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

276 Clin Child Fam Psychol Rev (2007) 10:275–293
emotions more intensely than other children (Suveg
andZeman 2004), and show poor emotion understanding
(Southam-Gerow and Kendall 2000). As noted by Vasey
and MacLeod (2001), anxious children may possess just
as much knowledge of good emotion regulation strategies
as most non-anxious children. However, when faced with
a difficult situation, they usually revert to maladaptive
strategies such as avoidance and distraction.
It is expected that anxious children demonstrate some
emotion regulation deficits since atypical emotional
experiences have often been considered a defining
characteristic of diverse forms of psychopathology (Cole
et al. 1994). Despite these considerations, it is surprising
that more treatment programs do not contain specific
emotion regulation components. Some CBT programs for
anxious children do include relaxation techniques, which
are aimed at controlling the physiological sensation of
anxiety, and others offer education on appropriate facial
expressions associated with different feeling states.
However, ways to regulate emotional states, both positive
and negative emotions, in sync with the situation
that the child is in are usually not the main focus of
therapy and deserve more explicit attention. Although
various authors have suggested the importance of targeting
emotion regulation in treatment directly (e.g.,
Davis and Ollendick 2005; Kendall et al. 2000; Samoilov
and Goldfried 2000; Southam-Gerow and Kendall 2002;
Stark et al. 2005), changes in emotion regulation skills
are typically not assessed nor specifically “tested” in
clinical settings or in treatment outcome studies. If
anxious children lack the skills or demonstrate dysfunctional
skills to regulate their emotions in various situations,
treatment should address these skills as well as the
dysfunctional cognitions and behaviors associated with
them.
The purpose of this review is to examine the
potential role of emotion regulation in CBT and introduce
strategies that might be incorporated into current
treatment programs for children with anxiety. Some of
the strategies discussed are already being utilized in
treatment for anxiety in some form, while others are
being used in treatment for other childhood disorders (e.
g., anger management) or with adults. The mechanisms
through which these regulatory processes could increase
treatment efficacy are explored, as well as issues of
measurement. Two anxiety disorders, social anxiety
andpanic disorder, are then reviewed from the perspective
of possible emotion regulation difficulties
andare usedto highlight how emotion regulation strategies
mightbe utilized in treatment. Finally, implications
for therapy in clinical and research settings are
highlighted.
Emotion and Emotion Regulation
Emotions organize much of a child´s experience and
behavior, and are central to most relationships
(Langlois 2004, p.315)
The ability to control one’s emotions is a highly valued
characteristic in today’s society. A child who is able to
conceal her emotions when receiving a disappointing gift is
usually better liked than a child who throws a tantrum or cries
in response to receiving such a gift. Being able to regulate
one’s emotions therefore increases flexibility in new situations
and adjustment overall. Currently, researchers are
focusing more and more on the development of emotions and
the process of emotion regulation. Despite lack of consensus
in the field about what constitutes “emotion” and “emotion
regulation” (Cole et al. 2004; Thompson 1994), a number of
studies have been conducted to examine the development of
emotion regulation, emotion regulation in atypical populations,
and biological indicators of emotion regulation.
Although the scientific study of emotion and emotion
regulation is still in its infancy, these concepts are
becoming increasingly important for the field of developmental
psychopathology and clinical child and adolescent
psychology. Since emotions organize children’s experience
in many ways (Cole et al. 2004), introducing the concept of
emotion regulation into clinical research and practice
seems intuitive and may prove to be beneficial. As proposed
by Eisenberg and Spinrad (2004), emotion regulation
can be viewed as a voluntary and goal-directed process
aimed at modifying emotional states to achieve social and
biological adaptation, as well as individual goals. At its
core, emotion regulation is a process triggered by emotional
arousal in an attempt to modulate and manage the
arousal. In light of the nature of psychopathology, therapy
should aim at enhancing efficient emotion regulation skills
elicited by intense negative emotions and the lack of
positive affect.
Emotion
Although it has been suggested that emotions cannot “exist
in an unregulated manner” (Campos et al. 2004, p. 378),
emotions and emotion regulation are defined here separately
in order to provide a working definition of them.
Emotions are defined as biologically endowed processes
that allow for a quick appraisal of situations and appropriate
responses in order to maintain favorable or to
terminate unfavorable conditions (Cole et al. 2004). The
nature of the appraisal determines the quality of the
emotion (negative or positive emotions) and the degree of
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