Social anxiety and depression are common mental health problems among adolescents and are frequently comorbid. Primary aims of this study were to (1) elucidate the nature of individual differences in specific emotion regulation deficits among adolescents with symptoms of social anxiety and depression, and (2) determine whether repetitive negative thinking (RNT) functions as a transdiagnostic factor. A diverse sample of adolescents (N = 1065) completed measures assessing emotion regulation and symptoms of social anxiety and depression. Results indicated that adolescents with high levels of social anxiety and depression symptoms reported decreased emotional awareness, dysregulated emotion expression, and reduced use of emotion management strategies. The hypothesized structural model in which RNT functions as a transdiagnostic factor exhibited a better fit than an alternative model in which worry and rumination function as separate predictors of symptomatology. Findings implicate emotion regulation deficits and RNT in the developmental psychopathology of youth anxiety and mood disorders.
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The decision to use a t-score of 60 (instead of 65) was made to a) approximate the prevalence of depression in our sample to estimated population prevalence rates and b) prioritize statistical power to detect group differences.
Abbott, M. J., & Rapee, R. M. (2004). Post-event rumination and negative self-appraisal in social phobia before and after treatment. Journal of Abnormal Psychology, 113(1), 136–144.
Abela, J. R., Brozina, K., & Haigh, E. P. (2002). An examination of the response styles theory of depression in third- and seventh-grade children: A short-term longitudinal study. Journal of Abnormal Child Psychology, 30, 515–527.
Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy, 48, 974–983.
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & May, J. T. E. (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press.
Barrett, P. M., & Ollendick, T. H. (Eds.). (2004). Handbook of interventions that work with children and adolescents: prevention and treatment. Hoboken: John Wiley & Sons.
Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Hofler, M., Lieb, R., et al. (2007). Incidence of social anxiety disorder and the consistent risk for secondary life depression in the first three decades of life. Archives of General Psychiatry, 64(8), 903–912.
Beidel, D. C., Fink, C. M., & Turner, S. M. (1996). Stability of anxious symptomatology in children. Journal of Abnormal Child Psychology, 24(3), 257–269.
Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess childhood social anxiety and phobia: The social phobia and anxiety inventory for children. Psychological Assessment, 71, 73–79.
Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting and Clinical Psychology, 68, 1072–1080.
Beidel, D. C., Turner, S. M., Young, B. J., Ammerman, R. T., Sallee, F. R., & Crosby, L. (2007). Psychopathology of adolescent social phobia. Journal of Psychopathology and Behavioral Assessment, 29, 47–54.
Berking, M., Ebert, D., Cuijpers, P., & Hofmann, S. G. (2013). Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(4), 234–245.
Blakemore, S. J. (2008). The social brain in adolescence. Nature Reviews Neuroscience, 9(4), 267–277.
Bohnert, A. M., Crnic, K. A., & Lim, K. G. (2003). Emotional competence and aggressive behavior in school-age children. Journal of Abnormal Child Psychology, 31, 79–91.
Bradley, S. J. (1990). Affect regulation and psychopathology: Bridging the mind–body gap. Canadian Journal of Psychiatry, 35, 540–547.
Bradley, S. J. (2000). Affect regulation and the development of psychopathology. New York: Guilford.
Broderick, P. C., & Korteland, C. (2004). A prospective study of rumination and depression in early adolescence. Clinical Child Psychology and Psychiatry, 9(3), 383–394.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing Structural Equation Models (pp. 136–162). Beverly Hills, CA: Sage.
Burstein, M., He, J. P., Kattan, G., Albano, A. M., Avenevoli, S., & Merikangas, K. R. (2011). Social Phobia and Subtypes in the National Comorbidity Survey-Adolescent Supplement: Prevalence, Correlates, and Comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry, 50(9), 870–880.
Campbell-Sills, L. & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In J.J. Gross (Ed., pp. 542-560) Handbook of Emotion Regulation. New York: Guilford Press.
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6, 587–595.
Campos, J. J., Mumme, D. L., Kermoian, R., & Campos, R. G. (1994). A functionalist perspective on the nature of emotion. Monographs of the Society for Research in Child Development, 59(2–3), 284–303.
Chartier, M. J., Hazen, A. L., & Stein, M. B. (1998). Lifetime patterns of social phobia: A retrospective study of the course of social phobia in a nonclinical population. Depression and Anxiety, 7(3), 113–121.
Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample. Journal of Affective Disorders, 80(2), 163–171.
Chorpita, B. F., Albana, A. M., & Barlow, D. H. (1998). The structure of negative emotions in a clinical sample of children and adolescents. Journal of Abnormal Psychology, 107(1), 74–85.
Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20.
Chorpita, B. F., Tracey, S. A., Brown, T. A., Collica, T. J., & Barlow, D. H. (1997). Assessment of worry in children and adolescents: An adaptation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 35(6), 569–581.
Cicchetti, D., Ackerman, B. P., & Izard, C. E. (1995). Emotions and emotion regulation in developmental psychopathology. Development and Psychopathology, 7, 1–10.
Clark, D. A. (2009). Cognitive behavioral therapy for anxiety and depression: possibilities and limitations of a transdiagnostic perspective. Cognitive behaviour therapy, 38(S1), 29–34.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope, & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, London: The Guilford Press.
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific construct: Challenges and directions for child development research. Child Development, 75, 317–333.
D’Avanzato, C., Joormann, J., Siemer, M., & Gotlib, I. H. (2013). Emotion regulation in depression and anxiety: examining diagnostic specificity and stability of strategy use. Cognitive Therapy and Research, 37(5), 968–980.
Doerfler, L. A., Felner, R. D., Rowlison, R. T., Raley, P. A., & Evans, E. (1988). Depression in children and adolescents: A comparative analysis of the utility and construct validity of two assessment measures. Journal of Consulting and Clinical Psychology, 56, 769–772.
Edwards, S. L., Rapee, R. M., & Franklin, J. (2003). Postevent rumination and recall bias for a social performance event in high and low socially anxious individuals. Cognitive Therapy and Research, 27(6), 603–617.
Ehrenreich, J. T., Goldstein, C. R., Wright, L. R., & Barlow, D. H. (2009). Development of a unified protocol for the treatment of emotional disorders in youth. Child & Family Behavior tTherapy, 31(1), 20–37.
Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205.
Eisenberg, N., Fabes, R. A., Guthrie, I. K., & Reiser, M. (2000). Dispositional emotionality and regulation: Their role in predicting quality of social functioning. Journal of Personality and Social Psychology, 78(1), 136–157.
Eisenberg, N., Guthrie, I. K., Fabes, R. A., Reiser, M., Murphy, B. C., Holgren, R., et al. (1997). The relations of regulation and emotionality to resiliency and competent social functioning in elementary school children. Child Development, 68(2), 295–311.
Eisenberg, N., & Spinrad, T. L. (2004). Emotion-related regulation: Sharpening the definition. Child Development, 75, 334–339.
Esbjørn, B. H., Lønfeldt, N. N., Nielsen, S. K., Reinholdt-Dunne, M. L., Sømhovd, M. J., & Cartwright-Hatton, S. (2014). Meta-worry, worry, and anxiety in children and adolescents: Relationships and interactions. Journal of Clinical Child & Adolescent Psychology, (ahead-of-print), 1-12. 31, 1086-1089
Fresco, D. M., Frankel, A. N., Mennin, D. S., Turk, C. L., & Heimberg, R. G. (2002). Distinct and overlapping features of rumination and worry: The relationship of cognitive production to negative affective states. Cognitive Therapy and Research, 26, 179–188.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299.
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). New York, NY: Guilford Press.
Hannesdottir, D. K., & Ollendick, T. H. (2007). The role of emotion regulation in the treatment of child anxiety disorders. Clinical Child and Family Psychology Review, 10, 275–293.
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36(4), 193–209.
Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409–416.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.
Kashdan, T. B. (2007). Social anxiety spectrum and diminished positive experiences: Theoretical synthesis and meta-analysis. Clinical Psychology Review, 27, 348–365.
Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: A prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1–12.
Kashdan, T. B., & Herbert, J. D. (2001). Social anxiety disorder in childhood and adolescence: Current status and future directions. Clinical Child and Family Psychology Review, 4(1), 37–61.
Kashdan, T. B., & Roberts, J. E. (2007). Social anxiety, depressive symptoms, and post-event rumination: Affective consequences and social contextual influences. Journal of Anxiety Disorders, 21(3), 284–301.
Kovacs, M. (1992). Children’s Depression Inventory manual. North Tonawanda, NY: Multi Health Systems.
Kovacs, M. (2009). Children’s Depression Inventory (CDI) Technical Manual Update. Toronto, Canada: Multi-Health Systems.
Kranzler, A., Young, J. F., Hankin, B. L., Abela, J. R., Elias, M. J., & Selby, E. A. (2016). Emotional Awareness: A Transdiagnostic Predictor of Depression and Anxiety for Children and Adolescents. Journal of Clinical Child & Adolescent Psychology, 45(3), 262–269.
London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes and consequences of rejection sensitivity. Journal of Research on Adolescence, 17(3), 481–506.
Mahoney, A. E., McEvoy, P. M., & Moulds, M. L. (2012). Psychometric properties of the Repetitive Thinking Questionnaire in a clinical sample. Journal of Anxiety Disorders, 26(2), 359–367.
McEvoy, P. M., Mahoney, A. E., & Moulds, M. L. (2010). Are worry, rumination, and post-event processing one and the same?: Development of the Repetitive Thinking Questionnaire. Journal of Anxiety Disorders, 24(5), 509–519.
McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013). The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151(1), 313–320.
McLaughlin, K. A., Aldao, A., Wisco, B. E., & Hilt, L. M. (2014). Rumination as a transdiagnostic factor underlying transitions between internalizing symptoms and aggressive behavior in early adolescents. Journal of Abnormal Psychology, 123(1), 13–23.
McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S., & Nolen-Hoeksema, S. (2011). Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour Research and Therapy, 49(9), 544–554.
McLaughlin, K. A., Mennin, D. S., & Farach, F. J. (2007). The contributory role of worry in emotion generation and dysregulation in generalized anxiety disorder. Behaviour Research and Therapy, 45, 1735–1752.
McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186–193.
Mellings, T. M. B., & Alden, L. E. (2000). Cognitive process in social anxiety: The effects of self focused attention, rumination, and mood-congruent memory retrieval. Behaviour Research and Therapy, 3, 243–257.
Mennin, D. S., & Fresco, D. M. (2013). What, Me Worry and Ruminate About DSM-5 and RDoC? The Importance of Targeting Negative Self-Referential Processing. Clinical Psychology: Science and Practice, 20(3), 258–267.
Mennin, D. S., Holoway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood pathology. Behavior Therapy, 38, 284–302.
Mennin, D. S., McLaughlin, K. A., & Flanagan, T. J. (2009). Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. Journal of Anxiety Disorders, 23, 866–871.
Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010a). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81.
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010b). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication-Adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.
Merikangas, K. R., Nakamura, B. A., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495.
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed/anxiety depressive symptoms. Journal of Abnormal Psychology, 109(3), 504–511.
Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187.
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116, 198–207.
Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6(6), 589–609.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.
Parker, G., Wilhelm, K., Mitchell, P., Austin, M. P., Roussos, J., & Gladstone, G. (1999). The influence of anxiety as a risk to early onset major depression. Journal of Affective Disorders, 52, 11–17.
Penza-Clyve, S., & Zeman, J. (2002). Initial validation of the emotion expression scale for children. Journal of Clinical Child and Adolescent Psychology, 31, 450–457.
Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38(6), 611–617.
Reinholt, N., & Krogh, J. (2014). Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: A systematic review and meta-analysis of published outcome studies. Cognitive Behaviour Therapy, 43(3), 171–184.
Reynolds, W. M. (1994). Assessment of depression in children and adolescents by self-report measures. In W. M. Reynolds & H. F. Johnston (Eds.), Handbook of depression in children and adolescents (pp. 209–234). New York: Plenum Press.
Silk, J. S., Steinberg, L., & Morris, A. S. (2003). Adolescents’ emotion regulation in daily life: Links to depressive symptoms and problem behavior. Child Development, 74, 1869–1880.
Sim, L., & Zeman, J. (2005). Emotion regulation factors as mediators between body dissatisfaction and bulimic symptoms in early adolescent girls. Journal of Early Adolescence, 25, 478–496.
Sim, L., & Zeman, J. (2006). The contribution of emotion regulation to body dissatisfaction and disordered eating in early adolescent girls. Journal of Youth and Adolescence, 35, 207–216.
Southam-Gerow, M. A., & Kendall, P. C. (2000). A preliminary study of the emotional understanding of youth referred for treatment of anxiety disorders. Journal of Clinical Child Psychology, 29, 319–327.
Spokas, M. M., Luterek, J. A., & Heimberg, R. G. (2009). Social anxiety and emotion suppression: The mediating role of beliefs. Journal of Behavior Therapy and Experimental Psychiatry, 40, 283–291.
Stein, M. B., & Chavira, D. A. (1998). Subtypes of social phobia and comorbidity with depression and other anxiety disorders. Journal of Affective Disorders, 50, 11–16.
Stein, M. B., Fuetsch, M., Müller, N., Höfler, M., Lieb, R., & Wittchen, H. (2001). Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry, 58, 251–256.
Steinberg, L., & Avenevoli, S. (2000). The role of context in the development of psychopathology: A conceptual framework and some speculative propositions. Child Development, 71, 66–74.
Steinberg, L., Dahl, R., Keating, D., Kupfer, D. J., Masten, A. S., & Pine, D. (2006). The study of developmental psychopathology in adolescence: Integrating affective neuroscience with the study of context. In D. Cicchetti & D. Cohen (Eds.), Handbook of developmental psychopathology (2nd ed., pp. 710–741). Hoboken, NJ: Wiley.
Steinberg, L., Graham, S., O’Brien, L., Woolard, J., Cauffman, E., & Banich, M. (2009). Age differences in future orientation and delay discounting. Child Development, 80, 28–44.
Stice, E., Shaw, H., Bohon, C., Marti, C. N., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77(3), 486.
Storch, E. A., Masia-Warner, C., Dent, H. C., Roberti, J. W., & Fisher, P. H. (2004). Psychometric evaluation of the Social Anxiety Scale for Adolescents and the Social Phobia and Anxiety Inventory for Children: Construct validity and normative data. Journal of Anxiety Disorders, 18, 665–679.
Suveg, C., & Zeman, J. (2004). Emotion regulation in children with anxiety disorders. Journal of Clinical Child and Adolescent Psychology, 33, 750–759.
Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. In N. A. Fox (Ed.), The development of emotion regulation and dysregulation: Biological and behavioral aspects. Monographs of the Society for Research in Child Development, 59 (2-3), 25-52.
Watkins, D. (1989). The role of confirmatory factor analysis in cross-cultural research. International Journal of Psychology, 24, 685–701.
Watkins, E. R. (2009). Depressive rumination and co-morbidity: Evidence for brooding as a transdiagnostic process. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 27(3), 160–175.
Watson, D., Clark, L. A., & Carey, G. (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97, 346–353.
Watson, D., Clark, L. A., Weber, K., Assenheimer, J. S., Strauss, M., & McCormick, R. A. (1995). Testing a tripartite model: Exploring the symptom structure of anxiety and depression in student, adult, and patient samples. Journal of Abnormal Psychology, 104, 15–25.
Weems, C. F., Hammond-Laurence, K., Silverman, W. K., & Ferguson, C. (1997). The relation between anxiety sensitivity and depression in children and adolescents referred for anxiety. Behaviour Research and Therapy, 35(10), 961–966.
Wells, A., & Carter, K. (2002). Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behavior Therapy, 32(1), 85–102.
Wittchen, H.-U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: Prevalence, risk factors and comorbidity. Psychological Medicine, 29, 309–323.
Zeman, J., Cassano, M., Perry-Parrish, C., & Stegall, S. (2006). Emotion regulation in children and adolescents. Journal of Developmental and Behavioral Pediatrics, 27, 155–168.
Zeman, J., Shipman, K., & Penza-Clyve, S. (2001). Development and initial validation of the children’s sadness management scale. Journal of Nonverbal Behavior, 25, 187–205.
Zeman, J., Shipman, K., & Suveg, C. (2002). Anger and sadness regulation: Predictions to internalizing and externalizing symptoms in children. Journal of Clinical Child and Adolescent Psychology, 31, 393–398.
This study was funded by Yale University.
Conflict of Interest
David Klemanski, Joshua Curtiss and Katie McLaughlin declare that they have no conflict of interest. Susan Nolen-Hoeksema (deceased) had no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Klemanski, D.H., Curtiss, J., McLaughlin, K.A. et al. Emotion Regulation and the Transdiagnostic Role of Repetitive Negative Thinking in Adolescents with Social Anxiety and Depression. Cogn Ther Res 41, 206–219 (2017). https://doi.org/10.1007/s10608-016-9817-6
- Repetitive negative thinking
- Emotion regulation
- Social anxiety
- Research Domain Criteria