Emotion Regulation Flexibility as a Mediator of Religious Influences on Cardiovascular Biomarkers in Bereavement

Abstract

Bereaved adults experience heightened cardiovascular risk during a time when they must cope with the profound stress of their loss. Religion and spirituality represent coping resources during bereavement and may mitigate the emotional and physiological toll of the death of a close loved one. Evidence suggests that religion contributes to emotion regulation, and that emotional dysregulation is a psychological determinant of cardiovascular risk in bereavement. The present research examined the associations between religious outlooks (Existential Quest, Religious and Spiritual Struggle) on one hand, and cardiovascular biomarkers on the other, among adults within the first year of bereavement (N = 75, Age M = 64.58, SD = 18.41) exposed to a grief-related emotion elicitation protocol. Participants completed a set of initial questionnaires prior to completing a 14-day daily diary, and then returned for collection of cardiovascular data including ECG during an emotion elicitation protocol. Existential Quest, an index of flexible existential and religious worldviews, was expected to correspond with more flexible styles of emotion regulation, contributing to biomarkers indicative of cardiovascular resilience. Religious and Spiritual Struggle, an index of religious distress, was expected to be associated with constrained and less flexible emotion regulation, and with cardiovascular biomarkers indicative of greater cardiovascular risk. Study analyses tested the mediating role of flexible emotion regulation—operationalized by an index derived from 14-day daily diary responses—in the relationship between religious/spiritual outlooks and cardiovascular biomarkers. Cardiovascular biomarkers included systolic and diastolic blood pressure and heart rate variability. In mediation analyses two groups of models were tested: one tested the mediating role of emotion regulation flexibility in the association between Existential Quest and cardiovascular biomarkers. The other tested the mediating role of emotion regulation flexibility in the association between Religious and Spiritual Struggle and cardiovascular biomarkers. Existential Quest was negatively associated with flexible emotion regulation (B = -.23, SE = .10, p = .02), but Religious and Spiritual Struggle was not (B = -.28, SE = .16, p = .08). Flexible emotion regulation was unassociated with cardiovascular biomarkers in any of the models. Only Religious and Spiritual Struggle exhibited a negative direct effect on systolic (but not diastolic) blood pressure (B = .29, SE = .11, p = .007). Exploratory analyses found that Existential Quest and Religious and Spiritual Struggle both predicted poorer outcomes on loneliness and grief severity. Religious and Spiritual Struggle predicted greater self-reported difficulties in emotion regulation, and Existential Quest predicted higher depression. These results suggest that Existential Quest orientation may be indicative of greater difficulties after bereavement, and lend further support for the importance of religious and meaning-making processes after the death of a close loved one. Alternative approaches to longitudinally conceptualizing emotion regulation flexibility as a variable of interest in future research are discussed.