Emotional Resilience Blog from The Fear Course

Largely there are three types of control that people use to cope with negative emotions: primary, secondary and disengagement control.
Primary control coping is based on changing and influencing our environment in order to cope. Choosing which friends to go out with based on who makes us feel good, problem solving to deal with the situation and engaging in emotion regulation techniques.
Secondary control is coping by adjusting ourselves to the environment, for example accepting the situation.
The third form of coping people engage in is to disengage completely or avoid the object or situation that is causing the negative emotion.

A study just published in Anxiety, Stress & Coping looked at the coping mechanisms of people who had previously been depressed and compared them with the coping mechanisms of people who have never been depressed
They found that people who had never had depression and who tend to use fewer primary coping skills in preference for avoidance coping strategies are significantly more likely to develop depression.
People, whether they had previously had depression or not, who develop secondary coping strategies, accepting the situation and their emotions (which is different to resignation), tend to see a decrease in their depressive symptoms.
They also discovered that people with greater levels of mental flexibility also tended to suffer from less depressive symptoms and recover more quickly from depression than people with less cognitive flexibility.

The researchers recommend that people at risk of depression should either be helped to develop emotion regulation strategies (primary control coping) or acceptance strategies (secondary control coping). Obviously learning both would be better, significantly reducing the risk of depression regardless of whether you have had it or not before.

Reference

Morris, M.C. et al (2014) Executive function moderates the relation between coping and depressive symptoms. Anxiety, Stress & Coping: An International Journal. 2014 June DOI: 10.1080/10615806.2014.925545

As reported in Thursdays blog, more and more evidence is being found that long term untreated anxiety is likely to turn into depression. The study quoted on thursday found that this was likely to happen to about 50% of the population of anxiety sufferers. Another study also published recently suggests that untreated long term anxiety is likely to turn into depression in up to 77% of cases.
It has also been found that those that develop depression following long term anxiety, tend to get more severe forms of depression compared to those who develop depression without first suffering bouts of anxiety.

These are sobering findings and really highlight the importance of dealing with anxiety in its early forms and of learning the tools and techniques of proper emotion regulation.

However a question arises as to what is causing the anxiety to turn into depression. Surprisingly only three studies have looked look at the potential causes of this phenomenon. The first research study from 1999 looked at whether specific negative life events or reassurance seeking behaviours could be what transforms anxiety into depression, however the researchers could not find the expected connections. The second study from 2009 looked at the hypothesis that a lack of problem solving skills or individuals with anxiety who perceive that they have little or no control over the things that happen to and around them might cause, in part at least, the anxiety to turn to depression. Like the 1999 study, this study was unable to find such a causal effect.

However a study published a few weeks ago does finally shed light on this transformation. The study by researchers at The Pennsylvania State University in the United States used a large scale sample between 1994 and 2008 in four waves of observation with between 6504 and 4834 people to try to find what might be one of the causes for depression with people suffering from anxiety.

A prominent feature of anxiety is avoidance or flight. If an individual is anxious about something, say meetings, or public speaking or flying for example, they will tend to avoid engaging in that activity as a method trying to regulate the anxiety. As members of the free course will know this is one of three primary responses to what is known as the 'fear of the fear' phenomenon.

The researchers tested the hypothesis that avoiding the anxiety inducing subject, e.g. flying, public speaking etc. was a factor in the onset of depression. If this hypothesis were to prove to be correct one would expect that the greater the level of avoidance the greater the chance the individual has of becoming depressed. Indeed this is exactly what the researchers found.
The more someone avoids the anxiety promoting stimulus the greater their chances of becoming depressed.

There is now a hunt ongoing to find why this might be the case.

Reference

N.C. Jacobson & M.G. Newman (2014) Avoidance mediates the relationship between anxiety and depression over a decade later. Journal of Anxiety Disorders. 28 (2014) 437-445.

A central question that has been argued over for years in the anxiety - depression field is, are anxiety and depression linked and importantly does can anxiety lead to depression?

A study published in the journal Psychological Medicine recently helps to answer this issue. The research by scientists at the Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago conducted a long term (12 years) analysis of the metal health of 425 women (278 Caucasian and 147 African American) women in america. The women were measured annually for symptoms of anxiety and depression to see if where any depression manifested itself, anxiety tended to be a precursor to the depression.

Firstly they found that women with anxiety were more likely to suffer from a major depressive disorder than those who did not suffer from anxiety in the first place. In fact they discovered that if you suffer from anxiety for a year you are almost 50% more likely to suffer from depression than people without anxiety. If you have already suffered from a bout of depression you are even more likely to suffer a recurring episode of depression.

The researchers recommend people with anxiety are closely monitored for signs of the onset of depression during the year. Obviously it would be better to treat the anxiety and reduce the chance of depression significantly.

Reference

Kravitz HM, Schott LL, Joffe H, Cyranowski JM, Bromberger JT (2014) Do anxiety symptoms predict major depressive disorder in midlife women? The Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS). Psychological Medicine [2014:1-10] DOI: 10.1017/S0033291714000075

A number of research studies have estimated that about 1 in 3 mothers of young children suffer from stress, anxiety and/or depression particularly during the first few years of motherhood. The question is does this have any effect on the children and if so what?

A series of studies have shown that that there is a connection between the stress, depression and anxiety levels of the mother and later life depression, stress and anxiety in the child. Other connections have been found with how well the children grow to learn how to regulate their own emotions. For example the greater the level of maternal stress, anxiety and depression during the first two to four years, the greater the chance the child will also have problems with regulating their own emotions as they grow up.

A new study about to be published next month in the academic journal Appetite, an international research journal specialising in the social science, psychology and neuroscience of food consumption, looked at the effects of the mother's level of anxiety, depression and stress on:

1. The mother's level of emotional eating, and
2. Whether the mother feeds the child in order to regulate the child's emotions.

The definition of emotional eating is eating for any reason other than just hunger.

There are broadly three feeding practices that parents tend to engage in with their children:

1. Nutritive feeding, which is giving the child food only when the child is hungry
2. Instrumental feeding, which is feeding a child as a reward, for example sweets for being good or doing something, and
3. Emotional feeding, which is when the parent feeds the child to pacify it when it is upset. An example of this would be when a child has hurt itself or has had a toy taken by another sibling and gets given chocolate to help calm it down as a kind of 'there there". Pleasure or feel good feeding, "I got you this because you like it" is also emotional feeding.

The study, conducted by scientists and practitioners at six universities and hospitals in the US, France and Australia, looked at the levels of stress, anxiety and depression in 3 mothers of children between one and a half and two and a half years old (the average age of the mothers in the study was 35), and examined the links with any emotional eating behaviours of the mothers, child- feeding practices, and lastly the child's own emotional eating habits.

This is important because other studies have found strong links between the use of consuming food to regulate emotions and both childhood and later life obesity, with all the health risks that entails. Additionally last week I reported on a study which found a link between being overweight and the level of anxiety a person experiences, and how losing weight can reduce anxiety levels as well as having a range of other health benefits.

The mothers were observed for whether or not they were using food as any kind of reward (called instrumental feeding) or when the child started to display unwanted emotions or behaviours (emotional feeding).

The first links the researchers found was that, as the mothers' anxiety, stress and/or depression increased so did their own emotional eating. They found exactly the same pattern with the children. As their anxiety or stress increased so did the level of emotional eating.

The question is how did the children learn to engage in emotional eating?

The researchers were able to separate out the factors and found a sequence of events that lead to the child self-medicating emotional issues with food.

They discovered that as the mothers' anxiety, stress and/or depression increased so did their tendency to engage in both instrumental and emotional eating themselves and as a consequence of this they then started engaging in non-nutritive feeding practices with their children.

In other words, when the mothers experienced stress, anxiety or depression, they tended to first engage in emotional eating themselves and then transfer this to their feeding behaviour towards the children. So it is much more likely that a mother would feed a child when she is feeling down or anxious rather than waiting until the child is hungry itself and as a result, the child then learns to use food as an emotion regulation strategy, rather than only eating when hungry.

As stated before, emotional eating tends to result in obesity which in turn increases a loss of self-worth and an increase in anxiety, which then leads to more emotional eating and so on.

Learning better and more healthy emotion regulation strategies than emotional eating is therefore essential to breaking this habit and the spiral that ensues.

Click here to learn how to regulate your emotions without engaging in emotional eating

Reference
Rachel F. Rodgers, Susan J. Paxton, Siân A. McLean, Karen J. Campbell, Eleanor H. Wertheim, Helen Skouteris, Kay Gibbons, Maternal Negative Affect is Associated with Emotional Feeding Practices and Emotional Eating in Young Children, Appetite (2014), http://dx.doi.org/doi:10.1016/j.appet.2014.05.022.

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Most parents try to provide a guiding hand as their children grow up with a mixture of control, support and encouragement. But as there isn't exactly a manual or formula for parenting it's often hard for parents to know what the best course of action is at times. As a father of five (4 girls and a boy) I often wondered whether we were being too hard, too soft,etc. However recent research is showing some interesting and more importantly useful ways forward.

One consistent question what is the ideal amount of control parents should exert over their children as they grow?

Now obviously that is going to depend on a lot of different things or variables. Things like how old the child is, how responsible the child is, what the situation or context is, what the attitude the parent has to the situation and their child for example.

An interesting study published this year in the Journal Parenting: Science and Practice looked at the effects of different levels of parental control on adolescents and in particular how parental control effects how well adjusted the adolescent is and how parental control might effect the childs' ability to regulate or control their own emotions.

The researchers, from five universities across the US and Canada* looked at the responses and outcomes of 206 adolescents (10 - 18 years old) and their parents in terms of reported levels of parental control (from both the adolescents and the parents), the levels of adolescent anger regulation, depression and aggressiveness.

The researchers found that the higher the level of parental control the lower the level of adjustment and flexibility the child was able to maintain. This was even more pronounced with adolescents who had emotion regulation problems to start with, which may be connected to the level of psychological control the parents exerted before the age of 10.

In effect the greater the level of psychological control parents exert on their children the less well adjusted they become. This is not however an argument for no control or laissez faire parenting. This also causes adjustment and emotion regulation problems.

References:

Barber, B. K. (1996). Parental psychological control: Revisiting a neglected construct.
Child Development, 67, 3296–3319. doi:10.2307/ 1131780

Barber, B. K., & Harmon, E. L. (2002). Violating the self: Parental psychological control of children and adoles-
cents. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents (pp.15–52). Washington, DC: American Psychological Association. doi:10.1037/10422-002

Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2003). Characteristics of resilient youths living in poverty: The role of self-regulatory processes.
Development and Psychopathology,15, 139–162. doi:10.1017/ S0954579403000087

Cui, L. teal (2014) Parental Psychological Control and Adolescent Adjustment: The Role of Adolescent Emotion Regulation. Parenting: Science and Practice. 14:1, 47-67, DOI:10.1080/15295192.2014.880018

Han, Z. R., & Shaffer, A. (2013). The relation of parental emotion dysregulation to children's psychopathology
symptoms: The moderating role of child emotion dysregulation. Child Psychiatry & Human Development, 44, 591–601. doi:10.1007/ s10578-012-0353-7

Kunz, J. H., & Grych, J. H. (2013). Parental psychological control and autonomy granting: Distinctions
and associations with child and family functioning. Parenting: Science and Practice, 13, 77–94. doi:10.1080/ 15295192.2012.709147

Pettit, G. S., & Laird, R. D. (2002). Psychological control and monitoring in early adolescent: The role of
parental involvement and earlier child adjustment. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents
(pp. 97–123). Washington, DC: American Psychological Association. doi:10.1037/10422-004

* Oklahoma State University, The University of Toronto, Oklahoma State University, Indiana University-Purdue University and The University of Pittsburgh

A study just released in the Journal of the American College of Cardiology looked at the connection between pre-operation anxiety levels in patients and how well those patients improved during the first year after the surgery.

The study by a group of cardiologists looked at the anxiety levels of patients just before they were to undergo heart surgery. They then tracked those patients for the first year of their recovery after the surgery to see if there was any impact of the anxiety levels on their quality of life during recovery. The study followed 720 patients who were operated on and measured their levels of anxiety just before the operation. They found that almost half (347 or 48%) of the patients had what could be described as high levels of anxiety just before the operation.

The researchers found that both the high and low anxiety groups had similar operation success rates, however the recovery of the high anxiety group was much slower and their quality of life had significantly poorer improvement outcomes.

This level of evidence should be a call to health providers and patients to ensure the patients are equipped to lower their levels of anxiety before surgery. occurs.

Reference

Mohanty, S. et al (2014) Baseline anxiety impacts improvement in quality of life in atrial fibrillation undergoing catheter albtion. J Am Coll Cardiol. 2014;63(12_S):. doi:10.1016/S0735-1097(14)60395-8