The Role of Emotion Regulation in the Treatment of Child Anxiety ...

288 Clin Child Fam Psychol Rev (2007) 10:275–293
mother might help her child reinterpret a failed attempt to
perform in public by saying that the act was too difficult. In
exposure therapy such reinterpretation of events is sometimes
offered by the therapist who points out to a socially
anxious child that a child in the front row yawned because
he was tired and not because her presentation was boring.
In a similar fashion, children can be taught how to interpret
physiological symptoms of anxiety in less threatening
ways. In fact, this is an important strategy in most treatment
programs for panic disorders (e.g., Mattis and Ollendick
2002) and has been utilized in other anxiety
programs as well (e.g., Kendall 1992). Teaching anxious
children to reinterpret emotionally arousing events in a
more positive light than they tend to do and normalizing
the experience for them can therefore help reduce distress
and the threat they often experience in everyday life. Ideally
children learn how to reinterpret events in a positive
light by themselves and do not need external help or
prompts to initiate this process.
There is some evidence that reframing and recoding
memories of stressful events can reduce anxiety and distress.
In one study, children who had received numerous
painful lumbar punctures as part of cancer treatment were
assisted in correctly recollecting their ability to cope during
their last procedure. Previous findings had indicated that
the more distressed children were during this procedure,
the less accurate and more negative their memories were of
it (Chen et al. 2000). As children were assisted in recollecting
correctly their ability to cope during the last procedure
and realistically appraise their responses (e.g., how
much they seemed distressed), they showed a greater
decrease in anticipatory heart rate, lower levels of cortisol,
and were rated as less distressed compared to a control
group which received no intervention before the lumbar
puncture (Chen et al. 1999). Reframing of negative events
may thus be a beneficial strategy for children with most
anxiety disorders, provided that they have experienced
events that they interpreted as traumatic or negative (e.g.,
someone yawned while a socially phobic child presented in
the class).
The Family Level
Although self-sufficiency in emotion regulation is eventually
encouraged, it appears that these skills initially
develop within the parent–child relationship (Malatesta and
Haviland 1982). As children age, they become more adept
at maintaining or modifying emotional states to achieve
interpersonal goals. However, it appears that children with
anxiety disorders may be at a disadvantage in developing
emotion regulation skills that allow them to adjust to their
environment. As previously noted, parents of anxious
children tend to encourage avoidance, model anxious
behavior, discourage discussion of negative emotional
experiences, and frequently accommodate their children’s
fears by shielding them from emotionally arousing situations.
To address these issues, parents of anxious children
need to receive direct training as part of their children’s
treatment. This training should consist of parent management
skills and reflective listening, as is frequently
involved in CBT programs with parent involvement (e.g.,
Barrett et al. 1996a), but the focus should also be on discussion
of emotional experiences and the modeling of
emotional responses.
First, parents could be educated about the effects of
projecting or placing their own fears onto their child. By
modeling anxious behavior (e.g., avoiding or catastrophizing
situations), and interpreting or anticipating situations
as dangerous and threatening, they are inadvertently
fueling their children’s anxiety and maintaining the disorder.
Thus, parents are preventing their children from
developing more adaptive emotion regulation skills when
faced with stressful situations. Programs (e.g., Wood et al.
2006) which have included family anxiety management
have shown promising results, especially for younger
children (Barrett et al. 1996a).
Second, parents could receive guidance in how to discuss
emotions with their children and be educated about the
importance of letting children express their emotions.
Studies have indicated that parental practices that encourage
children’s expression of emotion are associated with
positive outcomes (Eisenberg 1998). As suggested by Suveg
et al. (2005), asking parents to engage in discussions
about emotionally arousing events with children during
treatment could be beneficial, provided they receive constructive
feedback from the therapist. Allowing children
with anxiety disorders to discuss their emotional experiences,
without being discouraged or ignored, may help
them develop better skills to manage their emotions. Parents
could even utilize reflective listening (rewording and
reflecting back what the child said without questioning or
passing judgment) when helping their children express
themselves.
Specifically, parents of anxious children should engage
in an emotion-coaching parenting style, as opposed to an
emotion-dismissing parenting style. Emotion coaching
entails parents’ awareness of emotions in themselves and
their children, and their ability to use this knowledge to
enhance their children’s socialization. As emotion coaches,
parents tolerate their children’s negative mood states
without becoming upset or impatient and use these events
as opportunities to offer guidance on how to regulate the
emotions (Lagacé-Séguin and Coplan 2005). Since this
parenting style has been associated with better emotion
regulation, increased trust in one’s feelings and improved
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