Child & Youth Care Forum

, Volume 44, Issue 2, pp 175–190 | Cite as

Building Emotion and Affect Regulation (BEAR): Preliminary Evidence from an Open Trial in Children’s Residential Group Homes in Singapore

  • R. Pat-Horenczyk
  • C. Sim Wei Shi
  • S. Schramm-Yavin
  • M. Bar-Halpern
  • L. J. Tan
Original Paper



The Building Emotion and Affect Regulation (BEAR) program is a theory-based group intervention for enhancing resilience in children, with a focus on strengthening emotion regulation. The BEAR is a 6-session protocol for children aged 7–12 who have been subject to traumatic life events.


This paper presents the guiding principles of the BEAR program, evaluates its feasibility and presents the preliminary evidence from an open trial among children in residential group homes in Singapore.


Ten BEAR groups (N = 73, mean age = 10.52, SD = 1.53) were conducted and evaluated with questionnaires for children, facilitators and caregivers before and after the intervention.


The BEAR program was well received by children, caregivers and facilitators. The children reported high enjoyment of the program, learning positive coping strategies, and elevated help-seeking behavior. Facilitators indicated that the content of the program was well understood by the children, and that the children cooperated well and showed high levels of competence in performing the tasks. Additionally, there were minimal signs of distress during the sessions. The caregivers reported an increase in emotion regulation, (p < 0.001, Cohen’s d = 0.437) and positive coping (p = 0.003, Cohen’s d = 0.389), as well as a decrease in general distress among the participants (p = 0.036, Cohen’s d = 0.266).


This study demonstrated the feasibility of the BEAR intervention in children’s residential group homes in Singapore and provided promising preliminary evidence for positive outcomes. There is a need for randomized controlled studies and further evidence from implementation of the BEAR program in other cultural contexts.


Emotion regulation Resilience Children Group intervention Residential group homes 



We are very grateful to the dedicated team of the Ministry of Social and Family Development (MSF) of Singapore for their contribution to the training of the BEAR program. Special appreciation goes to Jason Nga Yong Kwang and Ashley Ng Li Pin for their assistance in implementation and data collection. We thank Tomer Miron for joining us as a co-trainer in Singapore and sharing his clinical experience. The project was supported by the Israel Center for the Treatment of Psychotrauma and the Ministry of Social and Family Development (MSF) in Singapore


  1. American Psychiatric Association. (2011). Resilience for teens: Got bounce?
  2. Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858.CrossRefPubMedGoogle Scholar
  3. Baum, N. L., Cardozo, B. L., Pat-Horenczyk, R., Ziv, Y., Blanton, C., Reza, A., et al. (2013). Training teachers to build resilience in children in the aftermath of war: A cluster randomized trial. Child & Youth Care Forum, 42, 339–350.CrossRefGoogle Scholar
  4. Beers, S. R., & De Bellis, M. D. (2002). Neuropsychological function in children with maltreatment-related posttraumatic stress disorder. American Journal of Psychiatry, 159(3), 483–486.CrossRefPubMedGoogle Scholar
  5. Betancourt, T. S., & Khan, K. T. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry, 20(3), 317–328.CrossRefPubMedCentralPubMedGoogle Scholar
  6. Bonanno, G. A. (2012). Uses and abuses of the resilience construct: Loss, trauma and health-related adversities. Social Science and Medicine, 74, 753–756.CrossRefPubMedGoogle Scholar
  7. Bonanno, G. A., & Diminich, E. D. (2012). Annual Research Review: Positive adjustment to adversity—Trajectories of minimal-impact resilience and emergent resilience. Journal of Child Psychology and Psychiatry, 54(4), 378–401.CrossRefPubMedCentralPubMedGoogle Scholar
  8. Crittenden, P. M., & DiLalla, D. L. (1988). Compulsive compliance: The development of an inhibitory coping strategy in infancy. Journal of Abnormal Child Psychology, 16(5), 585–599.CrossRefPubMedGoogle Scholar
  9. DeRosa, R., & Pelcovitz, D. (2009). Group treatment of chronically traumatized adolescents: Igniting SPARCS of change. In D. Brom, R. Pat-Horenczyk, & J. Ford (Eds.), Treating traumatized children: risk, resilience and recovery (pp. 225–239). London: Routledge.Google Scholar
  10. Eisenberg, N., Smith, C. L., Sadovsky, A., & Spinrad, T. L. (2004). Effortful control. In K. D. Vohs & R. F. Baumeister (Eds.), Handbook of self-regulation: Research, theory, and applications (pp. 259–282). New York: Guilford Press.Google Scholar
  11. Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (2010). Emotion-related self-regulation and its relation to children’s maladjustment. Annual Review of Clinical Psychology, 6(1), 495–525.CrossRefPubMedCentralPubMedGoogle Scholar
  12. Fagan, A. A., & Mihalic, S. (2003). Strategies for enhancing the adoption of school-based prevention programs: Lessons learned from the Blueprints for Violence Prevention replications of the Life Skills Training program. Journal of Community Psychology, 31(3), 235–253.CrossRefGoogle Scholar
  13. Fernandez-Duque, D., Baird, J. A., & Posner, M. I. (2000). Executive attention and metacognitive regulation. Consciousness and Cognition, 9(2), 288–307.CrossRefPubMedGoogle Scholar
  14. Fonagy, P., & Target, M. (2003). Evolution of the interpersonal interpretive function. September, 11, 900–1113.Google Scholar
  15. Ford, J. D., & Russo, E. (2006). A trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for post-traumatic stress and addiction: Trauma affect regulation: Guidelines for education and therapy (TARGET). American Journal of Psychotherapy, 60, 335–355.PubMedGoogle Scholar
  16. Ford, D. J., Steinberg, K., Halbach-Moffitt, K., & Zhang, W. (2008). Breaking the cycle of trauma and criminal justice involvement: The mothers overcoming and managing stress (MOMS) study.
  17. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.CrossRefGoogle Scholar
  18. Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271.CrossRefGoogle Scholar
  19. Gross, J. J. (2013). Emotion regulation: Taking stock and moving forward. Emotion, 13(3), 359.CrossRefPubMedGoogle Scholar
  20. Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. Handbook of Emotion Regulation, 3, 24.Google Scholar
  21. Gurwitch, R. H., & Messenbaugh, A. (2001). Healing after trauma skills: A manual for professionals, teachers, and families working with children after trauma/disaster. Oklahoma City: Children’s Medical Research Foundation.Google Scholar
  22. Kagan, R. (2007). Real life heroes practitioners manual. New York: Routledge.Google Scholar
  23. Kinniburgh, K. J., Blaustein, M., Spinazzola, J., & Van der Kolk, B. A. (2005). Attachment, self-regulation, and competency. Psychiatric Annals, 35(5), 424–430.Google Scholar
  24. Lahad, M. (1993). BASIC Ph: The story of coping resources. In M. Lahad & A. Cohen (Eds.), Community stress prevention (pp. 117–145). Kiryat Shmona: Community Stress Prevention Center.Google Scholar
  25. Linehan, M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  26. Luthar, S. S. (2006). Resilience in development: A synthesis of research across five decades. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (2nd ed., pp. 739–795). New York: Wiley.Google Scholar
  27. Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227–238.CrossRefPubMedGoogle Scholar
  28. Masten, A. S. (2011). Resilience in children threatened by extreme adversity: Frameworks for research, practice, and translational synergy. Development and Psychopathology, 23, 141–154.Google Scholar
  29. Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53(2), 205.CrossRefPubMedGoogle Scholar
  30. Medical University of South Carolina. (2005). TF-CBT web. Retrieved from:
  31. Meichenbaum, D. (2009). Bolstering resilience: Benefiting from lessons learned. In D. Brom, R. Pat-Horenczyk, & J. D. Ford (Eds.), Treating traumatized children: Risk, resilience and recovery (pp. 183–188). New York: Routledge.Google Scholar
  32. Meiklejohn, J., Phillips, C., Freedman, M. L., Griffin, M. L., Biegel, G., Roach, A., et al. (2012). Integrating mindfulness training into K-12 education: Fostering the resilience of teachers and students. Mindfulness, 3(4), 291–307.CrossRefGoogle Scholar
  33. Miller, A. L., Rathus, J. H., & Linehan, M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford.Google Scholar
  34. New, A. S., Fan, J., Murrough, J. W., Liu, X., Liebman, R. E., Guise, K. G., et al. (2009). A functional magnetic resonance imaging study of deliberate emotion regulation in resilience and posttraumatic stress disorder. Biological Psychiatry, 66(7), 656–664.CrossRefPubMedGoogle Scholar
  35. Pat-Horenczyk, R., & Berger, R., Kaplinsky, N. & Baum. N. (2004). The journey to resilence: Coping with ongoing stressful situations. Protocol for guidance counselors (adolescents version). Unpublished Manuscript.Google Scholar
  36. Post, R. M., Weiss, S. R. B., Li, H., Smith, M. A., Zhang, L. X., Xing, G., et al. (1998). Neural plasticity and emotional memory. Development and Psychopathology, 10(04), 829–855.CrossRefPubMedGoogle Scholar
  37. Shonk, S. M., & Cicchetti, D. (2001). Maltreatment, competency deficits, and risk for academic and behavioral maladjustment. Developmental Psychology, 37(1), 3.CrossRefPubMedGoogle Scholar
  38. Silva, R. R., Cloitre, M., Davis, L., Levitt, J., Gomez, S., Nagi, I., et al. (2003). Early intervention with traumatized children. Psychiatric Quarterly, 74(4), 333–347.CrossRefPubMedGoogle Scholar
  39. Slone, M., & Shoshani, A. (2008). Efficacy of a school-based primary prevention program for coping with exposure to political violence. International Journal of Behavioral Development, 32, 348–358.CrossRefGoogle Scholar
  40. Southam-Gerow, M. A. (2013). Emotion regulation in children and adolescents: A Practitioner’s Guide. New York: Guilford Press.Google Scholar
  41. Southwick, S. M., & Charney, D. S. (2012). The science of resilience: Implications for the Prevention and treatment of depression. Science, 338, 79–82.CrossRefPubMedGoogle Scholar
  42. Streeck-Fischer, A., & Van der Kolk, B. A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian and New Zealand Journal of Psychiatry, 34(6), 903–918.CrossRefPubMedGoogle Scholar
  43. Troy, A. S., & Mauss, I. B. (2011). Resilience in the face of stress: Emotion regulation as a protective factor. In S. Southwick, D. Charney, M. Friedman, & B. Litz (Eds.), Resilience to stress (pp. 30–44). Cambridge: Cambridge University Press.Google Scholar
  44. Van der Kolk, B., & d’Andera, W. (2010). Toward a developmental trauma disorder diagnosis for childhood interpersonal trauma. In R. Lanius, E. Vermetten, & C. Pain (Eds.), The impact of early life trauma on health and disease. Cambridge: Cambridge University Press.Google Scholar
  45. Watson, C. C., Rich, B. A., Sanchez, L., O’Brien, K., & Alvord, M. K. (2014). Preliminary Study of Resilience-based Group therapy for improving the functioning of anxious children. Child & Youth Care Forum, 43(3), 269–286.CrossRefGoogle Scholar
  46. Waugh, C. E., Fredrickson, B. L., & Taylor, S. F. (2008). Adapting to life’s slings and arrows: Individual differences in resilience when recovering from an anticipated threat. Journal of Research in Personality, 42(4), 1031–1046.CrossRefPubMedCentralPubMedGoogle Scholar
  47. Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feeling: A meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin, 138(4), 775.CrossRefPubMedGoogle Scholar
  48. Wooding, S., & Raphael, B. (2004). Psychological impact of disasters and terrorism on children and adolescents: Experiences from Australia. Prehospital and Disaster Medicine, 19(01), 10–20.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • R. Pat-Horenczyk
    • 1
    • 2
  • C. Sim Wei Shi
    • 3
  • S. Schramm-Yavin
    • 1
  • M. Bar-Halpern
    • 4
  • L. J. Tan
    • 3
  1. 1.Israel Center for the Treatment of PsychotraumaHerzog HospitalJerusalemIsrael
  2. 2.School of Social Work and Social WelfareThe Hebrew University of JerusalemJerusalemIsrael
  3. 3.Clinical and Forensic Psychology Branch, Rehabilitation and Protection GroupMinistry of Social and Family DevelopmentSingaporeSingapore
  4. 4.McLean HospitalHarvard Medical SchoolBostonUSA

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