Emotion Dysregulation as a Risk Factor for Psychopathology

1. Emotion Dysregulation as a Risk Factor for Psychopathology Chapter 11 Pamela M. Cole, Sarah E. Hall, and Nastassia J. Hajal

2. HISTORICAL CONTEXT • James (1884) thought physiological changes comprise emotion. • Cannon (1927) thought physiological changes were caused by emotions. • Schacter and Singer (1962) thought emotions were the interpretation of physiological change. • Zajonc (1980) asserted that emotion and cognition were separate processes and that emotion took precedence over cognition. • Most contemporary views acknowledge that emotions have been conserved over time because of their adaptive value in survival, that they often operate out of conscious awareness, and that emotional reactions that are poorly managed compromise behavioral functioning.

3. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotion • Comprise two integrated processes: • Appraising is the radar by which we evaluate the significance of circumstances vis-à-vis our goals for well-being. • Action preparation is readiness to respond in a particular way that enables us to regain or maintain well-being. • Are adaptive because they permit rapid detection of threats to well-being and ability to act on our own behalf without delay. • Being emotional entails continual processes of evaluating the meaning of, and readying responses to, ever-changing circumstances, a set of processes that both regulate other psychological systems and are inherently self-regulatory.

4. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotion Regulation • Emotion regulation is defined as changes in initial appraisal/action readiness responses to circumstances that can be modulated by other processes (Cole et al., 2004). • Mental health and emotional competence require both emotional responsiveness and regulation of responses such that behavior accords to social standards (Saarni, 1998).

5. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotion Dysregulation • Emotion dysregulation occurs when patterns of emotion regulation compromise longer-term functioning even as they serve the goal of achieving an immediate sense of well-being. • Patterns of emotion dysregulation develop when biology and circumstances conspire to compromise the development of, or override, patterns of emotion regulation that achieve well-being and promote the longer-term goals of becoming a competent, healthy person.

6. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotion Dysregulation From a Clinical Perspective • Emotion dysregulation is a risk factor of mental health problems. • Emotion dysregulation can be distinguished from emotionally competent patterns of regulation in the following ways: • Emotions endure and regulatory attempts are ineffective • Emotions interfere with appropriate behavior • Emotions are context inappropriate • Emotions change too abruptly or too slowly

7. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotions Are Enduring and Regulatory Attempts Are Ineffective • Adaptive Regulatory Strategies: • Delaying a reaction, reducing intensity, shortening duration, or shifting from one emotion to another, active problem solving, cognitive reappraisal, exercise, information-seeking, and support-seeking. • Less Optimal Regulatory Strategies: • Avoidance, denial, emotion suppression, rumination, substance use, aggression, and venting are less optimal • Evidence on Strategies for Children Suggests That: • Attention shifting, problem-focused information seeking, and appropriate, instrumental actions regulate children’s emotions, at least in the short term. • Greater reliance on these strategies is associated with better adjustment from infancy to adolescence. • Children with symptoms of anxiety, depression, and oppositionality are less likely to use these strategies and lack confidence that they can use them effectively.

8. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotions Interfere With Appropriate Behavior • Emotion dysregulation occurs when emotions lead to behaviors that violate social standards or compromise developmental goals. • Emotions That Are Context Inappropriate • Socially inappropriate emotion expression • An expressed emotion is inappropriate when it violates social or cultural norms for the situation, such as laughing when someone is hurt. • Inappropriate emotion expression may involve poor social awareness, disregard for social display rules, or inability to regulate expression even when the individual wishes to do so.

9. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Atypical emotional responses to specific contexts • Feeling sad or afraid in situations that most children enjoy. • Excessive distrust, pleasure at another’s distress, and emotional reactions for no apparent reason embody the idea of emotion-context mismatch. • Linked to anxiety • Emotional unresponsiveness • Emotional unresponsiveness to situations that usually evoke emotion. • Flat affect in children is seen in schizophrenia, depression, posttraumatic stress disorder, externalizing and internalizing symptoms.

10. TERMINOLOGICAL AND CONCEPTUAL ISSUES • Emotions Change Too Abruptly or Too Slowly • Emotions that resist change may signal dysregulation. • Resistance to emotional change is a feature of mood and anxiety disorders. • Prolonged sadness or irritability is the central symptom of adult and childhood depression.

11. ETIOLOGICAL FORMULATIONS • Normal Development • By the end of the first year anger, sadness, and fear are discernible (Bennett, Bendersky, & Lewis, 2002). • At first, infant emotions switch quickly, yet by 6 months facial expressions change less rapidly or frequently (Malatesta & Haviland, 1982). • Emotional lability appears to follow a normative decline across development (Gerson et al., 1996). • Caregivers help foster the development of more autonomous emotion regulation. • Being fear- or anger-prone or experiencing family adversity appears to compromise the development of emotion regulation.

12. GENETICS AND HERITABILITY OF EMOTION DYSREGULATION • Temperament • Predicts difficulties with emotion regulation even from early childhood (Calkins & Fox, 2002). • May render a child more susceptible to caregiving quality (Ellis et al., 2011). • Parenting and Parent-Child Relationships • Secure attachment is linked to parent-child discussion and validation of children’s emotions when they are upset (Waters, et. al, 2010). • Warm, supportive parental responses, and firm discipline when needed, appear to support the development of healthy emotion regulation (Bocknek, Brophy-Herb, & Banerjee, 2009).

13. GENETICS AND HERITABILITY OF EMOTION DYSREGULATION • Parental Psychopathology • Parents’ ability to regulate their own emotions is important for children and may explain links between parental mental health problems (i.e., depression) and child emotion dysregulation. • Maltreatment and Violence Exposure • Maltreatment may interfere with the development of healthy emotion regulation in several ways. • Trauma of maltreatment affects children neurologically. • Maltreating parents are less sensitive to their children’s needs and may lack the skills to both teach and model effective emotion regulation. • Maltreatment affects child emotion processing. Their negative internal representations of their parents may interfere with how well they regulate emotion in any interpersonal situation. • The way a child copes with maltreatment may require emotion dysregulation.

14. SUMMARY AND CONCLUSIONS • Four characteristics of emotional functioning that occur in the presence of psychopathology define dysregulation: • Emotions that endure due to ineffective strategies • Emotions that lead to inappropriate behavior • Emotions that are contextually inappropriate • Aberrations in how emotions change