DISTINGUISHING BETWEEN PEDIATRIC ANXIETY AND DEPRESSION: THE EXPERIENCE OF ...

137 Pages·2014·2.19 MB·English

DISTINGUISHING BETWEEN PEDIATRIC ANXIETY AND DEPRESSION:
THE EXPERIENCE OF EMOTION AND EMOTION REGULATION
by
Stephanie Davis
B.A., Colgate University, 2004
M.S., University of Pittsburgh, 2009
Submitted to the Graduate Faculty of
the Kenneth P. Dietrich School of Arts and Sciences in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
University of Pittsburgh
2014
UNIVERSITY OF PITTSBURGH
THE KENNETH P. DIETRICH SCHOOL OF ARTS AND SCIENCES
This dissertation was presented
by
Stephanie Davis
It was defended on
July 7, 2014
and approved by
Susan B. Campbell, Ph.D., Professor, Department of Psychology
Laura J. Dietz, Ph.D., Assistant Professor, Department of Psychiatry
Kirk Erickson, Ph.D., Assistant Professor, Department of Psychology
Daniel S. Shaw, Ph.D., Professor, Department of Psychology
Dissertation Advisor: Jennifer S. Silk, Ph.D., Associate Professor, Department of Psychiatry
ii
Copyright © by Stephanie Davis
2014
iii
DISTINGUISHING BETWEEN PEDIATRIC ANXIETY AND DEPRESSION:
THE EXPERIENCE OF EMOTION AND EMOTION REGULATION
Stephanie Davis, Ph.D.
University of Pittsburgh, 2014
Anxiety and depression, two common disorders in childhood and adolescence, are highly
comorbid. However, while the majority of depressed youth have a past history or current
diagnosis of anxiety, only one third of anxious youth have experienced depression. To elucidate
the substantial, but incomplete overlap between these disorders, this study sought to determine
whether youth with clinical diagnoses of depression and anxiety could be differentiated based on
features of emotion and emotion regulation. To achieve this, this study utilized ecological
momentary assessment (EMA) data to examine youth’s experience of and response to negative
emotions in real-life. The sample included 165 nine to 14 year-olds: 27 with diagnoses of
depression (DEP), 76 with diagnoses of Generalized Anxiety Disorder (ANX), and 62 healthy
controls (CON). None of the participants in the ANX group had diagnoses of depression, while
37% of participants in the DEP group had secondary diagnoses of anxiety. Over a 5 day block,
participants received phone calls in which they were asked to identify recent events that elicited
negative emotions, provide ratings of negative emotions, and report on how they handled these
emotions. Hypotheses were tested using both categorical groups (DEP, ANX, CON) and
continuous indices of depressive and anxious symptoms to examine the contribution of
depressive symptoms above and beyond anxious symptoms (and vice versa). Using either
approach, findings indicated that depression was uniquely linked with greater peak sadness and
higher levels of rumination, while anxiety was uniquely related to greater peak nervousness and
iv
higher levels of worry. While more tenuous, findings supported aspects of emotion regulation as
shared features (e.g., higher rumination, lower effortful control, greater mean intensity of worry).
In sum, this study lends support to anxiety and depression being different manifestations of
similar underlying phenomena with respect to how youth experience and respond to negative
emotions.
v
TABLE OF CONTENTS
LIST OF TABLES......................................................................................................................XI
1.0 INTRODUCTION........................................................................................................1
1.1 DEVELOPMENTAL CONSIDERATIONS.....................................................4
1.2 SIGNIFICANCE OF THE CURRENT PROJECT.........................................5
1.3 DEFINING KEY TERMS:EMOTION AND EMOTION REGULATION..7
1.4 EMOTION AND EMOTION REGULATION AS A MEANS OF
UNDERSTANDING THE RELATIONSHIP BETWEEN ANXIETY AND
DEPRESSION.......................................................................................................................8
1.5 A THEORETICAL PERSPECTIVE...............................................................11
1.6 EXPERIENCES OF EMOTIONALITY THAT MAY BE UNIQUE TO
DEPRESSION.....................................................................................................................14
1.6.1 Global emotionality: Positive affect.............................................................14
1.6.2 Discrete emotions: Sadness...........................................................................15
1.6.3 Context of negative emotions........................................................................15
1.7 EXPERIENCES OF EMOTIONALITY THAT MAY BE UNIQUE TO
ANXIETY............................................................................................................................16
1.7.1 Global emotionality: Physiological hyperarousal.......................................16
1.7.2 Discrete emotions: Fear/Nervousness..........................................................17
vi
1.7.3 Context of negative emotions........................................................................18
1.8 EXPERIENCES OF EMOTIONALITY LIKELY COMMON TO BOTH
ANXIETY AND DEPRESSION.......................................................................................18
1.8.1 Global emotionality: Negative affect............................................................18
1.8.2 Discrete emotions: Anger/Irritability..........................................................19
1.8.3 Context of negative emotions........................................................................20
1.9 EMOTION REGULATION.............................................................................21
1.9.1 Effortful control.............................................................................................21
1.10 EMOTION REGULATION STRATEGIES...................................................23
1.11 EMOTION REGULATION STRATEGIES LINKED TO DEPRESSION 23
1.11.1 Rumination.....................................................................................................23
1.12 EMOTION REGULATION STRATEGIES LINKED TO ANXIETY........25
1.12.1 Worry..............................................................................................................25
1.12.2 Avoidance.......................................................................................................26
1.13 EMOTION REGULATION STRATEGIES COMMON TO ANXIETY
AND DEPRESSION...........................................................................................................28
1.14 GAPS IN THE LITERATURE........................................................................29
1.15 THE CURRENT STUDY..................................................................................30
1.16 HYPOTHESES..................................................................................................32
2.0 METHOD...................................................................................................................36
2.1 PARTICIPANTS...............................................................................................36
2.2 RECRUITMENT...............................................................................................37
2.3 PROCEDURE....................................................................................................38
vii
2.4 MEASURES.......................................................................................................39
2.4.1 Diagnostic group............................................................................................41
2.4.2 Continuous measure of symptoms...............................................................41
2.4.3 Global and discrete emotions........................................................................42
2.4.4 Context of negative emotions........................................................................43
2.4.5 Emotion regulation........................................................................................44
2.4.6 Covariates.......................................................................................................45
3.0 DATA ANALYTIC PLAN........................................................................................46
4.0 RESULTS...................................................................................................................48
4.1 DESCRIPTIVE STATISTICS.........................................................................48
4.2 PRELIMINARY ANALYSES OF EMA DATA.............................................52
4.3 ASPECTS OF EMOTIONALITY AND EMOTION REGULATION
HYPOTHESIZED TO BE UNIQUE TO DEPRESSION...............................................53
4.3.1 Global emotionality: Positive affect.............................................................53
4.3.2 Discrete emotions: Sadness...........................................................................56
4.3.3 Context of negative emotions: Boredom, loneliness, and loss....................59
4.3.4 Emotion regulation strategies: Rumination................................................64
4.4 ASPECTS OF EMOTIONALITY AND EMOTION REGULATION
HYPOTHESIZED TO BE UNIQUE TO ANXIETY......................................................70
4.4.1 Global emotionality: Physiological hyperarousal.......................................70
4.4.2 Discrete emotions: Nervousness...................................................................70
4.4.3 Context of negative emotions: Health, pain, fear, world events, and
time…..........................................................................................................................71
viii
4.4.4 Emotion regulation strategies: Worry.........................................................71
4.4.5 Emotion regulation strategies: Avoidance. .................................................75
4.5 ASPECTS OF EMOTION AND EMOTION REGULATION
HYPOTHESIZED TO BE COMMON............................................................................76
4.5.1 Global emotionality: Negative affect............................................................76
4.5.2 Discrete emotions: Anger..............................................................................76
4.5.3 Context of negative emotions: School, peers, and family...........................77
4.5.4 Emotion regulation: Effortful control.........................................................78
4.5.5 Emotion regulation strategies: Acceptance, distraction, problem-solving,
and cognitive restructuring.......................................................................................79
4.6 DEVELOPMENTAL FINDINGS....................................................................79
5.0 DISCUSSION.............................................................................................................81
5.1 EXPERIENCES OF EMOTIONALITY AND EMOTION REGULATION
UNIQUE TO DEPRESSION.............................................................................................85
5.2 EXPERIENCES OF EMOTIONALITY AND EMOTION REGULATION
UNIQUE TO ANXIETY....................................................................................................87
5.3 EXPERIENCES OF EMOTIONALITY AND EMOTION REGULATION
COMMON TO DEPRESSION AND ANXIETY............................................................89
5.4 HYPOTHESES THAT WERE NOT SUPPORTED......................................91
5.5 DEVELOPMENTAL CONSIDERATIONS...................................................94
5.6 LIMITATIONS..................................................................................................95
5.7 OVERALL CONCLUSIONS REGARDING UNIQUE VERSUS SHARED
ASPECTS OF EMOTIONALITY AND EMOTION REGULATION.........................97
ix
5.8 FUTURE DIRECTIONS...................................................................................98
5.9 CLINICAL IMPLICATIONS..........................................................................99
5.10 RECOMMENDATIONS FORNEXT STEPS..............................................102
APPENDIX A............................................................................................................................103
APPENDIX B............................................................................................................................105
BIBLIOGRAPHY.....................................................................................................................106
x