Lecture notes with Clinical Child and Adolescent Psychology at Leiden University - 2015/2016

Lecture 1: What are emotions and why do we have them?

Emotions in folk psychology

There is a huge difference between scientific knowledge and ‘kitchen’ psychology. One of the folk psychology ideas is that you should be rational, and not act upon your emotions. Another common idea in the folk psychology is that ‘my heart says one thing, but my head says something else’, and that ‘emotions come over me, they happen to me’ or ‘time heals’.

Emotions: helpful or harmful?

Emotions are very important signals, just like pain tells you that something needs to be looked after in your body. Emotions tell you that something meaningful has happened. Everything else disappears, emotions give you a very clear focus. That is also what you communicate with your environment. The worst thing you can do is to ignore your emotions, just like it’s bad to ignore your pain, because it will only get worse when you neglect it.

Functional emotion theory

Frijda (1986) is one of the founding fathers of the current emotion theory. It is still very valid today. He says that there’s always a concern at stake. Something meaningful is happening, it can be either a positive or a negative emotion. These emotions, positive or negative, cause changes in action readiness. You can either fight or flight, but in both situations the whole body is involved. This is called physical arousal, which prepares the body to react to the situation. It is aimed to change or maintain relationships. This is the core of the whole emotion theory: emotions are there because you want or don’t want something in relation to others. It’s all about relationships with other persons. We have emotions to regulate our relationships with others. Sadness is a very powerful emotion, because it brings the focus of the person who sees that you’re sad on you. So the goal of this emotion is to get attention from someone, so you can get help from that person. There are competing theories, but the functionalistic perspective is the most important perspective. This is the perspective of Frijda.

James-Lange theory (1884/5)

James-Lange has a different view on emotions. First there is the perception of an event. After that there is physiological arousal, and because we feel this physiological arousal, we’re having a subjective feeling. Thus, emotion is our feeling (awareness) of the bodily changes as they occur. Subjective feeling state is a consequence rather than a cause, according to this theory. However, there’s a problem with this theory, because it’s open to misinterpretation. This is because an emotion always happens in a context. The primary function of physiological changes is provision of energy, mobilization of the organism and it prepares you for action.

What is an emotion? (Scherer, 2000)

There’s not one word to describe emotions, it has different aspects:

• Physiological arousal

• Motor expression

• Cognitive processing (appraisal)

• Subjective feeling state

• Action tendency

The subjective feeling state is just one part of the whole emotion process. It’s just a reflection of everything else that happens. The subjective feeling covers the whole process, but it is NOT the whole process.

There is always the primary appraisal, the very first judgment of the situation which means good or bad. So it defines good/not good, and is quasi automatic. It focuses you and gets you physiological aroused. After that stage you start thinking about it, and considering all the aspects involved in the situation. This period is called latency time. After that comes the stage of secondary appraisal. In this stage you’re considering previous experiences, your own abilities, and different responses that are possible. This determines which emotion you get.

Emotions and Mood states

The difference between emotions and mood states is that mood states aren’t linked to specific situations, while emotions do have a direct link with specific events, situations or memory. A mood state doesn’t have a clear cause, and it has a longer duration. It’s a more general feeling and the intensity is lower.

Which emotion?

The same situation can evoke different emotions, depending on what you focus on. When you’re angry with someone, the focus is on the other person. When you’re sad, you’re focus is on the thing someone destroyed. Emotions don’t just happen. The outcome one wants to achieve, or one thinks one is able to achieve, determines the emotional reaction. It is influenced by social context and focus.

Deaf children and emotions

The access to the social world is very limited for deaf children, which inhibits their social development. Rieffe et al. (2003) did research with deaf children and normal children, and used the following situation:

Imagine: your friend drops your Ipad, it doesn’t work well anymore… The question is: How do you feel; angry or sad?

They found that almost all deaf children chose for sadness, because they focused on their loss. For the hearing children, there was no significant difference in anger or sadness.

Emotions: innate or learned?

The whole process of emotional development is called emotional socialization. For example in China, people don’t express their anger because it’s not normal to express your anger there. The way of expressing differs between different cultures, but the experience of emotions is the same. So the level of anger does not differ between Chinese and Dutch people for example.

Emotions serve an interpersonal function. The function of fear is to avoid harm. The function of anger is to stop another from harming you. Love is to strengthen your relationship with someone, you also want something in return. Jealousy is about protecting what you think you own, what belongs to you. Shame is a social emotion. Shame means that you failed to live up to the ego-ideal in the context of social norms and values. Pride reinforces behavior that is valued positively within social context.

How do children learn about emotions?

Children learn emotions from different sources: self observation, observation of others and (verbal) passing on. Deaf children have to watch the other person in their communication so they rely more on visual cues, so they do better than deaf children who have a cochlear implant in distinguishing emotions. This shows the importance of the social context.

Lecture 2: Emotion communication

Emotional competence

Emotional competence affects children’s mental health and social functioning. In this course we see how important social learning is. How social learning affects emotional competence will be the most important thing in the course, and that will be important in the exam as well.

Infants’ smiles (Messinger, 2008)

Joy is one of the most important emotions that we have. Messinger does a study with neonates, children who are just born. Neonates smile, also during sleep. From one month of age, you see two different kinds of smiles, especially during positive interactions. The first one is the Duchenne smile, which is around the eye region. This is about eye constriction. This was shown in half of the newborn infants. The second one is the open mouth smile, which was seen in one tenth of the sample. All smiles are positive, but some are more positive than others. They eyes are very important in a smile.

Function of smiling (Messinger, 2008)

Smiling has a lot of functions. First of all, smiling signals joy, but also ‘it’s okay’. It’s also a powerful request for a positive response. Another function of smiling is to establish and maintain relationships. In interaction with caregivers, smiling stimulates attachment. Smiling behavior in infancy is predictive of later development. Children who show more positive emotions in interaction with their caregiver have a better outcome in the future.

Infants’ smiles, development (Messinger, 2008)

Neonates smile, but why they do this and when they do it is still unclear. When children are one to two months old, they show a social smile in reaction to positive interaction with their caregiver. For example when the caregiver tickles his or her child, or when the caregiver talks in a high-pitched voice. Children do this because they aren’t able to speak yet. Children with autism and deaf children don’t develop the social smile, which can be very difficult for their parents.

Around three months of age, children start showing their social smile to unfamiliar people. From 6 to 12 months of age, children show laughter, so they begin to make sound when they’re laughing. They also show smiling at mastery. This means that children smile when they learned something. Another very important thing which develops at this age is referential smiling. This means that the child and the caregiver or someone else are looking at an object together and smile at each other, so it’s a form of social communication. This is very crucial for the survival of the child.

An example is when a child comes across a chasm covered with glass. In this unfamiliar situation in which the child doesn’t know what to do, the child looks at his or her parent. When the parent is smiling, the child knows that it’s okay, and dares to cross the chasm. But when the parent doesn’t smile, the child doesn’t dare to cross the chasm. This shows that referential smiling is very important for the survival for the child.

Emotion Socialization

We all like positive emotions, it’s very good for bonding and to make you feel good and to show others that you’re happy. The expression of negative emotions is less accepted and requires better social skills than the expression of positive emotions. So it’s more difficult to express negative emotions than to express positive emotions. Children need to learn social rules for when and how strongly they can express negative emotions.

Emotion expression in toddlers

The cochlear implant is a major development for deaf children. Wiefferink et al. (2012) tried to measure emotion expression in toddlers. They did this with deaf children with a cochlear implant as well as with hearing children. Emotion expression was measured with a frustration task. The experimenter gave the child a bottle with a present in it, and told the child to get the present out of the bottle, which was too difficult. They also asked the parents to report how often the children showed positive and negative emotions during the day. According to the parents, children with a cochlear implant showed more negative emotions than hearing children. The expression of positive emotions was the same for children with a cochlear implant and hearing children. This could have different reasons. On the frustration task, the expression of negative and positive emotions was the same for children with a cochlear implant and hearing children. The question was how the emotional expression is related to social competence.

Social competence

According to Eisenberg et al., social competence is a set of skills that help individuals achieve personal goals in social interactions. Actually, something is missing in this definition. The complete definition is: a set of skills that help individuals achieve personal goals in social interactions while maintaining positive relationships. So it’s always about finding a balance between personal goals and social goals. In western countries, people focus much more on personal goals than on the maintenance of positive relationships. In collectivistic cultures, people focus much more on the group harmony. So this is a cultural difference between individualistic cultures and collectivistic cultures.

Social competence is often measured with a parent report. The parents fill in a questionnaire about their children with questions about how often their child is nice to other children and if their child can share things with other children, this is called social competence. There were also questions about behavioral problems.

People with a cochlear implant show less social competence than hearing children. This is related to positive emotion expression in hearing only. So hearing children use positive emotions in their social interactions. Children with a cochlear implant don’t use their positive emotions in their social relationships. There’s no difference in negative emotion expression between children with a cochlear implant and hearing children. So the amount of behavioral problems is equal in both groups.

The conclusion is that children with a cochlear implant seem to make less use of positive emotions to enhance relationships, and they have less strategic expression of emotions.

Strategic anger expression in deaf children (Rieffe & Meerum Terwogt, 2006)

Rieffe and Meerum Terwogt did a research with deaf children. They tried to find situations which across different cultures would evoke anger and that everyone would understand. One of this peer conflict vignettes is this one: imagine that you’re on a party and a friend spills cola on your clothes and hair. They wanted to see if children would express anger and how they would express their anger. The questions they asked were:

• How angry would you feel on a scale from 1 to 5? They found that the intensity of anger was the same for children across different cultures. The same is true for deaf and hearing children: there was no different in level of anger.

• What would you do or say to him/her?

• How will s/he react?

• Will you still be friends the next day?

They found that deaf children explained their answer less. Their answers were short, simple and very direct. The answers of hearing children were more elaborate. They explained more about the reason why they were angry. When you just show anger without explaining it, that’s enough to stop someone. But if you want to solve something, you need to explain your anger. Hearing children do that much more often than deaf children. Deaf children also expected fewer responses of empathy. What was surprising is that deaf children expected to stay friends much more often than hearing children.

Differentiating emotions (Jenkins & Ball, 2000)

Every emotion has a different goal, which you need to keep in mind when you read this study. Jenkins and Ball say that anger is an expression of dominance and evokes an anger response. They say that sadness and fear are prosocial expressions and evokes comforting behavior. Anger is focused on the personal goal, so the question is if sadness and fear are more focused on the social goal. Anger is the most difficult emotion to learn.

Parental effect on expressing anger (Kerr & Schneider, 2008)

Kerr & Schneider focused on inappropriate or maladaptive anger. This doesn’t work to solve your relationship, but it’s damaging for your relationship. They found that there are more inappropriate anger expressions in children when there’s more marital conflict, when their primary caregiver is distressed, and when there’s more verbal and/or nonverbal anger expression by the parents. So children model their caregivers. And when their parents are more authoritarian.

Socialization of anger (Kerr & Schneider, 2008)

Younger children are more likely to express anger than older children. With increasing age, expressing anger is seen as less acceptable in general. Nevertheless, anger is a functional emotion. According to Kerr and Schneider, who are developmental psychologists, children hide (mask) their anger to maintain relationships, especially girls. Carolien Rieffe thinks this isn’t true, and with her are a lot of other emotional theorists. This different views are interesting for the exam.

Display rules

When you’re not showing the emotion you’re feeling at the moment, you’re using display rules. So this is when you change the expression of an experienced emotion. You can do this for example when you think your emotion will harm someone else. This can be done in different ways: minimizing, maximizing, neutralizing and substitution.

Children need muscle control and ability to pose emotions; when a child is three years old, he’s able to pose happiness. Research shows that adults also have more problems posing positive emotions than negative emotions. Children and adults both failed to pose fear well, because it’s more a body movement than a facial expression.

There are different reasons for using display rules. It can be prosocial or protective; to protect relationships and to behave according to cultural norms and conventions. It can also be self protective; to avoid negative outcomes and to protect one’s self esteem.

Display rules in normal development

Verbal display rules are easier than facial display rules. Prosocial display rules come first in the development, and girls are better than boys in using display rules.

Lecture 3: Emotion regulation

Functionalistic perspective on emotions

The most important point is that we have emotions for a reason. It’s not just a feeling or a word, the word we use for an emotion is the reflection of a whole process. The process is an adaptive reaction to a change in the situation. Therefore there are different strategies. One emotion reflects a strategic approach to the situation. Every emotion is linked to a specific situation and each emotion contains a unique action tendency. Different emotions reflect different outcomes you want to achieve.

Emotion regulation (Cole, Martin & Dennis, 2004)

Emotions are regulating, this means that emotion processes influence other processes. But emotions need to be regulated as well: emotions have the capacity to be regulated. So we need to regulate our level of arousal. This is what we mean when we talk about emotion regulation. According to James Gross (1988), emotion regulation is the process by which we influence what emotions we experience, when we experience them, and how we express them.

There are two ways to regulate our emotions. When we regulate the response we show to others, we regulate the emotion expression by using display rules. But we can also regulate the emotion experience instead of the emotion expression, so we can regulate how we feel. We can do this when we’re focused on the antecedent of the emotion.
The response focused emotion regulation changes the behavioral responses, but there’s an equal emotion experience, and sometimes there’s even an increase in the emotion experience. So this is not a really good way to regulate your emotions, because it can evoke stress in people. The antecedent focused emotion regulation decreases the emotion experience and decreases your behavioral respons, but only if you do it right. In this case you focus on the cause of your emotion. To do it right, you have to know what you feel because it tells you that this situation is important for you. Therefore you should never ignore it. This is called emotion awareness, and this is very important in the emotion theory. But, according to another hypothesis, first of all you need to have cognitive control, and then you can regulate your arousal level. So there are different hypothesis.

Step 1: emotion awareness

Emotion awareness is important because it signals that the event is meaningful for you. It’s like pain: it directs your attention there, and nothing else is important. That’s the primary function of emotions. Therefore you should never ignore it or think it’s useless. It reveals one’s (not necessarily conscious) wishes and expectations. You start thinking about the situation and you analyze the situation more thoroughly than you would do normally. Emotion awareness focusses you on that specific situation, just because you feel very aroused about it. Children learn emotion awareness through emotion socialization. It is often based on bodily and behavioral signals (trembling, hiding one’s face). The labeling of emotions is the starting point for the regulation of emotions. It’s a very fragile development, and you need language for it.

Emotion awareness in children with ASD

The parents of children with ASD often report that their children are over-aroused when something happens. Even in positive situations these children aren’t able to control their emotions. So there’s a lot of over-arousal, and the question is if this is linked to external events. When you’re feeling ‘bad’, this is a very general feeling, so it’s difficult to link it to an external event and to do something about it.

There’s been a research with children with ASD and with control children. The children were asked three questions: do you feel angry sometimes, can you tell me about the last time you felt angry, and how angry did you feel? The same questions were asked for happiness, sadness and fear. When children with ASD were asked if they felt sad or angry sometimes, almost all of them answered ‘no’. When they were asked when they felt bad or angry or sad, children with autism gave more general answers and had more difficulties. They were much less referring to specific events. An example is when they were asked: when are you happy? Children with autism answer: when it’s your birthday, while normal developing children would answer for example: last month, when it was my birthday. Also the situations where they referred to were much less social, whereas the typical developing children would all come up with social events. So children with autism can’t link emotions to specific situations like normal developing children can. They also give very stereotyped answers.

Multiple emotions

Sometimes you have multiple emotions at one time, for example sadness and happiness. First, children think that you can’t have different emotions at the same time. But when children are six years of age, they begin to understand that you can have emotions with the same valence, like anger and sadness, come first in the development. When children are nine years of age, they begin to understand that you can have different emotions with opposite valence, for example happiness and sadness.
In children with ASD, it was found that there were no group differences in vignettes with positive versus negative emotions compared to normal developing children. In contrast to this, it was found that children with ASD did less well on vignettes with negative vs negative emotions, for example anger versus sadness. Based on these outcomes, the problem in children with autism is not a developmental delay. This is because the thing children with ASD have problems with, comes first in the development. The thing that children with autism do well, comes later in the development. Because of this, it is not a developmental problem according to Carolien Rieffe. Obviously it’s a different development in children with autism.

So children with ASD less often report how they feel and they give less examples from social situations. They also have fewer different same-valence emotional perspectives in multiple emotion scnearios. This is because they don’t analyze the situation thoroughly enough. But there were no group differences in emotion intensity.

Step 2: coping

Coping is the attempt to regulate your arousal level. According to Lazarus and Folkman (1984) coping contains the continually changing behavioral and cognitive efforts to deal with demands on the individual. It’s about constantly conflicting concerns. Coping means dealing with negative emotion experiences. Infants already try to deal with negative emotion experiences, they’re covering their ears or averting their gaze if they don’t like something. So they already try to regulate their level of arousal. But at different ages, children use different strategies.

Frydenberg (1997) says that coping depends on the situational factors (controllability), personal characteristics and the perception of the situation (e.g. theory of mind, biased by emotional experience). So C = f (S + P + pS). There are huge individual differences. There are different classification systems to look at coping strategies used in different research: problem focused vs. emotion focused, behavioral focused vs. cognitive focused, primary vs secondary control, approach vs. avoidance, and monitoring vs. blunting. Monitoring vs. blunting overlaps with approach vs. avoidance, but is used in medical situations like fear for the dentist. Carolien Rieffe uses the distinction between approaching and avoiding a situation in her research.

Examples of cognitive strategies (Fields and Prinz, 1997) are analysis of the situation, positive reappraisal, self-calming and distraction. Behavioral strategies are problem-solving, passive behavior, social support, avoidance or aggression. Some strategies are both cognitive and behavioral strategies, for example social support seeking. Infants want social support to solve their problem, so this is a behavioral strategy, but adults rely heavily on social support to calm down and to talk about the event. This is more cognitive.

Development of coping strategies

Behavioral strategies come first in the development. But when children become older, around the age of ten/eleven, children start to develop cognitive strategies because children start thinking about other persons. So older children can think about things rather than just do something. However, cognitive strategies don’t exclude behavioral strategies. When possible, one uses both. The same strategy can be adaptive or maladaptive, depending on the situation and the outcome. A cognitive analysis is helpful in a peer-conflict situation, but it’s not helpful in a lot competition.

Individual differences

There are a lot of individual differences in coping strategies. Maladaptive strategies are very much linked to internalizing problems. This shows you how important good emotion regulation is. If you can’t deal with negative emotions, there’s a high risk of internalizing problems. Children with internalizing problems (depression, anxiety, somatization) are more avoidant, use more rumination and make less use of problem solving strategies. Remember that avoidance is different from distraction. Distraction means thinking about something else, which can be useful. Avoidance is not useful. Children with internalizing problems use maladaptive coping strategies. Depressed boys use more maladaptive externalizing strategies.

Factors affecting effectiveness coping strategies

The factors affecting effectiveness of coping strategies are: temperament, age, gender, parenting styles, situation (controllable or not), and whether there are long and short term effects.

Lecture 4: Social emotions

Social emotions

Social emotions are really important for our social relationships. Shame guilt and pride motivate us to behave appropriately within the social context. You want to display your guilt to restore your relationships when it’s damaged in some way. Sometimes we don’t do something because we know in advance that it’s going to make us feel guilty or ashamed. Both guilt and shame are unpleasant emotions. Especially shame is considered to be a really painful emotion. Pride is way more positive.

Differences between social emotions

People often use shame and guilt in the same way because they can occur in the same situation, but they are quite different. You feel ashamed when people see you in a way you don’t want to be viewed. So there’s an unwanted identity. You usually feel guilty when you did something that costed any harm or disadvantage to someone and you feel responsible for that. It’s really hard to think of a situation in which you only feel guilt, without shame.

The appraisal you give to a situation will define which emotion you experience. So if you think ‘I’m a really dumb person, and that’s why it happened’, you will probably feel ashamed. This is stable and global. It’s stable because it’s not going to change the other day, and global because it involves not only that you did something dumb, but you consider yourself dumb as a person. When you experience guilt, it’s unstable because you’re not dumb but you did something dumb. It’s specific because it doesn’t include yourself but just a situation. If you feel ashamed, you want to withdraw from a situation, you want to escape. If you feel guilty, you want to approach the other person and say how sorry you are. So shame is really self-focused, while in guilt you focus on the other person because you did something to someone else.

Four major features distinguish social emotions from basic emotions. First of all, you need self-awareness and self-representations. Most researchers test this by placing a child in front of a mirror and applying a red dot on the forehead of the child. When children are between 1 and 1,5 years old, they don’t recognize themselves in the mirror. But when children are between 2 and 2,5 years old, they immediately recognize themselves. Your self-identity also influences which social emotions you feel.
Second, there are no universally recognized facial expressions for social emotions. This is the case because you need your body to express social emotions. It also has an advantage, because not in all cultures it’s normal to show pride for example. Because you need your body, it’s easier to regulate this emotion.

Third, you’re not born with social emotions. Social emotions emerge later in childhood because they’re cognitively complex. You need to recognize and internalize social standards. If your parents tell you what’s right and wrong, you internalize this. This is needed to experience social emotions. You also need to have a theory of mind, because you need to be able to take the perspective of others. And fourth, social emotions facilitate the attainment of complex social goals. You feel guilty when you harmed another person. Your action tendency is to repair the relationship. In shame, there’s a personal failure. You want to disappear. This is effective, because you communicate that what you did was wrong and that you know that it was wrong. Then it’s easier for people to reaccept you in a group.

Social emotions and behavior

Low levels of guilt are related to all kinds of norm-violating behaviors. So more delinquency, more psychopathy, more aggression and more bullying. High levels of shame are linked to aggression, social anxiety, a lower self-esteem and more depression. The link between shame and aggression seems strange. Because shame is so painful and you degrade yourself completely as a person, you’re trying to regain control over the situation by externalizing blame. In this way you can regain your self-esteem, so it’s seen as a way of coping.

Social emotions in clinical groups

Children with autism spectrum disorder and deaf children with a cochlear implant have been studied. There’s no reason to expect that deaf children would have different self-awareness. You would expect differences in recognizing and internalizing social standards, because parents use verbal communication to tell their children what’s right and wrong. Deaf children and parents have less communication. When they talk, it’s more about basic things, but not about abstract things like emotions. So they have less opportunities to learn. The other way parents communicate is by being angry at their child when they do something wrong. But deaf children have more difficulties with recognizing emotions as right or wrong. So these parents are left with punishment and reward. This might lead children to avoid punishment, but without the verbal rationale they’re not going to internalize these social standards.

For the children with an autism spectrum disorder, it’s different. Though they also have problems, they can learn certain rules. The typically developing children can take perspective and can understand false beliefs. But most of the children with an autism spectrum disorder fail this task, and the same is true for deaf children. Verbal communication is really important in learning perspective taking.

In the research of Carolien Rieffe et al., they measured shame, pride and guilt in control and clinical children. They expected that deaf children and children with an ASD (autism spectrum disorder) would show less shame, pride and guilt than normal developing children. In younger children, certain tasks were used. In young adolescents, social vignettes were used. It turned out that clinical children experienced less pride, shame and guilt.

Culture and social emotions

Culture defines your social standards, and your social standards define which social emotions you experience. Culture can be both objective and subjective. It’s produced by human and it’s learned. It’s functional because culture sets rules on how you should co-exist. It’s also changeable, our culture now is different from 40 years ago. Some cultures are individualistic, and some cultures are collectivistic. In an individualistic culture, people are really independent and don’t want to really on others for support. Your own development and needs are your first priorities. People want to stand out and they want to be better than someone else. This is usually the case in western cultures. In collectivistic cultures people see themselves as parts of a bigger group. You’re more concerned with others, and the family is more important. In an individualistic culture you see way less relations between people. There are groups, but most people stick to their group and don’t socialize a lot. In a collectivistic culture, everyone is connected with everyone. People in collectivistic cultures show more shame and pride than western children. Because the group is way more important in collectivistic cultures, it’s easier to devaluate yourself. But people in collectivistic cultures have less options and power to change things by themselves and to restore their relations because everyone is connected to everyone, so guilt is a less suitable emotion. There are also more rules and norms in collectivistic cultures that can be violated, so there are more opportunities to feel ashamed.

Empathy

Empathy is sort of a social glue: it’s really important in establishing meaningful friendships for example. It induces help behavior and leads to cooperation. There’s an affective part, where you feel what the other person is feeling. Then you have the cognitive part: you need to be able to understand the emotion someone else is experiencing. This has a big overlap with the theory of mind.

Development of empathy

Hoffman (1987) says that affective empathy can already be seen in infancy, right after babies are born. Affective empathy is the same as contagion. So when a baby starts crying, another baby starts crying too. This has a neurological basis in the mirror neurons. In order to experience empathy, children need to be able to focus their attention on someone else, because the affective part of empathy is an unpleasant emotion. This motivates you to help the other because you want to get rid of the emotion. Children start focusing their attention on others when they’re around 2/3 years old, and this is also when they begin to show prosocial behavior. Children also need to be able to understand why the other is upset, so they need to have a theory of mind.

Clinical groups and empathy

On the observation task with younger children (between 1-5 years old) there were no differences in empathy between deaf and hearing children. Also the parents reported no differences. In contrast to this, older deaf children scored lower on prosocial acts in the observation task. They also showed a lower understanding on the self-report task. The reason why they didn’t find any differences between younger deaf and hearing children is that the focus here is on affective empathy. Since affective empathy is innate, you wouldn’t expect any differences between deaf and hearing children. But you also need to explain why the deaf and hearing children both look at the experimenter and at what is happening. You would expect that deaf children would have less attention for the other person, but deaf children rely more on visual cues for their communication. This could be a reason why they looked at the experimenter and at what was happening. So it is not clear if deaf children looked at the experimenter just for visual cues, or if they were really interested in her emotion.

Emotion regulation is definitely more problematic in children with ASD (autism spectrum disorder), and their theory of mind is impaired too. For the observation task, there were no differences between normal developing children and children with ASD. But according to the parents, children with ASD showed less attention for the emotions of others and showed less prosocial acts. The explanation is that children with ASD actually show attention, but for the act, not for the emotion. So the attention was not directed to the emotion. So there’s a lower level of empathy in deaf children and in children with ASD, and because empathy is really important in establishing friendships, it’s not surprising that they also have a lower quality of friendship.

Lecture 5: Emotions, mental health and social adjustment

Socialization influences (von Salisch, 2001)

The von Salisch article talks about different relationship contexts, with parents peers and friends. These different relationships have different characteristics when you look to social power and closeness. You can also say whether the relationship context is chosen or involuntary, and you can say something about the influence.

Parent-child relationships

In the relationship between parents and child, the social power is asymmetrical because the child has less social power than the parents. The relationship is also close, involuntary (because the parent can’t choose the child and the child can’t choose his or her parents), and the influence is from birth onwards.

Parents can give a direct instruction to their child, for example about emotion expression. A parent might also instruct the child how to cope, so how to sooth him- or herself when experiencing a negative emotion. There are also three kinds of indirect influences. Ideally speaking, the parents should act as emotion coaches, so they should provide an emotional role model for the child.

The first indirect influence of the parents is called modelling. This means that the parent acts as a model and shows in his or her behavior how to express an emotion. Modelling can also be social referencing, this is when a parent highlights the emotional significance of an event unconsciously. Parents can also model how to cope with emotions. Modelling can also be about the general affective environment that the child grows up in: is the environment generally positive or generally negative, or a combination?

The second way in which parents socialize emotional behavior is through contingencies. There are two ways of being contingent. A parent can reinforce the emotional behavior of a child. This means that a parent validates the emotions of the child. This can help the child to deal with for example negative emotions. It facilitates emotional competence. It gives the idea to the child that they can talk about emotions in an open way.

On the other hand, if a parent is more punishing, this can be shown by the parent wanting the child to minimize the emotion display, or punishing the emotion display or even ignoring the emotion display. Then the child is more likely to learn that he or she is not allowed to show and communicate his or her emotions, and they will be less likely to seek help. This has negative consequences, because the child doesn’t learn how to cope with his or her emotions.

The third indirect way is communication. This is when parents give for example a verbal label to a certain type of feeling. Giving the child these labels allows the child to become aware of the different emotions. The parent can also talk about when, where and how to express emotions. The communication can also be about coping, so the child learns how to regulate their negative affect.

Preschoolers’ emotion self-awareness

Warren and Stifter (2008) found that the mothers who were high on supportive socialization predicted more self-awareness of happiness one year later. For sadness, they found that non-supportive socialization predicted poor awareness of sadness 1 year later. There were no significant results for anger. So anger was unrelated to socialization.

Limitations in parent-child relationship (von Salisch, 2001)

The parent is more mature in a lot of ways, and this may limit the understanding of the child’s appraisals of the situation. This is because they don’t think at the same level as the child. Because the parents are responsible for the well-being of the child, the parents are sometimes concerned when the child is very enthusiastic about something.

There are different things that affect how well a parent can regulate the emotions of a child. If a parent is able to regulate his or her own emotions well, this is usually a positive thing for the child. This can be a circular transactional process.

Peers as socialization influence

The peer-child relationship is described as symmetrical, because they have a similar degree of social power. It also tends to be a less close relationship, because you’re not choosing these peers. The relations are involuntary because you don’t choose the peers with which you are put in a classroom for example.

There are two reasons why peers can have a socialization influence. It’s about the similarity in the relationship. In these relationships, the peers are at the same social level, cognitive level, moral level and they share the same life events. This means that the age mates are in a good position to understand the emotional life of the other age mates. The second reason why peers have a socialization influence is because the formation of a group. Peers tend to form groups, and through this formation of a group, there is an intensification of emotional experience.

Peers teach other peers how to dampen the expression of negative emotions, because the expression of negative emotions is not accepted by the peer group. This sends the message to the child that showing these emotions in front of the peers is not allowed. Around the age of ten, children can also learn to put on an ‘emotional front’. This can be useful. Regarding the regulation of anger, older children use more distancing or avoidance than younger children.

Friends as socialization influence

Friendship-child relationships are symmetrical, close, voluntary and develops around pre-adolescent age. Just like with the peers, the two individuals in a relationship are similar in their developmental level. Friendships tend to be intense as well, because the relationships are closer. Within this type of relationship, the child or adolescent might learn new ways of regulating emotions or new aspects of emotional competence. These new dimensions can be positive, because you really learn how to be supportive of another person. When it comes to having a conflict with a friend, the way you regulate your emotion is likely to be different than the way you regulate your emotion in the peer context. In the friendship, your personal goal is to keep that relationship and the social goal is that your friend wants to stay friends with you. These goals are matching, so you’re more likely to approach the friend and solve the problem. You can also feel new emotions when you’re in conflict with a friend, like jealousy or envy. You need to learn how to deal with these emotions and also maintain the friendship. Friendships can be fragile because they’re voluntary.

Emotional competence and social adjustment

Blair et al., investigated the ‘developmental cascades model’. This means that development in one domain spills over into another domain and that spills over into a third domain. they said that the foundation of emotional competence is emotion regulation. According to the cascades model, better emotion regulation at age five will predict better social skills at age seven. Better social skills will predict a higher peer acceptance and better friendship quality at age ten. The study of murphy et al. showed that emotion regulation is really crucial to improve social competence in early adolescence.

Emotion regulation and aggression

There is a positive relation between emotion dysregulation and aggressive behavior, but not the other way around. So aggression does not predict greater emotion dysregulation later on, according to the study of Röll et al. (2012). This relationship is not the same for everybody. Gender is a possible moderator of emotion regulation and aggression/externalizing problems later on. This relationship is possibly stronger for girls than for boys. A mediator could be peer rejection. Emotion dysregulation is said to lead to peer rejection by peers, and that is associated with externalizing behavior.

Lecture 6: Emotional Competence and Depression

Sadness revisited

The function of sadness is to seek support from others, so to gain help from others. It’s a normal emotion to experience, but we have to learn to deal with the sadness. It’s normal to feel sad, and usually it will have a cause. But sadness can also be abnormal of atypical. Sadness is ‘not normal’ when its difficult to resolve the sadness, when it’s persistent and when it interferes with daily life.

According to the DSM, depression is not just the same as increased sadness. The other symptoms of depression are increased irritability (anger), anhedonia, and feelings of worthlessness or guilt. It is said that in children, irritability or anger is more present than sadness.

A prototypical disturbance of emotion

Emotional competence and depressive symptoms (Hughes et al., 2011)

In this study they measured three categories. The first one is emotional states, so they looked at the experience of guilt, shame and empathic concern. The second category is emotional awareness, which involves control, recognition and responsiveness. The third category is emotion regulation which concerns reappraisal and suppression. So they looked at guilt and shame. Guilt is seen in terms of behavior that might cause harm to another person, which causes the other person to repair and reinstall the relationship. Shame is measured in terms of the focus on the self, so it focuses on the personal failure and the person wants to disappear and re-acceptance by the group. If you compare the highly depressed group with the low depressed group, the highly depressed showed a higher level of shame and more suppression of their emotions. In contrast to this, the highly depressed group showed a lower level of guilt, recognition of their emotions, responsiveness, and reappraisal. Secondly, the authors wanted to know which variables predicted the membership of the highly depressed group. They found that scoring higher on shame gives you a higher chance to be in the highly depressed group. The same counts for lower emotional control and lower emotional self-awareness. They found that there were no differences on empathic concern. This corresponds with the fact that shame is linked to depression. You have to take into account that the depressive cognitive style can influence the self-report of the depressed group.

Affective experience D vs ND (Sheeber et al. 2009)

This study doesn’t focus on emotional competence but the focus is more on the behavioral and experiental components of emotion. The study looks at particular aspects on the emotions of sadness, anger and happiness. They looked at the intensity, duration and the frequency of the emotions. They had three different family interaction situations and they observed the affective behavior during these interactions. They also used self- and parent-report questionnaires. In the depressed adolescent groups, the adolescents experienced sadness and anger for a longer duration. Particularly with anger, they found that depressed adolescents experienced anger with greater frequency and intensity.

Emotional competence as a risk and consequence of depression

Emotional competence leads to depressive symptoms? (Rieffe & DeRooij, 2012).

In this study with children of 10/11 years old, the researchers showed that three of the emotional awareness subscales contributed to depressive symptoms over time. These subscales are differentiating emotions, analyzing emotions, and others’ emotions. They found that children who had higher levels of emotion awareness experienced a reduction in depressive symptoms over time. If there’s a build-up of negative emotions, this can result in a feeling of disconnection and can be problematic.

Wat is the effect of Depressive symptoms on emotional competence? (Larsen et al., 2013)

More depressive symptoms predicted more expressive suppression one year later. So emotional competence can be a risk factor for developing depressive symptoms, but depressive symptoms themselves can also impact the development of emotional competence.

Socialization influences

The access to the social world can influence the development of emotional competence, and this can in turn influence mental health. There are three socialization influences, namely modeling, contingencies and communication.

Modeling

When the mother of a child is depressed, she models emotions in a different way compared to children of mothers who are not depressed. Depressed mothers smile less to their children, show more negative expressions or neutral expression and are more withdrawn and muted in their interactions. This gives the developing infant a very different emotional experience. Székely et al. looked at this question: do 3 year old children of mothers with high levels of depressive symptoms recognize positive emotions less accurately and negative emotions more accurately than 3 year old children of mothers with no or low depressive symptoms? In contrast to their hypothesis, they found that children of mothers with high levels of depression weren’t as good in labeling all emotions as children of mothers with low levels of depression. Perhaps these children have difficulties in connecting appropriate verbal labels to facial displays of emotion. Facial expression recognition is important for social interactions, so it’s a key ability and it’s important for later life. So children of depressed mothers have more difficulty in recognizing emotions or labelling emotions, which can put these children at risk for higher levels of depressive symptoms.

Contingencies (Sander et al., 2015)

Contingencies is about how a parent respond to the emotion displays of their child. The parent can be supportive or unsupportive. When the parent is unsupportive, this gives the child the idea that it’s not good to show their emotions and that they have to keep their emotions for themselves. This study focused on sadness and anger and looked at mothers and fathers. We know from other studies that emotion dysregulation is linked to higher depressive symptoms in children and adolescents. They hypothesized that the parental unsupportive emotion responses act as a moderator in this relationship. They found a positive association between depression and a dysregulation of anger and sadness. It’s also negatively associated with coping with anger and sadness. They also found that the depressive symptoms are predicted by the mothers’ unsupportive emotion responses to sadness, and by the fathers’ unsupportive emotion responses to anger. This could be because the fathers’ responses to anger and the mothers’ responses to sadness are more salient. They also found that unsupportive emotion responses indeed act as a moderator in the relationship between anger dysregulation and higher depressive symptoms in children and adolescents. This relationship is bigger for anger than for sadness.
So it could be that parents who unsupportively respond to the emotion of the child can cause the child to have difficulties with their emotion regulation. This can in turn lead to depressive symptoms in the child.

Depression and social interactions (Kearney, 2013)

Children and adolescents who are clinically depressed tend to have a lack of smiling, more frowning and more complaining. We also know that in depression there is decreased social activity and decreased eye contact.

Social interactions (Van Beek et al., 2006)

The first research question of this study was as follows: do mildly depressed adolescents show fewer positive behaviors than non-depressed adolescents? Their second research question was: are mildly depressed adolescents responded to in a less positive way? They looked at three nonverbal behaviors: gazing, backchannel-behaviors that confirm interest in conversation eg. Nodding yes, and the frequency of smiling/laughing during listening. They found that particularly in females, the mildly depressed adolescents gazed less during listening. They also showed fewer smiles and the partners of depressed adolescents also smiled less often. So to conclude, the access to the social world can be affected by increased sadness or anger/depressive symptoms and social behavior. This can influence the emotional competence and this can reinforce the depression symptoms that were already present.

Lecture 7: Emotional competence and anxiety

Social anxiety

Social anxiety means an extreme fear of social interactions. This has to be an impairment of daily life. The prevalence of social anxiety is quite high, about 9.3% of all people experiences a social anxiety disorder once during their life. 20 to 50% of social anxiety is caused by genetic factors.

Physiological arousal

A social evaluation task is used to measure social anxiety. People were told that they had to hand in a picture of themselves, and that this pictures would be evaluated by others. They were asked if they expected to be liked by the other person, and after that they got the feedback from the other. The focus was on the unexpected rejection, because this is the most painful condition. The study expected to see a lower heart rate in the unexpected rejection condition, and that this was higher in adolescents than in younger children, because peers are more important for adolescents than for younger children. The study showed that the heart rate slowed down in the unexpected rejection condition, so compared to children, adolescents were more sensitive for peer rejection. This effect was higher for girls than for boys.

Cognitive processing

Social anxiety is related to attention, interpretation and expectations. Socially anxious persons directly focus their attention on a threatening stimulus. This happens in the first seconds after the stimulus, but after that they try to avoid the stimulus. Another bias in attention is the bias in detecting negative instead of positive responses in others. In this way socially anxious people confirm their idea that social interactions are threatening. The third example is self-focus attention. Socially anxious persons really focus on themselves, and think that people will see that they are very anxious. But they don’t look to other people to confirm their ideas. The second bias in information processing is interpretation. Socially anxious persons interpret social stimuli in negative ways. When they see someone laughing, they think that they’re laughing about them. The last bias is that socially anxious people think that they will perform badly in a social situation. So they have negative expectations about their performance.

Social anxiety is about normal increases in social fears and worries. This is always the case in adolescents. This is because the prefrontal regions develop a bit later in life than the subcortical regions. Adolescence is a period in which the subcortical, the emotional, regions are fully developed, but the prefrontal regions are not yet fully developed. So adolescents don’t have enough cognitive control to decrease their emotional reactions. In adolescence there’s also an increase in normal social fears and worries. So social anxiety often develops during adolescence, and this is related to the normal development of the emotional brain. They do have the emotional reactions, but not enough cognitive control to dampen these reactions. On the other hand, development of the prefrontal regions can lead to a bias in interpretation, which can lead to social anxiety disorder.

Motor expression

Another way to measure socially anxious reactions is the speech task. This consists of three stadia: the anticipation, the performance and the recovery stage. Blöte et al. (2015) talk about the Leiden public speaking task. One week before the experiment they let the children know that they would have to give a speech about movies they like or dislike in front of an audience. In the lab they gave their speech in front of a prerecorded audience that were neutrally listening, so the audience would be the same in all cases. There are two phases. The first phase is the development of an observation scale, and the second phase is the relation to social anxiety. High socially anxious participants were rated as less expressive and showed less confidence. High socially anxious people show a bit more agitation, but this was not significant. Safety behaviors are used by socially anxious people to hide their anxiety. This could be observed as inexpressive, because they’re so occupied with hiding their anxiety.

Subjective feeling

Subjective feelings are also measured by a speech task. People judged peers and after that they had to give a speech in front of a camera in which they had to talk about themselves. At several time points they were asked how nervous they were. This is a way to measure subjective feelings during this speech task. High socially anxious persons score higher on all the fear items, except for the positive rumination. High socially anxious persons were more nervous during the task. The more you are related to someone with a social anxiety disorder, the more social anxious you are yourself. This means that there’s something that is heritable in social anxiety.

Action tendencies

Avoidance is an important part of social anxiety disorder. Patients with social anxiety disorder avoid social situations, but they can’t test their beliefs because they don’t try out their beliefs. So there’s no disconfirmation of unrealistic beliefs, which maintains the social anxiety.

Emotion socialization of fear

Studies have shown that there are some differences between the brain of socially anxious people and people without social anxiety. The interaction of genes and environment is most important in the development of a social anxiety disorder. There are three ways in which parents can influence the behavior of their child, namely through modelling, contingencies and communication.
Majdandzic et al. (2014) looked at different types of parenting behaviors. According to them, there are three types of parenting behavior: overcontrolling, rejecting and challenging. They also make a distinction between the role of the mother and the father. The mother has a more attaching relationship with the child, while the father has a more opening relationship with the child. There’s a positive relation between the challenging behavior of the mother and the social anxiety of the child, while this is the opposite for challenging behavior of the father. This is the case because challenging behavior of the mother contradicts her attaching behavior.

There are also peer influences. Children learn the display rules for emotions from their peers, because peers show what kinds of behavior they should show. The influence of peers can be negative, but this is not always true. During adolescence, peers become increasing important for children, and the influence of the parents decreases.

Conclusion

There are different components of the emotion process, that can all contribute to the development of social anxiety. These components are physiological arousal, cognitive processing, motor expression, the subjective feeling state and action tendencies. Social anxiety is not always bad, because sometimes people like you better when you’re not extremely dominant but show some submission. So it does have an evolutionary function.

Lecture 8: Emotional competence as a transdiagnostic factor

What is a transdiagnostic factor?

This is a new approach in psychopathology. Transdiagnostic means that you look across a number of disorders. ‘trans’ literally means ‘across’ or ‘beyond’. This looks for a shared factor across different disorders. This is important because of the high co-occurrence of different symptoms/disorders. This is called ‘comorbidity’. Maybe this co-occurrence is because of a shared factor, process of mechanism. These factors, processes, mechanisms can be in a cognitive, affective or neurobiological area. The discovery of a transdiagnostic factor could be very important for interventions, because you need to focus on a number of disorders. This could also be more time- and cost-effective. There are internalizing and externalizing syndromes and there’s a group of neuro-developmental disorders. A transdiagnostic factor could be within the internalizing or the externalizing spectrum, but it could also cross the spectrums.

Rumination and internalizing symptoms (McLaughlin & Nolen-Hoeksema, 2011)

There is high co-occurrence within internalizing symptoms. 40 to 80% of the youth with a depressive disorder also have an anxiety disorder. In children this is mostly a separation anxiety disorder, while in adolescents this is most of the time a generalized anxiety disorder or social phobia. 30% of the adolescents with an anxiety disorder have a depression. A possible transdiagnostic factor in depression and anxiety is rumination.

Rumination

Rumination is a cognitive coping strategy, so it’s a way to deal with negative emotions. It’s described as passive and repetitive thinking about symptoms, the causes and consequences of symptoms. One of the negative things of rumination is that it does not alter the cause of distress. Rumination can also be a response to a negative event. In children and adolescents there’s more rumination when they have an anxiety disorder or high depression symptoms. Rumination predicts increasing avoidance of social situations during adolescence. The research question in the research of McLaughlin & Nolen-Hoeksema was: does rumination statistically account for the relationship between symptoms of anxiety and depression in adolescents? This is about mediation. Rumination is the mediating variable between depression and anxiety. A mediating variable is one that intervenes between two variables.

What the authors did first of all is looking if there’s a correlation between depression and anxiety. They also need to look if there’s a relationship between rumination and depression and a relationship between rumination and anxiety. Rumination was measured with the ‘Children’s Response Styles Questionnaire’ (CRSQ). They found that depression and anxiety were positively correlated. When they added rumination, they wanted to know if the correlation between depression and anxiety decrease. If there’s indeed a reduction in the correlation between anxiety and depression, than they can conclude that rumination is a mediating variable between depression and anxiety. They found that this was indeed the case. In the longitudinal model they found that depression predicted an increase in rumination, and that this rumination predicted an increase in the anxiety symptoms.

Explanations rumination

Rumination decreases positive affect and increases negative affect, so it causes a generation of the negative mood. Further, rumination interferes with social functioning and others will be less interested in helping them. Third, rumination interferes with effective problem solving.

Internalizing – externalizing

Internalizing and externalizing problems co-occur. Youth with disruptive behavior problems show an increased risk of depression and anxiety. The idea is that rumination may also play a role in the association between internalizing and externalizing symptoms. According to the failure model (Capaldi, 1992), aggression leads to conflict, social rejection and failure experiences in social and academic contexts. This can in turn lead to internalizing problems. It has been shown that failure experiences can cause more rumination. So social rejection predicts increases in rumination.

There’s another old theory (Caprara, 1986) for the explanation why internalizing symptoms can lead to aggression. If you’re provoked, you can response with rumination. This can lead to aggression. In this way rumination is associated with internalizing problems. McLaughlin et al. (2014) showed that in boys, rumination is a mediator between anxiety and depression with subsequent aggression and the other way around.

Empathy and externalizing problems

Empathy is the social glue for bonding and induces helping behavior and cooperation. It contains the affective component (contagion) and the cognitive component (theory of mind).

Empathy

Children with autism probably have too much of the affective component of empathy, but too less of the cognitive component. ADHD and Disruptive Behavior Disorder (DBD) are quite high in comorbidity. There’s only 31% of the children diagnosed with ADHD that are just diagnosed with ADHD without any other disorder. Possibly empathy is a transdiagnostic factor in ADHD, DBD and ASD. Deschamps et al. (2015) showed that empathy inhibits aggressive and antisocial behavior, and that there’s a central role of the display of sadness and distress in other persons.

Development of empathy

There are four components in the development of empathy. The first stage is contagion, this is when the child feels what the other feels. The second stage is the attention to other’s emotions. The third stage contains the prosocial behaviours. This means that the child intervenes to diminish distress in the other. The last stage is understanding why the other is upset, this is the cognitive component of empathy.

Findings empathy (Deschamps et al., 2015)

In children and adolescents with Disruptive Behavior Disorder (DBD), the affective empathy is impaired while the cognitive empathy is not impaired. In Children and Adolescents with ADHD, the affective empathy is impaired but if this is also the case for cognitive empathy is not sure. They also found that prosocial behavior negatively correlated with aggression and ADHD symptoms. The study sample consisted of children aged 6 and 7 years. They had an ADHD group, a comorbid DBD-ADHD group, and a Typically Developing group. They focused towards the children’s empathy to sadness and distress. They used parent and teacher reports. They also used a story task to measure affective empathy.

Results

There are different findings for the different measures in this study. According to the teachers, the children with DBD are less empathic than typically developing children. However, according to the parents and the story task, there were no differences between the children with DBD and typically developing children in empathy. But they did find that children with DBD are less prosocial than typically developing children. This was different from what they expected, because they expected to find more differences between the DBD group and the typically developing children.

For the ADHD group, it was found that children with ADHD are less empathic than typically developing children according to the teachers. But according to the parents and the story task, there were no differences between the children with ADHD and the typically developing children. There were also no differences between the ADHD group and the typically developing group in prosocial behavior.

Conclusions

According to the parents, the children with DBD have no problems sharing sadness, but they do show problems sharing sadness and distress at school according to their teachers. They’re also less likely to respond to sadness with prosocial acts. But there could be an influence of the monetary reward to the prosocial task. It could also be that this is more about emotion recognition than about empathy.

The children with ADHD have lower empathy according to the teachers but not the parents. This could be caused by the social demands of the school context. It could be that the child is overwhelmed by the different kind of stimuli at school and is then less able to show empathy. According to other measures, the dimensions of empathy (affective, prosocial) are intact in children with ADHD. Empathy can be looked at as a transdiagnostic factor, but this is not really clear yet.

Emotional competence in interventions

Cognitive Behavioral Therapy is the golden standard for the treatment of depression and anxiety disorders. In this therapy, there are already elements of emotional competence. The idea is to replace unhealthy thoughts with helpful thoughts. So it’s like cognitive restructuring. But in this kind of therapy, the focus is just on one emotion. In externalizing problems, parent-mediated behavioral therapy is the standard. In this program, one of the active ingredients is to change how emotional self-regulation is socialized by the parents. So the parents are taught how to manage their own emotional behavior, to model self-regulation and to respond to children’s regulation in an appropriate way. In the new protocol ‘Unified Protocol for treatment of Emotional Disorders in Youth’ (UP-Y), new components have been added to treatment.

Source

• Lecture notes 2015-2016