Patterns of Emotional Reactivity and Regulation in Children with Anxiety Disorders

Emotion dysregulation is believed to be a key factor in anxiety disorders. However, the empirical basis for this view is limited, particularly in children and adolescents. This study aimed to examine whether anxious children display negative emotional hyper-reactivity and deficits in emotion regulation, using a new task that presents ambiguous situations with potentially threatening meanings. Forty-nine children diagnosed with either generalized anxiety disorder, social anxiety, or separation anxiety disorder, were compared with 42 non-anxious controls. Relative to controls, anxious children demonstrated (a) greater intensity and frequency of negative emotional responses, (b) deficits in using reappraisal in negative emotional situations and corresponding deficits in reappraisal self-efficacy, and (c) greater reliance on emotion regulation strategies that increase the risk of functional impairment, intense negative emotion, and low emotion regulation self-efficacy. Implications for the assessment and treatment of childhood anxiety are discussed.

[1]  A. Osman,et al.  Reliability and validity of the Beck depression inventory--II with adolescent psychiatric inpatients. , 2004, Psychological assessment.

[2]  R. Rapee,et al.  The Role of Control in Childhood Anxiety Disorders , 2003, Cognitive Therapy and Research.

[3]  R. Davidson Affective Style and Affective Disorders: Perspectives from Affective Neuroscience , 1998 .

[4]  J. Gross,et al.  Neural bases of social anxiety disorder: emotional reactivity and cognitive regulation during social and physical threat. , 2009, Archives of general psychiatry.

[5]  D. Mennin,et al.  Evidence of Broad Deficits in Emotion Regulation Associated with Chronic Worry and Generalized Anxiety Disorder , 2006, Cognitive Therapy and Research.

[6]  J. Gross Emotion regulation: affective, cognitive, and social consequences. , 2002, Psychophysiology.

[7]  Michael D. Edge,et al.  Emotional reactivity and cognitive regulation in anxious children. , 2010, Behaviour research and therapy.

[8]  Ross A. Thompson,et al.  Childhood Anxiety Disorders from the Perspective of Emotion Regulation and Attachment , 2001 .

[9]  T. Ollendick,et al.  The Role of Emotion Regulation in the Treatment of Child Anxiety Disorders , 2007, Clinical child and family psychology review.

[10]  Rob B. Briner,et al.  Changing Moods: The Psychology of Mood and Mood Regulation , 1996 .

[11]  Donna B. Pincus,et al.  Self-efficacy: A Comparison Between Clinically Anxious and Non-referred Youth , 2007, Child psychiatry and human development.

[12]  B. Birmaher,et al.  Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[13]  R. Edelmann,et al.  Self-reported and actual physiological responses in social phobia. , 2002, The British journal of clinical psychology.

[14]  M. Tull,et al.  Emotion regulation difficulties associated with the experience of uncued panic attacks: evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. , 2007, Behavior therapy.

[15]  S. Watts,et al.  Physiological Response and Childhood Anxiety: Association With Symptoms of Anxiety Disorders and Cognitive Bias , 2005, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[16]  D. Watson,et al.  Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. , 1991, Journal of abnormal psychology.

[17]  Cynthia L. Turk,et al.  Emotion regulation among individuals classified with and without generalized anxiety disorder. , 2008, Journal of Anxiety Disorders.

[18]  Cynthia L. Turk,et al.  Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. , 2005, Behaviour research and therapy.

[19]  B. Olatunji,et al.  Implications of emotion regulation for the shift from normative fear-relevant learning to anxiety-related psychopathology. , 2007, The American psychologist.

[20]  B. J. Casey,et al.  Amygdala response to fearful faces in anxious and depressed children. , 2001, Archives of general psychiatry.

[21]  D. Barlow,et al.  Cognitive processing in children: Relation to anxiety and family influences , 1996 .

[22]  W. Silverman,et al.  An integrative model of control: implications for understanding emotion regulation and dysregulation in childhood anxiety. , 2006, Journal of affective disorders.

[23]  Beth M. Phillips,et al.  Temperament, Anxiety, and the Processing of Threat-Relevant Stimuli , 2004, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[24]  P. Muris,et al.  Attention control in middle childhood: relations to psychopathological symptoms and threat perception distortions. , 2007, Behaviour research and therapy.

[25]  Justin S. Feinstein,et al.  Increased amygdala and insula activation during emotion processing in anxiety-prone subjects. , 2007, The American journal of psychiatry.

[26]  J. Gross,et al.  Is there less to social anxiety than meets the eye? Emotion experience, expression, and bodily responding , 2004 .

[27]  Daniel A. Fitzgerald,et al.  Association between Amygdala Hyperactivity to Harsh Faces and Severity of Social Anxiety in Generalized Social Phobia , 2006, Biological Psychiatry.

[28]  T. Ollendick,et al.  The Developmental Psychopathology of Anxiety , 2001 .

[29]  Cynthia L. Turk,et al.  Emotion Dysregulation in Generalized Anxiety Disorder: A Comparison with Social Anxiety Disorder , 2005, Cognitive Therapy and Research.

[30]  C. Dancu,et al.  Physiological, cognitive and behavioral aspects of social anxiety. , 1985, Behaviour research and therapy.

[31]  S. Folkman,et al.  Stress, appraisal, and coping , 1974 .

[32]  Deborah A. Yurgelun-Todd,et al.  Social anxiety predicts amygdala activation in adolescents viewing fearful faces , 2005, Neuroreport.

[33]  Gregory G. Brown,et al.  Increased amygdala activation to angry and contemptuous faces in generalized social phobia. , 2002, Archives of general psychiatry.

[34]  Ross A. Thompson,et al.  Emotion regulation: Conceptual foundations , 2007 .

[35]  M. Smucker,et al.  Normative and reliability data for the children's depression inventory , 1986, Journal of abnormal child psychology.

[36]  A. Richards,et al.  An Anxiety-Related Bias in Semantic Activation When Processing Threat/Neutral Homographs , 1992, The Quarterly journal of experimental psychology. A, Human experimental psychology.

[37]  J. Zeman,et al.  Emotion Regulation in Children and Adolescents , 2006, Journal of developmental and behavioral pediatrics : JDBP.

[38]  Frank J. Farach,et al.  Emotion-Based Approaches to the Anxiety Disorders. , 2007 .

[39]  W. Gerrod Parrott,et al.  Beyond hedonism: Motives for inhibiting good moods and for maintaining bad moods. , 1993 .

[40]  James W. Pennebaker,et al.  The Handbook of Mental Control , 1992 .

[41]  Sandra M. Neer,et al.  The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  Ross A. Thompson,et al.  The double-edged sword : Emotional regulation for children at risk By : , 2009 .

[43]  S. Watts,et al.  Cognitive Errors, Anxiety Sensitivity, and Anxiety Control Beliefs , 2007, Behavior modification.

[44]  R. Rapee,et al.  Family enhancement of cognitive style in anxious and aggressive children , 1996, Journal of abnormal child psychology.

[45]  D. Fergusson,et al.  Life course outcomes of young people with anxiety disorders in adolescence. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[46]  Brian Parkinson,et al.  Classifying Affect-regulation Strategies , 1999 .

[47]  W. Silverman,et al.  Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[48]  James J Gross,et al.  Implicit theories of emotion: affective and social outcomes across a major life transition. , 2007, Journal of Personality and Social Psychology.

[49]  S. Bögels,et al.  Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder , 2000, Journal of abnormal child psychology.

[50]  James J. Gross,et al.  When Emotion Goes Wrong: Realizing the Promise of Affective Science , 2003 .

[51]  C. Suveg,et al.  Emotion Regulation in Children With Anxiety Disorders , 2004, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[52]  B. Mesquita,et al.  The experience of emotion. , 2007, Annual review of psychology.

[53]  S. Mineka,et al.  A contemporary learning theory perspective on the etiology of anxiety disorders: it's not what you thought it was. , 2006, The American psychologist.

[54]  P. Muris,et al.  Contingency-Competence-Control–Related Beliefs and Symptoms of Anxiety and Depression in a Young Adolescent Sample , 2003, Child psychiatry and human development.

[55]  C. MacLeod,et al.  The causal role of interpretive bias in anxiety reactivity. , 2006, Journal of abnormal psychology.

[56]  O. John,et al.  Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. , 2003, Journal of personality and social psychology.

[57]  R. Rapee,et al.  Evaluation and treatment of anxiety disorders in the general pediatric population: a clinician's guide. , 2005, Child and adolescent psychiatric clinics of North America.

[58]  Timothy A Brown,et al.  Acceptability and suppression of negative emotion in anxiety and mood disorders. , 2006, Emotion.

[59]  A. Beck,et al.  Anxiety disorders and phobias : a cognitive perspective , 2005 .

[60]  C. Suveg,et al.  "I'd rather not talk about it": emotion parenting in families of children with an anxiety disorder. , 2008, Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association.

[61]  C. G. Last,et al.  Anxious children in adulthood: a prospective study of adjustment. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[62]  O. John,et al.  Emotion Regulation in Everyday Life. , 2006 .

[63]  J. Gross The Emerging Field of Emotion Regulation: An Integrative Review , 1998 .