Editorial: Advances in Emotion Regulation: From Neuroscience to Psychotherapy

Emotional self-regulation and personality in the light of Thomas Aquinas's philosophical anthropology

This article aims to thoroughly understand the concept of emotional self-regulation (ESR) and its relationship with personality. Through an interdisciplinary dialogue between psychology and philosophy-specifically, the anthropology of Thomas Aquinas-three realities are proposed that could be considered as ESR. The conceptual relationship between ESR-understood as operation, faculty and habit-and personality is examined, specifically using the Five-Factor Model and the virtues model. Key findings include the need for consensus on a precise definition of ESR, the central role of reason as a faculty capable of ruling over emotions, the relevance of the distinction between ESR and self-control, and the understanding of ESR as a set of habits that include aspects of prudence, temperance and fortitude. Interdisciplinary dialogue seems to be a valuable intellectual approach to the advancement of the field of psychology.

Comparing reappraisal and acceptance strategies to understand the neural architecture of emotion regulation: a meta-analytic approach

Introduction

In the emotion regulation literature, the amount of neuroimaging studies on cognitive reappraisal led the impression that the same top-down, control-related neural mechanisms characterize all emotion regulation strategies. However, top-down processes may coexist with more bottom-up and emotion-focused processes that partially bypass the recruitment of executive functions. A case in point is acceptance-based strategies.

Method

To better understand neural commonalities and differences behind different emotion regulation processes, in the present study, we applied the Activation Likelihood Estimation (ALE) method to perform a meta-analysis on fMRI studies investigating task-related activity of reappraisal and acceptance. Both increased and decreased brain activity was taken into account in the contrast and conjunction analysis between the two strategies.

Results

Results showed increased activity in left-inferior frontal gyrus and insula for both strategies, and decreased activity in the basal ganglia for reappraisal, and decreased activity in limbic regions for acceptance.

Discussion

These findings are discussed in the context of a model of common and specific neural mechanisms of emotion regulation that support and expand the previous dual-routes models. We suggest that emotion regulation may rely on a core inhibitory circuit, and on strategy-specific top-down and bottom-up processes distinct for different strategies.

Anxious Brains: A Combined Data Fusion Machine Learning Approach to Predict Trait Anxiety from Morphometric Features

Trait anxiety relates to the steady propensity to experience and report negative emotions and thoughts such as fear and worries across different situations, along with a stable perception of the environment as characterized by threatening stimuli. Previous studies have tried to investigate neuroanatomical features related to anxiety mostly using univariate analyses and thus giving rise to contrasting results. The aim of this study is to build a predictive model of individual differences in trait anxiety from brain morphometric features, by taking advantage of a combined data fusion machine learning approach to allow generalization to new cases. Additionally, we aimed to perform a network analysis to test the hypothesis that anxiety-related networks have a central role in modulating other networks not strictly associated with anxiety. Finally, we wanted to test the hypothesis that trait anxiety was associated with specific cognitive emotion regulation strategies, and whether anxiety may decrease with ageing. Structural brain images of 158 participants were first decomposed into independent covarying gray and white matter networks with a data fusion unsupervised machine learning approach (Parallel ICA). Then, supervised machine learning (decision tree) and backward regression were used to extract and test the generalizability of a predictive model of trait anxiety. Two covarying gray and white matter independent networks successfully predicted trait anxiety. The first network included mainly parietal and temporal regions such as the postcentral gyrus, the precuneus, and the middle and superior temporal gyrus, while the second network included frontal and parietal regions such as the superior and middle temporal gyrus, the anterior cingulate, and the precuneus. We also found that trait anxiety was positively associated with catastrophizing, rumination, other- and self-blame, and negatively associated with positive refocusing and reappraisal. Moreover, trait anxiety was negatively associated with age. This paper provides new insights regarding the prediction of individual differences in trait anxiety from brain and psychological features and can pave the way for future diagnostic predictive models of anxiety.

Social reappraisal of emotions is linked with the social presence effect in the default mode network

Introduction

Social reappraisal, during which one person deliberately tries to regulate another's emotions, is a powerful cognitive form of social emotion regulation, crucial for both daily life and psychotherapy. The neural underpinnings of social reappraisal include activity in the default mode network (DMN), but it is unclear how social processes influence the DMN and thereby social reappraisal functioning. We tested whether the mere presence of a supportive social regulator had an effect on the DMN during rest, and whether this effect in the DMN was linked with social reappraisal-related neural activations and effectiveness during negative emotions.

Methods

A two-part fMRI experiment was performed, with a psychotherapist as the social regulator, involving two resting state (social, non-social) and two task-related (social reappraisal, social no-reappraisal) conditions.

Results

The psychotherapist's presence enhanced intrinsic functional connectivity of the dorsal anterior cingulate (dACC) within the anterior medial DMN, with the effect positively related to participants' trust in psychotherapists. Secondly, the social presence-induced change in the dACC was related with (a) the social reappraisal-related activation in the bilateral dorsomedial/dorsolateral prefrontal cortex and the right temporoparietal junction and (b) social reappraisal success, with the latter relationship moderated by trust in psychotherapists.

Conclusion

Results demonstrate that a psychotherapist's supportive presence can change anterior medial DMN's intrinsic connectivity even in the absence of stimuli and that this DMN change during rest is linked with social reappraisal functioning during negative emotions. Data suggest that trust-dependent social presence effects on DMN states are relevant for social reappraisal-an idea important for daily-life and psychotherapy-related emotion regulation.

Resting-state BOLD temporal variability in sensorimotor and salience networks underlies trait emotional intelligence and explains differences in emotion regulation strategies

A converging body of behavioural findings supports the hypothesis that the dispositional use of emotion regulation (ER) strategies depends on trait emotional intelligence (trait EI) levels. Unfortunately, neuroscientific investigations of such relationship are missing. To fill this gap, we analysed trait measures and resting state data from 79 healthy participants to investigate whether trait EI and ER processes are associated to similar neural circuits. An unsupervised machine learning approach (independent component analysis) was used to decompose resting-sate functional networks and to assess whether they predict trait EI and specific ER strategies. Individual differences results showed that high trait EI significantly predicts and negatively correlates with the frequency of use of typical dysfunctional ER strategies. Crucially, we observed that an increased BOLD temporal variability within sensorimotor and salience networks was associated with both high trait EI and the frequency of use of cognitive reappraisal. By contrast, a decreased variability in salience network was associated with the use of suppression. These findings support the tight connection between trait EI and individual tendency to use functional ER strategies, and provide the first evidence that modulations of BOLD temporal variability in specific brain networks may be pivotal in explaining this relationship.

Evidence for lateralized functional connectivity patterns at rest related to the tendency of externalizing or internalizing anger

Previous electroencephalographic and brain stimulation studies have shown that anger responses may be differently lateralized in the prefrontal cortex, with outward-oriented responses (externalized anger) linked to left prefrontal activity, and inward-oriented responses (internalized anger) linked to right prefrontal activity. However, the specific neural structures involved in this asymmetry, and how they interact to produce individual differences, remain unexplored. Furthermore, it is unclear whether such asymmetry may be explained by general behavioral tendencies, known as Behavioral Activation and Behavioral Inhibition Systems (BIS/BAS). Therefore, we analyzed the tendency of externalizing and internalizing anger, respectively measured by the Anger-Out and Anger-In subscales of the State-Trait Anger Expression Inventory, with the patterns of functional connectivity at rest of 71 participants. A left, prefrontal, resting-state, functional connectivity pattern was found for externalizing anger (Anger-Out), including the left inferior frontal gyrus and the left frontal eye fields. By contrast, a right, prefrontal, resting-state, functional connectivity pattern was found for internalizing anger (Anger-In), including the rostral and lateral prefrontal cortex, the orbitofrontal cortex, the frontal pole, the superior, middle and inferior frontal gyri, and the anterior cingulate. Notably, these patterns were not associated with the BIS/BAS scores. In this study, for the first time, we provide evidence using fMRI functional connectivity for two specific lateralized circuits contributing to individual differences in externalizing and internalizing anger. These results confirm and extend the asymmetry hypothesis for anger and have notable implications in the treatment of anger-related problems.

Built to last: Theta and delta changes in resting-state EEG activity after regulating emotions

BACKGROUND

Over the past years, electroencephalography (EEG) studies focused on task-related activity to characterize cortical responses associated with emotion regulation (ER), without exploring the possibility that regulating emotions can leave a trace in the brain by affecting its oscillatory activity. Demonstrating whether the effect of regulation alters the brain activity after the session and whether this reflects an increased cognitive regulatory ability has great relevance.

METHODS

To address this issue, 5 min of electrical brain activity at rest were recorded before and after (1) one session in which participants perceived and regulated (through distancing) their emotions (regulation session, ReS), and (2) another session in which they only perceived emotions (attend session, AtS). One hundred and sixty visual stimuli were presented, and subjective ratings of valence and arousal of stimuli were recorded.

RESULTS

Behavioral results showed the efficacy of the regulation strategy in modulating both arousal and valence. A cluster-based permutation test on EEG data at rest revealed a significant increase in theta and delta activity after the ReS compared to the AtS, suggesting that regulating emotions can alter brain activity after the session.

CONCLUSIONS

These results allowed us to outline a comprehensive view of the neurophysiological mechanisms associated with ER, as well as some possible implications in psychotherapy.

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 Features Predict Sexual Trauma and Interpersonal Problems in Borderline Personality Disorder but Not in Controls: A Multi-Voxel Pattern Analysis

Child trauma plays an important role in the etiology of Bordeline Personality Disorder (BPD). Of all traumas, sexual trauma is the most common, severe and most associated with receiving a BPD diagnosis when adult. Etiologic models posit sexual abuse as a prognostic factor in BPD. Here we apply machine learning using Multiple Kernel Regression to the Magnetic Resonance Structural Images of 20 BPD and 13 healthy control (HC) to see whether their brain predicts five sources of traumas: sex abuse, emotion neglect, emotional abuse, physical neglect, physical abuse (Child Trauma Questionnaire; CTQ). We also applied the same analysis to predict symptom severity in five domains: affective, cognitive, impulsivity, interpersonal (Zanarini Rating Scale for Borderline Personality Disorder; Zan-BPD) for BPD patients only. Results indicate that CTQ sexual trauma is predicted by a set of areas including the amygdala, the Heschl area, the Caudate, the Putamen, and portions of the Cerebellum in BPD patients only. Importantly, interpersonal problems only in BPD patients were predicted by a set of areas including temporal lobe and cerebellar regions. Notably, sexual trauma and interpersonal problems were not predicted by structural features in matched healthy controls. This finding may help elucidate the brain circuit affected by traumatic experiences and connected with interpersonal problems BPD suffer from.

Links between cognitive distortions and cognitive emotion regulation strategies in non-clinical young adulthood

This study examined the possible link between cognitive distortions (CDs), which involve erroneous information processing in normal reasoning, and cognitive emotion regulation strategies (CERS), which are strategies implemented at the cognitive level to modulate the emotional response following a negative or unpleasant event, in a non-clinical young adult population. Ninety-six participants (age 18-39 years; 48 women) completed the French version of the Cognitive Emotion Regulation Questionnaire and the French Cognitive Distortions Inventory for adults. Overall, negative distortions were positively correlated with the use of non-adaptive strategies of cognitive emotion regulation, while positive distortions were negatively correlated with the use of adaptive strategies. The CDs most associated with the use of adaptive CERS were positive dichotomous reasoning, minimization and neutral omission in favour of the positive. Selective abstraction was the CD most associated with the use of non-adaptive CERS. We observed a negative correlation effect between education level and several distortions and catastrophizing, and a positive correlation with acceptance. Men used more positive maximization, requalification as negative, acceptance and blaming others than women. The discussion of the results focuses on explaining the observed relationships between the variables in this non-clinical sample.

Die Affektphobietherapie

Hintergrund

Ein zentraler Faktor psychischer Gesundheit ist die Fähigkeit, Affekte wahrnehmen und adaptiv regulieren zu können. Die Verbesserung dieser Fähigkeit ist ein Ziel der psychodynamischen Psychotherapie. Psychodynamische Behandlungsmodelle, die sich aus der gut validierten Tradition der „short-term dynamic psychotherapy“ (STDP) ableiten und die heute unter dem Dach der International Experiential Dynamic Therapy Association (https://iedta.net/) versammelt sind, legen auf besondere Weise den Behandlungsfokus auf das emotionale Erleben. Ein derartiges psychodynamisches transdiagnostisches Behandlungsmodell ist die Affektphobietherapie (APT).

Ziel der Arbeit (Fragestellung)

Ziel der Übersicht ist es, den Leser mit dem Behandlungsrational und der Evidenz der APT vertraut zu machen.

Material und Methoden

Es werden die theoretischen Grundlagen der APT, typische Interventionen und Prozessinstrumente beschrieben. Die Evidenz des APT-Modells wird als narrative Übersicht der Studienlage dargestellt.

Ergebnisse und Schlussfolgerung

Die APT ist ein evidenzbasiertes psychodynamisches Behandlungsmodell. Das Rational ist schulenübergreifend. Ein Selbsthilfeprogramm auf der Basis der APT wird von Patienten gut aufgenommen. Manualisierung, Fertigkeitenorientierung und Prozessinstrumente machen es zu einem vielversprechenden Modell für die Aus- und Fortbildung.

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.

Emotional Dysregulation in Adolescents: Implications for the Development of Severe Psychiatric Disorders, Substance Abuse, and Suicidal Ideation and Behaviors

Well-tuned emotional regulation is fundamental for human life and psychological well-being. Negative physiological emotions are counterbalanced by positive ones, and this equilibrium is the mainstay of human physiological affective states. However, this mechanism may sometimes become dysfunctional when negative emotions are not correctly counterbalanced, causing maladaptive behaviors, especially during adolescence. A very interesting review by Young et al. was recently published (Brain Sci.2019, 9(4), 76) and stimulated us to reflect on this topic. The screening for emotional disturbances and dysregulation in adolescents must be included in all the preventive and interventional programs aimed to achieve both physical and psychological well-being of the population and early intervention should be provided in order to avoid progression toward clinically relevant psychiatric disorders in late adolescence and adulthood.

Your presence soothes me: a neural process model of aversive emotion regulation via social buffering

The reduction of aversive emotions by a conspecific's presence-called social buffering-is a universal phenomenon in the mammalian world and a powerful form of human social emotion regulation. Animal and human studies on neural pathways underlying social buffering typically examined physiological reactions or regional brain activations. However, direct links between emotional and social stimuli, distinct neural processes and behavioural outcomes are still missing. Using data of 27 female participants, the current study delineated a large-scale process model of social buffering's neural underpinnings, connecting changes in neural activity to emotional behaviour by means of voxel-wise multilevel mediation analysis. Our results confirmed that three processes underlie human social buffering: (i) social support-related reduction of activity in the orbitofrontal cortex, ventromedial and dorsolateral prefrontal cortices, anterior and mid-cingulate; (ii) downregulation of aversive emotion-induced brain activity in the superficial cortex-like amygdala and mediodorsal thalamus; and (iii) downregulation of reported aversive feelings. Results of the current study provide evidence for a distinct neural process model of aversive emotion regulation in humans by social buffering.

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.

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

Background

Whilst there has been extensive study of the mechanisms underlying the regulation for pictures, the ability and the mechanisms beyond the regulation of words remains to be clarified. Similarly, the effect of strategy when applying a regulatory process is still poorly explored. The present study seeks to elucidate these issues comparing the effect of regulation and of strategy to both neutral and emotional words and pictures.

Methodology/Principal findings

Thirty young adults applied the strategy of distancing to the emotions elicited by unpleasant and neutral pictures and words while their subjective ratings and ERPs were recorded. At a behavioral level, participants successfully regulated the arousal and the valence of both pictures and words. At a neural level, unpleasant pictures produced an increase in the late positive potential modulated during the regulate condition. Unpleasant linguistic stimuli elicited a posterior negativity as compared to neutral stimuli, but no effect of regulation on ERP was detectable. More importantly, the effect of strategy independently of stimulus type, produced a significant larger Stimulus Preceding Negativity. Dipole reconstruction localized this effect in the middle frontal areas of the brain.

Conclusions

As such, these new psychophysiological findings might help to understand how pictures and words can be regulated by distancing in daily life and clinical contexts, and the neural bases of the effect of strategy for which we suggest an integrative model.

Energy psychology: Efficacy, speed, mechanisms

The most well known forms of "energy psychology" combine cognitive and exposure techniques with the stimulation of selected acupuncture points (acupoints) by tapping on them. Most clinicians who learn and utilize an acupoint tapping protocol integrate the approach within their existing clinical frameworks rather than using it as a stand-alone therapy. The method has been highly controversial, with its efficacy, purported speed, and explanatory models all questioned. Nonetheless, its utilization within clinical settings and as a self-help method has continued to expand since it was introduced more than three decades ago. This paper reviews the most salient criticisms of the method and presents research and empirically based theoretical constructs that address them. More than 100 peer-reviewed outcome studies-51 of which are randomized controlled trials-provide an evidential base for evaluating the claims and criticisms surrounding the approach. This review concludes that a growing body of evidence indicates that acupoint-based energy psychology protocols are rapid and effective in producing beneficial outcomes in the treatment of anxiety, depression, PTSD, and possibly other conditions. Mechanisms by which acupoint tapping might bring about these treatment outcomes are also proposed.

Dysregulated Anxiety and Dysregulating Defenses: Toward an Emotion Regulation Informed Dynamic Psychotherapy

One of the main objectives of psychotherapy is to address emotion dysregulation that causes pathological symptoms and distress in patients. Following psychodynamic theory, we propose that in humans, the combination of emotions plus conditioned anxiety due to traumatic attachment can lead to dysregulated affects. Likewise, defenses can generate and maintain dysregulated affects (altogether Dysregulated Affective States, DAS). We propose the Experiential-Dynamic Emotion Regulation methodology, a framework to understand emotion dysregulation by integrating scientific evidence coming from the fields of affective neuroscience and Experiential-Dynamic Psychotherapy aimed at resolving DAS. This method and the techniques proposed can be integrated within other approaches. Similarities and differences with the Cognitive model of emotion regulation and cognitive-behavioral approaches are discussed within the paper.

Schema therapy for emotional dysregulation in personality disorders: a review

PURPOSE OF REVIEW

To give an update on the most recent studies regarding the role of schema therapy in the treatment of emotion dysregulation related to personality disorders.

RECENT FINDINGS

In personality disorders, a lack of emotion regulation can be found. Schema therapy treats emotion dysregulation with a series of techniques, such as imagery rescripting, limited reparenting, chairwork, and cognitive restructuring to remove dysregulatory mechanism.

SUMMARY

Schema therapy is one of the most efficient therapies for personality disorders. However, there is a lack of recent studies on how it treats emotion dysregulation. Although the treatment of emotional dysregulation is not the core of schema therapy, it is certainly important inside this theoretical framework. The mode model helps clinicians address their work toward the reduction of dysfunctional modes, whereas fostering functional modes.

How dare you not recognize the role of my contempt? Insight from experimental psychopathology

Gervais & Fessler argue that contempt is an attitude state defined as a lack of respect that potentiates the activation and deactivation of two different clusters of emotions. However, clinical and experimental findings do not support this view. We provide evidence that contempt is not an emotion, nor an attitude, but a reactive defensive mechanism evolved to help individuals avoid shame.