Longitudinal effects of emotion awareness and regulation on mental health symptoms in adolescents with and without hearing loss

Abstract

Emotion awareness (EA) and regulation (ER) are each known to associate with mental health symptoms, yet there is a paucity of longitudinal studies examining them jointly during adolescence. Furthermore, little is known about these skills and their relations in deaf and hard-of-hearing (DHH) adolescents, who are at risk for reduced emotion socialization and for more mental health symptoms. This longitudinal study examined the development and unique contributions of EA (emotion differentiation, emotion communication and bodily unawareness) and ER (approach, avoidance and worry/rumination) to internalizing and externalizing symptoms in adolescents with and without hearing loss. Using self- and parent's reports, we assessed 307 adolescents (age 9–15) three times over 18-month period. We found stability over time in development of EA and avoidance ER, increase in approach ER and decrease in worry/rumination. High levels and increases over time in two aspects of EA, emotion differentiation and communication, and in approach and avoidance ER were related to decreases in depressive symptoms. An increase in approach ER was also related to a decrease in anxiety symptoms. Yet, low levels or decreases in worry/rumination were related to decreased levels of depressive, anxiety and externalizing symptoms. Hearing loss did not moderate any of the variables or relations tested. Preliminary tests suggested heterogeneity within the DHH group according to educational placement, language abilities and parental education level. Overall, findings pointed at unique contributions of EA and ER to mental health development, suggesting that DHH adolescents, especially in mainstream schools, do not differ from their hearing peers in their emotion awareness and regulation.

Process-Oriented Measurement of Emotion Regulation: General and Specific Associations With Psychosocial Adjustment and Well-Being in (Pre-)Adolescence

“…Overall, the findings on general associations (Model 1, Research Question 1) supported our hypotheses: More functional ER was associated with better psychosocial adjustment (i.e., fewer internalizing and externalizing symptoms, and more prosocial behavior), while more dysfunctional ER was associated with more internalizing and externalizing problems. These results are in line with previous studies ( 1 – 3 , 9 , 23 ) and—given the significant relations of functional and dysfunctional ER strategies with both, internalizing and externalizing symptoms—underline the transdiagnostic nature of ER that has been suggested by several researchers (e.g., 24 , 25 ). However, associations between dysfunctional ER and problem behavior were more pronounced for internalizing symptoms (in comparison to externalizing symptoms).…”

“…Regulatory goals have also been incorporated within the ER assessment, but emotion awareness has not been included. The way individuals perceive and evaluate their own and others’ emotions (emotional awareness) has been found to be significantly associated with ER ( 58 , 74 ), emotional information processing ( 75 ), empathy ( 67 ), and mental health ( 9 , 70 , 76 ). Furthermore, there are other dimensions of emotions (e.g., duration, intensity) that need attention in future research in this field ( 11 ).…”

“…The internalizing dimension includes problems within the person, such as depression, anxiety, social withdrawal, or somatic problems (e.g., headaches), while the externalizing dimension comprises conflicts with social interaction partners and the environment, such as conduct problems, hyperactivity, aggression, destructive behavior, or delinquency. Overall, findings of numerous cross-sectional and longitudinal studies, meta-analyses, and literature reviews suggest that more functional and less dysfunctional ER are associated with fewer (non-clinical) problem behaviors and (clinically relevant) psychopathological disorders across different age groups (e.g., 1 – 3 , 9 , 23 ). ER has even been proposed as a transdiagnostic factor for different (internalizing and externalizing) symptoms (e.g., 24 , 25 ).…”

“…If individuals fail to achieve the regulatory goal or if negative emotions are increased and positive emotions are decreased too frequently (e.g., when suppressing emotions or dwelling on problems), this is most likely associated with lower well-being and more behavioral problems. Accordingly, these strategies (e.g., rumination, suppression, catastrophizing) can be described as dysfunctional or maladaptive (e.g., 1,[8][9][10][11][12].…”

“…In line with this assumption, it can be assumed that successfully reducing negative emotions (e.g., trying to calm down when being angry) and increasing positive emotions (e.g., sharing good news with close friends) is associated with higher well-being and fewer psychopathological symptoms. Hence, strategies serving these goals (e.g., reappraisal, problem solving) can be described as functional or adaptive (e.g., 1 , 8 , 9 ). If individuals fail to achieve the regulatory goal or if negative emotions are increased and positive emotions are decreased too frequently (e.g., when suppressing emotions or dwelling on problems), this is most likely associated with lower well-being and more behavioral problems.…”