Social anxiety news and stories round-up

“Taking LSD granted me a temporary lift off my anxiety, which, unfortunately, was chemically induced. I hoped that I would somehow be able to take those benefits into sober life by being in that anxiety-less state as often as I could manage to do so. I also noticed a great increase in my openness and creativity. I was enjoying music like I never had before and drew for hours on end. But it didn’t take long for the negative side effects of my consumption to manifest themselves.”

An insightful and inspiring interview with Vietnamese American mental health activist and travel blogger, Meggie Tran: “My organization, a travel and mental health blog called Mindful Meggie, normalizes the discussion about mental health and its illnesses. Being open about them is the antidote to the negative stigma. I hope that people will be encouraged to acknowledge their mental health struggles, seek help from a medical professional when necessary, and open up to supportive family and friends.

The travel aspect is there to liven up the discussion with fun and relatable content. (After all, lots of people love to travel, or at least, read travel stories). Many of my nonfiction narratives discuss both mental health and travel. I also have practical resources for travelers with a mental health condition, which equalizes the opportunity to travel.

I strive to make my Vietnamese American voice heard. That way, I can invite and empower fellow Asians in the travel and mental health fields, both of which are still not quite there yet in terms of racial and cultural inclusivity.”

On work commitments and health: “Here’s the thing – there are positives to where I work. I work part-time and mostly from home; I set my own schedule; I can take time off for illness or family emergencies whenever I need too without feeling any guilt; and I don’t have anyone breathing down my neck or micromanaging everything I do. It’s these things that make me stay. It’s about balance and what it important to me at this stage of my life. With my anxieties and health and family issues, the work environment and flexibility are more important to me than not being able to do my job the way I know it should be done. All I can do is do the best I can with what I am given, and of course keep good notes on the side. I don’t think I could handle a fulltime corporate job anymore, especially since it would pay less for more work.”

Reflecting on anger and emotional self-control: “One of the ways I’m still growing is in regard to my anger. It’s better than it was but it is still there, bubbling away just beneath the surface, raging into a fire when I’m not doing well. Sometimes, it flares so strongly that I become violent – not toward other people or living things, but still violent.”

News articles

“Social anxiety and depression symptoms were positively associated with participants’ extent of dating app use, and symptoms of psychopathology and gender interacted to predict various dating app use motivations.

Symptoms of social anxiety and depression predicted a lower likelihood of initiating contact with a dating app match among men but not women.”

“For the study, researchers from The Ohio State University and the University of Oregon set out to learn whether identifying with a fictional character is connected with the brain activity that occurs when a person thinks about themselves.”

“Individuals have conveyed that this trait identification allowed them to experience a greater level of self-confidence and self-compassion,” says Dr. Magavi. “For example, I evaluated a young man who identified with [“Game of Thrones” character] Samwell Tarly, as he similarly felt ostracized by society and his family. When Samwell Tarly found his calling and helped his friends, he was so touched that he found the courage to apply for a job, despite his debilitating social anxiety.”

“Stress hormones like epinephrine (adrenaline) and norepinephrine flood your body, which can increase your heart rate, blood pressure, and the blood flow to the muscles in your arms and legs. All of these can cause you to start shaking.”

“By strategic experiment I mean doing something to test your assumptions about how others react to you. Your goal in conducting an experiment is to obtain new facts, data, information about how others see you to begin constructing a new, more realistic image of yourself – – NOW – – to counteract the old, negative self-impression stored in your memory from THEN.”

“A study out of China published in April found that 10.8% of people met the diagnostic criteria for post-traumatic stress disorder (PTSD) after returning to work. Following personal protective measures, like wearing face masks, reduced psychiatric symptoms and made people feel more confident. It also helped when workplaces listened to employees concerns and increased workplace hygiene.”

“Curb the urge to seek reassurance from others that you are doing the right thing,” Shannon wrote. “Getting reassurance reinforces the belief that if we do everything right, we will avoid criticism. True confidence comes from allowing for mistakes and accepting that we cannot please everyone.”

“I began smiling at strangers when I went out in public and noticed how relaxed I was when I got home. In my mind, I was smiling as a way to tell people I was non-threatening, kind, maybe even a cool person to know. Lo and behold, seeing their smile in return eased my own mind; quelling my anxiety. I became confident going places solo. I could smile at a stranger at the grocery store and the incessant buzzing in my head would quiet down. I started traveling to different countries on both solo and group trips. Smiling at strangers made me more confident and safe. It was every kind of reassurance I needed.”

Research

“Results suggest that distractor stimuli that are either threatening or faces impair performance of high SA participants. Results demonstrate a hypervigilance for threatening faces in SA but indicate that this happens primarily when cognitive resources are available, that is, under low perceptual load.”

  • From scanners to cell-phones: Neural and real-world responses to social evaluation in adolescent girls Stefanie L. Sequeira, Jennifer S. Silk, Elizabeth A. Edershile, Neil P. Jones, Jamie L. Hanson, Erika E. Forbes, Cecile D. Ladouceur – Department of Psychology, University of Pittsburgh, Oxford University Press https://watermark.silverchair.com/nsab038.pdf

“As hypothesized, associations were found between reactivity to perceived social threat in daily life and neural activity in threat-related brain regions, including the left amygdala and bilateral insula, to peer rejection relative to a control condition. Daily life reactivity to perceived social threat was also related to functional connectivity between the left amygdala and dorsomedial prefrontal cortex during rejection feedback. Unexpectedly, daily life social threat reactivity was also related to heightened amygdala and insula activation to peer acceptance relative to a control condition. Findings may inform key brain-behavior associations supporting sensitivity to social evaluation in adolescence.”

A 2015 publication considering role of obesity, body esteem and social anxiety: “The structural equation modelling displayed that obese individuals with sedentary behaviour and poor body esteem were more likely to show social anxiety. Body esteem partially mediated between sedentary behaviour and social anxiety. Our results highlight the role of sedentary behaviour and body esteem as promising avenues for reducing social anxiety in obese individuals.”

2016 study: “These findings indicate that single dose testosterone administration can alleviate gaze avoidance in SAD. They support theories on the dominance enhancing effects of testosterone and extend those by showing that effects are particularly strong in individuals featured by socially submissive behavior. The finding that this core characteristic of SAD can be directly influenced by single dose testosterone administration calls for future inquiry into the clinical utility of testosterone in the treatment of SAD.”

“Results confirmed that self-reported emotional tendencies of social anxiety and psychopathy Factor I (interpersonal-affective deficit) correlated negatively, but self-reported behavioral tendencies (social avoidance and psychopathy Factor II [impulsive behavior]) correlated positively. Furthermore, Structural Equation Modelling demonstrated that participants with higher social anxiety and higher cortisol levels showed an avoidance tendency towards happy faces, while participants with higher psychopathic traits showed an approach tendency towards angry faces. In sum, the notion that social anxiety and psychopathic traits are opposing ends of one dimension was supported only in terms of self-reported emotional experiences, but a comparable relationship with regard to behavioral and endocrinological aspects is debatable. The current findings stress the necessity to study emotional, endocrinological and behavioral factors in unison in order to better understand the shared and distinctive mechanisms of social anxiety and psychopathic traits.

  • Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study Cathy Creswell, Eleanor Leigh, Michael Larkin, Gareth Stephens, Mara Violato, Emma Brooks, Samantha Pearcey, Lucy Taylor, Paul Stallard, Polly Waite, Shirley Reynolds, Gordon Taylor, Emma Warnock-Parkes, David M Clark, Health Technol Assess 2021 Mar;25(20):1-94 https://pubmed.ncbi.nlm.nih.gov/33759742/

“Objectives: To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive-behavioural therapy that is more commonly used.”

“If empathy is impaired in socially anxious individuals, appropriate emotional reaction to and interpretation of social cues is hampered. This in turn, might negatively impact social interactions thus reinforcing the socially anxious individual’s fear of acting inappropriately. An alternative line of reasoning might be that being unable to correctly infer the other persons’ emotional state provokes uncertainty and anxiety in social interactions (Hezel & McNally, 2014), thus fostering fear in and avoidance of social interactions. Altered empathic functioning might thus play a role in both the development and maintenance of SAD.”

Social anxiety news and stories round-up

Blogs

An artist studying art therapy gives an account of her life and experiences of bullying, judgement of her physical appearance and of subsequent social anxiety: “The pain and loneliness I felt from my social isolation was beyond imagining, so I drew to feel less alone. I am no stranger to heartbreak, betrayal and disappointment, and rather then let the pain defeat me I used it to create something beautiful. Heartbreak actually inspired most of my artworks. I use my emotional pain as a major source of inspiration in most of my works. I like to focus on the themes of life and death, nature because it brings life to my heart, and death which represents the suffering.”

A series of clearly written suggestions for using our senses to de-stress, highlighting sound, smell, feel and touch: “Figure out what sounds bring you a sense of peace or help relax you and begin using them to your advantage. The most commonly suggested method for this would be through listening to music, as this can have a positive psychological impact and has been shown to help ease low moods. Whether you are a fan of upbeat pop or more melancholy ballads, music can help us explore our emotions and ease our stress very effectively.”

A succinct post, describing emotions, particularly, feelings of helplessness: “Went for a walk with Sherri yesterday…and came back just full of social anxiety…I just have such a proliferation of thoughts after social encounters, even with people I trust. Why is it so hard to be straight forward? I’m so fed up with myself…”

The writer presents succinct descriptions of childhood friendships, which provide an insightful perspective into character and bonds: “From my infant friend Lincoln, I learnt in humans that I like those who complement my personality, but that’s not to say I atall dislike people similar to me. In fact a certain threshold of shared ethics is necessary. If you ask me when I juxtapose all of these friendships, I see very little in common. Maybe that’s the point. I build myself strong allies of a diverse settings.”

Research

This is a 1990 publication which suggests that social anxiety or phobia has a high incidence amongst the Saudi population and compares it to “the West” where “agoraphobia is the most common phobic disorder and constitutes about 60% of all clinically diagnosed phobic conditions, while social phobia is relatively rare.” The article goes on to suggest some possible reasons for this, including sociocultural.

I have included this article in this list particularly for the following quote: “Social anxiety seems to arise in people who are unduly sensitive to disapproval and criticism and who have inflexible ideas about social conventions which cause them to expect criticism unnecessarily.” This is attributed to a 1974 journal article which I could not find online: Nichols KA. Severe social anxiety. Br J Med Psychol. 1974; 47:301-6.

This quotation suggests an objective judgement of social fear based on an unspecified general standard, without reference to individual history, vulnerabilities or capacities. This objective standard may be helpful for identification of the need for treatment or support, but as a definition of social anxiety, it denies the subjective experience and condition of the person with symptoms and thus denies a holistic treatment approach. The definition also denies the reality of social power differences and social harms, beyond disapproval and criticism. I believe that this narrowly focused understanding of social anxiety disorder is found in modern medical understanding and treatments.

“Social anxiety is a highly prevalent and impairing condition. Understanding prodromal features of social anxiety in infancy can facilitate early intervention and mitigate negative long-term impacts. The present study is the first to examine social anxiety risk markers across multiple indices in infants with fragile X syndrome (FXS), who are at elevated risk for comorbid social anxiety disorder. Evidence suggests that infants with FXS display both behavioral and physiological markers of social anxiety that are detectable as early as 12 months of age. However, these findings were nuanced and not consistent across all measures, highlighting the importance of a multi-method biobehavioral approach.”

Articles

Australian freelance writer, Marnie Vinall, describes the positive experience of joining and integrating into a supportive Aussie rules football team: “I managed to make it a whole three weeks in before needing to sit out a training session because my anxiety got the better of me. It was in a regular drill called “chaos”, which involves a series of balls going in any and every direction. The purpose to practise kicking, marking, calling for the ball and making yourself open and available. “The aim,” the coach said, “is to get your hands on the ball as many times as possible.”

“For some, it will be hard to quiet the ‘threat brain’ and as a result, we may actually see a rise in OCD type symptoms. It’s important to understand that with OCD it is actually anxiety and fear at the root of the problem, it’s just the OCD are the symptoms we see.”

Another article looking at the fears that reopening of countries may bring, with particular attention on those most vulnerable, such as people with anxiety disorders: “Experts say it’s important to acknowledge your stress during this transition. It’s normal to feel nervous. People shouldn’t judge themselves too harshly for their anxieties.”

A deeper look at foods beneficial to emotional and physical health: “Serotonin has a calming effect and also promotes sleep and relaxation, McKittrick explained. In fact, low levels of brain serotonin, research has suggested, can lead to increased vulnerability to psychosocial stress.

Tryptophan is an amino acid that is necessary for the production of serotonin in the brain. Complex carbs including whole grains and vegetables can help boost levels of serotonin because they make tryptophan more available in the brain.”

Very frank and insighful account of a woman fearing social interactions after the lifting of pandemic restrictions in the UK: “Fortunately, I found a career where I could escape those feelings for a couple of hours. As a nanny, social anxiety dissipated as the focus was on the children and I was able to forget about me. I worked long hours and did something so fulfilling, that I realised when it came to caring for others – such as the children I worked with, or taking my husband to hospital – the feeling of being needed, the purpose of doing something for others, overtook the dread and fear.”

Prior to the lockdown in the UK, she had started a new job role: “I don’t currently know if I will be able to go back to it – the most I can achieve is going to a chemist to collect my husband’s medication once a month and that is a mammoth task that takes a lot of psychological build-up.”

Social anxiety news and stories round-up

Blogs

Introspective piece questioning the causes of feeling less desirous of being in love and more content with being single: “You’d think this lack of interest would be a comfort to me, considering how much I use to agonize over my loneliness. Yet, even though this new state doesn’t necessarily cause me pain, it’s still a cause for concern. How can it be that in the span of just a few years I can feel so completely different about something that was once so vitally important to me? If I could be certain these were an accurate reflection of inner growth and independence, I might not mind. However, there is part of me that wonders if this isn’t somehow a result of so many years on anti-depressants. Paxil has helped me in a lot of ways, and I am grateful for that. But now I’m beginning to question if I’m even still the same person I was before. Which version of myself would I ultimately prefer? Can I even trust the way I think and feel now?”

A perspective of a loving relationship: “I feel like love is everything. It’s the good, it’s the bad, it’s the glue that holds life together. Whether that’s in a romantic or platonic way, whether it’s between you and family, or you and your favourite song; love is the glue.”

A writer managing relationships with those who have caused them emotional harm in the past: “so, while i’m working on myself and my relationships, i’m going to let myself feel angry. i’m going to let myself feel bitter. i’m going to remind myself that all of these feelings are valid. healing from trauma is a nonlinear process that takes time, and i’m going to give myself that time.”

On the complex relationship we might have with mental health difficulties: “As much as I wish my coping mechanisms were healthy and productive, I can’t deny my anorexia didn’t serve me a temporary kind of protection, however much this point will overshoot the rational brain. It’s almost like hugging a cactus, expecting the delights of a teddy bear.”

An interesting perspective on the issue of courtship between genders with the backdrop of media attention on the sexual violence against women: “But in reality men are told from almost birth its their job to make the first move to ask women out, to initiate contact,. men have chat up lines, not usually women. I worked in a company for 20 year and never had a female try to befriend me in a romantic type of way ever. The odd hello is not the same as chatting someone up but I had plenty of people especially women think me weird for being quiet. As I said once before hearing girls say “he wont do anything at a bus stop!” as I did not chat their friend up Well if the world is equal then why didn’t she do something?”

A fascinating account of the pressures placed on workers by a grocery chain: “I don’t do this job to impress people. I do what I’m supposed to do, which is to deliver the groceries to customers. 97% of the time, customers drive away content or thrilled. Sure, we have hiccups. We do get bad reviews. Mistakes are made. Do you think that stops customers from using the online grocery pickup service? Not in a million years. We’re being asked to push these surveys as if the very existence and justification of a digital grocery department is in jeopardy. And it’s really not. Grocery pickup from online orders is here to stay. This is life now. No bad review is going to shut it down.”

On poor posture as a symptom of anxiety and fear: “I’ve carried heavy books in backpacks for years, but I don’t think they’ve weighed me down quite like fear and submission. My entire life, I’ve learned to shut up, cocoon myself, break off from the others, and shrink into myself whenever life became uncomfortable. Again, to stand up with a good posture is to face everything. My body follows how I feel on the inside. Therefore, slouching was always a subconscious norm. I adapted to fear and submission so easily that my physical reaction was just built-in.”

Research

“Results indicate no between-group differences in heart rate variability (HRV) and heart rate (HR) at baseline. When starting the working memory task, the control group decreased significantly in HRV and the anxious group did not differ substantially in their change pattern from baseline to the start of the stressor. Finally, during the recovery phase of the working memory task, the clinically anxious and control individuals did not differ in their HFV or HR response compared to baseline.

From a clinical perspective, the results suggest that screening for the presence of anxiety disorders may help to identify patients with impaired HRV and HR functioning and to intervene on these important patient characteristics early in the treatment process.”

  • Recalling autobiographical self-efficacy episodes boosts reappraisal-effects on negative emotional memories – Christina Paersch, Ava Schulz, Frank H Wilhelm, Adam D Brown, Birgit Kleim. Emotion Feb 25, 2021 https://pubmed.ncbi.nlm.nih.gov/33630625/ (Abstract)

“Self-efficacy is a key construct in behavioral science with significant impact on mental health and wellbeing. A growing body of work has shown that perceptions of self-efficacy can be increased through recall of autobiographical episodes (AEs) of mastery (“self-efficacy memories”) in experimental settings. Doing so contributes to improvements in clinically relevant processes, such as emotion regulation and problem solving. Here we examine whether the recall of self-efficacy AEs contributes to more adaptive appraisals for personally experienced negative memories.

These findings suggest that recalling self-efficacy episodes may promote adaptive self-appraisals for negative memories, which in turn may contribute to recovery from stressful events and, with further research, may prove to be a useful adjunctive strategy for treatments such as CBT.”

  • Crosstalk between Existential Phenomenological Psychotherapy and Neurological Science in Mood and Anxiety Disorders – Lehel Balogh, Masaru Tanaka, Nóra Török, László Vécsei, Shigeru Taguchi https://www.preprints.org/manuscript/202012.0625/v2 (This version is not peer-reviewed)

“Existential phenomenological psychotherapy (EPP) has been in the forefront of meaning-centered counseling for almost a century. The phenomenological approach in psychotherapy originated in the works of Martin Heidegger, Ludwig Binswanger, Medard Boss and Viktor Frankl, and it has been committed to account for the existential possibilities and limitations of one’s life. EPP provides philosophically rich interpretations and empowers counseling techniques to assist mentally suffering individuals by finding meaning and purpose of life. The approach has proven to be effective in treating mood and anxiety disorders. This narrative review article demonstrates the development of EPP, the therapeutic methodology, evidence-based accounts of its curative techniques, current understanding of mood and anxiety disorders in neurological science, and a possible converging path to translate and integrate meaning-centered psychotherapy and neurological science, concluding that the existential phenomenological psychotherapy potently plays a synergistic role with the currently prevailing medication-based approaches for the treatment of mood and anxiety disorders.”

“These exploratory results indicate that anxiety, but not regulation tendency, predicts how individuals regulate emotion in the laboratory. These findings suggest that how individuals report regulating in the real world does not map on to how they regulate in the laboratory. Taken together, this underscores the importance of developing emotion-regulation interventions and paradigms that more closely align to and predict real-world outcomes.”

“Social anxiety impairs the balance performance of older women, particularly in those most affected by the evaluator, and during more dynamic modified gait tasks that challenge balance while walking. However, co-performing balance tasks with a partner reduced the effects of social anxiety, suggesting that social support may help to mitigate some of the potential ‘white coat’ effects experienced during clinical balance assessments.”

News

“Mental health experts said this fraction of the population found the quarantine protective, a permission slip to glide into more predictable spaces, schedules, routines and relationships. And the experts warn that while quarantine has blessed the “avoidance” of social situations, the circumstances are poised to change.”

Social anxiety news and stories round up

Blogs

A very informative and personal account of the challenges of seeking the necessary support and adjusting ones diet to manage Type 2 diabetes, whilst also managing social anxiety symptoms. “I never went to the support group as my anxiety wouldn’t let me. So I spent the next year and a half flitting between eating healthy (what I read was healthy anyway) and comfort eating junk food because I blamed myself for giving myself diabetes (counter-productive I know). Stupid stupid brain!”

Personal account of struggles of growing up with undiagnosed autism and experiencing social anxiety and drug addiction: “i dropped out of college and moved into a broken down schoolbus-turned-RV with the boy that gave me meth for the first time. i’m not sure when exactly my addiction went from the addiction of being a normal person with no anxiety that was able to socialize and be part of a group and laugh and be cool to an addiction to the drug and only the drug. but it happened. and full circle i had gone back into my shell.”

Diary records of travelling in Poland, from Julia: “Ironically, for someone who experiences social anxiety, I absolutely adore those brief human interactions where I can talk, laugh, and smile with a stranger. It makes me feel positive about the world out there and reminds me of what we all are. In this case, the man spoke Russian but we both managed with our broken Polish to understand that he needed to use the internet to call his wife and family. The internet on the train was no use, so I offered up that he could use my hotspot. We didn’t talk too much after that, I read my book and he watched the world outside the window. Still, I had felt all the more connected to something beyond myself.”

An interesting thesis that fear is essentially a fear of death. The post considers the implications for this in addressing fear and anxieties. “Inside your brain are two little nuggets called your amygdalas. These naughty little nuggets are, biologically speaking, responsible for all of your emotional suffering. This is because they activate something called your fight, flight or freeze response system. And this has everything to do with your survival. (They love you really.)”

Creative writing, poems & stories

“I wonder if this is another superpower of Black women. To be able to see straight through the biggest and baddest. To have this thing on us, even before we become mothers or grandmothers, big mama’s or madea’s. We have this thing that the world knows they can’t hide from us, they can’t pretend to be strong with us, they can’t bullshit us, because we see through it all. It makes people act weird around us. It’s another example of our very existence being a resistance. This superpower can result in one of three things. Hatred, fear, or devotion.

I’ll let you guess which is the least likely of the three.”

“Let Go.

Of everything that is disturbing your peace and impacting your wellbeing.

Let Go.

Of trying to plan everything perfectly and trying to ensure there is no divergence.”

“For a girl like me,
To be born in the depths
Of corn fields and maple leaves
From a cowboy poorer than the mice
Eating slowly at his sanity
And his lover, savage as they come
Together, speaking a language of Freedom
Spreading their quiet wisdom
Passing it down to me,
Entrusting me with a vision
A dream to live as free as they be
As they always had envisioned.”

News

Article about Fight or Flight: Anxiety, an animated documentary series created by a New Zealand based film-maker, Michelle Cameron. ““My favourite quote is by Esther Perel, who says ‘the quality of our relationships determines the quality of our lives’ and I think the most important relationship is the one we have with ourselves.” Cameron encouraged people to not be afraid of their feelings and hoped anxiety would be just another accepted emotion in the future.”

The animated documentary series can be viewed on Youtube.

Short piece by blogger, Cat Borg, a 40-something wife and mother of three girls: “Don’t get me wrong, I am longing for hugs. I can’t wait to be in close contact with my extended family again without social distancing and the need for hand sanitizer every five minutes. But to think about the way we’re going to be rushing around again, possibly by the end of this year fills me with dread.”

An article hypothesising on potential causes of anxiety on the phone and possible remedies: “Pauses can feel extremely uncomfortable too. In person, you can see when someone is distracted or thinking but on the phone brief silences can feel awkward. We’re also becoming accustomed to being able to review emails, texts and social media posts before hitting the send button, so a phone conversation can feel impulsive and risky.”

Research

“We hypothesized that social anxiety would be significantly positively associated with DPDR (depersonalisation/derealisation) and this relationship would be stronger among individuals high in emotion regulation difficulties compared to those low in emotion regulation difficulties. The results of the current study provided support for both hypotheses. Results indicated that as social anxiety scores increased, the frequency and duration of DPDR experiences also increased. Furthermore, this relationship was significantly stronger at higher levels of emotion regulation difficulties. Additionally, even at low levels of emotion regulations difficulties (i.e., one standard deviation below the mean), social anxiety was still significantly positively associated with DPDR. When examining the sub-components of emotion regulation difficulties, it was found that difficulties controlling impulsive behavior and the ability to clearly identify and understand emotions both significantly moderated the relationship between social anxiety and DPDR. Similar to emotional regulation difficulties in general, while social anxiety was positively associated with DPDR at low levels of both types of emotion regulation difficulties, the relationship was stronger among individuals who reported high levels of emotion regulation difficulties in the areas of controlling impulsive behaviors and clearly identifying and understanding emotions.”