Mental health difficulties peak during adolescence, and the incidence of these difficulties among youth has increased, yet treatment effects have not improved accordingly. Because difficulties with emotions underlie most mental health difficulties, emotion regulation (ER) is a key target for prevention and intervention. Adolescents tend to rely on more maladaptive ER strategies and use fewer adaptive strategies compared to adults. Additionally, the habitual use of maladaptive strategies tends to be associated with more internalizing and externalizing symptoms. However, less is known about how adolescents regulate emotions in daily life, how automatic and deliberate emotional responses relate to individual symptoms, and whether ER strategies and broad-spectrum mental health difficulties are uniquely and reciprocally associated over time.
This thesis examines diverse aspects of ER and their associations with broad-spectrum mental health difficulties during adolescence. In Paper 1, using daily diaries, we investigated ER flexibility, and its links to affect and symptom outcomes. In Paper 2, we used network analysis to investigate how automatic and deliberate emotional responses are connected to individual symptoms from internalizing, externalizing, and thought problem domains. In Paper 3, we investigated reciprocal associations between five ER strategies (rumination, non-acceptance, reactive impulsivity, social support seeking, and problem-solving) and general psychopathology (i.e., the p factor) one year later in adolescence and again 13 years later in adulthood.
Several conclusions can be drawn from each paper individually and collectively. Firstly, in Paper 1, using more rumination, non-acceptance, and suppression over all other strategies in daily life was associated with more internalizing symptoms, more negative emotions, and fewer positive emotions. The number of strategies used was less important than which and how strategies were used. We found no significant evidence that prioritizing certain strategies over others predicted affect and symptoms. However, using strategies a lot on some days and very little or not at all on other days was associated with more externalizing symptoms and negative emotions, suggesting that adolescents may struggle to apply strategies flexibly and in contextually appropriate ways.
In Paper 2, we found that more automatic emotional responses, including maladaptive strategies, ER difficulties, and emotion-related impulsivity were most connected with symptoms across internalizing, externalizing, and thought problems. Limited access to ER strategies was most strongly linked to feelings of sadness or depression. Deliberate strategies were also connected to symptoms, with the strongest association showing that better adjustment to emotions (a sense of control over emotional responses) related to fewer feelings of not liking oneself. Impulsivity emerged as a central node with strong connections across emotional responses and symptoms. The internalizing symptom of feeling bad or not liking oneself emerged as a key transdiagnostic bridge. Adjusting to emotions had the most negative connections to other symptom domains and automatic emotional responses. Overall, the connections suggest that adolescents who struggle with automatic emotional responses, particularly impulsivity and limited access to strategies, are more vulnerable to diverse symptoms, whereas a stronger sense of emotional control appears to protect against key transdiagnostic difficulties.
In Paper 3, during adolescence, reactive impulsivity and general psychopathology were reciprocally associated. More than usual symptoms were associated with using more reactive impulsivity, rumination, and non-acceptance a year later, highlighting adolescence as a vulnerable period for both increased symptoms across domains and ER difficulties. From adolescence to adulthood, seeking social support and general psychopathology were reciprocally associated: adolescents who sought more social support than usual experienced fewer symptoms than usual in adulthood, whereas adolescents with more symptoms than usual tended to seek less support in adulthood. Overall, symptoms across domains increased risk for poorer ER across time, while social support seeking functioned as a long-term protective factor.
In conclusion, the overall thesis findings showcase that ER and mental health difficulties were consistently interlinked. Adolescents tended to rely on maladaptive and automatic emotional responses and showed limited flexibility in choosing or applying strategies, which were associated with poorer mental health in daily life, cross-sectionally, and across one year. The conclusions have important implications for intervention and prevention efforts. Helping adolescents develop greater flexibility in how they use ER strategies may reduce their reliance on maladaptive and automatic emotional responses, thereby protecting them from broad-spectrum mental health difficulties. In addition, ensuring that adolescents have access to social support represents an important protective factor as adolescents move into adulthood.