Emotion regulation in patients with cardiovascular disease: development and validation of the stress and anxiety regulation strategies scale (STARTS)

ABSTRACT

Background and Objectives: Anxiety and stress influence the onset and prognosis of cardiovascular disease (CVD), but little is known about what CVD patients do when experiencing stress/anxiety. This study aimed to identify the behavioral strategies CVD patients use to regulate these emotions. Design: Instrumental and longitudinal. Methods: A theoretically-guided scale, the Stress and Anxiety Regulation Strategies (STARTS), was developed considering the target population’s characteristics. CVD patients were recruited at three different points (N_T1= 721, N_T2= 566, N_T3= 311). Results: At T1 exploratory factor analysis was conducted (random sample 1). The validity of the most parsimonious three-factor solution was subsequently found via confirmatory factor analysis at T1 (random sample 2), T2, and T3, revealing good and stable model fit. The factors represented strategies differentiated by the type and level of activity required (passive, intellectual, and physical strategies). The scale showed good test-retest reliability and internal consistency. Correlation and regression analyses with positive and negative affect, psychological wellbeing (stress, anxiety, depression), and cardiac self-efficacy provided evidence for the validity of STARTS score. Physical and passive strategies showed opposite patterns. Conclusions: The scale shows adequate psychometric properties for assessing the strategies used by CVD patients to regulate stress and anxiety.

KEYWORDS:

• Cardiovascular health
• stress
• anxiety
• emotional regulation
• self-care

Acknowledgements

This work was supported by the Spanish Ministry of Economy and Competitiveness under Grant number PSI2014–58609-R, in which Dr. Carmen Tabernero is the principal investigator, and by the Spanish Ministry of Science, Innovation and Universities under Grant number PDI2019-107304RB-I00, in wich Dr. Bárbara Luque and Dr. Carmen Tabernero are the principal investigators.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher.

Additional information

Funding

This work was supported by Ministerio de Ciencia, Innovación y Universidades: [Grant Number PDI2019-107304RB-I00]; Ministerio de Economía y Competitividad: [Grant Number PSI2014–58609-R].