Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C)

Abstract

The Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) (Lippert et al., 2023) is an empirical psychometric instrument engineered to evaluate explicit avoidance-oriented and cognitive regulatory strategies utilized by youth during anticipatory anxiety-inducing situations. Emotion regulation (ER) impairments, specifically the reliance on maladaptive avoidance paradigms, constitute transdiagnostic vulnerabilities implicated in the etiology, maintenance, and clinical exacerbation of pediatric anxiety disorders. While extant childhood ER inventories predominantly assess overarching constructs such as generic cognitive reappraisal or emotional suppression, the BAER-C isolates the behavioral, verbal, interpersonal, and cognitive mechanisms underlying anticipatory avoidance.

The scale encompasses 21 self-report items distributed across five empirically derived dimensions: Behavioral Avoidance (6 items), Verbal Reassurance (2 items), Social Reassurance (3 items), Suppression (3 items), and Reappraisal (7 items). Respondents rate each statement on a 5-point Likert scale ranging from 1 (totally disagree) to 5 (totally agree), responding to the prompt condition “When I am anxious…”. Psychometric validation was conducted in cohorts of German community schoolchildren aged 8 to 14 years and clinical outpatients diagnosed with anxiety disorders aged 8 to 16 years, alongside their parents. Exploratory and confirmatory factor analyses confirmed an adequate fit for the five-factor model (TLI = .873–.890; CFI = .910; RMSEA = .070–.072; SRMR = .080; χ²/df = 1.54). Internal consistency coefficients demonstrate robust psychometric reliability, yielding an overall scale McDonald’s ω of .94, an overall avoidance composite Cronbach’s α of .86, and subscale reliabilities ranging from .78 to .85.

Convergent validity was established via significant correlations with the Spence Children’s Anxiety Scale (SCAS-C; r = .23, p < .001), while divergent validity was documented against the externalizing subscale of the Strengths and Difficulties Questionnaire (SDQ). By detailing avoidance profiles across situational anticipation, the BAER-C facilitates precision phenotyping in developmental psychopathology and serves as an outcome measure for pediatric cognitive-behavioral therapy (CBT).

Keywords

Avoidance-Based Emotion Regulation, Behavioral Avoidance, Children, Emotion Regulation, Reappraisal, Social Reassurance, Suppression, Verbal Reassurance, Anxiety, Cognitive Appraisal, Emotional Assessment, State Trait Level Measures, Stress Reactions

Authors

The BAER-C was conceptualized, developed, and standardized by a multi-institutional consortium of clinical child psychologists and psychotherapists in Germany:

• Michael W. Lippert, Ph.D. — Mental Health Research and Treatment Centre, Ruhr University Bochum, Germany. (ORCID: 0000-0002-5223-0137; Correspondence: [email protected]).
• Katharina Sommer, M.Sc. — Mental Health Research and Treatment Centre, Ruhr University Bochum, Germany. (ORCID: 0000-0002-3856-6697).
• Tabea Flasinski, M.Sc. — Mental Health Research and Treatment Centre, Ruhr University Bochum, Germany.
• Jan Schomberg, M.Sc. — Mental Health Research and Treatment Centre, Ruhr University Bochum, Germany.
• Verena Pflug, Ph.D. — Mental Health Research and Treatment Centre, Ruhr University Bochum, Germany. (ORCID: 0000-0002-6313-7296).
• Hanna Christiansen, Ph.D. — Department of Clinical Child and Adolescent Psychology, Philipps-University Marburg, Germany.
• Tina In-Albon, Ph.D. — Department of Clinical Child and Adolescent Psychology and Psychotherapy, University of Koblenz-Landau, Germany.
• Susanne Knappe, Ph.D. — Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
• Marcel Romanos, M.D. — Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Germany.
• Brunna Tuschen-Caffier, Ph.D. — Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany.
• Silvia Schneider, Ph.D. — Mental Health Research and Treatment Centre, Ruhr University Bochum, Germany. (ORCID: 0000-0003-0698-8411).

Purpose

The primary purpose of the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) is to isolate, differentiate, and quantify the specific avoidance mechanisms that children and adolescents mobilize when facing anticipated threat or distress. Anxiety disorders represent the most prevalent psychiatric conditions observed during childhood and adolescence, marked by profound distress, functional impairment across scholastic and interpersonal domains, and elevated risks for subsequent affective morbidity. Central to cognitive and behavioral models of pediatric anxiety is the premise that fear-conditioned stimuli elicit potent anticipatory distress, which individuals routinely counteract via immediate escape or persistent avoidance responses.

Although avoidance serves as an effective short-term down-regulator of sympathetic arousal and subjective dread, its deployment prevents cognitive habituation, inhibits inhibitory learning, and reinforces negative appraisals regarding personal vulnerability and situational catastrophic potential. In standard clinical paradigms, such behaviors are conceptualized as transdiagnostic maintenance mechanisms. Nonetheless, prior to the construction of the BAER-C, childhood emotion regulation assessments heavily prioritized broad, non-contextual constructs—such as global cognitive reappraisal, expressive suppression, rumination, or distraction (e.g., through generalized scales adapted directly from adult measures without developmental tailoring). Conventional tools regularly conflated overt behavioral avoidance with subtle intrapsychic avoidance, or omitted critical relational safety-seeking variants, including verbal and social reassurance seeking.

The BAER-C directly resolves this measurement gap. Specifically, it was constructed to fulfill four major objectives:

• Disaggregation of Avoidance Topographies: To decompose the heterogeneous construct of avoidance into discrete psychometric dimensions: overt behavioral retreat, proximity/contact-seeking social reassurance, repetitive questioning (verbal reassurance), covert thought suppression, and positive reappraisal mobilized in anticipation of fear.
• Anticipatory Contextualization: To contextualize self-reported emotion regulation specifically within prospective, anticipatory anxious states, capturing what the child attempts to do prior to or during the onset of subjective dread (“When I am anxious…”).
• Clinical Stratification and Safety-Behavior Identification: To assist clinicians in identifying subtle “safety behaviors” (such as compulsively seeking confirmation from caregivers or ensuring physical accompaniment) that masquerade as benign social connection but function functionally as avoidance mechanisms perpetuating anxiety pathology.
• Intervention Monitoring in Evidence-Based Psychotherapy: To function as a sensitive, developmentally appropriate treatment outcome metric in cognitive-behavioral therapy, particularly throughout graduated exposure therapy modules where the systemic fading of safety behaviors and avoidance strategies constitutes the primary therapeutic mechanism.

Psychological Construct

The BAER-C conceptualizes avoidance-based emotion regulation as a multi-channel operational matrix deployed to prevent, terminate, or attenuate distressing emotional experience. Rather than viewing avoidance as an undifferentiated, unitary defensive reflex, the instrument operationalizes five distinct cognitive, behavioral, and interpersonal regulatory dimensions:

1. Behavioral Avoidance

Behavioral avoidance denotes direct, overt, and physical actions aimed at circumventing, fleeing, or preventing contact with an anxiety-eliciting stimulus, context, or activity. In developmental psychopathology, behavioral avoidance represents the classic hallmark of phobic, panic, and generalized anxieties. This dimension captures both proactive preventive maneuvers (e.g., ensuring one never enters a situation where threat might materialize) and reactive termination actions (e.g., rapidly withdrawing from an ongoing environment). Children elevated on this dimension systematically restrict their experiential environment, sacrificing developmental milestones (e.g., school trips, classroom presentations, independent recreation) to preserve immediate perceived safety.

2. Verbal Reassurance

Verbal reassurance involves the repetitive, communicative elicitation of verbal confirmation from significant others (predominantly parents, educators, or peers) that imminent catastrophic outcomes will not transpire. Items in this subscale measure persistent inquiries regarding objective safety (e.g., repeatedly questioning if everything is going to be alright). In pediatric anxiety, verbal reassurance seeking operates as an externalized safety behavior; it provides transient alleviation of cognitive uncertainty and physiological panic at the expense of developing autonomous self-soothing capacities and distress tolerance.

3. Social Reassurance

Social reassurance assesses physical and proximity-based interpersonal anchoring behaviors designed to mitigate anticipated fear. Rather than seeking verbal declarations, the child attempts to avert distress by mandating the co-presence or physical proximity of a trusted attachment figure or companion. This strategy reflects interpersonal safety utilization: the child experiences severe panic when navigating challenging situations alone, but tolerates the context if another individual acts as an emotional buffer or surrogate regulator.

4. Suppression (Cognitive Avoidance)

Suppression in the BAER-C focuses on mental avoidance, characterized by deliberate, conscious efforts to forcibly evict, ignore, block, or forget distressing internal cues, intrusive images, and catastrophic thoughts. Derived from the theoretical traditions of thought suppression and cognitive avoidance, this dimension evaluates mental attempts to “push what makes me afraid out of my head.” Cognitive suppression is typically counterproductive; experimental literature confirms that attempts to suppress negative emotional content precipitate paradoxical rebound effects, escalating cognitive intrusion and prolonging emotional vulnerability.

5. Reappraisal

The reappraisal dimension measures cognitive attempts to reconstruct, reinterpret, or positively reframe an anxiogenic stressor to modify its emotional valence and reduce perceived threat. Within the BAER-C framework, reappraisal encompasses self-encouraging internal monologues (e.g., affirming personal coping capacity), perspective-taking (e.g., recognizing that the reality is not catastrophic), and cognitive reframing (e.g., finding adaptive meaning or positive elements within the challenge). Interestingly, within an anticipatory avoidance battery, reappraisal items also gauge efforts to cognitive-rationalize or minimize situations to modulate fear levels proactively.

Theoretical Framework

The theoretical architecture of the BAER-C is rooted in the synthesis of classic behavioral learning theories, cognitive models of anxiety maintenance, and contemporary process models of emotion regulation.

The Process Model of Emotion Regulation

The foundational bedrock of the BAER-C is derived from James J. Gross‘s (1998, 2015) Process Model of Emotion Regulation. Gross delineates five sequential points of intervention along the emotion-generative trajectory: situation selection, situation modification, attentional deployment, cognitive change, and response modulation. The BAER-C translates these theoretical loci into concrete pediatric behaviors:

• Situation Selection & Modification: Mapped onto Behavioral Avoidance, where the child selects out of contexts or modifies them by physical egress.
• Attentional Deployment & Cognitive Avoidance: Mapped onto Suppression, capturing internal strategies designed to direct attentional resources away from threat cues or suppress threat-related cognitions.
• Cognitive Change: Operationalized via the Reappraisal subscale, reflecting late-stage cognitive reinterpretations of situational meaning before full sympathetic mobilization occurs.
• Interpersonal / Relational Regulation: Extending beyond individualistic models, the BAER-C incorporates relational regulatory actions via Verbal Reassurance and Social Reassurance, acknowledging that pediatric emotion regulation is inherently interpersonal and co-regulated within attachment networks.

Mowrer’s Two-Factor Learning Theory and Functional Maintenance

Behavioral maintenance of anxiety rests firmly upon O. Hobart Mowrer‘s Two-Factor Theory. Mowrer posited that while classical conditioning accounts for the acquisition of fear (pairing neutral cues with unconditioned aversive stimuli), operant conditioning governs its maintenance. When a child engages in avoidance or enacts a safety behavior, the immediate consequence is the termination or attenuation of intense visceral distress.

This swift distress reduction serves as a powerful negative reinforcer, solidifying the child’s reliance on avoidance habits. Concurrently, because the individual removes themselves from the conditioned stimulus, extinction cannot occur. Inhibitory learning models (Michelle Craske et al., 2014) further underscore that avoidance behaviors forestall the critical mismatch between expected catastrophe and benign reality, systematically perpetuating cognitive bias and physiological reactivity across development.

Ironic Process Theory and Cognitive Avoidance

The Suppression facet of the BAER-C integrates Daniel Wegner’s Ironic Process Theory. Wegner illustrated that deliberate cognitive suppression involves two opposing operational systems: an intentional, conscious operating process that searches for mental distractors, and an automatic, unconscious monitoring process that scans for intrusions of the forbidden thought. Under cognitive load, stress, or intense physiological arousal (such as acute anxiety), the resource-intensive operating process degrades, while the automatic monitor continues unhindered, causing an ironic hyper-accessibility of the threatening cognition. By assessing suppression within anticipatory contexts, the BAER-C assesses the degree to which children deploy this paradoxical and cognitively exhaustive mechanism.

Validity

The psychometric evaluation of the BAER-C involved comprehensive testing of construct, convergent, and discriminant validity across both non-clinical student cohorts and a clinical sample of youth diagnosed with DSM-defined anxiety disorders (Lippert et al., 2023).

Convergent Validity

Convergent validity was established by evaluating the bivariate associations between the BAER-C subscales and validated measures of pediatric anxiety symptoms, specifically the Spence Children’s Anxiety Scale (SCAS-C; Spence, 1998). Consistent with theoretical predictions:

• The composite Total Avoidance Score demonstrated a statistically significant positive correlation with total anxiety symptoms on the SCAS-C (r = .23, p < .001).
• Independent avoidance subscales—namely Behavioral Avoidance, Verbal Reassurance, and Social Reassurance—exhibited significant positive correlations with the SCAS-C anxiety symptom indices (all rs > .17, all ps < .05).
• Interestingly, the Suppression subscale displayed an attenuated, non-significant direct correlation with the standard anxiety total scale in the primary validation cohort, suggesting that deliberate mental suppression may operate as a distinct internal regulatory strategy that diverges from overt panic symptomatology.

Discriminant and Divergent Validity

Discriminant validity was verified against general externalizing psychopathology using the Strengths and Difficulties Questionnaire (SDQ; Goodman et al., 2000):

• The avoidance subscales assessing Behavioral Avoidance, Social Reassurance, and Verbal Reassurance demonstrated no significant correlation with the SDQ externalizing symptom subscale (e.g., r = .01, p = .85), establishing that these core avoidance vectors specifically delineate internalizing anxiety pathology rather than general behavioral non-compliance or conduct difficulties.
• Conversely, unexpected patterns were documented regarding the SDQ internalizing and externalizing dimensions: within the non-clinical sample, only the Social Reassurance subscale correlated significantly with the SDQ internalizing problems scale.
• Moreover, the Suppression and Reappraisal subscales exhibited unexpected small positive correlations with SDQ externalizing scores. The authors theorized that youth experiencing behavioral dysregulation or impulsivity may invoke rudimentary suppression or surface-level cognitive rationalizations in an effort to regulate peer-related or instructional conflict. These complex patterns prompted Lippert et al. (2023) to note that while overall validity is promising, further multi-method research (e.g., using ecological momentary assessment and physiological stress testing) is required to clarify the boundaries of the construct.

Reliability

The BAER-C demonstrates robust psychometric reliability across internal consistency indices, evaluated using both conventional Cronbach’s α and modern composite reliability metrics (McDonald’s ω), which do not rely on the assumption of tau-equivalence.

Internal Consistency Metrics

In the primary empirical validation investigations across school-based community cohorts and outpatient clinical samples, the following parameters were documented:

• Overall Instrument Reliability: The total 21-item questionnaire demonstrated high internal consistency, yielding a McDonald’s ω coefficient of .94.
• Avoidance Composite Reliability: When aggregating the dedicated avoidance subscales into a unified global avoidance metric, the internal consistency remained substantial, with a Cronbach’s α of .86.
• Individual Subscale Reliability: Across all five isolated subscales, internal consistencies comfortably exceeded the standard psychometric adequacy threshold of .70, ranging from .78 to .85:

Subscale	Number of Items	Internal Consistency (α / ω)
Behavioral Avoidance	6	α = .81 – .84
Verbal Reassurance	2	α = .78 – .80
Social Reassurance	3	α = .80 – .83
Suppression	3	α = .79 – .82
Reappraisal	7	α = .82 – .85

Measurement Stability

The scale items demonstrated uniform discriminatory power without substantial variance degradation across clinical and non-clinical subgroups. While longitudinal test-retest reliability evaluations remain ongoing to evaluate sensitivity to developmental fluctuations, the internal cohesion across the latent factors confirms the instrument’s structural stability when measuring individual differences in children’s regulatory choices.

Factor Analysis

The structural composition of the BAER-C was established through systematic exploratory and confirmatory factor analytic procedures during instrument development.

Item Generation and Reduction

The development protocol began with an initial pool of 25 candidate items generated from clinical theoretical frameworks and review of empirical pediatric ER literature, accompanied by an open-ended question querying idiosyncratic ER strategies. All candidate items except one were deliberately phrased without negative syntax to mitigate pediatric cognitive comprehension errors.

Rigorous item difficulty analyses and corrected item-total correlations (discriminatory power) were calculated. Items failing to achieve a discriminatory power threshold of > .30 were excised. Consequently, three items were removed due to situational narrowness and poor discrimination (e.g., highly specific spatial behaviors such as “trying to hide in the room”). A final set of 21 psychometrically sound items was retained for structural modeling.

Exploratory Factor Analysis (EFA) & Parallel Analysis

To determine the latent dimensional framework, an exploratory factor analysis with oblique rotation was conducted on the item pool. An empirical parallel analysis indicated that a five-factor structure provided the most parsimonious and theoretically coherent fit, explaining 54% of the total cumulative variance across the indicators. The five identified latent factors corresponded precisely to Behavioral Avoidance, Reappraisal, Social Reassurance, Suppression, and Verbal Reassurance.

Confirmatory Model Fit Indices

The five-factor model was subsequently evaluated using confirmatory structural equation modeling across the validation samples. The model fit parameters confirmed acceptable-to-good correspondence with empirical data:

• Chi-Square to Degrees of Freedom Ratio: Although the formal χ² test reached statistical significance (χ²(184) = 288.81, p < .001)—a common finding in moderately sized samples—the relative ratio was well below conservative cutoffs: χ²/df = 1.54 (values < 2.0 or < 3.0 denote acceptable model fit).
• Root Mean Square Error of Approximation (RMSEA): .070 – .072, falling within the benchmark for reasonable approximate fit (RMSEA ≤ .08).
• Standardized Root Mean Square Residual (SRMR): .080, meeting the standard boundary criterion for acceptable structural models.
• Tucker-Lewis Index (TLI): Ranged from .873 to .890 across sample iterations.
• Comparative Fit Index (CFI): Reached .910. While TLI and CFI values resided marginally below the stringent, highly conservative .95 convention, they demonstrated adequate fit given the complexity of assessing multidimensional emotion regulation within childhood populations.

Instrument / Measurement Tool

The operational specifications of the BAER-C are summarized below:

• Instrument Name: Bochum Assessment of Avoidance-based Emotion Regulation for Children
• Acronym: BAER-C
• Test Type: Original psychometric inventory / self-report questionnaire
• Target Population: Children and adolescents; validated in school cohorts aged 8 to 14 years and clinical anxiety cohorts aged 8 to 16 years (with auxiliary parental applications)
• Administration Format: Standardized self-report pencil-and-paper or digital interactive questionnaire
• Item Count: 21 items across 5 core subscales (retained from a 25-item prototype)
• Prompt Condition: “When I am anxious…” (German original: “Wenn ich Angst habe…”)
• Subscale Structural Breakdown:
  • Behavioral Avoidance: 6 items (Items 2, 3, 9, 13, 20, 26)
  • Verbal Reassurance: 2 items (Items 5, 17)
  • Social Reassurance: 3 items (Items 12, 18, 22)
  • Suppression: 3 items (Items 7, 8, 28)
  • Reappraisal: 7 items (Items 4, 15, 16, 19, 21, 23, 27)
• Response Format: Five-point Likert scale:
  • 1 = totally disagree
  • 2 = disagree
  • 3 = partly agree / partly disagree
  • 4 = agree
  • 5 = totally agree
• Scoring Procedures:
  • Subscale Scores: Computed by summing or averaging the items designated within each specific subscale.
  • Overall Avoidance Composite Score: Derived by aggregating the behavioral, reassurance, and cognitive avoidance subscales.
  • Directionality: Higher scores reflect greater utilization of that specific emotion regulation or avoidance strategy when experiencing anticipatory fear.

Permissions & Fee and Test Year

The BAER-C was formally published and validated in 2023 by Michael W. Lippert and colleagues at the Ruhr University Bochum. In accordance with open-science initiatives, the instrument is published under the Creative Commons Attribution 4.0 International (CC BY 4.0) license.

Under this license, clinicians, researchers, and educators may freely utilize, reproduce, adapt, and distribute the instrument for empirical research, psychotherapeutic practice, and diagnostic instruction without paying licensing fees or royalties, provided appropriate academic attribution is accorded to the original authors and primary peer-reviewed citation (Lippert et al., 2023). Commercial redistribution, automated digital repackaging for profit, or unauthorized commercial trademarking is strictly regulated. Research inquiries regarding cross-cultural adaptations or parallel forms should be directed to the corresponding author, Dr. Michael W. Lippert ([email protected]).

References

• Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006
• Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. The British Journal of Psychiatry, 177(6), 534–539. https://doi.org/10.1192/bjp.177.6.534
• Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
• Gross, J. J. (2015). Emotion regulation: Conceptual and empirical foundations. In J. J. Gross (Ed.), Handbook of Emotion Regulation (2nd ed., pp. 3–20). The Guilford Press.
• Lippert, M. W., Sommer, K., Flasinski, T., Schomberg, J., Pflug, V., Christiansen, H., In-Albon, T., Knappe, S., Romanos, M., Tuschen-Caffier, B., & Schneider, S. (2023). Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C): Development and evaluation of a new instrument measuring anticipatory avoidance-based emotion regulation in anxiety eliciting situations. PLoS ONE, 18(1), Article e0279658. https://doi.org/10.1371/journal.pone.0279658
• Mowrer, O. H. (1956). Two-factor learning theory reconsidered, with special reference to secondary reinforcement and the concept of habit. Psychological Review, 63(2), 114–128. https://doi.org/10.1037/h0040613
• Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36(5), 545–566. https://doi.org/10.1016/S0005-7967(98)00034-5
• Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34–52. https://doi.org/10.1037/0033-295X.101.1.34

Items of the Scale