Moltrecht, Bettina; (2020) The role of emotion regulation in the development, treatment, and prevention of youth psychopathology. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Past research has consistently highlighted the prominence of emotion regulation difficulties in the development, maintenance and treatment of psychopathology. However, especially for young people the evidence from longitudinal studies has been limited, partly due to a lack of appropriate measures and effective interventions. With respect to current prevalence rates of mental health problems in children and young people the present research aims to increase our understanding of the role of emotion regulation in the development, treatment and prevention of youth psychopathology. The first part of the thesis consists of two main studies, which adopted two different statistical approaches to investigate the complex relationship between emotion regulation and psychopathology over time. Both studies utilized data from the UK’s Millennium Cohort study, a national longitudinal study. Previous studies have not investigated the bi-directional effects between emotion dysregulation and psychopathology over childhood, as longitudinal studies were either under-powered or simply not available. Hence, the first study aimed to uncover the temporal dynamics between emotion regulation and psychopathology in childhood by conducting a developmental cascade model. The results of the cascade model demonstrated significant bidirectional effects between the two constructs over time. Subsequently, the second study investigated whether and how the two constructs overlap conceptually. A bi-factor analysis examined the level of distinctness and commonality between emotion regulation and psychopathology. The findings suggested a significant overlap between emotion dysregulation and psychopathological symptoms, thereby highlighting the potential of emotion regulation as a transdiagnostic intervention and prevention target. The second part investigated the possibility of targeting emotion regulation difficulties in youth by developing and evaluating a newly mobile app intervention in the school context. An integrated design and development framework is presented that guided the development of the new intervention. In this part, the first study, a systematic review and meta-analysis summarised the effectiveness of existing interventions to improve emotion regulation in youth, and how these changes link to changes in psychopathological symptoms. Furthermore, a series of classroom observations, participatory co-design workshops and prototype testing sessions was conducted, of which the results are presented and how they informed the design and development of the new mobile app intervention. The final study evaluated the usability and acceptability of the new digital intervention as part of an exploratory feasibility trail in primary schools. The results suggested adequate levels of acceptability and engagement from a user perspective. Areas for future improvements were identified. The findings of the school trial suggest that a digital intervention can be used to overcome common barriers that are associated with the implementation of more traditional school-based interventions, which have not been sufficiently adopted if they required too much teacher time or preparation. This is of significant importance, as schools are considered key players in providing mental health support for young people. This research contributes to the current understanding of the complex relationship between emotion regulation and psychopathological symptoms in youth. The employed analytical approaches support the notion that emotion dysregulation processes are a central component in the development of youth psychopathology. The findings highlight new opportunities for the assessment of complex constructs as well as the treatment and prevention of mental health problems through technology-based interventions.

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