Journal of Abnormal Psychology 2011 American Psychological Association

2012, Vol. 121, No. 1, 276 281 0021-843X/11/$12.00 DOI: 10.1037/a0023598

BRIEF REPORT

When Are Adaptive Strategies Most Predictive of Psychopathology?

Amelia Aldao and Susan Nolen-Hoeksema

Yale University

In recent work, we showed that putatively adaptive emotion regulation strategies, such as reappraisal and
acceptance, have a weaker association with psychopathology than putatively maladaptive strategies, such
as rumination, suppression, and avoidance (e.g., Aldao & Nolen-Hoeksema, 2010; Aldao, Nolen-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Hoeksema, & Schweizer, 2010). In this investigation, we examined the interaction between adaptive and
This document is copyrighted by the American Psychological Association or one of its allied publishers.

maladaptive emotion regulation strategies in the prediction of psychopathology symptoms (depression,

anxiety, and alcohol problems) concurrently and prospectively. We assessed trait emotion regulation and
psychopathology symptoms in a sample of community residents at Time 1 (N 1,317) and then
reassessed psychopathology at Time 2 (N 1,132). Cross-sectionally, we found that the relationship
between adaptive strategies and psychopathology symptoms was moderated by levels of maladaptive
strategies: adaptive strategies had a negative association with psychopathology symptoms only at high
levels of maladaptive strategies. In contrast, adaptive strategies showed no prospective relationship to
psychopathology symptoms either alone or in interaction with maladaptive strategies. We discuss the
implications of this investigation for future work on the contextual factors surrounding the deployment
of emotion regulation strategies.

Keywords: emotion regulation, adaptive regulation strategies, maladaptive regulation strategies,

flexibility, longitudinal

In the last decade, researchers have been increasingly interested
in examining the process by which individuals regulate emotional
states to respond to environmental demands (e.g., Gross, 1998;
Kring & Sloan, 2010; Rottenberg & Gross, 2003). A substantial
amount of theoretical and empirical work has focused on the
processes by which emotion regulation strategies modify emo-
tional experiences and their associated expressions, behavioral
components, and physiological states, thereby increasing or de-
creasing the risk of psychopathology (e.g., Campbell-Sills, Bar-
low, Brown, & Hofmann, 2006; Gross, 1998; Hofmann, Heering,
Sawyer, & Asnaani, 2009).
The work on emotion regulation strategies has led to a func-
tional differentiation of strategies based on their ability to facilitate
adaptive versus maladaptive responding. Specifically, strategies
such as cognitive reappraisal, acceptance, and problem solving
generally have been associated with adaptive outcomes, including
reductions in the experience of negative affect (e.g., Goldin,
McRae, Ramel, & Gross, 2007), increased pain tolerance (e.g.,
Hayes et al., 1999), effective interpersonal functioning (e.g., Rich-
ards & Gross, 2000), and diminished maladaptive cardiac reactiv-
This article was published Online First May 9, 2011.
Amelia Aldao and Susan Nolen-Hoeksema, Department of Psychology,
Yale University, New Haven, Connecticut.
We thank Elena Wright and Yael Levin for their thorough comments on
earlier versions of this article.
Correspondence concerning this article should be addressed to Amelia
Aldao, Department of Psychology, Yale University, 2 Hillhouse Avenue,
New Haven, CT 06520. E-mail: Amelia.aldao@yale.edu
ity (e.g., Campbell-Sills et al., 2006). In addition, these putatively
adaptive strategies are important components of a variety of treat-
ment modalities, ranging from traditional cognitive behavioral
therapy to newer, third-wave approaches (e.g., Beck, 1976; Hayes,
2008; Hofmann & Asmundson, 2008; Roemer, Orsillo, & Salters-
Pedneault, 2008).
On the other hand, strategies like rumination, suppression,
avoidance, and worry generally have been associated with mal-
adaptive outcomes, including rebounds in negative affect follow-
ing engagement with emotion-eliciting stimuli (e.g., Campbell-
Sills et al., 2006), memory difficulties (e.g., Richards, Butler, &
Gross, 2003), increases in sympathetic activation (e.g., Gross &
Levenson, 1993; Wegner, Broome, & Blumberg, 1997), and di-
minished autonomic flexibility (e.g., Hofmann et al., 2005). Fur-
thermore, the self-reported use of these strategies has been asso-
ciated with the development and maintenance of a wide range of
disorders, including depression (Nolen-Hoeksema, Wisco, & Lyu-
bomirsky, 2008), generalized anxiety disorder (Mennin, Holaway,
Fresco, Moore, & Heimberg, 2007), alcohol problems (Nolen-
Hoeksema & Harrell, 2002), and eating disorders (Nolen-
Hoeksema, Stice, Wade, & Bohon, 2007).
Recently, we showed that putatively adaptive and maladaptive
strategies differ in their strength of association with psychopathol-
ogy. Specifically, we observed that maladaptive strategies are
consistently more strongly associated with psychopathology than
adaptive strategies (e.g., Aldao & Nolen-Hoeksema, 2010; Aldao,
Nolen-Hoeksema, & Schweizer, 2010). It is interesting to note that
we have seen this pattern of findings when examining both inter-
nalizing (e.g., depression, anxiety) and externalizing (e.g., alcohol,
eating) pathology in community samples and samples including

276
 ADAPTIVE STRATEGIES AND PSYCHOPATHOLOGY 277

clinical and nonclinical groups, suggesting that this asymmetry in
the strength of the relationship between adaptive and maladaptive
strategies and psychopathology generalizes across the range of
psychopathology (e.g., Harvey, Watkins, Mansell, & Shafran,
2004; Kring & Sloan, 2010). Understanding why adaptive strate-
gies are relatively weak predictors of psychopathology is impor-
tant given the centrality of such strategies to treatment and pre-
vention efforts (e.g., Beck, 1976; Hayes, 2008; Hofmann &
Asmundson, 2008; Roemer et al., 2008). In particular, understand-
ing when adaptive strategies are more or less useful would be
critical to teaching clients how to use these strategies effectively.
Using adaptive strategies may be more difficult for people who
are also prone to using maladaptive strategies, because maladap-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
psychopathology after controlling for baseline levels of psychopa-
thology (for a review, see Aldao et al., 2010). However, little is
know about how adaptive and maladaptive strategies interact to
predict changes in psychopathology over time. Therefore, in the
present investigation we also examined how the interaction be-
tween adaptive and maladaptive strategies at baseline (i.e., Time 1)
predicted psychopathology symptoms one year later (i.e., Time 2),
while controlling for baseline levels of psychopathology.
Method
Participants and Procedures

tive strategies may interfere with the use of adaptive strategies.

Participants were recruited through random-digit dialing of res-
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Indirect evidence for this interference hypothesis comes from work

idential telephone numbers in San Francisco, San Jose, and Oak-
showing that maladaptive strategies may narrow attentional focus,
land, California; 1,789 individuals were initially called. Of those,
therefore preventing individuals from noticing the context around
1,317 participated in the first interview, and 1,132 of the original
them (e.g., Borkovec, Alcaine, & Behar, 2004; Richards et al.,
participants responded to a second interview 1 year later. Individ-
2003; Richards & Gross, 2000; Wenzlaff & Wegner, 2000). For
uals who did not participate in the second interview scored higher
example, Joormann and colleagues (see Joormann & DAvanzato,
in psychopathology than those who did, t(1316) 3.05, p .01.1
2010) have found that rumination interferes with the ability to shift
At Time 1, the mean age of the sample was 47 years old (SD
attention away from negative stimuli. Therefore, to the extent that
15.22; range 24 82), and 52.7% of the sample identified as
maladaptive strategies narrow attentional focus, they might inter-
female. Seventy percent of the sample was Caucasian, 9.2% His-
fere with individuals ability to access and properly deploy adap-
panic, 8% African American, 6.3% Asian or Pacific Islander, and
tive regulation strategies.
6.5% identified as other or did not respond (for other demographic
On the other hand, a compensatory hypothesis suggests that
information, see Nolen-Hoeksema, 2000).
adaptive strategies may be most important in preventing psycho-
At both Time 1 and Time 2, all participants were interviewed in
pathology in people who also tend to use maladaptive strategies.
person. All measures were read aloud to participants and response
This hypothesis is consistent with models suggesting that people
options were presented on cards. Interviewers were extensively
have a repertoire of emotion regulation strategies that they use
trained in standardized responses to participants requests for clar-
flexibly depending on circumstances (e.g., Bonanno, Papa,
ification of items and probes to clarify participants answers to
ONeill, Westphal, & Coifman, 2004; Cheng, 2003; Kashdan &
questions when necessary.
Rottenberg, in press; Westphal, Seivert, & Bonanno, 2010).
Among people whose repertoire includes maladaptive strategies,
adaptive strategies may be particularly predictive of psychopathol- Measures
ogy outcomes.
Depression was assessed with the 13-item Beck Depression
In this investigation, we sought to further investigate the asym-
InventoryShort Form (BDI-SF; Beck & Beck, 1972). At Time 1,
metry in the strength of the relationship between adaptive and
internal consistency was good ( .83), and the testretest
maladaptive strategies and psychopathology. Specifically, we
correlation was .60 ( p .01). In addition, the module for major
tested whether trait maladaptive strategies moderated the relation-
depression from the Structured Clinical Interview for the Diag-
ship between trait adaptive strategies and symptoms of psychopa-
nostic and Statistical Manual of Mental Disorders, Fourth Edition
thology. Based on previous work (e.g., Aldao & Nolen-Hoeksema,
(SCID; First, Spitzer, Gibbon, & Williams, 1997) was adminis-
2010; Aldao et al., 2010), we predicted that maladaptive strategies
tered. Interrater reliability on this module was 100% (see Nolen-
would be a stronger predictor of psychopathology than adaptive
Hoeksema, 2000). We created a continuous measure of depression
strategies. In addition, we predicted that adaptive and maladaptive
by summing the number of symptoms recorded for each respon-
strategies would interact with each other. Two competing possi-
dent. Internal reliability at Time 1 was .68, and the testretest
bilities were examined. First, an interference hypothesis would
reliability was .48 (p .01).
suggest that adaptive strategies would have a weaker negative
Anxiety was assessed with the 21-item Beck Anxiety Inventory
relationship with psychopathology when levels of maladaptive
(BAI; Beck & Steer, 1990). Internal reliability at Time 1 was good
strategies are high than when they are low. On the other hand, a
( .88), and the testretest correlation was .63 (p .01). We did
compensatory hypothesis would suggest that adaptive strategies
not administer the SCID modules on anxiety for this study because
would have a stronger negative relationship with psychopathology
it was designed as a study of depression, but interviewers com-
when levels of maladaptive strategies are high than when they are
pleted a one-item global rating of the anxiety levels of the respon-
low.
In addition to examining this relationship concurrently, we
evaluated the interplay between adaptive and maladaptive strate- 1
In the results section, we present analyses conducted with the full
gies and changes in psychopathology symptoms over time. Previ- sample. Analyses conducted with the smaller set of individuals who par-
ous work has shown that the use of maladaptive strategies pro- ticipated in both assessments paralleled the results obtained with the full
spectively predicts the development and maintenance of sample.
 278 ALDAO AND NOLEN-HOEKSEMA
dents immediately after the interview on a scale ranging from 0
(none) to 4 (disabling), using information reported by the respon-
dents on the BAI, as well as information provided by the respon-
dents verbal and nonverbal behavior throughout the interview.
Testretest reliability was .32 (p .01).
Alcohol-related problems were assessed with the relevant mod-
ule of the SCID (First et al., 1997). We summed the number of
problems recorded to create a continuous score from 0 to 8 (see
Nolen-Hoeksema & Harrell, 2002). The internal consistency was
good ( .77). The testretest reliability was .57 (p .01). tions at Time 1 for the full sample. Consistent with previous work,
Recent work shows that emotion regulation strategies are asso-
ciated with all three types of psychopathology we assessed (e.g.,
Aldao & Nolen-Hoeksema, 2010; Kring & Sloan, 2010). Further-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
more, measures of the three symptom types were intercorrelated
(all ps .01). Thus, we standardized scores on each of the
This document is copyrighted by the American Psychological Association or one of its allied publishers.
measures (BDI, SCID depressive symptoms, BAI, anxiety rating,
SCID alcohol use problems) and averaged them for an overall
index of psychopathology. We note, however, that a similar pattern
of results is found whether we use this aggregated index of
psychopathology or separate indices of internalizing symptoms
(depression and anxiety) or alcohol problems.2 For parsimony, we
report only the analyses of the overall psychopathology index. The
testretest reliability for this index was .67 (p .01).
The Ruminative Responses Scale (RRS; Treynor, Gonzalez, &
Nolen-Hoeksema, 2003) is a 22-item measure that assesses the
tendency to engage in ruminative behavior in response to stress.
Treynor and colleagues (2003) have removed those items with a
high content overlap with depressive symptoms. The resulting
brooding subscale contains 5 items and reflects the moody rumi-
nation at the core of Nolen-Hoeksemas (1991) rumination theory
(e.g., What am I doing to deserve this). In this sample, internal
reliability of the brooding subscale was good ( .77).
The COPE InventoryShort Version (Carver, 1997) is a shorter
version of the original COPE inventory (Carver, Scheier, & Wein-
traub, 1989) that was adopted for this study because respondent
burden was already high. We utilized the following scales: accep-
tance, positive reframing, behavioral disengagement, and denial.
In the initial investigation (Carver, 1997), the internal consistency
for these scales ranged from .57 to .64 and in the current investi-
gation the range was from .53 to .70. In addition, because at the
time this study was conducted (mid-1990s), there was no widely
used measure of emotional, thought, and expressive suppression,
we created a 4-item subscale assessing all aspects of suppression
(i.e., expressive, thought, and emotional). These items had good
internal consistency ( .76).
To model the relationship between adaptive and maladaptive
strategies, we created two composite scores reflecting the use of
each type of strategy. The composite score of adaptive strategies
consisted of the average between COPE acceptance and COPE
positive reframing and the composite score of maladaptive strat-
egies consisted of the average of COPE behavioral disengagement,
COPE denial, suppression, and RRS brooding (they were all on the
same scale). We submitted these subscales to a factor analysis and
showed that the maladaptive scales loaded onto one factor (34% of
the variance), and the adaptive scales loaded onto a separate factor
(23% of the variance). The internal consistency was adequate for
adaptive strategies ( .68) and good for maladaptive strategies
( .81). The scores were mildly correlated with each other (r
.13, p .01), likely because individuals who experience elevated
levels of distress tend to use many types of coping or emotion
regulation in their attempts to regulate their negative affect (e.g.,
Nolen-Hoeksema et al., 2008).
Results
Cross-Sectional Analyses
Zero-order correlations. We examined zero-order correla-
the psychopathology composite score was positively correlated
with the maladaptive strategies composite score (r .50, p .01)
and was not correlated with the adaptive strategies composite score
(r .03, ns).
Regression analyses. We predicted the psychopathology
composite score using a stepwise regression. In the first step, we
entered adaptive and maladaptive strategies scores (which were
centered to reduce multicollinearity; Tabachnick & Fidell, 2007),
R2 .25, F(2, 1314) 217.06, p .01. Maladaptive strategies
contributed significantly to the prediction of psychopathology,
t(1314) 20.81, p .01, .50. Adaptive strategies were not
a significant predictor, t(1314) 1.58, ns, .04. In a
second step, we entered the interaction term between adaptive and
maladaptive strategies, R2 .004, F(1, 1313) 7.34, p .01.
Maladaptive strategies remained a significant predictor, t(1313)
20.88, p .01, .50, and adaptive strategies became a signif-
icant predictor, t(1313) 2.05, p .05, .056. More
important, the interaction term between adaptive and maladaptive
strategies was significant, t(1313) 2.71, p .01, .07.
We followed this interaction with simple slopes analyses (Aiken
& West, 1991). Both the interference hypothesis and the compen-
satory hypothesis entail predictions (in opposite directions) about
the relationship between adaptive strategies to psychopathology in
the presence of high versus low levels of maladaptive strategies.
Thus, we evaluated the role of adaptive strategies as a predictor of
psychopathology at high and low levels of maladaptive strategies
(i.e., 1 SD above/below the mean). At low levels of maladaptive
strategies, adaptive strategies were unrelated to psychopathology,
t(1313) .41, ns, .01. However, at high levels of maladaptive
strategies, greater levels of adaptive strategies were related to
lower levels of psychopathology, t(1313) 3.08, p .01,
.11.
Longitudinal Analyses
Correlations. We examined the relationship between strate-
gies at Time 1 and psychopathology symptoms at Time 2. In
parallel with the cross-sectional results, maladaptive strategies at
Time 1 were correlated with the composite score of psychopathol-
ogy at Time 2 (r .41, p .01), even after controlling for
symptoms at Time 1 (r .12, p .01). In addition, mimicking the
cross-sectional results, adaptive strategies at Time 1 were not
correlated with the psychopathology at Time 2 (r .03).
Regression analyses. We predicted psychopathology symp-
toms at Time 2 with adaptive and maladaptive strategies at Time
1. In Step 1, we entered psychopathology symptoms at Time 1 and,
2
Available from the first author.
 ADAPTIVE STRATEGIES AND PSYCHOPATHOLOGY
Figure 1. Cross-sectional interaction between adaptive and maladaptive
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strategies. High and low levels correspond to 1 SD above or below the
This document is copyrighted by the American Psychological Association or one of its allied publishers.
mean, respectively. Adaptive strategies have a negative association with
psychopathology only at high levels of maladaptive strategies.
as expected, we found that it was a significant predictor, t(1124)
29.87, p .01, .67, R2 .44. In Step 2, we entered adaptive
and maladaptive strategies at Time 1 centered, R2 .01, F(2,
1122) 8.13, p .01. Psychopathology symptoms at Time 1
remained a significant predictor, t(1122) 24.11, p .01,
.62, and the maladaptive strategies score was also a significant
predictor, t(1122) 3.97, p .01, .10, but adaptive strategies
was not a significant predictor, t(1122) .02, ns, .00. In step
3, we added the interaction between adaptive and maladaptive
strategies at Time 1, but, unlike in the cross-sectional models, it
was not a significant predictor, t(1121) .57, ns, .01.
Discussion
We examined the relationship between trait adaptive (positive
reframing and acceptance) and maladaptive (rumination, suppres-
sion, behavioral disengagement, and denial) emotion regulation
strategies in the prediction of psychopathology symptoms concur-
rently and prospectively. At the cross-sectional level, we found
that maladaptive strategies moderated the relationship between
adaptive strategies and psychopathology symptoms: adaptive strat-
egies had a negative association with psychopathology symptoms
only when levels of maladaptive strategies were elevated. This
provides support for the compensatory hypothesis that adaptive
strategies have significant relationships to psychopathology symp-
toms in the presence of maladaptive strategies. On the other hand,
in prospective analyses, only maladaptive strategies predicted psy-
chopathology symptoms at Time 2.
In previous work (Aldao & Nolen-Hoeksema, 2010), we argued
that adaptive strategies might show a weaker association with
psychopathology because their usefulness might be context depen-
dent (e.g., reappraisal might be mostly adaptive when the situation
can actually be reframed, or acceptance might be most appropriate
when there is little action an individual can take to change his or
her circumstances). One type of context may be the affective
and/or regulatory state of the individual. Sheppes, Cartan, and
Meiran (2009) have shown that the effects of reappraisal depend
on the point in time in the emotion process in which it is deployed.
Similarly, in this investigation we found that adaptive strategies
showed a negative association with concurrent levels of psycho-
pathology only when levels of maladaptive strategies were ele-
279
vated, therefore suggesting that their effectiveness might depend
on the other regulation strategies present in an individuals reper-
toire. Future empirical work should examine the process by which
individuals select one strategy over another one (e.g., Egloff,
Schmukle, Burns, & Schwerdtfeger, 2006) and can flexibly switch
between using different strategies that might be differentially
adaptive for varying contexts (e.g., Westphal et al., 2010). In
addition, it will be important to examine other contextual factors,
such as trait (e.g., emotion intensity, personality) and state (e.g.,
emotion reactivity, attention processes, physiology) components of
affective processes.
Although this study provided an important examination of the
moderating role of maladaptive strategies on adaptive strategies, it
had limitations. The first was our use of self-report measures of
psychopathology, which are subject to reporting bias (e.g., Rob-
inson & Clore, 2002). We attempted to reduce the influence of
such biases by administering these self-report measures in the
context of an interview and combining them with indices of
psychopathology that came from structured interviews and inter-
viewer ratings. Still, replicating our findings with measures of
psychopathology that are all based on structured clinical inter-
views will be important.
Second, our sample was a representative community sample,
raising the question of whether our results would be replicated in
comparisons of individuals with and without diagnosed disorders.
In our previous meta analytic review (Aldao et al., 2010), we
showed that maladaptive strategies were even more strongly re-
lated to psychopathology when clinical and nonclinical samples
were compared than when community samples with a range of
psychopathology were used; in contrast, adaptive strategies were
weakly and inconsistently related to psychopathology in both
community samples and comparisons of clinical and nonclinical
samples. Thus, our meta analysis suggests that we would find
similar results in comparisons of clinical and nonclinical samples.
Furthermore, emotion regulation theories suggest that the relation-
ship between specific strategies and emotional distress or un-
healthy behaviors (such as substance misuse) can be characterized
as continuous (for reviews, see Kring & Sloan, 2010); thus, the use
of a community sample with a representative range of psychopa-
thology provide an appropriate test of these theories. Still, the
generalizability of our results to comparisons of clinical versus
nonclinical samples remains to be tested.
Third, emotion regulation was measured through self-report
questionnaires, although they were administered in the context of
a structured interview. Future studies should utilize experimental
designs to assess the multiple emotional domains (e.g., subjective,
physiological, and behavioral; Bradley & Lang, 2000). Further-
more, we only examined 6 regulation strategies, so it will be
important for future work to incorporate a wider range of strategies
(e.g., problem solving, seeking social support).
Fourth, an alternative hypothesis for the stronger association be-
tween maladaptive strategies and psychopathology is that the scales
used to measure maladaptive strategies have content overlap with
psychopathology scales. In this investigation, we sought to minimize
this potential confound by utilizing the brooding scale of the RRS
(Treynor et al., 2003), from which the items that most obviously
overlapped with distress were removed. In addition, the COPE scales
we used had minimal overlap with symptoms of negative affect.
 280 ALDAO AND NOLEN-HOEKSEMA
In this investigation, we examined the relationship between
adaptive and maladaptive emotion regulation strategies in the
prediction of psychopathology symptoms concurrently and pro-
spectively. When predicting psychopathology symptoms cross-
sectionally, we found support for a context-dependent role of
adaptive strategies, so that their association with psychopathology
symptoms was moderated by levels of maladaptive strategies.
Specifically, adaptive strategies had a negative association with
psychopathology symptoms only at high levels of maladaptive
strategies, providing support for a compensatory hypothesis. In
contrast, adaptive strategies did not show an association with
psychopathology symptoms longitudinally, suggesting their pre-
dictive power might be limited.
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Received November 18, 2010
Revision received March 4, 2011
Accepted March 8, 2011