Monica Leppma, Judit Szente, Matthew J. Brosch
Media and societal conditions affect fear development in youth; thus, counselors must remain current in their understanding of these fears in order to meet children’s health, educational and developmental needs. Because of the changing content and course of children’s fears, it is imperative that treatment approaches evolve concurrently. Therefore, there is a need for a review and expansion of the current understanding of children’s fears and anxiety and related treatment considerations. This article aims to connect research and literature regarding children’s fears with current conceptions of emotions, affect regulation and resilience in order to advocate for a holistic and modern approach for addressing fear in children.
Keywords: affect regulation, anxiety, children, fears, resilience
More than a century of research confirms the need for professional counselors to remain current in their understanding and treatment of the fears of children and adolescents (Burnham, 2009; Hall, 1897; Jersild & Holmes, 1935). When discussing youths’ fears, the literature includes the terms fear, anxiety and anxiety disorders. Fear is defined as a distressing emotion resulting from a real or perceived threat, and anxiety is the anticipation (i.e., fear) of a potential future threat (American Psychiatric Association [APA], 2013). The terms fear and anxiety are often used interchangeably or in tandem in the literature as they appear to reflect similar underlying neurobiological processes. Anxiety disorders are included in the discussion because they are psychological disorders that are viewed as developmentally inappropriate or as reflecting pathological levels of fear and anxiety (APA, 2013; Klein, 2009).
While the content and severity of children’s fears varies greatly, the evidence is clear that as society changes, approaches to treating children’s fear and anxiety must be adapted (Burnham, 2009). Burnham (2009) concluded that contemporary fears of today’s youth are influenced by global events (such as natural disasters, war and terrorism), societal changes, and television and media exposure. Stress and negative events contribute to heightened fear responses in children (Ollendick, Langley, Jones, & Kephart, 2001). Any stressful incidents that children experience have the potential to generate fear-related disorders (Robinson, Rotter, Robinson, Fey, & Vogel, 2004). Because of the ever-changing nature of society, it is essential for counselors to remain cognizant of the impact that current events might have on the children with whom they work, particularly in relation to their fears and coping mechanisms.
Current literature points to positive emotions and affect regulation as means of increasing resilience (Fredrickson, 2001; Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008; Hannesdottir & Ollendick, 2007). Resilience, or the ability to overcome adversity, is an essential component of coping with fears and anxiety effectively (Masten, 2001). The increase in adversities during the past decade, such as terrorist attacks, war, hurricanes and school shootings (Burnham, 2005, 2007, 2009), warrants a renewed focus on children’s fears and the promotion of resilience (Burnham, 2009; Tugade, Fredrickson, & Barrett, 2004).
Fears, worries and other stressors (e.g., academic issues, conflict, change) are typical aspects of human development; however, children often do not learn effective or appropriate skills to help them cope with these challenges (Robinson et al., 2004). Although children may develop coping mechanisms in the absence of direct instruction, these are often avoidant mechanisms that lead to poorer outcomes (Abei, Giger, Plattner, Metzke, & Steinhausen, 2013). Maladaptive fear responses can lead to the development of anxiety disorders (Kiel & Buss, 2014). Anxiety is the most prevalent childhood disorder and a strong predictor of adult psychopathology (Weems & Silverman, 2006). Thus, teaching children helpful ways to cope with fears can promote healthy development.
The need for developing effective coping skills in children is most evident during times of natural disasters and global crises (Burnham, 2009). During these periods, children are at increased risk for developing situation-specific fears. For instance, children who witnessed the September 11th attacks became more fearful of war and terrorism as a result (Burnham, 2007). This increased fearfulness also is the case for children who experience natural disasters such as earthquakes, wildfires and even lightning strikes (Dollinger, O’Donnell, & Staley, 1984).
In addition to dealing with global crises or natural disasters, counselors must be able to help children with everyday problems such as graphic media coverage of war and disasters, teasing, bullying, family conflict, economic problems, and academic failure (Burnham, 2009). For example, Robinson, Robinson, and Whetsell (1988) found that children’s fears of people and of being alone have increased since early research began on children’s fears in the 1900s. While the causality behind this change is unknown, the authors suggested possible associations with increased exposure to violent media coverage, changes in family structure and the rise in programs teaching about stranger danger. There is increasingly more evidence that television and other media contribute to children’s fears (Burnham, 2009; Burnham & Hooper, 2008; Lahikainen, Kraav, Kirmanen, & Taimalu, 2006). Furthermore, children’s fears are not relegated only to realistic or plausible events. Elementary school-aged children, in particular, have a limited conception of the world and tend to confuse reality and fantasy, which can lead to unnecessary fears and distorted assumptions (Moses, Aldridge, Cellitti, & McCorquodale, 2003). This confluence presents children with a vast range of potential fears, and their inability to cope with such fears can have devastating effects.
It follows, then, that counseling approaches for fear-related problems in children should evolve commensurately with contemporary society, and professional counselors must improve their current practices for the treatment of children’s fears. The first step in this process is to identify areas that can be improved in order to accentuate current treatment modalities. The purpose of this article is to provide an overview of the emerging research relevant to the fear and anxiety experienced by school-aged children and adolescents. More specifically, this article aims to bring together new research and theory on positive emotions that can aid professional counselors in cultivating resilience and affect regulation in the children with whom they work. To this end, the following article explores the following: factors related to fear development in children and adolescents (children throughout this paper refers to children and adolescents), issues related to treatment, and implications for counselors.
Considerable literature exists outlining the normative progression of fear development in children (e.g., Burnham, 2005, 2009; Driessnack, 2006; Elbedour, Shulman, & Kedem, 1997; Lahikainen, Kirmanen, Kraav, & Taimalu, 2003; Lahikainen et al., 2006; Robinson, Rotter, Fey, & Robinson, 1991; Robinson et al., 2004; Sayfan, 2008). Research over the decades has indicated that common fears of children include the broad categories of animals, darkness, death and the supernatural. However, research also demonstrates that the content of youth’s fears changes along with the advancement of technology, incorporating elements that have become socially relevant and discarding those that have become obsolete (Burnham, 2009).
The fear response consists of three components: thoughts, emotions and physical sensations (Hannesdottir & Ollendick, 2007; Robinson et al., 2004). Distressing events stimulate fear and anxiety in children, but fears also can arise when a child anticipates possible risk of injury, pain or loss (Burnham, 2009; Robinson et al., 1991). As an upsetting event proceeds from either a real or imagined threat, this anticipation of injury, pain or loss can evoke a fear response in a child. Thus, fear can develop from actual events or from beliefs and perceptions.
While excessive childhood fears are correlated with adult psychopathology, it should be noted that fear is a normative aspect of childhood development, so fears themselves are not considered the problem (Moses et al., 2003; Robinson et al., 1988). In fact, there are positive aspects of fear, such as self-preservation, galvanizing of internal coping resources, improved focus and an increased sense of vitality (Goud, 2005; Robinson et al., 1988; Robinson et al., 1991), but the negative effects of children’s fears can be serious. Fears may disrupt sleep, create exhaustion and hinder performance (Cartwright-Hatton, 2006; Robinson et al., 1991). Moreover, children suffering from fear often exhibit diminished academic achievement because fear interrupts motivation and the ability to concentrate (Moses et al., 2003; National Scientific Council on the Developing Child, 2010).
Researchers still do not completely understand the etiology of childhood fears and anxiety (Ollendick et al., 2001). It is likely that fear development involves some hereditary predisposition and genetics (Eley, Rijsdijk, Perrin, O’Connor, & Bolton, 2008; Klein, 2009). There is evidence that children’s characteristics and temperaments influence their fear development (Weems & Silverman, 2006). For example, Muris and Ollendick (2005) found a link between fearful or inhibited temperament and childhood anxiety disorders. Overall, research indicates that there is a moderate correlation between genetics and fear-related symptoms, but fear and anxiety appear to arise from a complex interaction among a variety of factors (Weems & Stickle, 2005). Researchers believe that behavioral (Ollendick et al., 2001; Weems & Stickle, 2005) and social learning also play a part.
Behavioral and Social Learning Factors
The behaviorally based factors in fear acquisition include (a) exposure to negative stimuli, (b) conditioning through negative experiences, (c) social learning through others’ modeling or (d) exposure to upsetting information (Muris, Merckelbach, Gadet, & Moulaert, 2000; Ollendick et al., 2001). For example, Dubi, Rapee, Emerton, and Schniering (2008) found that toddlers indicated fear of objects based on their mother’s positive or negative reaction to the object, regardless of the child’s temperament, which supports a social learning aspect to fear acquisition. There is additional empirical evidence that fear acquired indirectly through social observation, with no personal experience of the aversive event, engages similar neural mechanisms as traditional behaviorally based stimulus-response fear conditioning (Olsson, Nearing, & Phelps, 2007). Field, Lawson, and Banerjee (2008) found support for the effect of verbal information on persistent fear acquisition in children. These studies reinforce the notion that fear can be acquired through behavioral and social learning factors. Fears resulting from behaviorally based factors have been correlated with anxiety, phobias (fearful or anxious responses to, or avoidance of, specific objects or situations; APA, 2013), and behavior problems in children (Gao, Raine, Venables, Dawson, & Mednick, 2010).
In addition to behavioral and social learning explanations of fear acquisition, there is evidence for cognitive-based fear development. Research indicates that some fears are associated with maladaptive thinking patterns (King, Muris, & Ollendick, 2005). Maladaptive thoughts can take the form of negative self-appraisal, negative self-talk or dysfunctional evaluation of circumstances (King et al., 2005). Sayfan and Lagattuta (2008) found that children between the ages of 3 and 7 are more aware than previously believed regarding the relationship between fears, beliefs and knowledge. Fearful children experience numerous cognitive distortions such as a tendency to doubt their ability to cope, overestimation of the likelihood of adverse consequences and interpretation of threatening information in a distorted manner (Prins & Ollendick, 2003). This habitual negative assessment of circumstances is associated with elevated fear and anxiety (Ollendick et al., 2001). Schell, Dawson, and Marinkovic (1991) suggested that fear development is a complex process that includes autonomic conditioned responses in addition to cognitive and emotional components. Cognitive factors, therefore, play a clear role alongside behavioral and social learning explanations of fear development.
It is important to note that children’s fears can intensify over time if they are not addressed appropriately (Moses et al., 2003). Gao et al. (2010) found 3 to 8 year olds’ fear conditioning increases with age, with the most substantial increase occurring between the ages of 5 and 6. Unresolved childhood fears may have deleterious effects on development and contribute to adult mental illness (Moses et al., 2003; Saavedra, Silverman, Morgan-Lopez, & Kurtines, 2010). This information suggests that addressing and treating fears in childhood may be an effective means of preventing fear-related psychopathology in adulthood.
Cognitive-behavior therapy (CBT) is the most widely used and empirically supported treatment for fear-related disorders. Research demonstrates that CBT is effective for 60–70% of children, leaving about one-third of the population who do not respond to CBT (Hannesdottir & Ollendick, 2007; Trosper, Buzzella, Bennett, & Ehrenreich, 2009). Because a sizeable number of children do not appear to benefit from CBT, it seems worthwhile to examine additional approaches or adjuncts to traditional CBT that may be effective in treating fearful children.
Awareness of emotions is the foundation of affect regulation (Suveg, Hoffman, Zeman, & Thomassin, 2009). Affect regulation, as defined here, is the intentional process that an individual employs to modify emotional states in order to achieve desirable social and individual goals (Eisenberg & Spinrad, 2004). This definition refers to controlling both negative and positive emotions, and encompasses understanding and expressing emotions (Hannesdottir & Ollendick, 2007; Ursache, Blair, & Raver, 2012). Research suggests that absence of emotion regulation skills often lead to the development of anxiety disorders (Esbjørn, Bender, Reinholdt-Dunne, Munck, & Ollendick, 2012; Hannesdottir & Ollendick, 2007; Weems & Silverman, 2006). This research on the role of emotion regulation in fear development is relevant to counselors working with the contemporary fears of children and adolescents.
Consequently, research indicates that the missing link in CBT approaches for working with fear-related issues in youth is greater emphasis on affect regulation (Hannesdottir & Ollendick, 2007; Suveg & Zeman, 2004). In other words, children who do not respond successfully to traditional CBT may need a more extensive education and greater focus on regulating emotions beyond feelings of anxiety. Children with fear-related issues tend to experience more negative thoughts and feelings than neutral or positive ones. Learning to correctly identify emotions across varying situations (both positive and negative) helps children gain a sense of control over their feelings (Hannesdottir & Ollendick, 2007). Thus, as an adjunct to CBT techniques such as relaxation training and cognitive restructuring, counselors can teach children and adolescents how to identify and manage their full range of emotions.
Emotional dysregulation is defined as a limited ability to control and modulate feelings in order to allow successful functioning in social relationships and emotional well-being (Hannesdottir & Ollendick, 2007; Ursache et al., 2012). Fearful children tend to avoid experiencing anxiety-provoking situations as well as discussing the associated negative emotions. This avoidance behavior is believed to contribute to emotional dysregulation because it denies opportunities for successfully managing triggered emotions (Hannesdottir & Ollendick, 2007). As a consequence, anxious and fearful children lack a sense of mastery over their internal emotional reactions (Weems, Silverman, Rapee, & Pina, 2003). Exposure therapy is an important and effective component of CBT that addresses avoidance behavior by behaviorally desensitizing children via gradual exposure to a hierarchy of fears until the fear response subsides (Hannesdottir & Ollendick, 2007; Trosper, Buzzella, Bennett, & Ehrenreich, 2009). While exposure helps children acclimate to anxiety-provoking situations or objects, it is unknown whether exposure improves children’s ability to cope with associated emotions (Hannesdottir & Ollendick, 2007). In those cases where the child does not appear to respond successfully to exposure therapy, or regresses to pathological reactions, counselors can consider additional affect regulation strategies and interventions.
In one example of an affect regulation intervention, the counselor and client each choose an emotion they are experiencing from a feelings chart. Next, the counselor models for the child a discussion of how he or she knows they are feeling that way and why. Finally, the child is given the opportunity to do the same. This process helps the child understand specific emotions, normalizes the experiencing of emotions and models effective communication about emotions. Another suggestion is to utilize vignettes or stories to elicit specific emotions, process these emotions with the client and then brainstorm ways to manage the emotions (Suveg, Kendall, Comer, & Robin, 2006). Bibliotherapy also has been shown to be particularly helpful when working with fearful children (Moses et al., 2003; Robinson et al., 2004).
Interventions such as these help children acquire a repertoire of emotion regulation skills (Suveg et al., 2006). Fearful children must learn to become aware of their internal emotional states and then express or discuss their emotions effectively (Ursache et al., 2012). Building upon children’s emotional awareness can be a useful adjunct in enhancing other skills training that counselors provide in their sessions with fearful children and adolescents. Suveg et al. (2006) suggested that treatment for fear-related issues should encompass all emotions that children may have difficulty regulating, not solely fear and anxiety. Learning to correctly identify emotions helps children and adolescents gain a sense of control over their emotions and self-efficacy to change their emotional state (Hannesdottir & Ollendick, 2007).
Researchers posit that explicitly targeting affect regulation would improve treatment outcomes for youth with fear-related disorders (Hannesdottir & Ollendick, 2007; Trosper, Buzzella, Bennett, & Ehrenreich, 2009). The ability to self-regulate emotion incorporates autonomy, self-efficacy, adaptability, positivity and prosocial behavior (Hannesdottir & Ollendick, 2007; Ursache et al., 2012). In addition, current research suggests that professional counselors should provide interventions and psychoeducation on positive emotions to promote emotion regulation and resilience in children and adolescents (Gloria & Steinhardt, 2014; Hutchinson & Pretelt, 2010).
Fredrickson’s (1998, 2001) broaden-and-build theory of positive emotions provides a framework for understanding the role of positive emotions in fostering resilience. Negative emotions, such as fear and anxiety, narrow one’s focus and attention as a survival mechanism in preparation to either confront or avoid a perceived threat. This is known as the fight or flight response. However, this type of narrow, focused response also can cause people to become stuck by limiting flexibility and creativity in finding new solutions (Hannesdottir & Ollendick, 2007; Hutchinson & Pretelt, 2010; Tugade et al., 2004). Negative emotions are central in the development of psychopathology because they tend to foster higher levels of arousal than positive emotions (Suveg et al., 2009). This information is relevant to working with youth experiencing fear-related problems, because “people have limited ability to think of and evaluate different solutions when they are overwhelmed by negative emotions in a stressful situation” (Hannesdottir & Ollendick, 2007, p. 286).
The cultivation of positive emotions such as joy, gratitude, hope, serenity, interest and inspiration builds resilience in the form of enduring internal and social resources that one can draw upon when necessary (Fredrickson, 1998). Positive emotions help discard old negative patterns of thought and behavior to pursue novel ideas and actions (Fredrickson, 2001; Isen, 2009). Positive emotions also are a source of human strength that facilitates flexibility, creative problem-solving and more efficient and open-minded thinking, all important factors in resilience (Fredrickson, 2001; Isen, 2009). Experiencing positive emotions broadens individuals’ perspectives and reduces self-focus, allowing for a greater variety of behavioral responses (Isen, 2009). Moreover, experiencing positive emotions creates an upward spiral wherein positive emotions build upon each other to foster emotional and psychological well-being. Positive emotions also facilitate broad-minded and flexible thinking, which in turn, increases coping and problem-solving ability. Successful coping then leads to more positive emotions (Tugade et al., 2004). Furthermore, successful coping and problem-solving cultivate self-worth in children, which fosters a sense of self-efficacy and belief in their capacity to successfully handle stressful situations (Cloitre, Morin, & Linares, 2010; Robinson et al., 2004).
Positive emotions build physical, social, emotional and intellectual capacity to confront and overcome obstacles (Fredrickson, 2001; Tugade et al., 2004). For example, the positive emotion of joy prompts play, motivation and exploration. There is evidence that play contributes a wide array of resources for children (Trice-Black, Bailey, & Riechel, 2013). Imaginative play provides a safe environment for pretending and experimenting with emotional expression, which is important to developing emotion regulation (Lester & Russel, 2010). In fact, Hoffman and Russ (2012) found a relationship between imaginative play, positive affect and emotion regulation in 5- to 10-year-old girls (n = 61). Furthermore, the pushing of limits and exploring that occurs during play increases a child’s sense of self-efficacy and provides new information about the environment (Lester & Russel, 2010). Play can build physical resources of agility, coordination and strength. Play also promotes social resources such as connection, bonding and social skills (O’Connor & Stagnitti, 2011). In addition, play fosters the intellectual resources of problem-solving, creativity and the learning of new information (Fredrickson, 2001; Lester & Russel, 2010; Trice-Black et al., 2013). Finally, play cultivates psychological and emotional resources such as optimism, goal-orientation, a sense of identity (Fredrickson, 2000, 2001), and increased self-worth (Hippe, 2004). Thus, the positive emotions involved in play promote a number of factors that build resilience.
The resources developed from joy and other positive emotions such as love, gratitude, awe, amusement, interest and hope can become adaptive features that may enhance resilience in the face of future adversity. Repeated experience of these positive emotions builds internal and social resources that accumulate over time and can be drawn upon in times of need (Fredrickson, 2001). Positive emotion-based coping strategies, such as positive reappraisal and infusing meaning into experiences, have been shown to buffer against stress (Folkman & Moskowitz, 2000). There is additional evidence that cultivating positive emotions during times of adversity also may replenish the ability to cope (Tugade et al., 2004).
In addition to buffering against stress, generating positive emotions seems to have an undoing effect. In other words, positive emotions appear to serve as an antidote to the effects of negative emotions such as fear and anxiety (Fredrickson, 2003) and therefore can reinforce resilience. For example, Fredrickson and Levenson (1998) demonstrated that the elicitation of positive emotions increased the speed of cardiovascular recovery following a distressing event. This increased resilience to a distressing event is an encouraging sign that positive emotions, which can be achieved through emotion regulation, have a beneficial effect during times of distress. Thus, cultivating positive emotions may improve youths’ responses to negative or stressful situations and counteract the effects of chronic worry or fear (Hannesdottir & Ollendick, 2007).
The key for counselors is to fill their therapeutic toolboxes with interventions that directly target the spectrum of emotions and affect regulation. It is important to remember that affect regulation requires the ability to distinguish between all emotions. Interventions should include teaching skills for generating positive emotions as a means of building internal and social resources. Fredrickson (2009) proposed a positivity ratio of three positive emotions for every negative emotion to develop resilience. In other words, experiencing a greater quantity of positive emotions over time helps to buffer against, and undo, the negative effects of stress.
Resilience and Emotions
Burgeoning research points to the importance of understanding the relationship between fear-related disorders and emotions in order to promote resilience in children. Esbjørn et al. (2012) cited evidence of a link between anxiety symptoms (e.g., overwhelming fear, worry, agitation, heart palpitations) and lack of emotion regulation skills. Moreover, fearful children tend to have an even more limited understanding of emotions in general than their normative peers (Hannesdottir & Ollendick, 2007; Suveg et al., 2009). Research findings have suggested that children diagnosed with anxiety disorders also report experiencing higher levels of emotional intensity and somatic symptoms in response to emotions than children without anxiety disorders (Suveg et al., 2009; Suveg & Zeman, 2004). Finally, there is evidence of a relationship between the inability to regulate emotion and heightened levels of negative emotion (Esbjørn et al., 2012; Suveg & Zeman, 2004). Conversely, research indicates that resilient people demonstrate greater positive emotionality (Tugade et al., 2004). These findings all suggest that emotions and emotion regulation play an integral role in the development, course and potential modulation of fear-related disorders as well as the development of resilience.
In fact, Gloria and Steinhardt (2014) found, in a sample of 200 postdoctoral fellows, that positive emotions were directly related to greater resilience. Their findings suggested that positive emotions were positively related to adaptive coping and negatively related to maladaptive coping. In addition, resilience moderated the relationship between stress and trait anxiety and depressive symptoms. The authors concluded that positive emotions may have the potential to build resilience in individuals experiencing stressful situations, and resilience may in turn increase positive emotions, thus providing support for Fredrickson’s (1998, 2001) broaden-and-build theory. These results further support the notion of emphasizing the cultivation of positive emotions in helping children to build resilience.
Children develop resilience when they successfully manage stressors throughout daily life (Cloitre et al., 2010). Resilience improves youths’ ability to cope with fear and anxiety and mitigates some of the adverse effects of fear-related experiences (Burnham, 2009). As mentioned earlier, resilience is a set of qualities that empowers people to successfully adapt or bounce back when facing some type of adversity (Burnham, 2009; Tugade et al., 2004). Examples of resilient qualities include self-efficacy, internal locus of control, adaptability, flexibility, self-worth, optimism, positivity and social connectedness (Burnham, 2009; Grotberg, 1995; Hutchinson & Pretelt, 2010; Robinson et al., 2004; Tugade et al., 2004). Research indicates that resilient individuals possess a positive attitude toward life and are curious and open to new experiences (Masten, 2001). Although the cultivation of resilience is a natural process in child development, it can be inhibited by traumatic events, temperament, and societal or environmental conditions (Masten, 2001). Improving affect regulation can help build resilience in youth, which may in turn minimize the negative effects of fearful or anxious experiences.
Implications and Recommendations
We have provided an overview of the current landscape of children’s fears to help delineate a contemporary, adaptive and holistic approach to treatment. Based on a review of the current literature, we recommend that counselors incorporate interventions that specifically teach emotional awareness when working with fearful or anxious children. While many CBT interventions implicitly address emotions, we are suggesting that counselors provide explicit psychoeducation concerning emotions, in order to explain the purpose, importance and range of emotions. This approach promotes affect regulation skills by helping children to become more aware of how they are feeling and why, and to adjust their emotional state to allow for a more beneficial outcome. Affect regulation is crucial as it provides children with tools that may be generalized across various situations and stressors. The major implication is that this broad-based approach equips children with the ability to counteract future stressors without the need for continued situation-specific interventions.
In addition to a direct emphasis on emotional awareness and regulation, we recommend incorporating interventions that cultivate positive emotions. While CBT is generally inclusive of the way that thoughts and feelings are interconnected, there is often little time devoted to the effects of positive emotions in relation to fears and anxiety. The development of skills that cultivate positive emotions, in addition to challenging negative thoughts and emotions, can improve resilience to future stressors. Developing skills related to positive emotions can help fearful and anxious children to maintain an outlook that is more conducive to normative functioning and resilience than techniques such as cognitive reframing can accomplish alone. This information is particularly relevant as many CBT approaches focus on the specific presenting fear such as spiders, heights or social situations. An approach that targets a wider range of emotions with the goal of creating more positive emotions helps children not just overcome their immediate fears, but may prepare them to adequately confront and manage future fears.
This focus on positive emotions has the intended benefit of promoting resilience. As children learn how to cumulatively produce positive emotional states, they build resilience that will buffer them against potentially distressing stimuli. There is burgeoning evidence that generating positive emotions builds resources, broadens one’s ability to respond to stressors and has an undoing effect on emotions such as fear and anxiety. Research in the area of positive emotions and positive psychology provides a rich assortment of techniques for building strengths and resilience (e.g., Seligman, Steen, Park, & Peterson, 2005). We recommend that counselors incorporate this information into their work with fearful children.
The premise of this paper is that counselors can help fill the current gaps in treatment methodology with a focus on developing increased resilience in children by teaching affect regulation and positive emotions. Incorporating these constructs into a counselor’s current approach provides him or her with the widest range of treatment options in a way that allows children to confront current and future fears in a holistic fashion that is both specific and generalizable. Giving children access to these tools can prepare them for a range of potentially fear-inducing experiences in a way that allows them to cope effectively and draw upon their internal resources. This process continually expands client resilience and self-efficacy, preparing clients to confront a variety of stressors effectively.
This concentration on affect regulation, resilience and positive emotions appears to be an effective means of expanding upon current treatment approaches. Further research is recommended in the arena of adjunctive counseling modalities that are inclusive of resilience, affect regulation and positive emotions in order to determine their efficacy for those who are unresponsive to CBT. It also would be worthwhile to examine how these concepts affect treatment when used alongside CBT for those who do respond well to traditional CBT. By focusing on these constructs in conjunction with other empirically supported treatments, it is our belief that children’s outcomes will improve and they will be better prepared to confront not only specific fears in the present, but myriad potential stressors in the future.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest or funding contributions for the development of this manuscript.
Abei, M., Giger, J., Plattner, B., Metzke, C. W., & Steinhausen, H.-C. (2013). Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood. European Child & Adolescent Psychiatry, 23, 283–293. doi:10.1007/s00787-013-0458-y
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Burnham, J. J. (2005). Fears of children in the United States: An examination of the American fear survey schedule with 20 new contemporary fear items. Measurement & Evaluation in Counseling & Development, 38, 78–91.
Burnham, J. J. (2007). Children’s fears: A pre-9/11 and post-9/11 comparison using the American fear survey schedule for children. Journal of Counseling & Development, 85, 461–466. doi:10.1002/j.1556-6678.2007.tb00614.x
Burnham, J. J. (2009). Contemporary fears of children and adolescents: Coping and resiliency in the 21st century. Journal of Counseling & Development, 87, 28–35. doi:10.1002/j.1556-6678.2009.tb00546.x
Burnham, J. J., & Hooper, L. M. (2008). The influence of the war in Iraq on American youth’s fears: Implications for professional school counselors. Professional School Counseling, 11, 395–403.
Cartwright-Hatton, S. (2006). Anxiety of childhood and adolescence: Challenges and opportunities. Clinical Psychology Review, 26, 813–816. doi:10.1016/j.cpr.2005.12.001
Cloitre, M., Morin, N. A., & Linares, O. (2010). Children’s resilience in the face of trauma. NYU Child Study Center. Retrieved from http://www.education.com/reference/article/Ref_Childrens_Resilience/
Dollinger, S. J., O’Donnell, J. P., & Staley, A. A. (1984). Lightning-strike disaster: Effects on children’s fears and worries. Journal of Consulting and Clinical Psychology, 52, 1028–1038.
Driessnack, M. (2006). Draw-and-tell conversations with children about fear. Qualitative Health Research, 16, 1414–1435. doi:10.1177/1049732306294127
Dubi, K., Rapee, R. M., Emerton, J. L., & Schniering, C. A. (2008). Maternal modeling and the acquisition of fear and avoidance in toddlers: Influence of stimulus preparedness and child temperament. Journal of Abnormal Child Psychology, 36, 499–512.doi:10.1007/s10802-007-9195-3
Eisenberg, N., & Spinrad, T. L. (2004). Emotion-related regulation: Sharpening the definition. Child Development, 75, 334–339. doi:10.1111/j.1467-8624.2004.00674.x
Elbedour, S., Shulman, S., & Kedem, P. (1997). Children’s fears: Cultural and developmental perspectives. Behaviour Research and Therapy, 35, 491–496.
Eley, T. C., Rijsdijk, F. V., Perrin, S., O’Connor, T. G., & Bolton, D. (2008). A multivariate genetic analysis of specific phobia, separation anxiety and social phobia in early childhood. Journal of Abnormal Child Psychology, 36, 839–848. doi:10.1007/s10802-008-9216-x
Esbjørn, B. H., Bender, P. K., Reinholdt-Dunne, M. L., Munck, L. A., & Ollendick, T. H. (2012). The development of anxiety disorders: Considering the contributions of attachment and emotion regulation. Clinical Child and Family Psychology Review, 15, 129–143.doi:10.1007/s10567-011-0105-4
Field, A. P., Lawson, J., & Banerjee, R. (2008). The verbal threat information pathway to fear in children: The longitudinal effects on fear cognitions and the immediate effects on avoidance behavior. Journal of Abnormal Psychology, 117, 214–224. doi:10.1037/0021-843X.117.1.214
Folkman, S., & Moskowitz, J. T. (2000). Positive affect and the other side of coping. American Psychologist, 55, 647–654. doi:10.1037//0003-066X.55.6.647
Fredrickson, B. L. (1998). Cultivated emotions: Parental socialization of positive emotions and self-conscious emotions. Psychological Inquiry: An International Journal for the Advancement of Psychological Theory, 9, 279–281. doi:10.1207/s15327965pli0904_4
Fredrickson, B. L. (2000). Cultivating positive emotions to optimize health and well-being. Prevention & Treatment, 3, 1–25. doi:10.1037/1522-3718.104.22.168a
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56, 218–226. doi:10.1037/0003-066X.56.3.218
Fredrickson, B. L. (2003). The value of positive emotions: The emerging science of positive psychology is coming to understand why it’s good to feel good. American Scientist, 91, 330–335. doi:10.1511/2003.4.330
Fredrickson, B. L. (2009). Positivity: Top-notch research reveals the 3-to-1 ratio that will change your life. New York, NY: Three Rivers.
Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95, 1045–1062. doi:10.1037/a0013262
Fredrickson, B. L., & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition & Emotion, 12, 191–220.
Gao, Y., Raine, A., Venables, P. H., Dawson, M. E., & Mednick, S. A. (2010). Reduced electrodermal fear conditioning from ages 3 to 8 years is associated with aggressive behaviors at age 8 years. The Journal of Child Psychology and Psychiatry, 51, 550–558.doi:10.1111/j.1469-7610.2009.02176.x
Gloria, C. T., & Steinhardt, M. A. (2014). Relationship among positive emotions, coping, resilience and mental health. Stress and Health. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/smi.2589/pdf
Goud, N. H. (2005). Courage: Its nature and development. The Journal of Humanistic Counseling, Education and Development, 44, 102–116. doi:10.1002/j.2164-490X.2005.tb00060.x
Grotberg, E. H. (1995). A guide to promoting resilience in children: Strengthening the human spirit. Retrieved from http://resilnet.uiuc.edu/library/grotb95b.html#chapter1
Hall, G. S. (1897). A study of fears. American Journal of Psychology, 8, 147–249. doi:10.2307/1410940
Hannesdottir, D. K., & Ollendick, T. H. (2007). The role of emotion regulation in the treatment of child anxiety disorders. Clinical Child and Family Psychology Review, 10, 275–293. doi:10.1007/s10567-007-0024-6
Hippe, J. (2004). Self-awareness: A precursor to resiliency. Reclaiming Children & Youth, 12, 240–242.
Hoffman, J., & Russ, S. (2012). Pretend play, creativity, and emotion regulation in children. Psychology of Aesthetics, Creativity, and the Arts, 6, 175–184.
Hutchinson, J., & Pretelt, V. (2010). Building resources and resilience: Why we should think about positive emotions when working with children, their families and their schools. Counselling Psychology Review, 25, 20–27.
Isen, A. M. (2009). A role for neuropsychology in understanding the facilitating influence of positive affect on social behavior and cognitive processes. In C. R. Snyder & S. J. Lopez (Eds.), Oxford handbook of positive psychology (2nd ed.; pp. 503–518). New York, NY: Oxford University Press.
Jersild, A. T., & Holmes, F. B. (1935). Children’s fears. New York, NY: Teachers College, Columbia University.
Kiel, E. J., & Buss, K. A. (2014). Dysregulated fear in toddlerhood predicts kindergarten social withdrawal through protective parenting. Infant and Child Development, 23, 304–313. doi:10.1002/icd.1855
King, N. J., Muris, P., & Ollendick, T. H. (2005). Childhood fears and phobias: Assessment and treatment. Child and Adolescent Mental Health, 10, 50–56.doi:10.1111/j.1475-3588.2005.00118.x
Klein, R. G. (2009). Anxiety disorders. Journal of Child Psychology and Psychiatry, 50(1–2), 153–162.
Lahikainen, A. R., Kirmanen, T., Kraav, I., & Taimalu, M. (2003). Studying fears in young children: Two interview methods. Childhood: A Global Journal of Child Research, 10, 83–104.
Lahikainen, A. R., Kraav, I., Kirmanen, T., & Taimalu, M. (2006). Child-parent agreement in the assessment of young children’s fears: A comparative perspective. Journal of Cross-Cultural Psychology, 37, 100–119. doi:10.1177/0022022105282298
Lester, S., & Russel, W. (2010). Children’s right to play: An examination of the importance of play in the lives of children worldwide. Working Paper No. 57. The Hague, The Netherlands: Bernard van Leer Foundation.
Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227–238. doi:10.1037//0003-066X.56.3.227
Moses, L. F., Aldridge, J., Cellitti, A., & McCorquodale, G. (2003). Children’s fears of war and terrorism: A resource for teachers and parents. Olney, MD: Association for Childhood Education International.
Muris, P., Merckelbach, H., Gadet, B., & Moulaert, V. (2000). Fears, worries, and scary dreams in 4- to 12-year-old children: Their content, developmental pattern, and origins. Journal of Clinical Child Psychology, 29, 43–52.
Muris, P., & Ollendick, T. H. (2005). The role of temperament in the etiology of child psychopathology. Clinical Child and Family Psychology Review, 8, 271–289. doi:10.1007/s10567-005-8809-y
National Scientific Council on the Developing Child. (2010). Persistent fear and anxiety can affect young children’s learning and development. Retrieved from http://developingchild.harvard.edu/resources/reports_and_working_papers/working_papers/wp9/
O’Connor, C., & Stagnitti, K. (2011). Play, behavior, language and social skills: The comparison of a
play and a non-play intervention within a specialist school setting. Research in Developmental
Disabilities, 32, 1205–1211. doi:10.1016/j.ridd.2010.12.037
Ollendick, T. H., Langley, A. K., Jones, R. T., & Kephart, C. (2001). Fear in children and adolescents: Relations with negative life events, attributional style, and avoidant coping. Journal of Child Psychology and Psychiatry, 42, 1029–1034. doi:10.1111/1469-7610.00801
Olsson, A., Nearing, K. I., & Phelps, E. A. (2007). Learning fears by observing others: The neural systems of social fear transmission. Social Cognitive and Affective Neuroscience, 2, 3–11. doi:10.1093/scan/nsm005
Prins, P. J. M., & Ollendick, T. H. (2003). Cognitive change and enhanced coping: Missing mediational links in cognitive behavior therapy with anxiety-disordered children. Clinical Child and Family Psychology Review, 6, 87–105. doi:10.1023/A:1023730526716
Robinson, E. H., Robinson, S. L., & Whetsell, M. V. (1988). A study of children’s fears. The Journal of Humanistic Education and Development, 27, 84–95. doi:10.1002/j.2164-4683.1988.tb00163.x
Robinson, E. H., Rotter, J. C., Fey, M. A., & Robinson, S. L. (1991). Children’s fears: Toward a preventive model. The School Counselor, 38, 187–202.
Robinson, E. H., Rotter, J. C., Robinson, S. L., Fey, M. A., & Vogel, J. E. (2004). Fears, stress, and trauma: Helping children cope. Greensboro, NC: CAPS Press.
Saavedra, L. M., Silverman, W. K., Morgan-Lopez, A. A., & Kurtines, W. M. (2010). Cognitive behavioral treatment for childhood anxiety disorders: long-term effects on anxiety and secondary disorders in young adulthood. Journal of Child Psychology and Psychiatry, 51, 924–934. doi:10.1111/j.1469-7610.2010.02242.x
Sayfan, L. (2008). Scaring the monster away: Children’s and parents’ conceptions of coping strategies to deal with children’s fear of real and imaginary entities (Doctoral dissertation). Retrieved from http://mindbrain.ucdavis.edu/people/lsayfan/Dissertation.%20Liat%20Sayfan.pdf
Sayfan, L., & Lagattuta, K. H. (2008). Grownups are not afraid of scary stuff, but kids are: Young children’s and adults’ reasoning about children’s, infants’, and adults’ fears. Child Development, 79, 821–835. doi:10.1111/j.1467-8624.2008.01161.x
Schell, A. M., Dawson, M. E., & Marinkovic, K. (1991). Effects of potentially phobic conditioned stimuli on retention, reconditioning, and extinction of the conditioned skin conductance response. Psychophysiology, 28, 140–153.
Seligman, M. E., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410–421. doi:10.1037/0003-066X.60.5.410
Suveg, C., Hoffman, B., Zeman, J. L., & Thomassin, K. (2009). Common and specific emotion-related predictors of anxious and depressive symptoms in youth. Child Psychiatry and Human Development, 40, 223–239. doi:10.1007/s10578-008-0121-x
Suveg, C., Kendall, P. C., Comer, J. S., & Robin, J. (2006). Emotion-focused cognitive-behavioral therapy for anxious youth: A multiple baseline evaluation. Journal of Contemporary Psychotherapy, 36, 77–85.
Suveg, C., & Zeman, J. (2004). Emotion regulation in children with anxiety disorders. Journal of Clinical Child & Adolescent Psychology, 33, 750–759. doi:10.1207/s15374424jccp3304_10
Trice-Black, S., Bailey, C. L., & Riechel, M. E. K. (2013). Play therapy in school counseling. Professional School Counseling, 16, 303–312.
Trosper, S. E., Buzzella, B. A., Bennett, S. M., & Ehrenreich, J. T. (2009). Emotion regulation in youth with emotional disorders: Implications for a unified treatment approach. Clinical Child and Family Psychology Review, 12, 234–254. doi:10.1007/s10567-009-0043-6
Tugade, M. M., Fredrickson, B. L., & Barrett, L. F. (2004). Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality, 72, 1161–1190. doi:10.1111/j.1467-6494.2004.00294.x
Ursache, A., Blair, C., & Raver, C. C. (2012). The promotion of self-regulation as a means of enhancing school readiness and early achievement in children at risk for school failure. Child Development Perspectives, 6, 122–128. doi:10.1111/j.1750-8606.2011.00209.x
Weems, C. F., & Silverman, W. K. (2006). An integrative model of control: Implications for understanding emotion regulation and dysregulation in childhood anxiety. Journal of Affective Disorders, 91, 113–124.
Weems, C. F., Silverman, W. K., Rapee, R. M., & Pina, A. A. (2003). The role of control in childhood anxiety disorders. Cognitive Therapy and Research, 27, 557–568. doi:10.1023/A:1026307121386
Weems, C. F., & Stickle, T. R. (2005). Anxiety disorders in children: Casting a nomological net. Clinical Child and Family Psychology Review, 8, 107–134. doi:10.1007/s10567-005-4751-2