Understanding Dysregulated Behaviors and Compulsions: An Extension of the Emotional Cascade Model and the Mediating Role of Intrusive Thoughts

Abstract

Objective: The Emotional Cascade Model (ECM) by Selby et al. (2008) proposes that people often engage in dysregulated behaviors to end extreme, aversive emotional states triggered by a self-perpetuating vicious cycle of (excessive) rumination, negative affect, and attempts to suppress negative thoughts.

Method: Besides replicating the ECM, we introduced intrusions as a mediator between rumination and behavioral dysregulation and tested this extended ECM for compulsions as part of obsessive-compulsive disorders. A structural equation modeling approach was used to test this in a sample of N = 414, randomly recruited from the general population.

Results: Intrusions were found to fully mediate the effect of rumination on a broad array of dysregulated behaviors and compulsions. This mediation endured when controlling for symptoms of depression.

Conclusion: These findings support the idea that rumination fuels intrusions, which in turn foster dysregulated behaviors. Therefore, addressing rumination as well as intrusions may improve psychotherapeutic interventions for mental disorders characterized by dysregulated behaviors and/or extreme aversive emotional states.

Keywords: (cognitive) emotion regulation; behavioral dysregulation; compulsions; emotional cascades; intrusion.

FIGURE 1

Structural equation model (SEM) testing the mediational effect of intrusion on the relationship between rumination and behavioral dysregulation, controlling for symptoms of depression. Rumination = Rumination latent variable; BehavDys = Behavioral Dysregulation latent variable; TSI = Thought Suppression Inventory; Intrusions = Intrusions latent variable; CERQ_Rum = Rumination scale of the Cognitive Emotion Regulation Questionnaire (shortened German version); CERQ_Cata = Catastrophizing Scale of the Cognitive Emotion Regulation Questionnaire (shortened German version); RSQ_RumSy = Rumination about Symptoms of the Response Styles Questionnaire; RSQ_RumSe = Rumination about Self of the Response Styles Questionnaire; DIRI_Reass = Reassurance Seeking scale of the Depressive Interpersonal Relationships Inventory; DMQ_Cope = Drinking to Cope scale of the Drinking Motives Questionnaire; EDI_Bulim = Bulimia scale of the Eating Disorder Inventory; STAXI_Out = Anger-Out scale of the State-Trait Anger Expression Inventory; UPPS_Urg = Urgency scale of the Urgency, Lack of Premeditation, Lack of Perseverance, Sensation Seeking-Impulsivity scale; MIHT_Behav = Behavioral scale of the Multidimensional Inventory of Hypochondriacal Traits; Symptoms of Depression were quantified by the 9 items of the PHQ-9 (factor loadings: 0.65–0.86); all scales are latent variables; single items are not presented due to space limitations; values in brackets: β-regression weights in SEM without control of depressive symptoms; all factor loadings were significant on the 1% level; ^∗∗∗p ≤ 0.001; model fit: χ²(1999): 2790.02 (p < 0.001), CFI: 0.93, TLI: 0.93, and RMSEA: 0.031. R² BehavDys: 0.65.

FIGURE 2

Structural equation model (SEM) testing of the mediational effect of intrusions on the relationship between rumination and compulsion, controlling for symptoms of depression. Rumination = Rumination latent variable; Compulsions = Compulsions latent variable; TSI = Thought Suppression Inventory; Intrusions = Intrusions latent variable; CERQ_Rum = Rumination scale of the Cognitive Emotion Regulation Questionnaire (shortened German version); CERQ_Cata = Catastrophizing Scale of the Cognitive Emotion Regulation Questionnaire (shortened German version); RSQ_RumSy = Rumination about Symptoms of the Response Styles Questionnaire; RSQ_RumSe = Rumination about Self of the Response Styles Questionnaire; OCI_Check = Checking scale of the Obsessive–Compulsive Inventory; OCI_Wash = Washing scale of the Obsessive–Compulsive Inventory; OCI_Order = Ordering scale of the Obsessive–Compulsive Inventory; OCI_Hoard = Hoarding scale of the Obsessive–Compulsive Inventory; OCI_Neutral = Neutralizing scale of the Obsessive–Compulsive Inventory; Symptoms of Depression were quantified by the 9 items of the PHQ-9 (factor loadings:0.65–0.86); all scales are latent variables; single items are not presented due to space limitations; values in brackets: β-regression weights in SEM without control of depressive symptoms; all factor loadings were significant on the 1% level; ^∗∗∗p ≤ 0.001; model fit: χ²(1160): 1782.38 (p < 0.001), CFI: 0.94, TLI: 0.94, and RMSEA: 0.036. R² Compulsions: 0.33.