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Child and Adolescent Psychiatry and Mental Health

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Open Access 01-12-2023 | Mood Disorders | Research

A network analysis of difficulties in emotion regulation, anxiety, and depression for adolescents in clinical settings

Authors: Qian-Nan Ruan, Yu-Hsin Chen, Wen-Jing Yan

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2023

Abstract

Background

Difficulties in emotion regulation (DER) are widely considered to underlie anxiety and depression. Given the prevalence of anxiety and depression in adolescents and the fact that adolescence is a key period for the development of emotion regulation ability, it is important to examine how DER is related to anxiety and depression in adolescents in clinical settings.

Methods

In the present study, we assessed 209 adolescents in clinical settings using the Difficulties in Emotion Regulation Scale (DERS) and the Hospital Anxiety and Depression Scale (HADS) and examined the associations between six components of DER and 14 symptoms of anxiety and depression. We used network analysis, constructed circular and multidimensional scaling (MDS) networks, and calculated network centrality, bridge centrality, and stability of centrality indices.

Results

The results showed that: (1) The global centrality index shows that the Strategy component (i.e., lack of access to strategies) is the center in the whole network, ranking highest in strength, closeness, betweenness, and expected influence. (2) The MDS network showed a closeness of anxiety and depression symptoms, while Awareness component (i.e., lack of emotional awareness) stayed away from other DER components, but Awareness is close to some depression symptoms. (3) The bridge nodes of three groups, Strategy from DERS, Worry and Relax from anxiety symptoms, and Cheerful and Slow from depression symptoms, had the strongest relationships with the other groups.

Conclusion

Lack of access to strategies remains in the center not only in DER but also in the DER-anxiety-depression network, while lack of awareness is close to depression but not to anxiety. Worrying thoughts and inability to relax are the bridging symptoms for anxiety, while lack of cheerful emotions and slowing down are the bridging symptoms for depression. These findings suggest that making emotion regulation strategies more accessible to patients and reducing these bridging symptoms may yield the greatest rewards for anxiety and depression therapy.

Following, the node labels with abbreviations will be in italics.

Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev. 2010;30(2):217–37.CrossRefPubMed

Amstadter A. Emotion regulation and anxiety disorders. J Anxiety Disord. 2008;22(2):211–21. https://doi.org/10.1016/j.janxdis.2007.02.004.CrossRefPubMed

Bardeen JR, Fergus TA. An examination of the incremental contribution of emotion regulation difficulties to health anxiety beyond specific emotion regulation strategies. J Anxiety Disord. 2014;28(4):394–401. https://doi.org/10.1016/j.janxdis.2014.03.002.CrossRefPubMed

Becerra R, Cruise K, Murray G, Bassett D, Harms C, Allan A, Hood S (2013) Emotion regulation in bipolar disorder: Are emotion regulation abilities less compromised in euthymic bipolar disorder than unipolar depressive or anxiety disorders?

Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. J Psychosom Res. 2002;52(2):69–77.CrossRefPubMed

Borsboom D. A network theory of mental disorders. World Psychiatry. 2017;16(1):5–13.CrossRefPubMedPubMedCentral

Carthy T, Horesh N, Apter A, Edge MD, Gross JJ. Emotional reactivity and cognitive regulation in anxious children. Behav Res Ther. 2010;48(5):384–93. https://doi.org/10.1016/j.brat.2009.12.013.CrossRefPubMed

Cisler JM, Olatunji BO, Feldner MT, Forsyth JP. Emotion regulation and the anxiety disorders: an integrative review. J Psychopathol Behav Assess. 2010;32(1):68–82. https://doi.org/10.1007/s10862-009-9161-1.CrossRefPubMedPubMedCentral

Ehring T, Quack D. Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD symptom severity. Behav Ther. 2010;41(4):587–98.CrossRefPubMed

10.

Epskamp S, Cramer AO, Waldorp LJ, Schmittmann VD, Borsboom D. qgraph: Network visualizations of relationships in psychometric data. J Stat Softw. 2012;48:1–18.CrossRef

11.

Epskamp S, Fried EI. A tutorial on regularized partial correlation networks. Psychol Methods. 2018;23(4):617.CrossRefPubMed

12.

Foygel R, Drton M. Extended Bayesian information criteria for Gaussian graphical models. Adv Neural Inform Process Syst. 2010;23:88.

13.

Friedman J, Hastie T, Tibshirani R. Sparse inverse covariance estimation with the graphical lasso. Biostatistics. 2008;9(3):432–41.

14.

Gonçalves SF, Chaplin TM, Turpyn CC, Niehaus CE, Curby TW, Sinha R, Ansell EB. Difficulties in emotion regulation predict depressive symptom trajectory from early to middle adolescence. Child Psychiatry Hum Dev. 2019;50:618–30.CrossRefPubMedPubMedCentral

15.

Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26(1):41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94.CrossRef

16.

Gratz KL, Rosenthal MZ, Tull MT, Lejuez CW, Gunderson JG. An experimental investigation of emotion dysregulation in borderline personality disorder. J Abnorm Psychol. 2006;115(4):850.CrossRefPubMed

17.

Gratz KL, Tull MT. Emotion regulation as a mechanism of change in acceptance-and mindfulness-based treatments. Assessing Mindfulness Acceptance Processes Clients. 2010;2:107–33.

18.

Gross JJ. Antecedent-and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. J Pers Soc Psychol. 1998;74(1):224.CrossRefPubMed

19.

Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):281–91. https://doi.org/10.1017/S0048577201393198.CrossRefPubMed

20.

Gross JJ, Feldman Barrett L. Emotion generation and emotion regulation: one or two depends on your point of view. Emot Rev. 2011;3(1):8–16. https://doi.org/10.1177/1754073910380974.CrossRefPubMedPubMedCentral

21.

Hallion LS, Steinman SA, Tolin DF, Diefenbach GJ. Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS) and its short forms in adults with emotional disorders. Front Psychol. 2018;9:539.CrossRefPubMedPubMedCentral

22.

Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychol. 2008;27(4):455–62. https://doi.org/10.1037/0278-6133.27.4.455.CrossRefPubMed

23.

Helbig-Lang S, Rusch S, Lincoln TM. Emotion regulation difficulties in social anxiety disorder and their specific contributions to anxious responding: emotion regulation in social anxiety disorder. J Clin Psychol. 2015;71(3):241–9. https://doi.org/10.1002/jclp.22135.CrossRefPubMed

24.

Heller AS, Casey BJ. The neurodynamics of emotion: Delineating typical and atypical emotional processes during adolescence. Dev Sci. 2016;19(1):3–18.CrossRefPubMed

25.

Herres J, James KM, Bounoua N, Krauthamer Ewing ES, Kobak R, Diamond GS. Anxiety-related difficulties in goal-directed behavior predict worse treatment outcome among adolescents treated for suicidal ideation and depressive symptoms. Psychotherapy. 2021;58(4):523.CrossRefPubMed

26.

Hu T, Zhang D, Wang J, Mistry R, Ran G, Wang X. Relation between emotion regulation and mental health: A meta-analysis review. Psychol Rep. 2014;114(2):341–62.CrossRefPubMed

27.

Jones PJ, Mair P, McNally RJ. Visualizing psychological networks: a tutorial in R. Front Psychol. 2018;9:1742. https://doi.org/10.3389/fpsyg.2018.01742.CrossRefPubMedPubMedCentral

28.

Kaufman EA, Xia M, Fosco G, Yaptangco M, Skidmore CR, Crowell SE. The difficulties in emotion regulation scale short form (DERS-SF): validation and replication in adolescent and adult samples. J Psychopathol Behav Assess. 2016;38(3):443–55. https://doi.org/10.1007/s10862-015-9529-3.CrossRef

29.

Kim J, Cicchetti D. Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology: pathways linking maltreatment, emotion regulation, and psychopathology. J Child Psychol Psychiatry. 2009;51(6):706–16. https://doi.org/10.1111/j.1469-7610.2009.02202.x.CrossRefPubMedPubMedCentral

30.

Ling D, Nan Z, Xiaobin D. Reliability and validity of difficulties in emotion regulation normal scale in chinese adolescent. Chin J Health Psychol. 2014;22(003):363–6.

31.

McRae K, Gross JJ, Weber J, Robertson ER, Sokol-Hessner P, Ray RD, Gabrieli JD, Ochsner KN. The development of emotion regulation: An fMRI study of cognitive reappraisal in children, adolescents and young adults. Soc Cognit Affect Neurosci. 2012;7(1):11–22.CrossRef

32.

Menefee DS, Ledoux T, Johnston CA. The importance of emotional regulation in mental health. Am J Lifestyle Med. 2022;16(1):28–31.CrossRefPubMedPubMedCentral

33.

Mennin DS. Emotion regulation therapy for generalized anxiety disorder. Clin Psychol Psychother. 2004;11(1):17–29. https://doi.org/10.1002/cpp.389.CrossRef

34.

Mennin DS, Heimberg RG, Turk CL, Fresco DM (2002) Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder.

35.

Mennin DS, Holaway RM, Fresco DM, Moore MT, Heimberg RG. Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behav Ther. 2007;38(3):284–302.CrossRefPubMed

36.

Moore R, Gillanders D, Stuart S. The impact of group emotion regulation interventions on emotion regulation ability: a systematic review. J Clin Med. 2022;11(9):2519.CrossRefPubMedPubMedCentral

37.

Neacsiu AD, Smith M, Fang CM. Challenging assumptions from emotion dysregulation psychological treatments. J Affect Disord. 2017;219:72–9. https://doi.org/10.1016/j.jad.2017.05.016.CrossRefPubMed

38.

Neumann A, van Lier PAC, Gratz KL, Koot HM. Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment. 2010;17(1):138–49. https://doi.org/10.1177/1073191109349579.CrossRefPubMed

39.

Nolen-Hoeksema S, Aldao A. Gender and age differences in emotion regulation strategies and their relationship to depressive symptoms. Personality Individ Differ. 2011;51(6):704–8.CrossRef

40.

Pepe M, Nicola M, Moccia L, Franza R, Chieffo D, Addolorato G, Janiri L, Sani G. Limited Access to Emotion Regulation Strategies Mediates the Association Between Positive Urgency and Sustained Binge Drinking in Patients with Alcohol Use Disorder. Int J Mental Health Addict 2022;78: 1–14.

41.

Poon JA, Turpyn CC, Hansen A, Jacangelo J, Chaplin TM. Adolescent substance use & psychopathology: interactive effects of cortisol reactivity and emotion regulation. Cogn Ther Res. 2016;40(3):368–80. https://doi.org/10.1007/s10608-015-9729-x.CrossRef

42.

Quoidbach J, Mikolajczak M, Gross JJ. Positive interventions: An emotion regulation perspective. Psychol Bull. 2015;141(3):655–93. https://doi.org/10.1037/a0038648.CrossRefPubMed

43.

Ren L, Wang Y, Wu L, Wei Z, Cui L-B, Wei X, Hu X, Peng J, Jin Y, Li F. Network structure of depression and anxiety symptoms in Chinese female nursing students. BMC Psychiatry. 2021;21(1):1–12.CrossRef

44.

Renna ME, Quintero JM, Fresco DM, Mennin DS. Emotion regulation therapy: A mechanism-targeted treatment for disorders of distress. Front Psychol. 2017;8:98.CrossRefPubMedPubMedCentral

45.

Ritschel LA, Tone EB, Schoemann AM, Lim NE. Psychometric properties of the Difficulties in Emotion Regulation Scale across demographic groups. Psychol Assess. 2015;27(3):944–54. https://doi.org/10.1037/pas0000099.CrossRefPubMed

46.

Ruan QN, Chen C, Jiang D-G, Yan WJ, Lin Z. A network analysis of social problem-solving and anxiety/depression in adolescents. Front Psychiatr. 2022; Doi https://doi.org/10.3389/fpsyt.2022.921781

47.

Rusch S, Westermann S, Lincoln TM. Specificity of emotion regulation deficits in social anxiety: An internet study. Psychol Psychother Theory Res Pract. 2012;85(3):268–77.CrossRef

48.

Schneider RL, Arch JJ, Landy LN, Hankin BL. The longitudinal effect of emotion regulation strategies on anxiety levels in children and adolescents. J Clin Child Adolesc Psychol. 2018;47(6):978–91. https://doi.org/10.1080/15374416.2016.1157757.CrossRefPubMed

49.

Selby EA, Anestis MD, Joiner TE. Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behav Res Ther. 2008;46(5):593–611.CrossRefPubMed

50.

Seymour KE, Chronis-Tuscano A, Halldorsdottir T, Stupica B, Owens K, Sacks T. Emotion regulation mediates the relationship between ADHD and depressive symptoms in youth. J Abnorm Child Psychol. 2012;40(4):595–606. https://doi.org/10.1007/s10802-011-9593-4.CrossRefPubMed

51.

Silvers JA, McRae K, Gabrieli JD, Gross JJ, Remy KA, Ochsner KN. Age-related differences in emotional reactivity, regulation, and rejection sensitivity in adolescence. Emotion. 2012;12(6):1235.CrossRefPubMedPubMedCentral

52.

Sörman K, Garke MÅ, Isacsson NH, Jangard S, Bjureberg J, Hellner C, Sinha R, Jayaram-Lindström N. Measures of emotion regulation: Convergence and psychometric properties of the difficulties in emotion regulation scale and emotion regulation questionnaire. J Clin Psychol. 2022;78(2):201–17. https://doi.org/10.1002/jclp.23206.CrossRefPubMed

53.

Tull MT, Aldao A. Editorial overview: New directions in the science of emotion regulation. Curr Opin Psychol. 2015;3:iv–x. https://doi.org/10.1016/j.copsyc.2015.03.009.CrossRef

54.

Tull MT, Barrett HM, McMillan ES, Roemer L. A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther. 2007;38(3):303–13. https://doi.org/10.1016/j.beth.2006.10.001.CrossRefPubMed

55.

Tull MT, Stipelman BA, Salters-Pedneault K, Gratz KL. An examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample. J Anxiety Disord. 2009;23(2):275–82. https://doi.org/10.1016/j.janxdis.2008.08.002.CrossRefPubMed

56.

Van Beveren M-L, Goossens L, Volkaert B, Grassmann C, Wante L, Vandeweghe L, Verbeken S, Braet C. How do I feel right now? Emotional awareness, emotion regulation, and depressive symptoms in youth. Eur Child Adolesc Psychiatry. 2019;28(3):389–98. https://doi.org/10.1007/s00787-018-1203-3.CrossRefPubMed

57.

van Borkulo C, Boschloo L, Borsboom D, Penninx BW, Waldorp LJ, Schoevers RA. Association of symptom network structure with the course of depression. JAMA Psychiat. 2015;72(12):1219–26.CrossRef

58.

Van Rheenen TE, Murray G, Rossell SL. Emotion regulation in bipolar disorder: Profile and utility in predicting trait mania and depression propensity. Psychiatry Res. 2015;225(3):425–32.CrossRefPubMed

59.

Victor SE, Klonsky ED. Validation of a brief version of the difficulties in emotion regulation scale (DERS-18) in Five Samples. J Psychopathol Behav Assess. 2016;38(4):582–9. https://doi.org/10.1007/s10862-016-9547-9.CrossRef

60.

Weems C. Developmental trajectories of childhood anxiety: Identifying continuity and change in anxious emotion☆. Dev Rev. 2008;28(4):488–502. https://doi.org/10.1016/j.dr.2008.01.001.CrossRef

61.

Wei Z, Ren L, Wang X, Liu C, Cao M, Hu M, Jiang Z, Hui B, Xia F, Yang Q. Network of depression and anxiety symptoms in patients with epilepsy. Epilepsy Res. 2021;175: 106696.CrossRefPubMed

62.

You J, Leung F. The role of depressive symptoms, family invalidation and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury in Chinese adolescents: A 2-year follow-up study. J Adolesc. 2012;35(2):389–95.CrossRefPubMed

Title: A network analysis of difficulties in emotion regulation, anxiety, and depression for adolescents in clinical settings
Authors: Qian-Nan Ruan
Yu-Hsin Chen
Wen-Jing Yan
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Anxiety
Published in: Child and Adolescent Psychiatry and Mental Health / Issue 1/2023
Electronic ISSN: 1753-2000
DOI: https://doi.org/10.1186/s13034-023-00574-2

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A network analysis of difficulties in emotion regulation, anxiety, and depression for adolescents in clinical settings

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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