The Importance of Being Flexible

How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal

It has been suggested that reappraisal strategies are more effective than suppression strategies for regulating emotions. Recently, proponents of the acceptance-based behavior therapy movement have further emphasized the importance of acceptance-based emotion regulation techniques. In order to directly compare these different emotion regulation strategies, 202 volunteers were asked to give an impromptu speech in front of a video camera. Participants were randomly assigned to one of three groups. The Reappraisal group was instructed to regulate their anxious arousal by reappraising the situation; the Suppression group was asked to suppress their anxious behaviors; and the Acceptance group was instructed to accept their anxiety. As expected, the Suppression group showed a greater increase in heart rate from baseline than the Reappraisal and Acceptance groups. Moreover, the Suppression group reported more anxiety than the Reappraisal group. However, the Acceptance and Suppression groups did not differ in their subjective anxiety response. These results suggest that both reappraising and accepting anxiety is more effective for moderating the physiological arousal than suppressing anxiety. However, reappraising is more effective for moderating the subjective feeling of anxiety than attempts to suppress or accept it.

The neural correlates of trait resilience when anticipating and recovering from threat

A facet of emotional resilience critical for adapting to adversity is flexible use of emotional resources. We hypothesized that in threatening situations, this emotional flexibility enables resilient people to use emotional resources during appropriately emotional events, and conserve emotional resources during innocuous events. We tested this hypothesis using functional magnetic resonance imaging in a repeated recovery from threat task with low- and high-trait resilient individuals (LowR and HighR, respectively, as measured by ER89). In an event-related design, 13 HighR and 13 LowR participants viewed 'threat' cues, which signaled either an aversive or neutral picture with equal probabilities, or 'nonthreat' cues, which signaled a neutral picture. Results show that when under threat, LowR individuals exhibited prolonged activation in the anterior insula to both the aversive and neutral pictures, whereas HighR individuals exhibited insula activation only to the aversive pictures. These data provide neural evidence that in threatening situations, resilient people flexibly and appropriately adjust the level of emotional resources needed to meet the demands of the situation.

The impact of pretrauma analogue GAD and posttraumatic emotional reactivity following exposure to the September 11 terrorist attacks: a longitudinal study

The relation between analogue generalized anxiety disorder (GAD) assessed the day before the events of September 11, 2001 (9/11) and long-term outcome was examined in 44 young adults who were directly exposed the following day to the terrorist attacks in New York City. After controlling for high exposure to the attacks, preattack analogue GAD was associated with greater social and work disability, loss of psychosocial resources, anxiety and mood symptoms, and worry, but not symptoms of posttraumatic stress, assessed 12 months after 9/11. Fear and avoidance of emotions assessed 4 months after 9/11 statistically mediated the relation between preattack analogue GAD and social and work disability, loss of psychosocial support, mood and anxiety symptoms, and worry at 12-month follow-up. Avoidance of emotions 4 months after 9/11 also mediated the relation between preattack analogue GAD and posttraumatic stress symptoms 12 months after 9/11.

The social-emotional processing stream: five core constructs and their translational potential for schizophrenia and beyond

BACKGROUND

Cognitive neuroscience approaches to translational research have made great strides toward understanding basic mechanisms of dysfunction and their relation to cognitive deficits, such as thought disorder in schizophrenia. The recent emergence of Social Cognitive and Affective Neuroscience has paved the way for similar progress to be made in explaining the mechanisms underlying the social and emotional dysfunctions (i.e., negative symptoms) of schizophrenia and that characterize virtually all DSM Axis I and II disorders more broadly.

METHODS

This article aims to provide a roadmap for this work by distilling from the emerging literature on the neural bases of social and emotional abilities a set of key constructs that can be used to generate questions about the mechanisms of clinical dysfunction in general and schizophrenia in particular.

RESULTS

To achieve these aims, the first part of this article sketches a framework of five constructs that comprise a social-emotional processing stream. The second part considers how future basic research might flesh out this framework and translational work might relate it to schizophrenia and other clinical populations.

CONCLUSIONS

Although the review suggests there is more basic research needed for each construct, two in particular--one involving the bottom-up recognition of social and emotional cues, the second involving the use of top-down processes to draw mental state inferences--are most ready for translational work.

Facilitating adaptive emotional analysis: distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction

Two studies examined the psychological processes that facilitate adaptive emotional analysis. In Study 1, participants recalled a depression experience and then analyzed their feelings from either a self-immersed (immersed-analysis) or self-distanced (distanced-analysis) perspective. Participants in the distanced-analysis group focused less on recounting their experience and more on reconstruing it, which in turn led to lower levels of depressed affect. Furthermore, comparisons to a distraction group indicated that distanced-analysis was as effective as distraction in reducing depressed affect relative to the immersed-analysis group. Study 2 replicated these findings and showed that both 1 day and 7 days after the experimental manipulations, participants in the distanced-analysis group remained buffered against depressed affect and reported experiencing fewer recurring thoughts about their depression experience over time compared to both the immersed-analysis and distraction groups.

The human capacity to thrive in the face of potential trauma

For decades, researchers have documented remarkable levels of resilience in children who were exposed to corrosive early environments, such as those in which poverty or chronic maltreatment were present; however, relatively little research has examined resilience in children or adults who were exposed to isolated and potentially traumatic events. The historical emphasis on psychological and physiologic dysfunction after potentially traumatic events has suggested that such events almost always produce lasting emotional damage. Recent research, however, has consistently shown that across different types of potentially traumatic events, including bereavement, serious illness, and terrorist attack, upward of 50% of people have been found to display resilience. Research has further identified substantial individual variation in response to potentially traumatic events, including 4 prototypical and empirically derived outcome trajectories: chronic dysfunction, recovery, resilience, and delayed reactions. Factors that promote resilience are heterogeneous and include a variety of person-centered variables (eg, temperament of the child, personality, coping strategies), demographic variables (eg, male gender, older age, greater education), and sociocontextual factors (eg, supportive relations, community resources). It is surprising that some factors that promote resilience to potentially traumatic events may be maladaptive in other contexts, whereas other factors are more broadly adaptive. Given the growing evidence that resilience is common, psychotherapeutic treatment should be reserved for those in genuine need.

Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies

Extending previous work, we conducted two studies concerning the toxic influences of experiential avoidance (EA) as a core mechanism in the development and maintenance of psychological distress, and disruption of pleasant, engaging, and spontaneous activity. Of particular interest was whether EA accounted for relationships between coping and emotion regulation strategies on anxiety-related pathology (Study 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). In Study 1, EA mediated the effects of maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears). In Study 2, EA completely mediated the effects of two emotion regulation strategies (i.e., suppression and reappraisal) on daily negative and positive experiences and was associated with diminished daily positive affective experiences and healthy life appraisals, diminished frequency of positive events and more frequent negative life events, and greater negative affective experiences. The present data show that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA. Further consideration of experiential avoidance as a generalized diathesis and toxic process will be useful in improving our understanding of the etiology, phenomenology, and treatment of anxiety conditions, general human suffering, and disruptions in hedonic capacity.

Acceptance and mindfulness-based therapy: new wave or old hat?

Some contemporary theorists and clinicians champion acceptance and mindfulness-based interventions, such as Acceptance and Commitment Therapy (ACT), over cognitive-behavioral therapy (CBT) for the treatment of emotional disorders. The objective of this article is to juxtapose these two treatment approaches, synthesize, and clarify the differences between them. The two treatment modalities can be placed within a larger context of the emotion regulation literature. Accordingly, emotions can be regulated either by manipulating the evaluation of the external or internal emotion cues (antecedent-focused emotion regulation) or by manipulating the emotional responses (response-focused emotion regulation). CBT and ACT both encourage adaptive emotion regulation strategies but target different stages of the generative emotion process: CBT promotes adaptive antecedent-focused emotion regulation strategies, whereas acceptance strategies of ACT counteract maladaptive response-focused emotion regulation strategies, such as suppression. Although there are fundamental differences in the philosophical foundation, ACT techniques are fully compatible with CBT and may lead to improved interventions for some disorders. Areas of future treatment research are discussed.

Differential Effects of Incongruent Anger Expression on Memory Performance

Abstract. There is growing evidence that certain strategies of emotion regulation may lead to impaired cognitive performance. The present study investigated the impact of manipulated discrepancy between felt and displayed anger on cognitive performance and how it is modulated by extraversion. Fifty-six female participants were asked to solve two blocks of anagrams. Additionally, half of the subjects were instructed to show an angry emotional expression while solving the second block of anagrams, the remaining half were asked to keep their expression neutral. Before the second anagram trial, half of the participants were provoked, half of them were not. The subsequent unexpected memory test revealed a detrimental effect of the incongruent anger expression on the recall of the anagram solutions seen in the second trial. Compared to participants low on extraversion, high extraverts appeared to profit from showing an emotional display that was congruent with their feelings.

Chinese widowers' self-perception of growth: an exploratory study

Presence of growth after traumatic events was introduced to the academic community about a decade ago (Tedeschi & Calhoun, 1995). From the conventionally neglected perspective of Chinese widowers, this paper reports seventeen Chinese widowers' views on growth after conjugal loss. Findings seem to suggest that Chinese widowers would define growth as human learning, a definition probably influenced by Confucian teachings. Furthermore, contrary to claims made by Tedeschi and Calhoun (2004), it was found that growth may occur for some individuals without the presence of distress if the individuals have either a stable philosophy of life and death or optimism to buffer their distress or a sense of responsibility to suppress their distress.

Emotion experience and expression across the adult life span: insights from a multimodal assessment study

This investigation represents a multimodal study of age-related differences in experienced and expressed affect and in emotion regulatory skills in a sample of young, middle-aged, and older adults (N=96), testing formulations derived from differential emotions theory. The experimental session consisted of a 10-min anger induction and a 10-min sadness induction using a relived emotion task; participants were also randomly assigned to an inhibition or noninhibition condition. In addition to subjective ratings of emotional experience provided by participants, their facial behavior was coded using an objective facial affect coding system; a content analysis also was applied to the emotion narratives. Separate repeated measures analyses of variance applied to each emotion domain indicated age differences in the co-occurrence of negative emotions and co-occurrence of positive and negative emotions across domains, thus extending the finding of emotion heterogeneity or complexity in emotion experience to facial behavior and verbal narratives. The authors also found that the inhibition condition resulted in a different pattern of results in the older versus middle-aged and younger adults. The intensity and frequency of discrete emotions were similar across age groups, with a few exceptions. Overall, the findings were generally consistent with differential emotions theory.

Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center

This study examined the relationship between individual differences in adult attachment and psychological adaptation in a sample of high-exposure survivors of the terrorist attacks on the World Trade Center on September 11, 2001. Symptoms of posttraumatic stress disorder (PTSD) and depression were assessed via self-report 7 and 18 months after the attacks. In addition, friends and relatives were asked to provide evaluations of participants' adjustment before and after the attacks. Findings indicate that securely attached individuals exhibited fewer symptoms of PTSD and depression than insecurely attached individuals and were viewed by friends and relatives as showing an increase in adjustment following the attacks. Highly dismissing adults were viewed by their friends and family as showing neither increments nor decrements in adjustment, despite the fact that highly dismissing people self-reported relatively high levels of PTSD and depression.

The mellow years?: neural basis of improving emotional stability over age

Contrary to the pervasive negative stereotypes of human aging, emotional functions may improve with advancing age. However, the brain mechanisms underlying changes in emotional function over age remain unknown. Here, we demonstrate that emotional stability improves linearly over seven decades (12-79 years) of the human lifespan. We used both functional magnetic resonance imaging and event-related potential recording to examine the neural basis of this improvement. With these multimodal techniques, we show that better stability is predicted by a shift toward greater medial prefrontal control over negative emotional input associated with increased activity later in the processing sequence (beyond 200 ms after stimulus) and less control over positive input, related to a decrease in early activity (within 150 ms). This shift was independent from gray matter loss, indexed by structural magnetic resonance data. We propose an integrative model in which accumulated life experience and the motivation for meaning over acquisition in older age contribute to plasticity of medial prefrontal systems, achieving a greater selective control over emotional functions.

How to bite your tongue without blowing your top: implicit evaluation of emotion regulation predicts affective responding to anger provocation

People frequently have to control their emotions to function in life. However, mounting evidence suggests that deliberate emotion regulation often is costly. This presents a dilemma: Is it better to let emotions go or to pay the price of exerting costly control? In two studies, the authors explore whether emotion regulatory processes associated with implicit positive evaluation of emotion regulation might provide the benefits of successful emotion regulation without the costs. In Study 1, the authors introduce a measure of implicit evaluation of emotion regulation (ER-IAT). Study 2 examined whether this measure is associated with actual emotional responses to an anger provocation. It was found that greater ER-IAT scores were associated with lesser anger experience, fewer negative thoughts, lessened self-reported effortful emotion regulation, and an adaptive pattern of cardiovascular responding. These findings suggest that implicit positive evaluation of emotion regulation is associated with successful, automatic, and physiologically adaptive down-regulation of anger.

Mindfulness, acceptance, and hypnosis: Cognitive and clinical perspectives

The authors propose that hypnosis and mindfulness-based approaches can be used in tandem to create adaptive response sets and to deautomatize maladaptive response sets. They summarize recent research on the effectiveness of mindfulness-based approaches in clinical and nonclinical contexts and propose that the cognitive underpinnings of mindfulness approaches can be conceptualized in terms of the metacognitive basis of mindful attention, Toneatto's elucidation of the Buddhist perspective on cognition, and Kirsch and Lynn's response-set theory. They also suggest that mindfulness can serve as a template for generating an array of suggestions that provides cognitive strategies to contend with problems in living and to ameliorate stress and negative affect more generally. Many of the ideas the authors advance are speculative and are intended to spur additional research and clinical work.

Exercise and Psychobiological Processes

Interventions that reduce the magnitude of psychobiological responses are justified, at least in part, by the notion that exaggerated responses to stress can have detrimental effects on health. The biological processes underlying the association between stress and coronary heart disease (CHD) are thought to involve haemodynamic, neuroendocrine, inflammatory and haemostatic pathways. One of the many recognised benefits of exercise is in buffering physiological responses to psychosocial stressors, which is thought to be partly mediated by sympatho-inhibitory mechanisms, although other potentially important psychobiological processes such as inflammatory, neuroendocrine and haemostatic pathways have gained little attention. Thus, the present review focuses on the role of exercise in buffering psychobiological processes, particularly in relation to pathways that are directly relevant for reducing CHD risk. There are inconsistencies in the literature regarding the effects of exercise on cardiovascular responses to stressors, which may in part be accounted for by differences in experimental design, characteristics of participants, inadequate assessment of physical fitness, and the confounding effects of acute exercise. However, new emerging evidence suggests that exercise promotes an anti-inflammatory environment and increases tissue sensitivity to glucocorticoids, which may have implications for the effects of exercise on stress-induced inflammatory pathways. Future work should focus on the efficacy of exercise for promoting anti-inflammatory pathways in relation to psychosocial stress.

Resilience in the face of potential trauma: Clinical practices and illustrations

Many persons exposed to loss or potentially traumatic events manage the stresses of these experiences with minimal to no impact on their daily functioning. The prevalence of this resilient capacity has surprised researchers and clinicians alike and refocused clinical practice. We review three key points about resilience: resilience is different from the process of recovery; resilience in the face of loss or potential trauma is common; and there are multiple and sometimes unexpected pathways to resilience. We then present six clinical practices informed by the study of resilience, illustrating key points with clinical vignettes.

Relationship of resilience to personality, coping, and psychiatric symptoms in young adults

Developing a comprehensive understanding of resilience across the lifespan is potentially important for mental health promotion, yet resilience has been vastly understudied compared to disease and vulnerability. The present study investigated the relationship of resilience to personality traits, coping styles, and psychiatric symptoms in a sample of college students. Measures included the Connor-Davidson Resilience Scale, NEO Five Factor Inventory, Coping Inventory for Stressful Situations, and Brief Symptom Inventory. Results supported hypotheses regarding the relationship of resilience to personality dimensions and coping styles. Resilience was negatively associated with neuroticism, and positively related to extraversion and conscientiousness. Coping styles also predicted variance in resilience above and beyond the contributions of these personality traits. Task-oriented coping was positively related to resilience, and mediated the relationship between conscientiousness and resilience. Emotion-oriented coping was associated with low resilience. Finally, resilience was shown to moderate the relationship between a form of childhood maltreatment (emotional neglect) and current psychiatric symptoms. These results augment the literature that seeks to better define resilience and provide evidence for the construct validity of the Connor-Davidson Resilience Scale.

Psychologic functioning and physical health: a paradigm of flexibility

Recent evidence suggests that positive psychologic factors may be protective against coronary artery disease (CAD). We consider this possibility through a paradigm that explores three interrelated factors that may promote healthy psychologic functioning: vitality, emotional flexibility, and coping flexibility. Vitality is a positive and restorative emotional state that is associated with a sense of enthusiasm and energy. Flexibility is related both to the ability to regulate emotions effectively and cope effectively with challenging daily experiences. A variety of factors may diminish vitality, including chronic stress and negative emotions. Pathophysiologically, chronic stress and negative emotional states can both invoke a "chronic stress response" characterized by increased stimulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, with resultant peripheral effects, including augmented heart rate and blood pressure responsiveness and delayed recovery to stressful stimuli. Research indicates a wide array of stressful conditions--associated with either elements of relative inflexibility in psychologic functioning and/or relatively unabated stressful stimulation--that are associated with this type of exhausting hyperarousal. Conversely, new data suggest that positive psychologic factors, including positive emotions, optimism, and social support, may diminish physiological hyperresponsiveness and/or reduce adverse clinical event rates. Still other positive factors such as gratitude and altruistic behavior have been linked to a heightened sense of well-being but have not yet been tested for beneficial physiological effects. Pending further study, these observations could serve as the basis for expanding the potential behavioral interventions that may be used to assist patients with psychosocial risk factors for CAD.

The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology

Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.

Self-Enhancement Among High-Exposure Survivors of the September 11th Terrorist Attack: Resilience or Social Maladjustment?

The authors examined self-enhancing bias as a predictor of adjustment among individuals in or near the World Trade Center during the September 11, 2001, terrorist attacks. Resilience was defined from categorical and continuous analyses of both participant self-report and friend and relative ratings of adjustment. Self-enhancement was associated with a resilient outcome, ratings of better adjustment prior to September 11th, greater positive affect, and reduced perceptions of social constraints. Additional analyses indicated that self-enhancers' reduced symptom levels were fully mediated by their low perceived social constraints. However, consistent with previous evidence suggesting a social cost to self-enhancement, at 18 months post-September 11th, self-enhancers' friends and relatives also rated them as decreasing in social adjustment and as being less honest.