Mechanisms of social emotion regulation: From neuroscience to psychotherapy

35 Pages·2015·0.465 MB·English

by  AAVV

Handbook of Emotion Regulation. Nova Publishers, 2005

Chapter

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Alessandro Grecucci(cid:13)1, Anthony Theuninck2,
Jon Frederickson3 and Remo Job1
1Department of Cognitive Science and Education, University of Trento,
Rovereto, Italy
2Oxleas NHS Foundation Trust, London, United Kingdom
3Washington School of Psychiatry, Washington, D.C.

ABSTRACT

The term Emotion Regulation refers to the neurocognitive
mechanisms by which we regulate the onset, strength, and the eventual
expression of our emotions. An important distinction to be considered is
between Individual Emotion Regulation (IER), or the regulation of basic
emotions within the self without the intervention of others, Socially cued
Emotion Regulation (SER) or the regulation of emotions elicited by the
interactions with others, and the emerging topic of how we regulate
(cid:82)(cid:87)(cid:75)(cid:72)(cid:85)(cid:86)(cid:182)(cid:3)(cid:72)(cid:80)(cid:82)(cid:87)(cid:76)(cid:82)(cid:81)(cid:86)(cid:3)(cid:82)(cid:85)(cid:3)(cid:44)(cid:81)(cid:87)(cid:72)(cid:85)(cid:83)ersonal emotion regulation (I-PER). Although
the mechanisms of the regulation of IER have received much attention, to
date there is little evidence on the psychological and neural mechanisms
behind the regulation of emotions in response to social interactions

(cid:13) Corresponding author: Alessandro Grecucci, [email protected]
2 Alessandro Grecucci, Anthony Theuninck, Jon Frederickson et al.
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The aim of this chapter is to present recent advances in the emerging field
of social emotion regulation (SER) and interpersonal emotion regulation
(I-PER), main mechanisms, their neural bases, and implications for
psychopathology and psychotherapy. Indeed, deficits in the regulation of
emotions has been linked to severe psychiatric disorders, with patients
showing heightened or suppressed emotional experience in reaction to
others. Understanding how patients experience and fail to regulate such
social emotions is of fundamental importance. We will discuss the
implications of regulating emotions for the treatment of psychiatric
disorders, proposing a new framework of emotion regulation based on
experiential and dynamic principles. After the presentation of the model,
a range of cognitive-behavioral (mainly belonging to IER) and dynamic-
experiential techniques (more related with SER and I-PER) for regulating
emotions in psychotherapy will be discussed. Finally a methodology of
experiential-dynamic emotion regulation will be presented. This model is
derived from the experiential-dynamic psychotherapies and holds the
promise of facilitating regulatory processes within the clinical setting to
guide strategies and techniques that can be incorporated into various
models of therapy.

1. NEUROCOGNITIVE MECHANISMS OF EMOTION
REGULATION

In daily life social interactions generate emotions affecting our internal
and interpersonal experiences. Thus, regulating our emotions and emotionally
driven behaviors is essential for successfully creating healthy relationships.
The term emotion regulation usually refers to the capacity to apply a strategy
to modulate our emotional experience (Gross, 1998). The vast majority of
these well-studied strategies act at the level of attention and cognition and are
consciously manipulated by subjects. They are applied by individuals to their
experience of their emotions such as fear, anger or sadness. We define this as
Individual Emotion Regulation (IER). This chapter will briefly review the
neurocognitive mechanisms behind IER, then introduce the concept of Social
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emotions, or Interpersonal Emo(cid:87)(cid:76)(cid:82)(cid:81)(cid:3)(cid:53)(cid:72)(cid:74)(cid:88)(cid:79)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3)(cid:11)(cid:179)(cid:44)-(cid:51)(cid:40)(cid:53)(cid:12)(cid:180)(cid:17)(cid:3)(cid:54)(cid:40)(cid:53)(cid:3)(cid:68)(cid:81)(cid:71)(cid:3)(cid:44)-PER are
particularly important in psychotherapy where the clinician helps the client
regulate the emotions aroused within the therapy relationship. Studying the
mechanisms involved in the regulation of social situations is particularly
relevant when considering the failure to regulate interpersonal emotions and
Mechanisms of Social Emotion Regulation 3
emotionally driven behaviors characteristic of psychiatric disorders such as
borderline personality disorders or social anxiety disorders (Kring & Werner,
2004; Ochsner & Gross, 2008; Grecucci, 2012).

1.1. Individual Emotion Regulation

In experimental studies of emotion regulation, the subject is asked to use a
given strategy when exposed to an emotion-eliciting stimulus (experimental
condition). In a control condition, subjects observe the same class of emotional
stimuli without applying any strategy. Usually, subjects in the experimental
condition experience reduction in intensity of subjective emotional experience
and reduced activation of relevant neural structures (see Gross and Ochsner,
2005 for a review of basic findings). Besides the limitations of such an
approach (for example the problem of disentangling the actual effect of the
strategy from the compliance of the subjects to the experimental
manipulation), notable results were obtained in two decades of experiments
(Ochsner and Gross, 2005; Ochsner & Gross, 2008). According to Gross (See
Gross, 2014 for a review of the science of emotion regulation), emotions can
be regulated in different modalities (Situation selection, Situation
modification, Attentional deployment, Cognitive change, Response
Modulation) (Process model of emotion regulation, Gross, 1998). The majority
of studies focused on the cognitive change modality using the strategy known
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These studies permit us to appreciate the main variables and mechanisms
involved in IER. We know that individuals can learn to regulate their emotions
using individual strategies (e.g., reappraisal, distancing, distraction,
suppression, etc.). Fronto-parietal regions are usually involved in the
implementation of cognitive strategies such as reappraisal (Ochsner et al.,
2002). Of these, the dorsolateral prefrontal cortex, dlPFC, and the inferior
parietal cortex, IPC, are commonly believed to control attention and working
memory (Corbetta & Shulman, 2002); the anterior cingulate cortex, ACC, is
associated with monitoring and control of ongoing process (Paus, 2001). Last
but not least, the ventrolateral prefrontal cortex and v1PFC appear to be
responsible for selecting goal appropriate responses (Badre & Wagner, 2007;
Thompson-Schill et al., 2005), and to inhibit inappropriate ones (Aron et al.,
2004). The target region of reappraisal is commonly believed to be the
amygdala, a key structure that supports the elaboration of external and internal
emotional stimuli (Cunningham et al.., 2008; 2011) and negative stimuli
4 Alessandro Grecucci, Anthony Theuninck, Jon Frederickson et al.
(Whalen et al., 2004). Other regions less frequently associated with IER are
the striatum and the insula (Silver et al., in press).

1.2. Social Emotion Regulation
Despite the extensive literature on IER (see Ochsner & Gross, 2008),
evidence of emotion regulation in social situations is relatively scant. We are
born from interactions and live through multiple interpersonal interactions our
whole lives. These interactions generate numerous emotional responses such
as anger at being treated unfairly, shame at being exposed, fear at being
threatened, or sadness when rejected. Regulating socially cued emotions
requires different mechanisms and neural processes. There are two broad
means of regulating social emotions. One involves the individual regulation of
socially cued emotions (SER) within ourselves, related to or aroused by
interactions with others, such as anger at being treated unfairly, shame at being
exposed, fear at being threatened, sadness when rejected. The second way
refers to the strategies we use to help others regulate their emotions in
relationships (I-PER).

1.2.1. The Regulation of Socially Cued Emotions
Different brain networks are engaged when processing socially cued
emotions than when processing non-socially cued emotions (Britton et al.,
2006; Harris, McClure, van den Bos, Cohen, & Fiske, 2007; Lestou, Pollick,
& Kourtzi, 2008). As far as we know, the first experiment looking at the
regulation of social emotions was done by Koenigsberg and colleagues
(Koenigsberg et al., 2011). Subjects observed emotional and neutral pictures
while applying reappraisal strategies. The emotional pictures used scenes with
social features, e.g., situations of loss, aggression, and abuse. Subjects were
able to regulate emotions associated with both social and non-social content.
Interestingly, pictures depicting social situations activated brain areas partially
involved in social cognition, such as the superior and middle temporal gyri, in
addition to emotional and cognitive structures similar to previous non-social
studies.
However, in this study (Koenigsberg et al., 2011) subjects were not
exposed to emotions stemming from real social interactions. Moreover an IER
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consider an emotional stimulus from the perspective of a detached and distant
observer (Koenigsberg et al., 2011; Ochsner & Gross, 2005; 2008). This
strategy may be reasonable when looking at a picture but less so during an
Mechanisms of Social Emotion Regulation 5
interpersonal interaction, where distancing may show disinterest and impede
interpersonal intimacy.
Another study from Vrticka, Sander and Vuillumier (2011), showed that
regulating social visual scenes (similar to the ones used by Koenigsberg et al.,
2011), modulated a network comprising the medial prefrontal cortex, mPFC,
the medial orbitofrontal cortex, mOFC, the posterior cingulate cortex, pCC,
and the amygdala. Of particular relevance for the present argument, is that the
mPFC is strictly related to mentalizing about self and others (Gilbert et al.,
2007; Mitchell et al., 2006). Also, the pCC may be related to the attribution of
emotions to others (Johnson et al., 2006; Ochsner et al., 2004).
In another set of studies Grecucci and collaborators (Grecucci et al.,
2013a, b, c), evaluated whether socially cued emotion regulation (SER)
stemming from real interactive situations is possible. These studies (Grecucci
et al., 2013a, b, c) showed that reappraising the intentions of the other player
as less negative, or mentalizing, changes emotional reactions, interpersonal
behaviors and neural responses (Grecucci et al., 2013a, b, c). Notably, this
strategy although very similar to reappraisal, is social in nature as it asks
subjects to focus on the other person. The tasks used in one of these
experiments were the Ultimatum Game and Dictator Game, where participants
played the role of responders. One study showed that subjects had weaker
emotional reactions, used less rejection behavior and had less neural activity
when receiving unfair offers, when they down-regulated their emotions using
mentalizing. This modulation of emotion was visible in an area of the brain
involved in aversive reactions elicited by unfair offers, namely the insula. The
insula has been found to represent the visceral affective experience (Mufson &
Mesulam, 1982; Craig, 2009; Wagner & Feldman Barret, 2004). Moreover, it
has been implied in sensory (Craig, 2009) and moral disgust and anger (Sanfey
et al., 2003). Reappraising the intentions of the other (mentalizing) may thus
act as an individual emotion regulation technique that modulates the emotional
and visceral impact of social cues.
Another recent study (Grecucci et al., 2015), further investigated the
hypothesis that experiential strategies can regulate social emotions. This study
compared the emotional experience and behavioural responses to socially
unpleasant stimuli in practiced and beginning meditators when using
mentalizing (interpersonal cognitive strategy) and intimate detachment
(interpersonal experiential strategy). Notably, experienced meditators were
able to down-regulate negative emotions stemming from interactive situations
(using a paradigm similar to Grecucci et al., 2013a) when using the
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6 Alessandro Grecucci, Anthony Theuninck, Jon Frederickson et al.
the groups was shown when participants used the interpersonal cognitive
reappraisal strategy of mentalization. This study suggests that experiential
strategies down-regulate socially cued negative emotions more than cognitive
strategy such as mentalization.

1.2.2. The Interpersonal Regulation of Emotions
In line with Niven et al. (2009) and Zaki and Williams (2013), we define
interpersonal emotion regulation (I-PER) as regulation that occurs within
social interactions between one person and another. Scholars have suggested
that the same mechanisms subserving IER/SER may be deployed for
interpersonal regulation (Niven et al., 2009). However, we must differentiate
those interventions where a therapist teaches a patient to regulate his own
emotions (more related to IER/SER) from interventions where the therapist
(cid:85)(cid:72)(cid:74)(cid:88)(cid:79)(cid:68)(cid:87)(cid:72)(cid:86)(cid:3) (cid:87)(cid:75)(cid:72)(cid:3) (cid:83)(cid:68)(cid:87)(cid:76)(cid:72)(cid:81)(cid:87)(cid:182)(cid:86)(cid:3) (cid:72)(cid:80)(cid:82)(cid:87)(cid:76)(cid:82)(cid:81)(cid:86)(cid:3) (cid:88)(cid:86)(cid:76)(cid:81)(cid:74) relational strategies (I-PER). Both
methods require one person to help another person regulate emotions, but they
are different in nature. The first type of intervention is typically used by
cognitive-behavioral therapists (especially IER), the second is prioritised by
experiential/dynamic therapists (see sections below).
Individuals turn to others for help in managing their distressing emotions
(Zaki & Williams, 2013), and reduce stress (Lazarus & Folkman, 1984;
Uchino et al., 1996). In turn, people respond to such requests with supportive
and empathic behaviors (Batson, 2011). It is not trivial that interpersonal
situations can foster emotion regulation. For example, being with another
person regulates emotions, especially if this other person means something to
the individual experiencing aversive emotions. In a beautiful set of
experiments, Coan and collaborators (see Coan et al., 2006; Coan, 2011)
showed that simply holding the hand of an intimate person (but also, to a
lesser extent, that of a stranger) helps regulate incoming aversive affects. This
is also confirmed by the observations that when we experience stressful events
we usually seek the help of others (Taylor et al., 2000). Verbally sharing our
emotions with someone also helps regulate emotions regardless of the other
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our emotions therefore helps a person to emotionally regulate at a
psychological and neural level (Lieberman et al., 2011; Kircanski et al., 2012).
Not only can others regulate our emotions, we can help regulate theirs in
relationships. The following sections of this chapter will describe the strategies
and the processes behind interpersonal emotion regulation. Notably, both sets
of mechanisms (passive and active) are certainly involved in the therapeutic
process. Psychodynamic approaches typically use the relationship and what
Mechanisms of Social Emotion Regulation 7
happens between the patient and the therapist to foster change in emotional
reactions.

Table 1. Key areas in individual and social and interpersonal emotion
regulation

INDIVIDUAL SOCIALLY CUED INTERPERSONAL
EMOTION EMOTION REGULATION EMOTION
REGULATION REGULATION
Regulating Regulated Regulating Regulated Regulating regions
regions regions regions regions
DLPFC Amygdala VMPFC Insula Left temporal pole /
VLPFC Striatum VLPFC Striatum inferior temporal gyrus
ACC OFC TPJ Cingulate Rostral medial prefrontal
Temporal cortex
pole Posterior insula
ACC Cingulate gyrus
Bilateral caudate
Cuneus/inferior parietal
lobule

Despite the relevance of this type of regulation for clinical situations, as
far as we know there was only one attempt to study it in a laboratory setting.
In a recent study (Hallan et al., 2014), 23 participants were asked to regulate
their own (intrapersonal conditi(cid:82)(cid:81)(cid:12)(cid:3) (cid:68)(cid:81)(cid:71)(cid:3) (cid:82)(cid:87)(cid:75)(cid:72)(cid:85)(cid:3) (cid:83)(cid:72)(cid:82)(cid:83)(cid:79)(cid:72)(cid:182)(cid:86)(cid:3) (cid:11)(cid:76)(cid:81)(cid:87)(cid:72)(cid:85)(cid:83)(cid:72)(cid:85)(cid:86)(cid:82)(cid:81)(cid:68)(cid:79)(cid:3)
condition) emotional state. In the interpersonal condition participants watched
videos of people watching and reacting to the same emotional video they were
watching. Participants were instructed to tell the person in the video how to
interpret (reappraisal strategy) or suppress (suppression strategy) the emotional
content of the video. Participants had to evaluate their emotions on a 7-point
Likert scale showing that they were able to reduce their emotional states when
applying the strategies. Participants using interpersonal regulation showed
decreased activation of the insula, the temporal-parietal junction, the temporal
pole, and the medial prefrontal cortex similar to previous studies on social
emotion regulation (Grecucci et al., 2013, a, c). Unfortunately, the
interpersonal condition was not well controlled and the strategies used were
cognitive and individual, rather than more experiential and interpersonal in
nature. Despite the theoretical and methodological limitations of this study it
shows that interpersonal emotion regulation is possible. See Table 1 for an
8 Alessandro Grecucci, Anthony Theuninck, Jon Frederickson et al.
outline of the neural structures involved in individual, social and interpersonal
emotion regulation.

2. MECHANISMS OF EMOTION GENERATION,
DYSREGULATION AND TREATMENT:
FROM THE LABORATORY TO THE CONSULTING ROOM

Emotion regulation is essential for healthy psychological functioning.
Deficits in the regulation of interpersonal emotions have been linked to
psychiatric disorders (Grecucci, 2011). Emotion dysregulation lies at the core
of many psychopathologies (Farchione et al., 2012). Although effective
psychotherapeutic treatments are available, many patients fail to demonstrate
clinically significant improvements in emotion regulation (Frederickson &
Grecucci, under revision). Indeed, one of the central problems we face when
working with patients with any psychopathological conditions is how to
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Appraisal theory is the predominant perspective on emotion regulation
and dysregulation (Frijda, 1998; Scherer et al., 2001) and relies on the
assumption that the experience of an event leads to a cognitive appraisal that
generates an emotional response. Based on this theory, cognitive-behavioral
therapies focus on discrete cognitive and behavioural factors to regulate
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based theory of emotion. According to this model emotions are generated
through the following sequence: 1) an individual, exposed to a situation
engages with it; 2) attends to a particular aspect of the situation; 3) interprets
the event; 4) experiences an emotional response with a behaviour (action
tendency), feeling, and physiological arousal; and 5) the individual modulates
that response. Following this model, emotion regulation or dysregulation can
happen at any step in this sequence.
According to the Process Model (Gross, 1998) every emotion can in
principle become dysregulated. The main mechanism of dysregulation is the
lack of, or failure to apply, an appropriate regulatory strategy. The field of
cognitive-behavioral therapies (from the classic Cognitive Behavior Therapy
by Beck, 1998, to third wave therapies like Dialectical Behavior Therapy by
Linehan, 1993a,b) use interventions for emotional regulation that fit with the
model. Within this model and these therapies, emotion dysregulation is treated
through behavioral methods (selecting exposure to appropriate situations and
Mechanisms of Social Emotion Regulation 9
adaptive modification of the situation), attentional methods (supporting
attentional flexibility and developing awareness to internal and external
situational cues), cognitive methods (cognitive evaluations and reappraisals)
and mindfulness and acceptance methods (accepting and mindfully attending
to our responses to situations without recourse to maladaptive responses). The
two basic assumptions of these approaches are that 1) patients lack emotion
regulation strategies to intervene at the different stages of emotion processing
and 2) that problematic appraisal styles are a core driver of dysregulated
emotion. These various methods of emotion regulation employed by the CBTs
and their fit with the Process Model of Emotion will be reviewed in the next
section.
The perspective we want to put forward departs from appraisal theory and
is grounded in affective neuroscience findings (Panksepp, 1998; Biven &
Panksepp, 2012) and modern psychodynamic psychotherapy. For purposes of
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(cid:53)(cid:72)(cid:74)(cid:88)(cid:79)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:180)(cid:3)(cid:80)(cid:82)(cid:71)(cid:72)(cid:79)(cid:3)(cid:82)(cid:85)(cid:3)(cid:38)(cid:40)(cid:53)(cid:15)(cid:3)(cid:68)(cid:86)(cid:3)(cid:76)(cid:87)(cid:3)(cid:76)(cid:86)(cid:3)(cid:69)(cid:68)(cid:86)(cid:72)(cid:71) on a cognitive model of emotions
(appraisal theory), whilst the perspective are putting forward is the
Experiential-Dynamic Emotion Regulation model, or EDER. In the EDER,
emotions are created as follows: events trigger emotional reactions which
comprise subjective and physiological responses from which a coherent
expression-action is produced. One important difference between the models is
that in the EDER model, emotional responses are regarded as having prewired
in the brain to have a certain duration and intensity. Once elicited they are
proportional to the stimulus and automatically self-regulate. The conscious
control or use of a specific strategy is therefore not required to regulate
emotions. Emotions are generated, expressed and channelled into healthy
actions and return to baseline (Frederickson, 2013). Another important aspect,
is that emotions are not inherently dysregulated (Frederickson & Grecucci,
under revision). Dysregulation results from 1) excessive anxiety paired with
the perception and or expression of emotions; or 2) defences which create
defensive affects (Frederickson 2013), or secondary affective responses (e.g., a
patient projects that you are criticizing him, and becomes chronically angry at
the projection placed upon the therapist). Frederickson and Grecucci (under
revision) define both cases as Dysregulated Affective States (DAS). DAS lead
to severe dysregulation. Notably, another departure from the CER model relies
on the fact that the clinician treats emotional problems by removing
dysregulatory mechanisms (anxiety and defensive affects, or DAS), rather than
adding new regulatory strategies.
10 Alessandro Grecucci, Anthony Theuninck, Jon Frederickson et al.
Table 2. Two views on the relation between emotion regulation,
psychopathology and psychotherapy

NORMALITY PATHOLOGY PSYCHOTHERAPY

HOW EMOTION IS HOW HOW
GENERATED DYSREGULATION DYSREGUALTION
HAPPENS CAN BE TREATED
Cognitive Emotion is The individual fails The clinician teaches
Emotion generated, the to use regulatory the patient individual
Regulation individual adopts strategies (deficit emotion regulation
model (Gross, regulatory strategies mechanism) and strategies to regulate
1998 and at different levels every emotion can his emotions.
further (situation selection, become (Therapeutic model:
developments). situation dysregulated. family of Cognitive-
modification, Behavioral
attentional Therapies)
deployment,
cognitive change,
response modulation)
to regulate it.
Experiential- Emotion is generated Emotion is The clinician focus to
Dynamic by mainly generated and then social events and
Emotion subcortical brain dysregulatory helps the patient to
Regulation structures with mechanisms remove dysregulatory
model certain properties intervene (anxiety mechanisms and
(Grecucci, (duration, intensity). or maladaptive down-regulates DAS
2012; The brain self- regulatory in an interpersonal
Frederickson regulates emotions strategies, defense context. At the same
& Grecucci, in through a biological mechanisms in time helps the patient
press; mechanism. psychodynamic to up-regulate the
Grecucci, terms) that stop true emotions
Theuninck, self-regulatory (Therapeutic model:
Frederickson, mechanisms and family of
Job, present cause dysregulated Experiential-
chapter). affective states Dynamic Therapies)
(DAS).

Once dysregulatory mechanisms are removed, the therapist helps the
patient experience the underlying emotion and translate it into adaptive action
(Coughlin 1996; McCullough et al., 2003). Notably, this perspective separates
what should be down-regulated from what should be up-regulated. While the
clinician helps (through experiential-dynamic strategies, see section below) to
eliminate (or down-regulate in emotion regulation terms) DAS, it helps the