Examining a Cascade Model of Urgency

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1 Running head: IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE

Impulsivity, Affect, and Stress in Daily Life: Examining a Cascade Model of Urgency

Brinkley M. Sharpe1

Leonard J. Simms2

Aidan G. C. Wright1

1 University of Pittsburgh

2 University at Buffalo, The State University of New York

In press, Journal of Personality Disorders

This is an unedited manuscript accepted for publication. The manuscript will undergo copyediting, typesetting, and review of resulting proof before it is published in its final form.

This research was supported by grants from the National Institute of Mental Health (F32

MH097325, Wright; R01 MH080086, Simms). The opinions expressed are solely those of the authors and not necessarily those of the funding source.

Correspondence concerning this article should be addressed to Brinkley Sharpe,

Department of Psychology, University of Pittsburgh, 3137 Sennott Square, 210 S. Bouquet St.,

Pittsburgh, PA, 15260. E-mail: [email protected] 2 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE Abstract

Using multilevel structural equation modeling, we examined within- and between-person predictors of daily impulsivity, with a particular focus on testing a cascade model of affect and daily stress in a 100-day daily diary study of 101 psychiatric patients with personality disorder diagnoses. On average (i.e., fixed effect), within-person increases in daily stress were associated with increased daily impulsivity, both independently and as accounted for by positive associations with increased negative and positive affect. Higher Personality Inventory for DSM-

5 (PID-5) Impulsivity scores were associated with amplified within-person links between impulsivity and daily stress and negative affect, but not the links between daily stress and either positive or negative affect. The results of this cascade model are consistent with the hypothesized links between daily affect and stress and daily impulsivity while providing further evidence for the validity of the PID-5 Impulsivity scale and its ability to predict daily impulsivity above and beyond fluctuations in affect and stress.

Keywords: Impulsivity, daily stress, urgency, multilevel structural equation modeling 3 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE Impulsivity, Affect, and Stress in Daily Life: Examining a Cascade Model of Urgency

Impulsivity is a common component of the diagnoses codified in the Diagnostic and

Statistical Manual for Mental Disorders (DSM; American Psychiatric Association, 2013). In the fourth edition of the DSM (APA, 2000), impulsivity was found to be the second most common symptom throughout (Lynam & Miller, 2004). However, “impulsivity” is conceptualized and assessed in the psychological literature in many different ways, reflecting a broad and heterogeneous concept comprised of distinct but related constructs, traits, and behaviors. These myriad definitions of “impulsivity” can largely be reduced to three factors— (lack of) behavioral control, urgency, and sensation seeking (Creswell et al., in press; Sharma, Kohl, Morgan, &

Clark, 2013; Sharma, Markon, & Clark, 2014).

Urgency, the focus of this report, originally was conceptualized solely as negative urgency, specifically the disposition toward rash action in the context of negative emotions

(Whiteside & Lynam, 2001). Sperry, Lynam, Walsh, Horton, and Kwapil (2016) characterize negative urgency as the “most pathological” (p. 157) facet of a four-factor model of impulsivity characterized by urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking, where the higher order factor of behavioral control is broken down into two component parts.

Higher trait levels of negative urgency have been shown to be associated with symptoms of borderline personality disorder (including non-suicidal self-injury, Bresin, Carter, & Gordon,

2013), disordered eating behaviors, aggression, and depression (Miller, Flory, Lynam, &

Leukefeld, 2003; Berg, Latzman, Bliwise, & Lilienfeld, 2015), as well as suicidality and anxiety

(Berg et al., 2015). Positive urgency, or disposition toward rash action in response to strong positive affect, has been suggested as a potential fifth factor contributing to impulsivity (Cyders et al., 2007). 4 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE The UPPS-P (Cyders et al., 2007) urgency scales were designed to measure if… then processes (“If one experiences strong negative (or positive) emotion, then one will engage in risky behaviors.”). Urgency is distinct from an average tendency towards intense affect and a general propensity toward ill-considered behavior (see Peterson & Smith; 2019)—it is the process by which one relates to the other over much briefer timescales. Just as a single measurement of ocean depth cannot account for tides and waves, contextualized dynamic processes such as urgency at best can only be approximated by dispositional scales. Global self- report measures like UPPS can provide information regarding individual differences, but studying a process using static methods risks missing important information. Furthermore, dispositional scales of contextualized dynamic processes risk becoming clouded by the influence of retrospective bias (Shiffman, Stone, & Hufford, 2008). Recognizing these limitations, researchers are increasingly turning to direct assessment and modeling of the urgency process.

Direct examination of the connection between fluctuations in positive and negative affect and impulsive behaviors is necessary to understand the processes of urgency. All individuals experience emotions in response to daily experiences, but the degree and quality of these emotions varies, even in those with high emotional reactivity. Similarly, not all strong emotions lead to impulsivity1, even in those with impulsive traits. In studying urgency, then, it is important to illuminate both the differences between individuals and the intraindividual processes which drive the connection between situation, affect, and risk taking.

Researchers are now beginning to examine urgency as a process. For instance, Sperry,

Lynam, and Kwapil (2018) used ecological momentary assessment (EMA) to examine the associations of UPPS-P scores at baseline with momentary affect, urges, and behaviors in daily

1 We acknowledge an inconsistency in our use of “impulsivity” in light of our stated objections. While we make efforts to use specific terminology (i.e., urgency; disinhibited impulsivity) when possible, we default to the less precise term when discussing the multidimensional construct as a whole. 5 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE life. Undergraduate students (N=294) completed an average of 37 EMA surveys (SD = 11.9) which included items addressing both positive and negative affect and a six-item impulsivity index written to assess risky behavior as well as lack of planning and perseverance (e.g., “Since the last beep, did something risky”; “Since the last beep, acted without thinking”). Ratings of negative and positive urgency correlated strongly (r = .77, p < .001) at baseline, and they showed a remarkably similar pattern of associations with momentary variables. Both baseline negative and positive urgency were associated with individual differences in momentary negative affect

(e.g., dysphoria, irritability) and momentary impulsivity (all individual items and their combination in the single index), and negatively associated with positive affect (e.g., happiness).

However, these findings are only adjacent to the key articulation of the urgency process, which is directly reflected in the within-person association between affect and impulsivity. Both types of urgency moderated within-person associations of the impulsivity index with a single-item indicator of stress (“My current situation is stressful”), and, as theorized, negative urgency moderated the association of impulsivity and negative affect. Positive urgency, however, did not moderate the association of impulsivity and positive affect. Instead, like negative urgency, it moderated the relationship between negative affect and impulsivity. These findings suggested that the UPPS-P urgency factors describe a single process of urgency which operates in conditions of strong negative affect. For individuals who describe themselves as tending to act rashly in the face of positive affect, there was no evidence of this predisposition in the moment.

Urgency is especially important to examine in clinical samples because emotion regulation and behavioral inhibition are common points of dysfunction across diverse syndromes of psychopathology. For example, in a daily diary study of young adults concurrently enrolled in a randomized controlled trial of naltrexone on alcohol use, Bold and colleagues (2017) examined 6 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE whether trait urgency moderated the effect of daily affect and alcohol consumption. As evidence for the discriminant validity of urgency, both positive and negative urgency were significant predictors of affect-driven drinking behavior, however the remaining UPPS-P factors were not.

For individuals with high trait negative urgency, high daily negative affect had a greater association with drinking to the point of intoxication than it did for individuals with lower levels of trait negative urgency. A similar pattern emerged for trait positive urgency and daily positive affect. However, in the case of negative urgency (but not positive urgency), this effect was not affect-specific. Higher levels of negative urgency rated at baseline showed significant associations with drinking behavior on days higher in both positive and negative affect.

The processes underlying fluctuations in affect and impulsive behavior also hold clinical relevance in the case of borderline personality disorder. In particular, urgency is associated with self-harm in both undergraduate (Tragesser & Robinson, 2009) and clinical samples (Whiteside,

Lynam, Miller, & Reynolds, 2005; for positive urgency, Peters, Upton, & Baer, 2013).

Miskewicz and colleagues (2015) used EMA to study the dynamic processes involved in borderline personality disorder with the aim of predicting symptoms from trigger occurrence.

Using multilevel modeling, the researchers fleshed out a Trigger-Symptom Contingency Model, showing that each trigger studied was a unique predictor of borderline personality disorder symptom expression and that the strength of “contingencies” between trigger and symptom provided significant explanations of disorder severity between persons. Specifically, individuals who had higher levels of borderline personality disorder symptomology experienced both more triggers and stronger connections between those triggers and symptom responses than individuals with lower levels of severity. The interaction of severity and several specific triggers

(e.g. being offended, disappointment, and having one’s self-concept threatened) predicted both 7 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE self-harm and other impulsive behaviors. In essence, this is a diagnosis specific model of urgency within borderline personality disorder (e.g. “If I experience disappointment (negative affect), then I will self-harm (impulsive behavior)”). In the present study, we consider a clinical sample with diverse diagnoses, moving beyond borderline personality disorder and alcohol use to include other maladaptive personality manifestations and externalizing problems, as well as individuals with internalizing disorders. This allows us to examine if and how urgency manifests as a shared process among various forms psychopathology and how this compares to results from undergraduate samples (Sperry et al., 2018).

Current Study

A major impetus for the present study is the disagreement regarding discriminant validity

(or a lack thereof) between positive and negative urgency. While Sperry and colleagues (2018) argued strongly against considering positive urgency as a distinct entity and instead suggested that all manifestations of impulsivity in the context of strong emotions be subsumed under a single urgency factor (without an affect modifier), not all research has generated such similar results for negative and positive urgency. Cyders and colleagues (Cyders et al., 2007; Cyders &

Smith, 2007) suggest that positive urgency uniquely explains variance in risky and impulsive behavior, relative to negative urgency. Specifically, positive urgency was a significantly better predictor for risky behaviors during positive affect than other conceptualizations of impulsivity

(including negative urgency; Cyders et al., 2007). In a sample of trauma-exposed individuals with substance use disorders, Weiss and colleagues (2015) found negative and positive urgency to independently mediate the relationship between symptoms of post-traumatic stress disorder and engagement in risk behaviors. In addition, Miller, Vachon, and Lynam (2009) suggested that impulsivity (unlike the broader domain of neuroticism) correlates with not just elevated 8 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE mean negative affect, but also with affective instability. We acknowledge the strong correlation between positive and negative urgency (.67, p < .01, Zapolski, Cyders, & Smith, 2009) in cross- sectional research and are aware that positive urgency has not demonstrated enough independent incremental predictive power to gain wide acceptance, especially when assessed as an individual difference. However, we believe further research on this construct is warranted, especially when directly assessed as a dynamic process, as the construct has been conceptualized and defined.

Replication of Sperry and colleagues’ (2018) results using different methodology, instruments of measurement, samples, and alternative statistical models is required before we wholly reject the notion of specificity in affectively driven impulses.

Sperry and colleagues’ (2018) work provides a broad template for the effect of dispositional urgency on process differences within individuals. They show not only correlations between positive and negative urgency and momentary impulsivity, but also find both types of urgency to moderate relationships among within-person variables in a manner that is largely consistent with a model of unitary urgency. Specifically, their research fails to support positive urgency as a unique construct or to confirm a hypothesized moderation effect of positive urgency on the momentary relationship between positive affect and impulsive behavior. However, as the authors discuss, these findings may be particular to the instruments (i.e., UPPS-P) used or characteristics of the sample population (e.g., undergraduates). Bold et al. (2017) considered the dynamics of affect and impulsivity within individuals in a treatment-seeking population and found differential patterns of association for positive and negative urgency, but this exploration was linked to specific risk behaviors (e.g., alcohol use).

In the present study, we draw on these previous efforts and expand upon them.

Specifically, we build upon Sperry et al. (2018) by moving from an undergraduate to a clinical 9 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE sample and by considering a multivariate, theoretically-derived model of urgency processes, from trigger to symptom expression. We seek to provide a complementary evaluation of urgency, taking a broader look at affect and impulsivity in a generalized clinical population—one limited only by severity of personality pathology, not a specific categorical typology. We extend previous findings by considering a specific cascade from which stressful experiences lead to affective reactions, which in turn lead to impulsive actions. Although these processes are important in individuals with certain disorders or behavior profiles, we believe that the more general dynamics at play deserve further consideration. Although impulsivity certainly plays a role in specific psychopathology, we assert that it is a more basic process that spans from healthy manifestations to extreme dysfunction. We extend findings from undergraduates (Sperry et al.,

2018) to a clinical sample in order to flesh out the continuum from very low to moderate levels of maladaptivity to include individuals with problems of a severe and pervasive nature. We also expand upon previous work by considering an intermediate level of analysis between momentary report and baseline measure—the daily diary. While daily diary reports cannot assess within-day variability, a single daily assessment is less burdensome on participants than EMA allowing for longer time-series that may capture more instances of relatively rare behaviors, such as impulsivity.

We briefly consider a dispositional measure of general impulsivity and its patterns of association between individuals, but unlike Sperry and colleagues (2018) we do not aim to compare UPPS-P or any other specific measures of trait urgency to daily-level stress, affect, or impulsivity. Instead, we derive a model of urgency from theory and model the process directly at the daily level, specifying separate cascades through positive and negative affect. This 10 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE methodology allows for a novel examination of the extent to which positive urgency and negative urgency explain impulsivity when controlling for the effects of the other.

Although the process of ignition will never describe the celebratory explosions that light up the sky, one cannot examine a display of fireworks without the strike of a match. Stress was selected as a non-specific catalyst for affective response and the daily manifestation of psychopathology. In contrast to Sperry and colleagues (2018), we measure stress as a summation of the severity of seven potential daily stressors (using the Daily Inventory of

Stressful Events; Almeida et al., 2002), instead of with a single item. Within the same sample,

Wright, Hopwood, and Simms (2015) found daily stress to be a significant predictor for concurrent and day-lagged instability in dominant and affiliative interpersonal behaviors, as well as positive and negative affect, supporting our selection. Thus, at the within-person level, positive and negative affect were expected to operate as waypoints on the contingency or pathway between a stress “trigger” and the target symptom of impulsive behavior (see

Miskewicz et al.’s [2015] Trigger-Symptom Contingency Model in an EMA study of borderline personality disorder for a similar approach to modeling dynamics in psychopathology). In other words, we modeled both urgency (affect to impulsivity) and its antecedent, emotional reactivity

(stress to affect). However, as we did not believe that positive and negative affect were the only intervening factors in the trajectory from stressful experience to impulsive behavior, the model also allowed for stress to have a direct effect upon impulsivity. At the between-person level we examined patterns of associations among individual differences in these within-person processes.

Of particular interest was whether a daily relationship between positive affect and impulsivity would be present adjusting for the effect of negative affect on impulsivity.

Additionally, we examined whether individual differences in the within-person link between 11 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE positive affect and impulsivity and negative affect and impulsivity were associated strongly, consistent with a unitary urgency process, or whether they were weakly associated, consistent with different processes. We did not test moderation of these within-person effects by trait impulsivity. Instead, at the between-person level, associations with dispositional ratings of impulsivity were examined. For individuals with higher levels of trait impulsivity, we expected that daily negative affect would be more strongly associated with impulsivity. We hypothesized a similar result for daily positive affect. However, because affective responses to stress were anticipated to be a more general process not specific to urgency, we did not anticipate that dispositional ratings of impulsivity would associate with the within-person links between stress and affect.

Methods

The present study uses data previously described in Wright and colleagues (2015) and

Wright and Simms (2016). Portions of these methods section are reproduced from previous publications by contributing authors.

Participants

Individuals were recruited for participation in a daily diary study from a clinical sample

(N = 628) enrolled in a study to improve efficient measurement of PD (Simms et al., 2011).

Participants were recruited into the broader sample by distributing flyers at mental health clinics across Western New York and were eligible for participation in the parent study if they reported psychiatric treatment within the past 2 years. Those who met the threshold for any specified PD diagnosis (PD-NOS was not evaluated or diagnosed) on a clinical interview were contacted for possible participation in the daily diary study. The sole additional requirement for participation was daily Internet access via computer or mobile device, with no additional exclusionary criteria. 12 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE One hundred sixteen participants attended the baseline assessment for the daily diary study. To ensure reliable estimates of variability, 15 individuals were excluded for providing less than 30 diaries, resulting in an effective sample size of 101. Of the retained participants, 66

(65.3%) were women, and the majority reported being either White (82.2%) or Black (14.9%).

The PD diagnosis base rates were as follows: 35.6% paranoid, 13.9% schizoid, 16.8% schizotypal, 7.9% antisocial, 36.6% borderline, 2.0% histrionic, 19.8% narcissistic, 53.5% avoidant, 5.9% dependent, and 50.5% obsessive– compulsive. The average number of PD diagnoses per participant was 2.4. Additionally, 62.4% were diagnosed with mood disorders,

69.3% with anxiety disorders, 8.9% with psychotic disorders, and 23% with substance/alcohol use disorders. Seventy-two percent of participants reported current outpatient mental health care treatment, 14% within the last year, and the remainder longer than 1 year before the daily diary protocol.

Procedure

Written informed consent was obtained before participation. The relevant institutional review board approved all study procedures. Participants attended an in-person training and assessment session during which study procedures were explained, and self- report measures were completed via computer. Starting the evening of the in-person assessment, participants began completing daily diaries via secure website every evening (between 8 PM and midnight) for 100 consecutive days. Participants received daily email reminders and also were provided several paper diaries they could use in the event of technological difficulties. Compliance rates were very high, with a total of 9,022 diaries completed by participants in this study after data cleaning (Mdn = 94 days, M = 89.5 days, range = 33–101 days), a small fraction of which were done by paper (~2% of completed diaries). Compensation was provided for daily participation at 13 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE the rate of $100 for participation of at least 80% and prorated at $1/day for < 80%. Participation also was incentivized though recurring raffles ($10 drawing every 5 days for those providing at least four diaries) and drawings for additional money and tablet computers at the end of the study, with the odds of winning proportionally tied to participation.

Measures

Reliability for included subscales is demonstrated with McDonald’s omega (휔; Zinbarg,

Revelle, Yovel, & Li, 2005) values (Table 1).

Baseline questionnaires.

During the in-person assessment, participants in Wright and Simms (2016) completed a variety of measures of personality and psychopathology. The present paper concerns only the

Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) and demographic information gathered during the same session.

Personality Inventory for DSM-5 (PID-5).

The PID-5 is provided by the American Psychiatric Association as a patient-report assessment of five pathological personality traits—Negative Affect, Detachment, Antagonism,

Disinhibition, and Psychoticism—comprised of 25 lower order facets. The 220 items are rated on a four-point Likert scale (0 – Very False or Often False; 1 – Sometimes or Somewhat False; 2

– Sometimes or Somewhat True; 3 – Very True or Often True). In the current study, we only used the facet of Impulsivity given that it is the closest match to extant measures and conceptualizations of the processes under study. Impulsivity is assessed with six items (e.g.

“Even though I know better, I can’t stop making rash decisions.”) and is defined in-part as

“acting on the spur of the moment in response to immediate stimuli … without a plan or 14 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE consideration of outcomes … [or] a sense of urgency and self-harming behavior under emotional distress.” (p. 780; APA, 2013)

Daily diary.

The daily diary was designed for the assessment of personality disorder manifestation.

Relevant to this analysis are the Daily Expression of Personality Disorders (DPDS; Wright &

Simms, 2016), the Daily Inventory of Stressful Events (DISE; Almeida, Wethington, & Kessler,

2002), and Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988).

Daily Expression of Personality Disorders Scale (DPDS).

The DPDS was developed specifically for the parent study and is described in detail in the supplementary material of Wright and Simms (2016). The 30 items were written to assess nine domains: Affectivity, Urgency, Detachment, Exhibitionism, Hostility, Manipulativeness,

Impulsivity, Compulsivity, and Psychoticism. Each item begins with the stem “Over the past 24 hours…” and is rated on a seven-point Likert scale from 0 (Not at All) to 7 (Very Much).

For the purpose of the present analysis, items from the Urgency and Impulsivity domains were combined into a single measure of impulsive behavior. Specifically, means of the ratings for the following four items were calculated to represent daily engagement in impulsive behavior: “I acted on impulse while feeling upset” and “I acted on my emotions” (both Urgency items); “I did something on impulse” and “I behaved irresponsibly” (two of the three

Impulsivity items). One item from the Impulsivity domain (“I did something dangerous just for the thrill.”) was excluded because it appeared to measure sensation-seeking or risk-taking instead of disinhibited or urgent impulsivity, as reflected in comparably lower factor loadings in prior analyses with these data (Wright et al., 2015).

Daily Inventory of Stressful Events (DISE). 15 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE The DISE (Almeida, Wethington, & Kessler, 2002) assesses stressful events relating to arguments/disagreements, potential arguments/disagreements, work/school, home, and discrimination, as well as stressful experiences that happened to close others. Other stressful events are captured with the item, “Did anything else happen to you since this time yesterday that most people would consider stressful?” In the present study, a self-report version (Neupert,

Almeida, Mroczek, & Spiro, 2006) of the original semi-structured interview was administered.

Participants answered the seven original stem questions, reporting whether or not the stressful event described happened to them in the preceding 24 hours. For each “Yes” answer, participants then rated the severity of the stressor on a four-point scale from “Not at all” to

“Very.” The sum of severity scores (with zero entered for “No” answers) across all seven items formed a measure of daily stress with a maximum value of 28. Scores ranged from 0 to 21.

Positive and Negative Affect Schedule (PANAS).

The positive and negative affect items used in the daily diary were drawn from Watson,

Clark, and Tellegen’s (1988) Positive and Negative Affect Schedule (PANAS). The PANAS traditionally includes 20 adjectives—10 each assessing negative and positive affect. For this study, ten adjectives were selected. Positive affect was represented by Active, Alert, Attentive,

Determined, and Inspired. Negative affect was represented by Afraid, Nervous, Hostile,

Ashamed, and Upset. For each adjective, participants were asked to “Please indicate to what extent you have felt this way over the past 24 hours” on a five-point Likert-style scale (0 – Very

Slightly, 1 – A Little, 2 – Moderately, 3 – Quite A Bit, 4 – Extremely). Daily negative affect and positive affect were calculated by taking the mean ratings for each set of items.

Analytic Plan 16 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE To test our hypothesized cascade model, we used Mplus Version 8.2 (Muthén & Muthén,

1998-2018) to estimate a multilevel structural equation model (MSEM). We specified random effects at the within-person level and added fixed effects to adjust for time and day of the week

(weekday vs. weekend). Bayesian estimation with uninformed priors was used because it provides a true latent decomposition into within- and between-person variance for both the predictors and outcome variables when random effects are specified, and because it provides estimates of standardized effects.

Within-subjects (Level 1).

The cascade from stress to impulsivity through both positive and negative affect is a process ongoing within the individual. We modeled this at the daily level by regressing daily impulsivity (IMP) on the severity of same-day stressors (STRESS), positive affect (PA) and negative affect (NA). PA and NA were simultaneously regressed upon STRESS and were allowed to associate with each other.

This model is presented in Figure 1, where ImpReactivity, PAReactivity, NAReactivity,

PosUrgency, and NegUrgency represent the regressions of IMP on STRESS; PA on STRESS; NA on STRESS; IMP on PA; and IMP on NA, respectively.

Between-subjects (Level 2).

Whereas the model of primary interest was expected to play out as a process within individuals, we additionally estimated an associative model at Level 2 with the inclusion of dispositional impulsivity (PID-IMP). Random intercepts measuring individual STRESS, IMP,

NA, and PA were also included, along with individual differences in the five slopes identified at

Level 1 (ImpReactivity, PAReactivity, NAReactivity, PosUrgency, and NegUrgency). We made no specific predictions regarding this level of the model other than the general notion that PID- 17 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE IMP would likely operate as an individual difference associated with the affective and impulsivity links in the cascade model.

Results

Means and standard deviations are listed in Table 2. Bayesian estimation was used to provide standardized values (except where noted).

Within-Subjects (Level 1)

All hypothesized paths (ImpReactivity, PAReactivity, NAReactivity, PosUrgency, and

NegUrgency) were significant at a 95% credibility interval. Results are presented in Table 3 alongside single-path (univariate) models. The strongest pathway in the model was the regression of NA on STRESS (NAReactivity), such that on average, a standard deviation increase in the severity of daily stress was associated with a half standard deviation increase in negative affect. Elevated daily negative affect in turn was associated with increased daily impulsive behavior (NegUrgency), supporting the full cascade of negative urgency. A cascade for positive urgency was also seen, but this effect was markedly weaker than the one seen in negative urgency (PAReactivity and PosUrgency) and the effect sizes suggest it is largely negligible on average. Daily stress also exhibited a direct effect on daily impulsive behavior that was unaccounted for by affect (ImpReactivity). PA and NA showed a very weak positive correlation at the daily level. Tests of indirect effects indicated that each of these pathways were significant.2

All estimated random effects were significant indicating significant individual variability in the effects. Fixed and random effects for the unstandardized model are reported in Table 4.

Between-Subjects (Level 2)

2 Unstandardized effects: Positive indirect effect = .003 (SE = .002, 95% CI = .000, .008); Negative indirect effect = .054, SE = .008, 95% CI = .040, .072) 18 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE As seen in Table 5, a number of associations emerged with dispositional impulsivity. As expected, PID-IMP correlated with daily impulsive behavior where greater impulsive behavior at the between person level was associated with a higher latent mean of daily impulsivity. PID-

IMP also showed positive and negative associations with NA and PA, respectively. Regarding the relationship with the random slopes from the cascade model at the within-person level, PID-

IMP was associated with both ImpReactivity and NegUrgency, but not any of the other paths. In other words, individuals who showed higher levels of impulsivity at the trait level showed stronger links between stress and impulsive behavior and negative affect and impulsive behavior at the daily level. No association of the positive urgency cascade was seen at the between- subjects level, nor did dispositional impulsivity appear to associate with the within-person relationship between daily stress and the affectual response.

Other associations can be seen between the regression paths from the cascade model—in fact, PosUrgency, or the within-person regression of impulsivity on positive affect, was the only pathway to fail to achieve any significant associations at Level 2. The random intercept of daily impulsive behavior correlated with both ImpReactivity and NegUrgency, mirroring the pattern seen with the PID-IMP scale. The random intercept of daily stress was negatively associated with NAReactivity, such that for individuals with higher mean daily stress, there was a weaker connection between stress and negative affect.

The random intercepts of NA and PA also associated with these within-person pathways.

NA showed an association with ImpReactivity, where higher mean daily negative affect strengthened the relationship between stress and impulsive behavior not accounted for by same- day affect. PA was negatively associated with PAReactivity such that mean daily positive affect was associated with a weaker within-person connection between stress and positive affect. 19 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE Finally, associations were seen between the random intercepts themselves. Specifically,

STRESS and IMP, NA and STRESS, and NA and IMP reached statistical significance.

Discussion

We examined within- and between-person predictors of daily impulsive behavior, with a particular focus on testing a cascade model of daily impulsivity and affect (both positive and negative). Specifically, we estimated a model where daily stress predicted positive affect and negative affect, and positive affect and negative affect predicted impulsive behavior. Stress also was specified to have a direct effect on impulsive behavior. Within-person increases in daily stress were associated with increased daily impulsivity both independently and as partially accounted for by positive associations with increased negative affect and positive affect. Each of these associations exhibited significant variability across participants, such that individuals differed in the strength of these within-person associations. Dispositional impulsivity, measured by the PID-5 Impulsivity facet, was added to the model as a between-person variable. We hypothesized that this might be associated with intra-individual variability in the strength of the within-person cascade. Higher PID-5 Impulsivity scores were associated with stronger links between daily stress, negative affect, and impulsive behavior. Our findings support a within- person cascade model of the process of urgency where, at the daily level, stress serves as to enhance impulsive behavior both directly and through negative and positive affect. Parts of this process (namely the connections between stress and impulsive behavior and between negative affect and impulsive behavior) are amplified in individuals who report stronger baseline impulsive traits.

The results in our heterogeneous sample of individuals with personality disorders are consistent with findings in more specific clinical samples. For example, Tomko and colleagues 20 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE (2015) found that both trait and momentary impulsivity were associated with increased negative affect in individuals with borderline personality disorder and major depressive disorder. The present study extends these findings beyond these populations and additionally explores stress as a situational catalyst for the affect-impulsivity connection.

The presence of independent effects for both regression pathways in the same model, as well as a lack of association among within-person links in positive affect, negative affect, and impulsive behavior suggests that the cascade of negative urgency and positive urgency may operate as separate processes. This stands in contrast to dispositional scale results which rely on retrospective self-report. (Note that prior research that has compared daily report of behavior compared with retrospective reports has found that retrospective reports do especially poorly at capturing the pattern of fluctuations in behavior [e.g., Carney, Tennen, Affleck, Del Boca, &

Kranzler, 1998; Shiffman et al., 1997].) Consistent with the equivocal nature of previous findings regarding positive urgency, no association between PID-5 Impulsivity and the relationship between daily positive affect and impulsive behavior was observed. However, considering both levels of analysis, our results provide a basis for the continued examination and use of positive urgency as a construct, especially when modeled directly as a process within individuals.

In the present study, we focused on negative urgency and positive urgency as theoretical processes and modeled them as such, rather than relying on dispositional ratings of the constructs. Using this approach, we were able to differentiate and describe pathways to impulsive behavior from both positive and negative affect in the context of stress. Although significant, the strength of the positive affect-related pathways was demonstrably weaker than those for stress to negative affect (.05 versus .24) and negative affect to impulsive behavior (.06 21 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE versus .52). Nevertheless, we do not view these results as directly contradicting those reported in

Sperry and colleagues (2018), whose results come down in favor of unitary urgency, as their study largely examined the discriminant validity of the UPPS-P Positive Urgency scale relative to its negative affect-related counterpart. We similarly find that the PID-5 Impulsivity facet preferentially associates with our cascade model of negative urgency.

Importantly, however, there were significant individual differences in the strength of the within-person linkages among daily affect and impulsivity, such that for some individuals there was a positive association between positive affect and impulsive behavior and for some a negative association. Thus, for some individuals the effect runs the opposite direction, such that daily positive affect is predictive of less impulsive behavior, echoing Sperry and colleagues’

(2018) results. The wide heterogeneity in individual effects also points to another limitation of cross-sectional dispositional scales of Urgency, which fail to treat the within-person link between affect and impulsive behavior as bi-polar. That is, while high values on the UPPS-P scales are indicative of urgency, low values do not consider opposite patterns, such as behaving impulsively when low in positive affect or behaving less impulsively when high in positive affect. Both are plausible and our findings suggest some individuals exhibit these patterns and comparable patterns with negative affect. We believe these findings have broader implications about the conceptualization of the within-person link between affect and impulsivity that go beyond unipolar urgency. Further, they provide impetus for clinicians and researchers concerned with intervention to continue considering positive affect as a unique pathway through which urgent impulsivity can originate or manifest.

Our cascade model—and the theory of urgency upon which it is based—suggests a series of directional effects such that stress (or another situational trigger) is the antecedent of affect 22 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE which, in turn presages impulsivity. Although a rate of sampling less frequent than the rate of the process being assessed can captures this process in a regression framework (Granger, 1969), strong causal conclusions should not be drawn from these results. However, at worst, this is no more of a problem for daily-level models than it is for dispositional scales. In fact, we believe that urgency is likely to be a self-reinforcing process in which situation leads to affect and then to impulsivity, which, in turn, leads to new situations which also generate affectual responses… and so forth, until this self-reinforcement results in a trait-like manifestation.

Limitations

Our results are tempered by several limitations. The sample in the parent study was wholly clinical, and limited to individuals with personality disorders. In particular, Wright and

Simms (2016) note that their sampling strategy resulted in an oversaturation of internalizing relative to externalizing psychopathology. This may have resulted in a sample with fewer and less extreme reports of impulsivity at both the state and trait levels. Further research in the community or in a clinical population enriched for externalizing behavior would be necessary to generalize this model more broadly. However, unlike prior samples who have been limited to undergraduates or selected on a single diagnosis, our findings provide reassuring generalizability.

All measures relied on participant self-report. This may reduce the reliability of our findings in comparison to studies which include several reporters or laboratory measures of these constructs. However, for impulsivity, laboratory behavioral measures show little relationship with the self-report measures of the construct (Sharma, Markon, & Clark, 2014). In addition, the daily measures used were created for the parent study, were not intended to separately measure impulsive behavior, and have not been extensively validated. Confirmation of these models 23 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE using other assessment methods is warranted. A daily level modification of the Momentary

Impulsivity Scale (Tomko et al., 2014) would be a natural choice, as the authors demonstrated its high correlation with UPPS (Negative) Urgency.

Due to the nature of secondary data analysis, the selection of catalysts for our cascade model was limited. As a result, we were unable to assess alternatives to stress in this sample.

This is particularly regrettable in the case of events or situations which would be hypothesized to generate a high degree of positive affect. Although we observed a weak positive association between daily stress and daily positive affect, this result may be specific to sample characteristics

(clinical vs. non-clinical), timing (daily vs. momentary) or, more likely, our somewhat idiosyncratic selection of PANAS adjectives. The index of positive affect used in the included a disproportionate number of high arousal items. The adjectives “alert” and “attentive” may present particular problems for interpretation. Although included as positively-valanced states by Watson and colleagues (1988), it is possible that the association with measures of stress is driven by arousal. Future studies should test the urgency cascade using both a variety of precipitating “triggers” for the cascade and unambiguous measures of positive affect that control for arousal.

Future Directions and Conclusion

The results of this cascade model are consistent with the hypothesized link between daily affect and stress and daily impulsive behavior while lending further confidence to the PID-5 facet of Impulsivity and its ability to predict daily impulsive behavior above and beyond fluctuations in affect and stress. However, we do not argue for the superiority of this approach for all research questions and clinical applications. Although we focused our analyses and discussion on the daily process model of urgency, it is unclear whether models drawn from direct 24 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE assessment of stress, affect, and impulsive action at a daily or more frequent interval will provide improved (or equivalent) prediction of risk behavior engagement or other indicators of psychopathology in comparison to dispositional scales which have the advantage of easier and more economical administration. Despite demonstrating significant individual differences in strength (and direction) of the theorized link between positive affect and impulsivity within- individuals and failing to confirm a significant association of positive and negative urgency between-individuals, we cannot draw definitive conclusions of independence as these findings have not been independently replicated.

Future research should seek to confirm this model using the UPPS or related NEO-PI-R facets at the trait level. Although we believe that PID-5 Impulsivity is an acceptable proxy for trait Urgency, such work would be necessary to confirm this. We are especially interested in seeing if the UPPS-P factors of Positive Urgency and Negative Urgency show differential patterns of amplification of our within-person cascade model, aligning with the positive affect and negative affect mediated paths respectively, or if they both index a unitary urgency factor.

Extension of the daily cascade model to the momentary level with more frequent measurement is also warranted. This would facilitate a more nuanced comparison of our process model with the results of Sperry and colleagues (2018) and other studies which relate trait urgency measures to daily or momentary affect and behavior. Additionally, modeling both lagged and contemporaneous associations of affect and impulsivity at the sub-daily level will allow us to draw stronger inferences regarding the hypothesized dynamics underlying emotion-based impulsivity. 25 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE References

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Figure 1. Diagram of within-person cascade model. Double-headed dashed line represents association between PAti and NAti. All other pathways represent regressions. 31 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE

Table 1

Reliability for included subscales, presented as McDonald's omega (Zinbarg, Revelle, Yovel, & Li, 2005) values.

Measures 휔 Between-Individuals PID-5 Impulsivity 0.86 DISE Severity 0.91 DPDS Impulsive Behavior * 0.91 PANAS PA 0.95 NA 0.91 Within-Individuals DISE Severity 0.58 DPDS Impulsive Behavior * 0.73 PANAS PA 0.80 NA 0.72 Note. DISE = Daily Inventory of Stressful Events; DPDS= Daily Expression of Personality Disorders; PID-5 = Personality Inventory for DSM-5; * One item removed for construct clarity

32 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE

Table 2

Means and Standard Deviations

n M SD IMP 9022 0.81 1.26 NA 9022 1.78 0.85 PA 9022 2.67 0.98 STRESS 9022 2.34 3.43 PID-IMP 101 0.96 0.71 Note. PID-IMP only measured at baseline. 33 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE Table 3

Within-subjects associations of stress, affect, and impulsivity in daily life.

Univariate Multivariate Lower Upper Lower Upper Estimate 2.5% CI 2.5% CI Estimate 2.5% CI 2.5% CI ImpReactivity 0.30 0.27 0.32 0.15 0.13 0.17 PosUrgency 0.07 0.04 0.09 0.05 0.02 0.07 NegUrgency 0.32 0.29 0.34 0.24 0.20 0.26 PAReactivity 0.06 0.03 0.09 0.06 0.03 0.08 NAReactivity 0.52 0.50 0.54 0.52 0.50 0.54 Note. All pathways estimated as random effects. Bayesian estimation is used to provide standardized values. Bolded values are significant at a 95% credibility interval. 34 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE Table 4

Fixed and random effects for the unstandardized model.

Fixed Effect SD of Random Effects ImpReactivity (IMP -> STRESS) 0.06 0.07 PosUrgency (IMP -> PA) 0.07 0.22 NegUrgency (IMP -> NA) 0.43 0.29 PAReactivity (PA -> STRESS) 0.01 0.06 NAReactivity (NA -> STRESS) 0.12 0.06 35 IMPULSIVITY, AFFECT, AND STRESS IN DAILY LIFE Table 5

Associations among individuals differences in stress, affect, impulsivity, urgency, and reactivity in daily life.

1 2 3 4 5 6 7 8 1. PIDIMP ------2. ImpReactivity .35 [.05, .58] ------3. PosUrgency .23 [-.07, .45] .12 (-.21, .44) ------4. NegUrgency .28 [.05, .42] .12 (-.13, .33) .12 (-.22, .40) - - - - - 5. PAReactivity .30 [-.01, .50] -.27 (-.50, .06) .14 (-.19, .40) .13 (-.12, .37) - - - - 6. NAReactivity -.04 [-.26, .16] .07 (-.24, .32) -.12 (-.39, .14) .22 (-.08, .45) -.07 (-.42, .13) - - - 7. STRESS .12 [-.08, .34] -.09 (-.33, .16) .01 (-.27, .33) .10 (-.12, .33) -.09 (-.31, .22) -.34 [-.55, -.11] - - 8. IMP .24 (.04, .43) .35 (.08, .56) .10 (-.24, .35) .34 (.01, .56) -.16 (-.42, .08) -.09 (-.34, .14) .54 (.37, .67) - 9. PA -.24 [-.45, -.07] -.03 (-.31, .16) -.09 (-.43, .17) .00 (-.27, .26) -.27 (-.49, -.03) -.13 (-.33, .08) .15 (-.14, .33) .22 (-.02, .39) 10. NA .22 (.01, .41) .31 (.02, .53) .02 (-.24, .30) .02 (-.25, .26) -.14 (-.39, .11) -.14 (-.37, .10) .64 (.56, .75) .65 (.53, .76)