Assessment

Multidimensional Assessment of 17(1) 138­–149

© The Author(s) 2010
Reprints and permission: http://www.
Emotion Regulation Difficulties in sagepub.com/journalsPermissions.nav
DOI: 10.1177/1073191109349579

Adolescents Using the Difficulties in http://asmnt.sagepub.com

Emotion Regulation Scale

Anna Neumann,1 Pol A. C. van Lier,1 Kim L. Gratz,2

and Hans M. Koot1

Abstract
The authors explored the utility of the Difficulties in Emotion Regulation Scale (DERS) in assessing adolescents’ emotion
regulation. Adolescents (11-17 years; N = 870) completed the DERS and measures of externalizing and internalizing
problems. Confirmatory factor analysis suggested a similar factor structure in the adolescent sample of the authors as
demonstrated previously among adults. Furthermore, results indicated no gender bias in ratings of DERS factors on three
scales (as evidenced by strong factorial gender invariance) and limited gender bias on the other three scales (as evidenced
by metric invariance). Female adolescents scored higher on four of six DERS factors than male adolescents. DERS factors
were meaningfully related to adolescents’ externalizing and internalizing problems. Results suggest that scores on the DERS
show promising internal consistency and validity in a community sample of adolescents.

Keywords
emotion regulation, adolescents, internalizing, externalizing, Difficulties in Emotion Regulation Scale

Recent research has led to an increased interest in the role One promising measure for the comprehensive assessment
of emotional processes in normal and atypical development of ER difficulties is the Difficulties in Emotion Regulation
(Southam-Gerow & Kendall, 2001), with the regulation Scale (DERS; Gratz & Roemer, 2004). Originally devel-
and dysregulation of emotions being a primary focus of this oped for use with adults, the DERS was designed to provide
research. Indeed, emotion regulation (ER) difficulties have a comprehensive assessment of clinically relevant ER dif-
been implicated in several forms of developmental psycho- ficulties across multiple domains. Moreover, suggesting its
pathology (e.g., Bradley, 2000; Cole, Michel, & Teti, 1994; potential utility for adolescents, the DERS is based on a
Gross, 1998). Furthermore, ER skills have been positively conceptual definition of ER influenced most directly by
linked to both prosocial behavior (e.g., Shields, Cicchetti, & theoretical literature on ER in youth (Cole et al., 1994;
Ryan, 1994) and resiliency to multiple risks (Lengua, 2002) Thompson, 1994). Whereas much of the literature on ER in
among children. adulthood emphasizes the control and reduction of negative
In contrast to the growing body of literature on ER among emotions, the childhood literature emphasizes the function-
children and adults, few studies have investigated ER and ality of emotions and the problems associated with deficits
ER difficulties in adolescents (Gross, 1998; Zeman, Cassano, in the capacity to experience the full range of emotions,
Perry-Parrish, & Stegall, 2006). However, emerging evi- with some developmental researchers defining ER as “the
dence for the central role of ER processes in adolescent extrinsic and intrinsic processes responsible for monitoring,
development (e.g., Garnefski, Kraaij, & van Etten, 2005; evaluating, and modifying emotional reactions to accom-
Silk, Steinberg, & Morris, 2003) highlights the importance plish one’s goals” (Thompson, 1994, pp. 27-28). the DERS
of examining ER among adolescents. One likely reason for
the relative lack of research in this area (despite its clear 1
VU University Amsterdam, Amsterdam, Netherlands
clinical significance) may be the limited number of available 2
University of Mississippi Medical Center, Jackson, MS, USA
measures of ER for adolescents (Zeman et al., 2006). Thus,
the primary goal of the present study was to extend the extant Corresponding Author:
Anna Neumann, Department of Developmental Psychology, Faculty
research on adolescent ER difficulties by exploring the of Psychology and Education,VU University Amsterdam, van der
factor structure and psychometric properties of an existing Boechorststraat 1, 1081 BT Amsterdam, Netherlands
adult measure of ER difficulties among adolescents. Email: [email protected]
Neumann et al. 139

is based on a conceptualization of ER as adaptive ways of only the specific subscales of difficulties controlling impul-
responding to emotions, including accepting res­ponses, the sive behaviors when distressed, limited access to effective
ability to experience and differentiate the full range of emo- ER strategies, and lack of emotional clarity have been found
tions, and the control of behaviors in the face of emotional to differentiate between trauma-exposed individuals with
distress (see Gratz & Roemer, 2004). Furthermore, items and without probable PTSD when controlling for negative
of the DERS focus mainly on the regulation of negative affect (Tull et al., 2007). As such, research has consistently
emotional states, because difficulties in this domain are linked the DERS and its subscales to a variety of forms of
considered to have particular clinical relevance. psychopathology in adults.
In support of the utility of the DERS among adults, scores
on this measure have been found to have good test–retest
reliability over a period of 4 to 8 weeks in a sample of col- Research on Emotion Regulation
lege students (rI = .88; Gratz & Roemer, 2004) and high Difficulties in Adolescence
internal consistency within clinical (e.g., Fox, Axelrod, Although relatively understudied (in comparison with ER
Paliwal, Sleeper, & Sinha, 2007; Gratz, Tull, Baruch, in children and adults), research on ER in adolescents pro-
Bornovalova, & Lejuez, 2008) and nonclinical populations vides preliminary evidence for the importance of specific
(e.g., Gratz & Roemer, 2004; Johnson et al., 2008). Further- aspects of ER and related constructs to adolescent develop-
more, research using this measure with adults has repeatedly ment. Some evidence comes from research in (trait) emotional
linked the DERS to clinically relevant phenomena in both intelligence, which focuses on understanding other’s emo-
clinical and nonclinical samples. Specifically, scores on the tions in addition to one’s own, and on perceived competencies
DERS showed statistically significant relations with behav- (instead of perceived difficulties, as in the present study;
iors thought to serve an emotion-regulating function, including Petrides, Frederickson, & Furnham, 2004). This research
deliberate self-harm (Gratz & Roemer, 2008), intimate part- provides evidence that perceptions of how one deals with
ner abuse perpetration among men (Gratz, Paulson, Jakupcak, emotions are associated with academic performance and devi-
& Tull, 2009), and cocaine dependence (Fox et al., 2007). ant behavior (Petrides et al., 2004) and self-esteem, anxiety,
Furthermore, scores on the DERS have been found to be and depression (Fernandez-Berrocal, Alcaide, Extremera, &
heightened among individuals with psychiatric disorders Pizarro, 2006). Of greater relevance to the present study,
thought to be characterized by ER difficulties, including studies examining ER strategies (Garnefski et al., 2005; Silk
borderline personality disorder (vs. non–personality disor- et al., 2003) and physiological markers of ER (e.g., Beauchaine,
der outpatients; Gratz, Rosenthal, Tull, Lejuez, & Gunderson, Gatzke-Kopp, & Mead, 2007) have found that ER is associ-
2006), probable posttraumatic stress disorder (PTSD; vs. ated with internalizing and externalizing problems (Garnefski
trauma-exposed individuals without PTSD; Tull, Barrett, et al; 2005), depression and problem behavior (Silk et al.,
McMillan, & Roemer, 2007), and panic attacks (vs. nonpan- 2003), and conduct problems (Beauchaine et al., 2007) among
ickers; Tull & Roemer, 2007). Finally, the DERS demonstrates adolescents. Furthermore, some evidence suggests that ER
statistically significant associations with a number of con- difficulties may play a greater role in adolescent internaliz­ing
structs thought to be related to ER difficulties, including positive than externalizing problems (Garnefski et al., 2005).
associations with negative affect (Johnson et al., 2008; These studies provide preliminary evidence for the impor-
Vujanovic, Zvolensky, & Bernstein, 2008), depression and tance of certain aspects of ER to adolescent functioning;
anxiety symptom severity (Roemer et al., 2009; Vujanovic however, other important dimensions of ER remain unstud-
et al., 2008), anxiety sensitivity (Johnson et al., 2008; Vuja- ied among adolescents. For example, two of the most commonly
novic et al., 2008), and experiential avoidance (Gratz & used measures of emotional intelligence (the Trait Meta
Roemer, 2004; Tull & Gratz, 2008; Tull & Roemer, 2007), Mood Scale and Swinburne University Emotional Intelli-
and negative associations with emotional expression and gence Test; see Salovey, Mayer, Goldman, Turvey, & Palfai,
processing (Johnson et al., 2008), mindfulness (Baer, Smith, 1995; Luebbers, Downey, & Stough, 2007, respectively) do
Hopkins, Krietemeyer, & Toney, 2006; Roemer et al., 2009), not assess the ability to control behaviors when experienc-
and self-compassion (Roemer et al., 2009). ing negative emotions or the acceptance of emotions. Likewise,
Furthermore, studies provide support for the utility of the measures of ER strategies (e.g., the Cognitive Emotion
DERS subscales, finding that particular subscales are dif- Regulation Scale; Garnefski, Kraaij, & Spinhoven, 2002,
ferentially associated with specific forms of psychopathology. cf. Garnefski et al., 2005) focus only on this particular
Salters-Pedneault, Roemer, Tull, Rucker, and Mennin (2006) dimension of ER difficulties, to the exclusion of aspects
found that all DERS subscales (with the exception of lack of such as the awareness, understanding, and acceptance of
emotional awareness) were significantly elevated among emotions. To better understand the nature and role of ER in
individuals with (vs. without) probable generalized anxiety adolescence, a comprehensive measure that assesses all
disorder when controlling for negative affect. In contrast, theoretically relevant aspects of ER difficulties is needed.
140 Assessment 17(1)

The Present Study Method

The goal of the present study was to examine if a widely
Participants
used and empirically supported measure of ER difficulties All 1,003 students at a school for secondary education, includ-
in adults (the DERS) has utility in the assessment of ER ing Atheneum (60.3%), Gymnasium (21.5%), and HAVO (a
difficulties among adolescents. To this end, we examined Dutch acronym for “higher general secondary education”;
three questions. First, we examined whether the factor struc- 18.2%), in Amsterdam, the Netherlands, were invited to par-
ture of the DERS previously found in adults is replicable ticipate in the study. These school forms represent higher
among a sample of adolescents. Given that the conceptual- levels of secondary education in the Netherlands and are
ization of ER of the DERS is based in theoretical literature attended by approximately 56% of all secondary school stu-
on ER among youth, we expected that this would be the dents in the Netherlands (Centraal Bureau voor Statistiek
case. Additionally, based on findings pertaining to emotional [CBS], 2008b). Parents of 6 of these 1,003 (0.6%) students
development among youth we expected that the specific did not grant permission for their children to complete the
dimensions of ER difficulties assessed in the DERS would questionnaires, and another 78 students (7.8%) were not
be observable and stable among adolescents (Stegge & present on the day of testing. All other adolescents took part
Meerum Terwogt, 2007). in the study. Furthermore, to ensure that this adolescent
The second question pertains to potential gender differences sample does not overlap in age with adult samples, only ado-
in ER difficulties. Findings of lower emotional expression/ lescents below the age of 18 were included, resulting in the
verbalization among boys versus girls (Brody & Hall, 1993) exclusion of an additional 49 students. Thus, the final sample
suggest that boys may have less emotional awareness than consisted of 870 adolescents (441 girls, 429 boys) with a
girls. Furthermore, a meta-analysis of gender differences in mean age of 14.34 years (SD = 1.60; age range 11-17 years).
temperament showed that girls are better at inhibiting inap- Female and male participants did not differ significantly in
propriate behavioral responses than boys (Else-Quest, Hyde, age, t(870) = 1.00, p > .05, Cohen’s d = .07. Almost all
Goldsmith, & van Hulle, 2006). Conversely, compared with (95.5%) of the participants were born in the Netherlands;
their male peers, adolescent girls have been found to use however, 40.1% reported having at least one parent born out-
more maladaptive coping strategies, such as resignation side the Netherlands. This percentage is comparable with that
(Hampel & Petermann, 2006), and to report experiencing of all Atheneum, Gymnasium, and HAVO students with a
higher levels of guilt, shame, and self-directed hostility minority background (defined as having at least one parent
(Hamilton & Jensvold, 1992), some of which may be in born outside the Netherlands) found in larger cities of the
response to emotions that are perceived as inappropriate. Netherlands (CBS, 2008a), and is higher than that found for
Accordingly, we hypothesized that female adolescents, com- the Netherlands as a whole (20% students with minority
pared with their male peers, would report greater emotional status).
awareness and less difficulty controlling their behaviors when
distressed, but also more emotional nonacceptance (in the
form of secondary emotional responses to negative emo- Measures
tions) and less access to ER strategies perceived as effective. Emotion Regulation
Before levels of ER difficulties between male and female Difficulties in Emotion Regulation Scale. The DERS (Gratz
adolescents can be compared, however, gender invariance in & Roemer, 2004) is a 36-item self-report questionnaire that
the measurement of ER difficulties must be established. Thus, assesses clinically relevant difficulties in ER (with a par-
we examined whether the DERS demonstrates measurement ticular emphasis on negative emotions). Items are scored on
invariance with respect to male and female participants. six scales, labeled Lack of Emotional Awareness (6 items),
The study’s third question pertained to the association bet­ Lack of Emotional Clarity (5 items), Difficulties Control-
ween ER difficulties and psychopathology in adolescence. ling Impulsive Behaviors When Distressed (6 items),
We explored the concurrent validity of DERS scores by Difficulties Engaging in Goal-Directed Behavior When
studying the association between the DERS and adolescents’ Distressed (5 items), Nonacceptance of Negative Emotional
symptoms of internalizing and externalizing psychopathol- Responses (6 items), and Limited Access to Effective ER
ogy. Based on previous studies using the DERS in adult Strategies (8 items). Items are scored on a 5-point scale
samples (as well as evidence of the role of ER strategies in ranging from 1 (almost never) to 5 (almost always). Sub-
adolescent psychopathology), we hypothesized that scores scale scores are obtained by summing the corresponding
on the DERS subscales would be associated with both exter- items. Evidence has been provided in support of the reli-
nalizing and internalizing difficulties among adolescents, with ability of DERS scores. Specifically, DERS scores have
generally stronger relations between the DERS and internal- been found to demonstrate good test–retest reliability over
izing as opposed to externalizing problems. a period of 4 to 8 weeks in a sample of college students
Neumann et al. 141

(rI = .88; Gratz & Roemer, 2004), and both the overall present sample (5.87 vs. 4.87 for Aggressive Behavior and
DERS score and subscale scores have been found to have 3.57 vs. 2.57 for Delinquent Behavior) compared with the
high internal consistency within both clinical (e.g., Fox et al., general Dutch sample. Given that the variance of the scale
2007; Gratz et al., 2008) and nonclinical populations (e.g., scores was at least as high in the present sample, compared
Gratz & Roemer, 2004; Johnson et al., 2008). Support for with the general population in which the full YSR was used,
the construct and predictive validity of DERS scores within the likelihood of detecting potential relations between the
both clinical and nonclinical populations have also been YSR externalizing scores in our sample and DERS factors
found (Fox et al., 2007; Gratz, Bornovalova, Delany-Brumsey, does not seem to be compromised by the fact that only the
Nick, & Lejuez, 2007; Gratz & Roemer, 2004, 2008; Gratz YSR externalizing scales were administered.
et al., 2006, 2009). The Flesch–Kincaid Grade Level of the
DERS is 5.3, meaning the questionnaire should be under- Internalizing Problems
standable by an average fifth grader (Kincaid, Fishburne, Screen for Child Anxiety Related Emotional Disorders (SCARED).
Rogers, & Chissom, 1975). For the purpose of the present The SCARED (Birmaher et al., 1997) is a 38-item self-
study, the DERS was translated to Dutch. First, the scale report questionnaire that assesses anxiety disorder symptoms
was translated independently from English to Dutch by in children and adolescents consistent with the Diagnostic
three translators, who then discussed their translations and and Statistical Manual of Mental Disorders, fourth edition
combined them into one. Next, the translated scale was (American Psychiatric Association, 1994) classification
administered to 46 Dutch high school students (28 girls, scheme (Generalized Anxiety, Separation Anxiety, Somatic/
mean age = 12.65, age range = 12-13 years). Difficult or Panic, Social Phobia, and School Phobia). Examples of
misinterpreted items were rephrased (n = 2). Although we items are “When I get frightened, I feel like I am choking”
did not use a formal back-translation procedure before the (Somatic/Panic), I feel shy with people I don’t know well”
study was conducted, the Dutch version of the DERS used (Social Phobia), and “I am a worrier” (Generalized Anxi-
in the study was back-translated to English by a profes- ety). In the present study, only the total anxiety score will be
sional translator after the assessment. The back-translated used. Items are rated on a 3-point scale, with 0 (almost
DERS was consistent with the original DERS. never), 1 (sometimes), and 2 (often). Evidence for the
SCARED scores’ concurrent validity has been demonstrated
Externalizing Problem Behavior (Muris et al., 1998), and the original five-factor structure has
Youth Self-Report (YSR): Externalizing items. The 30 YSR been shown to apply to the Dutch SCARED (Hale, Raaij-
Externalizing items (Achenbach, 1991) assess Aggressive makers, Muris, & Meeus, 2005). Cronbach’s alpha was .93
Behavior (19 items; e.g., “I physically attack people” and “I for the SCARED total score in the present adolescent sample.
argue a lot”) and Delinquent Behavior (11 items; e.g., “I Reynolds Adolescent Depression Scale–2nd Edition (RADS-2).
hang around with others who get in trouble” and “I steal The RADS-2 (Reynolds, 2002) assesses the severity of self-
from home”). Each item is scored on a 3-point scale of 0 reported depressive symptoms in adolescents. The RADS-2
(not true), 1 (somewhat or sometimes true), or 2 (very or contains 30 items and four subscales, named Dysphoric
often true). Raw scores were summed to obtain scores for Mood, Anhedonia/Negative Affect, Negative Self-Evaluation,
Aggressive and Delinquent Behavior, respectively. The and Somatic Complaints. Examples of items are “I feel sad”
Dutch version of the YSR Externalizing scales (Verhulst, (Dysphoric Mood) and “I feel I am bad” (Negative Self-
van der Ende, & Koot, 1997) was used with the permission Evaluation). In the present study, only the RADS-2 total
of the authors. Support for YSR scores’ construct and pre- score will be targeted for analyses, because the focus lies on
dictive validity have been provided (Verhulst et al., 1997). establishing the usefulness of the DERS in research with
Cronbach’s alphas were .79 for the scale Aggressive Behav- adolescents, rather than on showing how ER difficulties
ior and .70 for Delinquent Behavior in the present adolescent relate to diverse aspects of depression. Adolescents are
sample. The factor structure of the Dutch YSR was found to asked to indicate on a 4-point rating scale (ranging from 1
be similar to the U.S. version (de Groot, Koot, & Verhulst, almost never to 4 most of the time) the extent to which each
1996). To assess whether administering the YSR external- item applies to them. The total score is calculated by sum-
izing scales outside the standard item set of the entire YSR ming responses on all items. RADS-2 scores have shown
affected the variance of the scores, we compared the stan- adequate internal consistency (a = .92) and test–retest reli-
dard deviations (SDs) in our sample to the SDs of the Dutch ability (r = .80) in a sample of high school students, and the
general population sample (Verhulst et al., 1997). SDs were construct validity of scores on this measure has also been
highly similar for female adolescents in the two samples supported (e.g., scores on this scale have been found to dif-
(4.05 in the present sample vs. 4.51 in the general popula- ferentiate between clinically depressed adolescents and
tion for Aggressive Behavior; 2.26 vs. 2.21 for Delinquent nondepressed adolescents; Reynolds, 2002). Cronbach’s
Behavior) and somewhat higher for male adolescents in the alpha for the total scale was .90 in the present sample. The
142 Assessment 17(1)

RADS-2 was translated to Dutch using the procedure des­ Cronbach’s alphas were satisfactory to high within this ado-
cribed by Varni, Seid, and Rode (1999), including forward lescent sample (range = .72-.87; see Table 1).
and backward translation, and pilot testing.
Gender Differences in DERS Subscales
Procedure Next, we tested for measurement invariance between male
The adolescents’ parents received written information about and female participants, specified by subscale. Results are
the study and the possibility to disallow their children’s shown in Table 3. We started by fitting baseline sex differ-
participation. Adolescents themselves were informed about ence configural models, in which males (reference category)
the study in their classrooms and completed the question- were contrasted with females. Adequate model fit for this
naires after completing an informed assent form. Because model is a prerequirement for further testing of invariance.
assessment sessions lasted only 30 to 45 minutes per class, A latent factor was considered for each scale, indicated by
it was not possible for the students to complete all the mea- the items. The variance of the latent factor was fixed at 1,
sures of interest. Therefore, whereas all students completed and the means were fixed at 0 for both male and female
the DERS (N = 870), the other measures of interest in this adolescents. Factor loadings were freely estimated in both
study were distributed across participants, with 215 com- samples. All configural models had exact to acceptable fit
pleting the YSR Externalizing subscale, 212 completing the to the data (see Table 3).
SCARED, and 197 completing the RADS-2. Respondents Next, we specified metric invariance models in which
were assigned to one of the questionnaire packages ran- the factor loadings were held equal between the male and
domly, stratified by gender and age. On completion of the female samples, to test whether items contribute equally to
questionnaires, adolescents received a small gift in return the total score for male and female adolescents. In the male
for their participation. sample, the variance of the latent factor was fixed at 1,
whereas this was freely estimated in the female sample. The
means of the latent factors were fixed at 0 in both samples.
Results As these metric invariance models were nested within the
DERS Factor Structure: Confirmatory configural models, deterioration of model fit (usually
Factor Analysis in the Adolescent Sample assessed using the chi-square difference test) is the outcome
of interest. However, the chi-square difference test has sub-
We first tested whether the factor structure of the DERS in stantial power in large samples (n = 200) to detect small
our adolescent sample was equivalent to the structure found discrepancies of no theoretical or practical consequence
for adults using a confirmatory factor analysis (CFA). Six (Chen, Sousa, & West, 2005). We therefore considered only
latent variables were specified, corresponding to the six a decrease in the CFI greater than .01 to be an indication of a
subscales of the DERS, which were allowed to correlate. meaningful decrement in fit (see Cheung & Rensvold, 2002).
The CFA and all following structural models were analyzed Although some c2 difference tests were significant, no drop
in Mplus 4.21 (Muthén & Muthén, 1998-2007). Model fit in CFA > .01 was observed.
was determined through the comparative fit index (CFI) We then examined the factorial invariance of the DERS
and Tucker–Lewis Index (TLI; exact fit = 1.00, close fit = among female and male adolescents, to test whether the items’
0.95-0.99, acceptable fit = 0.90-0.95; Bentler & Bonett, intercepts are equivalent for males and females. Latent factor
1980) and root mean square error of approximation (RMSEA; means and variances were fixed at 0 and 1, respectively, in
exact fit = 0.00, close fit = 0.06-0.01, acceptable fit = 0.08- males, and estimated freely in females. A decrease in CFI >
0.06; Browne & Cudeck, 1993). Results are shown in Table 1. .01 was found for the subscales of Lack of Emotional Aware-
Based on model modification indices, Item 33 of the origi- ness (DCFI = .044), Difficulties Engaging in Goal-Directed
nal Difficulties Engaging in Goal-Directed Behavior When Behavior When Distressed (DCFI = .014), and Nonaccep-
Distressed scale (“When I’m upset, I have difficulty think- tance of Negative Emotional Responses (DCFI = .017).
ing about anything else”) was allowed to cross-load on the
Limited Access to ER Strategies scale. When allowing for this
cross-loading, model fit was acceptable (CFI = .92, TLI = .91, Mean Differences in DERS Between
RMSEA = .045; 90% CI = .043-.048), suggesting that the Males and Females
structure of the DERS in adolescents is equivalent to that A multivariate analysis of variance (MANOVA) on the
found among adults (Gratz & Roemer, 2004). The correla- DERS factors showed a significant overall effect of gender,
tions between the six subscales were low to medium in size Pillai’s Trace: F(6, 863) = 21.04, p < .001. No gender differ-
(range = -.12 to .54, median = .35), suggesting that the sub- ences were found for Difficulties Controlling Impulsive
scales tap different aspects of ER difficulties (see Table 2). Behaviors When Distressed. Female participants reported
Neumann et al. 143

Table 1. Factor Loadings for DERS Items Obtained From Confirmatory Factor Analysis in Dutch Adolescents (N = 870)

Item Factor Loadings

I. Lack of Emotional Awareness (a = .73 for boys and .76 for girls)
2. I pay attention to how I feel. .56
6. I am attentive to my feelings. .66
8. I care about what I am feeling. .79
10. When I’m upset, I acknowledge my emotions. .25
17. When I’m upset, I believe my emotions are valid and important. .57
34. I take time to figure out what I am really feeling. .49
II. Lack of Emotional Clarity (a = .74 for boys and .83 for girls)
1. I am clear about my feelings. .59
4. I have no idea how I am feeling. .57
5. I have difficulty making sense out of my feelings. .74
7. I know exactly how I am feeling. .59
9. I am confused about how I am feeling. .70
III. Difficulties Controlling Impulsive Behaviors When Distressed (a = .86 for boys and .83 for girls)
3. I experience my emotions as overwhelming and out of control. .38
14. When I’m upset, I become out of control. .81
19. When I’m upset, I feel out of control. .83
24. When I’m upset, I feel I can remain in control over my behavior. .62
27. When I’m upset, I have difficulty controlling my behavior. .72
32. When I’m upset, I lose control over my behavior. .83
IV. Difficulties Engaging in Goal-Directed Behaviors When Distressed (a = .81 for boys and .82 for girls)
13. When I’m upset, I have difficulty getting work done. .76
18. When I’m upset, I have difficulty focusing on other things. .77
20. When I’m upset, I can still get things done. .52
26. When I’m upset, I have difficulty concentrating. .79
33. When I’m upset, I have difficulty thinking about anything else. .44 [VI{.35}]
V. Nonacceptance of Negative Emotional Responses (a = .72 for boys and .81 for girls)
11. When I’m upset, I become angry at myself for feeling that way. .66
12. When I’m upset, I become embarrassed. .56
21. When I’m upset, I feel ashamed with myself. .63
23. When I’m upset, I feel like I am weak. .59
25. When I’m upset, I feel guilty. .62
29. When I’m upset, I become irritated with myself. .65
VI. Limited Access to ER Strategies (a = .80 for boys and .87 for girls)
15. When I’m upset, I believe I’ll remain that way for a long time. .67
16. When I’m upset, I believe that I’ll end up very depressed. .70
22. When I’m upset, I know that I can find a way to feel better. .40
28. When I’m upset, I believe there is nothing I can do to feel better. .67
30. When I’m upset, I start to feel very bad about myself. .68
31. When I’m upset, I believe that wallowing in it is all I can do. .77
35. When I’m upset, it takes me a long time to feel better. .68
36. When I’m upset, my emotions feel overwhelming. .65
Note: DERS = Difficulties in Emotion Regulation Scale; ER = Emotion Regulation; Numbers in square brackets indicate the factor on which an item
showed a cross-loading (given in {}).

significantly higher levels of Lack of Emotional Clarity, be interpreted with caution, as they may reflect gender-
Difficulties Engaging in Goal-Directed Behaviors When based differences in the ratings of items in addition to true
Distressed, Nonacceptance of Negative Emotional gender differences in these ER difficulties.
Responses, and Limited Access to ER Strategies. Male par-
ticipants reported higher levels of Lack of Emotional
Awareness (see Table 4). The observed gender differences DERS and Externalizing and Internalizing Problems
on the subscales Lack of Emotional Awareness, Difficulties Given that subsamples completed only one measure of psy-
Engaging in Goal-Directed Behavior When Distressed, and chopathology (see section Procedure), we first examined
Nonacceptance of Negative Emotional Responses should whether the subsamples differed on the DERS. Results of a
144 Assessment 17(1)

Table 2. Correlations Among DERS Factors in Adolescents inspected the questionnaires for possible overlapping items.
(N = 870) No evidence of item overlap between the SCARED and the
DERS was found. Furthermore, although five items of the
DERS Factors 1 2 3 4 5
RADS-2 had possible overlap with DERS items, exclusion
Lack of Emotional — of these overlapping items had only a minimal influence on
   Awareness the regression weights (change in bs = ±.01-.02).
Lack of Emotional .10* —
   Clarity
Difficulties Controlling .04 .34** — Discussion
   Impulsive Behavior
   when Distressed Results of the present study provide preliminary evidence
Difficulties Engaging in -.10* .35** .42** — for the utility of the DERS as a measure of ER difficulties
   Goal-Directed Behavior in adolescents. The factor structure of the DERS previously
  When Distressed established among adults was replicated in our adolescent
Nonacceptance of -.12** .35** .39** .37** — sample. Furthermore, metric invariance in the assessment
   Negative Emotional of ER difficulties between male and female adolescents was
   Responses
found for all subscales, and strong factorial invariance bet­
Limited Access to -.09* .47** .50** .54** .54**
   ER Strategies ween male and female adolescents was found for three of
the six subscales. Finally, results demonstrated a number of
Note: DERS = Difficulties in Emotion Regulation Scale; ER = Emotion gender differences in levels of self-reported ER difficulties
Regulation. 1 = Lack of Emotional Awareness; 2 = Lack of Emotional
Clarity; 3 = Difficulties Controlling Impulsive Behavior When Distressed;
as well as meaningful associations between DERS scores
4 = Difficulties Engaging in Goal-Directed Behavior When Distressed; and externalizing and internalizing problems.
5 = Nonacceptance of Negative Emotional Responses; 6 = Limited Findings from CFAs revealed that the structure of the
Access to Emotion Regulation Strategies. DERS in adolescents is equivalent to that previously found
*p < .01, one-tailed. **p < .001, one-tailed.
among adults. Furthermore, the internal consistency coef-
ficients of the factors were acceptable to high (average a
for the subscales = .81) and comparable with those reported
MANOVA showed no overall effect of sample on DERS by Gratz and Roemer (2004) in their adult sample (average
scores, Pillai’s Trace: F(12, 1234) = 1.65, p > .05. a for the subscales = .85).
Zero-order correlations between the DERS subscales With respect to gender differences in ER difficulties, find-
and each measure of psychopathology are given in Table 5. ings indicated factor loading equivalence for all subscales,
Small but statistically significant positive associations and strong factorial invariance for the Lack of Emotional
between DERS subscales and adolescent externalizing Clarity, Difficulties Controlling Impulsive Behaviors When
problems were found. Correlations between DERS sub- Distressed, and Limited Access to ER Strategies subscales.
scales and internalizing problems were generally large and With regard to the three subscales for which strong factorial
positive. invariance was not found (i.e., Lack of Emotional Aware-
To determine if particular DERS subscales are uniquely ness, Difficulties Engaging in Goal-Directed Behavior When
related to internalizing and externalizing problems, a series Distressed, and Nonacceptance of Negative Emotional Res­
of standard multiple regression analyses were conducted for ponses), a (limited) portion of the observed gender differences
each measure of psychopathology. The DERS subscales were obtained using these scales may reflect differences in the
entered together with gender in the first step of the equation interpretation or rating of some of the items, in addition to
(see Table 6). Results provide support for the differential rel- actual differences in ER difficulties. For all other subscales,
evance of particular DERS subscales to different forms of evidence of factorial invariance suggests that gender differ-
psychopathology. Specifically, both Difficulties Controlling ences in mean levels can be attributed to true differences in
Impulsive Behaviors When Distressed and Difficulties Eng­ self-reports of ER difficulties (cf. Gregorich, 2006).
aging in Goal-Directed Behavior When Distressed were Gender differences in levels of specific self-reported ER
associated with Aggressive Behavior; Lack of Emotional difficulties provided some support for the hypotheses, as
Awareness was associated with Delinquent Behavior; and female adolescents reported significantly greater emotional
Lack of Emotional Clarity, Nonacceptance of Negative nonacceptance, greater emotional awareness, and less access
Emotional Responses, and Limited Access to ER Strategies to effective ER strategies than male adolescents. Findings
were associated with Anxiety and Depression. that female adolescents may have less access to effective
Given that the associations of the DERS subscale scores ER strategies than their male counterparts are consistent with
with internalizing problems were somewhat stronger than findings that adolescent females score higher on measures
their associations with externalizing problems, we carefully of maladaptive coping than adolescent males (Hampel &
Neumann et al. 145

Table 3. Measurement Invariance Fit Statistics for DERS Factors for Female and Male Adolescents

Scale c2 df CFI TLI RMSEA 90% CI RMSEA Dc2 Ddf

Lack of Emotional Awareness (6)

Configural 2.74 12 1.000 1.000 0.00 0.00-0.00
Metric 16.00 17 1.000 1.000 0.00 0.00-0.04 13.26 5*
Strong factorial 74.69 22 0.956 0.940 0.07 0.06-0.09 58.69 5**
Lack of Emotional Clarity (5)
Configural 16.90 6 0.991 0.971 0.07 0.03-0.10
Metric 27.12 10 0.987 0.973 0.06 0.04-0.09 10.22 4*
Strong factorial 39.29 14 0.980 0.972 0.06 0.04-0.09 12.17 4*
Difficulties Controlling Impulsive Behavior When Distressed (6)
Configural 16.23 16 1.000 1.000 0.01 0.00-0.05
Metric 23.88 21 .999 .998 0.02 0.00-0.05 7.65 5
Strong factorial 34.06 26 .996 .996 0.03 0.00-0.05 10.18 5
Difficulties Engaging in Goal-Directed Behavior When Distressed (5)
Configural 17.20 8 0.994 0.984 0.05 0.02-0.09
Metric 19.07 12 0.995 0.992 0.04 0.00-0.07 1.87 4
Strong factorial 43.42 16 0.981 0.976 0.06 0.04-0.09 24.35 4**
Nonacceptance of Negative Emotional Responses (6)
Configural 26.05 14 0.990 0.978 0.04 0.02-0.07
Metric 37.57 19 0.985 0.976 0.05 0.02-0.07 11.52 5*
Strong factorial 63.46 24 0.968 0.960 0.06 0.04-0.08 25.89 5**
Limited Access to Emotion Regulation Strategies (8)
Configural 122.04 38 0.963 0.946 0.07 0.06-0.09
Metric 129.12 45 0.963 0.954 0.07 0.05-0.08 7.08 7
Strong factorial 156.80 52 0.954 0.951 0.07 0.06-0.08 27.68 7**
Note: DERS = Difficulties in Emotion Regulation Scale; CFI = comparative fit index; TLI = Tucker–Lewis index; RMSEA = root mean square error of
approximation.
*p < .05, two-tailed. **p < .001, two-tailed.

Table 4. Mean DERS, Anxiety, Depression, Aggression and Delinquency Scores (Standard Deviations) for Female and Male Adolescents

Total sample Males Females F Cohen’s d

DERS N = 870 n = 429 n = 441

Lack of Emotional Awareness 18.45 (4.92) 19.63 (4.74) 17.31 (4.81) 51.47** .49
Lack of Emotional Clarity 8.96 (3.27) 8.39 (3.00) 9.51 (3.46) 26.27** -.35
Difficulties Controlling Impulsive 10.82 (4.51) 10.94 (4.68) 10.71 (4.34) .58 .05
   Behavior When Distressed
Difficulties Engaging in Goal-Directed 14.50 (4.57) 13.71 (4.56) 15.27 (4.45) 25.99** -.35
   Behavior When Distressed
Nonacceptance of Negative 10.52 (4.00) 10.04 (3.59) 10.98 (4.31) 12.21** -.22
   Emotional Responses
Limited Access to ER Strategies 15.28 (5.64) 14.17 (4.80) 16.35 (6.17) 34.00** -.39
Externalizing N = 215 n = 108 n = 107
Aggression 7.77 (5.03) 8.21 (5.83) 7.32 (4.05) 1.71 .18
Delinquency 3.65 (3.11) 4.53 (3.57) 2.77 (2.26) 18.66** .59
Internalizing N = 212 n = 98 n = 114
Anxiety 55.39 (10.85) 50.74 (7.28) 59.38 (11.82) 39.54** -.88
Depression N = 197 n = 105 n = 92
51.45 (11.99) 48.86 (10.27) 54.41 (13.13) 11.04** -.48
Note: DERS = Difficulties in Emotion Regulation Scale; ER = Emotion Regulation. F values as obtained from (post hoc) univariate analyses of variance.
**p < .001, two-tailed.

Petermann, 2006). In addition, findings that male adolescents adolescents are consistent with Gratz and Roemer’s (2004)
reported lower levels of emotional awareness than female finding of gender differences on this subscale in particular.
146 Assessment 17(1)

Table 5. Zero-Order Correlations Between DERS Subscales and Externalizing and Internalizing Problems in Adolescents

YSR
RADS-2
Aggression Delinquency SCARED Anxiety Depression

DERS N = 215 N = 215 N = 210 N = 197

Lack of Emotional Awareness .10 .22** -.09 -.10

Lack of Emotional Clarity .07 -.01 .51*** .62***
Difficulties Controlling Impulsive Behavior When Distressed .30*** .10 .28*** .27***
Difficulties Engaging in Goal-Directed Behavior When Distressed .29*** .04 .48*** .29***
Nonacceptance of Negative Emotional Responses .11 .05 .52*** .52***
Limited Access to ER Strategies .25*** .07 .69*** .64***
Note: DERS = Difficulties in Emotion Regulation Scale;YSR = Youth Self-Report; SCARED = Screen for Child Anxiety Related Emotional Disorders;
RADS = Reynolds Adolescent Depression Scale; ER = Emotion regulation.
**p < .01, one-tailed. ***p < .001, one-tailed.

Table 6. Standardized Regression Weights of DERS Subscales Regressed on Internalizing and Externalizing Problems in Adolescents

YSR

Aggression Delinquency SCARED Anxiety RADS-2 Depression

DERS N = 215, R2 = .15 N = 215, R2 = .13 N = 210, R2 = .58 N = 197, R2 = .59

Lack of Emotional Awareness .12 .20** -.14 -.06

Lack of Emotional Clarity -.13 -.15 .21** .45***
Difficulties Controlling Impulsive .19* .04 -.13 -.04
   Behavior When Distressed
Difficulties Engaging in Goal-Directed .25** .04 .08 .06
   Behavior When Distressed
Nonacceptance of Negative -.03 .08 .20*** .23***
   Emotional Responses
Limited Access to ER Strategies .09 .07 .48**** .25***
Note: DERS = Difficulties in Emotion Regulation Scale; ER = Emotion Regulation.
*p < .05, two-tailed. **p < .01, two-tailed. ***p < .001, two-tailed.

Indeed, the effect sizes of these gender differences were com- behavior when distressed, and nonacceptance of negative
parable across these two studies (Cohen’s d = .42 as calculated emotional responses in particular may be due in part to the fact
from Gratz & Roemer’s, 2004, report, and d = .49 in the that boys and girls use a different zero-point in response to
present investigation). Contrary to hypotheses, however, some of the items of these subscales.
female adolescents also reported lower emotional clarity As expected, different dimensions of ER difficulties dem-
and greater difficulties engaging in goal-directed behaviors onstrated statistically significant and specific associations
when distressed. Furthermore, our hypothesis that male with both externalizing and internalizing problems, provid-
participants would report greater difficulties controlling ing support for the construct validity of DERS scores within
impulsive behaviors when distressed was not confirmed. this adolescent sample, as well as the utility (and distinctiv­
Although past studies have found that girls are better at eness) of the DERS subscales. Also, whereas ER difficulties
inhibiting inappropriate behavioral responses than boys together accounted for 15% and 13% of the variance in Aggres-
(Else-Quest et al., 2006), it is possible that boys develop sive Behavior and Delinquent Behavior, respectively, the
better inhibitory control as they age, becoming closer to DERS subscales accounted for 58% and 59% of the vari-
their female counterparts in this regard during adolescence. ance in Anxiety and Depression, respectively. Findings of a
Despite providing suggestive support for gender differ- stronger relationship between ER difficulties as assessed with
ences in levels of specific ER difficulties, however, it is the DERS and internalizing (vs. externalizing) problems are
important to note that findings of gender differences in lack consistent with the results of Garnefski et al. (2005), who
of emotional awareness, difficulties engaging in goal-directed found that cognitive ER strategies explained more of the
Neumann et al. 147

variance in internalizing than externalizing problems. Fur- Acknowledgment

thermore, the higher explained variance of DERS factors with
internalizing than with externalizing problems was not attrib- The staff and the students from the selected school are kindly
utable to item overlap between the DERS and internalizing thanked for their participation in the present study.
scales. Moreover, findings that ER difficulties accounted for
almost twice as much variance in aggressive behavior than Declaration of Conflicting Interests
in delinquent behavior are in line with past findings sug- The authors declared no potential conflicts of interests with respect
gesting that aggression implies more emotional involvement to the authorship and/or publication of this article.
than delinquency (specifically, psychopathic delinquency;
see Herpertz et al., 2001). Funding
Several limitations warrant consideration. First, the pres- The authors received no financial support for the research and/or
ent study was based on a general community sample, and authorship of this article.
associations might be different for clinical populations of
adolescents. Generalizability of the results is further restricted References
by the fact that all participants attended the same school. An Achenbach, T. M. (1991). Manual for the Youth Self Report and 1991
additional limitation is the exclusive reliance on self-report profiles. Burlington, VT: University Associates in Psychiatry.
measures, which may be influenced by an individual’s will- American Psychiatric Association. (1994). Diagnostic and statistical
ingness or ability to report accurately on their behaviors. manual of mental disorders (4th ed.). Washington, DC: Author.
Furthermore, whereas the sole use of self-report data does Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L.
not pose a limitation for our conclusions regarding the factor (2006). Using self-report assessment methods to explore facets
structure and internal consistency of the DERS scores in of mindfulness. Assessment, 13, 27-45.
this sample, it may have resulted in an overestimation of the Beauchaine, T. P., Gatzke-Kopp, L., & Mead, H. K. (2007). Poly-
links between ER difficulties and internalizing and exter- vagal theory and developmental psychopathology: Emotion
nalizing problems due to shared-method variance (e.g., dysregulation and conduct problems from preschool to adoles-
Fergusson & Horwood, 1987). Nonetheless, it is important cence. Biological Psychology, 74, 174-184.
to note that scores on the DERS and its subscales have been Bentler, P. B., & Bonett, D. G. (1980). Significance tests and
found to be associated with behavioral, neurological, and goodness-of-fit in the analyses of covariance structures. Psy-
experimental measures of related constructs, including behav- chological Bulletin, 88, 588-606.
ioral measures of the willingness to experience emotional Birmaher, B., Ketharpal, S., Brent, D., Cully, M., Balach, M.,
distress (Gratz et al., 2007), an experimental measure of ER Kaufman, J., et al. (1997). The screen for child anxiety related
(Gratz et al., 2006), and activation of the rostral anterior emotional disorders (SCARED): Scale construction and psy-
cingulate cortex (an area of the brain thought to be associ- chometric characteristics. Journal of the American Academy of
ated with inhibitory control) among cocaine-dependent Child and Adolescent Psychiatry, 36, 545-553.
patients (Li et al., 2008). Given that the DERS items focus Bradley, S. J. (2000). Affect regulation and the development of
primarily on the regulation of negative emotional states, psychopathology. New York: Guilford Press.
future research should examine the role of difficulties with Brody, L. R., & Hall, J. A. (1993). Gender and emotion. In J. Haviland &
the regulation of positive emotional states in adolescent M. Lewis (Eds.), Handbook of emotions (pp. 447-460). New
psychopathology as well. A final limitation regards the gen- York: Guilford Press.
eralizability of the relation between DERS scores and Browne, M. W., & Cudeck, R. (1993). Alternative ways of ass­essing
externalizing problems. Use of the YSR externalizing prob- model fit. Sociological Methods and Research, 21, 230-258.
lem items out of the context of the standard items may have Centraal Bureau voor de Statistiek. (2008a, April). Voortgezet
influenced the results in unknown ways. onderwijs; deelname van de leerlingen naar herkomstgroeper-
Despite the clear clinical significance of this line of rese­ ing [Secondary education; participation of students based on
arch, the study of ER in adolescents is still in its infancy. immigrant status]. Retrieved September 10, 2008, from http://
Future research needs to examine how dimensions of ER dif- statline.cbs.nl/StatWeb/table.asp?STB=G2,G3&LA=nl&D
ficulties develop over the course of adolescence, how they M=SLNL&PA=71215ned&D1=a&D2=l&D3=0-3&D4=0,
relate to the development of psychopathology, and the moder- 6-9&D5=a,!2,!5-9&D6=0-2&D7=a&D8=(l-2)-l&LYR=G1:0,
ating roles of personal and social factors (e.g., social relations G5:0,G6:0,G7:2&HDR=T,G4
and hormones and brain development) in the relationship Centraal Bureau voor de Statistiek. (2008b, August). Aantal leer-
between ER difficulties and psychopathology. This study sug- lingen in het voltijd voortgezet onderwijs [Number of full-
gests the potential utility of the DERS for future research on time students in secondary education]. Retrieved September
ER in adolescents, providing preliminary evidence for the 10, 2008, from http://statline.cbs.nl/StatWeb/table.asp?STB
reliability (specifically, internal consistency) and validity of =G1&LA=nl&DM=SLNL&PA=37545vol&D1=0&D2=0-4,
scores on this measure among community adolescents. 16-17,29,(l-3)-l&D3=a&D4=5,10,(l-1)-l&HDR=T,G2,G3
148 Assessment 17(1)

Chen, F. F., Sousa, K. H., & West, S. G. (2005). Testing measurement Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., &
invariance of second-order factor models. Structural Equation Gunderson, J. G. (2006). An experimental investigation of
Modeling, 12, 471-492. emotion dysregulation in borderline personality disorder. Jour-
Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness- nal of Abnormal Psychology, 115, 850-855.
of-fit indices for testing measurement invariance. Structural Gratz, K. L., Tull, M. T., Baruch, D. E., Bornovalova, M. A., &
Equation Modeling, 9, 233-255. Lejuez, C. W. (2008). Factors associated with co-occurring bor-
Cole, P. M., Michel, M., & Teti, L. (1994). The development of derline personality disorder among inner-city substance users:
emotion regulation and dysregulation: A clinical perspective. The roles of childhood maltreatment, negative affect intensity/
Monographs of the Society for Research in Child Develop- reactivity, and emotion dysregulation. Comprehensive Psychia-
ment, 59, 73-100. try, 49, 603-615.
de Groot, A., Koot, H. M., & Verhulst, F. C. (1996). Cross-cultural Gregorich, S. E. (2006). Do self-report instruments allow mean-
generalizability of the Youth Self-Report and Teacher’s Report ingful comparisons across diverse population groups? Testing
Form cross-informant syndromes. Journal of Abnormal Child measurement invariance using the confirmatory factor analy-
Psychology, 24, 651-664. ses framework. Medical Care, 44, 78-94.
Else-Quest, N. M., Hyde, J. S., Goldsmith, H. H., & van Hulle, C. A. Gross, J. J. (1998). The emerging field of emotion regulation: An
(2006). Gender differences in temperament: A meta-analysis. integrative review. Review of General Psychology, 2, 271-299.
Psychological Bulletin, 132, 33-72. Hale, W. W., III, Raaijmakers, Q., Muris, P., & Meeus, W. (2005).
Fergusson, D. M., & Horwood, L. J. (1987). The trait and method Psychometric properties of the Screen for Child Anxiety Related
components of ratings of conduct disorder: II. Factors relating Emotional Disorders (SCARED) in the general adolescent pop-
to the trait component of conduct disorder scores. Journal of ulation. Journal of the American Academy for Child and Ado-
Child Psychology and Psychiatry, 28, 261-272. lescent Psychiatry, 44, 283-290.
Fernandez-Berrocal, P., Alcaide, R., Extremera, N., & Pizarro, D. Hamilton, J. A., & Jensvold, M. (1992). Personality, psychopathol-
(2006). The role of emotional intelligence in anxiety and depres- ogy and depressions in women. In L. S. Brown & M. Ballou
sion among adolescents. Individual Differences Research, 4, (Eds.), Personality and psychopathology: Feminist reapprais-
16-27. als (pp. 116-143). New York: Guilford Press.
Fox, H. C., Axelrod, S. R., Paliwal, P., Sleeper, J., & Sinha, R. Hampel, P., & Petermann, F. (2006). Perceived stress, coping, and
(2007). Difficulties in emotion regulation and impulse control adjustment in adolescents. Journal of Adolescent Health, 38,
during cocaine abstinence. Drug and Alcohol Dependence, 89, 409-415.
298-301. Herpertz, S. C., Werth, U., Lukas, G., Qunaibi, M., Schuerkens, A.,
Garnefski, N., Kraaij, V., & Spinhoven, P. (2002). CERQ: Manual Kunert, H., et al. (2001). Emotion in criminal offenders with
for the use of the cognitive emotion regulation questionnaire. psychopathy and borderline personality disorder. Archives of
Leiderdorp, Netherlands: DATEC. General Psychiatry, 58, 737-745.
Garnefski, N., Kraaij, V., & van Etten, M. (2005). Specificity of Johnson, K. A., Zvolensky, M. J., Marshall, E. C., Gonzalez, A.,
relations between adolescents’ cognitive emotion regulation Abrams, K., & Vujanovic, A. A. (2008). Linkages between cig-
strategies and internalizing and externalizing psychopathology. arette smoking outcome expectancies and negative emotional
Journal of Adolescence, 28, 619-631. vulnerability. Addictive Behaviors, 33, 1416-1424.
Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., Kincaid, J. P., Fishburne, R. P., Rogers, R. L., & Chissom, B. S.
& Lejuez, C. W. (2007). A laboratory-based study of the rela- (1975). Derivation of new readability formulas for navy enlisted
tionship between childhood abuse and experiential avoidance personnel. Millington, TN: Navy Research Branch.
among inner-city substance users: The role of emotional non- Lengua, L. J. (2002). The contribution of emotionality and self-
acceptance. Behavior Therapy, 38, 256-268. regulation to the understanding of children’s responses to mul-
Gratz, K. L., Paulson, A., Jakupcak, M., & Tull, M. T. (2009). tiple risks. Child Development, 73, 144-161.
Exploring the relationship between childhood maltreatment and Li, C. R., Huang, C., Yan, P., Bhagwagar, Z., Milivojevic, V., &
intimate partner abuse: Gender differences in the mediating role Sinha, R. (2008). Neural correlates of impulse control during
of emotion dysregulation. Violence and Victims, 24, 68-82. stop signal inhibition in cocaine-dependent men. Neuropsy-
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment chopharmacology, 33, 1798-1806.
of emotion regulation and dysregulation: Development, factor Luebbers, S., Downey, L. A., & Stough, C. (2007). The develop-
structure, and initial validation of the Difficulties in Emotion ment of an adolescent measure of EI. Personality and Indi-
Regulation Scale. Journal of Psychopathology and Behavioral vidual Differences, 42, 999-1009.
Assessment, 26, 41-54. Muris, P., Merckelbach, H., Mayer, B., van Brakel, A., Thissen, S.,
Gratz, K. L., & Roemer, L. (2008). The relationship between Moulaert, V., et al. (1998). The Screen for Child Anxiety
emotion dysregulation and deliberate self-harm among female Related Emotional Disorders (SCARED) and traditional child-
undergraduate students at an urban commuter university. Cog- hood anxiety measures. Journal of Behavior Therapy and
nitive Behaviour Therapy, 37, 14-25. Experimental Psychiatry, 29, 327-339.
Neumann et al. 149

Muthén, L. K., & Muthén, B. O. (1998-2007). Mplus users’ guide J. J. Gross (Ed.), Handbook of emotion regulation (pp. 269-286).
(4th ed.). Los Angeles, CA: Muthén & Muthén. New York: Guilford Press.
Petrides, K. V., Frederickson, N., & Furnham, A. (2004). The role Thompson, R. A. (1994). Emotion regulation: A theme in search
of trait emotional intelligence in academic performance and of definition. Monographs of the Society for Research in Child
deviant behavior at school. Personality and Individual Differ- Development, 59, 25-52.
ences, 36, 277-293. Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007).
Reynolds, W. M. (2002). Reynolds Adolescent Depression Scale: A preliminary investigation of the relationship between emo-
Professional manual (2nd ed.). Lutz, FL: Psychological Assess- tion regulation difficulties and posttraumatic stress symptoms.
ment Resources. Behavior Therapy, 38, 303-313.
Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Tull, M. T., & Gratz, K. L. (2008). Further examination of the rela-
Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emo- tionship between anxiety sensitivity and depression: The medi-
tion regulation difficulties in generalized anxiety disorder: ating role of experiential avoidance and difficulties engaging
Preliminary evidence for independent and overlapping contri- in goal-directed behavior when distressed. Journal of Anxiety
butions. Behavior Therapy, 40, 142-154. Disorders, 22, 199-210.
Salovey, P., Mayer, J. D., Goldman, S. L., Turvey, C., & Palfai, Tull, M. T., & Roemer, L. (2007). Emotion regulation difficul-
T. P. (1995). Emotional attention, clarity, and repair: Exploring ties associated with the experience of uncued panic attacks:
emotional intelligence using the trait meta-mood scale. In Evidence of experiential avoidance, emotional nonaccep-
J. W. Pennebaker (Ed.), Emotion, disclosure, and health (pp. 125-154). tance, and decreased emotional clarity. Behavior Therapy,
Washington, DC: American Psychological Association. 38, 378-391.
Salters-Pedneault, K., Roemer, L., Tull, M., Rucker, L., & Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL: Mea-
Mennin, D. S. (2006). Evidence of broad deficits in emotion surement model for the Pediatric Quality of Life Inventory.
regulation associated with chronic worry and generalized anxi- Medical Care, 37, 126-139.
ety disorder. Cognitive Therapy and Research, 30, 469-480. Verhulst, F. C., van der Ende, J., & Koot, H. M. (1997). Han-
Shields, A., Cicchetti, D., & Ryan, R. M. (1994). The development dleiding voor de Youth Self-Report (YSR) [Manual for the
of emotional and behavioral self-regulation and social compe- Youth Self-Report]. Rotterdam, The Netherlands: Afdel-
tence among maltreated school-age children. Development and ing Kinder-en jeugdpsychiatrie, Sophia Kinderziekenhuis/
Psychopathology, 6, 57-75. Academisch Ziekenhuis Rotterdam/Erasmus Universiteit
Silk, J. S., Steinberg, L., & Morris, S. A. (2003). Adolescents’ Rotterdam.
emotion regulation in daily life: Links to depressive symptoms Vujanovic, A. A., Zvolensky, M. J., & Bernstein, A. (2008). The
and problem behavior. Child Development, 74, 1869-1880. interactive effects of anxiety sensitivity and emotion dysregu-
Southam-Gerow, M. A., & Kendall, P. (2001). Emotion regulation lation in predicting anxiety-related cognitive and affective
and understanding implications for child psychopathology and symptoms. Cognitive Therapy and Research, 32, 803-817.
therapy. Clinical Psychology Review, 22, 189-222. Zeman, J., Cassano, M., Perry-Parrish, & Stegall, S. (2006). Emo-
Stegge, G. T. M., & Meerum Terwogt, M. (2007). Awareness and tion regulation in children and adolescents. Developmental and
regulation of emotion in typical and atypical development. In Behavioral Pediatrics, 27, 155-168.