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