Emotionality and Emotion Regulation as Risk Markers for Social Anxiety: Considering Development, Multiple Dimensions, and Social Threat

Abstract

As a construct, emotion regulation has been conceptualised as the "processes used to manage and change if, when, and how (e.g., how intensely) one experiences emotions and emotion-related motivational and physiological states, as well as how emotions are expressed behaviourally” (pp. 495; Eisenberg et al., 1997, 2010). Although there is substantial heterogeneity within these processes, research generally supports the notion that some forms of emotion regulation are associated with greater psychosocial functioning and well-being, and that other emotion regulation responses (or greater “dysregulation”) are etiologically related with symptoms of numerous psychopathologies, including anxiety and mood disturbance (Compas et al., 2017; Schäfer et al., 2016). Adolescence is one developmental period that is marked by significant challenges to and changes in emotion regulation and symptoms (Gross, 2013; Skinner & Zimmer-Gembeck, 2016). Research also suggests that the transition from late-childhood to early adolescence (approximately 10 to 15 years) is a period of high risk for the onset of social anxiety disorder (Beidel, & Turner, 2007; Farmer & Kashdan, 2012; Golombek, Lidle, Tuschen-Caffier, Schmitz, & Vierrath, 2019; Masters et al., 2018), with higher prevalence estimates consistently identified in girls versus boys (Farmer & Kashdan, 2012; Zimmer-Gembeck, Hunter, Waters, & Pronk, 2009). There is also increasing evidence to suggest that the acquisition of social anxiety disorder during adolescence will often place these youth at an increased risk for difficulties that persist into adulthood (Muris, 2007; Sawyer et al., 2000). Thus, identifying early risk factors for social anxiety disorder has become especially important. Despite this knowledge, comprehensive conclusions about those aspects of emotion regulation most relevant to adolescent social anxiety symptom development remain unclear. By drawing upon two dominant theoretical models of emotion regulation, including Gratz and Roemer’s (2004) emotion regulation difficulties model, and Gross’s (1998) model of emotion generation and regulation, three studies were conducted in the current program of research. The general purpose of this research was to use a multi-dimensional approach to broaden, but also isolate, the specific aspects of emotionality and emotion regulation that are risk markers and precursors for the development of social anxiety symptoms and disorder in adolescence, as well as to clarify the benefits of adaptive emotion regulation skills for young people. Study 1 included 391 Australian adolescents in grades 6 to 8 (Mage = 12.0 years, SD = 0.9 years) followed until grades 9 to 11. Adolescents were recruited from three independent high schools. Study 2 included 298 Australian adolescents in grades 7 and 8 (Mage = 13.3 years, SD = 0.6) who were recruited from two different independent high schools than those in Study 1. Study 3 included 76 youth (Mage = 13.5 years, SD = 1.5 years) recruited from the large in-school survey study (Study 2), university “special projects” broadcast email, community mental health services, and social media platforms. Using structural equation modelling, the temporal associations between adolescents’ emotion regulation difficulties (e.g., lack of emotional awareness, lack of emotional clarity, non-acceptance of emotional responses, impulse control difficulties, limited access to regulation strategies, difficulties engaging in goal directed behaviour when aroused) and internalising symptoms (e.g., social anxiety and depression) were tested in Study 1. A focus was on uncovering which emotion regulation difficulties are most salient to the development and maintenance of adolescent internalising symptoms. Guided by the description of the five stages of Gross’s (1998) process model and past research, Study 2 identified a comprehensive and balanced (i.e., both characteristically adaptive and maladaptive) range of emotion regulation strategies. These included avoidance, approach, problem solving, helplessness, distraction, rumination, acceptance, reappraisal, catastrophising, emotional suppression, venting, and relaxing. Associations of these strategies with social anxiety symptoms were tested in a multivariate regression model in order to draw conclusions regarding those strategies most salient to adolescent social anxiety symptoms. Gender differences and gender moderation of associations were also investigated in Study 1 and 2. In Study 3, the associations of adolescents’ social anxiety symptom level (e.g., low, moderate or high) with threat appraisal (e.g., anxiety and perceived social evaluation), perceived coping, and state-based use of adaptive (e.g., approach, problem solving, distraction, acceptance, reappraisal, venting and relaxing) and maladaptive (e.g., escape, avoidance, helplessness, rumination, catastrophising, suppression) emotion regulation strategies were tested. Appraisals, coping and emotion regulation strategies were measured within person, across a range of in-vivo social situations that varied in social evaluative threat (e.g., low, moderate and high). This design was used to investigate whether within person patterns of responding and regulation could identify high socially anxious young adolescents relative to others. Two general conclusions can be drawn from the results of this program of research: 1) the associations between dysregulation and internalising symptoms are bidirectional, age and disorder specific; and, 2) adolescent social anxiety symptoms and disorder are most strongly associated with maladaptive emotion regulation strategies, and associations may be contextually dependent. Theoretical, methodological, and practical implications are discussed. The findings from the current program of research has implications for current treatment models and interventions, and provide a foundation to better understand and identify adolescents at risk of developing internalising disorders, especially social anxiety.