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

278 Clin Child Fam Psychol Rev (2007) 10:275–293
For the purpose of including emotion regulation skill
building into therapy with anxious children, the goaldirected
definition of Eisenberg and Spinrad will be used.
Since the aim of emotion regulation skill building is to
teach children adaptive ways of managing their emotions to
improve adjustment, the strategies are by definition goaldirected.
Although these skills may become more automatic
with time and practice, they are still enacted in service
of goal-directed actions and different from involuntary
regulatory processes.
Emotion Regulation in Anxious Children
Individual differences in emotion and emotion regulation
emerge early in childhood. Under certain conditions,
however, basic emotion and emotion regulation patterns
become maladaptive and impede functioning. When this
occurs, these patterns are considered symptoms of childhood
psychopathology (Cole et al. 1994). Although it is
difficult to define optimal emotion regulation without
examining it in its context, emotion dysregulation is generally
referred to as limited ability to manage and modulate
emotions to allow for interpersonal relatedness, prosocial
initiative, personal assertiveness, sympathy toward others,
and other indicators of successful functioning (Thompson
1994). Cicchetti et al. (1995) noted that emotion dysregulation
develops as emotions become connected to deviant
cognitive and action strategies, thus leading to difficulties
in preventing the elicitation of certain emotions or managing
emotions and expressions once they are elicited.
Many studies indicate that children with anxiety disorders
demonstrate emotion dysregulation in various ways.
For instance, anxious children frequently try to avoid
events and situations which produce intense emotional
arousal (Mash and Wolfe 2002). While avoidance may be
an efficient emotion regulation strategy for reducing or
preventing intense emotional reactions, it is often maladaptive.
A child with social anxiety, for example, may
engage in various avoidance behaviors to regulate her
anxiety, but these behaviors may be maladaptive in terms
of overall adjustment (e.g., failing an assignment because
the child refuses to present it to the class).
When anxious children find themselves in emotionally
arousing situations, they appear to have limited skills to
manage their emotions. For example, Suveg and Zeman
(2004) observed that anxious children reported experiencing
emotions more intensely, had dysregulated expressions,
showed less adaptive coping, and had lower self-efficacy in
their ability to improve their mood than non-anxious children.
Southam-Gerow and Kendall (2000) obtained similar
findings in which anxious children demonstrated limited
knowledge in their ability to change and hide their emotions
to achieve interpersonal goals.
Based on a review of studies of selective attention,
Vasey and MacLeod (2001) concluded that anxious children
give higher processing priority to threatening information
than non-anxious children. Anxious children have
also demonstrated hypersensitivity and responsiveness to
bodily cues that anticipate negative emotions (Thompson
2001). Anxious children also report having little control
over external anxiety provoking events and their internal
reactions to such events (Weems et al. 2003). In addition,
anxious adolescents have been shown to report more negative
memories than non-anxious controls (Miles et al.
2004). This suggests that anxious children may not only
have deficiencies in their understanding and regulation of
negative emotions, but also seek out information and
interpret events in ways that make them more likely to
experience associated negative moods.
The importance of emotion socialization among anxious
children must also be considered. Since anxious children
are likely to have anxious parents (e.g., Lieb et al. 2000;
Turner et al. 1987; Van Beek and Griez 2003), children’s
anxiety can become more intense through parental socialization
processes if the parent models maladaptive emotion
regulation skills. These hypotheses have certainly been
supported by extant research. For example, families of
anxious children tend to encourage or facilitate avoidance
and threat interpretations of ambiguous situations (Barrett
et al. 1996b). In addition, parents of anxious children
appear to model anxious behavior (Whaley et al. 1999) and
discourage discussion of negative emotional experiences
(Suveg et al. 2005). These findings indicate that anxious
children may learn through socialization processes that
avoidance of difficult situations and discussions about
emotions is the best emotion regulation strategy.
The dynamic interplay of children’s anxiety and parenting
styles must also be considered. All too frequently,
parents respond to their children’s fears and anxieties by
removing their child from the situation and accommodating
their fears. Results of various studies (e.g., Lieb et al. 2000;
Rapee 1997) have indicated that parents of anxious children
tend to exercise excessive control and protection over
their children. The combination of anxiety in both the child
and the parent seems to elicit excessive amounts of control
compared to non-anxious parents or anxious parents of
non-anxious children (Whaley et al. 1999). Due to removal
from or shielding of emotionally arousing situations, children
with anxiety disorders may have fewer opportunities
to develop adaptive emotion regulation skills. In addition
to these limited opportunities, these parents may model and
approve of avoidance of situations which elicit intense
emotions. Therefore, children with anxiety disorders may
both experience more intense emotions and have fewer
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