Changing Adolescent Beliefs about the Malleability of Emotions to Reduce Risk Behaviors and Improve Mental Health

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Background: Early adolescence is a key developmental period, in both the expansion of the Perception Box and engagement in health behaviors that can have lasting effects. Emotion regulation (ER) has a strong impact on these behaviors, including risk taking decisions (e.g., Wills et al., 2006) and mental health (Gross, 2014). However, the perception that emotions are uncontrollable in response to situational cues often interferes with engagement of ER processes, which are fundamental to emotional well-being (Ford & Gross, 2019). This is consistent with Dweck’s established work showing that beliefs in the malleability of intelligence are related to educational outcomes (Dweck et al., 1995). The proposed PI has developed a four-module digital intervention using activities, games, and videos to target ER development in three steps: 1) drawing the connection between feelings and behavior, 2) recognizing somatic cues that indicate unregulated emotions, and 3) teaching developmentally tailored strategies for managing emotions. By teaching ER in this way, an adolescent’s Perception Box is expected to expand by enhancing the belief that emotional experience can be changed. Indeed, in a small pilot trial (n=85) of the intervention, adolescents in the intervention condition showed marked improvements in emotional competence measures, including a moderate to large effect (d=.72; Houck et al., 2022) in beliefs that emotions are malleable, indicating preliminary efficacy for Perception Box expansion in this key area. Justification: The pilot study included only 85 youth and 3-months of follow-up; longer follow-up is needed to examine effects on real-world outcomes (e.g., risk behaviors and mental health) resulting from changes in emotion beliefs. It also did not include physiological measurement of ER. Aims: The proposed project will conduct a randomized controlled trial of 200 12-14 year-olds to examine intervention impact on perceived malleability of emotions, emotion regulation (ER), risk behaviors, and mental health. Hypotheses: The primary hypothesis is that intervention adolescents will report greater change (immediately after intervention and over 18 months) on the Implicit Theories of Emotion Scale, a measure of the belief in emotion malleability, when compared to adolescents in a waitlist comparison condition. It is also hypothesized that intervention participants will report fewer health risk behaviors (e.g., substance use, sexual risk, violence), endorse fewer mental health symptoms (e.g., anxiety, depression), and demonstrate faster RSA recovery in response to the virtual reality party at 18-month follow-up. Novelty: This project is innovative in its use of a developmentally tailored digital intervention designed to expand the perception that emotions can be changed and guide adolescents in ways to do so. In addition, the use of a virtual reality party scene, previously developed by this research lab (Hadley et al., 2014), provides a novel way of examining ER in response to risk behavior cues. Using respiratory sinus arrhythmia (RSA) as a marker of ER is also a novel addition to traditional self-report strategies. Methods: To accomplish the aims of the study, the team will 1) recruit early adolescents from middle schools; 2) conduct baseline assessments (prior to randomization) that include self-report, parent-report, and RSA in response to virtual reality; 3) administer the intervention to the intervention group after school (at school); 4) retain participants for follow-up assessments at 1-, 6-, 12-, and 18-month follow-ups; and 5) analyze and disseminate findings. Outputs: This project will generate data on the efficacy of the intervention for expanding the Perception Box (beliefs in emotion malleability), improving ER skills, delaying risk behaviors, and improving mental health. The sample size is expected to provide statistical power to inform conclusions for next steps of intervention use, as this cost-effective, digital intervention has high potential for engaging young people and being disseminated widely. Funded by Tiny Blue Dot Foundation.

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