1
|
Messina I, Grecucci A, Viviani R. Neurobiological models of emotion regulation: a meta-analysis of neuroimaging studies of acceptance as an emotion regulation strategy. Soc Cogn Affect Neurosci 2021; 16:257-267. [PMID: 33475715 PMCID: PMC7943364 DOI: 10.1093/scan/nsab007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Irene Messina
- Correspondence should be addressed to Irene Messina, Universitas Mercatorum, Piazza Mattei 10, Rome 00186, Italy. E-mail: ,
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Sciences, University of Trento, Trento 38068, Italy
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck 6020
- Austria—Psychiatry and Psychotherapy Clinic III, University of Ulm, Ulm 89075, Germany
| |
Collapse
|
2
|
Messina I, Scottà F, Marchi A, Benelli E, Grecucci A, Sambin M. Case Report: Individualization of Intensive Transactional Analysis Psychotherapy on the Basis of Ego Strength. Front Psychol 2021; 12:618762. [PMID: 34177686 PMCID: PMC8219863 DOI: 10.3389/fpsyg.2021.618762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
In intensive transactional analysis psychotherapy (ITAP), intensity is obtained with both technical expedients and the relational manner with the patient. In ITAP, the therapist modulates pressure and support commensurately to the patients' ego strength. In the present article, we contrast two clinical cases of young adults in which ego strength produced different therapy outcomes and processes. We present excerpts of the psychotherapy process that illustrates technical aspects of ITAP as well as the therapist's attitude that we describe as holding. We show quantitative therapy outcomes consisting of effects size values of changes in Clinical Outcome in Routine Evaluation—Outcome Measure scores in baseline, treatment, and follow-up phases and qualitative outcome evaluated with the Change Interview at the end of the therapy. In the patient with high ego strength, we observed a rapid improvement and a complete recovery at the end of the therapy, whereas the results of the patient with low ego strength were less consistent (more fluctuations in Clinical Outcome in Routine Evaluation—Outcome Measure scores including deterioration but good qualitative outcome). We conclude that quantitative and qualitative outcome data, together with process observations, are required to have a complete picture of therapy effectiveness. Moreover, we conclude that qualitative ego strength is not a limitation for the use of expressive therapy such as ITAP, but rather, it is an important variable that should be considered to dose confrontations and support.
Collapse
Affiliation(s)
- Irene Messina
- Universitas Mercatorum, Rome, Italy.,Centro Psicologia Dinamica, Padua, Italy
| | | | - Arianna Marchi
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Enrico Benelli
- Centro Psicologia Dinamica, Padua, Italy.,Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
| | - Marco Sambin
- Centro Psicologia Dinamica, Padua, Italy.,Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| |
Collapse
|
3
|
Grecucci A, Sığırcı H, Lapomarda G, Amodeo L, Messina I, Frederickson J. Anxiety Regulation: From Affective Neuroscience to Clinical Practice. Brain Sci 2020; 10:E846. [PMID: 33198228 PMCID: PMC7697078 DOI: 10.3390/brainsci10110846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alessandro Grecucci
- Department of Psychology and Cognitive Sciences, Clinical and Affective Neuroscience Lab, University of Trento, 38068 Rovereto, Italy; (H.S.); (G.L.); (L.A.)
| | - Hüseyin Sığırcı
- Department of Psychology and Cognitive Sciences, Clinical and Affective Neuroscience Lab, University of Trento, 38068 Rovereto, Italy; (H.S.); (G.L.); (L.A.)
| | - Gaia Lapomarda
- Department of Psychology and Cognitive Sciences, Clinical and Affective Neuroscience Lab, University of Trento, 38068 Rovereto, Italy; (H.S.); (G.L.); (L.A.)
| | - Letizia Amodeo
- Department of Psychology and Cognitive Sciences, Clinical and Affective Neuroscience Lab, University of Trento, 38068 Rovereto, Italy; (H.S.); (G.L.); (L.A.)
| | - Irene Messina
- Department of Psychiatry and Psychotherapy III, University of Ulm, 89069 Ulm, Germany;
| | - Jon Frederickson
- Washington School of Psychiatry, 5028 Wisconsin Ave NW, Washington, DC 20016, USA;
| |
Collapse
|
4
|
Grecucci A, Messina I, Amodeo L, Lapomarda G, Crescentini C, Dadomo H, Panzeri M, Theuninck A, Frederickson J. A Dual Route Model for Regulating Emotions: Comparing Models, Techniques and Biological Mechanisms. Front Psychol 2020; 11:930. [PMID: 32581903 PMCID: PMC7287186 DOI: 10.3389/fpsyg.2020.00930] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alessandro Grecucci
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
| | - Irene Messina
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Letizia Amodeo
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
| | - Gaia Lapomarda
- Clinical and Affective Neuroscience Lab, Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Harold Dadomo
- Department of Neuroscience, University of Parma, Parma, Italy.,Parma Schema Therapy Center, Parma, Italy
| | - Marta Panzeri
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | | | - Jon Frederickson
- Washington School of Psychiatry, Washington, DC, WA, United States
| |
Collapse
|