Emotion Reulation and Neural Connectivity After Frustrative Non-Reward in Adolescents: The Moderating Role of Cognitive Flexibility

Difficulties with emotion regulation are implicated in internalizing and externalizing disorders common in adolescence. Cognitive flexibility is foundational for emotion regulation. Prior studies examining neural patterns of adolescent emotion regulation have mainly used emotionally-valenced stimuli to induce negative emotions. However, adolescents' neural recovery after frustrative non-reward, a novel paradigm engaging both emotion regulation and reward networks, and the role of cognitive flexibility during this recovery period remain unexplored. Twenty-seven treatment-seeking adolescents with varying emotion regulation abilities (mean age = 14.53 years, SD = 1.76) completed a monetary incentive delay task modified for frustration induction, where rewards were blocked after 60% of hit trials, differentiating reward blocked v. received conditions. The Difficulties in Emotion Regulation Scale and NIH Toolbox Dimensional Change Card Sort measured emotion regulation and cognitive flexibility, respectively. Whole-brain ANCOVAs examined associations between emotion regulation and ventral striatum connectivity during the recovery period following reward feedback, with cognitive flexibility as a moderator. Among clusters across temporo- and fronto-striatal networks, adolescents exhibiting more positive relationships between emotion regulation and cognitive flexibility demonstrated less connectivity after reward received v. blocked. Opposite patterns (greater connectivity after reward received v. blocked) were observed in adolescents exhibiting more negative relationships between emotion regulation and cognitive flexibility. Our findings support a cognitive flexibility-related pathway to emotion regulation and a compensatory, noncognitive flexibility-related pathway. These mechanisms may inform novel interventions for improving adolescent emotion regulation.