Effects of Emotion Regulation and Intolerance of Uncertainty on Anxiety and Depression in Adolescents and Young Adults with Autism
Anxiety and depression are very frequent and disabling comorbid psychiatric conditions in individuals with autism, however, the reasons for such high prevalence are currently poorly understood. Emotion regulation (ER) and intolerance of uncertainty (IU) are factors most commonly implicated in the development and maintenance of anxiety and depression in non-ASD population. Recent research has started to explore the role of IU and ER in autism and some patterns are emerging e.g., maladaptive ER strategy use predicts internalizing symptoms and IU is a predictor of anxiety. However, previous research has not addressed relationship between IU and ER and depression, nor assessed the inter-relationship between ER and IU in predicting anxiety and depression.
To assess the inter-relationship between ER, IU, anxiety, and depression. It is hypothesized that both IU and ER strategy use would have direct and indirect effects on anxiety and depression, over and above autism symptoms, gender, and age. These effects will be tested using four mediation models: IU as a predictor of anxiety and depression (separately), mediated by ER, and ER as a predictor of anxiety and depression (also separately), mediated by IU.
Forty-eight individuals with autism (13 females; Mage= 18.20 years, SDage= 2.41) completed the online questionnaires Autism Spectrum Quotient-28 (AQ-28), Patient Health Questionnaire-9 (PHQ-9), Dimensional Anxiety Scale for DSM-5 (CROSS-D), Emotion Regulation Questionnaire (ERQ), and Intolerance of Uncertainty Scale-12 (IUS-12). For analyses, instead of using the suppression and reappraisal sub-scale scores, an ERQ ratio was calculated by diving the suppression score by the reappraisal score.
Pearson’s correlation analyses with bootstrapping showed ERQ ratio was moderately associated with IUS-12 (r=.37), CROSS-D (r =.40) and PHQ-9 (r =.47). IUS-12 was strongly associate with CROSS-D (r =.60) and PHQ-9 (r =.62). Age, gender, and AQ-28 were not associated with any of these four variables. Following the mediation model analyses, these results were found: 1) ER mediated the effect of IU on depression (b = 0.72, BCa CI [0.06, 1.79]), 2) ER did not mediate the effect IU had on anxiety (b = 0.68, BCa CI [-0.06, 1.81]), 3) IU mediated the effect of ER on anxiety (b = 3.89, BCa CI [0.67, 8.42]), and 4) IU mediated the effect of ER on depression (b = 2.98, BCa CI [0.41, 6.07]).
Consistent with previous research, individuals with autism who reported greater levels of IU and greater use of suppression reported higher symptoms of anxiety and depression. This study also builds on previous research by characterizing the nature inter-relationships between IU, ER, anxiety and depression for the first time. These findings have significant implications for designing intervention programmes for anxiety and depression in ASD; treatments combining both Cognitive Behavioural Therapy with the goal of increasing tolerance of uncertainty and Acceptance Commitment Therapy to accept painful emotions and thoughts in order to modify behaviour may be most effective for individuals.