sensitivity). Our final exploratory aim was to evaluate whether emotion regulation (i.e., ES and CR) for positive emotions differs from emotion regulation for negative emotions in the relationships proposed by our primary and secondary aims. Undergraduate participants (N=137) completed an in-person laboratory session (i.e., baseline), followed by a 14-day daily diary period. During the daily diary period, participants reported on their daily experiences of social anxiety, depressed mood, emotion, emotion regulation, and relationship quality. Approximately two weeks after the end of the daily diary period (i.e., four weeks after baseline), participants completed a final in-person laboratory session (i.e., endpoint). Multilevel modeling was used to analyze observation-level data over the two-week diary period, and bootstrapping methods were used for person-level analyses over the full four-week study period. Daily diary analyses failed to support the hypothesized mediation models. Average social anxiety across the daily diary period was positively associated with daily depressed mood, but observation-level social anxiety was not. Exploratory analyses revealed affect-specific effects of emotion regulation, such that higher perceived success in ES (i.e., daily ES self-efficacy) for positive affect and less frequent use of CR (i.e., daily CR frequency) for negative affect significantly predicted higher next-day depressed mood. Person-level analyses across the four-week study period yielded some support for our hypotheses, in that ES frequency and positive affect acted as sequential mediators of the relationship between social anxiety and depression. Higher social anxiety predicted more frequent ES, which predicted lower positive affect, which then predicted higher depression. However, the mediation model was no longer significant after controlling for baseline depression. Our results highlight the role of emotion dysregulation in predicting depression and provide initial support for the mediating effects of ES and CR in the relationship between social anxiety and depression. These findings also emphasize the importance of investigating affect-specific effects, with particular attention paid to emotion regulation for positive affect and its role in the co-occurrence of social anxiety and depression. Future research would benefit from longitudinal studies across longer time periods and examining these relationships within a clinical sample.