Emotional reactivity and cognitive regulation in anxious children

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Abstract

Recent models of anxiety disorders emphasize abnormalities in emotional reactivity and regulation. However, the empirical basis for this view is limited, particularly in children and adolescents. The present study examined whether anxious children suffer both negative emotional hyper-reactivity and deficits in cognitive emotion regulation. Participants were 49 children aged 10–17 with generalized anxiety disorder, social anxiety, or separation anxiety disorder as their primary diagnosis, as well as 42 age- and gender-matched non-anxious controls. After completing a diagnostic interview and self-report questionnaires, participants were presented with pictures of threatening scenes with the instructions either to simply view them or to use reappraisal, a cognitive emotion regulation strategy, to decrease their negative emotional response. Emotion ratings, content analysis of reappraisal responses, and reports of everyday use of reappraisal were used to assess negative emotional reactivity, reappraisal ability, efficacy and frequency. Relative to controls, children with anxiety disorders (1) experienced greater negative emotional responses to the images, (2) were less successful at applying reappraisals, but (3) showed intact ability to reduce their negative emotions following reappraisal. They also (4) reported less frequent use of reappraisal in everyday life. Implications for the assessment and treatment of childhood anxiety disorders are discussed.

Section snippets

Emotional reactivity in anxiety disorders

There is a striking variability across individuals in the quality and intensity of emotional reactions to similar stimuli, as manifested in experiential, behavioral, and physiological response systems. Emotional reactivity refers to the characteristics of the emotional response, including the threshold of stimuli needed to generate emotional response and the intensity of emotional response once emotion is generated (Davidson, 1998).

Anxious individuals seem to show emotional hyper-reactivity,

Emotion regulation in anxiety disorders

These accumulating findings of negative emotional hyper-reactivity in anxious individuals suggest down-regulating (decreasing) their negative emotion is a relatively more frequent and demanding challenge than for non-anxious people. Emotion regulation refers to the processes that influence the intensity, duration, and expression of emotions (Gross & Thompson, 2007), and effective emotion regulation can reduce the intensity of negative emotional responses in anxiety-provoking situations.

Indeed,

The present study

The primary goal of the present study was to examine abnormalities in emotional reactivity and in cognitive emotion regulation in children and adolescents1 with anxiety disorders. To address these goals, we developed a computerized age-appropriate task that presents emotion-inducing images and enables

Participants

Ninety-one Israeli children aged 10–17 participated in this study (44 girls and 47 boys). General inclusion criteria were fluency in Hebrew and normal intelligence. General exclusion criteria were reading disability, psychotic symptoms, current anti-anxiety psychological or pharmacological treatment, and a major life stressor within the past six months. All participants and their parents provided informed consent. The study was approved by the Helsinki committee of the Schneider's Children

Participant characteristics

Participants in the AD and NAC did not differ significantly in gender, χ2(1, N = 91) = .09, p > .75, or in age, (M = 13.74, SD = 1.93, M = 13.42, SD = 2.38 in the NAC and AD accordingly), t(89) = .69, p > .49. All participants' scores on reading and vocabulary tests were within normal range. The three AD subgroups did not differ in clinical symptoms (i.e., severity of anxiety, severity of depression and overall severity of illness), however the SAD subgroup was younger than the other two

Discussion

In this study, we tested the hypothesis that anxiety disorders in childhood involve negative emotional hyper-reactivity and deficits in reappraisal, a major cognitive regulation strategy. The study produced four key findings. First, compared to age- and gender-matched non-anxious controls, children with anxiety disorders experienced exaggerated negative emotional response to images with threatening scenes. Second, reappraisal effectively reduced negative emotion for both anxious and non-anxious

Limitations and future directions

Our task aimed to assess real-time emotional reactivity and regulation. However, because emotion generation and regulation are intertwined processes, it is not possible to entirely isolate each process from the other. This means we can't eliminate the possibility that to some extent, the children's ratings of their negative emotional response upon viewing the images have already included spontaneous use of reappraisal. Future studies will be needed to clarify whether anxious and non-anxious

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