Affective styles in mood and anxiety disorders - Clinical validation of the "Affective Style Questionnaire" (ASQ)

Background: Emotion regulation plays a critical role in the development and maintenance of psychological disorders. Less is known about the association of affective styles and psychopathology. The 20-item "Affective Style Questionnaire" (ASQ) has been validated in nonclinical samples. The American and German validation studies resulted in a three-factor structure (concealing, adjusting, and tolerating). The present study aimed to investigate three aspects: (1) the validation of the ASQ within a clinical sample, (2) the examination of possible differences in affective styles between patients suffering from affective versus anxiety disorders, and (3) the association of affective styles and anxiety, depression, and stress symptoms. Methods: Overall 917 patients receiving cognitive-behavioral therapy at an outpatient clinic participated in this study, 550 participants were female. All data were collected before the beginning of treatment. Results: Confirmatory factor analyses revealed the same three-factor structure found in the previous Western samples (CFI=0.90, RMSEA=0.06): Concealing (alpha=0.81), adjusting (alpha=0.71), and tolerating (alpha=0.70). Significantly lower scores in the ASQ subscale adjusting were found in patients suffering from affective disorders than patients suffering from anxiety disorders. The results of the regression analyses showed that the ASQ adjusting and concealing behavior seem to play a more important role than the ERQ reappraisal and suppression for depression, anxiety, and stress among clinical populations. Limitations: A number of limitations must be taken into consideration while evaluating the present study. First and foremost, the clinical data were based on primary diagnoses. We did not ascertain comorbid diagnoses. This distinction may be important, since affective and anxiety disorders are often linked to each other. In addition, we only used data collected before the beginning of psychotherapeutic treatment and were therefore not able to analyze changes in affective styles during and after intervention. Furthermore, all data were based on selfreported information of patients. We did not implement either a therapeutic rating of affective styles or physiological measures, for instance arousal, which could have shown whether the used strategies successfully reduce negative emotions. Future research should address this question. Another limitation is the fact that we concentrated on the main categories of mental disorders and, therefore, did not subdivide patients with affective and anxiety disorders in terms of their concrete diagnoses. This is of special importance, because there might also be differences in affective styles within the main categories.