Risk and Resilience in Child and Adolescent Psychopathology: Processes of Stress, Coping, and Emotion Regulation Chapter 4 Bruce E. Compas and Charissa Andreotti TERMINOLOGICAL AND CONCEPTUAL ISSUES Risk and Resilience Risk: Refers to increased probability of a negative developmental outcome in a specified population (Kraemer et al., 1997, 2001). Risk factor: Is an agent or characteristic of the individual or the environment that is related to the increased probability of a negative outcome. Resilience: Does not merely imply a personality trait or an attribute of the individual; rather, it is intended to reflect a process of positive adaptation in the presence of risk that may be the result of individual factors, environmental factors, or the interplay of the two (Luthar, 2006; Luthar & Cicchetti, 2000). TERMINOLOGICAL AND CONCEPTUAL ISSUES Stress and Coping: Unifying Concepts for Understanding Risk and Resilience Stress: Environmental circumstances or conditions that threaten, challenge, exceed, or harm the psychological or biological capacities of the individual. • Transactional approaches: Suggest that the occurrence of stress is dependent on the degree to which individuals perceive environmental demands as threatening, challenging, or harmful (Lazarus & Folkman, 1984). • Environmental perspectives: Have emphasized the importance of objectively documenting the occurrence of environmental events and conditions independent of the potential confounds of cognitive appraisals (Cohen, Kessler, & Gordon, 1995). TERMINOLOGICAL AND CONCEPTUAL ISSUES Stress Findings: Stress is best conceptualized in terms of the occurrence of acute events or chronic conditions or circumstances (stressors) that threaten the physical or mental health of the child or adolescent (Grant et al., 2003). Exposure to stressful events and chronic adversity predict increases in both internalizing and externalizing symptoms over time (Grant et al., 2004). Exposure to stressful life events functions as a distal risk factor and is mediated by more proximal family characteristics, including disrupted parenting and parent-child relationships (Grant et al., 2003, 2006). Exposure to stressful events and chronic sources of adversity appears to operate as a nonspecific risk factor that places children and adolescents at risk for the full range of internalizing and externalizing forms of psychopathology (McMahon et al., 2003). NEW DIRECTIONS IN RESEARCH ON STRESS Coping Refers to the ongoing dynamic process that changes in response to the changing demands of a stressful encounter or event. Coping is a purposeful response that is directed toward resolving the stressful relationship between the self and the environment (problemfocused coping) or toward alleviating negative emotions that arise as a result of stress (emotion-focused coping). Three-factor control-based model of coping for children and adolescents: • Primary control engagement (problem solving, emotional modulation, emotional expression) • Secondary control engagement (acceptance, cognitive reappraisal, positive thinking, distraction) • Disengagement (cognitive and behavioral avoidance, denial, wishful thinking). (Compas et al., 2001, in press; Connor-Smith et al., 2000; Rudolph, Dennig, & Weisz, 1995) The ability to cope with stress is a potential source of resilience. NEW DIRECTIONS IN RESEARCH ON STRESS Integration of coping and emotion regulation Emotion: A person-environment interaction requiring attention that involves considerable personal significance and evokes a complex, continuously evolving response (Gross & Thompson, 2007) Primary emotions: Are direct responses to environmental stimuli and constitute a biological preparation for response (including anger, sadness, fear, happiness, disgust, surprise). Secondary emotions: Occur as a result of primary emotions (e.g., shame, pride). NEW DIRECTIONS IN RESEARCH ON STRESS Emotion Regulation: “The extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal feature, to accomplish one’s goals” (Thompson, 1994, pp. 27– 28). There are multiple facets of emotion-regulation that range from recognizing and understanding one’s emotions to taking steps to try to alter or modify their intensity and duration. New Directions in Research on Coping Differences and similarities between coping and emotion regulation: Coping typically refers to the down-regulation of a negative emotion while emotion regulation also includes the maintenance or augmentation of a positive emotion (Eisenberg, Fabes, & Guthrie, 1997). In the coping literature cognitive restructuring or efforts to actively reinterpret stressful or negative events in more neutral or positive terms overlaps with the cognitive reappraisal form of emotion regulation, reduction of physiological and emotional arousal when an individual is presented with an emotional stimulus. RISK AND RESILIENCE: EXAMPLES FROM RESEARCH ON STRESS, COPING, AND DEPRESSION Depression provides a useful example of risk and resilience because it increases dramatically in prevalence over the course of childhood and adolescence and research has identified stress as a significant source of risk, stress reactivity as a potential vulnerability factor, and coping as a source of resilience. RISK AND RESILIENCE: EXAMPLES FROM RESEARCH ON STRESS, COPING, AND DEPRESSION Risk processes Through risk processes, offspring of depressed parents are at increased risk for depression and other forms of psychopathology. Yet, even under the stressful circumstances of having a parent with depression, some or even most children are resilient and adapt successfully. Effects of parental depression on offspring are likely transmitted through: • • • • Heritability of depression Innate dysfunctional neuroregulatory mechanisms Exposure to negative maternal cognitions, behaviors, and affect The stressful context of the adolescent’s life RISK AND RESILIENCE: EXAMPLES FROM RESEARCH ON STRESS, COPING, AND DEPRESSION Coping and emotion regulation as sources of resilience in children of depressed parents. Coping may function as a mediator or moderator between parental depression and child psychopathology Coping and Stress Responses • Adolescents with depressed mothers had higher levels stress reactivity (e.g., emotional and physiological arousal, intrusive thoughts), lower levels of secondary control coping and higher externalizing behaviors (Jaser et al., 2008). Coping and Emotion Regulation • Studies suggest that processes of coping and emotion regulation may develop during childhood and carry over into adolescence (Forbes et al., 2006a, 2006b; Silk et al., 2006a, 2006b). RISK AND RESILIENCE: EXAMPLES FROM RESEARCH ON STRESS, COPING, AND DEPRESSION Prevention of psychopathology in children of depressed parents Family group cognitive-behavioral (FGCB) intervention (Compas, Forehand, & Keller, 2011; Compas, Langrock, Keller, Merchant, & Copeland, 2001). • A manualized 12-session program (8 weekly and 4 monthly follow-up sessions) that is designed to teach coping skills to families with a parent who has a history of a depressive disorder in a small family group format. • Designed to address the hypothesized mediators of the effects of parental depression on children: parental depressive symptoms and negative affect, stressful parent-child interactions, and children’s coping with these stressors. • Focus on secondary control coping strategies. RISK AND RESILIENCE: EXAMPLES FROM RESEARCH ON STRESS, COPING, AND DEPRESSION Results of the FGCB intervention: • Significantly lower levels of internalizing symptoms at 2-, 6-, 12-, and 18 months. • Significantly lower externalizing symptoms at 12-, 18-, and 24 months. • There was an effect on a specific youth self-report measures of depressive symptoms at 12 months and mixed anxiety-depression symptoms at 2-, 6-, 12-, and 18 months. • Effects on parents’ reports of their children symptoms were quite limited, with the only significant effect occurring for externalizing symptoms on the CBCL at 12-months. • A significant effect on children’s episodes of major depression as measured with diagnostic interviews with the parents and children. RISK AND RESILIENCE: EXAMPLES FROM RESEARCH ON STRESS, COPING, AND DEPRESSION Meditational Effects of the FGCB intervention: • No significant effects of the intervention were found on children’s primary control coping. • Significant effects on secondary control coping, and strong evidence was found for secondary control coping as a protective factor for both internalizing and externalizing symptoms. CONCLUSIONS Exposure to stress and adversity and the ways that individuals cope with stress are central to understanding sources of risk and resilience to psychopathology in children and adolescents. Stressful life events and chronic adversity, most notably poverty and chronic abuse during development are powerful, nonspecific predictors of internalizing and externalizing symptoms and disorders. Advances in research on children and adolescents at high risk for depression provides salient examples of risk and resilience processes in this population.