Seeing emotions, reading emotions: Behavioral and ERPs evidence of the regulation of pictures and words

Therapist reactions to patient personality: A pilot study of clinicians’ emotional and neural responses using three clinical vignettes from in treatment series

Introduction

Therapists’ responses to patients play a crucial role in psychotherapy and are considered a key component of the patient–clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective.

Methods

In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants’ high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients’ faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists’ responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists’ event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast.

Results

The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists’ late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy.

Discussion

These results, albeit preliminary, shed light on the role played by therapists’ memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed.

Dissociating the role of dACC and dlPFC for emotion appraisal and mood regulation using cathodal tDCS

Several neuroimaging studies have shown that a distributed network of brain regions is involved in our ability to appraise the emotions we experience in daily life. In particular, scholars suggested that the dorsal anterior cingulate cortex (dACC) may play a role in the appraisal of emotional stimuli together with subcortical regions, especially when stimuli are negatively valenced, and the dorsolateral prefrontal cortex (dlPFC) may play a role in regulating emotions. However, proofs of the causal role of these regions are lacking. In the present study, we aim at testing this model by stimulating both the dACC and the left dlPFC via cathodal tDCS. Twenty-four participants were asked to attend and rate the arousal and valence of negative and neutral emotional stimuli (pictures and words) in three different experimental sessions: cathodal stimulation of dACC, left dlPFC, or sham. In addition to the experimental task, the baseline affective state was measured before and after the stimulation to further assess the effect of stimulation over the baseline affective state after the experimental session. Results showed that cathodal stimulation of dACC, but not the left dlPFC, was associated with reduced arousal ratings of emotional stimuli, both compared with the sham condition. Moreover, cathodal stimulation of left dlPFC decreased participant's positive affective state after the session. These findings suggest for the first time, a dissociation between the dACC and dlPFC, with the former more involved in emotion appraisal, and the latter more involved in mood modulation.

Structural and functional brain networks of individual differences in trait anger and anger control: An unsupervised machine learning study

The ability to experience, use and eventually control anger is crucial to maintain well-being and build healthy relationships. Despite its relevance, the neural mechanisms behind individual differences in experiencing and controlling anger are poorly understood. To elucidate these points, we employed an unsupervised machine learning approach based on independent component analysis to test the hypothesis that specific functional and structural networks are associated with individual differences in trait anger and anger control. Structural and functional resting state images of 71 subjects as well as their scores from the State-Trait Anger Expression Inventory entered the analyses. At a structural level, the concentration of grey matter in a network including ventromedial temporal areas, posterior cingulate, fusiform gyrus and cerebellum was associated with trait anger. The higher the concentration, the higher the proneness to experience anger in daily life due to the greater tendency to orient attention towards aversive events and interpret them with higher hostility. At a functional level, the activity of the default mode network (DMN) was associated with anger control. The higher the DMN temporal frequency, the stronger the exerted control over anger, thus extending previous evidence on the role of the DMN in regulating cognitive and emotional functions in the domain of anger. Taken together, these results show, for the first time, two specialized brain networks for encoding individual differences in trait anger and anger control.

Self-face and emotional faces-are they alike?

The image of one’s own face is a particularly distinctive feature of the self. The self-face differs from other faces not only in respect of its familiarity but also in respect of its subjective emotional significance and saliency. The current study aimed at elucidating similarities/dissimilarities between processing of one’s own face and emotional faces: happy faces (based on the self-positive bias) and fearful faces (because of their high perceptual saliency, a feature shared with self-face). Electroencephalogram data were collected in the group of 30 participants who performed a simple detection task. Event-related potential analyses indicated significantly increased P3 and late positive potential amplitudes to the self-face in comparison to all other faces: fearful, happy and neutral. Permutation tests confirmed the differences between the self-face and all three types of other faces for numerous electrode sites and in broad time windows. Representational similarity analysis, in turn, revealed distinct processing of the self-face and did not provide any evidence in favour of similarities between the self-face and emotional (either negative or positive) faces. These findings strongly suggest that the self-face processing do not resemble those of emotional faces, thus implying that prioritized self-referential processing is driven by the subjective relevance of one’s own face.

Neurobiological models of emotion regulation: a meta-analysis of neuroimaging studies of acceptance as an emotion regulation strategy

Emotional acceptance is an important emotion regulation strategy promoted by most psychotherapy approaches. We adopted the Activation Likelihood Estimation technique to obtain a quantitative summary of previous fMRI (functional Magnetic Resonance Imaging) studies of acceptance and test different hypotheses on its mechanisms of action. The main meta-analysis included 13 experiments contrasting acceptance to control conditions, yielding a total of 422 subjects and 170 foci of brain activity. Additionally, subgroups of studies with different control conditions (react naturally or focus on emotions) were identified and analysed separately. Our results showed executive areas to be affected by acceptance only in the subgroup of studies in which acceptance was compared to natural reactions. In contrast, a cluster of decreased brain activity located in the posterior cingulate cortex (PCC)/precuneus was associated with acceptance regardless of the control condition. These findings suggest that high-level executive cortical processes are not a distinctive feature of acceptance, whereas functional deactivations in the PCC/precuneus constitute its specific neural substrate. The neuroimaging of emotional acceptance calls into question a key tenet of current neurobiological models of emotion regulation consisting in the necessary involvement of high-level executive processes to actively modify emotional states, suggesting a complementary role for limbic portions of the default system.

Less is more: Morphometric and psychological differences between low and high reappraisers

Emotion regulation plays a crucial role in an individual's well-being, as it is known that deficits in regulating emotions can lead to psychological and psychiatric disorders. Cognitive reappraisal is widely considered to be an adaptive and effective emotion-regulation strategy. People are more or less able to apply it, but it is still not clear how reappraisal affects brain structures and the psychological profile of individuals. In our study we thus aimed to explore the impact of applying reappraisal at both the neural and the psychological level. Source-based morphometry (SBM), a whole-brain multivariate method based on the Independent Component Analysis that extracts patterns of covariation of gray matter ("independent networks"), was applied to the MRI images of 37 participants. In order to enrich their psychological profiles, we measured their experienced affectivity (PANAS) and their empathic abilities (IRI). Based on the frequency of applying reappraisal (ERQ), participants were divided into low and high reappraisers (18 vs. 19). An independent source of gray matter emerged as being different between the groups: specifically, low reappraisers showed more gray matter volume concentration in a network including the frontal, temporal, and parietal regions as compared to high reappraisers. At the psychological level, low reappraisers reported a more strongly experienced negative affect, while no difference among reappraisers emerged with regard to empathic abilities. Capitalizing on a multivariate method for structural analysis that is innovative in this field, this study extends previous observations on individual differences in the ability to regulate emotions, and it describes a plausible impact of reappraisal on brain structures and affectivity.

Emotional Arousal and Valence Jointly Modulate the Auditory Response: A 40-Hz ASSR Study

Emotion is defined as a response to external stimuli and internal mental representations. It has been characterized as a multidimensional concept, primarily comprising two dimensions: valence and arousal. Existing studies have demonstrated that emotional experience exerts a powerful impact on auditory processing in terms of valence. However, it has also been shown that while negative emotion can improve auditory perception in healthy subjects, patients with depression show deficits in auditory perception. We thus speculated that both arousal and valence jointly modulate auditory perception. To examine the emotion-driven effects on the auditory response, we induced positive, negative, and neutral emotional states in healthy subjects and collected auditory steady-state response (ASSR) evoked by a 40-Hz chirp sound. We calculated peak-to-peak amplitude (PPA) and event-related spectral perturbation (ERSP) of evoked ASSRs and observed that the positive emotions significantly enhanced brain responses to auditory stimuli (p < 0.001), but that ASSRs in a negative state were not significantly enhanced compared with the neutral state. Subsequently, regression analysis showed a significant positive multiple linear relationship between the PPA and ratings of two emotional dimensions, indicating that arousal and valence jointly regulated the auditory cortex's synchronous oscillation, rather than the valence in isolation, offering the potential to clarify the conflicting results surrounding the role of negative emotions in auditory responses. Because depression is generally characterized by low arousal and low valence in actual life, whereas the negative emotion evoked under laboratory conditions is always with low valence but high arousal.

The impact of emotional content on pseudoword recognition

The present study investigates the influence of emotional information on language processing. To this aim, we measured behavioral responses and event-related brain potentials (ERPs) during four Italian lexical decision experiments in which we used emotionally intense and neutral pseudowords—i.e., pseudowords derived from changing one letter in a word (e.g., cammelto, derived from cammello ‘camel’ vs. copezzolo, from capezzolo ‘nipple’)—as stimuli. In Experiment 1 and 2, half of the pseudowords were emotionally intense and half were neutral, and were mixed with neutral words. In Experiment 3, the list composition was manipulated, with ¼ of the pseudowords being derived from emotionally intense words and ¾ derived from neutral words. Experiment 4 was identical to Experiment 1, but ERPs were recorded. Emotionally intense pseudowords were categorized more slowly than neutral pseudowords, with the difference emerging both in the mean and at the leading edge of the response times distribution. Moreover, emotionally intense pseudowords elicited smaller N170 and N400 than neutral pseudowords. These results speak in favor of a fast and multi-level infiltration of the emotional information into the linguistic process of word recognition.

Anxiety Regulation: From Affective Neuroscience to Clinical Practice

According to psychoanalysis, anxiety signals a threat whenever a forbidden feeling emerges. Anxiety triggers defenses and maladaptive behaviors, thus leading to clinical problems. For these reasons, anxiety regulation is a core aspect of psychodynamic-oriented treatments to help clients. In the present theoretical paper, we review and discuss anxiety generation and dysregulation, first from a neural point of view, presenting findings from neuroimaging and psychophysiological studies. The aim is to trace parallels with psychodynamic theories of anxiety. Then, we discuss the psychological mechanisms and neural bases of emotion regulation in the laboratory, and possible neurobiological mechanisms of anxiety regulation in psychotherapy. We describe two different approaches to emotion/anxiety regulation, one based on the standard cognitive model of emotion regulation, the other based on psychodynamic principles and affective neuroscience. We then illustrate in detail a dynamic experiential approach to regulation. This model claims that emotions arise before cognition and are not inherently dysregulated. Dysregulation emerges from co-occurrences of emotions and associated anxiety. Technical consequences of this model are discussed and include strategies to regulate anxiety.

Tune in to the right frequency: Theta changes when distancing from emotions elicited by unpleasant images and words

Emotion regulation allows humans to successfully modulate their reactions to life events. Whether regulation strategies may alter brain oscillatory activity and how they are influenced by format and emotional dimensions is still under debate. We investigated oscillatory brain dynamics during the implementation of the strategy of Distancing and during the regulation of the emotions elicited by neutral and unpleasant pictures and, for the first time, words. When implementing the strategy, an early increase in theta band in posterior regions was observed (Effect of Strategy). We interpret this effect as a marker of emotion regulation, and we suggest an integrative framework of the role of theta on regulatory processes. When regulating the emotional impact elicited by stimuli, a decrease in the theta and beta bands in posterior regions for pictures, but not for words, was observed (Effect of Regulation). Behaviorally, the Effect of Regulation was evident for both pictures and words and more pronounced for Valence than for Arousal. These results contribute to better understand the neural and behavioral features of Distancing (both Effect of Strategy and of Regulation), and open up the possibility to clarify which strategy works better to modulate specific stimulus types and emotional dimensions.

A Dual Route Model for Regulating Emotions: Comparing Models, Techniques and Biological Mechanisms

The aim of this article is to present recent applications of emotion regulation theory and methods to the field of psychotherapy. The term Emotion Regulation refers to the neurocognitive mechanisms by which we regulate the onset, strength, and the eventual expression of our emotions. Deficits in the regulation of emotions have been linked to most, if not all, psychiatric disorders, with patients presenting either dysregulated emotions, or dysfunctional regulatory strategies. We discuss the implications of regulating emotions from two different theoretical perspectives: the Cognitive Emotion Regulation (CER), and the Experiential-Dynamic Emotion Regulation (EDER) model. Each proposes different views on how emotions are generated, dysregulated and regulated. These perspectives directly influence the way clinicians treat such problems. The CER model views emotional dysregulation as due to a deficit in regulation mechanisms that prioritizes modifying or developing cognitive skills, whilst the EDER model posits emotional dysregulation as due to the presence of dysregulatory mechanisms that prioritizes restoring natural regulatory processes. Examples of relevant techniques for each model are presented including a range of cognitive-behavioral, and experiential (including both dynamic and cognitive) techniques. The aim of the paper is to provide a toolbox from which clinician may gain different techniques to enhance and maintain their patient’s capacity for emotional regulation. Finally, the biological mechanisms behind the two models of emotion regulation are discussed as well as a proposal of a dual route model of emotion regulation.

Effects of Differential Strategies of Emotion Regulation

Patients suffering from mental disorders, especially anxiety disorders, are often impaired by inadequate emotional reactions. Specific aspects are the insufficient perception of their own emotional states and the use of dysfunctional emotion regulation strategies. Both aspects are interdependent. Thus, Cognitive Behavioral Therapy (CBT) comprises the development and training of adequate emotion regulation strategies. Traditionally, reappraisal is the most common strategy, but strategies of acceptance are becoming more important in the course of advancing CBT. Indeed, there is evidence that emotion regulation strategies differ in self-reported effectiveness, psychophysiological reactions, and underlying neural correlates. However, comprehensive comparisons of different emotion regulation strategies are sparse. The present study, therefore, compared the effect of three common emotion regulation strategies (reappraisal, acceptance, and suppression) on self-reported effectiveness, recollection, and psychophysiological as well as electroencephalographic dimensions. Twenty-nine healthy participants were instructed to either reappraise, accept, suppress, or passively observe their upcoming emotional reactions while anxiety- and sadness-inducing pictures were presented. Results showed a compelling effect of reappraisal on emotional experience, skin conductance response, and P300 amplitude. Acceptance was almost as effective as reappraisal, but led to increased emotional experience. Combining all results, suppression was shown to be the least effective but significantly decreased emotional experience when thoughts and feelings had to be suppressed. Moreover, results show that greater propensity for rumination differentially impairs strategies of emotion regulation.