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

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.