A multimodal approach to investigating the importance of emotional functioning in childhood and adolescence

Abstract

Emotional functioning is a key component of both healthy and abnormal development in children and adolescents. It entails the experience, expression and regulation of emotions as well as emotional disorders. Although both the experience and the regulation of emotions change across the lifespan, they do so at an especially intense and rapid rate throughout childhood and adolescence. It is therefore crucial to investigate the role of different aspects of emotional functioning in various domains in these populations. Moreover, the onset of most emotional disorders occurs in adolescence, and prevalence rates of anxiety and depressive disorders are especially high during this period of life. For the purpose of this thesis, three components of emotional functioning were studied, using various methods across several domains. The first aim was to examine the role of emotion regulation in chronic pain (Koechlin, Coakley, Schechter, Werner, & Kossowsky, 2018, Study I). For this purpose, a systematic literature search was conducted and studies meeting specific criteria were then synthesized to investigate whether emotion regulation might enhance existing frameworks of chronic pain. In addition, associations between two broad categories of emotion regulation (namely antecedent- and response-focused emotion regulation) and chronic pain were explored. Emotion regulation depends to a great extent on emotional reactivity, i.e. the individual threshold required for emotional reactions – experiencing more and more intense emotions can complicate adequate emotion regulation. Hence, the second aim of this study was to analyze how emotional reactivity influences the occurrence of adjustment problems in adolescents who experience stressful life events in their childhood years (Koechlin, Donado, Berde, & Kossowsky, 2018, Study II). In order to achieve this second aim, a large longitudinal dataset was used and several covariates, among them emotional reactivity, were analyzed with the aim of predicting adjustment problems in 956 children who had experienced some or many stressful life events. Finally, as the prevalence rates of emotional disorders are high in adolescence, the third aim was to examine the efficacy and safety of a common intervention, namely two classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). In order to address this aim, a meta-analytic approach was chosen, and all randomized, double-blind, placebo-controlled trials of SSRIs and SNRIs in children and adolescents younger than 18 years who had been diagnosed with an emotional disorder were included (Locher, Koechlin et al., 2017). Study I showed that in the included reports, emotion regulation was rarely directly associated with pain intensity or pain-related disability. Rather, the relationship between both groups of emotion regulation strategies (antecedent- and response-focused) and chronic pain seemed to be mediated by psychological factors such as high emotionality, anxiety, or negative mood. This raises questions for future research, such as whether interventions that target emotion regulation specifically have the potential to relieve symptoms of chronic pain and emotional disorders simultaneously. Study II found that adjustment problems were best predicted by high emotional reactivity and many stressful life events. The results of this study point to the potential that emotional reactivity holds for the prevention and treatment of adjustment problems in adolescence. Study III revealed that even though antidepressants were more effective than a placebo in treating common emotional disorders in children and adolescents, these effects were small and disorder-specific. The results of this analysis present multiple avenues for further research, such as the underlying differences and similarities in emotional disorders that might help explain the difference in response to antidepressants and placebo. Patterns of emotional functioning develop in childhood, but may persist into adulthood, which highlights the importance of adaptive emotional functioning. This thesis sheds light on how emotional functioning influences chronic pain and the occurrence of adjustment problems in the face of stressful life events, and examines a common treatment for emotional disorders. Future research should focus on age-specific changes in emotional functioning and how these influence chronic pain, emotional disorders and other domains. This approach would allow researchers to tailor interventions and prevention to age-specific needs and abilities.