Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Reductions in Anxiety are Associated with Decreased Expressive Suppression and Increased Cognitive Reappraisal After Cognitive-Behavioral Treatment: A Naturalistic Study in Youth

Broad deficits in emotion regulation skills have been observed in children with anxiety-related disorders. These deficits typically improve during cognitive-behavioral therapy (CBT), but few studies have examined changes in expressive suppression and cognitive reappraisal in youth with anxiety disorders and/or obsessive-compulsive disorder (OCD) during CBT, especially in real-world settings. In a naturalistic treatment-seeking sample, 123 youth completed measures of anxiety, depression, and emotion regulation strategy use before and after 15 sessions of CBT. For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD. Thus, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction; improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT.

[Effect of Family Functioning on Adolescents' Internalizing and Externalizing Problem Behaviors: The Multiple Mediating Roles of Empathy and Emotional Competence]

Objective

To examine the mediating role of empathy and emotional competence in the association between family functioning and internalizing and externalizing problem behaviors among adolescents in China.

Methods

In this study, we used the data from the June-July 2022 survey of Chengdu Positive Child Development (CPCD) cohort. All respondents were 5th-9th graders from six primary or secondary schools in Chengdu. The Achenbach Child Behavior Checklist (CBCL), the Chinese Family Assessment Instrument (C-FAI), the empathy subscale of the Chinese version of the Interpersonal Reactivity Index (C-IRI), and the emotional competence (EC) subscale of the Chinese Positive Youth Development Scale (CPYD) were used to evaluate the respondents' internalizing and externalizing problem behaviors, family functioning, empathy, and emotional competence, respectively. The average score derived from the total score of a scale divided by the number of entries in each dimension was used as the final score of the scale. Independent samples t-tests or one-way analysis of variance (ANOVA) were performed to examine the differences in family functioning, empathy, emotional competence, and internalizing and externalizing problem behaviors across student groups with different demographic characteristics (sex, grade, and region). Pearson correlation analysis was conducted to examine the relationship between family functioning, empathy, emotional competence, and internalizing and externalizing problem behaviors. AMOS 24.0 was used to validate the hypothesized model and structural equation modeling was used to analyze the mediating effects of empathy and emotional competence between family functioning and internalizing and externalizing problem behaviors among adolescents.

Results

A total of 3026 eligible participants were included, including 1548 (51.16%) male students and 1478 (48.84%) female students. Among the respondents, 798 (26.37%) were 5th graders, 738 (24.39%) were 6th graders, 567 (18.74%) were 7th graders, 614 (20.29%) were 8th graders, and 309 (10.21%) were 9th graders. In addition, 2064 (68.21%) of all respondents were from urban areas and 962 (31.79%) were from rural areas. The results of the difference analysis showed that the differences in adolescents' internalizing and externalizing problem behaviors were statistically significant between students of different grades (P=0.004), and that the differences in family functioning and empathy scores were also statistically significant between students of different grades (all P<0.001), whereas the differences in adolescents' internalizing and externalizing problem behaviors were not statistically significant between sexes and regions (P=0.919, 0.959). The results of correlation analysis showed that family functioning scores (the higher the score, the worse the family functioning) were significantly negatively correlated with empathy and emotional competence (r=-0.482, -0.432, P<0.01), and significantly positively correlated with internalizing and externalizing problem behaviors (r=0.220, P<0.01). Empathy was significantly positively correlated with emotional competence (r=0.402, P<0.01). Empathy and emotional competence were significantly negatively correlated with all the dimensions of internalizing and externalizing problem behaviors (r=-0.115, -0.305, P<0.01). Emotional competence partially mediated the relationship between family functioning and adolescents' internalizing and externalizing problem behaviors, with a mediation effect value being 0.042 (95% [confidence interval] CI: 0.031-0.057). Empathy and emotional competence had chain mediation effect between family functioning and adolescents' internalizing and externalizing problem behaviors, with the value of the mediation effect being 0.010 (95% CI: 0.007-0.014).

Conclusion

Family functioning influences adolescents' internalizing and externalizing problem behaviors in a direct way and through the chain-mediating roles of empathy and emotional competence.

A meta-analytic review of the relations between anxiety and empathy

Although theory suggests that empathy may signal a risk for anxiety (Tone & Tully, 2014), the relation between these constructs remains unclear due to the lack of a quantitative synthesis of empirical findings. We addressed this question by conducting three meta-analyses assessing anxiety and general, cognitive, and affective empathy (k's = 70-102 samples; N's = 19,410-25,102 participants). Results suggest that anxiety has a small and significant association with general empathy (r = .08). The relation of clinical anxiety with cognitive empathy was significant but very weak (r = -.03), and small for affective empathy (r = .16). Geographic region and the type of cognitive (e.g., perspective taking, fantasy) and affective empathy (e.g., affective resonance, empathic concern) emerged as moderators. Results suggest that anxiety has a weaker association with general empathy but a stronger association with affective empathy in participants from predominantly collectivistic geographic regions. Further, greater anxiety was weakly associated with less perspective-taking and greater fantasy, and anxiety had a more modest association with empathic concern than other types of affective empathy. Targeting affective empathy (e.g., promoting coping strategies when faced with others' distress) in interventions for anxiety may be beneficial.

Anxiety, academic achievement, and academic self-concept: Meta-analytic syntheses of their relations across developmental periods

This systematic review examined how anxiety symptoms and anxiety disorders relate to academic achievement, school dropout, and academic self-concept. Studies with children or adult samples were included in seven meta-analyses (ks for number of samples ranged from 5 to 156; N's for participants ranged from 780 to 37, 203). Results revealed significant but very small effect sizes for the relations between anxiety and overall academic achievement (r = -.06), language achievement (r = -.07), and math achievement (r = -.09), and a nonsignificant effect size for science achievement (r = -.01). Participants with greater anxiety were also significantly more likely to not complete high school (r = .11). They also had a poorer overall academic self-concept (r = -.25) and mathematics self-concept (r = -.30). Few methodological moderators (e.g., study design, age) were significant. Results show that anxiety does not strongly hinder academic achievement, but it is an important correlate of dropout and academic self-concept, which in turn could contribute to poorer life outcomes. Interventions and preventive programs need to consider ways to ameliorate the relations of anxiety with academic outcomes, especially school continuation and academic self-concept. Future studies should identify risk factors that may amplify these relations.

The mediating role of resilience on the association between family satisfaction and lower levels of depression and anxiety among Chinese adolescents

PURPOSE

This study aimed to explore the association between family satisfaction, resilience, and anxiety and depression among adolescents, and the mediating role of resilience in these relationships.

METHODS

A cross-sectional study was conducted among grade 8 to 9 students from 4 secondary schools in Hong Kong. A total of 1,146 participants completed the survey.

RESULTS

Respectively 45.8% and 58.0% of students scored above the cut-off for mild anxiety and mild depression. Results from linear regression analyses showed that family satisfaction was positively associated with resilience, and both family satisfaction and resilience were and negatively associated with anxiety and depression. The mediating effects of resilience on the relationship between family satisfaction and anxiety/ depression (26.3% and 31.1% effects accounted for, respectively) were significant.

CONCLUSIONS

Both family satisfaction and resilience have important influence on adolescent mental health. Interventions that seek to promote positive family relationships and resilience of adolescents may be effective in preventing and reducing anxiety and depression symptoms among adolescents.

Emotion socialization parenting interventions targeting emotional competence in young children: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children.

METHODS

Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months.

RESULTS

Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged.

CONCLUSIONS

Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.

Parent–Child Attachment and Dynamic Emotion Regulation: A Systematic Review

Although there is evidence parent–child attachment security is associated with trait-like emotion indices, trait perspectives do not fully capture children's responses to context, an important emotion regulation component. This paper evaluates whether attachment is associated with two dynamic emotion indicators: emotion reactivity and emotion recovery. We review conceptual and empirical connections, describe the dynamic emotion perspective, discuss hypotheses, and review evidence. Our review (15 studies) shows that secure attachment was more consistently related to recovery than reactivity, avoidant attachment was related to low emotion reactivity and recovery, ambivalent attachment was associated with greater emotion reactivity, and disorganized attachment was related to high reactivity and recovery difficulties. We close by comparing trait-like and dynamic emotion conclusions then propose future research directions.

Law Enforcement Officers’ Ability to Recognize Emotions: The Role of Personality Traits and Basic Needs’ Satisfaction

Background: This study intended to explore the role of personality traits and basic psychological needs in law enforcement officers’ ability to recognize emotions: anger, joy, sadness, fear, surprise, disgust, and neutral. It was significant to analyze law enforcement officers’ emotion recognition and the contributing factors, as this field has been under-researched despite increased excessive force use by officers in many countries. Methods: This study applied the Big Five–2 (BFI-2), the Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS), and the Karolinska Directed Emotional Faces set of stimuli (KDEF). The data was gathered using an online questionnaire provided directly to law enforcement agencies. A total of 154 law enforcement officers participated in the study, 50.65% were females, and 49.35% were males. The mean age was 41.2 (age range = 22–61). In order to analyze the data, SEM and multiple linear regression methods were used. Results: This study analyzed variables of motion recognition, personality traits, and needs satisfaction and confirmed that law enforcement officers’ personality traits play a significant role in emotion recognition. Respondents’ agreeableness significantly predicted increased overall emotion recognition; conscientiousness predicted increased anger recognition; joy recognition was significantly predicted by extraversion, neuroticism, and agreeableness. This study also confirmed that law enforcement officers’ basic psychological needs satisfaction/frustration play a significant role in emotion recognition. Respondents’ relatedness satisfaction significantly predicted increased overall emotion recognition, fear recognition, joy recognition, and sadness recognition. Relatedness frustration significantly predicted decreased anger recognition, surprise recognition, and neutral face recognition. Furthermore, this study confirmed links between law enforcement officers’ personality traits, satisfaction/frustration of basic psychological needs, and emotion recognition, χ2 = 57.924; df = 41; p = 0.042; TLI = 0.929; CFI = 0.956; RMSEA = 0.042 [0.009–0.065]. Discussion: The findings suggested that agreeableness, conscientiousness, extraversion, and neuroticism play an essential role in satisfaction and frustration of relatedness needs, which, subsequently, link to emotion recognition. Due to the relatively small sample size, the issues of validity/reliability of some instruments, and other limitations, the results of this study should preferably be regarded with concern.

Mindfulness and Regulatory Emotional Self-Efficacy of Injured Athletes Returning to Sports: The Mediating Role of Competitive State Anxiety and Athlete Burnout

Usually, both external environmental factors and internal psychological factors affect the self-efficacy of athletes returning to sports after an injury. Based upon COR theory, this study investigated mindfulness interventions' effects on competitive state anxiety and burnout in injured athletes who are returning to sports. The study was conducted in South China from March to April 2022. The snowball and convenience sampling methods were used to select high-level sports teams' injured athletes returning to sports, and a questionnaire survey was administered, from which 433 valid samples were obtained. Amos v. 26 was used to analyze the data. The results showed that mindfulness has a significant negative effect on competitive state anxiety and burnout, such that after strengthening the mindfulness intervention, athletes' competitive state anxiety and burnout decreased and regulatory emotional self-efficacy increased. Further, this study indicated that athletes are prone to negative emotions after injury, and among athletes who returned to sports after injury, those with mindfulness interventions reported lower levels of competitive state anxiety and burnout. Hence, the study demonstrated that mindfulness can improve regulatory emotional self-efficacy in injured athletes who are returning to sports by reducing competitive state anxiety and burnout.

Visualization, Self-Efficacy, and Locus of Control in a Virtual Reality Biofeedback Video Game for Anxiety Regulation

The current study aimed to identify specific feedback mechanics and psychological processes that may contribute to positive outcomes in biofeedback applications for anxiety regulation. Specifically, using a dismantling study design, the unique impact of visualizations that directly mirror users' breathing was examined in relation to anxiety regulation as well as locus of control and self-efficacy. Following an anxiety induction, participants (N = 67) were randomly assigned to play one of two variations of a biofeedback video game. In both versions, players' in-game movement was contingent on their breathing; however, the experimental condition additionally included visualizations that directly mirrored players' breathing. Changes in self-reported state anxiety and physiological arousal were measured as well as the level of internal control and self-efficacy participants experienced while playing the game. Results showed that all participants were able to effectively reduce their anxiety and arousal, but no condition differences were found. Implementing mirroring visualizations did not contribute to individuals' ability to self-regulate nor their self-efficacy or locus of control above and beyond receiving feedback based on their in-game movement. Overall, individuals who experienced higher self-efficacy and a stronger internal locus of control were better able to regulate their anxiety, but no clear links were found with changes in self-reported physiological arousal. In light of these results, we recommend the continued exploration of the role of specific design choices and intervention components as well as underlying mechanisms of change in biofeedback interventions, especially pertaining to how individuals perceive themselves and their ability to change.

Psychosocial Effects of COVID-19 in the Ecuadorian and Spanish Populations: A Cross-Cultural Study

The world's population is currently overcoming one of the worst pandemics, and the psychological and social effects of this are becoming more apparent. We will present an analysis of the psychosocial effects of COVID-19: first, a cross-sectional study in an Ecuadorian sample (n = 301) and second, a comparative study between two samples from the Ecuadorian and Spanish populations (n = 83 each one). Participants completed an online survey to (1) describe how they felt (depression, anxiety, and stress) before and after confinement; (2) analyze which emotional and behavioral variables predict depressive symptoms, anxiety, and stress perceived after the confinement; (3) carry out a comparative study in a sample of Ecuadorian and Spanish surveys. Results indicate, first, that Ecuadorians experience significantly more depressive symptoms, anxiety, and stress after confinement. Second, variables which predict depressive symptoms and anxiety are greater public prosocial tendency, less stress as a challenge, and greater stress as a threat, as well as an empathetic tendency that implies greater emotional regulation. Experienced stress after confinement was predicted by a greater public prosocial tendency, as well as an empathetic tendency. Finally, scores for depression, anxiety, and stress are higher after confinement in both countries. However, results reveal the similarity of the psychosocial effects that are being experienced, regardless of the country, and the differences in the variables that can help explain these effects. This can contribute to the constitution of intervention plans which aim to soften and alleviate the effects produced by a situation such as that experienced with COVID-19.

Combined Emotional Socialization Training and Family Accommodation Modification: Impact on Emotional Regulation and Anxiety Symptoms in Anxious Children

Past studies show that emotional socialization and family accommodation are involved in children's anxiety, but research has yet to investigate whether targeting emotional socialization training (EST), family accommodation modification (FAM), or EST and FAM in tandem can reduce anxiety in children. The purpose of this study was to evaluate the efficacy of a combination of EST and FAM on improving emotion regulation (ER) and reducing anxiety symptoms in anxious children. The sample consisted of 80 children with an anxiety disorder (M_age = 6.7, SD = 0.1) and their mothers. Mothers were randomly assigned to an EST (n = 17), FAM (n = 16), Combined (n = 17), or a waitlist control (WLC) (n = 16) groups. Mothers completed The Emotion Regulation Checklist (ERC) and Spence Children's Anxiety Scale (SCAS) at pre-test, post-test, and at 6-month of follow-up. The results showed that the EST, FAM, and Combined groups were more effective than WLC in improving ER and reducing anxiety severity at post-test and follow-up. Among the intervention groups, children in the combined group showed greater reductions in the severity of anxiety symptoms and emotion dysregulation than the other two groups. Assisting parents to use strategies that encourage healthy emotion regulation and decrease family accommodation might help reduce the severity of children's anxiety symptoms.

Longitudinal effects of emotion awareness and regulation on mental health symptoms in adolescents with and without hearing loss

Emotion awareness (EA) and regulation (ER) are each known to associate with mental health symptoms, yet there is a paucity of longitudinal studies examining them jointly during adolescence. Furthermore, little is known about these skills and their relations in deaf and hard-of-hearing (DHH) adolescents, who are at risk for reduced emotion socialization and for more mental health symptoms. This longitudinal study examined the development and unique contributions of EA (emotion differentiation, emotion communication and bodily unawareness) and ER (approach, avoidance and worry/rumination) to internalizing and externalizing symptoms in adolescents with and without hearing loss. Using self- and parent's reports, we assessed 307 adolescents (age 9-15) three times over 18-month period. We found stability over time in development of EA and avoidance ER, increase in approach ER and decrease in worry/rumination. High levels and increases over time in two aspects of EA, emotion differentiation and communication, and in approach and avoidance ER were related to decreases in depressive symptoms. An increase in approach ER was also related to a decrease in anxiety symptoms. Yet, low levels or decreases in worry/rumination were related to decreased levels of depressive, anxiety and externalizing symptoms. Hearing loss did not moderate any of the variables or relations tested. Preliminary tests suggested heterogeneity within the DHH group according to educational placement, language abilities and parental education level. Overall, findings pointed at unique contributions of EA and ER to mental health development, suggesting that DHH adolescents, especially in mainstream schools, do not differ from their hearing peers in their emotion awareness and regulation.

Academic performance under COVID-19: The role of online learning readiness and emotional competence

The COVID-19 pandemic caused school closures and social isolation, which created both learning and emotional challenges for adolescents. Schools worked hard to move classes online, but less attention was paid to whether students were cognitively and emotionally ready to learn effectively in a virtual environment. This study focused on online learning readiness and emotional competence as key constructs to investigate their implications for students' academic performance during the COVID-19 period. Two groups of students participated in this study, with 1,316 high school students (Mean age = 16.32, SD = 0.63) representing adolescents and 668 college students (Mean age = 20.20, SD = 1.43) representing young adults. Structural equation modeling was conducted to explore the associations among online learning readiness, emotional competence, and online academic performance during COVID-19 after controlling for pre-COVID-19 academic performance. The results showed that, for high school students, both online learning readiness and emotional competence were positively associated with online academic performance during COVID-19. However, for college students, only online learning readiness showed a significant positive relationship with online academic performance during COVID-19. These results demonstrated that being ready to study online and having high emotional competence could make adolescents more resilient toward COVID-19-related challenges and help them learn more effectively online. This study also highlighted different patterns of associations among cognitive factors, emotional factors, and online academic performance during COVID-19 in adolescence and young adulthood. Developmental implications were also discussed.

Mental Disorders and Emotional Competence Among Chinese Adolescents Before and During COVID-19 Pandemic: A Longitudinal Mediation Model

Background: The outbreak of the COVID-19 pandemic has had a profound influence on the mental health and well-being of individuals across the globe. Emotional competence, defined as one's ability to recognize, understand, and manage their emotions, has been found linked with mental health problems (e.g., depression and anxiety) in previous studies. However, there is limited knowledge about the direction of the association between these factors among populations exposed to COVID-19. This study examined the possible mediation relationships between depression, anxiety, emotional competence, and COVID-19 exposure among Chinese adolescents. Methods: Responses from 7,958 Chinese adolescents who had previously taken part in a two-wave study before (December 23, 2019-January 13, 2020) and during COVID-19 (June 16, 2020-July 8, 2020) were analyzed (51.67% males, mean age = 11.74, SD = 2.15). Structural equation modeling with three covariates (i.e., age, gender, and ethnicity) was used to test the longitudinal mediation relationships between COVID-19 exposure and depression, anxiety via emotional competence. Results: Results indicated that the prevalence of depression (38.67 to 36.74%) and anxiety (13.02 to 12.77%) decreased from Time 1 to Time 2. The T2 emotional competence significantly mediated the relationship between T2 COVID-19 exposure and T2 anxiety (indirect effect [95% CI] = 0.011 [0.004-0.019], p < 0.05). T2 emotional competence also significantly mediated the relationship between T2 COVID-19 exposure and T2 depression (indirect effect [95% CI] = 0.013 [0.005-0.022], p < 0.05). The results indicated that T2 emotional competence had a significant and negative influence on T2 anxiety (β = -0.266, SE = 0.005, p < 0.001), and T2 depression (β = -0.326, SE = 0.029, p < 0.001). Conclusions: This longitudinal research study demonstrated the crucial role of emotional competence in influencing the severity of long-term mental health problems, and suggested that emotional competence interventions can be conducted to improve mental well-being among Chinese adolescents exposed to COVID-19.

Reflective Functioning in Children and Adolescents With and Without an Anxiety Disorder

Reflective functioning (RF), meaning the capacity to interpret mental states (intentions, emotions, thoughts, desires, and beliefs) underlying one’s own and others’ behaviors, may help understand the dysfunctional self-regulation associated with anxiety disorders. However, research on anxiety and RF in clinical samples is scarce. This study aimed to assess whether mothers’ and youths’ RF was associated with youths’ (a) anxiety disorders and symptoms and (b) internalizing symptoms. Another goal was to explore whether RF predicted anxiety and internalizing symptoms beyond the more commonly established effect of attachment. Canadian children and adolescents aged between 8 and 16years, and their mothers were recruited in an outpatient psychiatric clinic (clinical group with a diagnosed anxiety disorder, n=30, mean age=11.5±2.8years) and in the general population (non-clinical group, n=23, mean age=11.5±2.1years). The Child Attachment Interview was used to assess youths’ attachment along with three dimensions of RF (global, regarding self, regarding others). Mothers’ attachment and RF were assessed with the Adult Attachment Interview. Children’s and adolescents’ anxiety and internalizing symptoms were measured with the Behavior Assessment Scale for Children, second version. The clinical and non-clinical groups did not differ in mothers’ or youths’ RF. However, in the overall sample, youths’ RF regarding themselves and maternal attachment preoccupation were associated with internalizing symptoms. Sequential regression analyses revealed that higher RF regarding self predicted a higher level of self-reported internalizing symptoms, beyond the effect of maternal attachment (β=0.43, p<0.05). This study’s finding suggests that clinically anxious children and adolescents have adequate RF. We propose that the sustained hypervigilance and apprehension associated with anxiety make anxious youths sensitive to their own and others’ mental states. Our findings suggest that psychotherapeutic treatments for anxiety should make use of patients’ RF abilities to help them make sense of their symptoms and thus reduce them.

Adversity and Emotional Functioning

Exposure to early adversity has been linked to variations in emotional functioning. To date, however, the precise nature of these variations has been difficult to pinpoint given widespread differences in the ways in which aspects of emotional functioning are defined and measured. Here, more consistent with models of emotional functioning in typically developing populations (e.g., Halberstadt et al., 2001), we propose defining emotional functioning as consisting of distinct domains of emotion expression, perception, knowledge, reactivity, and regulation. We argue that this framework is useful for guiding hypothesis generation about the specific impact of early adversity on children's emotional functioning. We operationalize the construct of emotional functioning, highlight what is currently known about the association between adversity exposure and each domain of emotional functioning, propose potential mechanisms for these associations, and set the stage for future research examining the development of emotional functioning in the context of early adversity.

The Association Between the 5Cs and Anxiety-Insights From Three Countries: Portugal, Slovenia, and Spain

Several of the most frequent psychological difficulties in childhood and adolescence are related to anxiety and lead to numerous short- and long-term negative outcomes in emotional, social, and academic domains. Empirical evidence consistently shows that the 5Cs (competence, caring, confidence, connection, and character) of Positive Youth Development (PYD) are positively related to adolescents’ contribution to self, family, and society as well as negatively related to risky behaviors and emotional difficulties, such as anxiety. Thus, the PYD can be one of the models that informs prevention programs. To provide contextualized, data-driven support for prevention efforts, we have analyzed the predictive value of the 5Cs for anxiety and anxiety dimensions using three different convenience youth samples from Portugal (N = 384, 46.6% female), Slovenia (N = 449, 69% females), and Spain (N = 768; 60.5% females). To assess the 5Cs, we used the same short form of the PYD scale in all samples (Geldhof et al., 2013) and different anxiety measures across samples: the Multidimensional Anxiety Scale for Children (MASC) in Portugal, the Lestvica anksioznosti za otroke in mladostnike anxiety scale (LAOM) in Slovenia and the Generalized Anxiety Disorder-7 (GAD-7) in Spain. The findings show significant associations of PYD and anxiety across all three contexts with all three different anxiety measures used. The associations vary across countries emphasizing the need to further research the role of contexts in anxiety prevention. Despite variations the results do indicate that connection is negatively associated with anxiety in all three contexts using the three anxiety measures, while confidence is a negative predictor and caring is a positive predictor of anxiety in Slovenia and Spain. Implications for practice within an educational framework for adolescents and youth are discussed, together with public policy recommendations.

The relationship between psychological resilience and emotion regulation among preschool left-behind children in rural China

To evaluate the relationship between resilience and emotion regulation among preschool left-behind children (LBC) in rural China. A total of 620 preschool LBC were enrolled from rural areas in Anhui province, China. Multivariate logistic regression was used to evaluate the associations between resilience and variables. The results showed that 20.2% of LBC had higher resilience. Emotion regulation was correlated with resilience among preschool LBC. Children with higher cognitive reconstruction (adjusted OR (AOR) = 0.349,95%CI:0.249-0.489), passive dealing (AOR = 0.577, 95%CI:0.411-0.810), alternative action (AOR = 0.369, 95%CI:0.267-0.510) and self-comforting (AOR = 0.441, 95%CI:0.315-0.619) would have lower risk of low resilience. Our findings suggest that strengthening emotion regulation could promote psychological resilience and prevent adverse developments in LBC.

An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint

Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful.

Intervening on the Developmental Course of Children With Borderline Intellectual Functioning With a Multimodal Intervention: Results From a Randomized Controlled Trial

An adverse social environment is a major risk factor for borderline intellectual functioning (BIF), a condition characterized by an intelligence quotient (IQ) within the low range of normality (70-85) with difficulties in the academic achievements and adaptive behavior. Children with BIF show impairments in planning, language, movement, emotion regulation, and social abilities. Moreover, the BIF condition exposes children to an increased risk of school failures and the development of mental health problems, and poverty in adulthood. Thus, an early and effective intervention capable of improving the neurodevelopmental trajectory of children with BIF is of great relevance.

AIM

The present work aims to report the results of a randomized controlled trial (RCT) in which an intensive, integrated and innovative intervention, the movement cognition and narration of the emotions (MCNT) was compared to standard speech therapy (SST) for the treatment of children with BIF.

METHODS

This was a multicenter, interventional, single blind RCT with two groups of children with BIF: the experimental treatment (MCNT) and the treatment as usual (SST). A mixed factorial ANOVA was carried out to assess differences in the effectiveness between treatments. Primary outcome measures were: WISC III, Child Behavior Checklist (CBCL), Vineland II, and Movement ABC.

RESULTS

MCNT proved to be more effective than SST in the increment of full-scale IQ (p = 0.0220), performance IQ (p < 0.0150), socialization abilities (p = 0.0220), and behavior (p = 0.0016). No improvement was observed in motor abilities. Both treatments were linked to improvements in verbal memory, selective attention, planning, and language comprehension. Finally, children in the SST group showed a significant worsening in their behavior.

CONCLUSION

Our data show that an intensive and multimodal treatment is more effective than a single domain treatment for improving intellectual, adaptive and behavioral functioning in children with BIF. These improvements are relevant as they might represent protective factors against the risk of school failure, poverty and psychopathology to which children with BIF are exposed in the adult age. Limitations of the study are represented by the small number of subjects and the lack of a no-treatment group.

CLINICAL TRIAL REGISTRATION

ISRCTN Registry (isrctn.com), identifier ISRCTN81710297.

Positive Aspects of Emotional Competence in Preventing Internalizing Symptoms in Children with and without Developmental Language Disorder: A Longitudinal Approach

In order to better understand protective factors for internalizing problems, this longitudinal study examined positive emotions, emotion awareness and (non-)emotional communication skills in relation to somatic complaints and social anxiety in children with (N = 104) and without (N = 183) Developmental Language Disorder (DLD) using self-reported measures twice with a 9-month interval. Additionally, parents reported on their child’s communication problems and emotion communication at Time 1. Most importantly, since we found that increasing levels of emotion awareness related to decreases in social anxiety and somatic complaints in children with and without DLD, we conclude that children with DLD are likely to benefit from interventions aimed at improving their emotion awareness in addition to language interventions.

The Role of Anxiety, Coping Strategies, and Emotional Intelligence on General Perceived Self-Efficacy in University Students

The main objective of the present research is to analyze the relationship of levels of self-efficacy and anxiety, coping strategies, and emotional intelligence in Spanish university students. This study has a cross-sectional design. The sample was composed of 258 university students recruited from three academic areas. Descriptive, bivariate, and multivariate regression analyses were performed. Significant bivariate analysis showed a significant inverse correlation between self-efficacy and state anxiety (r = -0.340) and trait anxiety (r = -0.466). In addition, a direct correlation was found between self-efficacy and the coping strategies of problem-solving (r = 0.312), emotional expression (r = 0.133), cognitive restructuring (r = 0.195), social withdrawal (r = 0.103), and coping with a situation (r = 0.303), as well as with the emotional intelligence dimensions of emotional clarity (r = 0.397) and repair mood (r = 0.347). Multivariate regression analysis showed that trait anxiety, problem-solving, emotional expression, social withdrawal, and emotional clarity were significantly related to the dependent variable, predicting 39% of total variance on levels of general perceived self-efficacy. In conclusion, this paper contributes to a better understanding of the related factors to general perceived self-efficacy in undergraduate students.

Emotional Awareness Predicts Specific Cognitive-Behavioral Therapy Outcomes for Anxious Youth

The current study examined emotional awareness as a predictor of differential outcomes for youth treated for an anxiety disorder. 37 youth ages 7-15 received either individual cognitive-behavioral therapy or family cognitive-behavioral therapy to treat generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Diagnoses were determined by independent evaluators, following semi-structured interviews (ADIS-IV-C/P) with youth and their parents. Self-report questionnaires, including the multidimensional anxiety scale for children and the emotion expressivity scale for children, were completed at pre- and posttreatment. Youth with higher levels of pretreatment emotional awareness had better treatment outcomes than youth with lower levels of emotional awareness, with specific regard to improved ability to cope with worry. Findings suggest that higher levels of emotional awareness facilitate better specific outcomes for anxious youth. Findings highlight the importance of understanding the emotions associated with worry during the treatment process.

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

Adolescent Mental Health Problems in Hong Kong: A Critical Review on Prevalence, Psychosocial Correlates, and Prevention

PURPOSE

Adolescent mental health problems are a public health issue in Hong Kong and a review of the situation can have implications for intervention and prevention. This paper aims to review the available prevalence rates of mental health problems among adolescents in Hong Kong and examines the correlates of these conditions through a positive youth development (PYD) framework.

METHODS

Local studies published in English between January 1995 and September 2017 were searched in ERIC, PsycArticles, PsycInfo, and PubMed. Data were selected and extracted by two reviewers. The primary outcome was the prevalence or the scores of mental health problems among adolescents. The secondary outcome was the correlates associated with the problems identified in the studies.

RESULTS

Twenty-three studies were identified. The prevalence of depression was between 0.55% and 2.2% (three studies), whereas the prevalence for anxiety (one study) and generalized anxiety disorder (two studies) were 6.9% and 2.6%, respectively. Comparatively higher levels of depressive symptoms and lower levels of general mental health among Hong Kong adolescents than adolescents in other regions. The protective factors examined in these studies were categorized into PYD constructs, namely: cognitive competence, behavioral competence, emotional competence, resilience, and bonding with family, which were associated with better mental health.

CONCLUSIONS

This review contends that future mental health research and intervention for adolescents should focus more on PYD constructs and family factors.

Girls' internalizing symptoms and white matter tracts in Cortico-Limbic circuitry

Dysfunction in cortico-limbic circuitry is implicated in internalizing disorders (i.e., depressive and anxious disorders), but less is known about whether structural variations precede frank disorder and thus potentially mark risk. We therefore examined associations between white matter (WM) tract microstructure in cortico-limbic circuitry at age 7 and concurrent and longitudinal patterns of internalizing symptoms in 42 typically developing girls using Diffusion Tensor Imaging (DTI). Girls' internalizing symptoms were concurrently associated with reduced fractional anisotropy (FA) in segments of the cingulum bundle (CB) and the uncinate fasciculus (UF), bilaterally. Moreover, latent profile analysis showed that girls with increasing internalizing symptoms, based on assessments at ages 3, 6, 7, and 8, had reduced FA in these segments compared to girls with stably low symptoms. These results point to a putative neural mechanism underlying the course of childhood internalizing symptoms.

Generalized Anxiety Disorder in Very Young Children: First Case Reports on Stability and Developmental Considerations

Generalized anxiety disorder (GAD) is purported to start in early childhood but concerns about attenuation of anxiety symptoms over time and the development of emerging cognitive and emotional processing capabilities pose multiple challenges for accurate detection. This paper presents the first known case reports of very young children with GAD to examine these developmental challenges at the item level. Three children, five-to-six years of age, were assessed with the Diagnostic Infant and Preschool Assessment twice in a test-retest reliability study. One case appeared to show attenuation of the worries during the test-retest period based on caregiver report but not when followed over two years. The other two cases showed stability of the full complement of diagnostic criteria. The cases were useful for demonstrating that the current diagnostic criteria appear adequate for this developmental period. The challenges of accurate assessment of young children that might cause missed diagnoses are discussed. Future research on the underlying dysregulation of negative emotionality and long-term follow-ups are needed to better understand the etiology, treatment, and course of GAD in this age group.

Understanding Emotion in Adolescents: A Review of Emotional Frequency, Intensity, Instability, and Clarity

Adolescence is a time of transition from childhood to adulthood during which significant changes occur across multiple domains, including emotional experience. This article reviews the relevant literature on adolescents’ experience of four specific dimensions of emotion: emotional frequency, intensity, instability, and clarity. In an effort to examine how emotional experiences change as individuals approach adulthood, we examine these dimensions across ages 10 to 19, and review how the emotional functioning of adolescents compares to that of adults. In addition, we explore whether and how gender and puberty explain age differences in emotional experience. Finally, we discuss how these findings could inform future research on both the typical trajectory of emotional experience and the development of psychopathology in adolescence.

The Interplay of Familial and Individual Risk in Predicting Clinical Improvements in Pediatric Anxiety Disorders

Bioecological models of developmental psychopathology underscore the role of familial experiences of adversity and children's individual-level characteristics in heightening risk for pediatric anxiety through direct, combined, and interactive effects. To date, much of the existing research dedicated to pediatric anxiety disorders has largely been examined in bioecological models of diathesis-stress using community samples. This study extends our understanding of children's differential responsiveness to familial adversity by examining the diathesis-stress interaction of cumulative risk and children's individual-level vulnerabilities (negative affectivity and coping efficacy) within a clinic-referred treatment study for pediatric anxiety disorders. A cumulative risk index assessing exposure to familial adversity (e.g., socioeconomic status [SES], parent psychiatric illness) and self-reported measures of children's negative affectivity and coping efficacy were each measured at the intake of a randomized controlled clinical trial for the treatment of pediatric anxiety disorders (N = 488; 7-17 years of age). Trajectories of interviewer-rated anxiety symptoms were assessed across 12 weeks of treatment at baseline, 4 weeks, 8 weeks, and 12 weeks. Consistent with models of temperamental risk for mental health problems, negative affectivity predicted higher anxiety symptoms at intake. A significant diathesis-stress interaction between cumulative risk and coping efficacy emerged, as high risk and perceptions of lower coping efficacy attenuated declines in anxiety across 12 weeks. These patterns did not differ across treatment conditions. The results indicate that for youth experiencing high levels of stress, additional treatment efforts targeting familial stressors and coping efficacy may be important in maximizing treatment outcomes.

A meta-analytic review of the relationship of cancer coping self-efficacy with distress and quality of life

Self-efficacy for coping with cancer is a specific construct that refers to behaviors that occur in the course of dealing with a cancer diagnosis, cancer treatments, and transitioning to survivorship. One of the more widely used measures of self-efficacy for coping strategies with cancer is the Cancer Behavior Inventory. The following general questions provide a framework for this research: 1. Is self-efficacy for coping with cancer related to distress and quality of life of a cancer patient?. 2. Do self-efficacy for coping with cancer and the target psychological outcomes (i.e., distress and quality of life) change in longitudinal studies, with or without intervention? One-hundred eighty studies cited the different versions of the Cancer Behavior Inventory and 47 used the scale. Result showed an inverse relationship between self-efficacy for coping with cancer and distress, and a positive relationship between self-efficacy for coping with cancer and Quality of Life, both with a large effect size. The strong relationship of self-efficacy and outcomes, resulted of the specificity of the instrument, which targets specific coping strategies that are closely aligned with positive outcomes in adjusting to cancer. However, the results are consistent with the theory, which states that compared to those with low efficacy, highly efficacious people demonstrate less anxiety and better adjustment in stressful situations and consistent with prior results in which self-efficacy is positively related to quality of life.

Anxiety in adolescence. Can we prevent it?

BACKGROUND

Emotions are potent modulators and motivators of the behaviour that the individual displays in the different situations they have to live and they can act as a protection factor or vulnerability of the adapted or maladaptive behaviour. This study focuses on anxiety in adolescence.

OBJECTIVES

The objective is, through a longitudinal study, to analyse the psychological processes and emotions that facilitate the symptoms of anxiety and those which protect the adolescent from these symptoms.

MATERIAL AND METHODS

417 adolescents (192 boys and 225 girls) participated in a three-wave longitudinal study in Valencia, Spain. In the first wave, adolescents were either in the third year of secondary school (81 boys and 85 girls) or the fourth year of secondary school (111 boys and 140 girls). The mean age was 14.70 (SD = 0.68; range = 13-17 years). This study monitored participating adolescents for three years.

RESULTS

The results indicate a differential profile in the evaluated emotions according to sex, with the girls being the ones to experiment more anxiety and more empathy, while the boys show more emotional instability and aggression.

CONCLUSIONS

It is concluded that the best predictors for anxiety are anger state, aggressive behaviour, empathic concern together with the lack of coping mechanisms focused on problem solving and the perception of stress as a threat.