Emotion Regulation and Psychopathology in Children and

(1)

(2)

(3)

(4)

1

Emotion Regulation and Psychopathology in Children and

Adolescents

Edited by

Cecilia A. Essau Sara Leblanc

Thomas H. Ollendick

(5)

1

Great Clarendon Street, Oxford, OX2 6DP, United Kingdom

Oxford University Press is a department of the University of Oxford.

It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries

The moral rights of the authors have been asserted First Edition published in 2017

Impression: 1

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above

You must not circulate this work in any other form and you must impose this same condition on any acquirer

Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data

Data available

Library of Congress Control Number: 2016963281 ISBN 978– 0– 19– 876584– 4

Printed and bound by

CPI Group (UK) Ltd, Croydon, CR0 4YY

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up- to- date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non- pregnant adult who is not breast- feeding

Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work.

(6)

Preface

This contemporary volume brings forefront research in emotion regulation and how processes underlying emotion regulation have a bearing on the field of child and adolescent psychopathology. The book shows continuity by initially introducing the topic of emotion and its regulation and then narrowing its scope, analyzing the role emotion regulation plays in specific disorders while critically examining current assessment and treatment strategies. In the concluding chapters, emotion regulation in high risk, targeted groups is assessed and intervention and prevention is explored.

This book has brought together an array of leading international scholars who specialize in the emotional disorders. We have asked them to summarize the latest findings in their field while assessing intervention through a comparative, critical lens in order to pass on this crucial knowledge to the next generation of mental health professionals. Each chapter is unique, as authors expose the reader to different approaches and outlooks from diverse specialties for diverse problems.

This 20- chapter volume consists of four parts. In Part 1, broad issues are discussed such as the biological, physiological and cultural factors underlying and impacting emotion regulation and psychopathology in children and adolescents. In Part 2, specific disorders are delineated and current treatment programs are discussed, including Attention Deficit Hyperactivity Disorder, conduct disorder, anxiety disorders, depression, eating disorders, substance use disorders, autism spectrum disorder, borderline personality disorder, and severe irritability and disruptive mood dysregulation disorder. Part 3 assesses emotion dysregulation in specific targeted populations, including children of abuse and neglect, children of divorce, children with incarcerated parents, children exposed to traumatic stress, and adolescents who engage in nonsuicidal self- injury. It investigates the interplay between environment, behavior and self- regulation and the etiology, maintenance and propagation of psychopathology in these diverse environments. The final part of this book conceptualizes emotional regulation as a transdiagnostic process and discusses innova- tive approaches to treatment that arise when viewed through this lens.

This book combines the latest research from leading academics on a variety of clinical topics with an emphasis on intervention from an applied perspective; this combination of appli- cation and theory makes it a suitable reference for mental health professionals by providing empirical review and current data on treatment efficacy. However, it was particularly designed for graduate students taking advanced courses in clinical psychology and psychiatry who want to remain abreast of current breakthroughs and leading treatment options for child and adolescent psychopathology.

We wish to acknowledge the efforts of the contributors, whose expertise and dedication to the project have been outstanding. Without them, a comprehensive coverage of the various topics would not have been achieved. Additionally, we wish to acknowledge the support and cooperation of the staff at Oxford University Press.

Cecilia A. Essau, Sara Leblanc, & Thomas H. Ollendick

(7)

(8)

Acknowledgments

I (Cecilia Essau) feel very honoured to have had this opportunity to co- edit this volume with my highly respected colleague, Tom Ollendick, who’s been a great inspiration, mentor, scientist, clinician and very good, patient and understanding friend to me, and with Sara Leblanc, who introduced me to emotion regulation during her research. I wish to thank my family in Malaysia, Canada and Germany, especially my husband, Juergen, and our daughter, Anna, for their continuing support and inspiration. I dedicate this volume to my late parents, Essau Indit and Runyan Megat, whose courage, love and belief in me have made me become who I am; had they still been alive, they would have been most proud of this accomplishment and my choice of emotion regulation strategies.

I (Sara LeBlanc) wish to express gratitude to my respected colleague Cecilia Essau for giving me the opportunity to serve as a co- editor on this influential volume. Over the years Cecilia has served as a role model, mentor and inspiration due to her humility, grace and impeccable ethic; it was through her determination and vision that this work came to fruition. I also wish to express my deepest thanks to Professor Ollendick, I am humbled and inspired by your contribution to the field of Psychology, it was a privilege and honor to have the opportunity to work with you. I also wish to thank my family and friends for their unwavering dedication and support, especially my parents Blaine, Noreen and grandmother, Juanita. Finally, I also wish to thank my late sister Amanda for our countless adventures; her valuable insights taught me to see the humor in all things and have given me many memories I will eternally cherish, to her I dedicate this volume.

I (Tom Ollendick) wish to give thanks to my good friend and colleague, Cecilia Essau, who invited me to serve as one of the co- editors of this important volume with her. This has been a rewarding project and one that would not have been possible without her vision and dedication.

I also wish to thank Sara LeBlanc whom I have met through this project and with whom I would very much like to work with in the future. Finally, I give thanks to my wife, Mary, our daughters, Laurie and Katie, and our sons- in- law, David and Billy, as well as our six grandchildren, Braden, Ethan, Calvin, Addison, Victoria and William. Without them, my life would be much less interest- ing and enjoyable. I thank them for their love and support over the years. My own emotion regulation has been much the better with them at my side. To them, I dedicate this work.

(9)

(10)

List of Abbreviations

ACC anterior cingulate cortex ACEs adverse child experiences ADHD Attention Deficit Hyperactivity

Disorder AG Agoraphobia

ALS Affective Lability Scales AM autobiographical memory

AN Anorexia Nervosa

ANS autonomic nervous system

APA American Psychiatric

Association

ARFID Avoidant/ Restrictive Food Intake Disorder

ASD Autism spectrum disorder

BA behavioural activation

BABCP British Association of Behavioural and Cognitive Psychotherapies

BP bipolar I disorder

BPD borderline personality disorder BPS British Psychological Society

BSI Brief Symptom Inventory

CAT Cognitive analytic therapy CBITS Cognitive Behavioral

Intervention for Trauma in Schools

CBT cognitive behaviour therapy

CD conduct disorder

CDC Centers for Disease Control and Prevention

CERQ Cognitive Emotion Regulation Questionnaire,

CGI Clinical Global Impression CIDI Composite International

Diagnostic Interview CODIP Children of Divorce Intervention Program

CP conduct problems

CSR clinical severity ratings

CU callous- unemotional

CVR cardiovascular reactivity

DBT Dialectical Behavior Therapy DBT- ST Dialectical Behavior Therapy

Skills Training DERS Difficulties in Emotion

Regulation Scale

DMDD disruptive mood dysregulation disorder

DSM Diagnostic and Statistical Manual of Mental Disorders DTS Distress Tolerance Scale

EA experiential avoidance

EABT Emotion Acceptance Behavior Therapy

ECBT Emotion- Focused Cognitive- Behavioral Therapy

ED emotional dysregulation

EF executive function

EMA Ecological Momentary

Assessment

EMDR eye- movement sensitization processing

EMG electromyography

EPM Extended Process Model

ERPs event- related potentials

ERT Emotion Regulation Training

EUC Enhanced Usual Care

FBT family based treatment

FFCWB Fragile Families and Child Well Being

FFT Functional family therapy fMRI functional magnetic resonance

imaging

GAD generalized anxiety disorder HCPC Health and Care Professions

Council

HED heavy episodic drinking

HF- HRV high- frequency heart rate variability

HFASD high- functioning autism spectrum disorder

HPA hypothalamic– pituitary– adrenal

(13)

HRV heart rate variability ICD- 6 Sixth edition of the

International Classification of Diseases

ID Intellectual disability INS insomnia

IPPA Inventory of Parent and Peer Attachment Inventory ISRE incarceration- specific risk

experiences

IY The Incredible Years

LHPA limbic- hypothalamic- pituitary- adrenal

LPE Limited Prosocial Emotions

LPP late positive potential MAAS Mindfulness Attention Scale MACT Manual Assisted Cognitive-

Behavioural Therapy MANTRA Maudsley Model of Anorexia

Nervosa Treatment for Adults MBT mentalization based therapy MBT- A MBT for adolescents

MBT- F MBT for families

MDD major depressive disorder MEAQ multidimensional experiential

avoidance questionnaire MPC medial prefrontal cortex

MST Multisystemic Therapy

MTF The Monitoring the Future

NBP New Beginnings Program

NC non- clinical comparisons NICE The National Institute of

Clinical Excellence

NIMH National Institute for Mental Health’s

NSDUH The National Survey on Drug Use and Health

NSPCC National Society for the Prevention of Cruelty to Children

NSSI nonsuicidal self- injury ODD oppositional defiant disorder OGM overgeneral

autobiographical memory OST One- session treatment PATHS Promoting Alternative

Thinking Strategies

PCMC- A Parents and Children Making Connections— Highlighting Attention

PD Panic Disorder

PDs personality disorders

PFC prefrontal cortex pgACC pregenual anterior

cingulate cortex

PMT Parent management training

PNS peripheral nervous system PSST Problem- Solving Skills

Training

PTS posttraumatic stress symptoms

PTSD posttraumatic stress disorder RCTs randomized controlled trials RDoC Research Domain Criteria RSA respiratory sinus arrhythmia RVLPFC right ventral lateral

prefrontal cortex RO- DBT Radically- Open DBT SA sinoartial

SAD Separation Anxiety Disorder SAS- OR Secret Agent Society- Operation

Regulation

SDQ Strengths and Difficulties Questionnaire

SHAPS Snaith- Hamilton Pleasure Scale

SIB self- injurious behavior SM Selective Mutism

SMD severe mood dysregulation

SNS sympathetic nervous system

SP Specific Phobias

SPACE Supportive Parenting for Anxious Childhood Emotions

SSRIs selective serotonin reuptake inhibitors

SSRT Stop Signal Reaction Time Task

STAIR Skills Training in Affect and Interpersonal Regulation STEPPS Systems Training for Emotional

Predictability and Problem Solving

SUD substance use disorder

(14)

TAU treatment- as- usual TFP transference- focused

psychotherapy

TRY Thinking about Reward in

Young People

UP Unified Protocol

UP- Y Unified Protocol for the Treatment of Emotional Disorders in Youth

WHO World Health Organization

WPVA Word, Perception,

Valuation, Action

(15)

(16)

List of Contributors

Ma. Araceli Balajadia- Alcala

De La Salle University- Manila, Philippines Julian Baudinet

Sydney Children’s Hospital Network (Westmead Campus), Sydney, Australia Renae Beaumont

University of Queensland, Australia Anna Bokszczanin

University of Opole, Poland Melissa A. Brotman

National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA Maria Aurora Assumpta D. Catipon InTouch Community Services, Makati City, Philippines

Luna C. M. Centifanti University of Liverpool,UK Junwen Chen

Flinders University, Adelaide, Australia Brian C. Chu

Rutgers, The State University of New Jersey, USA

Michelle G. Craske

University of California, Los Angeles, USA Danielle Dallaire

College of William and Mary, USA Shiri Davidovich

University College London, London, UK Lisa Dawson

University of Sydney, Sydney, Australia Sandra Dunsmuir

University College London, London, UK Nancy Eisenberg

Arizona State University, USA Cecilia A. Essau

University of Roehampton, London, UK

Blossom Fernandes

University of Roehampton, London, UK Dagmar Kr. Hannesdóttir

Throska- og hegdunarstod, Reykjavik, Iceland Penelope Hasking

Curtin University, Perth, Australia Phillipa Hay

Western Sydney University, Sydney, Australia Maciel M. Hernández

Arizona State University,USA Katharina Kircanski

National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA Selda Koydemir

Middle East Technical University, Northern Cyprus

Sara Leblanc

College of New Caledonia, Quesnel, Canada Ellen Leibenluft

National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA Elizabeth A. Lemerise

Western Kentucky University, USA Sloane Madden

Sydney Children’s Hospital Network (Westmead Campus), Sydney, Australia Olivia Manayan

University of Hawaii Cancer Center, Honolulu, Hawaii, USA

Carla A. Mazefsky

University of Pittsburgh School of Medicine,USA

Kateri McRae

University of Denver, USA

(17)

Christina Mele

Gregory A. Miller

University of California, Los Angeles, USA Thomas H. Ollendick

Virginia Polytechnic Institute and State University, USA

Frances Rice

Cardiff University, UK & University College London, UK

Faye Riley

University of Roehampton, London, UK Priscilla Burnham Riosa

York University, Canada M. Koa Robinson

Brandon G. Scott

Arizona State University, REACH Institute, USA

Carla Sharp

University of Houston, Houston, Texas, USA Michelle Shiota

Arizona State University, USA Jeffrey S. Simons

University of South Dakota, USA Tracy L. Spinrad

Arizona State University, USA

Michael Sun

University of California, Los Angeles, USA Roseann Tan- Mansukhani

De La Salle University- Manila, Philippines Maria Caridad H. Tarroja

De La Salle University- Manila, Philippines Andrea Temkin

Nicholas D. Thomson University of Durham, UK Timothy J. Trull

University of Missouri, Columbia, Missouri, USA

Meghan Vinograd

University of California, Los Angeles, USA David Voon

Monash University, Melbourne, Australia Carl F. Weems

Iowa State University, USA Jonathan A. Weiss York University, Canada Thomas A. Wills

Justine Xue

Flinders University, Adelaide, Australia Janice Zeman

College of William and Mary, USA

(18)

General Issues

(19)

(20)

Chapter 1 Emotion Regulation: An Introduction

Sara LeBlanc, Cecilia A. Essau, & Thomas H. Ollendick

Human emotions

Human emotions are an integral component of everyday life that influence cognitive functioning (Bebko, Franconeri, Ochsner, & Chiao, 2011; Eysenck, 2004; Gross, 2013) memory (Christianson, 2014) and overall wellbeing (Kotsou, Gregoire, & Mikolajczak, 2011). Emotions impact both intra- personal and interpersonal processes, and, when dysregulated, they may become destructive and intrusive in daily life (Frijda, 1986; Slee, Arensman, Garnefski, & Spinhoven, 2007), contributing to the development, maintenance, and propagation of psychopathology (Castella et al., 2013).

In general, emotion regulation competencies become differentiated as a function of development. Children tend to seek support from adults or use behavioral techniques to regulate emotions. As children reach adolescence, they become increasingly self- reliant, engaging in planful problem solving and utilizing cognitive strategies (for example, reappraisal) more frequently when faced with stressful life events (Zimmer- Gembeck & Skinner, 2011). Although the majority of children and adolescents will successfully navigate these developmental stages by cultivating adaptive coping skills, for some, this marks the beginning of lifelong challenges with emotion regulation and resultant dysregulation (Kessler et al., 2005).

This introductory chapter will begin by discussing both the definition and functionality of emotions; it will then turn to a discussion of emotion regulation and associated processes. Critically, it will consider the importance of this topic as it pertains to emotional wellbeing, whilst also examining the crucial link between emotion dysregulation and psychopathology in children and adolescents. Later in the chapter, various emotion regulation strategies will be described and categorized according to their utility, emphasizing strategies that demonstrate adaptive social, cognitive and physiological benefits. This information is critical in delineating the underlying mechanisms leading to the development and propagation of psychopathology, which is crucial when tailoring effective treatment and prevention programs specifically suited to both the child and adolescent populace.

Definition and function of emotions

Emotion is a dynamic and convoluted construct. A comprehensive definition of emotions must consider three key aspects, which include: The conscious experience elicited via the emotion;

the underlying neurological processes involved in emotion generation and finally, the observable behavior and facial expression evoked by the emotion (Izard, 2013). Universally accepted within the literature, emotion has been broadly defined as “[a] person- situation transaction that compels attention, has particular meaning to an individual, and gives rise to a coordinated, yet flexible, multi- system response to the on- going person- situation transaction” (Thompson, 2007, p. 5).

Emotions are important due to their relative influence on cognition, appraisal processes, perception, and ultimately, behavior. They impact decision- making (Cassotti, Habib, Poirel, Aïte, &

Moutier, 2012; Mikels, Maglio, Reed, & Kaplowitz, 2011; Oatley & Johnson- Laird, 1987), learning (Ahmed, van der Werf, Kuyper, & Minnaert, 2013; Cahill, Prins, Weber, & McGaugh, 1994) and

(21)

drive goal pursuits (Koole, 2009; Tice, Bratslavsky, & Baumeister, 2001). It has been hypothesized that emotions evolved to promote the species by eliciting specific action patterned responses to life threatening circumstance, thereby increasing the likelihood of survival. From this stand- point a negative bias would be adaptive; for example, in prehistoric times hearing a rustling in the bush if one was likely to interpret this as a threat, feel fear, and ultimately flee, one would be more likely to survive than if a more positive appraisal was made, viewing the sound as innocuous, rather than life threatening (Sapolsky, 2007). However, in post- industrial societies humans are often faced with psycho- social stressors, which activate the fight- or- flight response (Hypothalamic–

pituitary– adrenal axis: HPA axis) in the same manner even though they are no longer placed in life threatening circumstances. This chronic activation can have a deleterious impact on overall wellbeing if stress levels are not regulated.

In terms of adaptive function, the positive emotions may be facilitative, as they broaden attentional focus (Derryberry & Tucker, 1994) whilst concurrently enhancing the scope of cognition.

For example, a series of classical experiments demonstrated that when compared with a control condition, those in a positive state were able to make more unique associations with neutral words (Isen, Johnson, Mertz, & Robinson, 1985). This led researchers to conclude that positive affect enhances cognitive processing via the promotion of cognitive flexibility, elaboration, and integra- tion, whilst concomitantly fostering relatedness and interconnection between cognition, ideas, and action (Isen, 1987; Isen & Daubman, 1984).

Emotions in childhood and adolescence

In terms of development, infants will vary in individual difference with regards to the intensity and frequency at which they express emotion. Additionally, the way caregivers respond to their expression of emotion is critical in the development of their emotion regulation competencies and their attachment style (Izard, 2013). The famous strange situation experiment (Ainsworth

& Wittig, 1969) demonstrated varying attachment styles of children between the ages of 12 and 24 months based on their emotional response when placed in various stressful situations. Their behavior towards their caregiver in these situations allowed their attachment to be categorized as either secure, insecure avoidant, and insecure ambivalent/ resistant. Insecure attachment occurred when the infant’s emotional needs were not adequately met by the caregiver, this transactional process impacted both the behavior of the child and caregiver. Accordingly, insecure attachment has been associated with an increased risk of emotional, interpersonal, and behavioral problems (Dang & Gorzalka, 2015; Kobak et al., 1993).

In terms of development, emotions impact personality development two- fold (John & Gross, 2004). Firstly, genetic predisposition plays an integral role in establishing core traits, propensities, and thresholds for various emotive states (Hariri & Forbes 2007). The second key feature is the child’s experiences (Campos, Walle, Dahl, & Main 2011) and key learnings relating to their emotional health with particular importance placed on how the expression of emotion and regulation is socialized (Izard, 2013). In addition, an individual’s development of their emotional traits will play a critical role in their social development such that the child who is quick to anger, frightens easily, frequently smiles, will attract and receive differentiated responses based on their behavior (Van Reekum & Scherer, 1997). Thus, emotional development influences social development and also plays a critical role in intellectual development. An infant who is frequently distressed or afraid will be far less likely to explore their environment when compared with a child who is content and curious. Tomkins (1962) asserts that the emotion “interest” is a critical component required for intellectual development. Thus, adaptive emotional development serves a myriad of functions that influence social, intellectual and interpersonal growth.

(22)

Emotion regulation

Emotions are complex and dynamic: They can be useful or deleterious. Thus, the key to optimum emotional functioning is adaptive emotion regulation, which is characterized by implementing effective strategies that are contextually appropriate and account for individual difference and personal preference (Gross & John, 2003).

Varying definitions of emotion regulation exist within the developmental literature (Cole, Martin & Dennis, 2004). For example, according to Gross (1998) emotion regulation refers to the heterogeneous set of processes individuals implement to modulate their emotional experiences.

This definition subsumes both the “up” and “down” regulation of emotions, as an individual may decrease, increase or maintain negative and positive emotions (Erber, Wegner, & Therriault, 1996;

Parrott, 1993). Alternatively, emotion regulation has been defined as a “[p] rocess used to man- age and change if, when, and how (e.g., how intensely) one experiences emotions and emotion- related motivational and physiological states, as well as how emotions are expressed behaviorally”

(Eisenberg et al. 2007, p. 288). Eisenberg and Spinrad (2004) posit that although intrinsic and extrinsic factors play a role in emotion regulation, it is advantageous to distinguish between external and internal regulation. External regulation refers to external forces, such as parents, teachers, and peers, which influence emotion regulation. This may be particularly pertinent in the early childhood years, when support seeking from adults is a primary form of affect regulation in nor- mative development (Zimmer- Gembeck & Skinner, 2011). In contrast, internal regulation refers to effortful, self- regulation, which may include a variety of cognitive and behavioral strategies an individual chooses to implement to modulate their emotional response.

The primary focus of this chapter will be internal self- regulation, as this type of regulation is within the individual’s control and can be shaped through directed intervention, a topic that will be discussed in greater detail in Chapter 2. The definition utilized within this chapter will be consistent with the aforementioned definition put forth by Gross (1998), who views emotion regulation as a varied set of processes individuals engage in to modify their emotional experience.

The ability to effectively regulate emotions is a critical and common place activity (Oschner

& Gross, 2005). Various strategies may be employed that are broadly categorized as antecedent- focused or response- focused strategies (Gross, 1998). Antecedent strategies occur early in the emotion generative process, altering the impact of emotion- eliciting cues; whereas, response- focused emotion regulation occurs later in the process, impacting behavioral responses (Gross

& Thompson, 2007). Emotion regulation influences the intensity, duration, and expression of emotions (Gross, 1999), occurring on a continuum from controlled to automatic, conscious to unconscious (Koole, 2009).

Research has demonstrated the vast majority of emotional experience can be regulated (Canli, Ferri & Dunman, 2009). There are a variety of different strategies which can be employed to regulate emotions which include: Reappraisal of the event (Hofmann, Heering, Sawyer, & Asnaani, 2009), situation modification (Gross, 1998), change of attentional focus (Rothermund, Voss, &

Wentura, 2008), and suppression (Dalgleish, Schweizer, & Dunn, 2009). The two strategies that will be primarily focused on in this chapter are reappraisal and emotional suppression, as they have received the most attention in the literature, with reappraisal primarily associated with positive health outcomes and suppression, primarily associated with negative health outcomes (Gross

& John, 2003).

Cognitive reappraisal is an antecedent technique that involves changing the interpretation of a situation in order to reduce the emotional impact (Gross & Thompson, 2007). Perception is real- ity and our thoughts are linked to our actions, which are linked to our behavior: Every situation can be interpreted in a variety of different ways, and it is this interpretation, rather than the event

(23)

itself, that impacts thoughts, behaviors, and emotions (Malooly, Genet, & Siemer, 2013; Wilding

& Milne, 2010). In children, reappraisal has been shown to be an adaptive method of managing emotions, when compared to other strategies, such as suppression (Carthy et al., 2010; Garnefski

& Kraaij, 2009; McKrae, et al., 2012). In addition, both longitudinally and cross- sectionally, Garnefski and colleagues have demonstrated a strong negative relationship between the reported use of reappraisal and depression in both adolescent and adult populations (Garnefski & Kraaij, 2006; Garnefski, Kraaij, & Spinhoven, 2001; Kraaij, Pruymboom, & Garnefski, 2002). Similarly, research has shown children possessing a secure attachment style are more empathetic due to their superior emotion regulation competencies (Panfile & Laible, 2012). These findings are mir- rored in the adolescent populace, as adolescents demonstrating adaptive emotional regulation competencies are more likely to achieve their goals and form strong interpersonal relationships;

whereas, adolescents with impaired emotion regulation skills, often manifest behavioral problems and are less likely to achieve both long and short- term goals (Hum & Lewis, 2013).

In contrast to reappraisal, emotional suppression has been shown to have negative health outcomes, as studies have linked the frequent use of suppression with depressive symptomology in both children and adolescents (Betts, Gullone, & Allan, 2009; Hughes, Gullone, & Watson, 2011; Larsen et al., 2013). Relatedly, in adolescents, deficits in emotion regulation have been associated with substance abuse (Wilens et al., 2013), aggressive behavior (Herts, McLaughlin, &

Hatzenbuehler, 2012) and pathological gambling (Potenza, et al., 2011), topics which will be discussed in greater detail in subsequent chapters. In general, suppression has been associated with increased negative affect (Srivastava et al., 2009), decreased positive affect (Gross & John 2003), decreased social functioning (English & John, 2013), and enhanced levels of depressive symptomology and obsessive thinking (Corcoran & Woody, 2009; Marcks & Woods, 2005). Furthermore, suppression has been linked to decreased life satisfaction (Kashdan & Steger, 2006), decreased interpersonal skills (Butler et al., 2003), enhanced sympathetic nervous- system activation (Egloff, Schmuckle, Burns, & Schwerdtfeger, 2006), increased stress- related symptomology (Moore, Zoellner, & Mollenholt, 2008) and decreased memory recall (Richards, Butler, & Gross, 2003;

Richards & Gross, 2000). In conclusion, the frequent and inflexible use of emotional suppression may be damaging as it prolongs the experience of negative affect (Campbell- Sills & Barlow, 2007), makes excessive use of cognitive resources (Gross & John, 2003) and keeps physiological arousal chronically activated (Eglof et al., 2006; Ohira et al., 2006). Thus, the cultivation of adaptive strategies, such as cognitive reappraisal, is imperative during the formative years so that the use of emotional suppression is minimized.

Function of ER

Historically, it was hypothesized that emotion regulation functioned to satisfy hedonic needs, such that pleasure was maximized and pain minimized (Larsen, 2000; Westen, 1994). This may be due in part to the realization that negative emotions drain an extensive amount of an individual’s physical and mental resources (Sapolsky, 2004; 2007). However, even though hedonic needs may fuel emotion- regulation in some circumstances, they are not the sole motivation for all regulatory function (Erber & Erber, 2000; Erber, Wegner, & Therriault, 1996). For example, if one deems their emotions to be beneficial they may choose to stay in that emotional state even though it is associated with negative and unpleasant feelings (Gross, 2007).

Relatedly, goal pursuits may influence emotion regulation tendencies, leading to short- term discomfort in the quest towards delayed gratification based on a strong commitment to long- term goals (Mischel et al., 2010; Mischel & Ayduk, 2004). Delayed gratification is a common paradigm employed in the investigation of emotion regulation competencies in children dating back to the

(24)

1970’s. Early research showed that some children were able to practice emotion- regulation strategies, such as reframing and distraction, to delay gratification in the interest of garnering a greater reward at a later time. A recent follow- up of the original studies conducted by Mischel and colleagues, demonstrated the predictive validity of the delayed gratification test across a wide range of social, cognitive, and mental health indicators (Casey et al., 2011). Thus, one can infer from this research that the absence of delayed gratification in children can be an early sign of emotion dysregulation. In support, a study by Krueger and colleagues (1996) determined that, in pre- adolescents, the inability to delay gratification was linked to the externalizing disorders. Relatedly, the work of Shoda et al. (1990), determined that preschoolers’ performance on the delayed gratification task accurately predicted behavioral problems from age five to eight. In part, this may be attributed to deficiencies in attentional control and executive function.

Executive function and emotion regulation

Attentional processes play a key role in one’s ability to regulate motivation and emotional arousal;

therefore, executive function is considered a key component of effective emotion regulation.

Executive function (EF) is a multidimensional construct relating to the processes that exercise control over cognition, attention, and behaviors (Blair, Zelazo, & Greenberg, 2005). EF is goal oriented and involves higher order, self- regulatory processes (Nelson, Thomas, & Hann, 2006).

EF emerges during the end of infancy and shows striking changes during the preschool years, continuing to develop throughout adolescence (Zelazo et al., 2008). The literature on EF asserts that an important corollary of cognitive development in early childhood is the ability to diminish the emotional impact of disruptive and distractive stimuli. A study by Ursache, Blair, Stifter, and Voegtline (2013), for example, determined that high levels of executive function were associated with children who exhibited high levels of emotional reactivity in conjunction with high levels of emotion regulation competencies. In addition, children that rated high in both emotional reactivity and emotion regulation where more likely to have increased levels of adaptive parenting.

In adolescence, the cultivation of emotion regulation strategies shows an increase in the use of reappraisal and a reduction in the use of suppression, a progression that mirrors developmental changes occurring in executive functions during this period (Lantrip, Isquith, Koven, Welsh, &

Roth, 2015). More specifically, these researchers determined that the increased use of reappraisal was associated with improved executive function; whereas, the increased use of suppression was associated with worsened executive function in an adolescent sample. Deficiencies in EF are critical during this period, as they have been associated with a plethora of early onset psychiatric disorders, such as conduct disorder and attention deficit/ hyperactivity disorder (Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005), in addition to behavioral problems such as substance abuse and physical aggression (Séguin & Zelazo, 2005). Thus, EF is intimately tied to emotion regulation.

Factors influencing emotion regulation development

Emotion regulation is influenced by a variety of genetic, biological and environmental factors.

Children demonstrate enhanced control of both affect and behavior, shifting control from the brain’s orienting neuronal network during infancy to greater use of executive functions by the age of three to four years. From infancy to toddlerhood connectivity changes in the following way: During the early years, parietal and frontal areas play a crucial role in orienting; whereas, executive function and emotion regulation is regulated via the midfrontal and anterior cingulate regions of the brain in the later years (Rothbart, Sheese, Rueda, & Posner, 2011). On a neurobiological level, individual variations in serotonin levels have been identified, which impact

(25)

an individual’s emotional expressivity and regulation (Hariri & Forbes, 2007). Concordantly, dysregulation of the dopaminergic system has been associated with major depressive disorder (Kennedy, Koeppe, Young, & Zubieta, 2006). Moreover, there seems to be a distinct genetic component to emotion regulation, as evidenced by twin studies, which have shown that identical twins are more similar in emotional control, when compared with fraternal twins (Goldsmith, Buss, & Lemery, 1997).

From a neurobiological stand- point, the development of the prefrontal cortex, hippocampus, and amygdala is associated with higher decision making processes, sustained attentional control and the enhanced capacity to regulate one’s emotions (Ochsner & Gross, 2007) (see Chapter 3).

Environmental factors also play a key role in the development of emotion regulation competencies, particularly in infancy and early childhood. By six months of age an infant’s primary form of emotion regulation occurs through relative interactions with caregivers (Crockenberg & Leerkes, 2004). However, as the child ages, they are influenced by numerous factors such as the parents’

regulatory style, social referencing, peer influence, and parental reactions to their children’s displays of emotion (Zeman, Cassano, Perry- Parrish, & Stegall, 2006).

Furthermore, culture impacts emotion regulation in a myriad of ways, by determining what is valued (i.e., saving face, personal autonomy, etc.), which behaviors are socially acceptable and what is deemed appropriate behavior in varying contexts (see Chapter 4). This was illustrated in a study by Kagan (2003) who compared cultural norms in American and Chinese cultures. This study determined that children in the American sample were socialized to be outgoing, assertive, and bold; thus, children were taught to be highly expressive of both positive and negative affect.

In contrast, in the Chinese sample, shyness was seen as a positive attribute, as it demonstrated the child was studious, hard- working, and willing to prescribe to social norms. Relatedly, in some Asian cultures, emotional suppression is considered an adaptive emotion- regulation strategy, unlike in autonomous cultures (e.g., Australia, America, and the UK); therefore, its consequences do not manifest negatively in these cultures (Butler, Lee, & Gross, 2007) the way they do in cultures subscribing to Western- European value systems. Thus, adaptive emotion regulation is contextually specific and culturally motivated.

Emotion regulation development during childhood and adolescence

Changes in emotion regulation strategies become evident during the first few years of life. At this time, regulation becomes less reflexive (i.e., newborns) and more intentional, involving behavioral control in the absence of external input or monitoring from parents (i.e., self- regulation, see Kopp & Neufeld, 2003). In young infants and toddlers, behavior such as self- soothing (e.g., thumb sucking; Ekas, Lickenbrock, Braungart- Rieker, 2013), reorienting attention (Wiebe et al., 2011), and distracting one’s gaze from negative stimuli (Crockenberg & Leerkes 2004) have been shown to reduce negative affect. In addition, as noted, research has shown an increase in both executive function and effortful self- regulation as children age (Eisenberg et al., 2010).

As noted above, a common measure of emotional control in children is their ability to delay gratification. Improvements in the ability to delay gratification are found from 24 months to four years (Li- Grining, 2007). Further improvements in self- control and executive function occur during the late preschool years (Mezzacappa, 2004); moreover, substantial development in emotion regulation is manifested between six to ten years of age (Stegge & Terwogt, 2007). At this stage of development, critical changes in regulatory competencies occur, as children learn to identify, understand, and analyze emotion- eliciting situations in a cause and effect way, whilst also discov- ering alternative ways of expressing their feelings (Stegge & Terwogt, 2007). Thus, a large body

(26)

of literature has demonstrated that a healthier emotion regulation profile is demonstrated as a function of age and maturation (John & Gross, 2004; Silvers, McRae, Gabrieli, Gross, Remy, &

Ochsner, 2012; Tottenham, Hare, & Casey, 2011).

Sex differences in emotion regulation strategies also occur in line with the adult literature, which have demonstrated that males employ emotional suppression more frequently than females (Eisenberg, Spinrad, & Eggum, 2010). In part, this may be due to socialization processes.

Adolescent emotional development may be influenced by a variety of factors, such as interactions with peers, parents, and teachers, as well as societal influences such as the Internet, media, and contemporary culture (Klimes- Dougan et al., 2007; Morris et al., 2007).

One line of scientific inquiry has investigated the importance of parental influence on adolescents’ emotional development (Yap et al., 2008). This research determined that parental style of emotion regulation (i.e., suppressive, hostile, controlling vs. caring and warm) (Jaffe et al.

2010) and parental expression of emotions as well as their reactions to their children’s displays of emotion (Morris et al. 2007) are all important factors influencing regulatory development.

Eisenberg and colleagues (1998) posit that socialization of emotion regulation occurs in three primary ways, namely, 1) the socializers’ expression of their own emotions 2) the socializers’ reaction to the children’s display of emotions and the 3) the socializers’ amenability towards discussing emotion (see Chapter 2 by Eisenberg and her colleagues on the developmental aspects of emotion regulation).

Emotion regulation and psychopathology in children and adolescents

In children aged two to five years, general rates of psychopathology are 16.2 overall, 10.5% for internalizing/ emotional disorders (see Chapters 8 and 9) and 9% for externalizing/ behavioral disorders (see Chapters 6 and 7), rates which are comparable to those found among older children (Egger & Angold, 2006). Alarmingly, in children, levels of anxiety and depression have increased continually at a dramatic rate since the 1950s (Gray, 2011). Research has shown two broad types of contributing factors: Environmental context/ events and child temperament. In relation to environmental factors, this category includes both specific and global elements; in general, parental supervision, peer problems and sexual abuse have been shown to predict externalizing disorders, neglect has been linked to oppositional defiant disorder (ODD), lack of social support and expo- sure to violence have been associated with the internalizing disorders, while childrearing factors such as a controlling family environment have been linked to the anxiety and depressive disorders (Dierker & Szatmari, 1998; Jaffee, et al., 2002; Merikangas, et al., 2010; Rapee, 1997). However, it is important to note that risk factors are highly complex and it is likely that disorders do not have a single cause but rather a causal chain or multiple causal chains that are influenced by the interaction between various environmental, social, genetic, and biological risk factors (Kraemer, Stice, Kazdin, Offord, & Kupfer, 2014).

Adolescence is a period characterized by marked changes occurring on a hormonal, neurological, and developmental level. These changes directly impact emotionality, affecting both the valence and intensity of negative and positive emotions, providing an opportune time for regulatory skills to be cultivated and honed (Silk et al., 2003). In general, research has shown more extreme mood states (both positive and negative) are typical in adolescent daily life when compared with the adult demographic (Larson, Moneta, Richards, & Wilson, 2002; Larson &

Richards, 1994).

Roughly 20% of adolescents have a psychiatric disorder (McLeod, Uemura, & Rohrman, 2012). An epidemiological study by Costello, Copeland, and Angold (2011) determined the

(27)

prevalence rate for an anxiety disorder was 10.2%, with average onset occurring at eight years of age and 50% of cases falling between six to twelve years of age. Similarly, an epidemiological study investigating general rates of psychopathology in high school students found 10% of students currently had a clinical disorder and 33% had experienced one in their life- times. Additionally, within this sample, high relapse rates were found for both substance abuse (15%) and depression (18%) (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993).

Relatedly, a large scale, longitudinal study by Essau, Lewinsohn, Olaya, and Seeley (2014) determined that adolescent anxiety predicted poor adjustment across a variety of domains (work, family etc.); reduced life satisfaction, substance, alcohol abuse/ dependency, and anxiety in adulthood in a large, community sample of 800 participants.

In the developmental literature, the primary area of interest has focused on children’s malad- justed emotion regulation (Eisenberg, Spinrad, & Eggum, 2010). This research has investigated when normal emotional development is compromised and identified the risk factors associated with atypical development (Cicchetti & Cohen 2006). Factors influencing the development of emotion regulation skills include inherent disposition in addition to social and environmental resources available to the child. Additionally, genetic predisposition and parental influences have been shown to influence the development of psychopathology in adolescents (Rosenstein &

Horowitz, 1996).

From a genetic stand- point, a twin study by Eaves (2006) measuring symptoms of psychopathology, demonstrated that monozygotic twins were more strongly correlated than dizygotic twins with most measures showing small to moderate genetic effects. Concordantly, in relation to depression, the majority of twin studies suggest a moderate genetic influence, with heritability rates ranging between 30– 80% (Eley & Plomin, 1997; Murray & Sines, 1996; Thapar & McGuffin, 1997). In general, these studies support genetic susceptibility to psychopathology across a broad range of disorders in adolescent populations.

In relation to parental influences on emotion regulation propensities, research supports a paradigm of adolescent psychopathology that is influenced by interpersonal interactions with parents (Rosenstein & Horowitz, 1996). This is supported by the work of Grant (2006), who found con- siderable evidence supporting the mediating role that family relationships play in the relationship between stressors and psychological symptoms in both children and adolescents. A study by Rosenstein and Horowitz (1996) determined, in a clinical sample of 60 adolescents psychiatri- cally hospitalized, both child and maternal attachment style were highly concordant, manifesting insecure attachments styles in both the adolescent and the parent. In general, when researching parental influence on adolescent psychopathology, fathers have been highly underrepresented.

However, research shows there is substantial paternal influence; with particularly strong effects found with relation to externalizing problems manifested in adolescents. In most cases these effects were comparable to those associated with maternal psychopathology (Phares & Compas, 1992). A study by Achenbach (1991) determined that in four- to eight- year- olds, externalizing problems were associated with difficulties in emotion regulation including increased levels of anger and impulsivity. Similarly, internalizing problems were associated with enhanced levels of sadness, impulsivity, and reduced attentional control (Eisenberg et al., 2001). These relationships were investigated via a longitudinal design and similar findings were obtained two years later (Eisenberg et al., 2005). In children, certain components of emotion regulation have been associated with particular behavioral difficulties. For example, inhibiting anger or expressing anger in a maladaptive way has been linked to internalizing problems (Zeman, Shipman, & Suveg, 2002).

Similarly, in a sample of eight- to twelve- year olds with various anxiety disorders, a significant relationship was demonstrated between psychiatric disorder and maladaptive emotion regulation as assessed via both self and parent report measures (Suveg & Zeman, 2004). More specifically,

(28)

children with anxiety disorders were more likely to be inflexible, demonstrating heightened worry, anger and negative affect when compared with children in the control conditions. Likewise, a recent study by Tortella- Feliu, Balle, and Sesé (2010), determined that adolescents scoring high in negative affect were prone to implement dysfunctional emotion regulation coping styles.

Conclusion

Emotion dysregulation is strongly associated with psychiatric illness in youth. As mentioned pre- viously, in both children (Hughes, Gullone, & Watson, 2011) and adolescents, the use of emotional suppression has been linked to depressive and anxious symptomology (Betts, 2009; Hannesdottir

& Ollendick, 2007; Larsen et al., 2013). Furthermore, in adolescents, deficits in emotion regulation have been linked with aggressive behavior (Herts, McLaughlin, & Hatzenbuehler, 2012), substance abuse (Wilens et al., 2013), and pathological gambling (Potenza, et al., 2011). Due to the strong association between emotion dysregulation and psychopathology and related problems in living, many studies have been conducted on this topic in the past 15– 20 years. This book includes a collection of these studies, touching on numerous contemporary topics, such as developmental psychology, developmental psychopathology, transdiagonostic issues, and cultural aspects of emotion regulation with exciting incites from leading researchers in the field.

References

Achenbach, T. M. (1991). Child behavior checklist/ 4– 18. Burlington: University of Vermont.

Ainsworth, M. D. S., & Wittig, B. A. (1969). Determinants of infant behavior. Attachment and exploratory behavior of one- olds in a strange situation, 4.

Ahmed, W., Van der Werf, G., Kuyper, H., & Minnaert, A. (2013). Emotions, self- regulated learning, and achievement in mathematics: A growth curve analysis. Journal of Educational Psychology, 105(1), 150– 161.

Betts, J., Gullone, E., & Allen, J. S. (2009). An examination of emotion regulation, temperament, and parenting style as potential predictors of adolescent depression risk status: A correlational study. British Journal of Developmental Psychology, 27(2), 473– 485.

Blair, C., Zelazo, P. D., & Greenberg, M. T. (2005). The measurement of executive function in early childhood. Developmental Neuropsychology, 28(2), 561– 571.

Butler, E. A., Lee, T. L., & Gross, J. J. (2007). Emotion regulation and culture: are the social consequences of emotion suppression culture- specific? Emotion, 7(1), 30.

Cahill, L., Prins, B., Weber, M., & McGaugh, J. L. (1994). β- Adrenergic activation and memory for emotional events. Nature, 371(6499), 702– 704.

Carthy, T., Horesh, N., Apter, A., Edge, M. D., & Gross, J. J. (2010). Emotional reactivity and cognitive regulation in anxious children. Behaviour Research and Therapy, 48(5), 384– 393.

Campbell- Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In Gross (Ed.), Handbook of Emotion Regulation (pp. 542–

559). New York: Guilford Press.

Campos, J. J., Walle, E., Dahl, A., & Main, A. (2011). Reconceptualizing emotion regulation. Emotion Review, 3(1), 26– 35.

Canli, T., Ferri, J., & Duman, E.A. (2009). Genetics of emotion regulation. Special Issue: Neurogenetics as applied to systems and cognitive neuroscience. Neuroscience, 164, 43– 54.

Casey, B. J., Somerville, L. H., Gotlib, I. H., Ayduk, O., Franklin, N. T., Askren, M. K., … & Shoda, Y.

(2011). Behavioral and neural correlates of delay of gratification 40 years later. Proceedings of the National Academy of Sciences, 108(36), 14998– 15003.

Cassotti, M., Habib, M., Poirel, N., Aïte, A., Houdé, O., & Moutier, S. (2012). Positive emotional context eliminates the framing effect in decision- making. Emotion, 12(5), 926– 931.

(29)

Christianson, S. A. (2014). The handbook of emotion and memory: Research and theory. Psychology Press, New York.

Cicchetti, D., & Cohen, D. J. (2006). Developmental Psychopathology. Wiley, Hoboken, New Jersey.

Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific

construct: Methodological challenges and directions for child development research. Child Development, 75(2), 317– 333.

Corcoran, K. M. & Woody, S. R. (2009). Effects of thought suppression and appraisals on thought frequency and distress. Behaviour Research and Therapy, 47(12), 1024– 1031.

Costello, E. J., Egger, H. L., Copeland, W., Erkanli, A., & Angold, A. (2011). The developmental

epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. Anxiety Disorders in Children and Adolescents: Research, Assessment and Intervention, 14(4), 56– 75.

Crockenberg, S. C., & Leerkes, E. M. (2004). Infant and maternal behaviors regulate infant reactivity to novelty at 6 months. Developmental Psychology, 40(6), 1123.

Dalgleish, T., Yiend, J., Schweizer, S., & Dunn, B. D. (2009). Ironic effects of emotion suppression when recounting distressing memories. Emotion, 9(5), 744.

Dang, S. S., & Gorzalka, B. B. (2015). Insecure attachment style and dysfunctional sexual beliefs predict sexual coercion proclivity in university Men. Sexual medicine, 3(2), 99– 108.

De Castella, K., Goldin, P., Jazaieri, H., Ziv, M., Dweck, C. S., & Gross, J. J. (2013). Beliefs about emotion: Links to emotion regulation, wellbeing, and psychological distress. Basic and Applied Social Psychology, 35(6), 497– 505.

Derryberry, D., & Tucker, D. M. (1994). Motivating the focus of attention. In The heart’s eye: Emotional influences in perception and attention, (pp. 167– 196). San Diego, CA, US: Academic Press, xiv, 289 pp.

http:// dx.doi.org/ 10.1016/ B978- 0- 12- 410560- 7.50014- 4

Eaves, L. J. (2006). Genotype× environment interaction in psychopathology: fact or artifact? Twin Research and Human Genetics, 9(01), 1– 8.

Egger H. L, Angold A. (2006). Common emotional and behavioural disorders in preschool

children: presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry. 47(3– 4), 313– 37.

Egloff, B., Schmukle, S. C., Burns, L. R., & Schwerdtfeger, A. (2006). Spontaneous emotion regulation during evaluated speaking tasks: associations with negative affect, anxiety expression, memory, and physiological responding. Emotion, 6(3), 356– 366.

Eisenberg, N., Cumberland, A., & Spinrad, T. L. (1998). Parental socialization of emotion. Psychological Inquiry, 9(4), 241– 273.

Eisenberg, N., Cumberland, A., Spinrad, T. L., Fabes, R. A., Shepard, S. A., Reiser, M., … & Guthrie, I.

K. (2001). The relations of regulation and emotionality to children’s externalizing and internalizing problem behavior. Child Development, 72(4), 1112– 1134.

Eisenberg, N., Zhou, Q., Spinrad, T. L., Valiente, C., Fabes, R. A., & Liew, J. (2005). Relations Among Positive Parenting, Children’s Effortful Control, and Externalizing Problems: A Three‐Wave Longitudinal Study. Child Development, 76(5), 1055– 1071.

Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534– 542.

Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (2010). Emotion- related self- regulation and its relation to children’s maladjustment. Annual Review of Clinical Psychology, 6, 495.

Ekas, N. V., Lickenbrock, D. M., & Braungart‐Rieker, J. M. (2013). Developmental Trajectories of Emotion Regulation Across Infancy: Do Age and the Social Partner Influence Temporal Patterns. Infancy, 18(5), 729– 754.

Eley, T. C., & Plomin, R. (1997). Genetic analyses of emotionality. Current Opinion in Neurobiology, 7(2), 279– 284.

Emotion Regulation and Psychopathology in Children and

1

Emotion Regulation and Psychopathology in Children and

Adolescents

Cecilia A. Essau Sara Leblanc

Thomas H. Ollendick

1

Preface

Acknowledgments

Table of Contents

List of Abbreviations

List of Contributors

General Issues

Chapter 1

Emotion Regulation: An Introduction

Sara LeBlanc, Cecilia A. Essau, & Thomas H. Ollendick

Human emotions

Definition and function of emotions

Emotions in childhood and adolescence

Emotion regulation

Function of ER

Executive function and emotion regulation

Factors influencing emotion regulation development

Emotion regulation development during childhood and adolescence

Emotion regulation and psychopathology in children and adolescents

Conclusion