Adolescent Emotional Development PDF

Chapter 4: Adolescent Emotional Development Learning Objectives: Emotional Development 1. Define and describe the three aspects of adolescent emotional development. 2. Describe positive emotions and sensation seeking. 3. Describe negative emotions. 4. Discuss adole...

Chapter 4: Adolescent Emotional Development Learning Objectives: Emotional Development 1. Define and describe the three aspects of adolescent emotional development. 2. Describe positive emotions and sensation seeking. 3. Describe negative emotions. 4. Discuss adolescent emotion regulation and methods to increase it. 5. Name psychiatric disorders with onset during adolescence and early adulthood. Emotional development after age 12 years includes increases in positive emotions, negative emotions and emotion regulation. As we have discussed throughout this book, positive emotions arise from the BAS and are linked to left frontal lobe activation in most people. Anger is included as a positive emotion because it happens when a person is prevented from pursuing their goals. Likewise envy and jealousy are positive emotions linked to goals of protecting relationships and obtaining material possessions (Platt, 2017). Negative emotions, including sadness, fear, guilt, and shame arise in situations where the BIS is activated. During adolescence individuals experience strong and changing emotions due to imbalance between self-regulation ability and emotional systems that mature under the influence of gonadal steroids (Somerville et al., 2010). Adolescents with emotion regulation skills and less intense emotions cope better. The combination of intense emotions, insufficient emotion regulation skills, substance abuse and the social environment makes adolescence and early adulthood the peak time of onset for many psychiatric disorders. Positive Emotions and the BAS Figure 0-1 Areas of the brain involved in reward (BAS). ’Mesolimbic and Mesocortical Pathways’ by Casey Henley is licensed under a Creative Commons Attribution Non-Commercial Share-Alike (CC BY-NC-SA) 4.0 International License. The nucleus accumbens is located in the basal forebrain and is part of the ventral striatum (VS) (a group of subcortical structures involved in reward, emotion and the generation of behaviors) (Figure -1). Interestingly this part of the brain is active during all reward-oriented behavior, irrespective of the reward. Although there are separate brain circuits for feeding, sex, affiliation, caregiving, and dominance, the areas of the brain shown in Figure -1 (frontal mesocortical dopamine pathway, mesolimbic dopamine pathway, ventral tegmental area, and prefrontal cortex) are also active during these emotional behaviors. This circuit is altered with substance use/abuse. (For a more discussion of motivation and reward see Motivation and Reward.) Positive affect or feeling good is part of hedonic well-being (Ryan & Deci, 2001). We already pointed to early childhood as a time of overall positive affect and optimism for most children not under stress. Adolescence is a developmental period similar to early childhood in that “emotion mind” tends to be stronger than “rational mind” during these two life phases. Are adolescents as happy and cheerful as preschoolers? Longitudinal studies that assess daily positive affect find that positive affect declines following puberty (Larson et al., 2002; Weinstein et al., 2007). The average daily positive affect is about 6 out of 10 for teens (Weinstein et al., 2007). Most adolescents describe themselves as “happy” (Larson et al., 2002; Shen et al., 2018). A decline in positive emotions is linked to risk for depression (Weinstein et al., 2007) and poor sleep (Shen et al., 2018). Effective clinical interventions for adolescents teach skills for increasing daily positive emotion (Rathus & Miller, 2014). Reward responsiveness means how much a person has positive emotional responses to reward (Taubitz et al., 2015). Some adolescents are more likely than others to respond to reward with lasting positive emotions (Heller & Casey, 2016). Gonadal steroids including testosterone and estrogen modify the responsiveness of the regions of the brain involved in reward including the VS. “Adolescents (ages 13–17 years) show a larger VS response to rewards compared to children and adults” (van Duijvenvoorde et al., 2014, p. 3). As discussed in earlier chapters, individual differences in temperament determine individual differences in reward responsiveness. Furthermore, changes in reward responsiveness after puberty are seen. There are two sources of individual differences in reward responsiveness, temperament, and development after puberty. Adolescents learn faster from rewarding experiences and remember rewarding experiences more than adults (Davidow et al., 2016). Faster learning of reward may result in greater susceptibility to substance use disorders (Zilverstand et al., 2018). Anger in Adolescents Anger is a basic emotion found in humans after age 4-6 months defined as a state of arousal that results from threat to or frustration of goal directed behavior. As with all emotions anger does not come directly from situations, instead the thoughts individuals have trigger anger. Thoughts that are repeated in similar situations become attitudes and for anger. Attitudes and scripts once developed are stable over time and may lead 2 to high levels of trait anger (Kerr & Schneider, 2008). Trait anger then becomes a vulnerability factor for the experience of anger in various situations (Figure -2). Other vulnerability factors can include sleep deficit, insufficient exercise, poor diet, stress. Anger leads to sympathetic arousal and increases in heartrate and blood pressure that may predispose to cardiovascular disease even in adolescents (Kerr & Schneider, 2008). Emotion regulation skills determine how intense anger is, how long it lasts, and how often it occurs. Emotion regulation skill use also determines how a person behaves in response to angry emotion. Anger can be coped with or expressed inwardly toward the self and/or outwardly toward others or things. Figure 0-2. By early adolescence children have learned that anger expression may lead to peer rejection. They also expect less support from their friends for their angry feelings as opposed to their sadness. Teens tend not to express anger directly toward their friends but instead explain their feelings, use humor or attempt to reconcile (Kerr & Schneider, 2008). Teens with lower levels of prosocial orientation and connectedness are more likely to have high levels of anger in response to frustrating situations (Kerr & Schneider, 2008). Teens express more anger toward their parents than toward their peers. This angry behavior is often provoked by parents through threats and hostile criticism. Numerous studies show that the family environment and parental modeling influences the expression of anger. When parents speak to one another with sarcastic tones, insult each other, shout, and argue, their teens express more anger (Kerr & Schneider, 2008). Sensation Seeking Sensation seeking or the need for varied, novel, complex, and intense sensations and experiences, and the willingness to take physical, social, legal, and financial risks for the sake of such experiences (Lynne-Landsman et al., 2011; Zuckerman, 2005), is another psychological construct that overlaps with reward responsiveness. There are four facets to sensation seeking: experience seeking, thrill and adventure seeking, disinhibition, and boredom susceptibility. Because the definition of the 3 construct includes willingness to take risks to get rewards, this construct is predictive of delinquency, aggressiveness and substance abuse in adolescents and adults (Lynne- Landsman et al., 2011). Zuckerman (1964) was the first to develop a sensation seeking self-report scale. Representative items include I like to explore a strange city or section of town by myself, even if it means getting lost; I often wish I could be a mountain climber; and I like “wild” uninhibited parties. Visit this website to take the test. Sensation seeking is an important construct because it predicts outcomes such as aggression, delinquency, and substance abuse. Cross sectional and longitudinal studies show that average levels of sensation seeking tend to increase during childhood, peak in late adolescence, and decline in adulthood (Lynne-Landsman et al., 2011). Sensation seeking in boys is on average higher, peaks later and lasts longer than that in girls (Shulman et al., 2015). Three different patterns of changes in sensation seeking from late childhood through adulthood are also seen. Twenty percent of individuals are low in sensation seeking from childhood through adolescence and have the lowest risk for externalizing problems. Likewise, 20% of early adolescents are high in sensation seeking and are at high risk for externalizing disorders. The majority of early adolescents (59%) start puberty with low levels of sensation seeking and then sensation seeking increases during the teen years (Lynne-Landsman et al., 2011). Researchers and clinicians advising public policy suggest that one way to manage adolescent sensation seeking is to modify how it is expressed. Teens can be provided with healthy outlets for their reward-oriented behavior. Interventions for the middle (majority) group could be aimed at preventing sensation seeking from developing. Young teens with stable low sensation seeking show us that this pattern is possible and perhaps desirable (Lynne-Landsman et al., 2011). Negative Emotions and the BIS Negative emotions or affect include feelings of nervousness, tension, and sadness. These arise from the neural circuits of the BIS (Figure -3). Adolescents have increased amygdala activity compared to children and adults and this increased activity predicts anxiety (Hare et al., 2008). Worry and rumination are cognitive processes that accompany this negative affect. While experiencing negative affect, people disengage from reward and feel distressed. One way to study emotional development is to have individuals report on happy and sad affect over the course of each day. Studies of reported daily affect show that following puberty and the transition to middle school adolescents report increased negative affect. Their mood states are also more changeable. Negative mood and the ups and downs stabilize after 10th grade (Larson et al., 2002). Children who are high in negative affect tend to develop into teens high in negative affect but early adolescence is a period of instability due to the stresses associated with puberty and the changes in school environment (Larson et al., 2002; Lerner et al., 1988). Crying is more common in girls than in boys and this sex difference appears prior to puberty. As teens get older the sex difference increases because boys cry progressively less (Tilburg et al., 2002). 4  Frontal Lobes AMYGDALA HIPPOCAMPUS Figure 0-3 Ventral View of the brain showing the location of the amygdala and hippocampus within both temporal lobes. By Félix Vicq-d'Azyr - Photosubmissions 2014080810017516, CC0, https://commons.wikimedia.org/w/index.php?curid=34628948 The tendency to negative affect is also captured by the personality trait of neuroticism. Neuroticism reflects a person’s experience of negative emotions, such as anxiety and sadness, cognitions of worry, and difficulties coping with stress. In older children and adolescents neuroticism is assessed by self-report ratings of items such as, “Is nervous and fearful” (Soto & Tackett, 2015). During Middle childhood boys and girls do not differ in neuroticism. In early adolescence (about age 14) girls’ neuroticism begins to increase and by adulthood there are large sex differences in neuroticism (Borghuis et al., 2017; Slobodskaya, 2021; Soto & Tackett, 2015). Neuroticism increases risk for internalizing disorders such as anxiety and depression (Williams et al., 2021). Increases in neuroticism parallel the increases in depression and anxiety disorders seen in adolescents. In one population based study, The prevalence of anxiety and depression symptoms in 13-18 year olds was 6% of boys and 19% of girls, Substance abuse and low levels of physical activity increased risk whereas supportive relationships decreased 5 risk (Skrove et al., 2013). Between 2009 and 2019 the prevalence of clinical depression increased from 8.1% to 15.8% overall and from 11.4%-23.4% in girls (Daly, 2022). This increase in depression occurred prior to the pandemic and its cause is unknown. Emotion Regulation Strategy Description Adaptive Situation Selection Choice of activities that are optimal for self Yes Situation Modification Alter aspects of situation in service of regulation Yes ―Problem Solving/Planning Overcome difficulties by making plans that move self Yes from a starting situation to a desired goal ―Safety Behaviors Actions that reduce or prevent anxiety in a situation Yes/No where it usually occurs Attentional Deployment Selectively attending to non-threatening aspects of Yes situation ―Distraction Direct attention toward a pleasant or neutral stimulus Yes/No and away from a cause of negative affect ―Affective Control The capacity to attend and respond to goal-relevant Yes information and inhibit attention and responses to distracting emotions Changing Cognitions Change thoughts about a situation to reduce or increase Yes emotions ―Reappraisal Reframing the meaning of a situation to alter its Yes emotional impact ―Positive Refocusing Thinking about joyful and pleasant issues instead of Yes thinking about the actual event ―Mindfulness Non-judgmental acceptance Yes ―Worry Thinking about negative aspects of future events No ―Rumination Repetitive thinking or dwelling on negative feelings and No distress and the causes and consequences of these ―Thought Suppression Deliberately trying to rid the mind of unwanted thoughts Yes/No ―Catastrophizing Explicitly emphasizing the worst No ―Self-Blame Blaming and criticizing oneself No ―Blaming Others Blaming another person No Response Modulation Changing behavioral responses to emotions Yes Seeking Social Support Turning to another person for help with managing or Yes changing emotions Self-Soothing Self-comforting, self-compassionate behaviors that Yes reduce negative emotion Physiologic Regulation Taking steps to modify physical manifestations of Yes emotions like taking deep breaths and relaxing muscles Expressive Suppression Change facial expressions and body language to hide Yes/No emotions Impulse Control The ability to resist an impulse, desire, or temptation Yes and to regulate its translation into action Distress Tolerance The capacity to withstand negative emotional states and Yes to persist in goal directed activity when experiencing psychological distress Non-suicidal self-injury (NSSI) Intentional, self-inflicted damage to the surface of the No body without suicidal intent Substance Use/Abuse Use of substance to regulate emotions No Table 0-1. Emotion regulation strategies and abilities organized by the extended process model. 6 Early adolescence brings the stress of middle school with increased academic demands and class size. Teens may have fewer supportive relationships with teachers at a time when they are beginning to distance from their parents. The peer environment is also more competitive as everyone enters puberty and elevated gonadal steroids cause status and romantic relationships to become important. These stressors tax adolescent emotion regulation skills at a time when emotions are also changing as discussed above. Emotion regulation includes all the strategies individuals use (purposefully or automatically) to change current and expected emotional states. Emotional states can be altered by changing intensity, duration, speed of occurrence, and/or recovery time (Zimmermann & Iwanski, 2014). Emotion regulation of negative emotions in stressful situations is also called coping. “Coping is defined as constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” (Edwards & O’Neill, 1998, p. 957). While coping, people problem solve or use strategies to minimize, avoid, tolerate, or accept stressful conditions (Edwards & O’Neill, 1998). The construct of emotion regulation extends beyond just coping to consider what individuals do to increase positive emotions and avoid stressful situations. The extended process model of emotion regulation (Gross, 2015) organizes strategies used in emotion regulation according to the cognitive model (e.g., Figure -2) according to when strategies are implemented. Processes of emotion regulation include (a) taking steps to determine which situations one is exposed to (situation selection), (b) changing relevant aspects of situations (situation modification), (c) influencing which aspects situations are perceived (attentional deployment), (d) altering thinking about the situation (cognitive modification), and (e) directly modifying emotion-related actions (response modulation) (Table -1). Identification of emotions is the first step in regulation. Children and teens differ according to their ability to discriminate different emotions (Starr et al., 2020). Regulation also depends on recognizing the difference between a current state and a desired state. Values determine “desired states” and whether individuals are motivated to use emotion regulation strategies. Parents model, influence and teach emotion regulation strategies. Teens benefit from parents who support positive health habits such as getting enough sleep, eating well, and exercising because these habits reduce vulnerability to emotion dysregulation. Authoritarian, angry, and critical parenting increases stress and decreases ability to cope with negative emotions (Diaz & Eisenberg, 2015). Measurement of Emotion Regulation Clinicians and educational professionals should be familiar with the construct of emotion regulation as applied to themselves and others. Those who understand how they use these skills in their own lives are well-positioned to teach them to others. Recent research points to the importance of emotion regulation to human development and its link to positive adaptation. In the future, teaching of emotion regulation skills to teens will become routine practice in the schools and in clinics. 7 Measure Reporter Content Reference CERQ (Garnefski et al., 2005) Cognitive Emotion Regulation Self 35 Likert items Website Questionnaire (Neacsiu et al., 2010) DBT-WCCL Self 59 Likert items Website DBT-Ways of Coping Checklist DERS Self; 36 items; 16 and 18- (Neumann et al., 2010) Difficulties with Emotion Regulation Scale Parent item short versions Website ERQ (Gullone & Taffe, 2012) Self 10 Likert items Emotion Regulation Questionnaire Website (Catanzaro & Mearns, NMR 1990; Thorberg & Self 30 Likert items Negative Mood Regulation Lyvers, 2006) Website Table 0-2. Well Validated measures of emotion regulation. Psychologists have an easier time assessing emotion regulation in adolescents compared to children because adolescents can complete self-report inventories reliably. These scales use a Likert format where individuals rate themselves on an integer scale (e.g., 0-4). The most used emotion regulation scales are listed in Table -2. You are encouraged to visit the websites listed and look closely at the scales. Each of these scales has good predictive value with higher dysregulation scores in clinical populations. Example items from the scales are provided below (Table -3) to enable you to better understand the construct. Notice that the scales are directional measuring either function or dysfunction and some items are reversed scored. Strategy Item Examples CERQ― Self-Blame ‘I feel that I am the one to blame for it’ CERQ― Other Blame ‘I feel that others are to blame for it’ CERQ― Rumination ‘I often think about how I feel about what I have experienced’ CERQ― Catastrophizing ‘I often think that what I have experienced is the worst that can happen to a person’ CERQ― Putting into Perspective ‘I tell myself there are worse things in life’ CERQ― Positive Refocusing ‘I think of something nice instead of what has happened’ CERQ― Positive Reappraisal ‘I think I can learn something from the situation’ CERQ― Acceptance ‘I think that I have to accept that this has happened’ CERQ― Planning ‘I think about a plan of what I can do best’ DBT-WCCL―Skills Use Made sure I'm responding in a way that doesn’t alienate others. Tried to get centered before taking any action. DBT-WCCL―General Dysfunctional Coping Wished that I could change the way that I felt. Felt bad that I couldn't avoid the problem. DBT-WCCL―Blaming Others Took it out on others. Got mad at the people or things that caused the problem. DERS― Lack of Emotional Awareness I pay attention to how I feel. (R) I care about what I am feeling. (R) DERS― Lack of Emotional Clarity I have no idea how I am feeling. DERS― Difficulties Controlling Impulsive When I’m upset, I feel out of control. Behaviors When Distressed 8 Strategy Item Examples DERS― Difficulties Engaging in Goal- When I’m upset, I can still get things done. (R) Directed Behaviors When Distressed DERS― Nonacceptance of Negative When I’m upset, I feel like I am weak. Emotional Responses DERS― Limited Access to ER Strategies When I’m upset, I believe I’ll remain that way for a long time. ERQ― Reappraisal When I want to feel more positive emotion (such as joy or amusement), I change what I’m thinking about. ERQ―Suppression I control my emotions by not expressing them. NMR― General I can usually find a way to cheer myself up. NMR― Cognitive Telling myself it will pass will help me calm down. NMR― Behavioral I can feel better by treating myself to something I like. Table 0-3. Representative items from emotion regulation scales, Changes in Teen Emotion Regulation Important growth in cognition occurs with puberty. Increased declarative and conceptual knowledge, abstract thinking, hypothetical reasoning, and metacognition accompany improvements in executive functions (working memory, response inhibition and cognitive flexibility) (Chapter 2, Table 2.1). Growth in these cognitive abilities enables more sophisticated use of emotion regulation strategies. Life experiences and the ability to think abstractly help individuals envision more possible solutions to their problems. Increased metacognition improves reflection and insight. Improvements in executive functions enable greater mindfulness and flexibility as well as reduced impulsiveness. Adolescents apply their newfound cognitive abilities more readily to academic tasks than they do emotion regulation tasks. Emotion regulation worsens after age 11 and does not improve again until after age 15 (Cracco et al., 2017; Sanchis-Sanchis et al., 2020; Zimmermann & Iwanski, 2014). Individuals use different strategies for different emotions and sadness and anger are the most challenging emotions (Zimmermann & Iwanski, 2014). Though teens do use more reappraisal than preteens; teens in early adolescence report less use of distraction, problem solving, and humor than preteens (Cracco et al., 2017). Early teens also use more maladaptive strategies including giving up, withdrawal, aggression, and self-devaluation (Cracco et al., 2017; Sanchis-Sanchis et al., 2020). The biggest drop in emotion regulation is seen in early adolescent girls (Sanchis-Sanchis et al., 2020). Non-Suicidal Self Injury (NSSI) NSSI in DSM 5, Section 3 (1) engagement in NSSI on 5 or more days in the past year (Criterion A); (2) the expectation that NSSI will solve an interpersonal problem, provide relief from unpleasant thoughts and/or emotions, or induce a positive emotional state (Criterion B); (3) the experience of one or more of the following: (a) interpersonal problems or negative thoughts or emotions immediately prior to NSSI, (b) preoccupation with NSSI that is difficult to manage or (c) frequent thoughts about NSSI. 9 Non-Suicidal Self Injury (NSSI) is intentional, self-inflicted damage to the surface of the body without suicidal intent, which is not socially sanctioned. The most common methods reported by teens are cutting, scratching, hitting or banging, carving, and scraping (Brown & Plener, 2017). Clinicians and others working with teens can be more effective if they understand that NSSI is an emotion regulation strategy. Teens engaging in this behavior can be taught other more effective strategies. The Child and Adolescent Work Group of the DSM-5 recommended including NSSI as a separate diagnosis in the DSM-5 but instead, the condition was placed in Section 3 and marked for further study (Gratz et al., 2015). The prevalence of NSSI varies according to the criteria used. International lifetime prevalence rates in adolescents is 17–18% for at least one incidence of NSSI (Brown & Plener, 2017). In community samples prevalence of DSM 5 NSSI is 1.5-6.7% (Brown & Plener, 2017). Distress Tolerance a Transdiagnostic Risk Factor Distress tolerance is the capacity to withstand negative emotional states and to persist in goal directed activity when experiencing psychological distress. A person with high distress tolerance accepts their psychological distress and is able to be effective in high stress situations. Distress tolerance skills are taught separately from emotion regulation skills in Dialectical Behavioral Therapy (DBT) partly because distress tolerance is a transdiagnostic risk factor for mental health concerns including substance misuse, antisocial behavior, personality disorders, non-suicidal self-injury, and disordered eating (Cummings et al., 2013). Among those individuals with clinical concerns low distress tolerance predicts dropping out of treatment. Without intervention, distress tolerance seems to be a relatively stable trait of children and adolescents with little change over time (Cummings et al., 2013). Emotion Regulation a Transdiagnostic Risk Factor Infrequent use of effective emotion regulation strategies and frequent use of maladaptive/ineffective strategies are central to many clinical conditions such that emotion regulation is also a transdiagnostic risk factor. Rumination, self-blame, and catastrophizing predict depression and anxiety in both adolescents and adults. Positive reappraisal associates with lower risk for anxiety and depression but this effect is stronger for adults who may be better at using the strategy (Garnefski et al., 2002). Research points to the effectiveness of training emotion regulation skills in the prevention and treatment of clinical issues where emotion regulation is an important feature, including mood, anxiety, eating, personality, and substance use disorders (Moltrecht et al., 2020). Programs to teach emotion regulation to youth are delivered weekly for 8-24 weeks because learning the skills takes considerable time and requires homework. Mindfulness Based Cognitive Therapy is an 8 week program that has been delivered in school settings (Perry-Parrish et al., 2016). In the Cognitive Emotion Regulation Intended for Youth (CERTIFY) program students are introduced to cognitive emotion 10 regulation in a series of 11 sessions (Claro et al., 2015). The Learning to BREATHE program (L2B) is delivered over 12 sessions. Lessons are organized around six themes from the BREATHE acronym: Body, Reflection, Emotion, Attention, Tenderness, Habits, and Empowerment. , with six modules focusing on topics such as awareness, thoughts, and feelings (Metz et al., 2013) (see https://learning2breathe.org/). The very well- studied dialectical behavioral therapy for adolescents skills program for adolescents (DBT-A) has been adapted for use in schools (Mazza et al., 2016). Numerous districts in the Northeastern United States have implemented this program in high schools (see https://www.dbtinschools.com/). References Borghuis, J., Denissen, J. J., Oberski, D., Sijtsma, K., Meeus, W. H., Branje, S., Koot, H. M., & Bleidorn, W. (2017). 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