Emotional Awareness in Depressive and Anxiety Symptoms in Youth: A Meta-Analytic Review

Specific emotion regulation difficulties mediate the relationship between personal distress and depressive symptoms in medical students

Several studies indicate a link between personal distress and vulnerability to depression. The literature also suggests that personal distress is associated with emotion dysregulation and that emotion dysregulation plays a role in depression. However, which of the various emotion regulation difficulties mediates the relationship between personal distress and depression remains unexplored. This study therefore aims to investigate the mediating role of specific emotion regulation difficulties in the relationship between personal distress and depression. Of the 702 initially recruited participants, 635 completed a survey comprising the Interpersonal Reactivity Index, the Difficulties in Emotion Regulation Scale, and the Beck Depression Inventory. A mediation analysis was used to explore which emotion regulation difficulties mediate the relationship between personal distress and depression. Over a quarter (27%) of participants reported moderate-severe depression symptoms. Difficulties in accessing adaptive emotion regulation strategies and in having a clear understanding about one's own emotions partly mediated the relationship between personal distress and depression symptoms. Our results are the first to indicate that personal distress is linked to depression risk through specific emotion regulation difficulties in medical students. They also highlight possible modifiable skills that could be targeted by prevention intervention.

Reliability and Validity of Ecological Momentary Assessment Response Time-Based Measures of Emotional Clarity: Secondary Data Analysis

BACKGROUND

Emotional clarity has often been assessed with self-report measures, but efforts have also been made to measure it passively, which has advantages such as avoiding potential inaccuracy in responses stemming from social desirability bias or poor insight into emotional clarity. Response times (RTs) to emotion items administered in ecological momentary assessments (EMAs) may be an indirect indicator of emotional clarity. Another proposed indicator is the drift rate parameter, which assumes that, aside from how fast a person responds to emotion items, the measurement of emotional clarity also requires the consideration of how careful participants were in providing responses.

OBJECTIVE

This paper aims to examine the reliability and validity of RTs and drift rate parameters from EMA emotion items as indicators of individual differences in emotional clarity.

METHODS

Secondary data analysis was conducted on data from 196 adults with type 1 diabetes who completed a 2-week EMA study involving the completion of 5 to 6 surveys daily. If lower RTs and higher drift rates (from EMA emotion items) were indicators of emotional clarity, we hypothesized that greater levels (ie, higher clarity) should be associated with greater life satisfaction; lower levels of neuroticism, depression, anxiety, and diabetes distress; and fewer difficulties with emotion regulation. Because prior literature suggested emotional clarity could be valence specific, EMA items for negative affect (NA) and positive affect were examined separately.

RESULTS

Reliability of the proposed indicators of emotional clarity was acceptable with a small number of EMA prompts (ie, 4 to 7 prompts in total or 1 to 2 days of EMA surveys). Consistent with expectations, the average drift rate of NA items across multiple EMAs had expected associations with other measures, such as correlations of r=-0.27 (P<.001) with depression symptoms, r=-0.27 (P=.001) with anxiety symptoms, r=-0.15 (P=.03) with emotion regulation difficulties, and r=0.63 (P<.001) with RTs to NA items. People with a higher NA drift rate responded faster to NA emotion items, had greater subjective well-being (eg, fewer depression symptoms), and had fewer difficulties with overall emotion regulation, which are all aligned with the expectation for an emotional clarity measure. Contrary to expectations, the validities of average RTs to NA items, the drift rate of positive affect items, and RTs to positive affect items were not strongly supported by our results.

CONCLUSIONS

Study findings provided initial support for the validity of NA drift rate as an indicator of emotional clarity but not for that of other RT-based clarity measures. Evidence was preliminary because the sample size was not sufficient to detect small but potentially meaningful correlations, as the sample size of the diabetes EMA study was chosen for other more primary research questions. Further research on passive emotional clarity measures is needed.

Gamified Assessment of the Emotion Regulation Abilities in Youth: Validation of the REThink Online System

Objective: Emotional problems in the youth population are a major issue that can have a significant negative impact for their future development as adults. Their emotion regulation (ER) abilities represent a preventive measure for those emotional problems. REThink is an online therapeutic game that was proved to be effective in rigorous studies, and is based on the rational emotive behavioral therapy, with seven levels built to train various emotional regulation skills. Each level has a section that can be used for the assessment of the targeted skills within the level. The present study aimed at investigating the reliability and validity of the evaluation modules from the REThink game regarding the assessment of ER abilities in children/adolescents. Methods: In accordance with established guidelines, 110 children and adolescents aged 8-14 years old were recruited. Following parental informed consent, the participants filled out the standard questionnaires and, subsequently, they played the evaluation module of the REThink game. The reliability aspect was investigated by evaluating internal consistency, while validity was evaluated by using concurrent and predictive validity analyses. Results: The results revealed statistically significant positive associations between the game scores obtained by the participants and the emotion regulation scale. In terms of predictive validity, there were significant negative associations between game scores and the presence of emotional and behavioral problems. Moreover, in terms of the reliability of the REThink game, an acceptable value for the internal consistency was observed. Conclusion: In conclusion, the REThink therapeutic game was proved to be a valid measure for assessing emotion regulation abilities in children and adolescents. Clinical Trial Registration No. NCT04788901.

Heart rate variability and psychological health: The key role of trait emotional awareness

Studies have shown that Trait Emotional Awareness (TEA) - the ability to recognize one's emotions - and Heart Rate Variability (HRV) are both negatively associated with psychological disorders. Although these studies imply that TEA is related to HRV and may explain the association between HRV and psychological disorders, there is limited research investigating this implication. Such investigation is essential to illuminate the psychophysiological processes linked to psychological disorders. The present study aims to investigate a) the association between TEA and HRV, b) the association between HRV and psychological disorders, and c) whether TEA explains the association between HRV and psychological disorders. A sample of 41 German students completed self-report questionnaires as indicators of psychological disorders, including the Hospital Anxiety and Depression Scale (HADS; Snaith & Zigmond, 1983) for anxiousness and depressiveness, as well as the somatization scale of the Hopkins Symptom Checklist (HSCL; Derogatis et al., 1976) for physical complaints. HRV was measured at baseline (resting HRV) and during exposure to a fear-provoking movie clip (reactive HRV). As hypothesized, a) TEA showed a positive association with reactive HRV, b) HRV showed negative associations with anxiousness and physical complaints, and c) TEA explained the relationships between reactive HRV and anxiousness, as well as physical complaints. Contrary to our hypothesis, we did not find any association between HRV and depressiveness. We discussed the contribution of TEA to psychophysiological health, limited generalizability of the current study, and direct future research to explore the underlying mechanisms linking TEA to health.

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.

Hypnosis with depressed children and teens: Building skills, creating connection

Depression in children and teens has been on the rise for several years. Recent increases in anxiety and loneliness, both contributors to the development of depression, are putting more young people at risk for chronic and comorbid mental health struggles. The use of hypnosis with depressed children offers the opportunity to target the identified skills depressed and anxious children need and is a modality clinicians should embrace. This article describes how to create hypnotic interventions focusing on improved emotional and cognitive management, better sleep, and the ability to make positive social connections. Such interventions serve to not only build the resources depressed children need for recovery, but also support a paradigm shift toward prevention in children and families.

Alexithymia in Adult Autism Clinic Service-Users: Relationships with Sensory Processing Differences and Mental Health

Mental health difficulties commonly co-occur with autism, especially in autistic people accessing clinic services, impacting substantially on quality-of-life. Alexithymia (difficulty describing/identifying feelings) and sensory processing differences are prevalent traits in autism that have been associated with depression/anxiety in autistic community samples. However, it is important to better understand interrelationships between these traits in clinical populations to improve identification of service-user needs. In this study, 190 autistic adults (65.3% male), seen in a tertiary autism clinic, completed self-report measures of alexithymia (20-item Toronto Alexithymia Scale), sensory processing differences (Adolescent/Adult Sensory Profile) and depression/anxiety (Hospital Anxiety and Depression Scale). Multiple linear regression models and mediation analyses were used to examine associations between alexithymia, sensory processing differences, and depression/anxiety severity. Across the sample, 66.3% of individuals (N = 126) were classified as alexithymic (score ≥ 61). Total alexithymia and difficulty describing/identifying feelings were significantly associated with depression severity (β = 0.30-0.38, highest p < 0.002), and difficulty identifying feelings was significantly associated with anxiety severity (β = 0.36, p < 0.001). Sensory processing differences were also significantly associated with depression severity (β = 0.29, p = 0.002) and anxiety severity across all models (β = 0.34-0.48, highest p < 0.001) Finally, difficulty describing/identifying feelings partially mediated the relationships between sensory processing differences and both depression/anxiety severity. Overall, these results highlight that interventions adapted for and targeting emotional awareness and sensory-related uncertainty may improve mental health outcomes in autistic service-users.

Common Issues for General Practitioners in the Medical Management of Child and Adolescent Psychiatric Care

With a limited number of child and adolescent psychiatrists available to see youth patients, many common psychiatric problems in youth are managed by other providers. Clinical pearls from experts in child and adolescent psychiatry can help general practitioners with this management. Some common issues are discussed here for which practical guidance is offered, ranging from approaches to assessment and how to start and titrate medications for the treatment of attention deficit hyperactivity disorder, depression, and sleep problems.

Parental criticism affects adolescents' mood and ruminative state: Self-perception appears to influence their mood response

Feeling and/or being criticized is a known risk factor for various psychiatric disorders in adolescents. However, the link between the experience of social stressors and the development of psychopathological symptoms is not yet fully understood. Identifying which adolescent subgroups are more vulnerable to parental criticism could be of great clinical relevance. In this study, 90 nondepressed 14- to 17-year-old adolescents were exposed to a sequence of auditory segments with a positive, neutral, and finally negative valence, mirroring parental criticism. Their mood and ruminative states were assessed before and after exposure to criticism. We observed an overall increase in mood disturbance and ruminative thoughts. Self-perception appeared to influence these mood changes, whereas no significant influence by perceived criticism, self-worth, or the general tendency to ruminate was found. Emotional awareness seemed to account for some of the variance in positive mood state changes. These findings point to the importance of adolescent self-perception (and emotional awareness) in dealing with parental criticism.

The Contribution of Bullying Involvement and Alexithymia to Somatic Complaints in Preadolescents

Somatic complaints during preadolescence are connected to individual and contextual factors, and extant research highlights the relevance of alexithymia and bullying involvement. In this cross-sectional study, we explored the joint and unique influence of bullying involvement-as perpetrators, victims, or outsiders-and alexithymia on somatic complaints in a sample of 179 Italian middle-school students (aged 11-15). Findings revealed an indirect association between bullying perpetration and victimization complaints through alexithymia. We also found a significant direct association between victimization and somatic complaints. No significant association between outsider behavior and somatization was found. Our results revealed that bullying perpetration and victimization could increase youths' risk for somatic complaints and clarify one of the processes underlying this association. The current findings further emphasize the relevance of emotional awareness for youths' well-being and propose that implementing social-emotional skills might prevent some of the adverse consequences of being involved in bullying episodes.

Emotion regulation as a mediator on the relationship between emotional awareness and depression in elementary school students

As a cognitive skill, emotional awareness plays a fundamental role in emotional intelligence and significant effect on the development of individuals’ social adaptation. However, the role of emotional awareness in children’s social adaptation, especially emotional development, remains unclear, the current study sought to determine the significant influence of emotional awareness in children’s emotional development. By using cross-sectional and longitudinal study designs, the current study explored the relationship between emotional awareness and children’s depression, as well as the mediation effect of emotion regulation on this relationship. The sample comprised 166 Chinese elementary school students (89 girls and 77 boys) ranging from 8 to 12 years old. After adjusting for demographic variables (gender, grade, etc.), the results showed that children with high emotional awareness were less likely to adopt expressive suppression as an emotion regulation strategy and had lower depression levels currently and in the future. In contrast, children with low emotional awareness were more likely to use suppression strategies and showed higher depression levels. Thus, the results indicated that emotional awareness could predict children’s current and future depression status. Meanwhile, emotional regulation strategies are an important mediating variable explaining the relationship between emotional awareness and children’s depression. Implications and limitations were also discussed.

Development and validation of a computer program for measuring emotional awareness in German-The geLEAS (German electronic Levels of Emotional Awareness Scale)

Introduction

Emotional awareness is the ability to identify, interpret, and verbalize the emotional responses of oneself and those of others. The Levels of Emotional Awareness Scale (LEAS) is an objective performance inventory that accurately measures an individual's emotional awareness. LEAS assessments are typically scored manually and are therefore both time consuming and cognitively demanding. This study presents a German electronic scoring program for the LEAS (geLEAS), the first non-English computerized assessment approach of the LEAS.

Methods

Data were collected from a healthy German community sample (N = 208). We developed a modern software for computerizing LEAS scoring, an open-source text-based emotion assessment tool called VETA (Verbal Emotion in Text Assessment). We investigated if the software would arrive at similar results as hand scoring in German and if emotional awareness would show similar associations to sociodemographic information and psychometric test results as in previous studies.

Results

The most frequently used scoring method of the geLEAS shows excellent internal consistency (α = 0.94) and high correlations with hand scoring (r = 0.97, p < 0.001). Higher emotional awareness measured by the geLEAS is associated with female gender, older age, and higher academic achievement (all p < 0.001). Moreover, it is linked to the ability to identify emotions in facial expressions (p < 0.001) and more accurate theory of mind functioning (p < 0.001).

Discussion

An automated method for evaluating emotional awareness greatly expands the ability to study emotional awareness in clinical care and research. This study aims to advance the use of emotional awareness as a clinical and scientific parameter.

Psychopathic tendencies are selectively associated with reduced emotional awareness in the context of early adversity

It is unclear at present whether psychopathic tendencies are associated with lower or higher levels of emotional awareness (EA). Given that psychopathy includes a proficiency for manipulating others, one might expect an elevated ability to identify and use information about others' emotions. On the other hand, empathic deficits in psychopathy could arise from reduced emotional awareness. Further, heterogeneity in psychopathy may also play a role, wherein 'secondary' psychopathy is associated with early adversity and high negative affect, while 'primary' psychopathy is not. In this paper, we tested the relationship between EA and psychopathic tendencies in 177 undergraduate students (40 males) who completed the levels of emotional awareness scale (LEAS), the triarchic psychopathy measure (TPM), the affective (empathy-related) subscales of the interpersonal reactivity index (IRI), and two measures of early adversity: the childhood experiences of care and abuse questionnaire (CECA) and the childhood trauma questionnaire (CTQ). We found that lower LEAS scores were associated with higher TPM and lower IRI empathy scores, but these relationships were primarily present in those with early adversity and high negative affect. This suggests that lower EA may be selectively associated with higher levels of secondary psychopathy, while those with higher levels of primary psychopathy remain capable of higher EA.

Attachment and Depressive Symptoms in Adolescence: The Mediatory Role of Emotion Awareness

Attachment seems to influence depression through emotion regulation. However, no study has yet examined the mediatory role of emotion awareness, a particular subset of emotion regulation abilities, in the relationship between attachment and depressive problems in early and middle adolescence. The aim of this study is to examine the direct and indirect effects of attachment on depressive symptoms in adolescence, considering the mediatory role of emotion awareness dimensions. A sample of adolescents (n = 223) filled up self-report questionnaires on attachment, emotion awareness and depression. Serial mediation models suggest direct effects on depression: negative for secure attachment and positive for anxious/ambivalent attachment. Anxious/ambivalent attachment has a positive indirect effect through lower differentiation of emotions. Both secure and anxious/ambivalent attachment have indirect positive effects on depression through the sequence of bodily unawareness and differentiation of emotions. Differentiating emotions has a central role in mediating the relationship between attachment and depressive symptoms, and the lack of bodily awareness of emotions contributes to such mediation.

Adiposity affects emotional information processing

Obesity is a worldwide epidemic associated with severe health and psychological wellbeing impairments expressed by an increased prevalence of affective disorders. Emotional dysfunction is important due to its effect on social performance. The aim of the present narrative review is to provide a general overview of human research exploring emotional information processing in overweight and obese people. Evidence suggests that obesity is associated with an attenuation of emotional experience, contradictory findings about emotion recognition, and scarce research about automatic emotional information processing. Finally, we made some concluding considerations for future research on emotional information processing in overweight and obese people.

A brief emotion regulation training in children and adolescents with obesity: A feasibility study

BACKGROUND

Recent studies emphasize the role of emotion dysregulation as an underlying mechanism initiating and maintaining emotional eating in obesity. Since multidisciplinary obesity treatment (MOT) does not directly address emotion regulation (ER), the current study aimed to investigate the feasibility of an ER training in children and adolescents with obesity on top of MOT. Feasibility was evaluated multi-informant on relevant parameters e.g. practicability, satisfaction, change in affect and homework compliance.

METHODS

Participants (N = 50, M_age = 12.26, 60.7 % girls) with obesity received a brief ER training and were assigned to one out of three conditions to learn one specific ER strategy (i.e., Cognitive reappraisal, Distraction or Acceptance). Afterwards the ER strategy was further trained by a homework assignment during 5 consecutive days. Children and adolescents, trainers and as well as the educators of the treatment center completed a feasibility questionnaire.

RESULTS

The training was positively evaluated by different informants for 11 out of 19 feasibility criteria. Only one implementation barrier was reported regarding homework compliance. Furthermore, some important considerations could be taken into account e.g. session length and motivation.

CONCLUSIONS

Reports suggest that, with some modifications, it is feasible to implement an ER training on top of MOT. In addition, future training protocols should focus on other essential components of ER (e.g., emotional awareness, emotional flexibility).

Stress reactivity in salivary cortisol and electrocardiogram in adolescents: Investigating sleep disturbances and insomnia

This study examined the role of sleep disturbances and insomnia in the context of stress reactivity in adolescence. One-hundred and thirty-five 11-18 year olds (M_age  = 14.2 years, SD = 1.9, 52% female) completed the Trier Social Stress Test for Children. Salivary cortisol and subjective stress ratings were collected at six time points, and heart rate as well as heart rate variability were measured pre-, during and post-stress induction. Additionally, sleep disturbances and insomnia diagnosis were assessed by a self-report questionnaire and a sleep interview. Robust mixed models investigated if adolescents with compared with adolescents without (a) sleep disturbances and (b) insomnia differ regarding cortisol, heart rate, heart rate variability and psychological stress reactivity considering gender effects. The results indicated that boys with high sleep disturbances showed higher cortisol activity compared with boys with low sleep disturbances, B = 0.88, p < 0.05. Moreover, in boys with insomnia, heart rate and alpha 1 significantly differ less than in boys without insomnia. These findings support the notion of sex differences regarding the association between poor sleep and increased activity of the hypothalamic-pituitary-adrenal axis, and a less adaptable autonomic nervous system in boys in response to an experimental social stress task.

School bullying victimization-associated anxiety in Chinese children and adolescents: the mediation of resilience

BACKGROUND

School bullying victimization is associated with increased risk of anxiety in children and adolescents. However, little is known about the role of resilience in this association. The purpose of this study was to investigate the possible mediation by resilience in this association in a large group of Chinese children and adolescents.

METHODS

A population-based cross-sectional study adopting two-stage simple random cluster sampling was implemented in Yunnan province, southwestern China. A comprehensive questionnaire was used to collect information from the participants. Among all the participants, 4624 were included in the final analysis. Descriptive statistics were used to present general characteristics of the study participants. Univariate and multivariate logistic regression models were adopted to estimate crude and adjusted associations among bullying victimization, anxiety, and resilience. A path model was used to analyze the hypothesized mediation by resilience in the association between bullying victimization and anxiety.

RESULTS

Analytical results of multivariate logistic regression models suggested that bullying victimization was significantly associated with anxiety in Chinese children and adolescents; compared with individuals who had not been bullied, victims of bullying were more likely to experience anxiety symptoms, with an adjusted odds ratio (OR) of 3.02 (95% CI 2.46-3.71). Path analysis revealed a prominent mediating effect of resilience in the association between bullying victimization and anxiety, accounting for 31.89% of the total association. Further analysis indicated that, among the five dimensions of resilience, emotional regulation, interpersonal assistance, and family support were significant mediators, accounting for 30.34%, 10.79%, and 8.35% of the total association.

CONCLUSIONS

Our major findings highlighted the promising role of resilience-based intervention measures in reducing the risk of anxiety associated with school bullying victimization in Chinese children and adolescents.

Usability, Feasibility, and Effect of a Biocueing Intervention in Addition to a Moderated Digital Social Therapy-Platform in Young People With Emerging Mental Health Problems: A Mixed-Method Approach

Introduction

To optimize treatment, it is of utmost importance to take into account the myriad of biological, social, and psychological changes that young people go through during adolescence which make them more vulnerable for developing mental health problems. Biocueing, a non-invasive method to transform physiological parameters into an observable signal, could strengthen stress- and emotion regulation by cueing physiologically unusual values in daily life. The aim of this study is to investigate the usability, feasibility, and exploratory effect of biocueing in addition to ENgage YOung people earlY (ENYOY), a moderated digital social therapy-platform, in young people with emerging mental health complaints.

Methods

A user-centered mixed-method design was used. A focus group was conducted to optimize the ENYOY-platform and biocueing intervention. Biocueing was operationalized by a smartwatch and the Sense-IT app. A within-subjects design was used; 10 days for all participants 'biofeedback off' (control), followed by 10 days 'biofeedback on' (experimental). Emotional awareness and perceived stress were measured using ecological momentary assessment. Eight individuals participated. User-friendliness, usability, and acceptance were assessed using a qualitative design.

Results

Findings from the focus group resulted in several adaptations of the biocueing intervention to the ENYOY-platform and vice versa. The average measurement compliance rate was 78.8%. Level-one findings showed different individual effects on perceived stress and emotional awareness. Level-two analyses showed no overall effects on perceived stress (B = -0.020, p = 0.562) and overall positive effects on emotional awareness (B = 0.030, p = 0.048) with small effect sizes (Improvement Rate Difference = 0.05-0.35). The intervention was found to be acceptable and showed moderate usability. Participants indicated they experienced improvements in reflection on feelings and changes in behavior, such as pausing and evaluating the situation.

Conclusion

These preliminary results show that biocueing could be a promising addition to digital treatment platforms and help young people become more emotionally aware. Improvements should be made regarding the usability and acceptability of the smartwatch, as well as more extensive integration of the biocueing intervention with a digital treatment platform. It would be relevant to gain a better understanding of which individuals would benefit most from an additional biocueing intervention.

The interplay between expressive suppression, emotional self-efficacy and internalizing behavior in middle adolescence

Background

Maladaptive emotion regulation strategies are predictive of negative outcomes in adolescence which, in turn, may impact on later well-being.

Objective

The current study aimed at testing the moderating role of emotional self-efficacy on the relation between expressive suppression and the engagement in internalizing behavior, controlling for gender effect.

Method

A total of 526 adolescents (Mage = 14.7 years, age range = 14–17 years) filled out self-report questionnaires evaluating expressive suppression, emotional regulatory self-efficacy, and internalizing behavior, respectively.

Results

Suppressors with lower positive emotion self-efficacy were more likely to engage in internalizing behavior than suppressors with higher positive emotion self-efficacy.

Conclusions

Despite several limitations, the study provided preliminary insights on the role played by emotional self-efficacy in the relation between expressive suppression and internalizing behavior in middle adolescence.

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.

Process-Oriented Measurement of Emotion Regulation: General and Specific Associations With Psychosocial Adjustment and Well-Being in (Pre-)Adolescence

The development of emotion regulation (ER) is associated with children's and adolescents' psychosocial adjustment and well-being. In this regard, previous studies have examined the role of different ER strategies, which can be characterized as being functional (e.g., reappraisal, problem solving) or dysfunctional (e.g., suppression, rumination). Based on the process model of emotion regulation, the strategies can also be classified according to their temporal position within the emotion generative process, with five families of ER strategies being proposed: situation selection, situation modification, attentional deployment, cognitive change, and response modulation. This study aimed to examine the role of ER for adolescents' psychosocial adjustment (internalizing and externalizing problems, prosocial behavior) and well-being. First, associations were investigated on a more general level by distinguishing between functional and dysfunctional ER. Second, relations were examined on a more specific level by additionally distinguishing between the five families of ER strategies as suggested in the process model of ER. Questionnaire self-reports of N = 1,727 German children and adolescents (55% girls) aged 9-18 years (M = 13.03, SD = 1.75) collected in schools were analyzed. Path analyses showed that more functional and less dysfunctional ER in general is associated with fewer internalizing and externalizing symptoms, and higher well-being. Prosocial behavior was only positively related to functional but not dysfunctional ER. Analyses of associations on the level of specific categories of ER strategies generally showed a similar pattern, but in part indicated differential associations with the dependent variables: Internalizing problems were particularly associated with functional situation selection, dysfunctional cognitive change, and dysfunctional response modulation. Externalizing problems were associated with functional situation selection and response modulation, as well as numerous dysfunctional strategies, none of which were particularly salient. Similarly, numerous rather than single specific associations emerged between prosocial behavior and the five categories of functional ER strategies. Well-being was particularly associated with functional situation selection and dysfunctional cognitive change. Overall, a more precise assessment of ER, as implemented in this study, could not only advance research in this field, but can also be helpful in planning and evaluating prevention and intervention programs.

Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review

BACKGROUND

Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities.

OBJECTIVE

This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines.

METHODS

The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents.

RESULTS

A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play.

CONCLUSIONS

The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology.

[A Multidimensional Assessment of Emotion Regulation in Adolescent Non-Suicidal Self-Injury]

The ability to regulate one's emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.

Teaching Simple Strategies to Foster Emotional Well-Being

The COVID-19 pandemic has presented considerable disruptions to routines that have challenged emotional well-being for children and their caregivers. One direction for supporting emotional well-being includes strategies that help children feel their best in the moment, which can bolster their capacity to respond appropriately to thoughts and behaviors. Strengthening emotional well-being equitably, however, must include opportunities in settings that are easily accessible to all, such as schools. In this paper, we focus on simple, evidence-informed strategies that can be used in schools to promote positive feelings in the moment and build coping behaviors that facilitate tolerance of uncertainty. We focus on those strategies that educators can easily and routinely use across ages, stages, and activities. Selected strategies are primarily tied to cognitive behavioral theory, with our review broadly organized across categories of self-awareness, self-soothing, and social relationships. We review evidence for each, providing examples that illustrate ease of use in school settings.

Self- but Not Other-Dimensions of Mentalizing Moderate the Impairment Associated With Social Anxiety in Adolescents From the General Population

Mentalizing, or social cognition, refers to the brain's higher order capacity that allows humans to be aware of one's own and others' mental states (e.g., emotions, feelings, intentions). While cognition in social anxiety has been broadly analyzed, there is a paucity of research regarding the role of social cognition. Moreover, mentalizing or social cognition research is traditionally focused on the understanding of others' mental states, rather than self-mentalizing. Finally, most studies analyze the role of social cognition in the development or maintenance of social anxiety, yet no study to date has analyzed whether social cognition moderates functional impairment associated with it. This study analyzes whether self- and other-mentalizing moderate the relationship between social anxiety and impairment in social and self-functioning. A sample of 262 adolescents from the non-clinical population was assessed on measures of social anxiety, self- and other- mentalization, indicators of social functioning (social competence and sociometric status), and indicators of self-functioning (depression and self-esteem). Multiple linear regressions were conducted to test possible moderation effects of self-mentalizing and other-mentalizing on the relationships between social anxiety and social and self-functioning. Results revealed that other-mentalizing does not moderate social- nor self-functioning, while self-mentalizing moderates the impairment of all of them. While impairment in social functioning is buffered by one dimension of self-mentalizing (emotional clarity; b = 0.003, p = 0.043 and b = 0.016, p = 0.008 for social competence and sociometric status, respectively), impairment in self-functioning is strengthened by the other dimension (attention to emotions; b = -0.007, p = 0.008 and b = 0.009, p = 0.047 for self-esteem and depression, respectively). Probing the moderation at the 16th, 50th, and 84th percentiles revealed that the negative imbalance between dimensions (i.e., high attention and low clarity) tended to exacerbate impairment most on all indicators, while the positive imbalance (i.e., low attention and high clarity) was usually the most buffering condition. This supports that "low-flying" or implicit mentalizing provides more resilience than explicit mentalizing (i.e., high attention and high clarity). Findings suggest that the work on emotional self-awareness should be stressed in the intervention of the social anxiety spectrum conditions in order to improve prevention, functioning, and ultimately, treatments, of people impaired by symptoms of social anxiety.

Development and Preliminary Italian Validation of the Emergency Response and Psychological Adjustment Scale

Evaluating the personal adaptation response to the emergency situations is very important for the prevention of mental distress, for the activation of network and community synergies and for the planning and implementation of appropriate psycho-social interventions. So far there are no short tools for the overall assessment of cognitive, emotional and behavioral responses of psychological adaptation to the emergency in the psychometric panorama. The Emergency Response and Psychological Adjustment Scale (ERPAS) was administered to a sample of 1,088 participants, while the concurrent validity was tested through a second administration to 600 participants along with the GSE (Generalized Self-Efficacy Scale) and the BDI-II (Beck Depression Inventory-II). Confirmatory factor analysis bore out a five-factor solution (including 18 items) with good fit indices of adaptation to data, χ²/df = 1.440, RMSEA = 0.028, RMSEA 90% CI = 0.018–0.038, GFI = 0.996, AGFI = 0.959, CFI = 0.982, and NFI = 0.944. Evidence of convergent validity was provided by the significant correlations with variables such as cognitive and somatic depression, and perceived general self-efficacy. The analyses also showed a strong invariance across gender. The ERPAS tool prefigures application during the assessment in multiple emergency contexts (e.g. earthquakes, floods, pandemics, terrorist attacks, war events, major accidents, major fires). This validation study of the ERPAS has shown that this version is a reliable and valid measurement for assessing people's modes of personal response (cognitive, emotional, behavioral) in emergency contexts.

Prevention and early intervention of depression in young people: an integrated narrative review of affective awareness and Ecological Momentary Assessment

Depression has a devastating impact on young people around the world. This impact is pervasive and long-long lasting, still causing havoc as young people transition into adulthood. Prevention and timely early intervention efforts are necessary to lessen the disease burden of depression in young people. There is some evidence for the effectiveness of existing prevention and early intervention programs when delivered early. However, there is no consensus on what the active ingredients of these programs are. Identifying these ingredients is important because focusing on those that have maximal benefit will help to minimise the costs and resourcing of (already intensive) therapeutic approaches. We explored whether, and in what circumstances, affective awareness (i.e., knowing how one feels) is a candidate for protecting against and decreasing vulnerability to depression in young people. We specifically looked at how Ecological Momentary Assessment methods (EMA) were used to measure and/or increase affective awareness. We integrated three streams of data, including narrative review findings, perspectives from young people and psychologists, and publicly available information online (e.g., discussion forums). Across data sources, we found converging evidence that affective awareness is important in the prevention and early intervention of depression although there were considerable gaps in knowledge. More work needs to be done with young people and their health care teams to build affective awareness in the right way, at the right time, with individual differences in mind. The identification of how EMA can be best incorporated into young people's lives to facilitate these outcomes is also needed.

Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience

The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.

Are emotions better left unknown? Sex-specific effects of emotional awareness and daily hassles on internalizing symptoms among college students

Amid growing concern about internalizing disorders on college campuses, few researchers have examined the ways emotional awareness deficits may contribute to risk. We examined the effect of the interaction between daily hassles, emotional awareness, and sex on depression and anxiety symptoms. Participants: Data were collected from 196 college students (M_age = 19.6, SD_age = 2.26) at a large university in June 2016. Methods: Participants completed online surveys to assess daily hassles, emotional awareness, and internalizing symptoms. Results: Daily hassles were significantly associated with internalizing symptoms, p < .01. For women, daily hassles were significantly associated with internalizing symptoms at all levels of emotional awareness, ps < .05. For men, daily hassles were significantly associated with internalizing symptoms only at high levels of emotional awareness, ps < .05. Conclusion: Future researchers could examine the context in which emotional awareness may be most beneficial to college students.

Emotion regulation abilities as a predictor of anxiety, positive emotions, heart rate, and alpha asymmetry during an impromptu speech task

BACKGROUND AND OBJECTIVES

Recent approaches suggest that emotion regulation (ER) abilities represent potential predictors of emotional response among youths navigating stressful situations. To test this, we investigated whether ER abilities predicted the subjective and physiological emotional response experienced by youths during a stressful situation.

DESIGN

A cross-sectional design was employed.

METHOD

One hundred and thirty-four youths completed measures of ER abilities (emotional awareness, anxiety sensitivity, emotional control) and were asked to deliver a speech while their anxiety, positive emotions, heart rate, and alpha asymmetry were collected at four time points: baseline, anticipation, speech, and post-recovery.

RESULTS

Pearson r correlations showed that poor emotional control and awareness, as well as high anxiety sensitivity were related to greater anxiety and lower positive emotions experienced during the speech. Hierarchical multiple regressions also revealed that emotional control and emotional awareness predicted greater speech anxiety and lower positive emotions. Moreover, anxiety sensitivity was related to and predicted an increased heart rate experienced during speech.

CONCLUSIONS

Findings suggest that difficulties in emotional awareness, anxiety sensitivity, and emotional control predict the emotional response experienced by youths during a stressful situation. Interventions delivered by clinicians/teachers that target ER difficulties may be effective in improving emotional functioning when navigating stressful situations.

Comorbid posttraumatic stress disorder and major depressive disorder: The usefulness of a sequential treatment approach within a randomised design

Cognitive Processing Therapy (CPT) and Behavioural Activation Therapy (BA) were used to treat individuals with comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Fifty-two individuals (48 women, 4 men) were randomized to CPT alone (n = 18), CPT then BA for MDD (n = 17), or BA then CPT (n = 17). Presenting trauma was primarily interpersonal (87 %). Participants were assessed at pre-, posttreatment, and 6-month follow-up. PTSD and MDD symptoms were the main outcome of interest; trauma cognitions, rumination, and emotional numbing were secondary outcomes. All groups showed sizeable reductions in PTSD and depression (effect sizes at follow-up ranging between 1.02-2.54). A pattern of findings indicated CPT/BA showed better outcomes in terms of larger effect sizes and loss of diagnoses relative to CPT alone and BA/CPT. At follow-up greater numbers of the CPT/BA group were estimated to have achieved good end-state for remission of both PTSD and depression (49 %, CI₉₅ [.26, .73]) relative to CPT alone (18 %, CI₉₅ [.03, .38]) and BA/CPT (11 %, CI₉₅ [.01, .29]). Although tempered by the modest sample size, the findings suggest that individuals with comorbid PTSD and MDD may benefit from having PTSD targeted first before remaining MDD symptoms are addressed.

Biocueing and ambulatory biofeedback to enhance emotion regulation: A review of studies investigating non-psychiatric and psychiatric populations

Over the last years, biofeedback applications are increasingly used to enhance interoceptive awareness and self-regulation, in psychiatry and beyond. These applications are used to strengthen emotion regulation skills by home training (ambulatory biofeedback) and real-time support in everyday life stressful situations (biocueing). Unfortunately, knowledge about the feasibility and effectivity of these applications is still scarce. Therefore, a systematic literature search was performed. In total, 30 studies (4 biocueing, 26 ambulatory biofeedback) were reviewed; 21 of these studies were conducted in non-psychiatric samples and 9 studies in psychiatric samples. Study characteristics, biofeedback characteristics, effectivity and feasibility outcomes were extracted. Despite the rapid advances in wearable technology, only a few biocueing studies were found. In the majority of the studies significant positive effects were found on self-reported (stress-related) psychological measures. Significant improvements on physiological measures were also reported, though these measures were used less frequently. Feasibility of the applications was often reported as sufficient, though not adequately assessed in most studies. Taken into account the small sample sizes and the limited quality of the majority of the studies in this recently emerging field, biocueing and ambulatory biofeedback interventions showed promising results. Future research is expected to be focusing on biocueing as a just-in-time adaptive intervention. To establish this research field, closer cooperation between research groups, use of more rigorous as well as individually tailored research designs and more valid feasibility and effectivity assessment are recommended.

Systematic Review of Preinjury Mental Health Problems as a Vulnerability Factor for Worse Outcome After Sport-Related Concussion

Background:

It is difficult to predict who will experience prolonged health problems after sustaining a sport-related concussion.

Purpose:

To synthesize the literature and conduct a gap analysis on the association between preinjury mental health problems and clinical outcome from sport-related concussion.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Data sources were PubMed, PsycINFO, MEDLINE (and MEDLINE in Process), CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. Studies published before February 2019 that addressed preinjury mental health problems as a possible predictor of worse clinical outcome or clinical recovery from concussion were eligible for inclusion.

Results:

Of 4013 studies screened, 358 full texts were reviewed, and 12 studies involving 3761 participants (n = 471 [12.5%] with preexisting mental health problems) were ultimately included. The participants with a preinjury history of mental health problems were at greater risk for having persistent symptoms or worse outcome in 9 of 12 studies. The studies had major methodological differences, and most studies were not focused on mental health as a primary predictor or prognostic factor. Rather, they included it as a secondary or tertiary predictor. The sample sizes with preinjury mental health problems in most studies were small or very small (ie, <25). The age of onset, type, course, severity, and duration of mental health problems were not defined. The extent to which mental health problems were present before the season, during baseline testing, was not reported.

Conclusion:

Preinjury mental health problems appear to confer risk for worse clinical outcome after sport-related concussion. Future research is needed to (1) examine this risk factor in large representative populations of middle school students, high school students, and collegiate athletes; (2) quantify the risk for each mental health condition; (3) understand the mechanisms underlying this increased risk; and (4) develop more refined treatment and rehabilitation approaches for these student-athletes.

Board Games on Emotional Competences for School-Age Children

Objective: Emotional competences (EC) are important for social and academic outcomes and positive life trajectories. Due to their social setting and tendency to stimulate intrinsic motivation, board games may constitute efficient learning tools for promoting socioemotional development in children. The current project therefore aimed at developing and testing three theory-driven board games explicitly targeting EC. First, we explored the quality of these EC games in terms of game experience, compared to off-the-shelf games (without an EC focus). Second, we tested whether targeted EC were linked to game experience in the EC games by measuring associations between children's trait EC and subjective effort and difficulty during gameplay. Materials and Methods: Children (N = 177) aged 8-12 years old were randomly assigned to a four-session protocol that comprised EC board games (experimental group) or off-the-shelf board games (control group). At baseline, participants' trait EC (emotion recognition, differentiation, and cognitive reappraisal) were assessed, while game experience (e.g., positive and negative affect, flow and immersion, difficulty, and effort) was assessed after each game. Results: Both groups perceived the games they played as positive and playable. Furthermore, regression analyses showed that higher trait EC was linked to lower self-reported effort and difficulty in two of the EC board games focusing on emotion recognition and differentiation. Conclusion: The present study shows that the board games on EC designed for children seem to elicit game experiences comparable to off-the-shelf games. Moreover, children's trait EC were linked to subjective game experience in two of the three games. Future interventions should examine the potential of the novel games to promote EC.

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 Association Between Juvenile Onset of Depression and Emotion Regulation Difficulties

Juvenile onset of Major Depressive Disorder (MDD) is associated with increased likelihood of recurrent episodes of depression and more detrimental clinical trajectories. The aim of the current study was to investigate the effect of juvenile onset of MDD on emotion regulation as measured by self-report and Heart Rate Variability (HRV). Furthermore, we wanted to assess whether juvenile onset impacted the association between rumination and depressive symptoms. Sixty-four individuals with at least three prior episodes of MDD were recruited and filled out self-report questionnaires measuring rumination and emotion regulation abilities. In addition, electrocardiographic assessments were used to calculate HRV. Based on self-reported age of MDD onset, individuals were divided in two groups: Juvenile onset of MDD (first MDD episode before the age of 18, n = 30) and adult onset of MDD (first MDD episode after the age of 18, n = 34). Results showed that individuals whose first depressive episode occurred in childhood and adolescence reported more rumination and less emotional clarity compared to individuals who had their first episode of MDD in adulthood. Moreover, the tendency to ruminate was strongly associated with depressive symptoms in the juvenile onset of MDD group, whereas no such association was found in the adult onset group. There was no significant group difference for HRV. The findings are discussed in light of existing literature, in addition to suggesting how our findings may inform clinical practice and future research. We conclude that juvenile onset of MDD may lead to difficulties in emotion regulation and that these difficulties may increase depressive symptoms and vulnerability for relapse in this particular subgroup.

Social anxiety disorder and emotion regulation problems in adolescents

BACKGROUND

Social anxiety disorder (SAD) in adolescents may be associated with the use of maladaptive emotion regulation (ER) strategies. The present study examined the use of maladaptive and adaptive ER strategies in adolescents with SAD.

METHODS

30 adolescents with SAD (CLIN) and 36 healthy adolescents for the control group (CON) aged between 11 and 16 years were assessed with the standardized questionnaires PHOKI (Phobiefragebogen für Kinder und Jugendliche) for self-reported fears as well as FEEL-KJ (Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen) for different emotion regulation strategies.

RESULTS

Compared to controls, adolescents with SAD used adaptive ER strategies significantly less often, but made use of maladaptive ER strategies significantly more often. There was a significant positive correlation between maladaptive ER and social anxiety in adolescents. Examining group differences of single ER strategy use, the CLIN and CON differed significantly in the use of the adaptive ER strategy reappraisal with CLIN reporting less use of reappraisal than CON. Group differences regarding the maladaptive ER strategies withdrawal and rumination, as well as the adaptive ER strategy problem-solving were found present, with CLIN reporting more use of withdrawal and rumination and less use of problem-solving than CON.

CONCLUSIONS

Promoting adaptive emotion regulation should be a central component of psychotherapy (cognitive behavioral therapy-CBT) for social anxiety in adolescents from the beginning of the therapy process. These findings provide rationale for special therapy programs concentrating on the establishment of different adaptive ER strategies (including reappraisal). As an increased use of maladaptive ER may be associated with SAD in adolescents, it may be paramount to focus on reduction of maladaptive ER (for example withdrawal and rumination) from the beginning of the psychotherapy process. Incorporating more ER components into psychotherapy (CBT) could increase the treatment efficacy. Further investigations of the patterns of emotion regulation in specific anxiety groups like SAD in adolescents is needed to continue to optimize the psychotherapy (CBT) concept.

Emotionsbewusstsein und depressive Symptome im frühen Jugendalter

Zusammenfassung. Theoretischer Hintergrund: Ergebnisse aus Querschnittstudien weisen darauf hin, dass Emotionsregulationsstrategien den Effekt zwischen dem Emotionsbewusstsein und depressiven Symptomen vermitteln. Es fehlen jedoch prospektive Studien, die diesen Effekt bestätigen. Fragestellung: Diese Studie überprüft, ob die Veränderung in der Nutzung adaptiver und maladaptiver Trauer-Regulationsstrategien über drei Monate die Beziehung zwischen dem Emotionsbewusstsein zu T1 und der depressiven Symptomatik zu T2 vermittelt. Methodik: Bei N = 136 Jugendlichen (55.9 % ♀, M = 11.53 Jahre; SD = 0.82) wurde zu T1 das Emotionsbewusstsein erfasst. Adaptive sowie maladaptive Strategien zur Trauerregulation und die Depressionssymptomatik wurden zu zwei Messzeitpunkten, zwischen denen ein Abstand von M = 15 Wochen ( SD = 4.22) lag, erhoben. Ergebnisse: Die Ergebnisse zeigen, dass ein hohes Emotionsbewusstsein zu T1 über eine Zunahme maladaptiver Regulationsstrategien mit einer stärkeren depressiven Symptomatik zu T2 verknüpft ist. Ein vermittelnder Effekt über die Veränderung adaptiver Regulationsstrategien fand sich nicht. Eine Zunahme adaptiver Strategien stand in Zusammenhang mit niedrigen Depressionswerten zu T2. Schlussfolgerung: In der Prävention sollte das Emotionsbewusstsein in Kombination mit Techniken zur Beendigung maladaptiver Trauer-Regulationsstrategien vermittelt werden. Adaptive Strategien zur Bewältigung von Trauer sollten systematisch aufgebaut und eingeübt werden.

Parenting styles, perceived social support and emotion regulation in adolescents with internet addiction

AIM

The aim of this study is to investigate parental attitudes, perceived social support, emotion regulation and the accompanying psychiatric disorders seen in adolescents who, having been diagnosed with Internet Addiction (IA), were referred to an outpatient child and adolescent psychiatric clinic.

METHODS

Of 176 adolescents aged 12-17, 40 were included in the study group. These scored 80 or higher on Young's Internet Addiction Test (IAT) and met Young's diagnostic criteria for IA based on psychiatric interviews. Forty adolescents who matched them in terms of age, gender and socio-economic level were included in the control group. The Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL), the Parenting Style Scale (PSS), the Lum Emotional Availabilty of Parents (LEAP), the Social Support Appraisals Scale for Children (SSAS-C), the Difficulties in Emotion Regulation Scale (DERS) and the Toronto Alexithymia Scale-20 (TAS-20) were applied.

RESULTS

The results showed that the parents of adolescents with IA were more frequently inadequate in acceptance/involvement, supervision/monitoring and they had less emotional availability. The adolescents with IA had less perceived social support, greater difficulty in the identification and verbal expression of their feelings and emotion regulation. Lower parental strictness/supervision, higher alexithymia and the existence of an anxiety disorder were found to be significant predictors of IA. Internet addicted adolescents with comorbid major depressive disorder had higher levels of alexithymia and lower levels of emotional availability in their parents.

CONCLUSION

It can be concluded that strategies for the prevention and treatment of IA in adolescents should focus on improving the quality of parenting parent-adolescent relationships, enhancing perceived social support and emotion regulation while reducing the associated psychiatric symptoms in adolescents.

Emotion dysregulation, temperamental vulnerability, and parental depression in adolescents: Correspondence between physiological and informant-report measures

Although numerous studies reveal altered respiratory sinus arrhythmia (RSA) among children, adolescents, and adults who exhibit emotion dysregulation, effects of temperamental vulnerability and parental mental health on RSA remain unclear. We evaluated the relationship among emotion regulation, RSA, and RSA reactivity in a pooled sample of 24 vulnerable and 31 resilient adolescents (mean age = 13.69 years; 60% girls), including associations with temperamental vulnerability and parental depressive symptoms. Participants watched a neutral film clip while their resting RSA was recorded, and then completed a reward and frustration task, using an affective Posner paradigm. Temperament and emotion regulation were assessed via self-report and parent report, and parents reported on their own depressive symptoms. Low resting RSA was associated with temperamental negative emotionality, whereas greater RSA reactivity to frustration was associated with maladaptive emotion regulation strategies. No significant relations were found between RSA and parental depressive symptoms. This study elucidates the role of RSA as a biomarker of individual differences in emotion dysregulation and temperamental vulnerability and stresses the importance of considering multiple units of analyses, as well as functional domains, when studying emotional responding and regulation in adolescents.

How do I feel right now? Emotional awareness, emotion regulation, and depressive symptoms in youth

Decreased emotional awareness contributes to the risk of internalizing disorders, such as depression. Although emotional awareness may be especially important during adolescence, a developmental period in which emotional arousal is high and the risk of depression rises dramatically, little research has examined the mechanisms linking emotional awareness to depression. Starting from affect regulation models, the current study proposes emotion regulation (ER) as a key underlying mechanism in the emotional awareness-depression relationship. The current study investigated whether maladaptive and adaptive ER strategies mediate the relationship between emotional awareness and depressive symptoms among youth using a cross-sectional design. Participants were 220 youth (65% girls; [Formula: see text] = 11.87, SD = 1.94) who filled out a set of questionnaires assessing emotional awareness, ER strategies, and depressive symptoms. Results revealed no direct relationship between emotional awareness and depressive symptoms. However, emotional awareness yielded a significant mediation effect through total adaptive ER strategies on higher depressive symptoms. No evidence was found for the mediating role of maladaptive ER strategies in this relationship. The current study provides further support for affect regulation models positing that emotional awareness may be a basic skill that is required for learning adaptive ER skills, and thus call for greater attention to adaptive ER strategies.

A longitudinal view of rumination, poor sleep and psychological distress in adolescents

BACKGROUND

Given the high prevalence and negative impact of psychological problems during adolescence, examining transdiagnostic factors that may have scope to positively influence a variety of psychological problems is imperative. The main purpose of this study was to investigate the longitudinal relationship between rumination and psychological distress and whether sleep mediated this relationship over a 2 year period.

METHODS

Participants were 1620 high school students in the 7th and 8th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2014, 2015 and 2016. Rumination and psychological distress were self-reported, and sleep duration was calculated from reported bed-times, wake-times and sleep onset latencies.

RESULTS

Sleep duration declined with age, whereas rumination and psychological distress increased. Rumination was predictive of future psychological distress and distress at a given time was predictive of concurrent rumination. Sleep duration did not consistently mediate the reciprocal relationships between rumination and psychological distress over time.

LIMITATIONS

Stronger longitudinal associations may have been obtained by using smaller measurement intervals or further delineation of outcome constructs.

CONCLUSIONS

Reducing rumination, rather than targeting sleep patterns, may work towards preventing the development of a number of psychological problems and is a strategy anticipated to function across disorders to improve young people's mental wellbeing.

The relationship of internalizing problems with emotional intelligence and social skills in secondary education students: gender differences

Internalizing problems (depression, anxiety, social anxiety, somatic complaints, post-traumatic symptoms, and obsession-compulsion) are very important in adolescents’ development. These problems can be related with people who lack social skills and poorly handle their emotions. This study assessed 1358 secondary education students (12–17 years) to analyze the relationship linking internalizing problems, emotional intelligence, and social skills. The results showed not only how these constructs were related, but how students’ internalizing problems varied according to their emotional intelligence and social skills. They also indicated that two in every three males, and just over one in every two females, obtained high scores for internalizing problems. The model showed a good fit: χ²(85) = 201.161 p < 0.001; χ²/gl = 2.367; CFI = 0.919; NFI = 0.869; TLI = 0.900; RMSEA = 0.075, IC 95% (0.062–0.089). Finally, gender influenced the way that internalizing problems, emotional intelligence, and social skills were related, and an inverse relation appeared to link internalizing problems, emotional intelligence (r = − .77), and social skills (r = − .52) for females, while this relationship was poorer for males. By way of conclusion, we state that internalizing problems are related with emotional intelligence and social skills in secondary education students, but this relationship differs according to gender.

Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression

BACKGROUND

Among adolescent girls, anorexia nervosa (AN) and major depression (MD) are common and often comorbid mental health problems. Both disorders are characterised by difficulties in recognising and verbalising (alexithymia) as well as regulating one's emotions, but research in adolescent patients is scarce and little is known about the relation between alexithymia and difficulties in emotion regulation. The aims of this study were to investigate alexithymia and emotion regulation skills in adolescents with AN, adolescents with MD, and healthy adolescents, and to determine whether alexithymia functions as a predictor for emotion regulation skills.

METHODS

Emotion regulation strategies, alexithymia, and depressive symptoms were assessed by questionnaire measures in 12-18 year old girls with AN (n = 26), girls with MD (n = 25), and healthy girls (n = 35). Groups were compared with respect to the these variables and multiple regression analyses were calculated separately for adaptive and maladaptive emotion regulation strategies in order to examine if alexithymia predicted emotion regulation over and above age and depressive symptoms.

RESULTS

Girls with AN or MD both reported using adaptive emotion regulation strategies less frequently and maladaptive emotion regulation skills more frequently as well as higher levels of alexithymia compared to healthy girls. Alexithymia positively predicted maladaptive emotion regulation strategies, while depressive symptoms negatively predicted adaptive emotion regulation strategies.

CONCLUSIONS

The results suggest that different mechanisms may underlie the lack of adaptive and the surplus of maladaptive emotion regulation strategies in adolescent psychiatric patients.

Depressive symptoms and emotion regulation strategies in children with and without developmental language disorder: a longitudinal study

BACKGROUND

Depressive symptoms are common in children with developmental language disorder (DLD). However, risk and protective factors contributing to these problems are currently underspecified.

AIMS

The current longitudinal study examined the role of emotion-regulation (ER) strategies in the severity of depressive symptoms in children with and without DLD, taking into account the severity of communication problems of children with DLD.

METHODS & PROCEDURES

We followed clinically referred children with DLD (n = 114, 49% girls) and without DLD (n = 214, 58% girls) between the ages of 8 and 16 years across an 18-month period. Participants completed self-report questionnaires at three time points. Parents of children with DLD reported on their child's communication problems.

OUTCOMES & RESULTS

Multilevel analyses confirmed higher levels of depressive symptoms in youngsters with DLD compared with peers without DLD, with a decrease across time in the DLD group. In both groups, higher levels of approach and increasing avoidant strategies aimed at distraction or trivializing a problem explained lower depressive symptoms, whereas more worry and externalizing strategies contributed to more depressive symptoms. Within the DLD group, semantic language problems were associated with higher depressive symptoms. However, this relation was mediated by the tendency to worry or use externalizing strategies.

CONCLUSIONS & IMPLICATIONS

Results suggest that interventions for children with DLD should focus on enhancing their adaptive ER strategies to help them cope with daily stressors just as in the general population.

Victimization, Bullying, and Emotional Competence: Longitudinal Associations in (Pre)Adolescents With and Without Developmental Language Disorder

PURPOSE

Victimization is a common problem for many children but is exacerbated for children with a developmental language disorder (DLD). However, the severity of communication problems does not explain their victimization rates. In children without DLD, difficulties with emotional competence are a risk factor for victimization and also increase the risk of bullying. In this longitudinal study, we examined the extent to which the level and development of emotional competence (understanding of one's own emotions and levels of anger, sadness, and fear) contributed to the prediction of victimization and bullying in children with and without DLD, over and above the type and severity of communication problems of children with DLD.

METHOD

Clinically referred youngsters (8-16 years old) with (n = 112; 48% girls, 52% boys) and without (n = 233; 58% girls, 42% boys) DLD completed self-reports 3 times over an 18-month period. Parents of children with DLD reported on their children's communication problems.

RESULTS

Participants with DLD reported more victimization but comparable levels of bullying behavior compared with peers without DLD. Higher levels of sadness and fear were risk factors for more victimization in both groups. Better understanding of one's own emotions had a larger effect on less victimization in children with DLD, independent of their communication problems. In addition, increased levels of anger and lower levels of understanding of one's own emotions explained more bullying in both groups.

CONCLUSION

Outcomes indicate that secondary difficulties in emotional competence in children with DLD make these children more vulnerable to victimization and warrant specific support and interventions.