A multi-method assessment of emotional processes predicting longitudinal anxiety symptom trajectories in an adolescent clinical sample.

Objective: Emotion recognition, reactivity, and regulation are important in the development and maintenance of anxiety disorders. Whether and how these processes differentiate between different trajectories in anxiety remain unclear. The current study examined emotional processes as prospective predictors of anxiety symptom trajectories in psychiatrically hospitalized youth.

Method: Participants were 180 adolescents ( = 14.89; = 1.35) from a psychiatric inpatient unit. At index hospitalization, participants completed a behavioral task assessing facial emotion recognition, and self-report measures of emotion dysregulation and reactivity. They completed a self-report measure on anxiety symptoms at baseline and 3, 6, 12, and 18 months post-discharge. Latent growth curve analysis was conducted to identify subgroups of individuals based upon their trajectory of anxiety symptoms across 18-months. ANOVAs were used to examine subgroup differences in emotional processing variables.

Results: Three distinct trajectories were identified, a stable moderate-to-high anxiety group, a group with moderate-to-high anxiety at baseline with symptom improvement over time, and a group characterized by relatively stable low-to-moderate anxiety throughout the study. The two initially moderate-to-high anxiety groups scored higher for emotion dysregulation and emotion reactivity at baseline compared to the low-to-moderate anxiety group. Emotion regulation difficulties relating to emotional non-acceptance were higher for the stable moderate-to-high anxiety group than for the moderate-to-high anxiety group that experience symptom improvement over time.

Conclusions: These findings may have clinical implications for discharge planning. Future studies should explore emotion regulation with a focus on non-acceptance of one's emotional experiences as a potential target of intervention in individuals with elevated anxiety.