Acceptance as an Emotion Regulation Strategy in Experimental Psychological Research: What We Know and How We Can Improve That Knowledge

GLP-1 agonists and risk of suicidal thoughts and behaviours: Confound by indication once again? A narrative review

Glucagon-like peptide-1 (GLP-1) agonists have been successfully used in clinical practice for the treatment of diabetes and obesity, offering significant clinical benefits. However, concerns regarding their potential link to psychiatric side effects, like suicidal thoughts and behaviours (STB) have emerged. This narrative review investigates the complex interplay between GLP-1 agonists and STB, focusing on the biological stress induced by rapid weight loss, psychological and social consequences, similar mechanism with addiction, and the evaluative lens of the Bradford Hill criteria on causality. While GLP-1 agonists can contribute to substantial health improvements, they also introduce biological and psychological stressors. Disruptions in homeostasis from quick weight reduction can elevate cortisol and norepinephrine levels, heightening the risk for, or exacerbation of STB. Psychological factors, including unfulfilled expectations and identity changes after significant weight loss, compound these risks. Utilizing the Bradford Hill criteria reveals insufficient evidence for a direct causal link between GLP-1 agonists and STB. Yet, the indirect effects related to the metabolic and psychological disturbances associated with rapid weight loss call for a cautious approach. Used carefully in targeted populations GLP-1 agonists may even emerge as protective agents against STB. Therefore, it is crucial to monitor patients during the treatment and screen for preexisting mental health conditions. If detected, appropriate clinical management should be applied. Future studies should aim at optimizing dosing schedules to mitigate the adverse effects of rapid weight loss and further investigate GLP-1 agonists in possible STB prevention.

The influence of an emotion regulation intervention on challenges in emotion regulation and cognitive strategies in patients with depression

BACKGROUND

Patients with depression struggle with significant emotion regulation difficulties, which adversely affect their psychological well-being and hinder recovery. Traditional therapeutic approaches often fail to adequately address these challenges, leading to a persistent gap in effective mental health care. This research seeks to address this gap by investigating the impact of emotion regulation skills training on patients with depression.

AIM

To assess the difficulties in emotion regulation among patients with depression and evaluate the impact of an emotion regulation skills training intervention on those with higher levels of emotion regulation difficulties, specifically focusing on increasing the use of adaptive emotion regulation strategies and reducing the use of maladaptive emotion regulation strategies.

METHOD

A quasi-experimental research design was utilized, using three tools: a socio-demographic and Clinical Data structured interview schedule, Difficulties in Emotional Regulation Scale, and Cognitive Emotion Regulation Questionnaire. Eighty patients with depression were recruited to assess those with higher levels of emotion regulation difficulties; out of those with greater difficulties, 30 patients were chosen to participate in the emotion regulation skills training intervention.

RESULT

The 80 studied subjects' emotion regulation difficulties scores ranged from 158 to 169 (164.5 ± 3.21), and they indicated less use of adaptive cognitive emotion regulation strategies and more use of maladaptive cognitive emotion regulation strategies (56.07 ± 2.67). Regarding the intervention group, the overall mean score of the 30 patients' emotion regulation difficulties decreased from 167.35 ± 2.21 pre-intervention to 105.85 ± 3.33 post-intervention (p < 0.0001). Cognitive emotion regulation total scores improved markedly from 54.07 ± 1.66 to 35.2 ± 3.46 (p < 0.01).

IMPLICATION

Healthcare providers should routinely assess emotion regulation difficulties in patients with depression and integrate personalized treatment plans that target individual emotion regulation difficulties.

CONCLUSION

The findings suggest that the emotion regulation intervention has the potential to improve emotion regulation difficulties and cognitive emotion regulation strategies among patients with depression.

Integrating mindfulness into the extended process model of emotion regulation: The dual-mode model of mindful emotion regulation

Extensive research has been conducted regarding how people manage their emotions. Within this research, there has been growing attention toward the role of mindfulness in emotion regulation. While prior reviews have discussed mindfulness in the context of emotion regulation, they have not provided a thorough integration using the prevailing models of emotion regulation or mindfulness. The present review discusses the Extended Process Model of Emotion Regulation and Monitoring and Acceptance Theory of mindfulness in order to propose a novel integrated framework, the Dual-mode Model of Mindful Emotion Regulation (D-MER). This model proposes two "modes" of mindfulness: Implementation and facilitation. Implementation posits that mindfulness skills can be used as emotion regulation strategies through attentional deployment and cognitive change. Facilitation posits that mindfulness as a state or trait affects emotion generation and regulation through effects on cognitive processes and positive or negative valence systems. Further, the D-MER posits that mindfulness experience can improve the efficiency of mindfulness-based emotion regulation strategies (implementation) while effects of mindfulness on emotion regulation processes become increasingly trait-like and automatic over time (facilitation). Empirical and theoretical support for this model are discussed, specific hypotheses to guide further research are provided, and clinical implications are presented. Use of this model may identify mechanisms underlying the interaction between mindfulness and emotion regulation which can be used in ongoing affective and clinical research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Roles of Parental Psychological Flexibility, Self-Compassion, and Self-Efficacy in Affecting Mental Health and Quality of Life in Parents of Children with Eczema

Parents of young children with eczema often experience adverse mental health consequences, including depression, anxiety, stress, and a reduced health-related quality of life (HRQoL), due to the unpredictable nature of flare-ups and exacerbations. This study investigated the roles of psychological flexibility, self-compassion, and self-efficacy in fostering parental mental health outcomes and HRQoL while caring for children diagnosed with eczema. Baseline data from an ongoing clinical trial examining the effects of a family acceptance-and-commitment-therapy-based eczema management program (FACT-EMP) on parent-child dyads affected by eczema (N = 110 dyads, 75.5% mothers; 66.4% boys) were analyzed using adjusted hierarchical regression analyses. The findings indicate that psychological inflexibility was significantly associated with symptoms of anxiety, depression, stress, and HRQoL. Self-compassion was significantly linked to all assessed mental health outcomes, whereas self-efficacy showed a significant association only with symptoms of depression. These results underscore the significance of promoting parental psychological flexibility and self-compassion through acceptance and commitment therapy and compassion-based approaches to enhance mental health and quality of life while managing children's eczema.

Adverse Childhood Experiences and Poor Sleep Quality in Older Adults: The Influence of Emotion Regulation

BACKGROUND

Adverse childhood experiences (ACEs) are associated with sleep impairment across the life span, but little is known about modifiable factors that may ameliorate this relationship, such as adaptive emotion regulation (ER) skills.

METHODS

Data were obtained from an online questionnaire completed by a community sample of older adults (N = 278). The questionnaire included the Pittsburgh Sleep Quality Index, an Adverse Childhood Experiences questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), and measures of health conditions, and other sample demographics. Moderation analyses were used to examine the interaction between ACEs and 5 adaptive ER skills of CERQ on sleep quality in older adults, while accounting for the effects of age, sex, income, body mass index, and health.

RESULTS

ACEs were significantly associated with worse sleep quality in older adults, and this effect was moderated by positive reappraisal and refocusing on planning (all ps < .05). For individuals reporting greater use of these ER skills, ACEs had no effect on sleep quality, whereas for individuals reporting less frequent use of these ER skills, ACEs were associated with substantially worse sleep quality. This relationship remained significant after accounting for age, sex, income, body mass index, and health conditions in the model.

CONCLUSIONS

The effects of ACEs on sleep quality persist into older age; however, greater use of ER skills that focus on positively reframing negative events and identifying strategies for coping protect against sleep impairment in individuals with higher ACEs.

Emotional regulation strategies in daily life: the intensity of emotions and regulation choice

Objective

Emotion regulation is an adaptive ability affecting people's physical and mental health, quality of life and functioning. In the present study we focused on the influence of the intensity of experienced emotions on emotion regulation strategies (ERS) that are applied in everyday life.

Methods

For 7 days the participants kept an online diary where every day they described the situation which had aroused their strongest negative emotions. Next, they identified the emotions, their intensity and the type of applied strategies (acceptance vs. reappraisal vs. rumination vs. distraction vs. suppression). The study involved 88 people N = 88, which gives 538 observations.

Results

The obtained results indicate that the intensity of emotions affects the choice of regulation strategies. When the intensity increases, people are more likely to choose the rumination strategy and less likely to choose the reappraisal strategy. However, the expected relationship between the intensity and the number of regulation strategies was not confirmed. In turn, it was gender (male) that turned out to be associated with a greater number of strategies used.

Conclusion

The concern of this research was to look at making regulatory decisions in personally relevant and complex everyday situations. Although the emotions experienced in response to a difficult situation were varied, the intensity of the emotional experience was an important factor determining the choice of a regulation strategy. It indicates that this emotional dimension is a basic and determining aspect in people's regulatory capabilities. These results also indicate that perhaps men in a situation perceived as stressful and worthy of emotional involvement use more regulatory strategies than women. These findings may find an application in all kinds of psychological interventions (e.g., psychotherapy, anger management therapies).

Effectiveness of emotion regulation strategies measured by self-report and EMG as a result of strategy used, negative emotion strength and participants' baseline HRV

We investigated how emotion regulation (ER) effectiveness-on both a self-reported rating as well as emotional expression (corrugator supercilii muscle activity) level-is affected by the characteristics of the situation (low vs. high negativity), the strategy used (reinterpretation, distraction, suppression, no regulation control condition) and individual dispositions (low vs. high baseline Heart Rate Variability) as well as their interaction. For this purpose, 54 adult women participated in a laboratory study. All the included factors significantly influenced both corrugator activity and appraisals of pictures' negativity (in specific experimental conditions). For example, for high HRV participants, (1) distraction, suppression and reinterpretation significantly decreased corrugator activity compared to the control condition, and (2) distraction decreased appraised picture negativity for high negativity photos. For low HRV participants, distraction and suppression were most effective in decreasing corrugator responses, while suppression was more effective than reinterpretation in decreasing perceived picture negativity in the high negativity condition. Subjectively reported effort and success in applying ER strategies were also dependent on manipulated and dispositional factors. Overall, our results lend support to the flexible emotion regulation framework, showing that emotion regulation effectiveness relies on situational context as well as individual dispositions and their interaction.

Emotion in Organizations: Theory and Research

The workplace elicits a wide range of emotions and, likewise, emotions change our experience of the workplace. This article reviews the scientific field of emotion in organizations, drawing from classic theories and cutting-edge advances to integrate a disparate body of research. The review is organized around the definition of emotion as an unfolding sequence of processes: We interpret the world around us for its subjective meaning, which results in emotional experience. Emotional experience, in turn, has consequences for behaviors, attitudes, and cognition. Emotional experience also elicits expressive cues that can be recognized by others. Each process in the emotion sequence can be regulated. Processes can also iterate until emotion is shared throughout workgroups and even entire organizations. A distinct body of organizationally relevant research exists for each process, and emotional intelligence refers to effectiveness across all. Differences across culture and gender, future research directions, and practical implications are discussed.

Going within, between and beyond: An exploration of regular Ashtanga Yoga practitioners' conceptualizations of five dimensions of wellbeing

Yoga is an embodied practice underpinned by philosophical elements, seeking to evolve different dimensions of human existence for optimal functioning in relation to oneself, others and beyond. This mixed-methods research focused on 137 regular Ashtanga Yoga practitioners (AYPs) by investigating their conceptualizations of five dimensions of wellbeing (i.e., physical, emotional, psychological, social, spiritual). Conceptualizations were analysed through word count analysis and Reflexive Thematic Analysis separately for each dimension, yielding four themes in each case, which partly aligned with existing wellbeing and yoga models, and partly extended on the existing literature. Further higher level analysis identified shared meanings across these five dimensions, expressed in themes grouped within five topics (i.e., freedom from and managing suffering, a positive and integrated sense of self, a sense of equanimity and steadiness, the self in relation to others and the world, meta-awareness). Furthermore, it also portrayed each dimension as multileveled, represented in three levels of human functioning. The foundational level encompassed the absence and managing suffering, representing functioning in coping and recovery mode. The optimal functioning level included a positive and integrated sense of self, a sense of equanimity and steadiness, and the self in relation to others and the world, representing functioning in personal development and growth mode. The contemplative and transcendental level involved meta-awareness in every dimension of wellbeing, representing functioning in transpersonal mode. As a result, we propose a preliminary model informed both by this empirical work and previous theories. While the continuousness of themes across dimensions reinforces the importance of embodiment and transcendence in wellbeing frameworks, the notion of the self as a multi-level system could be further explored in relation to knowing about and cultivating wellbeing.

Chronic Stress Is Associated with Reduced Mindful Acceptance Skills but Not with Mindful Attention Monitoring: A Cross-Sectional Study

Mindfulness-based interventions (MBIs) are effective in reducing chronic stress, but their therapeutic mechanisms are unclear. One possibility is that MBIs act by re-training attention monitoring and acceptance skills that have been impaired by chronic stress exposure. However, little research has investigated the association between chronic stress, monitoring, and acceptance. In this cross-sectional study we hypothesised observing correlations between stress, and (impaired) monitoring and acceptance. Moreover, we exploratively compared the magnitude of the correlations between chronic stress and four acceptance measures. Finally, we explored whether the association between stress and monitoring is moderated by acceptance. Eighty-five adults participated in the study and completed self-reported chronic stress and acceptance questionnaires and a mindful attention behavioural task. The results revealed that chronic stress was associated with reduced acceptance (all ps < 0.01) but not with monitoring. Exploratory analyses revealed no differences in the magnitude of the correlations between stress and each acceptance measure, except for the combined facets of mindfulness acceptance subscales and nonreactivity subscale (p = 0.023). Further analyses revealed a significant negative association between stress and the interaction between acceptance and the target detection component of monitoring (p = 0.044). Surprisingly, these results show that stress is associated with reduced monitoring at higher levels of acceptance. Theory-driven intervention studies are warranted to complement our results.

Are We Sailing in the Right Direction for Deeper Insights Into Acceptance? Evidence From a Systematic Review of Research in Laboratory Settings

This systematic review aims to review and update the current state of research on the acceptance strategy for a healthy population in a laboratory setting. Using a previously defined search strategy, the PsycInfo, PubMed, and Web of Science databases were searched from 1961 to May 2020 for articles on this topic. Twenty-five high-quality articles, involving a total of 2265 participants, met inclusion criteria. According to these results, acceptance is a strategy with promising outcomes for handling pain in healthy populations, although its superiority over other strategies to reduce negative affect, anger, and other pain variables is unclear. The instructions and outcome variables vary widely between studies, and few studies compare acceptance with mindfulness. We discuss these findings and provide information to guide future researchers for designing fine-grained investigations that can address the gaps in this area.

What Do We Know About Aging and Emotion Regulation?

Older adults report surprisingly positive affective experience. The idea that older adults are better at emotion regulation has emerged as an intuitively appealing explanation for why they report such high levels of affective well-being despite other age-related declines. In this article, I review key theories and current evidence on age differences in the use and effectiveness of emotion-regulation strategies from a range of studies, including laboratory-based and experience sampling. These studies do not yet provide consistent evidence for age differences in emotion regulation and thus do not clearly support the assertion that older adults are better at emotion regulation. However, current approaches may be limited in describing and testing possible age-related changes in emotion regulation. Future work will need to more directly investigate individual trajectories of stability and change in emotion-regulation strategy use and effectiveness over time and also consider the possible roles of context, physiological reactivity, neural changes, acceptance, and personality.

Aging and emotion regulation during the COVID-19 pandemic

Objectives: Self-reported emotional well-being tends to increase with age (Charles & Carstensen, Annual Review of Psychology, 61, 383-409, 2010), and this has remained true during the COVID-19 pandemic (e.g. Bruine de Bruin, The Journals of Gerontology: Series B, 76(2), e24-e29, 2021) despite older adults being disproportionately affected by the virus (CDC, Coronavirus disease 2019 (COVID-19): Older adults, 2020). This study aimed to investigate how younger and older adults are regulating their emotions during the current pandemic. Specifically, this study measured potential age differences in acceptance (broken down into situational and emotional acceptance), because it has been identified as a possible underlying mechanism of the relationship between aging and reduced negative affect (Shallcross et al., Journal of Personality and Social Psychology, 104(4), 734-749, 2013). Methods: Younger (N = 150) and older (N = 150) adults completed trait-level questionnaires of emotional and situational acceptance, and completed a task where they reacted to 24 negative, arousing COVID-19 news headlines, half of which were old-age focused, to capture trial-level acceptance use. Results: Older adults reported greater trait-level acceptance and used emotional acceptance more frequently than younger adults during the headlines task, especially on trials containing old-age focused headlines. Interestingly, younger adults reported reduced trial-level subjective arousal when engaging in emotional acceptance compared to active emotion regulation (suggesting beneficial affective outcomes of acceptance), while older adults reported no differences in arousal between trials when they engaged in acceptance and when they engaged in more active emotion regulation. Conclusion: We discuss potential explanations for these findings as well as present future research directions on acceptance across the lifespan.

Neural correlates of emotion acceptance and suppression in borderline personality disorder

BACKGROUND

Emotion dysregulation is a central feature of borderline personality disorder (BPD). Since impaired emotion regulation contributes to disturbed emotion functioning in BPD, it is crucial to study underlying neural activity. The current study aimed at investigating the neural correlates of two emotion regulation strategies, namely emotion acceptance and suppression, which are both important treatment targets in BPD.

METHODS

Twenty-one women with BPD and 23 female healthy control participants performed an emotion regulation task during functional magnetic resonance imaging (fMRI). While watching fearful movie clips, participants were instructed to either accept or to suppress upcoming emotions compared to passive viewing.

RESULTS

Results revealed acceptance-related insular underactivation and suppression-related caudate overactivation in subjects with BPD during the emotion regulation task.

CONCLUSION

This is a first study on the neural correlates of emotion acceptance and suppression in BPD. Altered insula functioning during emotion acceptance may reflect impairments in emotional awareness in BPD. Increased caudate activity is linked to habitual motor and cognitive processes and therefore may accord to the well-established routine in BPD patients to suppress emotional experiences.

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.

Effects of Loving-Kindness Meditation on Doctors' Mindfulness, Empathy, and Communication Skills

Background: In the context of increasing doctor–patient tensions in China, the objective of this study was to explore and examine the effects of loving-kindness meditation (LKM) on doctors’ mindfulness, empathy, and communication skills. Methods: A total of 106 doctors were recruited from a hospital in China, and randomly divided into an LKM training group (n = 53) and waiting control group (n = 53). The LKM training group received 8 weeks of LKM training intervention, whereas the control group received no intervention. Three major variables (mindfulness, empathy, and communication skills) were measured before (pre-test) and after (post-test) the LKM training intervention. Results: The empathy and communication skills of the LKM group were significantly improved compared with those of the control group, but the level of mindfulness did not significantly change. Conclusions: The results suggested that LKM may contribute to improving physicians’ empathy and communication skills. However, the mechanisms that underlie the effects of the LKM on mindfulness, empathy, and communication skills and other psychological constructs needs further elucidation.