Motivation and emotion/Book/2024/Adverse childhood experiences and emotion regulation

Adverse childhood experiences and emotion regulation:
What is the relationship between ACEs and emotion regulation?

Overview

Case study

Mason grew up in a home where the mood was unpredictable. He can recall several instances where he was exposed to physical violence between his parents. There were long periods of time where Mason was left to fend for himself as, without warning, his parents could become distant or angry, which made Mason tip-toe around them, afraid to approach them not knowing if he would catch them on a good or a bad day. As Mason got older, he became withdrawn from his peers, afraid to disappoint those around him, and found it challenging to cope with frequent and overwhelming feelings of anger, sadness, and feeling on edge.

How do you think Mason's upbringing influenced his emotional development? Do you think Mason is struggling to regulate his emotions as a result of his experiences? How might these early experiences shape his ability to form trusting relationships in the future?

This case study is not a unique scenario. Many children experience adverse events such as abuse, neglect and exposure to domestic violence, which may have lasting impacts on their emotional development. According to 2024 UNICEF estimates, nearly 400 million children under the age of 5 or 6 in 10 children within that age group globally, endure psychological aggression or physical abuse at home on a regular basis. Adverse Childhood experiences are also linked to a range of negative outcomes in adulthood, including mental health disorders, substance abuse, and relationship challenges. Understanding the impact of ACEs on emotion/emotional regulation is important as it aids in preventing long-term psychological issues that can stem from significant adversity in childhood, and it can aid in developing effective interventions.

Through vast and abundant research spanning over half a century, there have been valuable insights into how ACEs influence emotional regulation [Use internal link style as shown in Tutorial 2], and how interventions can mitigate the effects of childhood adversity. This chapter explores the relationship between ACEs and emotional regulation, addressing the following focus questions.

[Use numbered list as shown in Tutorial 2] 1. How are ACEs and Emotion Regulation defined?

2. What is the relationship between ACEs and Emotion Regulation?

3. How do theoretical perspectives explain the role of ACEs on emotion regulation?

4. How can interventions help mitigate the effects of ACEs on emotional regulation?

Defining and clarifying the relationships between the constructs

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What is an adverse childhood experience?

According to Harvard's Center of the Developing Child, the term ACEs serves as an acronym for Adverse Childhood Experiences, originating from a study conducted in 1995 by the Centres for Disease Control and the Kaiser Permanent[spelling?] health care organisation in California. Kaiser (1998) suggested the presence of three forms of childhood adversity, including physical and emotional abuse, neglect, and household dysfunction, but can extend to experiences beyond the household, such as adverse social or school experiences such as bullying.

What is emotion/emotional regulation?

The American Psychological Association defines emotional regulation as the ability to modulate an emotion or set of emotions, using explicit mechanisms such as learning to construe situations differently in order to manage them better, and to change the target of an emotion to produce a more positive outcome, while recognising how different responses can be used in the service of a given emotional state[improve clarity]. Implicit mechanisms occur without deliberate monitoring, which involve modulating the intensity or duration of an emotional response without the need for awareness. Emotional regulation typically increases across the lifespan (American Psychological Association, 2018).

What is the relationship between ACEs and Emotion Regulation?

There is an wealth of research providing empirical support to suggest that ACEs to have a directional impact on emotion regulation. For instance, according to Snyder, et al (2024) and Ye et al (2024), difficulties with emotion regulation are well-documented reactions to early ACEs, as a multitude of studies have reported ACEs to have detrimental effects on emotion regulation[improve clarity]. Studies including Chefetz (2015), Hughes et al (2017) and Poole et al (2018), have indicated a greater occurence[spelling?] of ACEs as being associated with difficulties in the regulation of emotion, as well as structural alterations in personality, interpersonal difficulties in adulthood, insecure attachment styles, and mental illness. These contributions, along with many others have emphasised the developmental importance of childhood experience on later functioning, substantiating the need to further explore the roles of ACEs on psychological functioning. However, establishing causality is challenging, as without the consideration of other factors, such as temperament, genetics, study design and other environmental influences and contextual factors, the impact of ACEs alone is difficult to observe.

Theoretical approaches to understanding the relationship between ACEs and emotional regulation

Theoretical frameworks, particularly those established over time, can provide valuable insights into how ACEs contribute to emotional challenges. Well renowned theories such as the Attachment Theory, The Social Learning Theory, the Family Systems Theory and the Polyvagal Theory in particular, offer critical perspectives into how ACEs can impair or disrupt emotional regulation.

Attachment Theory

The Attachment theory, developed by John Bowlby from the 1950s through to the 1970s, has become a useful contemporary framework for understanding emotional development and regulation. It highlights the importance of interpersonal experiences as a source of individual differences in psychological resilience, emotion regulation, and adjustment as the result of child to caregiver relationships (Mikulincer et al 2006). An abundance of research dating back decades, suggests that attachment orientations and early relationship contexts can have a variety of implications and hypothesised links with emotional regulation, health, and the ability to form and maintain relationships (see figure 2 for the Attachment Theory two dimensional model).

Also central to

Bowlby's theory (1969, 1973), is the idea that early caregivers play an important role in the ways the child organises emotional experience and acquires methods to regulate feelings of security. According to Bowlby, the goal to maintain a sense of security is universal, however strategies used to achieve it can vary with their attachment history. For example, when the caregiver is available and responsive to the child's distress signals, the child begins to understand that they can regulate distressing emotions and experiences (Cooper, 1998).

Under unpleasant circumstances, or in ACEs however, children can learn to associate the experience of distress with negative outcomes, and acquire the perception that distressing emotions cannot be efficiently regulated. Kobak and Sceery (1988) produced a concise summary of attachment theory's account of individual differences in emotion regulation: stating that, secure individuals are able to acknowledge and manage negative emotions, avoidant individuals try not to acknowledge negative emotions (see figure 3) and without fully acknowledging the reasons, can respond emotionally, and anxious individuals are highly emotionally expressive, and are sometimes unable to regulate their emotions or respond according to personal interests or social norms. The consequences of each attachment style vary, for instance, insecure attachment with lower self-esteem and less self-confidence[grammar?].

According to Mikulincer & Shaver (2019), attachment-related individual differences in emotion regulation have been documented in behavioural and neuroscience studies, providing strong empirical support for Bowlby's attachment theory and its extending impacts on adult dispositions and relationships. For example, two major findings suggested that those with avoidant attachments can be fragile and prone to collapse under stress, and that attachment insecurities (anxiety and avoidance) are associated with deficits in neural structure associated with emotion regulation[factual?].

Social Learning Theory

The Social Learning Theory can provide valuable insights into the relationship between ACEs and emotion regulation. According to Bandura's 1977 publication on the Social Learning Theory, new patterns of behaviour are acquired through direct experience or by observing the behaviour of others. This form of learning can be governed by rewards and punishments that follow any given consequence. It is commonly believed that these responses are automatically and unconsciously strengthened by their immediate consequences. Through modelling behaviour, children can learn emotional responses and coping strategies by observing the behaviours of caregivers and peers, for example by witnessing unhealthy emotional regulation such as aggression in response the stress, they may imitate these behaviours. Regulating emotions in maladaptive ways can also be the result of social contexts, such as neglect of violence, where there is no positive role model for emotional regulation. Bandura's concept of self-efficacy can also play a role, where children who experience ACEs, may develop low self-efficacy in regards to their ability to manage emotions (Bandura, 1977).

According to Delaney (2006), maltreated children often display significant dysregulation in regards to their experience and expression of emotions, partially due to their reduced capacity to recognise social cues and emotional expression[Provide more detail].

Family Systems Theory

Family Systems Theory (Minuchin, 1974) ties [missing something?] closely with the Social Learning Theory, as it recognises the importance of familial relationships as key components, or subsystems of a complex and multifaceted family system. Kramer (2014) and Whitemen et al (2011) suggested that sibling relationships provide important contexts for the development of children’s emotional understanding, particularly when it comes to learning and decoding others' emotions, anticipating the emotional responses of others, and the use of emotional understanding to build or impede relationships and influence the behaviours of others. Sibling interactions can enable children to learn how to label specific feelings, when it is appropriate to display these feelings, and how to detect them in others, which raises questions about the emotional development of those who did not grow up with siblings, learning emotional understanding through caregivers solely.[factual?]

Polyvagal Theory

(Porges & Buczynski, 2011) suggested the Polyvagal Theory of trauma, to be unique from other ways of understanding how the body responds to life threatening or stressful situations. It emphasises that the nervous system has multiple defence strategies, and will involuntarily respond is one of two ways, a mobilised flight or flight or an immobilised shut down defence strategy.

According to a systematic review (Balzarotti et al, 2017) on 135 applications of the Polyvagal Theory on emotional regulation in adulthood, trauma survivors can become stuck in the mobilised or immobilised state, as initial responses to threats might involve fighting back, hiding, fleeing, or shutting down (see figure 3). The ability to regulate the nervous system can become impaired, and opportunities for connection can be replaced with patterns of protection, programmed for threat and danger instead of safety and connection, making it difficult to build trust and feel safe.

Case Study Update:

Using the knowledge you have gained, how might you explain Mason's struggles with his emotions and coping mechanisms? Critically reflect on the theories discussed, and think about the types of treatment styles that Mason could benefit from in the long term.

Interventions and treatment approaches

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Trauma-informed care and community level strategies

According to Blodgett (2013), 25-35% of the population is affected by ACEs, calling for a multifactorial, public health approach consisting of trauma informed care, identification of at-risk individuals, and tailored strategies to accommodate for local circumstances in effort to prevent and mitigate the impacts of ACEs. Additionally, Hernandez (2020) highlighted the utility in implementing trauma informed care principles across community initiatives in addressing the broader impacts of ACEs.

Mindfulness for enhancing emotional awareness and regulation

Techniques for enhancing emotional awareness and control such as mindfulness, meditation and expressing writing have show significant promise in helping those with a history of ACEs observe their thoughts and feelings without judgement, and in improving outcomes (Korotana et al., 2016; Di Lemma et al., 2019). Some suggested benefits by Korotana et al (2016) include:

Increased awareness: enhance ability to recognise emotion patterns and triggers.
Improved control: lowered reactivity and impulsive behaviours, leading to more thoughtful emotional responses (Arbel et al., 2018; Soares et al., 2021).

Arbel et al (2018) found that ACEs correlated with higher daily worry levels in adolescents, suggesting that early interventions to target worry reduction and emotional regulation could be beneficial for high ACE youth. Similarly, Korotana et al (2016) advocated for mindfulness-based interventions to support emotional regulation among adults with a history of ACEs.

Resilience building in cognitive behavioural therapy

Several studies have emphasised the significance of resilience building as a protective factor against the adverse effects of trauma (Hernandez, 2020; Di Lemma et al., 2019; Korotana et al., 2016). Key strategies to enhance resilience include:

Building relationships: encouraging supportive connections to facilitate feelings of belonging and emotional understanding. Kramer (2014) highlights the importance of sibling relationships as a potential for children's emotional growth, leading to positive developmental outcomes.
Promoting coping strategies: Resilience-building interventions focus on developing coping skills and emotional regulation techniques, which can help individuals manage stress and adversity. For example, Korotana et al (2016) highlighted to utility of cognitive behavioural therapies (CBT) in improving mental health outcomes for individuals with a history of ACEs.
Enhancing social and emotional competence: Programs aimed at strengthening social and emotional skills can aid in building resilience by equipping individuals with tools to navigate life challenges and can mitigate the impact of ACEs, facilitating healthier coping mechanisms (Hernandez, 2020; Di Lemma et al., 2019).

Family systems therapy and supporting parenting

Supporting effective parenting: providing caregivers with training and resources to create a nurturing environment is vital for emotional growth (Hernandez, 2020).
Implementing accessible parenting programs: Community-based programs that offer support to parents, especially those from high-risk populations can lead to positive developmental outcomes (Di Lemma et al., 2019).
Family systems therapy: family systems therapies aim to restructure and establish family dynamics, communication patterns and boundaries, which can help families manage stressors (Ramage and Shipp, 2009). Kramer (2014), highlights the importance of maintaining sibling interactions as a means to foster emotional growth, which family systems therapy can support by facilitating healthy family dynamics and communication.

Table 1. An overview of common components, interventions, settings, and protective factors associated with four approaches to prevent and mitigate the harm of ACEs as identified and based of Di Lemma et al (2019).


Approach	Key Components	Programs	Settings	Protective Factors
Supporting Parenting	Supporting, teaching and empowering parents to build positive relationships and attachments with the child.	Parenting interventions	Home School Community	Healthy parent-child attachment Parental involvement
Building Relationships & Resilience	Building positive relationships. Behavioural regulation Promoting wellbeing, mental health and a healthy lifestyle. Holistic approaches to coping with stress. Multi-agency approaches.	School-based interventions Mentoring	School Community	Strengthened social and emotional competency Supportive relationships and healthy role models outside from parents
Early Identification of Adversity	Increased awarness[spelling?] Specific early actions, i.e. referrals to services,	Early identification of adversities	Home School Welfare Community	Early intervention access
Responding to Trauma	Psychological and pharmacological treatments Tailored treatments to support families, parents, and children	psychotherapeutic interventions.	Home School Community	Resilience building and coping strategies positive community and family ties.

Conclusion

Based on psychological theory and empirical research findings, the general understanding is that ACEs, encompassing a range of negative and traumatic childhood experiences, can significantly hinder and disrupt the development of emotion regulation. Empirical research findings suggest a strong link between ACEs and difficulties in managing emotions, such as experiences adversities link heightened emotional reactivity and maladaptive coping mechanisms. Theoretical perspectives such as the Attachment Theory, offer an understanding of how insecure attachments formed in early childhood can impede emotional regulation, while the Social Learning Theory suggests that children can obtain emotional responses through observing their caregivers. Family Systems Theory highlights the influence for family dynamics, communication, and boundaries on emotional understanding and expression, and Polyvagal Theory explains how the autonomic nervous system reacts to initial ACEs and later challenges, impacting emotional responses. Interventions such as trauma-informed care, mindfulness and CBT with a focus on resilience building, are necessary in mitigating the adverse effects of ACEs, facilitating emotion awareness, and promoting healthier coping strategies. Early identification and support also make a profound difference in a child's life, potentially altering their developmental trajectory and improving their overall well being. Ultimately, understanding the pervasive impact of ACEs and implementing effective, tailored interventions can work to enhance emotional functioning, providing support for those navigating the challenges that stem from their early life experiences.

References

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External links

ACEs and Toxic Stress: Frequently Asked Questions (Harvard University)
Nearly 400 million young children worldwide regularly experience violent discipline at home – UNICEF(UNICEF Global Child Abuse Estimates)

	Emotional and physical neglect
	Physical, sexual, emotional and psychological abuse
	Bullying
	Divorce between parents
	Deaths in the family
	All of the above