Emotion Coaching and Emotion
Regulation as Protective Factors
for Children with Oppositional
Defiant Disorder
Julie C. Dunsmore
Department of Psychology
Virginia Tech
in collaboration with
Thomas H. Ollendick
Psychosocial Treatment of ODD:
A Randomized Clinical Trial (R01 MH59308)
• Compare Parent Management Training (PMT) to
Collaborative Problem Solving (CPS) and Wait-List
Control (WLC) in the treatment of children and
adolescents with ODD.
• Study conducted in Virginia with 150 families (60 each
treatment condition; 30 waitlist control condition)
• Examine mediators and moderators of treatment
outcome
• Explore the role of caregivers in onset and maintenance
of ODD and their contributions to treatment outcome
Inclusion/Exclusion Criteria
Inclusion Criteria
•
•
•
•
•
Diagnosis of ODD according to DSM-IV
Severity of ODD of at least 4 on a 0-8 scale
Age 7-14 years
Duration of ODD at least 6 months
Accept random assignment to study conditions
• Exclusion Criteria
•
•
•
•
Primary major depression, but only if suicide intent
Drug or alcohol abuse, chronic
Psychotic symptoms/childhood schizophrenia
Developmental disorder (e.g., ASD)
Current Status of Project Enrollment
• 90 families enrolled to date; all youth have ODD
• 56 boys, 34 girls; average age = 9.58 years
• 56 of 90 (62.2%) families are two-parent
families; income is highly variable
• 75 Caucasian, 8 African American, 4 Hispanic, 2
Asian American, 1 other
• Approximately 55% are comorbid with ADHD
and about 45% with an Anxiety Disorder; over
90% are comorbid with at least one other disorder
What is Oppositional Defiant Disorder?
• Often loses temper
• Often argues with adults
• Often defies or refuses to comply with adult
requests
• Often deliberately annoys people
• Often blames others for own mistakes
• Often touchy or easily annoyed by others
• Often angry and resentful
• Often spiteful or vindictive
Assessments
• Diagnostic Screening Interview
• Anxiety Disorders Interview Schedule
• Diagnostic Interview Schedule for Children
• Independent Assessor Rating
• Severity of ODD and other disorders (0-8)
• Children’s Global Assessment Scale (1 – 100)
• Self-Report: Beck Youth Inventory, Disruptive Behavior
Disorders Rating Scale, Behavioral Assessment System
for Children (parent, teacher, self), Emotion Regulation
Checklist (parent)
• Laboratory-Based Measures: Problem Solving Task,
Tangram Task, Stroop, Emotion Coaching Task
Emotion Regulation
• Increasing or decreasing experience of emotions; coping
• Expressing emotions in socially appropriate ways
• Concurrently and longitudinally associated with more
adaptive socio-emotional outcomes
• Sample items from the Emotion Regulation Checklist:
• Responds positively to neutral or friendly overtures by adults
• Can say when s/he is feeling sad, angry or mad, fearful or
afraid
• Displays appropriate negative emotion (for example, anger,
fear, frustration, distress) in response to hostile, aggressive, or
intrusive acts by peers
Blandon et al., 2010; Cole, Michel, & Teti, 1998; Graziano et al., 2007; Gross, 2006; Miller et al., 2006;
Saarni, 1990; Shields & Cicchetti, 1999; Trentacosta & Izard, 2007
Emotion Lability/Negativity
•
•
•
•
Sensitivity to affective environmental cues
Rapidity in responding to emotion-eliciting stimuli
Difficulty recovering from emotional reactions
Concurrently associated with social anxiety, depression,
and antisocial behaviors
• Sample items from the Emotion Regulation Checklist:
• Exhibits wide mood swings (for example, the child’s emotional
state is difficult to anticipate because s/he moves quickly from
very positive to very negative emotional states)
• Is prone to disruptive outbursts of energy and exuberance
• Responds angrily to limit-setting by adults
Barrett, 1998, 2006; Bierman, 2004; Dodge, 1986, 2003; Eisenberg et al., 1995; Gross, 2002; Hanish et al., 2004;
Pietromonaco & Barrett, 2009 ; Shields & Cicchetti, 1997, 1998, 1999; Silk, Steinberg, & Morris, 2003
Elements of Emotion Coaching
• Parents’ awareness of their own emotions
• Parents’ acceptance and expression of their own
emotions
• Parents’ awareness of their child’s emotions
• Parents’ acceptance of their child’s emotions
• Parents’ active coaching of their child’s emotions
•
•
•
•
Labelling and discussing emotions
Respecting the child’s experience
Teaching appropriate rules for emotional expression
Teaching coping strategies for dealing with emotion-eliciting
situations and with emotions themselves
Gottman, Katz, & Hooven, 1997; Katz & Gottman, 1997; Katz & Hunter, 2007; Katz & Windecker-Nelson, 2004
What Emotion Coaching is NOT:
• Parenting style (authoritative, authoritarian,
permissive)
• Parental warmth
• Positive parenting
Emotion Coaching Outcomes
• Concurrently associated with:
• Positive social behavior
• Less internalizing symptoms
• Less behavior problems
• Longitudinally associated with resiliency to marital
dissolution (less behavior and peer problems, better
school achievement)
• Concurrent and longitudinal evidence for indirect
influence on child outcomes through emotion regulation
Cunningham et al., 2009; Gottman et al., 1996, 1997; Katz & Gottman, 1997; Katz & Hunter, 2007;
Katz & Windecker-Nelson, 2006; Lagacé-Seguin & d’Entremont, 2006 ; Ramsden & Hubbard, 2002;
Shipman et al., 2007 ; Stocker, Richmond, Rhoades & Kiang, 2007
Measurement of Emotion Coaching
• Meta-Emotion Interview (Gottman et al., 1997)
• Family Narrative Task (Lunkenheimer, et al., 2007)
• Our composite:
• Parents’ Beliefs about Children’s Emotions questionnaire
(Halberstadt et al., 2008)
• Value of positive emotions (“It is important for children to be able to show
when they are happy”)
• Value of negative emotions (“It is useful for children to be angry sometimes”)
• Parents’ role in guiding children’s emotions (“It’s a parent’s job to teach their
children how to handle their emotions”)
• Emotion Coaching Task
• 9 minute conversation about 3 family events: fun, upset (sad, mad,
afraid), and last Sunday
• Coded for encouragement of child’s positive and negative emotions
Coding of Emotion Coaching Task
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•
•
•
0 = no encouragement (does not respond or discourages)
1 = acknowledges the facts or discusses the event
2 = acknowledges the emotion
3 = coaching
•
•
•
•
•
talking about causes and consequences
helps the child to verbally label the emotions in their response
seeks intimacy or teaching opportunity about the emotion
verbally empathizes with or validates the emotion
helps the child to problem-solve
Jordan Booker, M.S.
coding team leader
Emotion Regulation, Lability, and
Emotion Coaching at Pre-Treatment
•
•
•
•
73 mother-child dyads (25 daughters, 48 sons)
Emotion coaching composite
Emotion regulation checklist
Child outcomes:
• Externalizing symptoms (mother report, BASC; child
report of disruptive behavior, Beck)
• Internalizing symptoms (mother & child report,
BASC)
• Adjustment (mother report of adaptive skills, BASC;
child report of personal adjustment, BASC; CSR)
Correlations
Emot. Lab.
Reg.
Ext.
(M)
Int.
(M)
Adj.
(M)
Ext.
(C)
Emot. .29*
Coach
-.08
-.10
-.17
.18
Emot.
Reg.
-.13
-.01
-.10
.34** -.02
Lab.
---
---
-.28*
.50*** .43*** -.34** .07
Note. †p < .10, *p < .05, **p < .01, ***p < .001
Int.
(C)
-.02
Adj.
(C)
-.01
CSR
-.31*
.44*** -.24*
.00
.14
.34†
.08
Externalizing Symptoms (Mother report)
100
95
90
85
80
75
low in emotion lability
70
65
high in emotion lability
60
55
50
45
low in emotion
coaching (-1 SD)
high in emotion
coaching (+1 SD)
Disruptive Behavior (Child report)
80
75
70
65
60
low in emotion lability
55
high in emotion lability
50
45
40
35
low in emotion
coaching (-1 SD)
high in emotion
coaching (+1 SD)
ODD Clinician Severity Report
8
7.5
7
6.5
low in emotion lability
6
high in emotion
lability
5.5
5
4.5
4
low in emotion
coaching (-1 SD)
high in emotion
coaching (+1 SD)
Emotion Regulation, Lability, and
Emotion Coaching at Post-Treatment
• 36 mother-child dyads (11 daughters, 25 sons)
• Mid-treatment and post-treatment emotion regulation
and lability
• Post-treatment:
• ODD Clinician Severity Ratings
• Mother report of disruptive behavior on DBDRS
• Mother report of child adjustment on BASC
• Were PMT and CPS effective?
• Second, did associations of emotion regulation, lability,
and emotion coaching with child outcomes vary
according to treatment (PMT vs CPS)? (no)
ODD Clinician Severity Ratings
8
7
6.17
6
5.90
6.00
5.68
5
PMT
4
3.68
CPS
3.57
Wait
3
2
1
0
Pre
Post
DBDRS ODD Symptom Totals (Parent Report)
8
7
6
5
5.82
5.63
5.91
5.47
PMT
4
CPS
3
2.88
2.54
2
1
0
Pre
Post
Wait
Emotion Regulation, Lability, and
Emotion Coaching at Post-Treatment
• Were PMT and CPS effective? (yes)
• Did associations of emotion regulation, lability, and
emotion coaching with child outcomes vary according to
treatment (PMT vs CPS)? (no)
• How did emotion regulation, lability, and emotion
coaching relate to child post-treatment outcomes?
Mediation:
Coaching  Regulation  Adjustment
β = .42*
Pre-treatment
emotion
coaching
Mid-treatment
emotion
regulation
β = -.10
β = .44**
Post-treatment
adjustment
(mother report)
Bootstrap results for indirect effect of coaching on adjustment:
M = .45, SE = .25, 95% confidence interval = .08 – 1.06
Moderation: Coaching X Lability
DBDRS (mother report)
2
1.9
1.8
1.7
1.6
mothers low in emotion
coaching
mothers high in
emotion coaching
1.5
1.4
1.3
1.2
1.1
1
children low in lability
children high in
lability
Moderation: Coaching X Lability
Change in Clinician Severity Ratings
8
7
6
5
mothers low in emotion
coaching
mothers high in
emotion coaching
4
3
2
1
0
children low in lability children high in lability
Where to go from here?
Alice: “Would you tell me, please, which way I ought
to go from here?”
Cheshire Cat: “That depends a good deal on where
you want to get to.”
Alice’s Adventures in Wonderland
Mediators, Moderators, and Predictors
of Treatment Outcome
• Mediators of Treatment Outcome: A variable that occurs
during the period of treatment, signifying a process
through which treatment “works.” Mediator variables
can help explain how and why the treatment works.
• Moderators of Treatment Outcome: A variable that is
measured prior to the treatment assignment and
implementation of the treatment that differentially
predicts treatment outcomes. Moderator variables can
identify subgroups of individuals for whom a specific
treatment is more or less effective.
Augmented PMT
• Enhancing PMT by including emotion coaching
activities for the parents and emotion regulation skill
development for the children
• Continued exploration of moderators and mediators of
change, with special emphasis on mechanisms of change
including both an examination of emotion coaching and
emotion regulation processes throughout the treatment
protocol
With Special Thanks
Scott Anderson, Kristin Austin, Kristine Bannister, Kristy Benoit,
Jordan Booker, Stephen Brown, Lisa Buonomano, Kristin
Canavera, Natalie Costa, Maria Cowart, Karla Delgado, Kimberly
Dunbeck, Maria Fraire, Stephanie Giunta, Thora Halldorsdottir,
Michelle Hendrickson, Shelmeshia Hill, Matthew Jarrett, Krystal
Lewis, Molly Madden, Emily McWhinney, Ryoichi Noguchi, Erin
Pennington, Jennifer Poon, Natoshia Raishevich, Megan Ransone,
Maggie Schwab, Jasmine Williams and Ross Greene!
With additional thanks to our sponsors: National Institute of
Mental Health and the Institute for Society, Culture and
Environment
Blue Ridge Mountains – Virginia