Handbook of Emotion Regulation, Second Edition

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THE GUILFORD PRESS

HANDBOOK OF EMOTION REGULATION

Handbook of

EMOTION

REGUL ATION

SECOND EDITION

Edited by

James J. Gross

THE GUILFORD PRESS

New York London

A Division of Guilford Publications, Inc.

72 Spring Street, New York, NY 10012

www.guilford.com

No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted,

in any form or by any means, electronic, mechanical, photocopying, microfilming, recording,

or otherwise, without written permission from the publisher.

Printed in the United States of America

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Last digit is print number: 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data is available from the Publisher

ISBN 978-1-4625-0350-6

To Paul, Mark, and Anne

James J. Gross, PhD, is Professor of Psychology at Stanford University and Director

of the Stanford Psychophysiology Laboratory (http://spl.stanford.edu). He is a leading

figure in the areas of emotion and emotion regulation and is a recipient of early career

awards from the American Psychological Association, the Western Psychological Asso-

ciation, and the Society for Psychophysiological Research. A Bass University Fellow

in Undergraduate Education and Director of the Stanford Psychology One Teaching

Program, Dr. Gross has won numerous awards for his teaching, including the Dean’s

Award for Distinguished Teaching, the Phi Beta Kappa Teaching Prize, the Stanford

Postdoctoral Mentoring Award, and the Walter J. Gores Award for Excellence in Teach-

ing. He has an extensive program of investigator-initiated research, with grants from

the National Institutes of Health, the National Science Foundation, and the Institute

of Education Sciences. He is the author of over 250 publications and is a Fellow in the

Association for Psychological Science and the American Psychological Association.

About the Editor

vii

Dustin Albert, PhD, Center for Child and Family Policy, Duke University,

Durham, North Carolina

Adam K. Anderson, PhD, Department of Human Development, College of Human Ecology,

Cornell University, Ithaca, New York

Allison A. Appleton, ScD, Geisel School of Medicine at Dartmouth College,

Hanover, New Hampshire

Ozlem Ayduk, PhD, Department of Psychology, University of California, Berkeley,

Berkeley, California

David H. Barlow, PhD, Center for Anxiety and Related Disorders, Boston University,

Boston, Massachusetts

Lisa Feldman Barrett, PhD, Department of Psychology, Northeastern University,

Boston, Massachusetts

Lawrence W. Barsalou, PhD, Department of Psychology, Emory University, Atlanta, Georgia

Matthias Berking, PhD, Department of Clinical Psychology and Psychotherapy,

University of Marburg, Marburg, Germany

Lian Bloch, PhD, Department of Psychology, Stanford University, Stanford, California

Martin Bohus, MD, Central Institute of Mental Health, University of Heidelberg,

Mannheim, Germany

Laura Campbell-Sills, PhD, Department of Psychiatry, University of California, San Diego,

La Jolla, California

Laura L. Carstensen, PhD, Department of Psychology, Stanford University, Stanford, California

Susan Turk Charles, PhD, Department of Psychology and Social Behavior,

University of California, Irvine, Irvine, California

Edith Chen, PhD, Department of Psychology, Northwestern University, Evanston, Illinois

James A. Coan, PhD, Department of Psychology, University of Virginia,

Charlottesville, Virginia

Steven W. Cole, PhD, Geffen School of Medicine, University of California, Los Angeles,

Los Angeles, California

William A. Cunningham, PhD, Department of Psychology, University of Toronto,

Toronto, Ontario, Canada

Contributors

viii Contributors

Jozefien De Leersnyder, MA, Center for Social and Cultural Psychology,

Katholieke

Universiteit

Leuven, Leuven,

Belgium

Jonathan P. Dunning, PhD, Department of Psychology, Nevada State College,

Henderson, Nevada

Nancy Eisenberg, PhD, Department of Psychology, Arizona State University, Tempe, Arizona

Kristen K. Ellard, PhD, Department of Psychology, Massachusetts General Hospital/

Harvard Medical School, Boston, Massachusetts

Joshua Eng, PhD, Department of

Psychology, University of California, Berkeley,

Berkeley,

California

Amit Etkin, MD, PhD, Department of

Psychiatry and Behavioral Sciences, Stanford University

School of

Medicine, Stanford, California

Norman A. S. Farb, PhD, Rotman Research Institute, Toronto, Ontario,

Canada

Daniel Foti, PhD, Department of

Psychology, Stony Brook University, Stony Brook, New York

David M. Fresco, PhD, Department of

Psychology, Kent State University, Kent, Ohio

Dina Gohar, MA, Department of

Psychology and Neuroscience, Duke University,

Durham,

North

Carolina

Ben Grafton, MA, Centre for

the Advancement of Research on Emotion, School of Psychology,

University of

Western Australia, Crawley, Australia; School of Psychology,

Babes‑Bolyai

University, Cluj

‑N

apoca,

Romania

Alessandro Grecucci, PhD, Department of

Cognitive Science, University of Trento,

Rovereto,

Italy

James J. Gross, PhD, Department of

Psychology, Stanford University, Stanford, California

Anett Gyurak, PhD, Department of

Psychology, Stanford University, Stanford, California

Claudia M. Haase, PhD, Department of

Psychology, University of California, Berkeley,

Berkeley,

California

Todd F. Heatherton, PhD, Department of

Psychological and Brain Sciences,

Dartmouth College, Hanover,

New

Hampshire

Claire Hofer, PhD, Department of

Psychology, Charles de Gaulle University,

Villeneuve

d’Ascq,

France

Wilhelm Hofmann, PhD, Center for

Decision Research, University of Chicago

Booth

School of Business, Chicago, Illinois

Sarah R. Holley, PhD, Psychology Department, San Francisco State University,

San

Francisco, California

Julie A. Irving, PhD, Mood and Anxiety Disorders Program, Centre for

Addiction

and

Mental Health, Toronto, Ontario, Canada

Oliver P. John, PhD, Department of

Psychology and Institute of Personality

and

Social Research, University of California, Berkeley, Berkeley, California

Tom Johnstone, PhD, School of

Psychology, Centre for Integrative Neuroscience

and

Neurodynamics, University of Reading, Reading, United Kingdom

Christopher R. Jones, PhD, Annenberg School for

Communication, University of Pennsylvania,

Philadelphia,

Pennsylvania

Jutta Joormann, PhD, Department of

Psychology, Northwestern University, Evanston, Illinois

Bokyung Kim, MA, Department of

Psychology, Stanford University, Stanford, California

Contributors ix

Tabitha Kirkland, MA, Department of Psychology, The Ohio State University, Columbus, Ohio

Kathrin Klipker, PhD, Max Planck Research Group “Affect Across the Lifespan,” Max Planck

Institute for Human Development, Berlin, Germany

Hedy Kober, PhD, Interdepartmental Neuroscience Program, Yale University,

New Haven, Connecticut

Hiroki P. Kotabe, BA, Center for Decision Research, University of Chicago Booth School

of Business, Chicago, Illinois

Laura D. Kubzansky, PhD, Department of

Social and Behavioral Sciences,

Harvard

School of Public Health, Boston, Massachusetts

Mark R. Leary, PhD, Department of

Psychology and Neuroscience, Duke University,

Durham,

North

Carolina

Robert W. Levenson, PhD, Department of

Psychology, University of California, Berkeley,

Berkeley,

California

Marsha M. Linehan, PhD, Department of

Psychology, University of Washington,

Seattle,

Washington

Anna Luerssen, PhD, Department of

Psychology, Lehman College, City University

New York, New York, New York

Colin MacLeod, PhD, School of

Psychology, University of Western Australia, Perth, Australia

Erin L. Maresh, MA, Department of

Psychology, University of Virginia,

Charlottesville,

Virginia

Iris B. Mauss, PhD, Department of

Psychology, University of California, Berkeley,

Berkeley,

California

Samuel M. McClure, PhD, Department of

Psychology, Stanford University, Stanford, California

Douglas S. Mennin, PhD, Department of

Psychology, Hunter College, and The

Graduate

Center, City University of New York, New York, New York

Batja Mesquita, PhD, Department of

Psychology, Katholieke Universiteit Leuven,

Leuven,

Belgium

Mario Mikulincer, PhD, Interdisciplinary Center, New

School of Psychology, Herzliya, Israel

Eric M. Miller, PhD, Department of

Psychology, Stanford University, Stanford, California

Gregory E. Miller, PhD, Department of

Psychology, University of British Columbia, Vancouver,

British Columbia,

Canada

Andrada D. Neacsiu, PhD, Department of

Psychiatry and Behavioral Sciences, Duke University

Medical Center, Durham,

North Carolina

Kevin N. Ochsner, PhD, Department of

Psychology, Columbia University,

New

York, New York

Michael I. Posner, PhD, Department of

Psychology, University of Oregon, Eugene, Oregon

Greg Hajcak Proudfit, PhD, Department of

Psychology, Stony Brook University,

Stony

Brook, New York

Michaela Riediger, PhD, Max Planck Research Group “Affect Across the

Lifespan,”

Max

Planck Institute for Human Development, Berlin, Germany

Christian Rodriguez, BA, Department of

Psychology, Stanford University, Stanford, California

Mary K. Rothbart, PhD, Distinguished Professor Emerita, Department of

Psychology,

University of

Oregon, Eugene,

Oregon

x Contributors

Alan G. Sanfey, PhD, Centre for Cognitive Neuroimaging, Donders Institute for Brain,

Cognition, and Behavior, Nijmegen, The Netherlands

Jeanine Schwarz, MA, Department of Clinical Psychology and Psychotherapy,

University of Marburg, Marburg, Germany

Zindel V. Segal, PhD, Centre for Addiction and Mental Health, University of Toronto,

Toronto, Ontario, Canada

Benjamin H. Seider, PhD, Marin County Department of Health and Human Services,

San Rafael, California

Phillip R. Shaver, PhD, Department of Psychology, University of California, Davis,

Davis, California

Brad E. Sheese, PhD, Department of Psychology, Illinois Wesleyan University,

Bloomington, Illinois

Gal Sheppes, PhD, The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel

Matthias Siemer, PhD, Department of Psychology, University of Miami, Coral Gables, Florida

Tracy L. Spinrad, PhD, School of Social and Family Dynamics, Arizona State University,

Tempe, Arizona

Michael J. Sulik, MA, Department of Psychology, Arizona State University, Tempe, Arizona

Maya Tamir, PhD, Department of Psychology, The Hebrew University, Jerusalem, Israel

Ross A. Thompson, PhD, Department of Psychology, University of California, Davis,

Davis, California

Dylan D. Wagner, PhD, Department of Psychological and Brain Sciences, Dartmouth College,

Hanover, New Hampshire

Henrik Walter, MD, PhD, Department of Psychiatry and Psychotherapy,

Charité Universitätsmedizin, Berlin, Germany

Anna Weinberg, MA, Department of Psychology, Stony Brook University,

Stony Brook, New York

Christine D. Wilson-Mendenhall, MA, Department of Psychology, Northeastern University,

Boston, Massachusetts

By any measure, the field of emotion regulation is thriving. Books, articles, special jour-

nal issues, and conferences related to emotion regulation seem to be everywhere. This

high (and growing) level of interest in emotion regulation is reflected in citation trends.

Until the early 1990s, there were just a few citations each year containing the term

emotion regulation. By 2007—the year in which the first edition of this handbook was

published—there were more than 3,000 Google Scholar citations for that year alone. In

2012, the citation count passed 8,000 for that year alone. Doing the math, it turns out

that many more papers have been published on emotion regulation in the years since

the first edition of this handbook was published than in all years up to—and includ-

ing—2007. Hence, this second edition of the Handbook of Emotion Regulation.

The goal of this edition is to provide an authoritative and up-to-date account of

findings in this field that will (1) encourage cumulative science by drawing together and

integrating the specialized literatures on emotion regulation that exist in each of the

subareas of psychology; and (2) facilitate cross-disciplinary dialogue about one of the

most fascinating puzzles regarding the human condition, namely, that we are at once

governed by—and governors of—our emotions. Of the 36 chapters in this new edition,

two-thirds are brand new chapters for this edition, and the remaining chapters have

been thoroughly updated. To reflect exciting new developments in the field, three new

sections have been added in this edition: Psychopathology, Interventions, and Health

Implications.

The Handbook begins with a section on foundations, in which I provide a concep-

tual and empirical orientation to the field. To this end, I first set emotion in the context

of other affective processes. Next, I relate emotion regulation to other forms of affect

regulation. I then selectively review what is known about emotion regulation goals,

strategies, and outcomes. In the final part of the chapter, I highlight several fundamen-

tal questions and associated directions for future research on emotion and emotion

regulation.

The second section considers biological bases of emotion regulation. Ochsner and I

draw upon the human neuroimaging literature to present an integrated framework that

links emotion and emotion regulation to other important forms of valuation, including

affective learning, affective decision making, and expectancies, beliefs, and placebo

effects. Proudfit, Dunning, Foti, and Weinberg review electroencephalographic studies

of the temporal dynamics of emotion generation and emotion regulation, demonstrating

that one particular event-related brain potential—the late positive potential—is sen-

sitive to attentional and cognitive emotion regulation manipulations. Johnstone and

Preface

xii Preface

Walter describe the network of prefrontal and subcortical brain structures that are cru-

cial for optimal health and show how this network is dysfunctional in clinical disorders.

Finally, Gyurak and Etkin present a process-oriented neurobiological framework that

seeks to integrate a wide range of implicit and explicit emotion regulation processes that

are crucial to understanding mental health and illness.

The third section examines cognitive aspects of emotion regulation. Miller, Rodri-

guez, Kim, and McClure present a multiple systems account of delay discounting, and

argue that delay discounting provides a framework for studying important instances

of emotion regulation, including responses to temptations, procrastination, willpower,

and addictions. Luerssen and Ayduk review the literature on delay of gratification, with

an emphasis on identifying precursors, assessing the role of current affective state, link-

ing delay of gratification to emotion regulation, and discussing insights from neuroim-

aging. Sheppes introduces the notion of emotion regulation choice; explains why it is

crucial for healthy functioning; and explores the emotional, cognitive, and motivational

determinants of emotion regulation choice. Finally, Grecucci and Sanfey review the

literature on emotion and decision making, and make the case that emotion regulation

influences our decision making in a number of important ways.

The fourth section focuses on developmental considerations, ranging from child-

hood through old age. Eisenberg, Hofer, Sulik, and Spinrad examine the development

of effortful control in childhood and assess its impact on socioemotional, academic,

and moral development. Thompson reviews the literature on the socialization of emo-

tion and emotion regulation in the family, framing the socialization process in terms

of an interaction between bottom-up and top-down influences. Riediger and Klipker

consider emotion regulation in adolescence, with particular attention to the acquisition

of emotion regulation skills, the motivation to regulate, and emotion regulation effec-

tiveness. Finally, Charles and Carstensen take a lifespan perspective, and show how bio-

logical and motivational changes interact to shape the trajectory of emotion regulation

throughout adulthood and into older age.

The fifth section considers social aspects of emotion regulation. Coan and Maresh

present social baseline theory, which they use to explain how and why each of us uses

other people to help regulate our emotions. Shaver and Mikulincer apply attachment

theory to adolescents and adults, and show how this theory illuminates basic processes

and individual differences in interpersonal emotion regulation. Jones, Kirkland, and

Cunningham link the literature on attitudes and evaluation to emotion regulation,

with particular attention to their iterative reprocessing model. Levenson, Haase, Bloch,

Holley, and Seider consider emotion regulation in couples, with particular attention to

the nature, development, and consequences of this form of social emotion regulation.

Finally, Mesquita, De Leersnyder, and Albert present a cultural perspective on emo-

tion regulation and show that regulatory patterns are aligned with cultural ideas and

practices.

The sixth section examines personality processes and individual differences. Roth-

bart, Sheese, and Posner present a temperament systems approach, which provides a

context for understanding individual differences, as well as the development of emo-

tion regulation. John and Eng consider individual differences in emotion regulation,

with particular attention to individual differences in coping, emotional competence,

and specific regulatory processes such as reappraisal and suppression. Hofmann and

Kotabe argue that desires share many similarities with emotion and show how an emo-

tion regulation perspective can be used to organize findings relative to the regulation

Preface xiii

of desire. Mauss and Tamir argue that emotion goals are critical to emotion regula-

tion, and consider their content, hierarchical structure, and modes of operation. Finally,

Leary and Gohar analyze the many ways self-awareness influences emotion regulation.

The seventh section focuses on emotion regulation and psychopathology.

Campbell-Sills, Ellard, and Barlow review behavioral and neurobiological findings rela-

tive to the role of emotion regulation in the development, phenomenology, and treatment

of anxiety disorders. Joormann and Siemer apply an emotion regulation perspective to

mood disorders, with an eye toward understanding the factors that govern the onset

and maintenance of these disorders. Kober discusses the role of emotion regulation in

substance use disorders, featuring both the ways drugs regulate emotions and the ways

in which emotion dysregulation is at once a cause for and a consequence of drug use.

Finally, Barrett, Wilson-Mendenhall, and Barsalou examine emotion regulation from

the perspective of situated conceptualizations and show how this perspective sheds new

light on emotion dysregulation.

The eighth section considers clinical interventions designed to change emotion

regulation. Mennin and Fresco present emotion regulation therapy, and show how this

integrative intervention can be applied to generalized anxiety disorder and major depres-

sion. Neacsiu, Bohus, and Linehan describe dialectical behavior therapy, a treatment

designed for individuals with severe and pervasive disorders of emotion regulation, such

as borderline personality disorder. MacLeod and Grafton review research on atten-

tional bias modification procedures and show how these procedures help individuals

with conditions involving deficient emotion regulation. Berking and Schwarz describe

the development of affect regulation training, which seeks to enhance emotional com-

petence by training specific affect regulation skills. Finally, Farb, Anderson, Irving,

and Segal review the literature on mindfulness meditation, showing how mindfulness

meditation engages basic emotion regulation processes.

The ninth section of this handbook focuses on emotion regulation and health. Cole

draws upon research on social genomics to show how emotional suppression might

affect the molecular underpinnings of disease. Chen and Miller document how socio-

economic status predicts health outcomes, and argue that one reason for this associa-

tion may be that low-socioeconomic-status children fail to learn adaptive forms of emo-

tion regulation. Appleton and Kubzansky employ an emotion regulation framework to

explain the association between negative emotions and cardiovascular disease. Finally,

Wagner and Heatherton show how negative affect—and its misregulation—can lead to

self-control failures ranging from binge eating to aggression.

Although this handbook is divided into sections, one of its major goals is break-

ing down barriers to cross-area communication. For this reason, there are considerably

more cross-chapter links and citations than is typical in a handbook of this kind. There

are also many points at which an author in one section will present material that makes

contact with ideas, methods, and evidence from another section (e.g., developmental

considerations in the health section; neuroscience in the cognitive section; analyses of

individual differences in the social section). My hope is that these carefully assembled

chapters—written by leading scholars in the field—will bring the field of emotion regu-

lation together in a way that will be productive and new.

A large number of wonderful people helped to bring this handbook into being. I

am grateful to Seymour Weingarten, Editor-in-Chief at The Guilford Press, for convinc-

ing me that the time was right for this handbook, and to Robert Levenson, with whom

my work on emotion regulation began. I am also grateful to my many friends and col-

xiv Preface

leagues who have helped shape my thinking about emotion regulation, and I would like

to particularly thank the generous reviewers who provided helpful feedback on each of

these chapters. Finally, I would like to acknowledge the contributions of the members

of the Stanford Psychophysiology Laboratory, who help make Stanford such a fun place

to be.

James J. Gross

Part I. Foundations

1. Emotion Regulation: Conceptual and Empirical Foundations 3

James J. Gross

Part II. Biological Bases

2. The Neural Bases of Emotion and Emotion Regulation: 23

A Valuation Perspective

Kevin N. Ochsner and James J. Gross

3. Temporal Dynamics of Emotion Regulation 43

Greg Hajcak Proudfit, Jonathan P. Dunning, Daniel Foti, and Anna Weinberg

4. The Neural Basis of Emotion Dysregulation 58

Tom Johnstone and Henrik Walter

5. A Neurobiological Model of Implicit and Explicit Emotion Regulation 76

Anett Gyurak and Amit Etkin

Part III. Cognitive Approaches

6. Delay Discounting: A Two‑Systems Perspective 93

Eric M. Miller, Christian Rodriguez, Bokyung Kim, and Samuel M. McClure

7. The Role of Emotion and Emotion Regulation 111

in the Ability to Delay Gratification

Anna Luerssen and Ozlem Ayduk

Contents

xvi Contents

8. Emotion Regulation Choice: Theory and Findings 126

Gal Sheppes

9. Emotion Regulation and Decision Making 140

Alessandro Grecucci and Alan G. Sanfey

Part IV. Developmental Considerations

10. Self-Regulation, Effortful Control, and Their Socioemotional Correlates 157

Nancy Eisenberg, Claire Hofer, Michael J. Sulik, and Tracy L. Spinrad

11. Socialization of Emotion and Emotion Regulation in the Family 173

Ross A. Thompson

12. Emotion Regulation in Adolescence 187

Michaela Riediger and Kathrin Klipker

13. Emotion Regulation and Aging 203

Susan Turk Charles and Laura L. Carstensen

Part V. Social Aspects

14. Social Baseline Theory and the Social Regulation of Emotion 221

James A. Coan and Erin L. Maresh

15. Adult Attachment and Emotion Regulation 237

Phillip R. Shaver and Mario Mikulincer

16. Attitudes, Evaluation, and Emotion Regulation 251

Christopher R. Jones, Tabitha Kirkland, and William A. Cunningham

17. Emotion Regulation in Couples 267

Robert W. Levenson, Claudia M. Haase, Lian Bloch, Sarah R. Holley,

and Benjamin H. Seider

18. The Cultural Regulation of Emotions 284

Batja Mesquita, Jozefien De Leersnyder, and Dustin Albert

Part VI. Personality Processes and Individual Differences

19. Temperament and Emotion Regulation 305

Mary K. Rothbart, Brad E. Sheese, and Michael I. Posner

20. Three Approaches to Individual Differences in Affect Regulation: 321

Conceptualizations, Measures, and Findings

Oliver P. John and Joshua Eng

Contents xvii

21. Desire and Desire Regulation: Basic Processes 346

and Individual Differences

Wilhelm Hofmann and Hiroki P. Kotabe

22. Emotion Goals: How Their Content, Structure, and Operation 361

Shape Emotion Regulation

Iris B. Mauss and Maya Tamir

23. Self-Awareness and Self-Relevant Thought in the Experience 376

and Regulation of Emotion

Mark R. Leary and Dina Gohar

Part VII. Psychopathology

24. Emotion Regulation in Anxiety Disorders 393

Laura Campbell-Sills, Kristen K. Ellard, and David H. Barlow

25. Emotion Regulation in Mood Disorders 413

Jutta Joormann and Matthias Siemer

26. Emotion Regulation in Substance Use Disorders 428

Hedy Kober

27. A Psychological Construction Account of Emotion Regulation 447

and Dysregulation: The Role of Situated Conceptualizations

Lisa Feldman Barrett, Christine D. Wilson-Mendenhall,

and Lawrence W. Barsalou

Part VIII. Interventions

28. Emotion Regulation Therapy 469

Douglas S. Mennin and David M. Fresco

29. Dialectical Behavior Therapy: An Intervention 491

for Emotion Dysregulation

Andrada D. Neacsiu, Martin Bohus, and Marsha M. Linehan

30. Regulation of Emotion through Modification of Attention 508

Colin MacLeod and Ben Grafton

31. Affect Regulation Training 529

Matthias Berking and Jeanine Schwarz

32. Mindfulness Interventions and Emotion Regulation 548

Norman A. S. Farb, Adam K. Anderson, Julie A. Irving,

and Zindel V. Segal

xviii Contents

Part IX. Health Implications

33. Emotion Regulation and Gene Expression 571

Steven W. Cole

34. Early-Life Socioeconomic Status, Emotion Regulation, 586

and the Biological Mechanisms of Disease across the Lifespan

Edith Chen and Gregory E. Miller

35. Emotion Regulation and Cardiovascular Disease Risk 596

Allison A. Appleton and Laura D. Kubzansky

36. Emotion and Self-Regulation Failure 613

Dylan D. Wagner and Todd F. Heatherton

Author Index 629

Subject Index 657

PART I

FOUNDATIONS

Emotions often are wonderfully helpful.

They can direct attention to key features of

the environment, optimize sensory intake,

tune decision making, ready behavioral

responses, facilitate social interactions, and

enhance episodic memory. However, emo-

tions can harm as well as help, particularly

when they are of the wrong type, intensity,

or duration for a given situation.

At such moments, we may try to regulate

our emotions. This fundamental insight—

that emotions can and should be regulated

in certain situations— is well represented

over the centuries in each of the major world

traditions (for a more detailed historical

overview of the field, see Gross, 1999).

In the past century, psychological inves-

tigations of emotion regulation have

focused on psychological defenses (Freud,

1926/1959), stress and coping (Lazarus,

1966), attachment (Bowlby, 1969), and self-

regulation (Mischel, 1996). However, until

the early 1990s, there were relatively few

papers each year containing the term emo-

tion regulation (see Figure 1.1). Now there

are thousands of new publications each year,

making emotion regulation one of the fastest

growing areas within the field of psychology

(Koole, 2009; Tamir, 2011).

What is needed is a framework for orga-

nizing this bewildering array of findings. My

aim in this chapter is to provide such a con-

ceptual and empirical framework. Because

a discussion of emotion regulation presup-

poses an understanding of what emotion is,

in the first section I present the modal model

of emotion and relate emotion to other

affective processes. In the second section, I

describe the process model of emotion regu-

lation and distinguish emotion regulation

from other forms of self- regulation. This pre-

pares the way for the third section, in which

I discuss key findings regarding emotion

regulation goals, strategies, and outcomes.

In the final section, I highlight three of the

biggest challenges— and opportunities— for

those interested in emotion regulation.

Emotions and Related Processes

One of the toughest questions in the field

of affective science is one of the simplest,

namely: What is an emotion? Theorists have

tried to address this question by posing two

other questions: What attributes are shared

by all emotions (necessary conditions)?

What attributes— if present— guarantee that

something is an emotion (sufficient condi-

tions)? Unfortunately, efforts to derive this

kind of tidy classical definition of emotion

are thwarted by the fact that emotion refers

to an astonishing array of responses, from the

mild to the intense, the brief to the extended,

CHAPTER 1

Emotion Regulation:

Conceptual and Empirical Foundations

James J. Gross

4 FOUNDATIONS

the simple to the complex, and the private to

the public. Disgust at a prejudiced comment

counts as an emotion. So does amusement

at a funny mishap, anger at social injustice,

joy at the prospect of receiving a promotion,

surprise at a friend’s “new look,” grief at the

death of a spouse, and embarrassment at a

child’s misbehavior. What are the core fea-

tures of these diverse emotions?

Core Features of Emotion

The first core feature of emotion has to do

with when it occurs. According to appraisal

theory, emotions arise when an individual

attends to and evaluates (appraises) a situ-

ation as being relevant to a particular type

of currently active goal (Lazarus, 1991;

Scherer, Schorr, & Johnstone, 2001). The

goals that underlie this evaluation may be

enduring (staying alive) or transient (want-

ing another piece of cake). They may be con-

scious and complicated (aspiring to become

a professor) or unconscious and simple (try-

ing to avoid stepping in puddles). They may

be widely shared (having close friends) or

highly idiosyncratic (finding a new way of

tying one’s shoes). Whatever the goal, and

whatever meaning the situation has in light

of the goal, it is this meaning that gives rise

to emotion. As this meaning changes over

time—due either to changes in the situation

itself or changes in the meaning the situation

holds for the individual— the emotion will

also change.

The second core feature of emotion has to

do with its multifaceted nature. Emotions

are whole-body phenomena that involve

loosely coupled changes in the domains of

subjective experience, behavior, and central

and peripheral physiology (Mauss, Leven-

son, McCarter, Wilhelm, & Gross, 2005).

The subjective aspect of emotion is so cen-

tral to many instances of emotion that the

terms “emotion” and “feeling” often are

used interchangeably. But emotions not

only make us feel, they also incline us to

act (Frijda, 1986). These impulses to act in

certain ways (and not act in others) include

changes in facial behavior and body posture,

as well as situation- specific instrumental

actions such as staring, hitting, or running.

1000

2000

3000

4000

5000

6000

7000

8000

9000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

FIGURE 1.1. Number of publications containing the exact term emotion regulation in Google Scholar

each year from 1990 to 2012 (Gross, 2013). Note that this is not a cumulative plot; each point repre-

sents 1 year’s citations.

Conceptual and Empirical Foundations 5

These changes in experience and behavior

are associated with autonomic and neuro-

endocrine responses that both anticipate

emotion- related behaviors (thereby provid-

ing metabolic support for the action) and

follow them, often as a consequence of the

motor activity associated with the emotional

response (Lang & Bradley, 2010). As func-

tionalist accounts of emotion make clear,

the multifaceted responses that comprise

emotion often (but not always) are useful in

helping to achieve the goals that gave rise to

emotions in the first place (Levenson, 1999).

The Modal Model of Emotion

These core features constitute what has

been referred to as the modal model of

emotion— so called because these features

are evident in many different approaches to

emotion (Barrett, Ochsner, & Gross, 2007;

Gross, 1998a). According to this model,

emotions involve person– situation transac-

tions that compel attention, have meaning

to an individual in light of currently active

goals, and give rise to coordinated yet flex-

ible multisystem responses that modify the

ongoing person– situation transaction in

crucial ways. The modal model lies at the

heart of lay intuitions about emotion and

also represents key points of convergence

among researchers and theoreticians con-

cerned with emotion.

In Figure 1.2, I present the situation–

attention– appraisal– response sequence speci-

fied by the modal model of emotion in

highly abstracted and simplified form. This

sequence begins with a psychologically rel-

evant situation. Often, this is a situation that

can be specified by referring to features of

the external environment (e.g., the snake

slithering into my tent). However, psycho-

logically relevant “situations” can also be

internal (e.g., the sneaking suspicion that

I’ll never amount to anything). Whether

external or internal, situations are attended

to in various ways, giving rise to appraisals

that constitute the individual’s assessment

of what the situation means in light of rel-

evant goals (Ellsworth & Scherer, 2003).

The emotional responses generated by these

unfolding appraisals involve changes in

experiential, behavioral, and neurobiologi-

cal response systems.

Like many other responses we make,

emotional responses often change the situ-

ation that gave rise to the response in the

first place. Figure 1.2 depicts this aspect of

emotion by showing the response looping

back to (and modifying) the situation that

gave rise to the emotion. To make this idea

more concrete, imagine a husband and wife

heatedly disagreeing about whether house-

hold chores are being fairly divided. Several

minutes into the discussion, the husband

starts to cry (yes, the husband). This emo-

tional response dramatically alters the inter-

personal situation. This new situation now

gives rise to a new response from the wife—

now no longer angry but instead feeling

compassion. This compassionate response

itself further changes the interpersonal situ-

ation, giving rise to other emotions in each

of them. The key idea here is that emotional

responses often lead to changes in the envi-

ronment that alter the probability of subse-

quent instances of that and other emotions

(for a more detailed discussion of this point,

see Gross & Thompson, 2007).

Emotions and Other

Affective

Processes

One thing that makes the emotion literature

challenging is that many different terms are

used to refer to emotion- related processes,

including affect, emotion, stress, and mood

(Davidson, 1994). Unfortunately, these

terms are used in different ways by differ-

ent researchers, leading at times to some

degree of “conceptual and definitional

chaos” (Buck, 1990, p. 330). To organize

this chaotic landscape, I find it useful to

view affect as the umbrella term for states

that involve relatively quick good–bad dis-

criminations (Scherer, 1984). These affec-

tive states include (1) emotions such as anger

and sadness, (2) stress responses to circum-

stances that exceed an individual’s ability to FIGURE 1.2. The modal model of emotion.

Situation Attention Appraisal Response

6 FOUNDATIONS

cope, and (3) moods such as depression and

euphoria.

How are these various affective processes

distinguished? Although both emotion and

stress involve whole-body responses to sig-

nificant events, “stress” typically refers to

negative (but otherwise unspecified) affec-

tive responses, whereas “emotion” refers to

both negative and positive affective states

(Lazarus, 1993). Emotions also may be

distinguished from moods (Parkinson, Tot-

terdell, Briner, & Reynolds, 1996). Moods

often last longer than emotions, and com-

pared to moods, emotions are typically

elicited by specific objects and give rise to

behavioral response tendencies relevant to

these objects. By contrast, moods are more

diffuse, and although they may give rise to

broad action tendencies such as approach or

withdrawal (Lang, 1995), moods bias cog-

nition more than they bias action (Siemer,

2001).

Lest these distinctions seem academic,

consider the term affect. From my perspec-

tive, affect belongs at the top of the hier-

archy, as the superordinate term in this set

of emotion- related terms. However, others

take a different view. For example, some use

the terms affect and emotion interchange-

ably (Zajonc, 1984). For others, affect refers

to the experiential component of emotion

(Buck, 1993; MacLean, 1990). Still others

use affect to refer to the behavioral compo-

nent of emotion (American Psychiatric Asso-

ciation, 2013; Kaplan & Sadock, 1991). As

these observations suggest, clarity regarding

how each of these constructs is being used

is a necessary prerequisite for an analysis of

how these various processes are (or are not)

regulated (Gross, 2010).

Emotion Regulation

and Related Processes

Emotion regulation refers to shaping which

emotions one has, when one has them, and

how one experiences or expresses these emo-

tions (Gross, 1998b). Thus, emotion regula-

tion is concerned with how emotions them-

selves are regulated (regulation of emotions),

rather than how emotions regulate some-

thing else (regulation by emotions). Defined

in this way, many different activities count

as emotion regulatory. These include pound-

ing your pillow when you’re angry at a boss,

imagining your audience naked when you’re

nervous about performing in a piano recital,

picking up the phone to call a friend when

you’re feeling sad, telling a child who is hav-

ing a tantrum not to act like such a baby,

anticipating going to a fun party on the

weekend to reenergize yourself midweek,

going for a run after an upsetting fight

with a friend, playing calming music after

a long day at work, leaving a tense meeting

early to cool down, going to a club to have

a drink, and watching It’s a Wonderful Life

for the 600th time. Because there seems to

be no limit to the activities that may qualify

as emotion regulatory, what is needed— as

with emotion— is a description of its core

features.

Core Features of Emotion Regulation

The first core feature of emotion regula-

tion is the activation of a goal to modify the

emotion- generative process (Gross, Sheppes,

& Urry, 2011). This goal may be activated

either in oneself or in someone else. To

mark this distinction, it is useful to refer

to intrinsic emotion regulation in the first

case (James regulates his own emotions:

emotion regulation in self) and to extrin-

sic emotion regulation in the second case

(James regulates Sarah’s emotions: emotion

regulation in another). Researchers who

work with adults typically focus on intrinsic

emotion regulation (Gross, 1998b; but see

Levenson, Haase, Bloch, Holley, & Seider,

this volume). By contrast, researchers who

work with infants and children typically

focus on extrinsic emotion regulation (e.g.,

Cole, Martin, & Dennis, 2004). Although

this distinction is often helpful, it is worth

noting that in some situations intrinsic and

extrinsic emotion regulation co-occur, such

as when James regulates Sarah’s emotions

(extrinsic regulation) in order to calm him-

self down (intrinsic regulation).

The second core feature of emotion reg-

ulation is the engagement of the processes

that are responsible for altering the emotion

trajectory. Many different processes can be

recruited to regulate emotions, and these

vary considerably in the degree to which

they are explicit versus implicit. Many pro-

totypical instances of emotion regulation are

explicit, and thus conscious, such as when

Conceptual and Empirical Foundations 7

we try hard to look calm even though we are

very anxious before a talk, or when we try to

look on the bright side of a bad outcome to

cheer ourselves up. However, emotion regu-

latory activity can also be implicit and take

place without conscious awareness. Exam-

ples include hiding the affection one feels for

another person due to a fear that one will

be rejected, or quickly turning one’s atten-

tion away from potentially upsetting mate-

rial. Previous discussions have distinguished

categorically between explicit and implicit

processes (Masters, 1991). However, it may

be more useful to think of a continuum of

emotion regulation possibilities that range

from explicit, conscious, effortful, and con-

trolled regulation to implicit, unconscious,

effortless, and automatic regulation (Gyurak

& Etkin, this volume; Gyurak, Gross, &

Etkin, 2011).

The third core feature of emotion regu-

lation is its impact on emotion dynamics

(Thompson, 1990), or the latency, rise time,

magnitude, duration, and offset of responses

in experiential, behavioral, or physiologi-

cal domains. Depending on the individual’s

goals, emotion regulation may increase or

decrease the latency, rise time, magnitude,

duration, or offset of the emotional response

(compared to the emotional response that

would have occurred in the absence of

emotion regulation) (Gross, 1998b). Emo-

tion regulation also may change the degree

to which emotion response components

cohere as the emotion unfolds, such as when

changes in emotion experience and physi-

ological responding occur in the absence

of facial behavior (Dan- Glauser & Gross,

2013).

These three core features of emotion

regulation— the activation of a regulatory

goal, the engagement of regulatory pro-

cesses, and the modulation of the emotion

trajectory— are common features of many

diverse types of emotion regulation. In a

later section, I turn to a more complete dis-

cussion of each of these three core features,

as I review what is known about emotion

regulation goals, emotion regulation strat-

egies, and emotion regulation outcomes.

Before elaborating upon each of these core

features, however, we need to consider what

makes different forms of emotion regulation

so different from one another.

The Process Model

of Emotion Regulation

One framework that has proven useful for

addressing this question is the process model

of emotion regulation (Gross, 1998b). This

information- processing model takes as

its starting point the modal model (Figure

1.2), which—as we have seen— specifies the

sequence of processes involved in emotion

generation. The process model of emotion

regulation builds on the modal model, and

treats each step in the emotion- generative

process that is described in the modal model

as a potential target for regulation. In Fig-

ure 1.3, I present the process model, which

highlights five points at which individuals

can regulate their emotions.

These five points represent five families

of emotion regulation processes: situation

selection, situation modification, atten-

tional deployment, cognitive change, and

response modulation (Gross, 1998b). These

FIGURE 1.3. The process model of emotion regulation.

Situation Attention Appraisal Response

Response

Modulation

Cognitive

Change

Attentional

Deployment

Situation

Modification

Situation

Selection

8 FOUNDATIONS

families are distinguished by the point in the

emotion- generative process at which they

have their primary impact. Movement from

left to right in Figure 1.3 represents move-

ment through time: A particular situation is

selected, modified, attended to, appraised,

and yields a particular set of emotional

responses. However, as emphasized in Fig-

ure 1.2, emotion generation is an ongoing

process, extending beyond a single episode.

This dynamic aspect of emotion and emotion

regulation is signaled by the feedback arrow

in Figure 1.3 from the emotional response

back to the situation (there may in fact be

many such points of feedback). I describe

these five families of regulatory strategies in

more detail below.

Emotion Regulation

and Related Constructs

Before considering emotion regulation pro-

cesses in greater detail, however, it is impor-

tant to note in passing that— paralleling the

distinctions drawn among members of the

affective family presented earlier— emotion

regulation can be seen as subordinate to

the broader construct of affect regulation.

Under this broad heading fall all manner of

efforts to influence our valenced responses

(Westen, 1994), including (1) emotion regu-

lation, (2) coping, and (3) mood regulation.

Because virtually all goal- directed behavior

can be construed as maximizing pleasure or

minimizing pain—and thus as affect regula-

tory in a broad sense—it is frequently useful

to sharpen the focus by examining one or

more of these three second- level families of

processes.

Coping is distinguished from emotion

regulation both by its predominant focus on

decreasing negative affect and its emphasis

on much larger periods of time (e.g., cop-

ing with bereavement). As noted earlier,

moods are typically of longer duration and

are less likely to involve responses to spe-

cific “objects” than are emotions (Parkinson

et al., 1996). In part due to their less well-

defined behavioral response tendencies, in

comparison with emotion regulation, mood

regulation and mood repair are more con-

cerned with altering emotion experience

than emotion behavior (Larsen, 2000). It

is not yet known whether the regulation of

emotion, stress responses, and moods are

more similar than different, more different

than similar, or somewhere in between. It

therefore is usually a good idea to pay close

attention to the type of affect targeted for

regulation.

Emotion Regulation Goals,

Strategies, and Outcomes

As we have seen, emotion regulation has

three core features. The first—the emotion

regulation goal—is what people are trying to

accomplish. The second— the emotion regu-

lation strategy—is the particular processes

that are engaged in order to achieve that

goal. The third—the outcome—refers to the

consequences of trying to achieve that par-

ticular emotion regulation goal using that

particular strategy. In the following sections,

I review each of these three core features of

emotion regulation in turn, selectively high-

lighting what we know about each.

Emotion Regulation Goals

If asked about times they have tried to regu-

late their emotions, people often describe

efforts to down- regulate negative emotions

(i.e., diminish their intensity or duration),

especially anger, sadness, and anxiety, with

a particular focus on decreasing the expe-

riential and behavioral aspects of negative

emotions (Gross, Richards, & John, 2006).

People also report trying to up- regulate pos-

itive emotions (i.e., increase their intensity or

duration), especially love, interest, and joy,

often by sharing their positive experiences

with others (Quoidbach, Berry, Hansenne,

& Mikolajczak, 2010). These reports of

everyday emotion regulation are consistent

with traditional hedonic accounts of affect

regulation, which assume that individuals

are motivated to decrease negative emo-

tional states and increase positive emotional

states (Larsen, 2000).

It turns out, however, that there is more

to emotion regulation than this. Indeed,

the down- regulation of negative emotions

and the up- regulation of positive emotions

can be seen as just two cells in the 2 × 2

matrix shown in Figure 1.4. It may seem

odd to imagine people wanting more of a

“bad” thing or less of a “good” thing, but

there are many reasons people might want

Conceptual and Empirical Foundations 9

to up- regulate negative emotions or down-

regulate positive emotions, as Parrott (1993)

has observed in the context of mood regu-

lation. Motives for up- regulating negative

emotions include promoting a focused, ana-

lytic mindset; fostering an empathic stance;

and influencing others’ actions. Motives for

down- regulating positive emotions include

maintaining a realistic mindset; being mind-

ful of social conventions; and concealing

one’s feelings from others.

This broader view of emotion regulation

goals suggests something important about

what people are trying to accomplish when

they regulate their emotions. Sometimes—

and perhaps often— people are motivated

by “hedonic considerations,” or the wish to

increase short-term pleasure and decrease

short-term pain. At other times, however,

people are motivated by “instrumental con-

siderations”; that is, they are motivated to

change their emotions in order to achieve

some other, nonemotional outcome (Mauss

& Tamir, this volume; Tamir, 2009). Some-

times, these instrumental goals may be

related to specific work demands, such as

appearing relaxed and upbeat for nervous

airline passengers (Hochschild, 1983), seem-

ing calm yet empathic for nervous medical

patients (Larson & Yao, 2005), showing

high levels of interest in students (R. E. Sut-

ton, 2004), or sounding angry when trying

to collect payment on debts (R. I. Sutton,

1991). At other times, these instrumental

goals are related to broader cultural impera-

tives (Mesquita, De Leersnyder, & Albert,

this volume); these may dictate that people

show (Szczurek, Monin, & Gross, 2012) or

feel (Tsai, 2007) particular emotions and

not others in a given situation.

Emotion Regulation Strategies

Whatever emotion regulation goals people

may have, they can do many different things

to achieve them. They can even do many dif-

ferent things at once—or at least in quick

succession. For example, after a stressful

day, some people might turn off their cell

phone, have a beer, and watch an entertain-

ing program on television while holding

hands with their partner. This kind of mix-

ing of regulation strategies is probably com-

mon in everyday life. For analytic purposes,

however, the process model distinguishes

five families of regulatory processes.

The most forward- looking approach to

emotion regulation is situation selection.

This type of emotion regulation involves

taking actions that make it more (or less)

likely that one will end up in a situation

that one expects will give rise to desirable

(or undesirable) emotions. Examples include

avoiding a grumpy neighbor, arranging a

play date for a child, or seeking out a friend

with whom one can have a good cry. Despite

the commonness of situation selection, it is

hard to tell how one will feel in different sit-

uations (in the case of intrinsic regulation),

and harder still to be sure how another per-

son will feel in various situations (in the case

of extrinsic regulation).

Situation modification refers to directly

modifying a situation so as to alter its emo-

tional impact. When one’s parents visit at

college, situation modification may take

the form of hiding piles of dirty laundry or

questionable artwork. Parents also engage

in their share of situation modification,

which ranges from helping with frustrating

math problems to suggesting games to play

on a rainy day. Because efforts to modify a

Decrease Increase

Negative

emotion

Trying to calm

oneself down when

angry (Int)

Helping a tearful

child untangle his

kite (Ext)

Firing oneself up

before a big game

(Int)

Reframing a friend’s

“little fight” with a

spouse as serious

(Ext)

Positive

emotion

Wiping a smile

off one’s face at a

funeral (Int)

Helping giggling

girls calm down at

bedtime (Ext)

Sharing great news

with close friends

(Int)

Telling someone a

joke to cheer her up

(Ext)

FIGURE 1.4. Emotion regulation goals can

include efforts to decrease or increase either the

magnitude or duration of negative or positive

emotion. Decreasing negative emotion appears

to be the most common regulation goal in every-

day life, followed by increasing positive emotion.

Emotion regulation may be either intrinsic (Int)

or extrinsic (Ext).

10 FOUNDATIONS

situation may effectively call a new situa-

tion into being, it is sometimes difficult to

distinguish between situation selection and

situation modification. Also, although “situ-

ations” can be external or internal, situation

modification— as I mean it here—has to do

with modifying external, physical environ-

ments. Modifying “internal” environments

(i.e., thoughts) will be considered later, in

the context of cognitive change.

Attentional deployment refers to direct-

ing attention within a given situation in

order to influence one’s emotions. Atten-

tional deployment is one of the first emotion

regulatory processes to appear during devel-

opment (Rothbart, Ziaie, & O’Boyle, 1992),

and it is used from cradle to grave, particu-

larly when it is not possible to modify one’s

situation. One of the most common forms of

attentional deployment is distraction, which

focuses attention on other aspects of the situ-

ation or moves attention away from the situ-

ation altogether; distraction also may involve

changing internal focus, such as when some-

one calls to mind thoughts or memories that

help to instantiate the desired emotional state

(Thiruchselvam, Hajcak, & Gross, 2012).

Cognitive change refers to modifying

how one appraises a situation so as to alter

its emotional significance, either by chang-

ing how one thinks about the situation or

about one’s capacity to manage the demands

it poses. Sometimes, cognitive change is

applied to an external situation (e.g., “This

interview is a chance for me to learn more

about the company”). At other times, cogni-

tive change is applied to an internal situation

(e.g., “I’m not anxious— I’m getting ‘pumped

up’ for a game, and this will help me play my

best”). One particularly well- studied form

of cognitive change is reappraisal; this form

of cognitive change is often used to decrease

negative emotions, but it can also be used

to increase or decrease negative or positive

emotions (Samson & Gross, 2012).

The fifth family of emotion regulatory

processes, response modulation, occurs

late in the emotion- generative process, after

response tendencies have already been initi-

ated, and refers to directly influencing expe-

riential, behavioral, or physiological com-

ponents of the emotional response. Physical

exercise and deep- breathing relaxation tech-

niques can be used to decrease experiential

and physiological aspects of negative emo-

tions, and alcohol, cigarettes, drugs, and

even food also may be used to modify emo-

tion experience. Another common form of

response modulation involves regulating

emotion- expressive behavior. One well-

researched example of response modulation

is expressive suppression, in which a person

tries to inhibit ongoing negative or positive

emotion- expressive behavior.

Emotion Regulation Outcomes

At the heart of the process model is the intu-

ition that different forms of emotion regula-

tion might have different consequences, both

immediately and over the long term. This

prediction flows from the idea that if emo-

tions develop over time, then intervening at

different points in the emotion- generative

process should lead to different outcomes.

To test this idea, researchers have used

both experimental and correlational

approaches to investigate the affective, cog-

nitive, and social consequences of different

types of emotion regulation. This work is

yielding a rich and nuanced understanding

of how specific forms of emotion regulation

affect both the people who are doing the

regulating and the people around them.

To illustrate this rapidly growing body

of work, I focus on one of the most well-

researched contrasts in the field, namely, the

contrast between reappraisal (from the cog-

nitive change family) and suppression (from

the response modulation family). This con-

trast is an interesting one because although

both suppression and reappraisal are com-

monly employed to down- regulate emotion,

suppression is a behaviorally oriented form

of emotion regulation in which a person

decreases emotion- expressive behavior while

emotionally aroused, whereas reappraisal is

a cognitively oriented form of emotion regu-

lation in which a person tries to think about

a situation in a way that alters the emotional

response (for a more comprehensive review

of the effects of different emotion regula-

tion strategies, see Webb, Miles, & Sheeran,

2012).

Affectively, experimental studies have

shown that suppression leads to decreased

positive but not negative emotion experi-

ence (Gross, 1998a; Gross & Levenson,

1993, 1997; Stepper & Strack, 1993; Strack,

Martin, & Stepper, 1988), increased sympa-

Conceptual and Empirical Foundations 11

thetic nervous system responses (Demaree

et al., 2006; Gross, 1998a; Gross & Lev-

enson, 1993, 1997; Harris, 2001; Richards

& Gross, 2000), and greater activation in

emotion- generative brain regions such as

the amygdala (Goldin, McRae, Ramel, &

Gross, 2008). Correlational studies are

largely congruent with these experimental

findings and, if anything, suggest a more

negative profile of affective consequences

for suppression, in that compared to people

who do not report using suppression, people

who report using suppression experience less

positive emotion and more negative emo-

tion, including painful feelings of inauthen-

ticity as well as depressive symptoms (Gross

& John, 2003; Moore, Zoellner, & Mollen-

holt, 2008; Nezlek & Kuppens, 2008).

By contrast, experimental studies have

shown that reappraisal leads to decreased

levels of negative emotion experience and

increased positive emotion experience

(Gross, 1998a; Feinberg, Willer, Antonenko,

& John, 2012; Lieberman, Inagaki, Tabib-

nia, & Crockett, 2011; Ray, McRae, Och-

sner, & Gross, 2010; Szasz, Szentagotai, &

Hofmann, 2011; Wolgast, Lundh, & Viborg,

2011), has no impact on or even decreases

sympathetic nervous system responses

(Gross, 1998a; Kim & Hamann, 2012;

Stemmler, 1997; Shiota & Levenson, 2012;

Wolgast et al., 2011), and leads to lesser acti-

vation in emotion- generative brain regions

such as the amygdala (Goldin et al., 2008;

Kanske, Heissler, Schonfelder, Bongers,

& Wessa, 2011; Ochsner & Gross, 2008;

Ochsner et al., 2004) and ventral striatum

(Staudinger, Erk, Abler, & Walter, 2009).

Correlational studies suggest that compared

to people who do not use reappraisal, people

who use reappraisal experience and express

more positive emotion and less negative

emotion, including fewer depressive symp-

toms (Gross & John, 2003; Nezlek & Kup-

pens, 2008). Reappraisers’ reports of less

negative emotion are corroborated by func-

tional imaging studies that show less activa-

tion in emotion- related regions such as the

amygdala (Drabant et al., 2009).

Cognitively, experimental studies have

shown that suppression leads to worse mem-

ory (Johns, Inzlicht, & Schmader, 2008;

Richards, Butler, & Gross, 2003; Richards

& Gross, 1999, 2000, 2006). Correlational

findings support these conclusions: Indi-

viduals who typically use suppression have

worse memory for emotional interactions

than do individuals who use suppression less

frequently (Richards & Gross, 2000).

By contrast, experimental studies have

found that reappraisal either has no impact

on subsequent memory or actually improves

it (Richards & Gross, 2000; Hayes et al.,

2011), and can enhance performance on

standardized exams (Jamieson, Mendes,

Blackstock, & Schmader, 2010). Correla-

tional studies bear out these findings, show-

ing that individuals who typically reappraise

have comparable or even enhanced memory

compared to others (Richards & Gross,

2000).

Socially, experimental studies have

reported that suppression leads to less lik-

ing from social interaction partners, and to

an increase in partners’ blood pressure lev-

els (Butler et al., 2003). Correlational stud-

ies support these laboratory findings. Indi-

viduals who typically use suppression report

avoiding close relationships and having less

positive relations with others; this dove-

tails with peers’ reports that suppressors

have relationships with others that are less

emotionally close (English, John, & Gross,

2013; Gross & John, 2003; Srivastava,

Tamir, McGonigal, John, & Gross, 2009).

Reappraisal, by contrast, has no detectable

adverse consequences for social affiliation in

a laboratory context (Butler et al., 2003).

Correlational studies support these findings:

Individuals who typically use reappraisal

are more likely to share their emotions—

both positive and negative— and report hav-

ing closer relationships with friends, which

matches their peers’ reports of greater liking

(Gross & John, 2003; Mauss et al., 2011).

Across these three outcome domains,

reappraisal seems preferable to suppression.

However, caution is required here, because

the effects of emotion regulation vary by con-

text. Thus, the adverse social consequences

of suppression are not evident in individu-

als with bicultural European– Asian values

(Butler, Lee, & Gross, 2007; Soto, Perez,

Kim, Lee, & Minnick, 2011). Similarly,

some of the benefits of reappraisal are mod-

erated by context. For example, if emotional

intensity is already high when reappraisal is

engaged, it no longer has the experiential or

physiological benefits seen in other contexts

(Sheppes, Catran, & Meiran, 2009).

12 FOUNDATIONS

The context specificity of the effects of sup-

pression and reappraisal (and, presumably,

other forms of emotion regulation) means

that global conclusions about one strategy

being “better” than another are likely to be

misleading. Indeed, any given emotion regu-

lation strategy may be used to make things

either better or worse, depending on whose

point of view is adopted, on the outcome

of interest, and on details regarding the

context. For example, cognitive strategies

that dampen negative emotions may help a

medical professional operate efficiently in

stressful circumstances, but they also may

neutralize negative emotions associated

with empathy and thereby decrease helping.

It also bears emphasizing that regulatory

strategies may accomplish one person’s goals

at the expense of another’s. For example, a

mother may accomplish her goals when she

stops a child from crying for candy in the

supermarket, but this success may come at

the expense of the child’s failure to achieve

his or her goal of getting candy.

Fundamental Questions

and Directions for Future Research

As is the case with any new and vital area

of science, the study of emotion regulation

has generated many more questions than

answers (Gross, 2013). In the following

sections, I describe three of the questions I

think are particularly important to the field

of emotion regulation.

How Separable Are Emotion

and Emotion Regulation?

One of the most intuitively compelling dis-

tinctions in the field of emotion research is

that between emotion and emotion regula-

tion. We feel angry, and try not to show it. A

child cries, and we comfort her. We are dis-

couraged, and try to find hope. In each case,

it seems utterly obvious that one set of psy-

chological processes governs the emergence

of an emotion, and another governs whether

and how we manage these emotions.

However, the closer one looks, the harder

it is to draw a bright line between emotion

and emotion regulation (Gross et al., 2011).

Many situations seem to call forth both

emotion and emotion regulation (Campos,

Frankel, & Camras, 2004), and many of the

brain systems that give rise to emotion are

also engaged by emotion regulation (Ochsner

et al., 2009). This has led some commenta-

tors to argue that the two sets of processes

are so intertwined that no clear distinction

can be made between them (Kappas, 2011;

Thompson, 2011).

Part of the problem here is that there are

many different ways to define emotion, each

of which suggests a different take on how

(and whether) emotion and emotion regu-

lation should be distinguished (Gross &

Barrett, 2011). From my perspective, the

crucial distinction between emotion and

emotion regulation is a functional one. As

we have seen, an emotion arises when a

person attends to a situation that he or she

evaluates as relevant to a particular type of

goal. For example, I may feel angry at others

when they throw garbage from their cars. I

may even have an emotion about my anger

response. For example, I may feel proud that

I feel anger at others who are degrading the

environment. Emotion regulation may be

said to occur when (1) an emotional response

itself is subject to valuation as good or bad,

and (2) this valuation leads to the activation

of a goal to change that particular emotion

response trajectory. To continue the earlier

example, if I find myself getting so annoyed

at others who pollute the environment that I

snap at my children, I may negatively value

my anger and feel upset that I am snapping

at my children. If this is all that happens,

there’s no emotion regulation— just two

overlapping instances of emotion (anger at

polluters, and upset at myself for snapping at

my children). But if this feeling of upset leads

me to try to curb my anger, then this would

be an instance of emotion regulation.

A more general way of putting this idea is

to say that emotion regulation involves the

valuation of a valuation. That is, an emo-

tional response is itself judged to be good or

bad—hence leading to an affective response

about the target emotional response— and

this second affective response motivates an

effort to modify the first affective response.

This perspective on emotion regulation is

functional in that it doesn’t define a priori

what should “count” as emotion versus

emotion regulation; instead, the question of

separability hinges on whether a goal has

been activated to influence the emotion-

Conceptual and Empirical Foundations 13

generative process itself (for a more detailed

exposition of this valuation perspective on

emotion regulation, see Ochsner & Gross,

this volume).

Why Do People Regulate Their

Emotions as They Do?

Anyone who has ever seen two grown men

step out of their cars to fight over who is the

bigger idiot has likely wondered why on earth

the two can’t manage to regulate their emo-

tions in more productive ways. This puzzle-

ment points to a more general question about

why people regulate (or fail to regulate) their

emotions as they do. Answering this ques-

tion requires a more complete analysis of

the emotion regulatory process than I have

provided so far, and one of the most press-

ing challenges for researchers in this area is

to contribute to this analysis. In answering

this overarching question, a number of more

specific questions must be addressed:

1. What leads people to activate a goal to

regulate emotion?

2. What determines the fate of this regula-

tory goal?

3. Which strategy is employed to achieve a

given emotion regulatory goal?

Why do some people activate a goal to

regulate emotions when others do not? One

reason may be differences in awareness of

the person’s own ongoing (or anticipated)

emotional responses— in the case of intrin-

sic emotion regulation— or in awareness of

another person’s ongoing (or anticipated)

emotional response— in the case of extrinsic

emotion regulation. People differ substan-

tially in their ability to track subtle emotion

dynamics and represent these in a differen-

tiated fashion; some do this very well, but

others (e.g., those who have alexithymia

or low levels of emotion awareness) have

little or no awareness of ongoing emotional

responses (Salovey & Mayer, 1990; Taylor,

1994). Emotional awareness appears to be

a crucial rate- limiting factor in successfully

regulating emotions (Barrett, Gross, Con-

ner, & Benvenuto, 2001; Samson, Huber,

& Gross, 2012), but much remains to be

learned about the precise role of emotional

awareness in activation of the goal to engage

in emotion regulation.

Even after a person has become aware of

an emotion and activated a goal to regulate

that emotion, there remains the question:

What determines how this regulatory goal

will fare in its competition with other cur-

rently active goals? As discussed earlier,

people have both hedonic and instrumen-

tal goals, but it is far from clear how these

various goals interact. What is known sug-

gests that emotion regulation often involves

tradeoffs between hedonic and instrumental

motives. Avoidance that may bring short-

term relief (“If I skip the cocktail party, I

can avoid feeling anxious”) may have a sub-

stantial long-term price tag (“If I skip the

cocktail party, I may miss out on develop-

ing helpful professional contacts”). Over the

course of development, it appears that the

balance of motives shifts repeatedly, first

from hedonic to instrumental goals, then,

later in life, away from instrumental motives

and toward hedonic motives, reflecting an

awareness of the reduced value of long-

term investments as one moves toward the

end of one’s life (Carstensen, Isaacowitz, &

Charles, 1999; Charles & Carstensen, this

volume). Just how people flexibly manage

competing regulatory goals is likely to be an

important determinant of healthy adapta-

tion.

Once an emotion regulatory goal has

been activated and has survived a com-

petition with other currently active goals,

there remains the question: Which emotion

regulatory strategy (or strategies) will be

selected in order to achieve that particular

emotion regulatory goal? Part of the answer

may hinge on context- specific factors, such

as the type and intensity of emotion that

needs regulating. For example, people pre-

fer reappraisal to distraction when emotion

intensity is low, but prefer distraction to

reappraisal when emotion intensity is high,

because at high- intensity levels, reappraisal

is often no longer effective (Sheppes, this

volume; Sheppes, Scheibe, Suri, & Gross,

2011). Another important context- specific

factor may be a person’s perceptions of his

or her currently available social and/or psy-

chological resources (Coan & Maresh, this

volume; Opitz, Gross, & Urry, 2012). Other

factors that govern strategy selection may be

more stable across situations. For example,

some people have incremental beliefs about

emotion, and see emotions as the kinds of

14 FOUNDATIONS

things that can be changed. Others have

entity beliefs about emotion, and see emo-

tions as relatively immutable. Perhaps not

surprisingly, those with incremental beliefs

seem to be more adept at emotion regula-

tion than those with entity beliefs (Mauss

& Tamir, this volume; Tamir, John, Srivas-

tava, & Gross, 2007). Another important

kind of belief has to do with whether one

believes one is able to engage in a particular

form of emotion regulation when one wishes

to do so. This type of belief is referred to

as emotion regulation self- efficacy, and

self- efficacy beliefs can be modified. For

example, in the context of generalized social

anxiety disorder, patients who received

cognitive- behavioral therapy (vs. those

randomized to a wait-list group) showed

increased reappraisal self- efficacy, and these

changes in self- efficacy mediated the effects

of therapy on clinical improvement (Goldin

et al., 2012; John & Eng, this volume).

It is evident that these three questions—

regarding the activation of a regulatory goal,

the relative dominance of that regulation

goal compared to other goals, and the emo-

tion regulation strategy that is selected—

represent a small subset of the many ques-

tions that need to be answered before we

fully understand whether (and how) a par-

ticular person will regulate emotion in a

particular situation, and whether he or she

will do so successfully. Other determinants

include person- based factors, such as work-

ing memory capacity, as well as situation-

based factors that make some forms of emo-

tion regulation easier to implement than

others. One pressing challenge for future

research is to clarify the rules that govern

the skillful application of emotion regula-

tion. This work is important, because it

will create a framework for understanding

individual and group differences in emotion

regulation, and suggest strategies for inter-

vention when regulation is deficient.

How Can We Use What We Know

to Make the World a Better Place?

Although we still have much to learn about

the psychological processes that are neces-

sary for skillful and flexible emotion regula-

tion, we now know enough to begin think-

ing about how to use what we know about

emotion regulation to make the world a

better place. Efforts in this direction are jus-

tified by not only their ends but also what

they can teach us about basic processes as

we apply what we think we know to real-

world situations.

One type of application— and perhaps the

most obvious— is individual- level interven-

tions designed to teach healthier patterns of

emotion regulation (Gross & Munoz, 1995).

Such interventions might take the form of

crafting instructional materials, teacher

workshops, classroom- based interventions,

and parenting classes designed to increase

awareness of the importance of emotion and

skillful emotion regulation. Interventions

may target individuals at heightened risk

of adverse outcomes, such as daughters of

depressed mothers, children who live in abu-

sive families, members of underrepresented

minorities in work or academic contexts,

or those with high temperamental levels of

negative emotion. More specific interven-

tions will target individuals who have clini-

cal diagnoses (Barrett, Wilson- Mendenhall,

& Barsalou, this volume; Campbell- Sills,

Ellard, & Barlow, this volume; Joormann

& Siemer, this volume; Kober, this volume).

These are the inventions that come to mind

most easily, and many of our pharmacologi-

cal and psychosocial interventions for psy-

chiatric disorders have an emotion regula-

tion component, although much remains to

be learned about exactly how each type of

intervention influences particular aspects

of emotion regulation (Berking & Schwarz,

this volume; Neacsiu, Bohus, & Linehan,

this volume; MacLeod & Grafton, this vol-

ume; Mennin & Fresco, this volume; Farb,

Anderson, Irving, & Segal, this volume).

A second type of application involves

making larger changes in the physical and

social worlds in which we live. An example

of this class of interventions comes from

applying an emotion regulation perspec-

tive to seemingly intractable global con-

flicts (Halperin, 2013). These conflicts are

characterized by high levels of negative

emotions that powerfully shape attitudes

and behaviors of each of the parties to the

conflict. In particular, negative intergroup

emotions— emotions that arise as a result

of belonging to a certain group—can lead

to the commencement and maintenance of

hostilities, then block progress toward a

peaceful solution to the ongoing conflict. To

Conceptual and Empirical Foundations 15

assess the role of emotion regulation in one

such conflict, namely, the ongoing Israeli–

Palestinian conflict, a nationwide survey of

Jewish- Israeli adults was conducted during

the Gaza War between Israelis and Palestin-

ians. This survey assessed both reappraisal

use and attitudes toward providing humani-

tarian aid to Palestinian citizens. Findings

indicated that Israelis who regulated their

negative emotions during the war by using

reappraisal were more supportive of pro-

viding humanitarian aid than Israelis who

did not use reappraisal (Halperin & Gross,

2011). Building on this foundation, a sec-

ond study randomized Israeli participants to

either a reappraisal training condition or a

control condition just before the Palestinian

United Nations (UN) bid in 2011. Findings

indicated that a week following the training,

participants who had been trained to use

reappraisal showed greater support for con-

ciliatory policies and less support for aggres-

sive policies toward Palestinians. These

effects persisted when assessed 5 months

after training, and at each time point, nega-

tive emotion mediated the effects of reap-

praisal on conflict- related attitudes (Hal-

perin, Porat, Tamir, & Gross, 2012). These

findings hint at the broader, real-world rel-

evance of an emotion regulation perspective,

and in future work it will be interesting to

investigate how such a perspective might be

applied in other arenas.

Acknowledgments

I would like to thank Gal Sheppes, Heather Urry,

and members of the Stanford Psychophysiology

Laboratory for comments on a prior version of

this chapter.

References

American Psychiatric Association. (2013). Diag-

nostic and statistical manual of mental disor-

ders (5th ed.). Arlington, VA: Author.

Barrett, L. F., Wilson- Mendenhall, C. D., &

Barsalou, L. W. (this volume, 2014). A psy-

chological construction account of emotion

dysregulation. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 447–465).

New York: Guilford Press.

Barrett, L. F., Gross, J. J., Conner, T., & Benve-

nuto, M. (2001). Knowing what you’re feeling

and knowing what to do about it: Mapping the

relation between emotion differentiation and

emotion regulation. Cognition and Emotion,

15, 713–724.

Barrett, L. F., Ochsner, K. N., & Gross, J. J.

(2007). On the automaticity of emotion. In J.

Bargh (Ed.), Social psychology and the uncon-

scious: The automaticity of higher mental

processes (pp. 173–217). New York: Psychol-

ogy Press.

Berking, M., & Schwarz, J. (this volume, 2014).

Affect regulation training. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 529–547). New York: Guilford Press.

Bowlby, J. (1969). Attachment and loss: Attach-

ment. New York: Basic Books.

Buck, R. (1990). Mood and emotion: A compari-

son of five contemporary views. Psychological

Inquiry, 1, 330–336.

Buck, R. (1993). What is this thing called sub-

jective experience?: Reflections on the neuro-

psychology of qualia. Neuropsychology, 7,

490–499.

Butler, E. A., Egloff, B., Wilhelm, F. W., Smith,

N. C., Erickson, E. A., & Gross, J. J. (2003).

The social consequences of expressive suppres-

sion. Emotion, 3, 48 – 67.

Butler, E. A., Lee, T. L., & Gross, J. J. (2007).

Emotion regulation and culture: Are the social

consequences of emotion suppression culture-

specific? Emotion, 7, 30–48.

Campbell- Sills, L., Ellard, K. K., & Barlow, D.

H. (this volume, 2014). Emotion regulation in

anxiety disorders. In J. J. Gross (Ed.), Hand-

book of emotion regulation (2nd ed., pp. 393–

412). New York: Guilford Press.

Campos, J. J., Frankel, C. B., & Camras, L.

(2004). On the nature of emotion regulation.

Child Development, 75, 377–394.

Carstensen, L. L., Isaacowitz, D. M., & Charles,

S. T. (1999). Taking time seriously. American

Psychologist, 54, 165–181.

Charles, S. T., & Carstensen, L. L. (this volume,

2014). Emotion regulation and aging. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 203–218). New York: Guilford

Press.

Coan, J. A., & Maresh, E. L. (this volume, 2014).

Social baseline theory and the social regula-

tion of emotion. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 221–236).

New York: Guilford Press.

Cole, P., Martin, S., & Dennis, T. (2004). Emo-

tion regulation as a scientific construct: Meth-

16 FOUNDATIONS

odological challenges and directions for child

development research. Child Development,

75, 317–333.

Dan- Glauser, E. S., & Gross, J. J. (2013). Emo-

tion regulation and emotion coherence: Evi-

dence for strategy- specific effects. Emotion.

Davidson, R. J. (1994). On emotion, mood, and

related affective constructs. In P. Ekman &

R. J. Davidson (Eds.), The nature of emotion:

Fundamental questions (pp. 51–55). New

York: Oxford University Press.

Demaree, H. A., Schmeichel, B. J., Robinson,

J. L., Pu, J., Everhart, D., & Berntson, G. G.

(2006). Up- and down- regulating facial dis-

gust: Affective, vagal, sympathetic, and respi-

ratory consequences. Biological Psychology,

71, 90 –99.

Drabant, E. M., McRae, K., Manuck, S. B.,

Hariri, A. R., & Gross, J. J. (2009). Individual

differences in typical reappraisal use predict

amygdala and prefrontal responses. Biological

Psychiatry, 65, 367–373.

Ellsworth, P. C., & Scherer, K. R. (2003).

Appraisal processes in emotion. In R. J. David-

son, K. R., Scherer, & H. H. Goldsmith (Eds.),

Handbook of affective sciences (pp. 572–595).

New York: Oxford University Press.

English, T., John, O. P., & Gross, J. J. (2013).

Emotion regulation in close relationships. In J.

A. Simpson & L. Campbell (Eds.), The Oxford

handbook of close relationships (pp. 500–

513). New York: Oxford University Press.

Farb, N. A. S., Anderson, A. K., & Segal, Z. V.

(this volume, 2014). Mindfulness interven-

tions and emotion regulation. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp. 548–568). New York: Guilford Press.

Feinberg, M., Willer, R., Antonenko, O., &

John, O. P. (2012). Liberating reason from the

passions. Psychological Science, 23, 788–795.

Freud, S. (1959). Inhibitions, symptoms, anxiety

(A. Strachey, Trans.; J. Strachey, Ed.). New

York: Norton. (Original work published 1926)

Frijda, N. H. (1986). The emotions. Cambridge,

UK: Cambridge University Press.

Goldin, P. R., McRae, K., Ramel, W., & Gross,

J. J. (2008). The neural bases of emotion

regulation: Reappraisal and suppression of

negative emotion. Biological Psychiatry, 63,

577–586.

Goldin, P., Ziv, M., Jazaieri, H., Werner, K.,

Kraemer, H., Heimberg, R. G., et al. (2012).

Cognitive reappraisal self- efficacy mediates

the effects of individual cognitive- behavioral

therapy for social anxiety disorder. Journal

of Consulting and Clinical Psychology, 80,

1034–1040.

Gross, J. J. (1998a). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74, 224–237.

Gross, J. J. (1998b). The emerging field of emo-

tion regulation: An integrative review. Review

of General Psychology, 2, 271–299.

Gross, J. J. (1999). Emotion regulation: Past,

present, future. Cognition and Emotion, 13,

551–573.

Gross, J. J. (2010). The future’s so bright, I gotta

wear shades. Emotion Review, 2, 212–216.

Gross, J. J. (2013). Emotion regulation: Tak-

ing stock and moving forward. Emotion, 13,

359–365.

Gross, J. J. & Barrett, L. F. (2011). Emotion

generation and emotion regulation: One or

two depends on your point of view. Emotion

Review, 3, 8–16.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85, 348–362.

Gross, J. J., & Levenson, R. W. (1993). Emo-

tional suppression: Physiology, self- report,

and expressive behavior. Journal of Personal-

ity and Social Psychology, 64, 970–986.

Gross, J. J., & Levenson, R. W. (1997). Hiding

feelings: The acute effects of inhibiting posi-

tive and negative emotions. Journal of Abnor-

mal Psychology, 106, 95–103.

Gross, J. J., & Munoz, R. F. (1995). Emotion

regulation and mental health. Clinical Psy-

chology: Science and Practice, 2, 151–164.

Gross, J. J., Richards, J. M., & John, O. P.

(2006). Emotion regulation in everyday life. In

D. K. Snyder, J. A. Simpson, & J. N. Hughes

(Eds.), Emotion regulation in couples and

families: Pathways to dysfunction and health.

Washington, DC: American Psychological

Association.

Gross, J. J., Sheppes, G., & Urry, H. L. (2011).

Emotion generation and emotion regulation: A

distinction we should make (carefully). Cogni-

tion and Emotion, 25, 765–781.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp. 3–24). New York: Guilford Press.

Gyurak, A., & Etkin, A. (this volume, 2014). A

neurobiological model of implicit and explicit

Conceptual and Empirical Foundations 17

emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 76–90). New York: Guilford Press.

Gyurak, A., Gross, J. J., & Etkin, A. (2011).

Explicit and implicit emotion regulation: A

dual-

process framework. Cognition and Emo-

tion, 25, 400– 412.

Halperin, E. (2013). Current and potential con-

tributions of the study of emotion and emotion

regulation to the study and practice of conflict

resolution. Emotion Review.

Halperin, E., & Gross, J. J. (2011). Emotion reg-

ulation in violent conflict: Reappraisal, hope,

and support for humanitarian aid to the oppo-

nent in war time. Cognition and Emotion, 25,

1228–1236.

Halperin, E., Porat, R., Tamir, M., & Gross, J. J.

(2012). Can emotion regulation change politi-

cal attitudes in intractable conflict?: From the

laboratory to the field. Psychological Science,

24(1), 106–111.

Harris, C. R. (2001). Cardiovascular responses

of embarrassment and effects of emotional

suppression in a social setting. Journal of Per-

sonality and Social Psychology, 81, 886– 897.

Hayes, J. P., Morey, R. A., Petty, C. M., Seth,

S., Smoski, M. J., McCarthy, G., et al. (2011).

Staying cool when things get hot: Emotion

regulation modulates neural mechanisms of

memory encoding. Frontiers in Human Neu-

roscience, 4, 1–10.

Hochschild, A. R. (1983). The managed heart.

Berkeley: University of California Press.

Jamieson, J. P., Mendes, W. B., Blackstock, E.,

& Schmader, T. (2010). Turning the knots in

your stomach into bows: Reappraising arousal

improves performance on the GRE. Journal

of Experimental Social Psychology, 46, 208–

212.

John, O. P., & Eng, J. (this volume, 2014). Indi-

vidual differences in emotion regulation: Con-

ceptualization, measures, and findings. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp.

321–345). New York: Guilford

Press.

Johns, M. J., Inzlicht, M., & Schmader, T.

(2008). Stereotype threat and executive

resource depletion: Examining the influence

of emotion regulation. Journal of Experimen-

tal Psychology: General, 137, 691–705.

Joormann, J., & Siemer, M. (this volume, 2014).

Emotion regulation in mood disorders. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 413–427). New York: Guilford

Press.

Kanske, P., Heissler, J., Schonfelder, S., Bongers,

A., & Wessa, M. (2011). How to regulate emo-

tion?: Neural networks for reappraisal and

distraction. Cerebral Cortex, 21, 1379–1388.

Kaplan, H. I., & Sadock, B. J. (1991). Synopsis

of psychiatry (6th ed.). Baltimore: Williams &

Wilkins.

Kappas, A. (2011). Emotion and regulation are

one! Emotion Review, 3, 17–25.

Kim, S. H., & Hamann, S. (2012). The effect of

cognitive reappraisal on physiological reac-

tivity and emotional memory. International

Journal of Psychophysiology, 83, 348–56.

Kober, H. (this volume, 2014). Emotion regula-

tion in substance use disorders. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp.

428–446). New York: Guilford Press.

Koole, S. L. (2009). The psychology of emotion

regulation: An integrative review. Cognition

and Emotion, 23, 4– 41.

Lang, P. J. (1995). The emotion probe: Studies of

motivation and attention. American Psycholo-

gist, 50, 372–385.

Lang, P. J., & Bradley, M. M. (2010). Emotion

and the motivational brain. Biological Psy-

chology, 84, 437–450.

Larsen, R. J. (2000). Toward a science of mood

regulation. Psychological Inquiry, 11, 129–

141.

Larson, E. B., & Yao, X. (2005). Clinical empa-

thy as emotional labor in the patient–

ysician

relationship. Journal of the American Medical

Association, 293, 1100–1106.

Lazarus, R. S. (1966). Psychological stress and

the coping process. New York: McGraw-Hill.

Lazarus, R. S. (1991). Emotion and adaptation.

Oxford, UK: Oxford University Press.

Lazarus, R. S. (1993). From psychological stress

to the emotions: A history of changing out-

looks. Annual Review of Psychology, 44,

1–21.

Levenson, R. W. (1999). The intrapersonal func-

tions of emotion. Cognition and Emotion, 13,

481–504.

Levenson, R. W., Haase, C. M., Bloch, L., Hol-

ley, S. R., & Seider, H. (this volume, 2014).

Emotion regulation in couples. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp.

267–283). New York: Guilford Press.

Lieberman, M. D., Inagaki, T. K., Tabibnia, G.,

& Crockett, M. J. (2011). Subjective responses

to emotional stimuli during labeling, reap-

praisal, and distraction. Emotion, 11, 468–80.

Masters, J. C. (1991). Strategies and mechanisms

for the personal and social control of emotion.

18 FOUNDATIONS

In J. Garber & K. A. Dodge (Eds.), The devel-

opment of emotion regulation and dysregu-

lation (pp. 182–207). Cambridge, UK: Cam-

bridge University Press.

MacLean, P. D. (1990). The triune brain in evo-

lution: Role in paleocerebral functions. New

York: Plenum.

MacLeod, C., & Grafton, B. (this volume, 2014).

Regulation of emotion through modification

of attention. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 508–528).

New York: Guilford Press.

Mauss, I. B., Levenson, R. W., McCarter, L.,

Wilhelm, F. H., & Gross, J. J. (2005). The tie

that binds?: Coherence among emotion expe-

rience, behavior, and physiology. Emotion, 5,

175–190.

Mauss, I. B., & Tamir, M. (this volume, 2014).

Emotion goals: How their content, structure,

and operation shape emotion regulation. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp.

361–375). New York: Guil-

ford Press.

Mauss, I. B., Shallcross, A. J., Troy, A. S., John,

O. P., Ferrer, E., Wilhelm, F. H., et al. (2011).

Don’t hide your happiness!: Positive emotion

dissociation, social connectedness, and psy-

chological functioning. Journal of Personality

and Social Psychology, 100, 738–748.

Mennin, D. S., & Fresco, D. M. (this volume,

2014). Emotion regulation therapy. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp.

469–490). New York: Guilford

Press.

Mesquita, B., De Leersnyder, J., & Albert, D.

(this volume, 2014). The cultural regulation

of emotions. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp.

84–302).

New York: Guilford Press.

Mischel, W. (1996). From good intentions to

willpower. In P. Gollwitzer & J. Bargh (Eds.),

The psychology of action (pp.

197–218). New

York: Guilford Press.

Moore, S. A., Zoellner, L. A., & Mollenholt, N.

(2008). Are expressive suppression and cogni-

tive reappraisal associated with stress-

elated

symptoms? Behaviour Research and Therapy,

46, 993–1000.

Neacsiu, A. D., Bohus, M., & Linehan, M. (this

volume, 2014). Dialectical behavior therapy:

An intervention for emotion dysregulation.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp.

491–507). New York:

Guilford Press.

Nezlek, J. B., & Kuppens, P. (2008). Regulating

positive and negative emotions in daily life.

Journal of Personality, 76, 561–579.

Ochsner, K. N., & Gross, J. J. (2008). Cogni-

tive emotion regulation: Insights from social

cognitive and affective neuroscience. Current

Directions in Psychological Science, 17, 153–

158.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp.

23–42). New York: Guilford

Press.

Ochsner, K. N., Ray, R. R., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D. E.,

et al. (2004). For better or for worse: Neural

systems supporting the cognitive down- and

up-

egulation of negative emotion. NeuroIm-

age, 23, 483–499.

Ochsner, K. N., Ray, R. R., Hughes, B., McRae,

K., Cooper, J. C., Weber, J., et al. (2009).

Bottom-up and top-down processes in emo-

tion generation: Common and distinct neu-

ral mechanisms. Psychological Science, 20,

1322–1331.

Opitz, P., Gross, J. J., & Urry, H. L. (2012).

Selection, optimization, and compensation

in the domain of emotion regulation: Appli-

cations to adolescence, older age, and major

depressive disorder. Social and Personality

Psychology Compass, 6, 142–155.

Parkinson, B., Totterdell, P., Briner, R. B., &

Reynolds, S. (1996). Changing moods: The

psychology of mood and mood regulation.

London: Longman.

Parrott, W. G. (1993). Beyond hedonism: Motives

for inhibiting good moods and for maintain-

ing bad moods. In D. M. Wegner & J. W. Pen-

nebaker (Eds.), Handbook of mental control

(pp.

278–305). Englewood Cliffs, NJ: Prentice

Hall.

Quoidbach, J., Berry, E. V., Hansenne, M., &

Mikolajczak, M. (2010). Positive emotion reg-

ulation and well-being: Comparing the impact

of eight savoring and dampening strategies.

Personality and Individual Differences, 49,

368–373.

Ray, R. D., McRae, K., Ochsner, K. N., & Gross,

J. J. (2010). Cognitive reappraisal of negative

affect: Converging evidence from EMG and

self-

report. Emotion, 10, 587–592.

Richards, J. M., Butler, E., & Gross, J. J. (2003).

Emotion regulation in romantic relationships:

Conceptual and Empirical Foundations 19

The cognitive consequences of concealing feel-

ings. Journal of Personal and Social Relation-

ships, 20, 599–620.

Richards, J. M., & Gross, J. J. (1999). Compo-

sure at any cost?: The cognitive consequences

of emotion suppression. Personality and Social

Psychology Bulletin, 25, 1033–1044.

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79, 410–424.

Richards, J. M., & Gross, J. J. (2006). Person-

ality and emotional memory: How regulat-

ing emotion impairs memory for emotional

events. Journal of Research in Personality, 40,

631–651.

Rothbart, M. K., Ziaie, H., & O’Boyle, C. G.

(1992). Self- regulation and emotion in infancy.

In N. Eisenberg & R. A. Fabes (Eds.), Emo-

tion and its regulation in early development

(pp. 7–23). San Francisco: Jossey-Bass.

Salovey, P., & Mayer, J. D. (1990). Emotional

intelligence. Imagination, Cognition and Per-

sonality, 9, 185–211.

Samson, A., & Gross, J. J. (2012). Humor as

emotion regulation: The differential conse-

quences of negative versus positive humor.

Cognition and Emotion, 26, 375–384.

Samson, A. C., Huber, O., & Gross, J. J. (2012).

Emotion regulation in Asperger’s syndrome

and high functioning autism. Emotion, 12(4),

659–665.

Scherer, K. R. (1984). On the nature and func-

tion of emotion: A component process

approach. In K. R. Scherer & P. E. Ekman

(Eds.), Approaches to emotion (pp. 293–317).

Hillsdale, NJ: Erlbaum.

Scherer, K. R., Schorr, A., & Johnstone, T.

(2001). Appraisal processes in emotion: The-

ory, methods, research. New York: Oxford

University Press.

Sheppes, G. (this volume, 2014). Emotion reg-

ulation choice: Theory and findings. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 126–139). New York: Guilford

Press.

Sheppes, G., Catran, E., & Meiran, N. (2009).

Reappraisal (but not distraction) is going to

make you sweat: Physiological evidence for

self- control effort. International Journal of

Psychophysiology, 71, 91–96.

Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J.

(2011). Emotion regulation choice. Psycholog-

ical Science, 22, 1391–1396.

Shiota, M. N., & Levenson, R. W. (2012). Turn

down the volume or change the channel?:

Emotional effects of detached versus positive

reappraisal. Journal of Personality and Social

Psychology, 103(3), 416–429.

Siemer, M. (2001). Mood- specific effects on

appraisal and emotion judgements. Cognition

and Emotion, 15, 453–485.

Soto, J. A., Perez, C. R., Kim, Y.-H., Lee, E.

A., & Minnick, M. R. (2011). Is expressive

suppression always associated with poorer

psychological functioning?: A cross- cultural

comparison between European Americans

and Hong Kong Chinese. Emotion, 11, 1450 –

1455.

Srivastava, S., Tamir, M., McGonigal, K. M.,

John, O. P., & Gross, J. J. (2009). The social

costs of emotional suppression: A prospective

study of the transition to college. Journal of

Personality and Social Psychology, 96, 883–

897.

Staudinger, M. R., Erk, S., Abler, B., & Walter,

H. (2009). Cognitive reappraisal modulates

expected value and prediction error encod-

ing in the ventral striatum. NeuroImage, 47,

713–721.

Stemmler, G. (1997). Selective activation of

traits: Boundary conditions for the activation

of anger. Personality and Individual Differ-

ences, 22, 213–233.

Stepper, S., & Strack, F. (1993). Proprioceptive

determinants of emotional and nonemotional

feelings. Journal of Personality and Social

Psychology, 64, 211–220.

Strack, F., Martin, L. L., & Stepper, S. (1988).

Inhibiting and facilitating conditions of the

human smile: A nonobtrusive test of the facial

feedback hypothesis. Journal of Personality

and Social Psychology, 54, 768–777.

Sutton, R. E. (2004). Emotional regulation goals

and strategies of teachers. Social Psychology

of Education, 7, 379–398.

Sutton, R. I. (1991). Maintaining norms about

expressed emotions: The case of bill collec-

tors. Administrative Science Quarterly, 36,

245–268.

Szasz, P. L., Szentagotai, A., & Hofmann, S. G.

(2011). The effect of emotion regulation strat-

egies on anger. Behaviour Research and Ther-

apy, 49, 114–119.

Szczurek, L., Monin, B., & Gross, J. J. (2012).

The stranger effect: The rejection of affec-

tive deviants. Psychological Science, 23(10),

1105–1111.

20 FOUNDATIONS

Tamir, M. (2009). What do people want to feel

and why?: Pleasure and utility in emotion reg-

ulation. Current Directions in Psychological

Science, 18, 101–105.

Tamir, M. (2011). The maturing field of emotion

regulation. Emotion Review, 3, 3 –7.

Tamir, M., John, O. P., Srivastava, S., & Gross, J.

J. (2007). Implicit theories of emotion: Affec-

tive and social outcomes across a major life

transition. Journal of Personality and Social

Psychology, 92, 731–744.

Taylor, G. J. (1994). The alexithymia construct:

Conceptualization, validation, and relation-

ship with basic dimensions of personality.

New Trends in Experimental and Clinical

Psychiatry, 10, 61–74.

Thiruchselvam, R., Hajcak, G., & Gross, J. J.

(2012). Looking inwards: Shifting attention

within working memory representations alters

emotional responses. Psychological Science,

23(12), 1461–1466.

Thompson, R. A. (1990). Emotion and self-

regulation. In Socioemotional development:

Nebraska Symposium on Motivation (Vol. 36,

pp. 367–467). Lincoln: University of Nebraska

Press.

Thompson, R. (2011). Emotion and emotion

regulation: Two sides of the developing coin.

Emotion Review, 3, 53–61.

Tsai, J. L. (2007). Ideal affect: Cultural causes

and behavioral consequences. Perspectives on

Psychological Science, 2, 242–259.

Webb, T. L., Miles, E., & Sheeran, P. (2012).

Dealing with feeling: A meta- analysis of the

effectiveness of strategies derived from the

process model of emotion regulation. Psycho-

logical Bulletin, 138(4), 775–808.

Westen, D. (1994). Toward an integrative model

of affect regulation: Applications to social-

psychological research. Journal of Personal-

ity, 62, 641– 667.

Wolgast, M., Lundh, L.-G., & Viborg, G.

(2011). Cognitive reappraisal and acceptance:

An experimental comparison of two emotion

regulation strategies. Behaviour Research and

Therapy, 49, 858–866.

Zajonc, R. B. (1984). On the primacy of affect.

American Psychologist, 39, 117–123.

PART II

BIOLOGICAL BASES

The observation that emotions can be pow-

erful forces for good and for ill has moti-

vated researchers’ efforts to understand how

emotions arise and how they are regulated

(Gross, 2007; Kalisch, 2009; Ochsner &

Gross, 2005, 2008; Phillips, Ladouceur,

& Drevets, 2008; Quirk & Beer, 2006). In

particular, neuroscience research recently

has made great strides in describing the

neural systems that give rise to emotional

responses and that permit their regulation.

At the same time, parallel progress has been

made in delineating the neural bases of

related abilities, including affective learning,

affective decision making, and expectancies,

beliefs, and placebo effects (Cunningham

& Zelazo, 2007; Hartley & Phelps, 2010;

Murray, O’Doherty, & Schoenbaum, 2007;

Pessoa, 2008; Rangel, Camerer, & Mon-

tague, 2008). It is becoming evident that the

neural systems implicated across these vari-

ous literatures— including those concerned

with emotion and emotion regulation— are

strikingly similar. This suggests that any

account of the neural bases of emotion and

its regulation— or related abilities— should

be informed by these similarities. Such an

integrated framework would be both more

robust and more translatable to multiple

basic and clinical contexts. Our goal in this

chapter is to provide such a framework.

Our starting point is the assertion that

goal- directed (motivated) behavior may be

defined as behavior that aims to decrease the

probability of states of either our bodies or

of the world that have negative value for us

(e.g., putting on a sweater when we are cold;

picking up trash in the park), or increase

the probability of states that have positive

value for us (e.g., opening a can of soup to

eat when we are hungry; arranging to have

coffee with a friend).

The determination of value occurs

dynamically at many levels of the brain,

at different time scales, and with respect

to many features in the environment (Lev-

enthal, 1984; Rangel et al., 2008; Scherer,

2001). A sudden loss of blood pressure may

occasion a valuation, as may the smell of

dinner being prepared, an aggressive driver

cutting one off, or a new way of thinking

about a poem. If valuations are assessments

of what is bad for me (negative value) or

good for me (positive value), computed for

many different objects, then different types

of valuation might be expected to give rise

to different types of responses, and indeed,

they do (Ortony, Clore, & Collins, 1988;

CHAPTER 2

The Neural Bases of Emotion

and Emotion Regulation:

A Valuation Perspective

Kevin N. Ochsner

James J. Gross

24 BIOLOGICAL BASES

Scherer, Schorr, & Johnstone, 2001). One

particularly important type of valuation is

emotion, which arises when a situation is

evaluated as relevant to an individual’s goals,

thereby triggering a loosely coordinated set

of experiential, behavioral, and peripheral

physiological responses (Mauss, Levenson,

McCarter, Wilhelm, & Gross, 2005). Emo-

tional responses such as joy, anger, and dis-

gust all have at their core an evaluation of

whether something is good for me or bad for

me.

Given the major role that emotions play

in shaping how we feel about and respond

to the world around us, it is no surprise that

emotions themselves can become the tar-

get of valuation. For example, we may feel

angry at a child’s impolite behavior, and

judge our anger as either inappropriate (hav-

ing negative value) or appropriate (having

positive value), depending on the age of the

child. In this and in similar cases, we assign

negative or positive value to the valuation

process itself, thereby energizing processes

that tend to make the emotion in question

either less or more likely to occur, depend-

ing on whether the valuation is negative or

positive. When individuals influence their

emotions in this way, they are engaging in

emotion regulation.

Our framework therefore holds that emo-

tions arise via the valuation of internal or

external stimuli, and that emotion regula-

tion arises via the valuation of the emotion

itself. From this perspective, emotion and

emotion regulation both have valuation at

their core.

This three-part chapter uses a valuation

perspective to integrate diverse findings

in current neuroscience research regard-

ing emotion, emotion regulation, affective

learning, decision making, and expectancy.

In the first part, we propose a multilevel

framework that analyzes emotion and emo-

tion regulation in terms of valuation. In

the second part we use this framework to

understand current research on emotion

and its regulation. Finally, in the third part

we explore the general utility of this frame-

work by giving examples of how it can be

extended to account for current research

on related phenomena, including affective

learning, decision making, and expectancy

effects.

The Functional Architecture

of Valuation

According to the framework we propose

here, valuation can be schematized as the

three-stage processing cycle outlined in

Figure 2.1A. As detailed below, a percep-

tion stage takes various kinds of stimuli

as inputs; a valuation stage dynamically

appraises the value of these stimuli given

current goals, context, and prior experience

with similar stimuli; and an action stage

comprises valuation- appropriate responses

ranging from covert adjustments of low-level

sensory (e.g., increased pupil dilation) or

higher- level cognitive processes (e.g., shifts

in effortful attention) to overt adjustments of

a wide range of response systems (e.g., facial

behavior, postural adjustments, sympathetic

nervous system activation). This perception–

valuation– action (PVA) sequence repeats as

the new state of the world, resulting from the

action, becomes the input for the next PVA

sequence, thus setting in motion a new PVA

cycle. Because multiple PVA cycles are typi-

cally running at any given time, these cycles

interact, and it is these processing dynamics

that give rise to behavior.

PVA Components:

The Perception Stage

A PVA sequence is initiated by an external

or internal stimulus that can vary in com-

plexity from low-level perceptual features

(like eye whites or low spatial frequencies) or

physiological responses (e.g., a racing heart)

to organized perceptual exemplars (e.g.,

objects or scenes) to abstract constructs

such as the self. In this initial perception

stage of the sequence, sensory systems (e.g.,

thalamus plus primary and secondary sen-

sory cortices) encode these types of sensory

inputs and pass them along to systems for

computing value (Kravitz, Saleem, Baker, &

Mishkin, 2011).

PVA Components: The Valuation Stage

Valuations are subserved by an overlapping

set of interacting brain systems that com-

pute the badness or goodness of perceptual

inputs (Hamann, Ely, Hoffman, & Kilts,

2002; Ochsner & Barrett, 2001; Rangel et

Valuation and Emotion Regulation 25

al., 2008; Rolls, 1999), thereby providing

a common currency for comparing vari-

ous objects and events (Levy & Glimcher,

2011). In this chapter we use valuation as an

umbrella term to connote the same kinds of

underlying processes that emotion theorists

would describe using the term appraisal and

attitude researchers would describe using the

term evaluation. Targets of valuation range

from primary reinforcers— objects that are

innately seen as “bad” or “good,” such as

a sweet drink, to secondary reinforcers—

objects that derive their negative or positive

value from their association with primary

reinforcers, such as an A+ written at the top

of one’s term paper (Rangel et al., 2008;

Rolls, 1999). Figure 2.2A shows the brain

regions associated with valuation processes.

Multiple valuations are computed for a

given stimulus, and these vary along a con-

tinuum of representational complexity, with

more complex valuations typically taking

B. Regulation

W2 P2 V2

W1 P1 V1

Present

Future

A. Valuation

FIGURE 2.1A. The perception– valuation– action (PVA) processing cycle that comprises the fundamen-

tal building block of emotion and other types of valuation. As described in the text, multiple PVA cycles

can operate at once, here represented by subscripts 1 to n. Each cycle involves individual PVA sequences

that iteratively feed into one another across time (shown here progressively spiraling into the future),

thereby comprising a PVA cycle. For each cycle, some set of internal and external stimuli comprising

an initial state of the world (W) is represented perceptually (P), values are placed upon the stimuli (V),

and associated action links (A) that are activated result in a new state of the world that feeds into the

next iteration of the PVA processing cycle. Note that here we place emphasis on the three-stage (P-V-A)

processing cycle, and the world (W) is considered to be the result of a prior action and the input for the

next PVA sequence. PVAs can interact with one another, exciting or inhibiting each other’s activation

(schematically shown here by double- headed arrows between PVAs). Emotions are specific types of

PVA sequences that involve specific types of perceptions, valuations, and actions. The neural systems

supporting valuation are shown in Figure 2.2A and elaborated in the text and in Figure 2.3.

FIGURE 2.1B. How PVA sequences instantiate regulation. To illustrate how PVA sequences enable

regulation, we zoom in on two PVA sequences, PVA

and PVA

. As shown here, emotion regulation

(or value regulation more generally) is a functional relationship between two PVA sequences in which

one (PVA

) is “generating emotion” and the other (PVA

) is taking the first PVA as its “P,” valuing it

(negatively or positively), and targeting that first PVA for change via its “A.” The “A” of PVA

enacts

an emotion regulation strategy that influences one or more steps of PVA

. As described in the text, five

types of regulatory strategies may be distinguished. Each regulatory strategy depends on different com-

binations of cognitive control systems (see text, Figure 2.2B, and Figure 2.3) whose regulatory effects

can be understood in terms of the stage of the PVA sequence that is targeted for change. On this view,

emotion regulation is a type of valuation in which the valuation process is itself the target of valuation.

26 BIOLOGICAL BASES

longer to compute than less complex valua-

tions (Leventhal, 1984; Scherer, 2001).

At the lowest level of this continuum,

core valuations are made. These represent

relatively direct associations between per-

cepts and basic physiological and behav-

ioral responses at the action stage (e.g.,

snake → fear response). Core valuation

involves primarily subcortical and brain-

stem systems implicated in affective learning

and responding. While many of these sys-

tems, including the ventral striatum, amyg-

dala, and periaqueductal gray (PAG), receive

inputs from a variety of sensory inputs

(Keay & Bandler, 2001; Packard, 2009),

and as such can be involved in the valuation

of a variety of stimuli, there is evidence that

core valuations for pain sensations involve

dedicated pathways from the thalamus to

nociceptive regions of the midcingulate cor-

tex and anterior insula (Willis & Westlund,

1997). In addition, while the ventral stria-

tum and amygdala are typically linked with

positive/appetitive and negative/aversive

valuations, respectively, both human and

animal studies suggest that subregions of

each structure may play roles in both kinds

of valuations (Delgado, Jou, LeDoux, &

Phelps, 2009; Holland & Gallagher, 2004;

Wager, Barrett, et al., 2008). The associa-

tions underlying core valuations can be (but

are not always) activated automatically and

B. Regulation/Control SystemsA. Valuation Systems

FIGURE 2.2A. Neural systems supporting valuation. Medial (top), lateral (bottom left), and coronal

(bottom right) views of the brain showing systems implicated in different types of valuation processes

that can be arrayed along a continuum from core level valuations (amygdala, ventral striatum) that

consist of links between stimuli and reinforcers, to contextual level valuations (vmPFC/OFC) that

place these S-R links in their historical, social, and motivational context, to conceptual level valua-

tions that represent the value of stimuli in belief– desire terms (rostral and dorsal medial PFC) that may

be verbalizable and consciously reportable. The insula, implicated in the representation of body states,

may play a role in representing the body states associated with all three types of valuation. See text

and Figure 2.3 for examples of how these systems play roles in specific types of valuation and emotion.

FIGURE 2.2B. Neural systems supporting regulation. Medial (left) and lateral (right) views of the

brain showing systems implicated in regulatory strategies that can be used to regulate valuation in

general, and emotion in particular Regions include: the dorsal anterior cingulate cortex (dACC), impli-

cated in monitoring conflicts between desired and actual actions, posterior and dlPFC and inferior

parietal cortex, implicated in holding control strategies and goals in mind and directing attention to

relevant perceptual inputs, and vlPFC, implicated in selecting context- appropriate responses and inhib-

iting context- inappropriate responses. See text and Figure 2.3 for examples of how these systems play

roles in specific types of emotion regulation and related phenomena.

Valuation and Emotion Regulation 27

without conscious intent, and are implicit

insofar as they are not directly accessible

to awareness, although one can be aware of

the actions they trigger, and thereby become

aware of them indirectly. Core valuations

typically are linked to stereotyped action

impulses (Kober et al., 2008; LeDoux, 2000;

Rolls, 1999; Russell & Barrett, 1999), and

as such, can provide the basis for stimulus–

response (S-R) links of the sort that under-

lie Pavlovian conditioning and other basic

forms of affective responding that involve

pleasure and pain (Rangel et al., 2008).

At an intermediate level, contextual valu-

ations evaluate inputs that represent combi-

nations of S-R links and at least three types

of contextual information: the historical as

well as current social and motivational con-

texts of the person (for an illustrative exam-

ple, see the section “Emotion as a Type of

PVA Sequence”). This computational step

involves at least three regions. The first com-

prises the orbitofrontal cortex (OFC) and

ventromedial prefrontal cortex (vmPFC)

(Ongur, Ferry, & Price, 2003; Price, 1999),

whose inputs include the output of both the

core valuation level and the medial tempo-

ral lobe (MTL) and the cortical associative

memory systems, which provide temporal

and spatial context (Davachi, 2006; Murray

et al., 2007). Second is the superior tempo-

ral sulcus/temporoparietal junction (STS/

TPJ), which itself is a multisensory zone that

integrates expectancies with feedback, and

reorients attention accordingly, including

when expectations must be adjusted about

the beliefs, actions, and intentions of others

(Saxe, 2006; Young, Camprodon, Hauser,

Pascual- Leone, & Saxe, 2010). Third is the

anterior insula (AI), which integrates and

makes available to awareness information

about current body states, especially as they

pertain to one’s current affective state (Craig,

2003; Harrison, Gray, Gianaros, & Critch-

ley, 2010; Kurth, Zilles, Fox, Laird, & Eick-

hoff, 2010; Zaki, Davis, & Ochsner, 2012).

Contextual valuations indicate whether an

object is good or bad in the present context,

and therefore whether it should be sought or

avoided at the present time. One commonly

studied form of contextual valuation is fear

extinction, in which an organism learns that

a stimulus that previously predicted an aver-

sive outcome (and was therefore negatively

valued) no longer does so (and in the present

temporal context, can be valued less nega-

tively; Quirk & Beer, 2006). More gener-

ally, contextual valuations play key roles in

other forms of affective learning, in deter-

mining whether the value of stimuli change

across contexts, and in subjective awareness

of one’s affective states (Craig, 2009; Cun-

ningham, Raye, & Johnson, 2004; Holland

& Gallagher, 2004; Lieberman, Jarcho, &

Satpute, 2004; Rangel et al., 2008; Schoen-

baum, Saddoris, & Stalnaker, 2007). Con-

textual valuations influence behavior either

by activating action impulses themselves

or—as detailed below in the section on emo-

tion regulation— by influencing which core

valuations are expressed via actions (Och-

sner, Ray, et al., 2009).

At the highest level of this continuum,

conceptual valuations represent apprais-

als of stimuli that are abstract and often

verbalizable. By this we mean representa-

tions of evaluations and affective states that

abstracted across exemplars and contexts

and are accessible to awareness in the form

of “belief– desire” language. For example, a

conceptual valuation of a snake may involve

activation of a conceptual representation of

“fear,” which one can verbalize using that

word.

We propose that this level involves at least

four regions. First, the rostromedial (rmPFC)

and dorsomedial (dmPFC) prefrontal regions

implicated in attending to and explicitly

judging the value of stimuli and use of cat-

egories and belief– desire language to elabo-

rate semantically the affective value of a

wide range of stimuli, from simple objects to

the self (Cato et al., 2004; Lindquist & Bar-

rett, 2008; Lindquist, Wager, Kober, Bliss-

Moreau, & Barrett, 2012; Mitchell, 2009;

Olsson & Ochsner, 2008; Zysset, Huber,

Ferstl, & von Cramon, 2002). An unre-

solved question about medial PFC (mPFC)

is whether different subregions are involved

in making judgments (whether evaluative or

not) about others, the self, and/or stimuli in

general (Denny, Kober, Wager, & Ochsner,

2012; Ferstl & von Cramon, 2002; Zys-

set, Huber, Samson, Ferstl, & von Cramon,

2003). For our present purposes, we con-

sider mPFC to be critical for using concep-

tual information to elaborate the affective

meaning of stimuli, whether the stimulus

triggering the valuation and emotion is the

self, another person, or some other object/

28 BIOLOGICAL BASES

event/situation. A third region involved in

conceptual valuation is the ventrolateral

prefrontal cortex (vlPFC), which helps select

desired and inhibit undesired value represen-

tations (Aron, Robbins, & Poldrack, 2004;

Badre & Wagner, 2007; Barrett, 2006; Gal-

lagher & Frith, 2003; Lieberman et al.,

2007; Lindquist & Barrett, 2008; Mitchell,

2009; Olsson & Ochsner, 2008; Thompson-

Schill, Bedny, & Goldberg, 2005). Finally,

regions of the anterior insula that support

introspective awareness of body states also

may be integral to awareness of body states

and use of conceptual knowledge about

them to make judgments about one’s cur-

rent affective states (Craig, 2009; Damasio,

Damasio, & Tranel, 2013; Gray et al., 2012;

Harrison et al., 2010; Zaki et al., 2012).

Conceptual valuations influence behavior

either by activating action impulses them-

selves or—as detailed below in the section

on regulation— influencing which contex-

tual and core valuations are expressed via

actions (Ochsner, Ray, et al., 2009). We

propose that conceptual valuations play key

roles in introspection about and self- reports

of affective states, in mental state attribu-

tion, and in judgments about the values of

stimuli and actions that involve conscious

reasoning about their value (Kalisch, Wiech,

Critchley, & Dolan, 2006; Mitchell, 2009;

Olsson & Ochsner, 2008).

PVA Components: The Action Stage

At any given level of valuation, the action

impulses associated with a PVA sequence can

be either mental (e.g., retrieving information

from memory, forming a mental image, or

introspecting about one’s mood) or physical

(e.g., including overt behaviors such as shifts

of gaze or starting to run, and autonomic/

physiological responses such as heart rate

increases or the release of stress hormones;

Levenson, 1999). Although elaborating the

brain systems supporting the action stage is

not the focus of this chapter, it likely involves

subcortical and cortical regions involved in

selecting motor actions, as well as initiating

autonomic responses (e.g., the PAG, primary

motor and supplementary motor areas, cin-

gulate motor regions, and insula) (Buhle et

al., 2012; Critchley, 2005; Dum, Levinthal,

& Strick, 2009; Mobbs et al., 2009).

PVA Operating Principles:

Processing Dynamics

As multiple valuations are computed at dif-

ferent levels and time scales— each with

its own associated action impulses— only

a subset of the possible actions associated

with a percept and its valuations can be

enacted. What determines which actions are

expressed, whether mental (e.g., thoughts

and feelings) or physical (e.g., smiling and

hugging)?

One factor is the existing structure of the

PVA sequences an individual possesses at

any given moment in time. This factor has

been addressed primarily in psychologi-

cal and computational models of associa-

tive memory networks that suggest the P’s,

V’s, and A’s of all currently activated PVAs

mutually excite and/or inhibit one another

in such a way that the most activated action

tendency or (a set of equally activated) ten-

dencies “win” and are manifested as mental

and/or physical actions (Desimone & Dun-

can, 1995; Barrett, Ochsner, & Gross, 2007;

Maas, 2000; Miller & Cohen, 2001). The

schematic PVA sequences of Figure 2.1A

illustrate the possible kinds of links that may

exist between P, V, and A nodes.

A second factor is the multiple contextual

and historical considerations that determine

the level of activation for each PVA sequence

and whether they have inhibitory or excit-

atory links with other PVAs— including

the stimuli that are (or have been) present

as inputs, their activation history (which

determines the strength of links within and

across PVAs, and hence their relative ease of

activation [Anderson, 1983; Neely, 1991]),

and whether they are in the focus of atten-

tion (which enhances activity, especially at

the perception stage [Pessoa, Kastner, &

Ungerleider, 2003; Polk, Drake, Jonides,

Smith, & Smith, 2008]).

At any given moment, an individual’s

affective response comprises the profile of

activation across all PVAs—at all levels—

that may combine or cancel one another

depending on the nature of their connections

and levels of activation (Barrett, Mesquita,

Ochsner, & Gross, 2007; Scherer, 2001). As

described below, depending on the circum-

stances, core, contextual, and/or conceptual

PVAs may be activated most strongly and

lead to action.

Valuation and Emotion Regulation 29

PVA Operating Principles:

Interacting Networks

As our process- level description makes clear,

the PVA sequence is continually unfolding

in real time for multiple stimuli as multi-

ple levels of analysis. This means that net-

works of interacting brain systems underlie

each stage of the PVA sequence, as well as

the interactions among stages. This follows

from the fact that an individual’s affective

response comprises the profile of activation

across all PVAs, at all levels, which in turn

follows from the idea that the P, V, and A

stages all involve multiple brain systems

working together to compute the perceptual,

evaluative, and action components of one’s

response to a given stimulus.

Thus, the totality of one’s valuation of a

stimulus cannot be understood in terms of

the activation of a single brain system. That

said, most of what we know about the func-

tions of brain systems implicated in the P,

V, and A stages comes from studies employ-

ing analytic techniques (e.g., simple con-

trasts) designed to isolate the contributions

to behavior of single regions rather than

integrated networks. Increasingly, however,

various kinds of connectivity, network, and

multivoxel pattern analyses are being used

to describe the task- varying functional rela-

tionships among regions that define them as

critical for aspects of the P, V, and A stages

(Kober et al., 2008). For example, we and

others have used mediation and structural

equation modeling to describe the ways in

which prefrontal control regions regulate

emotional response via their impact on

subcortical regions that trigger affective

responses (Johnstone, van Reekum, Urry,

Kalin, & Davidson, 2007; Kober et al.,

2010; Urry et al., 2006; Wager, Barrett, et

al., 2008; for review, see Ochsner, Silvers,

& Buhle, 2012). As such analytic techniques

mature, we expect that our framework will

be able to describe more precisely the func-

tional interactions governing the P, V, and A

stages, as well as their interactions.

A Valuation Perspective on Emotion

and Emotion Regulation

Emotions are particular types of valuation

that (1) have a well- specified object (i.e.,

one is angry about something), (2) unfold

over seconds to minutes, and (3) involve

coordinated changes in subjective experi-

ence, behavior, and physiology (Barrett et

al., 2007; Mauss et al., 2005; Scherer et al.,

2001). In keeping with our overall goal of

showing how the valuation framework is

broadly applicable, in the sections that fol-

low we employ an expansive view of emo-

tion.

Emotion as a Type of PVA Sequence

Imagine you are a commuter in a crowded

New York subway car. Across from you sit

a sleepy- eyed old man, a muscular teen, and

an attractive woman. As the subway rattles

toward your stop, the teen removes a knife

from his pocket, shifting it from hand to

hand.

In our framework, emotional reactions to

the knife- wielding teen may be conceived of

as specific kinds of PVA sequences derived

from particular perceptions, valuations, and

associated action impulses (Ortony et al.,

1988; Scherer et al., 2001). Thus, an ini-

tial response may reflect a core-level valua-

tion of the teen and his knife as potentially

threatening by the amygdala and related

regions, which triggers corresponding action

impulses that mobilize you to avoid harm

(e.g., increased heart rate, behavioral readi-

ness to fight or flee; LeDoux, 2000; Phelps,

2006). At the contextual level, the action

outputs of core-level PVA sequences become

perceptual inputs that are integrated with

other inputs representing the historical (epi-

sodic) context of, for example, having prior

subway conversations with the teen (via

MTL inputs), the social context of multiple

other passengers being present (via STS/TPJ

inputs), and the motivational context of cur-

rent stress and bodily complaints (via AI and

other subcortical inputs). As time passes,

activation of the contextual- level PVAs,

which dictate other courses of action, can

begin to build, and the initial valuation may

evolve dynamically into valuations of the

teen as relatively innocuous or highly dan-

gerous, depending on whether the teen pre-

viously indicated he has a role as a thug in

a school play or is on medication for a delu-

sional disorder (historical context), whether

he elicits calm or anxious reactions from

30 BIOLOGICAL BASES

other passengers (social context), or whether

you are stressed from work or just had a

great day (motivational context). Then, the

action outputs of activated contextual- level

PVAs are taken as inputs to systems (rmPFC,

and/or vlPFC) that compute a valuation of

the teen in belief– desire terms that can—at

the action stage—be introspectively accessed

or reported to others as the thoughts and

feelings you attribute to yourself or others,

including, for example, the thoughts that

you yourself are brave, that the knife- wielder

looks aggressive, and that the old man and

young woman seem calm.

The order in which these valuation sys-

tems is activated, and their interplay, is not

fixed and depends on the circumstances of

your encounter with a stimulus. For exam-

ple, if you are sitting on the subway, and the

teen enters from the opposite end of the car

and does not pose an immediate threat, then

conceptual valuation systems might evaluate

his intentions (“Is he dangerous?”) and your

own level of fear (“I’m not scared— yet”). As

the teen moves closer, contextual systems

might be most active as you evaluate the

goodness or badness of potential courses of

action based on your changing motivational

state (increasing anxiety), history (the seat

next to you was just vacated, and the teen

moves toward this open seat) and the appar-

ent anxiety of your fellow passengers (who

look increasingly afraid). Finally, as the teen

moves even closer and the threat level is very

high, activation in core valuation systems

may escalate to promote defensive actions

such as freezing, escape or fighting (Mobbs

et al., 2007).

The key idea is that, taken together, all of

these PVAs, however they were activated,

and each with their associated mental and

physical action tendencies, comprise an

emotional response.

Emotion Regulation as a Type

of PVA Sequence

As noted earlier, emotions themselves are

sometimes the target of valuation. For

example, in the previous subway exam-

ple, we might wish to protect our view of

ourselves as brave and, as a consequence,

desire to decrease our fear responses. To

do this, we can take as objects of valuation

the action outputs of PVAs that comprise a

fear response. When we do this— thereby

activating a goal to influence the nature of

the emotional response— we are engaging in

emotion regulation. As described below, this

involves interactions among regions impli-

cated in cognitive control (i.e., regulation)

and/or valuation.

In our framework, emotion regulation is

initiated when a PVA cycle that gives rise

to emotion becomes the object of valua-

tion (see Figure 2.1B). We propose that this

typically happens across levels of valuation,

as a higher- level PVA places a good or bad

valuation on a lower-level PVA (although it

also can happen between PVAs at a single

level). It also can happen if there is a high

level of conflict between active PVAs, such

as whether the impulse to flee a poten-

tially dangerous situation conflicts with the

impulse to freeze, and a clear set of emo-

tional responses isn’t activated. We propose

that when this happens, the level of conflict

constitutes an input to the next PVA cycle,

and evaluation of that conflict triggers an

appropriate course of regulatory action.

One key feature of our framework is the

idea that some of the prefrontal systems that

support emotion regulation are involved in

the control of nonaffective forms of behav-

ior as well (Miller & Cohen, 2001; Ochsner

& Gross, 2005). These systems (see Figure

2.2B) include dorsal and ventrolateral pre-

frontal regions that support selective atten-

tion, working memory, and retrieval from

semantic memory; cingulate regions that

monitor conflicts between competing As

and the need for continued control; medial

regions that support mental state attribu-

tion; and ventromedial prefrontal regions

that place contextual constraints on the

expression of core-level PVAs (Miller, 2000;

Ochsner & Gross, 2005; Olsson & Ochsner,

2008; Wager, Jonides, & Reading, 2004;

Wager & Smith, 2003). As detailed below,

the regulatory actions supported by these

systems comprise different types of “A’s” in

PVA sequences that place a value on one’s

current affective state.

Distinguishing among Emotion

Regulation Processes

We have previously argued that emotion

regulation processes can be differentiated

into five families according to which stage

Valuation and Emotion Regulation 31

of the emotion generation sequence they

target. In the context of the present frame-

work, this idea is expressed by suggesting

that emotion regulatory processes differ

in the stage of the PVA sequence at which

they have their primary impact (see Figure

2.3). Some strategies influence the situation-

dependent perceptual inputs (situation selec-

tion, situation modification, and attention

deployment). Others influence the valua-

tion step itself (cognitive change). Still oth-

ers influence the response output associated

with activated action sequences (response

modulation). By impacting different states

of the PVA cycle, different strategies impact

emotional responding in different ways, as

detailed below.

Situation selection refers to altering the

inputs to the PVA sequence through deci-

sions about whether to expose oneself to a

given situation/stimulus based on its pro-

jected affective impact. For example, call-

ing to mind the image of the subway might

lead to a negative evaluation, and a feeling

of fear. This feeling might motivate a higher-

level PVA that would trigger a decision to

take an alternative means of transportation

in order to decrease the probability of the

negative experiences that one associates with

taking the subway. More generally, situation

selection can take many forms, for example,

when a socially anxious individual avoids a

social event. To date, the neural bases of sit-

uation selection have been studied only with

avoidance conditioning tasks in which an

animal learns to select an action (e.g., run-

ning in a wheel when a light is illuminated

predicts an upcoming shock) that enables

it to avoid experiencing a noxious stimulus

(that prevents shock administration). Rodent

studies have shown this involves modulation

of two core valuation systems, the striatum

and amygdala (Everitt et al., 1999; LeDoux

& Gorman, 2001), and one human imaging

study (Delgado et al., 2009) indicates that

it also engages vlPFC and dorsolateral pre-

frontal cortex (dlPFC) regions involved in

cognitive control that presumably modulate

the core valuation systems.

Situation modification refers to alter-

ing the situation one is in, thereby modi-

fying inputs to the PVA sequence, and

changing the emotion (e.g., sitting further

away from the teen or exiting the subway).

We would expect that prefrontal systems

should be involved in the selection of escape

behaviors— especially in the kinds of emo-

tionally arousing situations humans face in

everyday life. Although this hypothesis has

not been tested, the involvement of prefron-

tal regions is suggested by behavioral stud-

ies in humans showing that emotion can be

regulated by deliberately changing situation-

dependent stimulus inputs in the service of

explicit regulatory goals. For example, either

physically or mentally, using visual imagery,

one can move closer to or further away from

an emotion- eliciting stimulus (e.g., making

oneself feel more positive by approaching a

pleasant stimulus or less negative by with-

drawing from an unpleasant one; Davis,

Gross, & Ochsner, 2011; Muhlberger, Neu-

mann, Wieser, & Pauli, 2008; Williams &

Bargh, 2008).

Attentional deployment refers to altering

the inputs to the PVA sequence by increasing

or decreasing attention to them (e.g., look-

ing away from the teen and at the man or

woman). While this can gate specific stim-

uli wholly into or out of the PVA stream,

thereby promoting or preventing responses

to them, we propose that more graded

changes in attention to stimuli may result

in correspondingly graded levels of acti-

vation of their associated PVA sequences.

This strategy involves interactions between

cognitive control systems and valuation sys-

tems, with particular involvement of dorsal

PFC and inferior parietal regions associated

with selective attention (Pessoa et al., 2003),

and in some cases rmPFC regions implicated

in attending to and explicitly judging the

value of stimuli (Bishop, 2007; Egner, Etkin,

Gale, & Hirsch, 2008; Etkin, Egner, Peraza,

Kandel, & Hirsch, 2006; Lane et al., 1998;

Ochsner, Hughes, Robertson, Cooper, &

Gabrieli, 2009). A growing but somewhat

inconsistent imaging literature shows that,

by and large, when a task manipulation

diminishes attention to an affectively arous-

ing stimulus, activation increases in PFC

regions implicated in cognitive control (sug-

gesting that cognitive control systems are

involved in manipulating attention), and

activity decreases in regions implicated in

core (e.g., amygdala, PAG), contextual (e.g.,

insula) or conceptual (e.g., mPFC) valuation

(e.g., Ochsner & Gross, 2005; Pessoa, 2009).

While it is clear that the specific valuation

systems modulated by attentional deploy-

Neural Systems

Emotion Regulation Strategies Related Phenomena

Region

Type of

System Processes

Attentional

Deployment

Cognitive

Change

(Reappraisal)

Response

Modulation

(e.g.,

Expressive

Suppression)

Affective

Learning

(e.g., Fear

Extinction)

Affective

Decisions

(e.g.,

Intertemporal

Choice)

Expectancies

(e.g., Placebo

Effects)

dorsolateral

PFC

Control

selective

attention/

working

memory

dorsal

posterior

mPFC

inferior parietal

dorsal ACC

performance

monitoring

ventrolateral

PFC

selection/

inhibiti

dorsal mPFC

Conceptual

Valuation

Contextual

Valuation

Core Valuation

conceptual/

categorical

valuations

rostral mPFC

attention to

valuation

ventromedial

PFC/OFC

value of

stimulus in

current context

? ?

ventral

striatum

reward/

reinforcement

value

amygdala

arousal (and

threat) value of

stimulus

insula Valuation

representation

and awareness

of body states

for all types of

valuation

PVA Cycle Illustrations

    

  

    

    

 

  

   

  

     



     

1 1 1 1

2 2 2 2

W P V A

Vsafe

Vthreat

Option2

Option1

Placebo

Painful

Stimulus

1 1 1 1

2 2 2 2

W P V A

1 1 1 1

1 2 2 2

W P V A

FIGURE 2.3. Neural systems for valuation and control postulated by the valuation framework pre-

sented in the chapter (left-hand columns), as well as the roles these neural systems play in three kinds

of emotion regulation strategies (center columns, see text) and three kinds of related phenomena (right-

hand columns, see text). Up arrows indicate increased activation, down arrows indicate decreased

activation, and “?” indicates involvement in some (but not the majority) of the studies. The final row

diagrams, in PVA terms, how each emotion regulation strategy or related phenomenon might oper-

ate (see text for details). The three center columns show, for each emotion regulation strategy, how

control actions impact either attention paid to particular stimuli at the perception stage (attentional

deployment), how one values those stimuli (reappraisal), or what actions one takes as a consequence of

this valuation (response modulation). The three right-hand columns show for related phenomena how

initial valuations (e.g., threat) may be overridden if one learns new valuations (e.g., safe) for a stimulus

(extinction) one may select among choice options as a function of their relative valuations, with control

actions coming into play when the choice options are similarly valued and/or in conflict (intertemporal

choice), or a placebo may influence the valuation of a painful stimulus via the action of control pro-

cesses (placebo effects).

Valuation and Emotion Regulation 33

ment depend on the sensory qualities of the

stimulus, distraction from pain modulates

nociceptive regions of insula and cingulate

cortex (Frankenstein, Richter, McIntyre, &

Remy, 2001; Tracey et al., 2002), whereas

distraction from an aversive image modu-

lates the amygdala (McRae et al., 2010; Pes-

soa, 2009); for example, cross-study vari-

ability in attentional deployment strategies

and the lack of a common metric for deter-

mining how much any given strategy dimin-

ishes attention to a stimulus in one study

compared to others (see Ochsner & Gross,

2005, for a detailed review) have limited the

conclusions that can be drawn about when

and how specific cognitive control systems

are involved.

Cognitive change refers to altering the

subjective meaning and/or perceived self-

relevance of the present situation (e.g.,

thinking of the knife as a stage prop or that

knife- tossing is an innocent way of pass-

ing time). The framework suggests that this

strategy should involve interactions between

cognitive control systems that can be used

deliberately to change one’s interpretation of

a stimulus and valuation systems that trigger

an affective response. Of note here is the fact

that the framework predicts that conceptual

valuation systems can play a role on either

side of this regulatory equation: on the one

hand, being the target of cognitive control

systems that seek to change one’s high-level

conceptual valuation of a stimulus, and on

the other, assisting those cognitive control

systems in reformulating the attributions one

makes about the nature of one’s own beliefs,

desires, and feelings (e.g., “I’m feeling less

afraid now”)—or those expressed by others

(e.g., “The subway passengers are anxious

about the crowding, not the teen”)—as one

deliberately changes his or her interpretation

of an emotion- eliciting stimulus. Research

on cognitive change— referred to in the lit-

erature as “reappraisal”—consistently sup-

ports the predictions of the framework:

When engaging in a cognitive change strat-

egy, activation is observed in lPFC and cin-

gulate PFC regions associated with cognitive

control, as well as mPFC regions associated

with conceptual valuation (albeit primarily

when up- regulating emotional responses)

and at the same time increasing or decreas-

ing activity in core (e.g., amygdala, striatum)

and/or contextual (e.g., insula) valuation

systems (e.g., Kober et al., 2010; Ochsner et

al., 2004; Urry et al., 2006; Wager, David-

son, Hughes, Lindquist, & Ochsner, 2008;

reviewed in Kalisch, 2009; Ochsner &

Gross, 2005, 2008) in accordance with one’s

regulatory goals.

Finally, response modulation refers to tar-

geting behavioral manifestations of emotion

(e.g., playing it cool by not showing fear of

the knife- wielding teen). Human research

primarily has focused on one exemplar of

this strategy, expressive suppression, which

involves hiding behavioral manifestations of

emotion (Gross, 1998). Behaviorally, expres-

sive suppression effectively reduces facial

expressions of emotion, but the effort and

attention required to do so trigger autonomic

responses, impair memory for visual cues,

and can negatively impact social interactions

(Butler et al., 2003; Gross, 1998; Richards

& Gross, 2000). In keeping with these find-

ings, an initial imaging study showed that

suppressing the expression of disgust acti-

vated two key PFC regions associated with

cognitive control (dlPFC associated with

maintaining goals, and vlPFC associated

with response selection and inhibition more

generally; Aron et al., 2004; Badre & Wag-

ner, 2007; Thompson- Schill et al., 2005),

and increased activation in core (amgydala)

and contextual (insula) valuation regions

associated with detection of threats and

awareness of body states (Goldin, McRae,

Ramel, & Gross, 2008). This supports the

idea that expressive suppression, like other

strategies, depends on interactions between

cognitive control and valuation regions, and

may have neural bases similar to those sup-

porting response inhibition more generally

(Aron et al., 2004).

Applications of

the Valuation Perspective

The neural systems implicated in emotion

and emotion regulation play key roles in

other phenomena that involve valuation and

cognitive control (Hartley & Phelps, 2010;

Murray et al., 2007; Pessoa, 2008; Phillips

et al., 2008; Rangel et al., 2008). We believe

it is important that any account of emotion

and emotion regulation use terminology and

concepts that are broadly applicable to allied

phenomena as well.

34 BIOLOGICAL BASES

With this in mind, we illustrate in this

section the broad applicability of our valu-

ation perspective on emotion and emotion

regulation by showing how it can provide a

framework for describing the mechanisms

underlying three types of related phenomena

that traditionally are considered in relatively

separate literatures. This has the dual bene-

fits of broadening the framework to account

for aspects of related phenomena it was not

initially formulated to address, and in so

doing, making the framework more robust

and generally applicable.

Affective or Emotional Learning

As noted in the earlier section on the PVA

processing dynamics, our valuation perspec-

tive allows learning to occur by updating

the valuations placed on stimuli with each

iteration of the PVA sequence. To account

more broadly for various forms of affective

or emotional learning, we can elaborate the

way in which this updating process occurs.

When encountering a stimulus, one’s cur-

rent valuation of it sets an expectation for the

outcome states of the world that should fol-

low from execution of the associated action

impulse(s). These outcomes become inputs to

the next PVA, which evaluates discrepancies

between the expected and actual outcomes.

If this valuation is negative (i.e., when the

discrepancy is large and/or important in

light of currently active goals), this valuation

triggers learning and updating processes

that change links between a stimulus and its

valuation (P-V) or between a valuation and

an action (V-A)—or between separate PVA

sequences— so that future valuations are

more accurate (Delgado, Olsson, & Phelps,

2006; Rangel et al., 2008; Schultz, Dayan, &

Montague, 1997). Each change is small, so

that one’s value expectations for a stimulus

at a given moment in time are a function of

one’s prior experiences with it, biased more

heavily toward recent experiences. While

this value updating process typically is stud-

ied in the context of conditioning, reward,

and affective learning, it fits neatly within

our valuation framework as the way that

changes in the contingency between actions

and outcomes can adaptively alter the valua-

tions that drive the actions.

To illustrate this, we can use our subway

example to consider one of the most studied

examples of value updating, namely, extinc-

tion of a fear response. We discussed extinc-

tion earlier as an example of contextual

valuation in which an organism learns that

a previously feared stimulus need no longer

be feared in the current temporal context.

In that section, however, we did not explain

how the organism learns this contextual

association. Here we propose that value

updating is the learning mechanism.

The subway example can help make this

concrete. Recall that the knife- wielding teen

initially elicits a threat valuation and fear

response involving amygdala- mediated core

level PVAs. If the expected outcome does

not transpire (i.e., the teen takes no harm-

ful actions), however, then over time a new

contextual- level PVA is acquired by ventro-

medial/orbitomedial PFC systems indicating

the teen is not a threat. The longer the teen

takes no harmful action, the stronger this

PVA becomes. Ultimately, even though the

knife still connotes threat at the core level,

the contextual PVA wins out for expression

in behavior (see the section on PVA process-

ing dynamics). Because the core-level PVA

itself remains unchanged, a fear response

can be quickly reinstated in the future

should the teen become truly threatening

(Bouton, 2004; LeDoux, 1993). The frame-

work can be similarly applied to other cases

in which one learns, or already has learned,

that a given emotional impulse is inappro-

priate or unnecessary in the current context,

as in reversal of learned appetitive or aver-

sive associations (Bouton, 2004; Corcoran

& Quirk, 2007; Schoenbaum et al., 2007).

As this example makes clear, affective

learning and the types of regulatory strate-

gies reviewed earlier are not mutually exclu-

sive and may in many contexts work together.

For example, the act of reappraising can be

seen as a way of cognitively creating a dis-

crepancy between an expected internal out-

come (e.g., a fear response) associated with

a given percept (e.g., the knife- wielding teen)

and the response that actually occurs (e.g.,

calmness). This discrepancy could activate

learning processes that weaken core-level

PVA representations of the teen as threat-

ening, build new contextual- level represen-

tations of the teen as nonthreatening, and

strengthen conceptual- level PVAs of the teen

as an actor. In this way, reappraisal— and

by extension other regulatory strategies—

Valuation and Emotion Regulation 35

can be seen as providing top-down “teach-

ing” inputs to outcome- driven regulatory

processes that typically are triggered by

external cues (cf. Delgado, Gillis, & Phelps,

2008; Delgado, Nearing, LeDoux, & Phelps,

2008).

Affective Decision Making

Our valuation perspective also may be

applied to affect- laden decision making.

Affective decisions require a choice between

options that are associated with different

expected rewards or punishments. In our

framework, these expectations are reflected

in the values computed for choice options

at various levels of the valuation hierarchy.

To the extent that the play of activation

and inhibition across PVA sequences associ-

ated with choice options results in a core-,

contextual-, or conceptual- level valuation

determining the behavioral output, then the

choice option associated with that valuation

will be selected. However, in some cases, this

play of activation fails to determine clearly a

most highly valued selection, and cognitive

control processes may be engaged in order to

construct, hold in mind, and implement top-

down processes that influence PVAs associ-

ated with choice options. This commonly

happens when choice options are similarly

valued and/or conflict with one another,

but it also may happen when the valuation

process itself becomes a target of valuation

(e.g., when there is a negative valuation of an

attractive response option).

To illustrate (see Figure 2.3), consider

how the framework accounts for a com-

monly studied choice dilemma in behavioral

economics and neuroeconomics known

as “intertemporal choice” (or as delay of

gratification in the developmental litera-

ture; Mischel, Shoda, & Rodriguez, 1989).

This dilemma involves choosing between

a smaller reward available now or a larger

reward available at some point in the future.

In our framework, selection of the immedi-

ate reward would be promoted by core-level

(striatal) or contextual- level (medial/orbital

frontal) valuation systems that represent

the reward value of the currently available

stimulus. By contrast, picking the delayed

reward would require the use of lateral pre-

frontal cognitive control systems in order

to maintain a representation of the delayed

reward in working memory and inhibit acti-

vation of PVAs for the immediately avail-

able choice option (Figner et al., 2011). In

keeping with this account, human imaging

studies have shown greater ventral striatal

(VS) and/or vmPFC versus greater dlPFC

activity when participants select immediate

versus delayed rewards (McClure, Ericson,

Laibson, Loewenstein, & Cohen, 2007;

McClure, Laibson, Loewenstein, & Cohen,

2004), and a recent transcranial magnetic

stimulation study showed that disruption of

left—but not right—dlPFC led participants

to “impulsively” select immediate rewards

when they had shown a prior preference

for the delayed reward (Figner et al., 2011).

Strikingly, this result dovetails with the find-

ing that a pathway from left dlPFC to the VS

supports the use of reappraisal to diminish

craving for desired substances (e.g., sugary/

fattening foods) when participants think

about the negative long term (e.g., diabetes)

as opposed to the immediate (e.g., delicious

taste) consequences of consuming them

(Kober et al., 2010).

As these findings make clear, affective

decision making and the regulatory strate-

gies reviewed earlier may depend upon very

similar neural systems and, as such, the line

between them is not always clear. Indeed,

intertemporal choices— and other choices

that require selecting between options con-

sistent with long- versus short-term goals—

can be viewed as self- control tasks (Figner et

al., 2011; Hare, Camerer, & Rangel, 2009;

Wunderlich, Rangel, & O’Doherty, 2009) in

which the decision to select an option consis-

tent with a long-term goal is influenced by

attention deployment and cognitive change

strategies (Mischel et al., 1989). Our valua-

tion perspective can also be applied to other

types of choice dilemmas in which control

and valuation processes interact to deter-

mine choice, including risky decision making

(Gianotti et al., 2009), in which the choice is

to be fair toward or to punish others (Knoch

et al., 2008; Knoch, Pascual- Leone, Meyer,

Treyer, & Fehr, 2006), and when the act of

choice itself changes our valuations of stim-

uli via the value- updating process (Sharot,

De Martino, & Dolan, 2009; Sharot, Shiner,

& Dolan, 2010) as in cognitive dissonance

reduction (Lieberman, Ochsner, Gilbert,

& Schacter, 2001; Sharot et al., 2009; van

Veen, Krug, Schooler, & Carter, 2009).

36 BIOLOGICAL BASES

Expectancies, Beliefs,

and Placebo Effects

Our valuation framework also helps make

sense of the growing imaging literatures on

the ways in which expectancies and beliefs of

various sorts— including placebo effects—

influence responses to various kinds of affec-

tive stimuli (Wager, 2005). In these tasks,

participants are given one of two kinds of

explicit expectations. In studies of expectan-

cies or anticipation, participants are told that

an upcoming stimulus— whether a painful

sensation, an image, or something else—will

be of a particular intensity or kind. In pla-

cebo experiments, participants are told that

a drug (e.g., a cream or a pill) will increase

or decrease their subsequent responses to a

stimulus. In either case, these expectations

lead participants to experience the stimulus,

when presented, as subjectively more simi-

lar to what they expected than would have

been the case had they held no expectations

or beliefs about its nature or the protective

properties of a drug.

From the perspective of our framework,

these phenomena all involve the top-down

influence of cognitive control systems on

valuation systems or the influence of higher

level valuation systems on lower level valu-

ation systems. Our interpretation of these

effects is consistent with results of imaging

studies of expectancies and placebo effects

on pain responses. Such studies indicate

that expectancies and placebo beliefs about

pain are maintained in a combination of

lateral prefrontal/parietal working memory

systems and/or medial prefrontal systems

(Atlas, Bolger, Lindquist, & Wager, 2010;

Lieberman, Jarcho, Berman, et al., 2004;

Wager, 2005; Wager, Atlas, Leotti, & Rill-

ing, 2011) that in the framework could be

described as representing either conceptual-

level beliefs (e.g., “The cream on my forearm

should lessen the pain”) or contextual- level

expectations about the stimulus or placebo.

According to our framework, these systems

influence attention to and appraisal of the

value of stimuli in contextual- level and/

or core-level valuation systems (see Figure

2.3), modifying their levels of activation to

be consistent with top-down beliefs (e.g.,

lessening activation of pain- sensitive valu-

ations systems, including contextual- level

regions (e.g., cingulate and insular cortex)

and core-level regions (e.g., amygdala and

PAG) (Ploghaus, Becerra, Borras, & Bor-

sook, 2003; Wager, 2005).

Thus, from the viewpoint of the frame-

work, expectancies and beliefs operate much

like two of the emotion regulation strategies

described earlier— attention deployment

and cognitive change— in that they alter

lower-level inputs to PVA systems and/or the

valuation process.

Summary

One of the fundamental challenges faced by

any animal is computing and expressing the

value of stimuli in an accurate and timely

manner. This is difficult, because the ani-

mal’s internal state and external environment

change over time, and its information acqui-

sition, processing, and response resources

and capabilities are limited. To address these

challenges, humans (and other animals) have

developed a complex set of interacting valua-

tion systems, each of which can be described

in terms of a simplified P-V-A sequence, in

which a particular perceptual input is valued

(negatively or positively to a given degree),

leading to an impulse to alter ongoing behav-

ioral or cognitive responses. These P-V-A

sequences run in parallel at various levels in

the brain and compete for expression.

This process- oriented valuation frame-

work suggests a number of directions for

future research. One direction concerns

the valuation systems. While Figures 2.2A

and 2.3 feature three kinds of valuation

systems (core, contextual, and conceptual),

future work should clarify the number and

kind of valuation systems, as well as the

rules that govern their engagement in par-

ticular contexts. A second direction has to

do with how the often- competing action

impulses associated with different P-V-A

sequences are coordinated. We have empha-

sized the role of competitive activation and

inhibition, but how this and other processes

lead to coordinated and sustained adaptive

behavior rather than erratic and conflicting

behavior is not yet clear. A third direction

concerns the inputs and outputs of valuation

systems. We have suggested that the class

of P-V-A sequences whose inputs are other

P-V-A sequences, and outputs that include

the engagement of cognitive control pro-

cesses are fundamental to emotion regula-

Valuation and Emotion Regulation 37

tion and self- control more generally. That

said, the range of relevant inputs and out-

puts, and the malleability of input– output

relations requires further study. A fourth

direction concerns the efficacy of various

forms of value regulation and how they are

intermixed in everyday life. Which “pure”

or “hybrid” forms of value regulation are

most effective? A fifth direction concerns

translation of what we learn to illuminate

individual differences. In our framework,

a given emotional response and regulation

profile could involve individual differences

in (1) the initial valuations placed on spe-

cific classes of stimuli by systems at the core,

contextual, and/or conceptual levels; (2) the

speed with which these valuations are made;

(3) how quickly and easily one resolves con-

flicts between them to express emotional

responses; (4) how quickly and effectively

learning processes update these valuations

given that some emotional responses may be

more difficult to change than others; (5) the

knowledge of how and when to deploy emo-

tion regulatory strategies; and (6) the capac-

ity and ability to deploy top-down control

systems to implement these strategies. One

important direction for future research is

examining how each of these differences—

and others— may interact to produce vari-

ous forms of psychopathology.

Our goal in presenting this valuation

framework is to provide a common plat-

form for analyzing the neural systems that

are important for many different types of

valuation. The impetus for this framework

came from the observation that neural sys-

tems implicated in emotion generation and

emotion regulation overlapped in important

ways with neural systems implicated in other

literatures that typically are not considered

side by side (see Figure 2.3). Across all these

research domains an organism’s adaptive

capacity crucially hinges on the coordina-

tion of multiple valuation systems in real

time, and a key challenge for future research

is delineating these PVA interactions, ideally

with adequate specificity to permit more

explicitly computational approaches. We

believe that an explicitly integrative valu-

ation framework represents a step in this

direction, and holds out the possibility of

better coordinating hitherto unconnected

research literatures, while simultaneously

deepening our understanding of each one.

References

Anderson, J. R. (1983). A spreading activation

theory of memory. Journal of Verbal Learning

and Verbal Behavior, 22(3), 261–295.

Aron, A. R., Robbins, T. W., & Poldrack, R. A.

(2004). Inhibition and the right inferior fron-

tal cortex. Trends in Cognitive Sciences, 8(4),

170–177.

Atlas, L. Y., Bolger, N., Lindquist, M. A., &

Wager, T. D. (2010). Brain mediators of pre-

dictive cue effects on perceived pain. Journal

of Neuroscience, 30(39), 12964–12977.

Badre, D., & Wagner, A. D. (2007). Left ven-

trolateral prefrontal cortex and the cognitive

control of memory. Neuropsychologia, 45(13),

2883–2901.

Barrett, L. F. (2006). Solving the emotion para-

dox: Categorization and the experience of

emotion. Personality and Social Psychology

Review, 10(1), 20 – 46.

Barrett, L. F., Mesquita, B., Ochsner, K. N., &

Gross, J. J. (2007). The experience of emotion.

Annual Review of Psychology, 58, 373–403.

Barrett, L. F., Ochsner, K. N., & Gross, J. J.

(2007). Automaticity and emotion. In J.

A. Bargh (Ed.), Social Psychology and the

Unconscious (pp. 173–218). New York: Psy-

chology Press.

Bishop, S. J. (2007). Neurocognitive mechanisms

of anxiety: An integrative account. Trends in

Cognitive Sciences, 11(7), 307–316.

Bouton, M. E. (2004). Context and behavioral

processes in extinction. Learning and Mem-

ory, 11(5), 485–494.

Buhle, J. T., Kober, H., Ochsner, K. N., Mende-

Siedlecki, P., Weber, J., Hughes, B. L., et al.

(2012). Common representation of pain and

negative emotion in the midbrain periaque-

ductal gray. Social Cognitive and Affective

Neuroscience. [E-publication ahead of print]

Butler, E. A., Egloff, B., Wilhelm, F. H., Smith,

N. C., Erickson, E. A., & Gross, J. J. (2003).

The social consequences of expressive suppres-

sion. Emotion, 3(1), 48– 67.

Cato, M. A., Crosson, B., Gokcay, D., Soltysik,

D., Wierenga, C., Gopinath, K., et al. (2004).

Processing words with emotional connotation:

An fMRI study of time course and laterality

in rostral frontal and retrosplenial cortices.

Journal of Cognitive Neuroscience, 16(2),

167–177.

Corcoran, K. A., & Quirk, G. J. (2007). Recall-

ing safety: Cooperative functions of the ven-

tromedial prefrontal cortex and the hippo-

38 BIOLOGICAL BASES

campus in extinction. CNS Spectrums, 12(3),

200–206.

Craig, A. D. (2003). Interoception: The sense of

the physiological condition of the body. Cur-

rent Opinion in Neurobiology, 13(4), 500–

505.

Craig, A. D. (2009). How do you feel—now?:

The anterior insula and human awareness.

Nature Reviews Neuroscience, 10(1), 59–70.

Critchley, H. D. (2005). Neural mechanisms of

autonomic, affective, and cognitive integra-

tion. Journal of Comparative Neurology,

493(1), 154–166.

Cunningham, W. A., Raye, C. L., & Johnson,

M. K. (2004). Implicit and explicit evaluation:

fMRI correlates of valence, emotional inten-

sity, and control in the processing of attitudes.

Journal of Cognitive Neuroscience, 16(10),

1717–1729.

Cunningham, W. A., & Zelazo, P. D. (2007).

Attitudes and evaluations: A social cognitive

neuroscience perspective. Trends in Cognitive

Sciences, 11(3), 97–104.

Damasio, A., Damasio, H., & Tranel, D. (2013).

Persistence of feelings and sentience after

bilateral damage of the insula. Cerebral Cor-

tex, 23(4), 833–846.

Davachi, L. (2006). Item, context and relational

episodic encoding in humans. Current Opin-

ion in Neurobiology, 16(6), 693–700.

Davis, J. I., Gross, J. J., & Ochsner, K. N. (2011).

Psychological distance and emotional experi-

ence: What you see is what you get. Emotion,

11(2), 438–444.

Delgado, M. R., Gillis, M. M., & Phelps, E. A.

(2008). Regulating the expectation of reward

via cognitive strategies. Nature Neuroscience,

11(8), 880–881.

Delgado, M. R., Jou, R. L., LeDoux, J. E., &

Phelps, E. A. (2009). Avoiding negative out-

comes: Tracking the mechanisms of avoidance

learning in humans during fear conditioning.

Frontiers in Behavioral Neuroscience, 3, 33.

Delgado, M. R., Nearing, K. I., Ledoux, J. E.,

& Phelps, E. A. (2008). Neural circuitry

underlying the regulation of conditioned fear

and its relation to extinction. Neuron, 59(5),

829–838.

Delgado, M. R., Olsson, A., & Phelps, E. A.

(2006). Extending animal models of fear con-

ditioning to humans. Biological Psychology,

73(1), 39–48.

Denny, B. T., Kober, H., Wager, T. D., & Och-

sner, K. N. (2012). A meta- analysis of func-

tional neuroimaging studies of self- and other

judgments reveals a spatial gradient for men-

talizing in medial prefrontal cortex. Journal

of Cognitive Neuroscience, 24(8), 1742–1752.

Desimone, R., & Duncan, J. (1995). Neural

mechanisms of selective visual attention.

Annual Review of Neuroscience, 18, 193–

222.

Dum, R. P., Levinthal, D. J., & Strick, P. L.

(2009). The spinothalamic system targets

motor and sensory areas in the cerebral cortex

of monkeys. Journal of Neuroscience, 29(45),

14223–14235.

Egner, T., Etkin, A., Gale, S., & Hirsch, J. (2008).

Dissociable neural systems resolve conflict

from emotional versus nonemotional distract-

ers. Cerebral Cortex, 18(6), 1475–1484.

Etkin, A., Egner, T., Peraza, D. M., Kandel, E.

R., & Hirsch, J. (2006). Resolving emotional

conflict: A role for the rostral anterior cingu-

late cortex in modulating activity in the amyg-

dala. Neuron, 51(6), 871–882.

Everitt, B. J., Parkinson, J. A., Olmstead, M. C.,

Arroyo, M., Robledo, P., & Robbins, T. W.

(1999). Associative processes in addiction and

reward: The role of amygdala– ventral striatal

subsystems. Annals of the New York Acad-

emy of Sciences, 877, 412–438.

Ferstl, E. C., & von Cramon, D. Y. (2002). What

does the frontomedian cortex contribute to

language processing: coherence or theory of

mind? NeuroImage, 17(3), 1599–1612.

Figner, B., Knoch, D., Johnson, E. J., Krosch, A.

R., Lisanby, S. H., Fehr, E., et al. (2011). Lat-

eral prefrontal cortex and self- control in inter-

temporal choice. Nature Neuroscience, 13(5),

538–539.

Frankenstein, U. N., Richter, W., McIntyre, M.

C., & Remy, F. (2001). Distraction modu-

lates anterior cingulate gyrus activations dur-

ing the cold pressor test. NeuroImage, 14(4),

827–836.

Gallagher, H. L., & Frith, C. D. (2003). Func-

tional imaging of “theory of mind.” Trends in

Cognitive Sciences, 7(2), 77–83.

Gianotti, L. R., Knoch, D., Faber, P. L., Lehm-

ann, D., Pascual- Marqui, R. D., Diezi, C., et

al. (2009). Tonic activity level in the right pre-

frontal cortex predicts individuals’ risk tak-

ing. Psychological Science, 20(1), 33–38.

Goldin, P. R., McRae, K., Ramel, W., & Gross,

J. J. (2008). The neural bases of emotion regu-

lation: Reappraisal and suppression of nega-

tive emotion. Biological Psychiatry, 63(6),

577–586.

Gray, M. A., Beacher, F. D., Minati, L., Nagai,

Valuation and Emotion Regulation 39

Y., Kemp, A. H., Harrison, N. A., et al.

(2012). Emotional appraisal is influenced by

cardiac afferent information. Emotion, 12(1),

180–191.

Gross, J. J. (1998). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74(1), 224–237.

Gross, J. J. (2007). The handbook of emotion

regulation. New York: Guilford Press.

Hamann, S. B., Ely, T. D., Hoffman, J. M., &

Kilts, C. D. (2002). Ecstasy and agony: Acti-

vation of the human amygdala in positive

and negative emotion. Psychological Science,

13(2), 135–141.

Hare, T. A., Camerer, C. F., & Rangel, A. (2009).

Self- control in decision- making involves mod-

ulation of the vmPFC valuation system. Sci-

ence, 324(5927), 646–648.

Harrison, N. A., Gray, M. A., Gianaros, P. J.,

& Critchley, H. D. (2010). The embodiment

of emotional feelings in the brain. Journal of

Neuroscience, 30(38), 12878–12884.

Hartley, C. A., & Phelps, E. A. (2010). Chang-

ing fear: The neurocircuitry of emotion regu-

lation. Neuropsychopharmacology, 35(1),

136–146.

Holland, P. C., & Gallagher, M. (2004).

Amygdala– frontal interactions and reward

expectancy. Current Opinion in Neurobiol-

ogy, 14(2), 148–155.

Johnstone, T., van Reekum, C. M., Urry, H. L.,

Kalin, N. H., & Davidson, R. J. (2007). Failure

to regulate: Counterproductive recruitment of

top-down prefrontal– subcortical circuitry in

major depression. Journal of Neuroscience,

27(33), 8877–8884.

Kalisch, R. (2009). The functional neuroanat-

omy of reappraisal: Time matters. Neurosci-

ence and Biobehavioral Reviews, 33(8), 1215–

1226.

Kalisch, R., Wiech, K., Critchley, H. D., &

Dolan, R. J. (2006). Levels of appraisal: A

medial prefrontal role in high-level appraisal

of emotional material. NeuroImage, 30(4),

1458–1466.

Keay, K. A., & Bandler, R. (2001). Parallel cir-

cuits mediating distinct emotional coping

reactions to different types of stress. Neuro-

science and Biobehavioral Reviews, 25(7–8),

669–678.

Knoch, D., Nitsche, M. A., Fischbacher, U.,

Eisenegger, C., Pascual- Leone, A., & Fehr, E.

(2008). Studying the neurobiology of social

interaction with transcranial direct current

stimulation— the example of punishing unfair-

ness. Cerebral Cortex, 18(9), 1987–1990.

Knoch, D., Pascual- Leone, A., Meyer, K., Treyer,

V., & Fehr, E. (2006). Diminishing reciprocal

fairness by disrupting the right prefrontal cor-

tex. Science, 314(5800), 829–832.

Kober, H., Barrett, L. F., Joseph, J., Bliss-

Moreau, E., Lindquist, K., & Wager, T. D.

(2008). Functional grouping and cortical–

subcortical interactions in emotion: A meta-

analysis of neuroimaging studies. NeuroIm-

age, 42(2), 998–1031.

Kober, H., Mende- Siedlecki, P., Kross, E. F.,

Weber, J., Mischel, W., Hart, C. L., et al.

(2010). Prefrontal– striatal pathway underlies

cognitive regulation of craving. Proceedings

of the National Academy of Sciences USA,

107(33), 14811–14816.

Kravitz, D. J., Saleem, K. S., Baker, C. I., &

Mishkin, M. (2011). A new neural framework

for visuospatial processing. Nature Reviews

Neuroscience, 12(4), 217–230.

Kurth, F., Zilles, K., Fox, P. T., Laird, A. R.,

& Eickhoff, S. B. (2010). A link between the

systems: Functional differentiation and inte-

gration within the human insula revealed by

meta- analysis. Brain Structure and Function,

214(5–6), 519–534.

Lane, R. D., Reiman, E. M., Axelrod, B., Yun,

L. S., Holmes, A., & Schwartz, G. E. (1998).

Neural correlates of levels of emotional aware-

ness: Evidence of an interaction between emo-

tion and attention in the anterior cingulate

cortex. Journal of Cognitive Neuroscience,

10(4), 525–535.

LeDoux, J. E. (1993). Emotional memory: In

search of systems and synapses. Annals of the

New York Academy of Sciences, 702, 149–

157.

LeDoux, J. E. (2000). Emotion circuits in the

brain. Annual Review of Neuroscience, 23,

155–184.

LeDoux, J. E., & Gorman, J. M. (2001). A call

to action: Overcoming anxiety through active

coping. American Journal of Psychiatry,

158(12), 1953–1955.

Levenson, R. W. (1999). The intrapersonal func-

tions of emotion [Special issue]. Cognition and

Emotion, 13(5), 481–504.

Leventhal, H. (1984). A perceptual– motor the-

ory of emotion. Advances in Experimental

Social Psychology, 17, 117–182.

Levy, D. J., & Glimcher, P. W. (2011). Compar-

ing apples and oranges: Using reward- specific

40 BIOLOGICAL BASES

and reward- general subjective value represen-

tation in the brain. Journal of Neuroscience,

31(41), 14693–14707.

Lieberman, M. D., Eisenberger, N. I., Crockett,

M. J., Tom, S. M., Pfeifer, J. H., & Way, B.

M. (2007). Putting feelings into words: Affect

labeling disrupts amygdala activity in response

to affective stimuli. Psychological Science,

18(5), 421–428.

Lieberman, M. D., Jarcho, J. M., Berman, S.,

Naliboff, B. D., Suyenobu, B. Y., Mandelkern,

M., et al. (2004). The neural correlates of pla-

cebo effects: A disruption account. NeuroIm-

age, 22(1), 447– 455.

Lieberman, M. D., Jarcho, J. M., & Satpute, A.

B. (2004). Evidence- based and intuition- based

self- knowledge: An fMRI study. Journal of

Personality and Social Psychology, 87(4),

421–435.

Lieberman, M. D., Ochsner, K. N., Gilbert, D.

T., & Schacter, D. L. (2001). Do amnesics

exhibit cognitive dissonance reduction?: The

role of explicit memory and attention in atti-

tude change. Psychological Science, 12(2),

135–140.

Lindquist, K. A., & Barrett, L. F. (2008). Con-

structing emotion: The experience of fear as a

conceptual act. Psychological Science, 19(9),

898–903.

Lindquist, K. A., Wager, T. D., Kober, H., Bliss-

Moreau, E., & Barrett, L. F. (2012). The brain

basis of emotion: A meta- analytic review.

Behavioral and Brain Sciences, 35(3), 121–

143.

Maas, W. (2000). On the computational power

of winner- take-all. Neural Computation,

12(11), 2519–2535.

Mauss, I. B., Levenson, R. W., McCarter, L.,

Wilhelm, F. H., & Gross, J. J. (2005). The tie

that binds?: Coherence among emotion experi-

ence, behavior, and physiology. Emotion, 5(2),

175–190.

McClure, S. M., Ericson, K. M., Laibson, D. I.,

Loewenstein, G., & Cohen, J. D. (2007). Time

discounting for primary rewards. Journal of

Neuroscience, 27(21), 5796–5804.

McClure, S. M., Laibson, D. I., Loewenstein, G.,

& Cohen, J. D. (2004). Separate neural sys-

tems value immediate and delayed monetary

rewards. Science, 306(5695), 503–507.

McRae, K., Hughes, B., Chopra, S., Gabrieli, J.

D., Gross, J. J., & Ochsner, K. N. (2010). The

neural bases of distraction and reappraisal.

Journal of Cognitive Neuroscience, 22(2),

248–262.

Miller, E. K. (2000). The prefrontal cortex and

cognitive control. Nature Reviews Neurosci-

ence, 1(1), 59–65.

Miller, E. K., & Cohen, J. D. (2001). An inte-

grative theory of prefrontal cortex function.

Annual Review of Neuroscience, 24, 167–

202.

Mischel, W., Shoda, Y., & Rodriguez, M. L.

(1989). Delay of gratification in children. Sci-

ence, 244(4907), 933–938.

Mitchell, J. P. (2009). Inferences about men-

tal states. Philosophical Transactions of the

Royal Society of London B: Biological Sci-

ences, 364(1521), 1309–1316.

Mobbs, D., Hassabis, D., Seymour, B., March-

ant, J. L., Weiskopf, N., Dolan, R. J., et al.

(2009). Choking on the money: Reward-based

performance decrements are associated with

midbrain activity. Psychological Science,

20(8), 955–962.

Mobbs, D., Petrovic, P., Marchant, J. L., Has-

sabis, D., Weiskopf, N., Seymour, B., et al.

(2007). When fear is near: Threat imminence

elicits prefrontal– periaqueductal gray shifts in

humans. Science, 317(5841), 1079–1083.

Muhlberger, A., Neumann, R., Wieser, M. J.,

& Pauli, P. (2008). The impact of changes in

spatial distance on emotional responses. Emo-

tion, 8(2), 192–198.

Murray, E. A., O’Doherty, J. P., & Schoenbaum,

G. (2007). What we know and do not know

about the functions of the orbitofrontal cortex

after 20 years of cross- species studies. Journal

of Neuroscience, 27(31), 8166–8169.

Neely, J. H. (1991). Semantic priming effects in

visual word recognition: A selective review of

current findings and theories. In D. Besner &

G. Humphreys (Eds.), Basic processes in read-

ing: Visual word recognition (pp. 264–336).

Hillsdale, NJ: Erlbaum.

Ochsner, K. N., & Barrett, L. F. (2001). A mul-

tiprocess perspective on the neuroscience of

emotion. In T. J. Mayne & G. A. Bonanno

(Eds.), Emotions: Currrent issues and future

directions (pp. 38–81). New York: Guilford

Press.

Ochsner, K. N., & Gross, J. J. (2005). The cogni-

tive control of emotion. Trends in Cognitive

Sciences, 9(5), 242–249.

Ochsner, K. N., & Gross, J. J. (2008). Cogni-

tive emotion regulation: Insights from social

cognitive and affective neuroscience. Currents

Directions in Psychological Science, 17(1),

153–158.

Ochsner, K. N., Hughes, B., Robertson, E. R.,

Valuation and Emotion Regulation 41

Cooper, J. C., & Gabrieli, J. D. (2009). Neural

systems supporting the control of affective and

cognitive conflicts. Journal of Cognitive Neu-

roscience, 21(9), 1842–1855.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D. E.,

et al. (2004). For better or for worse: Neural

systems supporting the cognitive down- and

up- regulation of negative emotion. NeuroIm-

age, 23(2), 483– 499.

Ochsner, K. N., Ray, R. R., Hughes, B., McRae,

K., Cooper, J. C., Weber, J., et al. (2009).

Bottom-up and top-down processes in emo-

tion generation: Common and distinct neural

mechanisms. Psychological Science, 20(11),

1322–1331.

Ochsner, K. N., Silvers, J. A., & Buhle, J. T.

(2012). Functional imaging studies of emo-

tion regulation: A synthetic review and evolv-

ing model of the cognitive control of emotion.

Annals of the New York Academy of Sciences,

1251, E1–E24.

Olsson, A., & Ochsner, K. N. (2008). The role of

social cognition in emotion. Trends in Cogni-

tive Sciences, 12(2), 65–71.

Ongur, D., Ferry, A. T., & Price, J. L. (2003).

Architectonic subdivision of the human orbital

and medial prefrontal cortex. Journal of Com-

parative Neurology, 460(3), 425–449.

Ortony, A., Clore, G. L., & Collins, A. (1988).

The cognitive structure of emotions. New

York: Cambridge University Press.

Packard, M. G. (2009). Anxiety, cognition, and

habit: A multiple memory systems perspective.

Brain Research, 1293, 121–128.

Pessoa, L. (2008). On the relationship between

emotion and cognition. Nature Reviews Neu-

roscience, 9(2), 148–158.

Pessoa, L. (2009). How do emotion and motiva-

tion direct executive control? Trends in Cogni-

tive Sciences, 13(4), 160–166.

Pessoa, L., Kastner, S., & Ungerleider, L. G.

(2003). Neuroimaging studies of attention:

From modulation of sensory processing to

top-down control. Journal of Neuroscience,

23(10), 3990–3998.

Phelps, E. A. (2006). Emotion and cognition:

Insights from studies of the human amygdala.

Annual Review of Psychology, 57, 27–53.

Phillips, M. L., Ladouceur, C. D., & Drevets, W.

C. (2008). A neural model of voluntary and

automatic emotion regulation: Implications

for understanding the pathophysiology and

neurodevelopment of bipolar disorder. Molec-

ular Psychiatry, 13(9), 829, 833–857.

Ploghaus, A., Becerra, L., Borras, C., & Bor-

sook, D. (2003). Neural circuitry underly-

ing pain modulation: Expectation, hypnosis,

placebo. Trends in Cognitive Sciences, 7(5),

197–200.

Polk, T. A., Drake, R. M., Jonides, J. J., Smith, M.

R., & Smith, E. E. (2008). Attention enhances

the neural processing of relevant features and

suppresses the processing of irrelevant features

in humans: A functional magnetic resonance

imaging study of the Stroop task. Journal of

Neuroscience, 28(51), 13786–13792.

Price, J. L. (1999). Prefrontal cortical networks

related to visceral function and mood. Annals

of the New York Academy of Sciences, 877,

383–396.

Quirk, G. J., & Beer, J. S. (2006). Prefron-

tal involvement in the regulation of emo-

tion: Convergence of rat and human studies.

Curentr Opinion in Neurobiology, 16(6),

723–727.

Rangel, A., Camerer, C., & Montague, P. R.

(2008). A framework for studying the neurobi-

ology of value-based decision making. Nature

Reviews Neuroscience, 9(7), 545–556.

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79(3), 410–424.

Rolls, E. T. (1999). The brain and emotion.

Oxford, UK: Oxford University Press.

Russell, J. A., & Barrett, L. F. (1999). Core

affect, prototypical emotional episodes, and

other things called emotion: Dissecting the

elephant. Journal of Personality and Social

Psychology, 76(5), 805–819.

Saxe, R. (2006). Uniquely human social cog-

nition. Current Opinion in Neurobiology,

16(2), 235–239.

Scherer, K. R. (2001). Appraisal considered as a

process of multilevel sequential checking. In K.

R. Scherer & A. Schorr (Eds.), Appraisal pro-

cesses in emotion: Theory, methods, research

(pp. 92–120). New York: Oxford University

Press.

Scherer, K. R., Schorr, A., & Johnstone, T.

(Eds.). (2001). Appraisal processes in emo-

tion: Theory, methods, research. New York:

Oxford University Press.

Schoenbaum, G., Saddoris, M. P., & Stalnaker,

T. A. (2007). Reconciling the roles of orbi-

tofrontal cortex in reversal learning and the

encoding of outcome expectancies. Annals

of the New York Academy of Sciences, 1121,

320–335.

42 BIOLOGICAL BASES

Schultz, W., Dayan, P., & Montague, P. R.

(1997). A neural substrate of prediction and

reward. Science, 275(5306), 1593–1599.

Sharot, T., De Martino, B., & Dolan, R. J.

(2009). How choice reveals and shapes

expected hedonic outcome. Journal of Neuro-

science, 29(12), 3760–3765.

Sharot, T., Shiner, T., & Dolan, R. J. (2010).

Experience and choice shape expected aversive

outcomes. Journal of Neuroscience, 30(27),

9209–9215.

Thompson- Schill, S. L., Bedny, M., & Goldberg,

R. F. (2005). The frontal lobes and the regu-

lation of mental activity. Current Opinion in

Neurobiology, 15(2), 219–224.

Tracey, I., Ploghaus, A., Gati, J. S., Clare, S.,

Smith, S., Menon, R. S., et al. (2002). Imaging

attentional modulation of pain in the periaq-

ueductal gray in humans. Journal of Neurosci-

ence, 22(7), 2748–2752.

Urry, H. L., van Reekum, C. M., Johnstone, T.,

Kalin, N. H., Thurow, M. E., Schaefer, H.

S., et al. (2006). Amygdala and ventromedial

prefrontal cortex are inversely coupled during

regulation of negative affect and predict the

diurnal pattern of cortisol secretion among

older adults. Journal of Neuroscience, 26(16),

4415–4425.

van Veen, V., Krug, M. K., Schooler, J. W., &

Carter, C. S. (2009). Neural activity pre-

dicts attitude change in cognitive dissonance.

Nature Neuroscience, 12(11), 1469–1474.

Wager, T. D. (2005). The neural bases of placebo

effects in pain. Current Directions in Psycho-

logical Science, 14(4), 175–179.

Wager, T. D., Atlas, L. Y., Leotti, L. A., & Rill-

ing, J. K. (2011). Predicting individual differ-

ences in placebo analgesia: Contributions of

brain activity during anticipation and pain

experience. Journal of Neuroscience, 31(2),

439–452.

Wager, T. D., Barrett, L. F., Bliss- Moreau, E.,

Lindquist, K., Duncan, S., Kober, H., et al.

(2008). The neuroimaging of emotion. In M.

Lewis, J. M. Haviland- Jones, & L. F. Barrett

(Eds.), The handbook of emotion (3rd ed.,

pp. 249–271). New York: Guilford Press.

Wager, T. D., Davidson, M. L., Hughes, B. L.,

Lindquist, M. A., & Ochsner, K. N. (2008).

Prefrontal– subcortical pathways mediating

successful emotion regulation. Neuron, 59(6),

1037–1050.

Wager, T. D., Jonides, J., & Reading, S. (2004).

Neuroimaging studies of shifting attention:

A meta- analysis. NeuroImage, 22(4), 1679–

1693.

Wager, T. D., & Smith, E. E. (2003). Neuroim-

aging studies of working memory: A meta-

analysis. Cognitive, Affective, and Behavioral

Neuroscience, 3(4), 255–274.

Williams, L. E., & Bargh, J. A. (2008). Keeping

one’s distance: The influence of spatial dis-

tance cues on affect and evaluation. Psycho-

logical Science, 19(3), 302–308.

Willis, W. D., & Westlund, K. N. (1997). Neu-

roanatomy of the pain system and of the path-

ways that modulate pain. Journal of Clinical

Neurophysiology, 14(1), 2–31.

Wunderlich, K., Rangel, A., & O’Doherty, J.

P. (2009). Neural computations underlying

action- based decision making in the human

brain. Proceedings of the National Academy

of Sciences USA, 106(40), 17199–17204.

Young, L., Camprodon, J. A., Hauser, M.,

Pascual- Leone, A., & Saxe, R. (2010). Disrup-

tion of the right temporoparietal junction with

transcranial magnetic stimulation reduces the

role of beliefs in moral judgments. Proceedings

of the National Academy of Sciences USA,

107(15), 6753–6758.

Zaki, J., Davis, J. I., & Ochsner, K. N. (2012).

Overlapping activity in anterior insula during

interoception and emotional experience. Neu-

roImage, 62(1), 493–499.

Zysset, S., Huber, O., Ferstl, E., & von Cramon,

D. Y. (2002). The anterior frontomedian cor-

tex and evaluative judgment: An fMRI study.

NeuroImage, 15(4), 983–991.

Zysset, S., Huber, O., Samson, A., Ferstl, E. C.,

& von Cramon, D. Y. (2003). Functional spe-

cialization within the anterior medial prefron-

tal cortex: A functional magnetic resonance

imaging study with human subjects. Neurosci-

ence Letters, 335(3), 183–186.

Gross and colleagues have framed emotion

generation and regulation as a recursive

process involving attention and appraisal,

whereby an emotional response unfolds over

time as a function of both how attention is

allocated to an emotion- eliciting stimulus

or situation and the interpretation of (or

meaning attributed to) the stimulus or situ-

ation (see Gross, this volume). Based on this

model, both attentional deployment and

reappraisal are increasingly studied strate-

gies for emotion regulation— and both strat-

egies are effective means of altering emotion.

Functional magnetic resonance imaging

(fMRI) measures have been used in the con-

text of emotion regulation studies, provid-

ing a portrait of neural regions that are more

active during emotion regulation than con-

trol conditions— and these data suggest that

areas of the prefrontal cortex become more

active, and amygdala activity is decreased,

when emotion is down- regulated (see Och-

sner & Gross, this volume). Though we are

coming to know the circuitry of emotion

regulation, this is a static portrait: a fine-

grained but frozen map representing “more

activation here” and “less activation there.”

To be sure, more advanced analytic tech-

niques can augment traditional analyses of

fMRI data to indicate the temporal sequenc-

ing of these effects: Presumably, increases

in frontal activation precede decreases in

amygdala activity.

This chapter focuses on a different neu-

roimaging method that complements the

excellent spatial resolution of fMRI: We

review research that uses neural activity in

the electroencephalogram (EEG) to study

mechanisms and the time course of emo-

tion regulation. We believe that investiga-

tions of emotion regulation benefit enor-

mously from measures that are temporally

precise and can track processes unfolding—

and changing— over time. Much of our

work has focused on event- related poten-

tials (ERPs) derived from the EEG. ERPs

reflect the near- instantaneous activity of

underlying neuronal populations and are

well- suited for tracking rapidly changing

brain activity. For instance, ERPs can index

emotional reactivity and its regulation from

one second to the next—and can be used

to separately quantify reactivity and regu-

lation. Moreover, ERPs are relatively inex-

pensive and well- tolerated neural measures.

In this chapter, we focus mainly on the late

positive potential (LPP), an ERP compo-

nent that reflects the flexible and dynamic

deployment of motivated attention, and as

such represents an ideal vehicle for investi-

gating iterative and interactive processes as

they unfold over time.

CHAPTER 3

Temporal Dynamics of Emotion Regulation

Greg Hajcak Proudfit

Jonathan P. Dunning

Daniel Foti

Anna Weinberg

44 BIOLOGICAL BASES

ERPs and the LPP

What Is an ERP?

ERPs are a direct measure of neural activ-

ity. Scalp- recorded ERPs reflect the summed

activity of excitatory and inhibitory post-

synaptic potentials (PSPs) generated by large

populations of pyramidal cortical neurons

aligned perpendicular to the cortical sur-

face. Because these neurons are oriented in

the same direction, simultaneously occur-

ring or closely occurring signals typically

do not cancel each other out; moreover,

because PSPs tend to be rather sustained in

nature (compared to, for example, action

potentials), it is possible for this activity to

summate and propagate to the surface of the

scalp (Luck, 2005). This summated activity

is what is recorded in the ongoing EEG (see

Figure 3.1). ERPs then reflect the activity

of the EEG, time- locked to specific events

and averaged across many trials to increase

signal and reduce noise. In the studies we

discuss, the event of interest is typically the

presentation of a visual stimulus, frequently

images from the International Affective

Picture System (IAPS; Lang, Bradley, &

Cuthbert, 2008), a standardized database

containing hundreds of pictures that have

been normed on ratings of hedonic valence

and arousal. Neural activity elicited by emo-

tional compared to neutral pictures, and as a

function of emotion regulation instructions,

can then be averaged and compared within

and between subjects.

The LPP

The LPP is a sustained positive- going ERP

with a central– parietal scalp distribution;

the amplitude of the LPP is modulated by

emotional content, becoming more positive

as early as 200 milliseconds following the

presentation of both pleasant and unpleas-

ant compared to neutral stimuli (see Figure

3.1; Foti, Hajcak, & Dien, 2009; Hajcak

& Olvet, 2008; Hajcak, Weinberg, Mac-

Namara, & Foti, 2011). The LPP is larger

FIGURE 3.1. A participant views images as the ongoing electroencephalogram (EEG) is recorded via

sensors affixed to the scalp (left). Event-related potentials (ERPs) reflect the activity of the EEG time-

locked to an event of interest, in this case, the onset of an image. On the right, the LPP is presented as a

positive-going deflection in the waveform, which is enhanced for both pleasant and unpleasant images

compared to neutral (data from Weinberg & Hajcak, 2010). Additionally, while the early portion of

the LPP (400–800 milliseconds) has a parietal distribution—represented here by the positive difference

between unpleasant and neutral images, as indicated by the dark area on the scalp—the later LPP (after

1,000 milliseconds) has a broader and more frontal distribution.

Temporal Dynamics of Emotion Regulation 45

following the presentation of emotional

images (Cuthbert, Schupp, Bradley, Birbau-

mer, & Lang, 2000; Foti et al., 2009),

words (Kissler, Herbert, Winkler, & Jung-

hofer, 2009; Tacikowski & Nowicka, 2010),

and even hand gestures (Flaisch, Häcker,

Renner, & Schupp, 2011).

It has been argued that the LPP reflects

sustained attention to visual stimuli (Haj-

cak, MacNamara, & Olvet, 2010; Hajcak

& Olvet, 2008; Hajcak et al., 2011; Wein-

berg & Hajcak, 2011b). Furthermore, there

may be functional differences between

early compared to late portions of the LPP,

highlighting the utility of this component

in tracking multiple processes over time.

Relatively early portions of the LPP (i.e.,

300–600 milliseconds) appear to reflect

more obligatory processing of emotional

stimuli, whereas later time windows (i.e.,

600 milliseconds and beyond) might reflect

more sustained and elaborative engagement

with stimuli (Olofsson, Nordin, Sequeira, &

Polich, 2008; Weinberg & Hajcak, 2011b;

Weinberg, Hilgard, Bartholow, & Hajcak,

2012). For instance, in one study, larger LPPs

in response to task- irrelevant pictures pre-

dicted greater behavioral interference— in

both within- and between- subjects analyses

(Weinberg & Hajcak, 2011b). Moreover,

though the early LPP was modulated by

emotional stimuli, it was the later portion

of the LPP (i.e., just preceding target onset)

that uniquely predicted behavioral interfer-

ence: Only increased sustained attention just

prior to target presentation related to slower

reaction times.

During passive picture- viewing para-

digms, the emotional modulation of the LPP

is sustained throughout stimulus presenta-

tion (i.e., up to several seconds; Hajcak et

al., 2010), and can even be observed for as

long as 1,000 milliseconds after stimulus

offset. These data are consistent with the

notion that emotional stimuli not only cap-

ture but also hold attention (Vuilleumier,

2005)—and we have suggested that the LPP

is sensitive to the continued allocation of

attention to emotional stimuli. Consistent

with this view, it is possible to manipulate

the duration of the LPP by instructions

that encourage maintainance of previously

viewed images in working memory, again

suggesting that this later component may

reflect more volitional engagement with

emotional stimuli (Hajcak et al., 2010; Thi-

ruchselvam, Hajcak, & Gross, 2012).

The modulation of the LPP is thought to

reflect the motivational salience of the stim-

ulus being viewed. In the case of emotional

stimuli, salience is thought to be determined

by the content of the stimuli— and how rele-

vant the content is to basic biological imper-

atives (e.g., survival themes that include

defense and reproduction). Indeed, evidence

suggests that the LPP is most enhanced by

image content more directly related to these

imperatives, such as images of mutilation

and gore, or erotic images (Weinberg &

Hajcak, 2010). Additionally, food depriva-

tion compared to satiated states enhances

the magnitude of the LPP elicited by images

of food—a motivationally salient category

of images when one is hungry (Stock-

burger, Schmälzle, Flaisch, Bublatzky, &

Schupp, 2009). The LPP is also enhanced

by personally relevant stimuli (e.g., photo-

graphs of relatives, or one’s own name and

face; Grasso & Simons, 2010; Tacikowski

& Nowicka, 2010) compared to even very

familiar famous faces.

There is also evidence that extrinsic

manipulations of salience can impact the

LPP. It is possible to designate specific stim-

uli as “targets” by asking participants to

count or otherwise respond to them when

they are presented among other nontarget

stimuli. The LPP is enhanced for arbitrarily

designated target stimuli compared to non-

target stimuli (Ferrari, Bradley, Codispoti,

& Lang, 2010; Weinberg et al., 2012), even

when the same images serve as both targets

and nontargets (Weinberg et al., 2012). The

LPP is largest when emotional images are

also targets, compared to both neutral tar-

gets and emotional nontargets (Ferrari et al.,

2010; Weinberg et al., 2012). This suggests

that intrinsic and extrinsic manipulations of

salience are additive in their impact on the

magnitude of the LPP.

Work that combines EEG and fMRI sug-

gests that the LPP reflects widespread and

concurrent activity across the visual system

(Sabatinelli, Keil, Frank, & Lang, 2013),

including the visual cortex (Bradley et al.,

2003; Keil et al., 2002) as well as occipital,

parietal, and inferotemporal regions of the

brain (Sabatinelli, Lang, Keil, & Bradley,

2007). Rather than the activation of a sin-

gle anatomical node, it is possible that the

46 BIOLOGICAL BASES

LPP reflects fairly widespread neuromodu-

latory activity (de Rover et al., 2012; Haj-

cak et al., 2010), or communication among

diverse brain regions. This latter possibility

is supported by a recent study indicating

that the magnetic equivalent of the LPP was

generated in occipitoparietal and prefrontal

cortices— and that the emotional modula-

tion of the LPP might index the coordina-

tion of frontoparietal attention networks

(Moratti, Saugar, & Strange, 2011).

The involvement of frontal areas in the

generation of the LPP is consistent with stud-

ies indicating that both physical stimulation

(Hajcak, Anderson, et al., 2010) and func-

tional activation (based on working memory

load; MacNamara, Ferri, & Hajcak, 2011)

of the dorsolateral prefrontal cortex reduces

the amplitude of the LPP. Moreover, fron-

tal involvement in the LPP is also consistent

with our observation that the scalp distri-

bution of the emotional modulation of the

LPP during passive picture viewing becomes

evident at central and even frontal recording

sites after approximately 1,000 milliseconds

(see Figure 3.1; Foti et al., 2009; MacNa-

mara, Foti, & Hajcak, 2009).

A substantial literature indicates that the

LPP is a robust measure of neural activity

associated with emotional processing. In

contrast to the majority of peripheral and

central measures that are sensitive to emo-

tional stimuli, emotional modulation of the

LPP is highly stable. Whereas skin conduc-

tance, heart rate, facial muscle activity, and

neural activation indexed by fMRI habitu-

ate over repeated presentations of stimuli

(Codispoti & De Cesarei, 2007; Codispoti,

Ferrari, & Bradley, 2006; Phan, Liberzon,

Welsh, Britton, & Taylor, 2003), emotional

modulation of the LPP does not (Codispoti

et al., 2006; Codispoti, Ferrari, & Bradley,

2007; Olofsson & Polich, 2007).

The LPP and Individual Differences

The LPP has proven to be an effective

measure of attentional allocation to emo-

tional stimuli across multiple populations.

For example, enhancement of LPP ampli-

tude by emotional content appears cross-

culturally (Hot, Saito, Mandai, Kobayashi,

& Sequeira, 2006; Yen, Chen, & Liu, 2010).

The LPP has also been applied to the study

of emotional processing across the lifespan;

affective modulation of the LPP has been

observed in both very young children (Den-

nis & Hajcak, 2009; Kujawa, Hajcak, Tor-

pey, Kim, & Klein, 2012) and in adults as

old as 81 (Kisley, Wood, & Burrows, 2007;

Langeslag & Van Strien, 2010). Further-

more, the LPP has been used to test theo-

ries of aging, which posit that younger com-

pared to older participants are more reactive

to unpleasant stimuli, and less reactive to

pleasant stimuli (Kisley et al., 2007; Lang-

eslag & Van Strien, 2010).

Additionally, the LPP has been used effec-

tively to characterize the abnormal process-

ing of affective stimuli in anxiety, mood, and

substance use disorders (e.g., Dunning et al.,

2011; Foti, Olvet, Klein, & Hajcak, 2010;

Weinberg & Hajcak, 2011a). For instance,

consistent with the notion that depression

is characterized by motivational disengage-

ment from the environment, depressed indi-

viduals tend to show decreased emotional

modulation of the LPP compared to healthy

controls (Foti et al., 2010). Likewise, while

cocaine use disorders are associated with a

decreased LPP in response to normative emo-

tional stimuli, individuals with this diagno-

sis also show an increased LPP in response

to cocaine- related images compared to

healthy controls (Dunning et al., 2011). The

relationship of the LPP to anxiety appears

to be somewhat context- dependent. For

instance, anxiety has been associated with

an increased LPP when pictures are task-

irrelevant (MacNamara, Ferri, et al., 2011),

suggesting deficits in disengaging attention

from emotional stimuli. However, there is

also evidence from passive- viewing tasks—

in which the pictures are task- relevant— that

anxiety is instead characterized by initial

vigilance for threat images, as indicated by

enhancement of early ERP components, fol-

lowed by a failure to engage in sustained

processing of these images, as indicated by

an attenuation of the LPP (Weinberg & Haj-

cak, 2011a). These data indicate that the

LPP is a useful tool for quantifying abnor-

malities in the temporal dynamics of emo-

tional processing across different forms of

psychopathology. Below, we review findings

that have extended this literature to emotion

regulation, focusing in particular on atten-

tional deployment and reappraisal.

Temporal Dynamics of Emotion Regulation 47

The LPP and Emotion Regulation

Directed Attention

An emotional response to a stimulus unfolds

over time as a function of multiple pro-

cesses, including the allocation of attention

to the content of the stimulus, as well as the

meaning that is assigned to that stimulus

(Sheppes & Gross, 2011). With regard to

emotion regulation, distraction and other

attentional deployment strategies alter the

emotional response by directing attention

away from affective content. Spatial atten-

tion, in particular, plays a large role in

the electrocortical response to emotional

images (Eimer, Holmes, & McGlone, 2003;

Holmes, Vuilleumier, & Eimer, 2003; Keil,

Moratti, Sabatinelli, Bradley, & Lang, 2005)

and, consequently, emotion regulation pro-

cesses. Indeed, a growing body of work

demonstrates that directing attention, either

implicitly or explicitly, away from emotion-

ally salient features of a stimulus is an effec-

tive method of down- regulating emotional

response.

Online Regulation

Attempts to regulate an emotional response

after a stimulus has been encountered are

considered “online” regulation. Recent

work has examined whether the amplitude

of the LPP can be manipulated by explic-

itly directing participants’ visual attention

to various areas within unpleasant images.

This approach is considered online regula-

tion insofar as visual attention is manipu-

lated during the generation of the emotional

response. In one study, participants were

shown an unpleasant picture for 6 sec-

onds; after passively viewing the image for

3 seconds, participants’ attention was then

directed to either an arousing or nonarous-

ing area of the picture for the last 3 seconds

of each trial. As indicated in Figure 3.2,

directing attention to nonarousing com-

FIGURE 3.2. Grand averaged ERPs at electrode site Pz elicited by neutral pictures (solid black line;

always associated with an instruction to focus on a nonarousing area of the image) and unpleasant pic-

tures (associated with an instruction to attend to either a nonarousing [dotted line] or arousing [dashed

line area of the image]). Picture onset occurred at 0 milliseconds and the instruction tone occurred at

3,000 milliseconds. The figure is based on data collected by Hajcak, Dunning, and Foti (2009).

LPP to unpleasant

pictures during

passive viewing

Reduction in LPP when

focusing on nonarousing

areas of unpleasant

pictures

48 BIOLOGICAL BASES

pared to highly arousing areas of unpleasant

images resulted in a decreased LPP (Dun-

ning & Hajcak, 2009). This finding was

subsequently replicated with a focus on the

time course of LPP modulation: Sequential

significance testing indicated that reduction

of the LPP occurred 620 milliseconds after

signaling participants to attend to nonar-

ousing areas of unpleasant images (Hajcak,

Dunning, & Foti, 2009).

Directed attention also appears to impact

the emotional response to representations

in working memory during a post- stimulus

period. Thiruchselvam and colleagues

(2012) had participants view unpleasant and

neutral pictures, then maintain representa-

tions of each image in working memory

after picture offset. Participants were then

instructed to focus on arousing or nonarous-

ing aspects of their mental representation.

Results showed that focusing on nonarous-

ing compared to arousing aspects of pic-

tures held in working memory was related

to a reduction in both the LPP and self-

reported ratings of unpleasantness. These

results suggest that the emotional response

can be modulated, and indexed by the LPP,

even after images have been fully encoded in

working memory.

Convergence of Directed Attention

Findings across Neural Measures

This same pattern of LPP modulation via

directed spatial attention has also been rep-

licated and extended to steady- state visual

evoked potentials (ssVEP; Hajcak, MacNa-

mara, Foti, Ferri, & Keil, 2013). The ssVEP

can be used to index visual processing of

stimuli flickering at a particular frequency. It

is not an ERP component, but rather a mea-

sure of the degree to which the EEG signal

over occipital cortex is being driven at the

flicker frequency. For instance, suppose two

faces are simultaneously presented to the left

and right of fixation, flickered at 8 and 18

Hz, respectively. The ssVEP would be charac-

terized by increased activity at both frequen-

cies, which is typically maximal at occipital

electrodes. Furthermore, if participants were

instructed to attend to the left face, power at

8 Hz in the ssVEP would be increased (Hill-

yard et al., 1997). Related to this chapter, the

ssVEP is larger for emotional compared to

neutral flickering stimuli, and modulation of

this activity is linked to facilitated process-

ing in the visual cortex (Keil et al., 2003).

In a study combining the LPP and ssVEP

within a single paradigm, directing attention

to nonarousing areas of unpleasant pictures

reduced both of these electrocortical indices,

indicating that each neural measure tracks

the effective down- regulation of the emo-

tional response via attentional deployment

(Hajcak et al., 2013). Moreover, modula-

tions of the LPP and ssVEP were unrelated,

suggesting that these measures provide dis-

tinct sources of information regarding emo-

tional processing.

Cognitive Reappraisal

Unlike distraction and other attentional

deployment techniques, where attention is

directed away from the emotional content

of a stimulus, reappraisal involves attend-

ing directly to emotional content and alter-

ing the emotional response by reinterpret-

ing the meaning of the stimulus (Sheppes &

Gross, 2011). In this way, emotion regula-

tion is achieved while engaging directly with

emotionally arousing aspects of stimuli, an

approach that has been shown to be effec-

tive for reducing both subjective and periph-

eral physiological indicators of emotional

arousal (Urry, 2010). Of interest is how LPP

amplitude may complement these data as a

neurobiological index of effective emotion

regulation, clarifying the impact of cognitive

reappraisal on the time course of emotional

processing.

According to the process- specific tim-

ing hypothesis, online emotion regulation

likely requires significant effort (i.e., cogni-

tive resources) in order to modify existing

and incoming emotional information— and

that effort would be directly proportional

to the strength and intensity of the emotion

being experienced (Sheppes & Gross, 2011).

On the other hand, several studies have

presented emotion regulation instructions

to participants prior to the presentation of

emotional stimuli. In this way, regulation

goals might be established while emotional

intensity is low, in anticipation of the emo-

tional response to come. Anticipatory regu-

lation ought to impact the initial processing

of an affective stimulus, indicated by the

Temporal Dynamics of Emotion Regulation 49

affective modulation of the LPP elicited by

the first presentation of the stimulus.

In one of the first investigations of cogni-

tive reappraisal using the LPP, Hajcak and

Nieuwenhuis (2006) had participants view

a series of unpleasant IAPS images for 1

second; an instruction to “reinterpret” (i.e.,

reappraise the picture in order to reduce

one’s negative response) or “attend” (i.e.,

focus on one’s natural feelings about the

picture) was then presented for 4,500 mil-

liseconds, after which the same picture was

again presented for 2,000 milliseconds.

Compared to unpleasant pictures presented

after the attend instructions, those presented

after reappraisal instructions were associ-

ated with a reduced LPP, beginning 200 mil-

liseconds after picture onset—an effect that

lasted for the duration of picture presenta-

tion. Furthermore, greater reduction in the

LPP was related to greater reduction in self-

reported arousal ratings of the images. This

study was the first to demonstrate that the

magnitude of the LPP could be modulated

by cognitive reappraisal, down- regulating

the LPP by reinterpreting the meaning of

emotional stimuli.

Anticipatory Regulation

In the Hajcak and Nieuwenhuis (2006)

study, regulation instructions were pre-

sented after the first encounter with the

emotional stimulus, indicating that the LPP

is sensitive to cognitive reappraisal when it

is done online. Separate from this study, and

consistent with the notion of anticipatory

regulation, experimental manipulations that

vary how participants attend to affective

stimuli during the initial presentation have

also been shown to modulate the LPP. For

example, Hajcak, Moser, and Simons (2006)

had participants view pleasant and unpleas-

ant pictures, and either categorize the pic-

tures affectively (i.e., indicating whether

the picture was pleasant or unpleasant) or

nonaffectively (i.e., indicating how many

people were present in the picture). Results

indicated that the LPP elicited by both pleas-

ant and unpleasant pictures was reduced

when participants evaluated images— and,

presumably, interpreted the meaning of the

images— along a nonaffective compared to

an affective dimension.

In three additional studies, the impact of

cognitive reappraisal within an anticipatory

emotion regulation context was examined,

testing whether alteration of the manner

in which participants appraise stimuli dur-

ing the initial presentation would modulate

LPP amplitude. Participants were instructed

to use effortful cognitive reappraisal of

emotional scenes (Krompinger, Moser,

& Simons, 2008; Moser, Hajcak, Bukay,

& Simons, 2006) and angry faces (Blech-

ert, Sheppes, Di Tella, Williams, & Gross,

2012). Prior to viewing each stimulus, par-

ticipants were instructed to decrease the

intensity of their emotional response by rein-

terpreting the image. Compared to a passive

viewing condition, the LPP elicited by pleas-

ant and unpleasant images was blunted for

the reappraisal condition at an early latency

range, beginning approximately 300–600

milliseconds following picture presentation.

Together, these lines of research demonstrate

that LPP amplitude tracks the successful

down- regulation of an emotional response

using cognitive reappraisal, whether reap-

praisal is enacted online or in anticipation of

an affective stimulus.

Building on these lines of research, Thi-

ruchselvam, Blechert, Sheppes, Rydstrom,

and Gross (2011) compared the effects of

different anticipatory regulation strategies

on LPP amplitude at both the initial pre-

sentation of stimuli and a later reexposure.

Whereas the aforementioned studies com-

pared reappraisal to a passive viewing con-

dition, here the impact of reappraisal on the

temporal dynamics of LPP amplitude was

also contrasted with the impact of distrac-

tion instructions. Reappraisal was achieved

by instructing participants to reinterpret

affective stimuli in a more neutral man-

ner. Distraction, on the other hand, was

achieved by asking participants to generate

neutral thoughts unrelated to the stimulus,

such as imagining complex geometric pat-

terns. During a baseline session, the LPP in

response to unpleasant images was recorded

under conditions of passive viewing, effort-

ful reappraisal, and distraction; 30 minutes

later, participants passively viewed the same

images with no regulation instructions.

Effortful reappraisal, compared to passive

viewing, yielded a blunted LPP only within

a relatively later latency range (i.e., 1,500–

50 BIOLOGICAL BASES

1,700 milliseconds). The effect of distrac-

tion was stronger and apparent earlier, with

a significant and sustained reduction in LPP

amplitude as early as 300 milliseconds. A

very different pattern emerged during the

reexposure session: Images that had previ-

ously been processed under the reappraisal

condition again yielded a blunted LPP com-

pared to the passive viewing condition, from

800 to 1,400 milliseconds. Images that had

previously been processed under the dis-

traction condition, however, yielded a sus-

tained increase in LPP amplitude compared

to the passive viewing condition, beginning

at approximately 1,200 milliseconds. This

study highlights the fact that emotion reg-

ulation strategies likely have a differential

impact on initial compared to subsequent

encounters with emotional stimuli. Unlike

reappraisal, distraction may only be an

effective emotion regulation strategy in the

short-term, reducing LPP amplitude during

the initial stimulus exposure but resulting in

an enhanced LPP during reexposure.

Preappraisal

The previous studies indicate that LPP

amplitude is sensitive to the implementation

of anticipatory emotion regulation through

cognitive reappraisal, but they do not fully

address whether the down- regulation of the

LPP is due to a shift in stimulus appraisal/

meaning per se. An alternate explanation

is that the reduction in LPP amplitude is a

result of reappraisal being more difficult and

more cognitively taxing than passive view-

ing, an important possibility to rule out in

light of evidence that cognitive load results

in a reduced LPP (MacNamara, Ferri, et al.,

2011). To pursue this issue further, several

studies have used a guided version of cog-

nitive reappraisal, in which images are pre-

ceded by verbal descriptions that frame the

upcoming stimuli in either a more negative

or more neutral manner (Foti & Hajcak,

2008; MacNamara et al., 2009). In other

words, reappraisal frames were provided to

participants, a manipulation that might be

best described as preappraisal. For example,

an unpleasant image of a man pointing a

gun at his head might be preceded by either

“This man is about to commit suicide” or

“This man ends up not committing suicide”;

the latter description is designed to down-

regulate the initial emotional response elic-

ited by the image. On each trial, the descrip-

tion precedes the presentation of the image,

thereby shaping the first appraisal of the

stimulus during the initial iteration of the

emotion- generative cycle. Guiding the ini-

tial stimulus appraisal with verbal descrip-

tions removes the potential confound of task

difficulty, such that each condition simply

involves listening to descriptions and then

viewing pictures.

In an initial study using this paradigm with

an adult sample, modulation of LPP ampli-

tude by description type was evident as early

as 400 milliseconds following picture pre-

sentation, with neutral descriptions reducing

the subsequent LPP elicited by unpleasant

images (Foti & Hajcak, 2008). Compared

to neutral images— which in this study were

always preceded by a neutral description—

the LPP in response to unpleasant images

preceded by unpleasant descriptions was

increased throughout stimulus presentation,

from 400 to 3,000 milliseconds. The LPP in

response to unpleasant images was increased

only from 400 to 1,000 milliseconds when

preceded by neutral descriptions, and to a

lesser extent than when preceded by nega-

tive descriptions. This temporal pattern sug-

gests that unpleasant images preappraised

by a neutral description were associated with

reduced early, obligatory attentional capture

associated with emotion generation; more-

over, the sustained, elaborative processing

that is typically observed for highly arousing

affective stimuli was nearly absent. Unpleas-

ant images preceded by neutral descriptions

were also rated as less unpleasant and less

emotionally arousing than those preceded

by negative descriptions, providing fur-

ther evidence that manipulating the initial

appraisal of the stimuli effectively regulated

the subsequent emotional response.

Because neutral images were always pre-

ceded by neutral descriptions in this initial

study, an important alternative explanation

was that the reduced LPP observed for neu-

trally described unpleasant images was due

to the mismatch between the valence of the

description and the image. To address this

confound in a follow- up study on preap-

praisal, description and image type were

fully crossed: Neutral and negative descrip-

tions preceded both neutral and unpleas-

ant images (MacNamara et al., 2009). For

Temporal Dynamics of Emotion Regulation 51

instance, a neutral image of a drill might be

described as “This drill is used by a repair-

man” or “This drill was used in a grisly mur-

der,” with the latter description designed

to up- regulate the emotional response elic-

ited by the image. As before, the LPP was

reduced in response to unpleasant images

preceded by neutral descriptions compared

to those preceded by negative descriptions.

Importantly, though, the LPP was increased

in response to neutral pictures that were

preceded by negative compared to neutral

descriptions. Framing neutral images in a

more negative manner elicited affective mod-

ulation of the LPP that would not normally

be observed for low- arousal, neutral stimuli.

These data demonstrate that the LPP tracks

the emotionality of the preappraisal and not

the match between description and image. In

fact, at late latencies (>1,500 milliseconds),

affective modulation of LPP amplitude was

apparent only for images preceded by nega-

tive descriptions, regardless of whether the

image itself was unpleasant or neutral. Thus,

the later portion of the LPP was only sensi-

tive to meaning imbued by the preappraisals.

Altering the context in which stimuli are

initially appraised has a robust impact on

LPP amplitude during the first viewing of a

stimulus. A further question is how modify-

ing the initial appraisal may influence sub-

sequent iterations of the emotion- generative

process when the stimuli are encountered

again. To examine this, MacNamara, Och-

sner, and Hajcak (2011) first presented

images paired with negative or neutral

descriptions, then conducted a second view-

ing session 30 minutes later without the pre-

ceding descriptions. During the reexposure

session, images that had previously been pre-

appraised in a more neutral manner elicited

a blunted LPP in a middle latency range (i.e.,

700–1,400 milliseconds), and the images

were rated as being less unpleasant and less

emotionally arousing. This is a less pro-

tracted effect of preappraisal on LPP than

observed previously (Foti & Hajcak, 2008;

MacNamara et al., 2009), suggesting that

preappraisal effects may diminish over time.

However, modifying the initial appraisal of

an affective stimulus— whether by effortful

reappraisal (Thiruchselvam et al., 2011) or

preappraisal (MacNamara, Ochsner, et al.,

2011)—appears to yield down- regulation of

the LPP upon reexposure.

Although the aforementioned studies used

paradigms in which the stimuli were task-

relevant and the primary focus of attention,

modifying the initial stimulus appraisal

also appears to impact the LPP elicited by

task- irrelevant, distracting images. For

instance, during a task in which participants

were required to judge the spatial orienta-

tion of geometric shapes, mutilation and

neutral scenes were presented as distrac-

tors (Mocaiber et al., 2010). These images

were described beforehand as being either

real or fictitious, thereby shaping the initial

appraisal. In the “real” context, unpleasant

images elicited an increased LPP compared

to neutral images in an early latency range

(i.e., 300–600 milliseconds) and were asso-

ciated with significant reaction time slow-

ing, indicating attentional capture that inter-

fered with performance on the primary task.

In the “fictitious” context, however, there

was no affective modulation of the LPP and

no reaction time slowing, indicating that

the distractor images were less salient and

produced less behavioral interference. This

study is consistent with other research link-

ing the LPP to attentional capture and task

interference (Weinberg & Hajcak, 2011b),

and it demonstrates that the LPP elicited by

task- irrelevant stimuli can be modulated by

preappraisal.

Convergence of Cognitive Reappraisal

Findings across Neural Measures

The work reviewed thus far focused on iden-

tifying the consequences of regulation on

the emotion- generative process, as indexed

by electrocortical measures. In other words,

electrocortical measures were used to index

the downstream impact of emotion regu-

lation on neural activity. In addition to

this, it may be possible to measure neural

activation responsible for these regulation

effects. For instance, Parvaz, MacNamara,

Goldstein, and Hajcak (2012) examined

the LPP and alpha bandwidth power while

participants either passively viewed or reap-

praised unpleasant pictures. Consistent with

previous work, the amplitude of the LPP

was reduced when reappraising unpleas-

ant pictures. However, reappraisal was also

associated with increased left prefrontal

cortex activation, as evidenced by reduced

left frontal alpha band power (alpha power

52 BIOLOGICAL BASES

is inversely related to brain activity). LPP

amplitude and alpha power were not corre-

lated in this study, though, suggesting that

both of these measures contributed unique

information about cognitive reappraisal

processes. These data are consistent with

fMRI research indicating that reappraisal

is associated with increased activity in the

ventromedial and lateral prefrontal cor-

tex (Johnstone, van Reekum, Urry, Kalin,

& Davidson, 2007; Ochsner et al., 2004;

Wager, Davidson, Hughes, Lindquist, &

Ochsner, 2008), and suggests that EEG can

be used not only to index the downstream

consequences of emotion regulation but also

the neural activity that may be responsible

for regulatory effects.

Clinical Applications

Researchers have begun to apply the LPP to

the study of emotion regulation in clinical

contexts. For example, the effects of preap-

praisal have been studied in children, with

the purpose of identifying risk factors that

might aid in detection and treatment of emo-

tion regulation difficulties early in life. In

one study of children ages 7–10, the LPP was

reduced for unpleasant images preceded by a

neutral description, compared to unpleasant

images preceded by a negative description

(Dennis & Hajcak, 2009). This modulation

of the LPP by description type was associ-

ated with reduced symptoms of depression

and anxiety, suggesting that modulation of

LPP amplitude may serve as an early marker

for emotion regulation difficulties or mood

disruptions. In younger children ages 5–7,

however, preappraisal does not appear to

modulate LPP amplitude (Decicco, Solo-

mon, & Dennis, 2012; Dennis & Hajcak,

2009), suggesting important developmental

differences that warrant further investiga-

tion.

The LPP has also been used to track

emotion regulation processes related to the

treatment of psychological disorders. For

example, individuals with phobias are char-

acterized by an attentional pattern of vigi-

lance followed by avoidance: They rapidly

detect and attend to phobic objects initially

but quickly direct attention away from the

phobic object. This is a maladaptive emo-

tion regulation strategy that prevents habit-

uation and reinforces the anxiety response

over time through active attentional avoid-

ance. In one study of individuals with a

spider phobia, the LPP elicited by spider

stimuli was increased compared to other

negative stimuli during an early time win-

dow (340–770 milliseconds) but not a later

time window (800–1,500 milliseconds;

Leutgeb, Schafer, & Schienle, 2009)—con-

sistent with an attentional pattern of vigi-

lance followed by avoidance. Participants

were then treated with exposure therapy in

which they were trained to approach and

engage with a spider until their anxiety

diminished, rather than avoid the spider.

Compared to a wait-list control group, indi-

viduals in the exposure therapy condition

exhibited an increased and sustained LPP in

response to spider stimuli from 800 to 1,500

milliseconds at a follow- up testing session.

This effect of treatment on LPP amplitude

was specific to spider stimuli and was not

observed for other unpleasant stimuli. These

data suggest that successful treatment led to

increased attention and engagement with the

phobic object.

Other researchers have used the LPP to

clarify patterns of emotion regulation defi-

cits associated with the treatment of sub-

stance use disorders. Attentional biases

toward drug- related stimuli play a sig-

nificant role in drug abuse and addiction

(Field & Cox, 2008), and several studies

have found that larger LPPs are elicited by

drug- related compared to neutral pictures

in alcoholics (Herrmann et al., 2000; Nam-

koong, Lee, Lee, Lee, & An, 2004), cocaine-

addicted individuals (Dunning et al., 2011;

Franken et al., 2008), and smokers (Littel

& Franken, 2007, 2011a). Furthermore,

attentional bias toward drug cues and away

from other, intrinsically pleasant stimuli

has been related to risk for relapse. In one

smoking cessation study, the LPP elicited by

cigarette- related cues was increased among

all smokers, but a subgroup of individuals

also exhibited a blunted LPP to normative

pleasant stimuli that was associated with

higher rates of relapse over 6 months (Ver-

sace et al., 2012). This suggests that the LPP

could serve as a biomarker for identifying

smokers with a higher risk of relapse (Ver-

sace et al., 2012).

Given that drug craving has been shown

to be modulated by cognitive regulation

(Kober, Kross, Mischel, Hart, & Ochsner,

Temporal Dynamics of Emotion Regulation 53

2010), Littel and Franken (2011b) sought

to examine whether the LPP in response to

smoking- related images could be modulated

by emotion regulation strategies in smok-

ers. Indeed, both reappraisal (i.e., viewing

the scenes from an uninvolved, rational, and

detached perspective) and distraction (i.e.,

identifying the dominant color in the scene)

strategies reduced the amplitude of the LPP

to smoking- related pictures; this effect was

prevalent in both light and heavy smokers,

suggesting that regulation of drug- related

stimuli can be accomplished by smokers

with differing levels of dependency (Littel &

Franken, 2011b).

Future Research Directions

Although electrocortical activity has been

used for decades to study cognitive pro-

cesses that include attention, it has more

recently been used to measure attention to

emotional stimuli (Hajcak et al., 2011). We

have argued that the LPP is modulated by

sustained attention to motivationally salient

stimuli, possibly indexing the coordinated

increased activity of frontoparietal attention

networks. However, the precise mechanisms

of this sustained attention remain unclear.

Although evidence suggests that the LPP

reflects enhanced attention to emotional

stimuli, some have suggested that the LPP

might instead reflect the suppressed pro-

cessing of competing stimuli (Brown, van

Steenbergen, Band, de Rover, & Nieuwen-

huis, 2012; MacNamara, Ferri, et al., 2011;

Mocaiber et al., 2010; Weinberg & Hajcak,

2011b). Future work using fMRI might help

to clarify whether the LPP indexes facili-

tated attention to emotional stimuli. For

instance, given that the LPP is modulated

by both attentional deployment and cogni-

tive reappraisal, it would be informative

to know what neural circuits are similarly

increased or decreased during these emotion

regulation strategies. Moreover, it is impera-

tive to combine EEG and fMRI technologies

in future research. What neural regions and

networks support the emotional modula-

tion of the LPP and its reduction through

reappraisal and attentional deployment? Do

fMRI and EEG provide complementary or

redundant information within and between

subjects? In our view, these are crucial and

exciting questions that can be answered in

the years ahead.

Initial research indicated that the LPP

is reduced via reappraisal, and subsequent

studies confirm that changes in stimulus

meaning are sufficient to modulate the LPP.

Moreover, meaning- based changes that

characterize reappraisal appear to alter the

LPP elicited by subsequent encounters with

emotional stimuli— and more so than other

emotion regulation strategies (i.e., distrac-

tion). Both the LPP and ssVEPs are modu-

lated by attentional deployment: When

participants focus on less arousing aspects

of emotional stimuli, both metrics of neu-

ral activity are down- regulated— and these

effects become evident within about 200

milliseconds. Because of this temporal reso-

lution, electrocortical indices of emotion and

its regulation can be used to index the itera-

tive and recursive processes that determine

an emotional response. Recent work also

highlights the possibility that frontal acti-

vation in reappraisal can be indexed using

time- frequency decompositions of EEG data

(Parvaz et al., 2012).

Electrocortical measures of emotion and

its regulation have been fruitful, yet there

are many open avenues for further explora-

tion, particularly with regard to the study

of individual differences in emotion regula-

tion. What emotion strategies work best for

whom? In what ways does emotion regula-

tion go awry across psychological disorders?

There is an emerging clinical literature uti-

lizing the LPP to shed light on the temporal

dynamics of information processing abnor-

malities associated with psychopathology.

As discussed elsewhere in this volume (Parts

VII and VIII, Chapters 24–32), research on

emotion regulation has important implica-

tions for the treatment of a range of psy-

chological disorders, and bringing the LPP

to bear on this topic may be useful for both

quantifying impairment in emotion regula-

tion and clarifying mechanisms of change

over the course of treatment. As a neuro-

biological complement to self- report and

behavioral indices of emotion regulation

difficulties, LPP data may provide unique

information regarding the time course of

abnormal emotional information processing

within a specific patient population, which

may then become a target for subsequent

intervention.

54 BIOLOGICAL BASES

As evidenced by the chapters in this vol-

ume, emotion regulation is a topic that

figures heavily in both developmental and

clinical literatures. Although electrocortical

activity has been relatively underutilized in

these areas, EEG-based measures of neural

function might be particularly suitable for

emotion regulation studies in children and

clinical populations. The few and emerging

studies in these areas suggest a large and

positive potential.

References

Blechert, J., Sheppes, G., Di Tella, C., Williams,

H., & Gross, J. J. (2012). See what you think:

Reappraisal modulates behavioral and neural

responses to social stimuli. Psychological Sci-

ence, 23(4), 346–353.

Bradley, M., Sabatinelli, D., Lang, P., Fitzsim-

mons, J., King, W., & Desai, P. (2003). Activa-

tion of the visual cortex in motivated attention.

Behavioral Neuroscience, 117(2), 369–380.

Brown, S. B. R. E., van Steenbergen, H., Band,

G. P. H., de Rover, M., & Nieuwenhuis,

S. (2012). Functional significance of the

emotion- related late positive potential. Fron-

tiers in Human Neuroscience, 6. [E-publica-

tion ahead of print]

Codispoti, M., & De Cesarei, A. (2007). Arousal

and attention: Picture size and emotional reac-

tions. Psychophysiology, 44(5), 680–686.

Codispoti, M., Ferrari, V., & Bradley, M. (2006).

Repetitive picture processing: Autonomic and

cortical correlates. Brain Research, 1068(1),

213–220.

Codispoti, M., Ferrari, V., & Bradley, M. (2007).

Repetition and event- related potentials: Dis-

tinguishing early and late processes in affec-

tive picture perception. Journal of Cognitive

Neuroscience, 19(4), 577–586.

Codispoti, M., Mazzetti, M., & Bradley, M.

(2009). Unmasking emotion: Exposure dura-

tion and emotional engagement. Psychophysi-

ology, 46(4), 731–738.

Cuthbert, B., Schupp, H., Bradley, M., Birbau-

mer, N., & Lang, P. (2000). Brain potentials in

affective picture processing: Covariation with

autonomic arousal and affective report. Bio-

logical Psychology, 52(2), 95–111.

de Rover, M., Brown, S., Boot, N., Hajcak, G.,

van Noorden, M., van der Wee, N., & Nieu-

wenhuis, S. (2012). Beta receptor– mediated

modulation of the late positive potential in

humans. Psychopharmacology, 219(4), 971–

979.

Decicco, J. M., Solomon, B., & Dennis, T. A.

(2012). Neural Correlates of Cognitive Reap-

praisal in Children: An ERP study. Develop-

mental Cognitive Neuroscience, 2(1), 79–80.

Dennis, T., & Hajcak, G. (2009). The late posi-

tive potential: A neurophysiological marker

for emotion regulation in children. Journal

of Child Psychology and Psychiatry, 50(11),

1373–1383.

Dunning, J. P., & Hajcak, G. (2009). See no evil:

Directing visual attention within unpleasant

images modulates the electrocortical response.

Psychophysiology, 46(1), 28–33.

Dunning, J. P., Parvaz, M. A., Hajcak, G.,

Maloney, T., Alia-Klein, N., Woicik, P. A.,

et al. (2011). Motivated attention to cocaine

and emotional cues in abstinent and current

cocaine users—An ERP study. European Jour-

nal of Neuroscience, 33, 1716–1723.

Eimer, M., Holmes, A., & McGlone, F. (2003).

The role of spatial attention in the processing

of facial expression: An ERP study of rapid

brain responses to six basic emotions. Cogni-

tive, Affective, and Behavioral Neuroscience,

3(2), 97–110.

Ferrari, V., Bradley, M., Codispoti, M., & Lang,

P. (2010). Detecting novelty and significance.

Journal of Cognitive Neuroscience, 22(2),

404–411.

Field, M., & Cox, W. M. (2008). Attentional bias

in addictive behaviors: A review of its devel-

opment, causes, and consequences. Drug and

Alcohol Dependence, 97(1–2), 1–20.

Flaisch, T., Häcker, F., Renner, B., & Schupp, H.

(2011). Emotion and the processing of sym-

bolic gestures: An event- related brain poten-

tial study. Social Cognitive and Affective Neu-

roscience, 6(1), 109–118.

Foti, D., & Hajcak, G. (2008). Deconstructing

reappraisal: Descriptions preceding arous-

ing pictures modulate the subsequent neural

response. Journal of Cognitive Neuroscience,

20(6), 977–988.

Foti, D., Hajcak, G., & Dien, J. (2009). Differen-

tiating neural responses to emotional pictures:

Evidence from temporal– spatial PCA. Psycho-

physiology, 46, 521–530.

Foti, D., Olvet, D., Klein, D., & Hajcak, G.

(2010). Reduced electrocortical response to

threatening faces in major depressive disorder.

Depression and Anxiety, 27(9), 813–820.

Franken, I. H. A., Dietvorst, R. C., Hesselmans,

M., Franzek, E. J., Van De Wetering, B. J. M.,

Temporal Dynamics of Emotion Regulation 55

& Van Strien, J. W. (2008). Cocaine craving

is associated with electrophysiological brain

responses to cocaine- related stimuli. Addic-

tion Biology, 13, 386–392.

Grasso, D. J., & Simons, R. F. (2011). Perceived

parental support predicts enhanced late posi-

tive event- related brain potentials to parent

faces. Biological Psychology, 86(1), 26–30.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Hajcak, G., Anderson, B., Arana, A., Borckardt,

J., Takacs, I., George, M., et al. (2010). Dorso-

lateral prefrontal cortex stimulation modulates

electrocortical measures of visual attention:

Evidence from direct bilateral epidural cortical

stimulation in treatment- resistant mood disor-

der. Neuroscience, 170(1), 281–288.

Hajcak, G., Dunning, J. P., & Foti, D. (2009).

Motivated and controlled attention to emo-

tion: Time- course of the late positive poten-

tial. Clinical Neurophysiology, 120, 505–510.

Hajcak, G., MacNamara, A., Foti, D., Ferri, J.,

& Keil, A. (2013). The dynamic allocation of

attention to emotion: Simultaneous and inde-

pendent evidence from the late positive poten-

tial and steady state visual evoked potentials.

Biological Psychology, 92(3), 447–455.

Hajcak, G., MacNamara, A., & Olvet, D. M.

(2010). Event- related potentials, emotion, and

emotion regulation: An integrative review.

Developmental Neuropsychology, 35(2),

129–155.

Hajcak, G., Moser, J. S., & Simons, R. F. (2006).

Attending to affect: Appraisal strategies mod-

ulate the electrocortical response to arousing

pictures. Emotion, 6(3), 517–522.

Hajcak, G., & Nieuwenhuis, S. (2006). Reap-

praisal modulates the electrocortical response

to unpleasant pictures. Cognitive, Affective,

and Behavioral Neuroscience, 6, 291–297.

Hajcak, G., & Olvet, D. M. (2008). The persis-

tence of attention to emotion: Brain potentials

during and after picture presentation. Emo-

tion, 8(2), 250–255.

Hajcak, G., Weinberg, A., MacNamara, A., &

Foti, D. (2011). ERPs and the study of emo-

tion. In S. Luck & E. Kappenman (Eds.), The

Oxford handbook of event- related poten-

tial components (pp. 441–474). New York:

Oxford University Press.

Herrmann, M. J., Weijers, H., Wiesbeck, G.

A., Aranda, D., Böning, J., & Fallgatter, A.

J. (2000). Event- related potentials and cue-

reactivity in alcoholism. Alcoholism: Clinical

and Experimental Research, 24(11), 1724–

1729.

Hillyard, S. A., Hinrichs, H., Tempelmann, C.,

Morgan, S. T., Hansen, J. C., Scheich, H.,

et al. (1997). Combining steady- state visual

evoked potentials and fMRI to localize brain

activity during selective attention. Human

Brain Mapping, 5(4), 287–292.

Holmes, A., Vuilleumier, P., & Eimer, M. (2003).

The processing of emotional facial expression

is gated by spatial attention: Evidence from

event- related brain potentials. Cognitive Brain

Research, 16(2), 174–184.

Hot, P., Saito, Y., Mandai, O., Kobayashi, T.,

& Sequeira, H. (2006). An ERP investiga-

tion of emotional processing in European and

Japanese individuals. Brain Research, 1122(1),

171–178.

Johnstone, T., van Reekum, C. M., Urry, H. L.,

Kalin, N. H., & Davidson, R. J. (2007). Failure

to regulate: Counterproductive recruitment of

top-down prefrontal– subcortical circuitry in

major depression. Journal of Neuroscience,

27(33), 8877–8884.

Keil, A., Bradley, M., Hauk, O., Rockstroh, B.,

Elbert, T., & Lang, P. (2002). Large-scale neu-

ral correlates of affective picture processing.

Psychophysiology, 39(5), 641–649.

Keil, A., Gruber, T., Muller, M., Moratti, S., Sto-

larova, M., Bradley, M., & Lang, P. (2003).

Early modulation of visual perception by emo-

tional arousal: Evidence from steady- state

visual evoked brain potentials. Cognitive,

Affective, and Behavioral Neuroscience, 3(3),

195–206.

Keil, A., Moratti, S., Sabatinelli, D., Bradley, M.,

& Lang, P. (2005). Additive effects of emo-

tional content and spatial selective attention

on electrocortical facilitation. Cerebral Cor-

tex, 15(8), 1187–1197.

Kisley, M. A., Wood, S., & Burrows, C. L.

(2007). Looking at the sunny side of life. Psy-

chological Science, 18(9), 838–843.

Kissler, J., Herbert, C., Winkler, I., & Junghofer,

M. (2009). Emotion and attention in visual

word processing— An ERP study. Biological

Psychology, 80(1), 75–83.

Kober, H., Kross, E. F., Mischel, W., Hart, C. L.,

& Ochsner, K. N. (2010). Regulation of crav-

ing by cognitive strategies in cigarette smok-

ers. Drug and Alcohol Dependence, 106(1),

52–55.

Krompinger, J., Moser, J., & Simons, R. (2008).

56 BIOLOGICAL BASES

Modulations of the electrophysiological

response to pleasant stimuli by cognitive reap-

praisal. Emotion, 8(1), 132–137.

Kujawa, A., Hajcak, G., Torpey, D., Kim, J., &

Klein, D. (2012). Electrocortical reactivity to

emotional faces in young children and associa-

tions with maternal and paternal depression.

Journal of Child Psychology and Psychiatry,

53, 207–215.

Lang, P. J., Bradley, M. M., & Cuthbert, B. N.

(2008). International Affective Picture Sys-

tem (IAPS): Affective ratings of pictures and

instructional manual (Technical Report A-8).

Gainesville: University of Florida.

Langeslag, S. J. E., & Van Strien, J. W. (2010).

Comparable modulation of the late positive

potential by emotion regulation in younger

and older adults. Journal of Psychophysiol-

ogy, 24(3), 186–197.

Leutgeb, V., Schafer, A., & Schienle, A. (2009).

An event- related potential study on exposure

therapy for patients suffering from spider pho-

bia. Biological Psychology, 82(3), 293–300.

Littel, M., & Franken, I. H. A. (2007). The

effects of prolonged abstinence on the process-

ing of smoking cues: An ERP study among

smokers, ex- smokers and never- smokers. Jour-

nal of Psychopharmacology, 21(8), 873–882.

Littel, M., & Franken, I. H. A. (2011a). Implicit

and explicit selective attention to smoking

cues in smokers indexed by brain potentials.

Journal of Psychopharmacology, 25(4), 503–

513.

Littel, M., & Franken, I. H. A. (2011b). Inten-

tional modulation of the late positive potential

in response to smoking cues by cognitive strat-

egies in smokers. PloS ONE, 6(11), e27519.

Luck, S. (2005). An introduction to the event-

related potential technique. Cambridge, MA:

MIT Press.

MacNamara, A., Ferri, J., & Hajcak, G. (2011).

Working memory load reduces the late posi-

tive potential and this effect is attenuated with

increasing anxiety. Cognitive, Affective, and

Behavioral Neuroscience, 11(3), 321–331.

MacNamara, A., Foti, D., & Hajcak, G. (2009).

Tell me about it: Neural activity elicited by

emotional stimuli and preceding descriptions.

Emotion, 9(4), 531–543.

MacNamara, A., Ochsner, K. N., & Hajcak, G.

(2011). Previously reappraised: The lasting

effect of description type on picture- elicited

electrocortical activity. Social Cognitive and

Affective Neuroscience, 6(3), 348–358.

Mocaiber, I., Pereira, M. G., Erthal, F. S.,

Machado- Pinheiro, W., David, I. A., Cagy,

M., et al. (2010). Fact or fiction?: An event-

related potential study of implicit emotion

regulation. Neuroscience Letters, 476(2),

84–88.

Moratti, S., Saugar, C., & Strange, B. A. (2011).

Prefrontal– occipitoparietal coupling under-

lies late latency human neuronal responses

to emotion. Journal of Neuroscience, 31(47),

17278–17286.

Moser, J., Hajcak, G., Bukay, E., & Simons, R.

(2006). Intentional modulation of emotional

responding to unpleasant pictures: An ERP

study. Psychophysiology, 43(3), 292–296.

Namkoong, K., Lee, E., Lee, C. H., Lee, B. O.,

& An, S. K. (2004). Increased P3 amplitudes

induced by alcohol- related pictures in patients

with alcohol dependence. Alcoholism: Clini-

cal and Experimental Research, 28(9), 1317–

1323.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp.23–42). New York: Guilford

Press.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D. E., et

al. (2004). For better or for worse: Neural sys-

tems supporting the cognitive down-and up-

regulation of negative emotion. NeuroImage,

23(2), 483–499.

Olofsson, J., Nordin, S., Sequeira, H., & Polich,

J. (2008). Affective picture processing: An

integrative review of ERP findings. Biological

Psychology, 77(3), 247–265.

Olofsson, J., & Polich, J. (2007). Affective visual

event- related potentials: Arousal, repetition,

and time-on-task. Biological Psychology,

75(1), 101–108.

Parvaz, M., MacNamara, A., Goldstein, R., &

Hajcak, G. (2012). Event- related frontal alpha

as a marker of lateral prefrontal cortex acti-

vation during cognitive reappraisal. Cogni-

tive, Affective, and Behavioral Neuroscience,

12(4), 730 –740.

Phan, K., Liberzon, I., Welsh, R., Britton, J., &

Taylor, S. (2003). Habituation of rostral ante-

rior cingulate cortex to repeated emotionally

salient pictures. Neuropsychopharmacology,

28(7), 1344–1350.

Sabatinelli, D., Keil, A., Frank, D., & Lang, P.

(2013). Emotional perception: Correspon-

Temporal Dynamics of Emotion Regulation 57

dence of early and late event- related potentials

with cortical and subcortical functional MRI.

Biological Psychology, 92(3), 513–519.

Sabatinelli, D., Lang, P., Keil, A., & Bradley, M.

(2007). Emotional perception: Correlation of

functional MRI and event- related potentials.

Cerebral Cortex, 17(5), 1085–1091.

Sheppes, G., & Gross, J. J. (2011). Is timing

everything?: Temporal considerations in emo-

tion regulation. Personality and Social Psy-

chology Review, 15(4), 319–331.

Stockburger, J., Schmälzle, R., Flaisch, T., Bub-

latzky, F., & Schupp, H. T. (2009). The impact

of hunger on food cue processing: An event-

related brain potential study. NeuroImage,

47(4), 1819–1829.

Tacikowski, P., & Nowicka, A. (2010). Alloca-

tion of attention to self-name and self-face:

An ERP study. Biological Psychology, 84(2),

318–324.

Thiruchselvam, R., Blechert, J., Sheppes, G.,

Rydstrom, A., & Gross, J. J. (2011). The tem-

poral dynamics of emotion regulation: An

EEG study of distraction and reappraisal. Bio-

logical Psychology, 87(1), 84–92.

Thiruchselvam, R., Hajcak, G., & Gross, J. J.

(2012). Looking inwards: Shifting attention

within working memory representations alters

emotional responses. Psychological Science,

23(12), 1461–1466.

Urry, H. L. (2010). Seeing, thinking, and feeling:

Emotion- regulating effects of gaze- directed

cognitive reappraisal. Emotion, 10(1), 125–

135.

Versace, F., Lam, C. Y., Engelmann, J. M., Rob-

inson, J. D., Minnix, J. A., Brown, V. L., et al.

(2012). Beyond cue reactivity: Blunted brain

responses to pleasant stimuli predict long-term

smoking abstinence. Addiction Biology, 17(6),

991–1000.

Vuilleumier, P. (2005). How brains beware: Neu-

ral mechanisms of emotional attention. Trends

in Cognitive Sciences, 9(12), 585–594.

Wager, T. D., Davidson, M. L., Hughes, B. L.,

Lindquist, M. A., & Ochsner, K. N. (2008).

Prefrontal- subcortical pathways mediating

successful emotion regulation. Neuron, 59(6),

1037–1050.

Weinberg, A., & Hajcak, G. (2010). Beyond

good and evil: The time- course of neural activ-

ity elicited by specific picture content. Emo-

tion, 10, 767–782.

Weinberg, A., & Hajcak, G. (2011a). Electrocor-

tical evidence for vigilance- avoidance in Gen-

eralized Anxiety Disorder. Psychophysiology,

48, 842–851.

Weinberg, A., & Hajcak, G. (2011b). The Late

Positive Potential predicts subsequent interfer-

ence with target processing. Journal of Cogni-

tive Neuroscience, 23, 2995 –3007.

Weinberg, A., Hilgard, J., Bartholow, B., & Haj-

cak, G. (2012). Emotional targets: Evaluative

categorization as a function of context and

content. International Journal of Psychophys-

iology, 84, 149–154.

Yen, N. S., Chen, K. H., & Liu, E. H. (2010).

Emotional modulation of the late positive

potential (LPP) generalizes to Chinese individ-

uals. International Journal of Psychophysiol-

ogy, 75(3), 319–325.

Humans have long had an ambivalent rela-

tionship with their emotions. Emotions have

been celebrated as the inspiration for pin-

nacles of human art, literature, and music.

Equally, however, emotions have often been

seen as “evil spirits” that misguide us and

tempt us to do things we should not— as

“primal” instincts that need to be conquered

by the rational human mind. Indeed, history

is replete with fables of the terrible conse-

quences of unchecked emotion, from the

tragedies of Shakespeare and his recurring

theme of “the fatalism of overmastering pas-

sion” (Corson, 1890, Preface) to the appall-

ing crowd violence that can occur anywhere,

from the streets of war- torn Baghdad to the

neighborhoods of London.

The uncertainty with which we view

our emotions reflects their function, both

through our evolutionary past and in day-

to- day life. Emotions allow us to respond to

important environmental changes quickly

and with a minimum of deliberation, and

provide us with the drive to seek out things

that are good for us and avoid things that

are harmful. Emotion and mood

can be

seen as arising from heuristic neural systems

that act upon a vast quantity of incoming

information and make speedy decisions,

guiding behavior in a way that is robust

against incomplete information or computa-

tional overload. Emotions are vital for quick,

adaptive responses in the face of complexity

that rules out a rational calculation of all

our options but afford us far more flexibility

than simple stimulus– response rules.

Emotion Regulation

and Dysregulation

Emotions are not always “correct,” based as

they are on probabilistic systems that have

evolved to ensure our survival across a wide

range of circumstances. One of the func-

tions emotions serve is to interrupt ongo-

ing behavior when an encountered event

or stimulus is highly personally significant

and deserves our attention or requires us

to prepare for action (Frijda, 1986; Gross,

this volume). Yet we cannot afford to be

constantly interrupted; emotions exist in

a balance with other, ongoing cognitive,

attentional, and behavioral processes. In

order for us to benefit, emotions need to be

appropriately managed depending on the

specific contexts in which they occur. Given

the importance of emotion regulation, it is

unsurprising that neural systems have been

identified that serve to manage emotions

and moods in such a way that, on the bal-

ance, they contribute to, rather than inter-

fere with, our daily lives (Ochsner & Gross,

this volume).

CHAPTER 4

The Neural Basis of Emotion Dysregulation

Tom Johnstone

Henrik Walter

The Neural Basis of Emotion Dysregulation 59

In this chapter we consider how the dys-

function of these neural systems might

underlie the inability to regulate emotions

appropriately. The outcome of such a fail-

ure to regulate can range from a short-

term inability to stop getting angry during

a debate with a colleague, all the way to

long- term psychopathology such as mood

and anxiety disorders. We limit discussion

to types of emotion dysregulation that are

in some sense not normative. Thus, we do

not discuss mechanisms that give rise to

panic behavior when a bomb explodes, even

though remaining calm might be the most

adaptive thing to do in the context, since

panic in such a situation would be considered

quite normal. We also take a look at how

knowledge of the neural systems involved in

emotion regulation, and their dysfunction in

psychopathology, is leading to novel, brain-

focused clinical treatments.

Emotion regulation processes can be

examined at multiple levels, from neu-

rotransmitters and inhibitory interneurons

to cortical and subcortical network feed-

back loops, to socially mediated regulation

of moods and emotional behaviors. All of

these types of regulation may be at least par-

tially automatic and subconscious (Gyurak

& Etkin, this volume), so limiting a discus-

sion of emotion regulation to that which is

“deliberate” or “conscious” is not particu-

larly useful. Gross (this volume) makes the

distinction between antecedent- focused and

response- focused emotion regulation. Neu-

robiologically, this conceptual distinction

can be elaborated by considering the neural

circuits involved in detecting and appraising

situations and contexts that call for certain

emotional responses (e.g., threat detection,

relevance detection, recognition of socially

rewarding stimuli, evaluation of possible

outcomes and their probabilities), as well

as those responsible for generating the neu-

ral, physiological, and behavioral responses

that make up emotions. Many of the brain

processes involved in emotion regulation

have thus been extensively studied in other

domains of psychology and cognitive neuro-

science, including (but not limited to) selec-

tive attention, cognitive control, working

memory, and response inhibition. Effective

emotion regulation involves the coordinated

recruitment of these different neural mecha-

nisms in specific contexts (Ochsner & Gross,

this volume). One important question is the

extent to which different manifestations of

emotion dysregulation can be understood in

terms of specific patterns of dysfunction in

one or more of these neural systems.

Prefrontal Cortex

and Emotion Regulation

Given the broad sweep of processes we

just outlined, an exhaustive review of the

role of different neural systems in emotion

regulation and dysregulation would require

an entire book. Instead, we focus here on

research demonstrating the involvement of

the prefrontal cortex (PFC) in the regulation

of “bottom- up” emotion- generating neural

circuits, which has provided the clearest

empirical distinction between generation

and regulation of emotions, and also poten-

tially has the greatest implications for emo-

tion regulation– based therapies for a variety

of affective disorders (see Figure 4.1; also see

Ochsner & Gross, this volume). Research on

prefrontal cortical regulation of emotion

has largely followed one of two approaches.

Studies of cognitive reappraisal have focused

on how the explicit cognitive reinterpreta-

tion of the emotional meaning or possible

outcome of a stimulus can be used to mod-

ify the resulting emotional response. On a

more automatic level, a range of studies has

examined the more automatic engagement

of prefrontal mechanisms that serve to regu-

late attention and the contents of working

memory, and to shield these processes from

emotional interference.

Cognitive Reappraisal

Based on cognitive appraisal theories of emo-

tion (Scherer, Schorr, & Johnstone, 2001),

the study of emotion regulation through

reappraisal has formed the core of cognitive

neuroscience research on emotion regulation

(Gross, this volume). Reappraising the affec-

tive meaning of negative emotional stimuli

can reduce the magnitude of felt negative

emotion, as well as physiological indicators,

such as potentiated eyeblink startle (Jackson,

Malmstadt, Larson, & Davidson, 2000).

Eyeblink startle increases in magnitude dur-

ing presentation of negative pictures, rela-

tive to neutral pictures, an effect thought to

60 BIOLOGICAL BASES

be mediated by projections from the central

nucleus of the amygdala to the brainstem

(Davis, 2006). Evidence that reappraisal can

directly influence this amygdala circuitry

comes from consistent findings in positron

emission tomographic (PET) and functional

magnetic resonance imaging (fMRI) studies

of healthy individuals showing reappraisal-

dependent decreases in amygdala activation

in response to negative stimuli. Increased

dorsolateral and ventrolateral PFC activa-

tion is commonly measured in such reap-

praisal studies (Ochsner & Gross, this

volume), though discrepancies such as the

hemispheric lateralization of PFC activation

still exist, with some studies finding predom-

inantly right prefrontal activation and others

finding left prefrontal activation.

Spontaneous Regulation

and Cognitive Control

In daily life we need to regulate our emo-

tions continuously and automatically in

order to remain focused on current thoughts

and actions; we do not always have the

luxury of being able to reappraise con-

sciously the emotion- inducing events around

us. A number of studies have used tasks

in which regulating emotion is required

but not explicitly instructed. For example,

when cognitive tasks, such as those that

tax working memory, are performed under

an anxiety induction or in the presence of

emotional distractors, a drop in task perfor-

mance is observed. There is some evidence

that this interference is reduced when the

FIGURE 4.1. Depiction of prefrontal cortical and subcortical regions commonly linked to emotion

regulation. dmPFC, dorsomedial PFC; dACC, dorsal anterior cingulate cortex; vmPFC, ventromedial

PFC; NAc: nucleus accumbens; Amyg, amygdala; vlPFC, ventrolateral PFC; dlPFC, dorsolateral PFC.

The Neural Basis of Emotion Dysregulation 61

cognitive load of the task increases, possi-

bly through the automatic engagement of

top-down control mechanisms (Blair et al.,

2007; Clarke & Johnstone, 2013; Erthal et

al., 2005; Van Dillen, Heslenfeld, & Koole,

2009). The specific subregions of the PFC

that are involved in such automatic emo-

tion regulation may depend on properties

of the distractors, for example, the relative

involvement of ventrolateral or dorsal PFC

in regulating negative or positive distrac-

tors, respectively (Erk, Kleczar, & Walter,

2007). A number of the prefrontal regions

implicated in either spontaneous or explicit

emotion regulation, including the ventrolat-

eral PFC, dorsolateral PFC, and the dorsal

anterior cingulate, overlap with those com-

monly identified in studies of cognitive and

attentional control (Mitchell, 2011). The

dorsal anterior cingulate cortex (dACC) is

posited to be involved in performance moni-

toring and detecting when control is neces-

sary (Ridderinkhof, Ullsperger, Crone, &

Nieuwenhuis, 2004). Lateral regions of the

PFC, including the ventrolateral and dor-

solateral PFC, are involved in maintaining

and manipulating information in working

memory, and in implementing attentional,

cognitive, or behavioral adjustments (Rid-

derinkhof et al., 2004).

Prefrontal–Subcortical Connectivity

There are few direct neural connections

between dorsal and lateral PFC and the

amygdala (Ghashghaei, Hilgetag, & Barbas,

2007), raising the question of how these

lateral PFC brain regions might exert their

top-down regulatory influence. One possi-

bility is that the ventromedial PFC (vmPFC),

which has neural connections with lateral

PFC and the amygdala, might provide the

missing link. Ventral parts of the medial PFC

have been implicated in down- regulation

of amygdala function in nonhuman and

human studies of fear conditioning and

extinction. Extinction of conditioned fear

responses can be considered a form of emo-

tion regulation, since the fear association

itself is not destroyed (Bouton, 2004), but

rather a new association indicating safety is

created and inhibits or overcomes the origi-

nal conditioned response in specific con-

texts. In rodent studies, the infralimbic cor-

tex (homologous to the vmPFC in humans)

plays an important role in the creation and

maintenance and/or recall of extinction of

conditioned fear responses (Milad & Quirk,

2002, 2012). Consistent with these stud-

ies, activation in the vmPFC correlates with

recall of extinction in humans (Kalisch et

al., 2006; Milad et al., 2007; Phelps, Del-

gado, Nearing, & LeDoux, 2004). The role

of vmPFC– amygdala connectivity seems to

be under genetic control, pointing to a role

of dynorphins in human extinction learning

(Bilkei- Gorzo et al., 2012). Thus, based on

its role in fear conditioning and extinction

paradigms, the vmPFC would appear to be

a promising candidate as a region that can

mediate more lateral PFC regulatory effects

on the amygdala.

Evidence that this might be the case comes

from studies of spontaneous regulation, as

well as reappraisal- based down- regulation

of emotional responses to aversive pictures.

For example, Etkin, Egner, Peraza, Kandel,

and Hirsch (2006) used a variant of an emo-

tional Stroop task, in which participants

responded to the words fear and happy

superimposed on faces expressing either fear

or happiness. In this task, there is a need

to down- regulate automatic responses to

the emotional facial expressions when they

conflict with the word (e.g., the word happy

superimposed on a fearful face). Their

results indicated that while dorsal and lat-

eral PFC detect the need for top-down regu-

lation, rostral ACC (rACC) implements that

regulation. Specifically, rACC activation

was higher and amygdala activation was

lower during the down- regulation of emo-

tionally conflicting information, with a neg-

ative correlation between the two regions.

Two studies of reappraisal- based emotion

regulation, (Johnstone, van Reekum, Urry,

Kalin, & Davidson, 2007; Urry et al., 2006)

found that individual differences in activa-

tion of the vmPFC during down- regulation

correlated negatively with amygdala acti-

vation; the more activated the vmPFC dur-

ing down- regulation, the less activated the

amygdala. Furthermore, vmPFC activation

was found statistically to mediate the associ-

ation between dorsomedial PFC (Urry et al.,

2006) ventrolateral PFC (Johnstone et al.,

2007) or dorsolateral PFC (Erk et al., 2010)

and amygdala activation during the down-

regulation condition. It should be noted,

however, that these studies did not find cat-

62 BIOLOGICAL BASES

egorically increased activation of vmPFC

during down- regulation.

One study (Delgado, Nearing, LeDoux,

& Phelps, 2008) directly tested the con-

nection between reappraisal- based emo-

tion regulation and extinction. Participants

were instructed simply to attend to a colored

square that might give them a shock (the

conditioned stimulus) or to down- regulate

their conditioned response to the square by

reappraising the meaning of the color (e.g.,

by thinking of contexts in which the color

had a more calming influence, such as the

sky for a blue square). Greater activation in

the down- regulation relative to the attend

condition was measured in dorsolateral

PFC and vmPFC, with less activation in the

amygdala. Prefrontal activation correlated

negatively with skin conductance responses,

providing evidence of its role in regulating

emotional responses. Notably, the region of

activation in vmPFC overlapped with that

found in prior studies of extinction using the

same stimuli.

In summary, evidence points to a pre-

frontal regulatory network in which dorsal

and lateral regions of the PFC exert a top-

down influence on subcortical structures

involved in generating emotional responses.

Some evidence suggests that this regula-

tory effect is via the same region of vmPFC

involved in extinction, though whether this

is the primary pathway, or other important

regulatory pathways exist (Wager, David-

son, Hughes, Lindquist, & Ochsner, 2008)

is the topic of continuing investigation (e.g.

see Clarke & Johnstone [2013] for an exam-

ination of the role of dACC in inhibition of

amygdala output to PFC during spontane-

ous threat regulation). Identifying the exact

pathways involved in effective emotion regu-

lation will be vital in determining the extent

to which the dysregulation of emotion can

be explained in terms of a malfunction in

the prefrontal emotion regulation network.

Emotion Dysregulation

and Affective Disorders

Emotional disorders such as depression and

anxiety are estimated by the World Health

Organization to be the greatest cause of dis-

ability worldwide (Mathers, Lopez, & Mur-

ray, 2006). Efforts to understand the neu-

robiological causes of these conditions and

potential avenues for treatment are there-

fore of enormous importance to the general

population. Most brain research into mood

and anxiety disorders has focused on the

“bottom-up” determinants of emotions,

with a focus on subcortical and early sen-

sory processing that generates emotional

responses and biases our behavior in a fairly

automatic way. For example, much of the

focus in anxiety disorders has been on atten-

tional biases toward anxiety- relevant stimuli

(Campbell- Sills, Ellard, & Barlow, this vol-

ume; MacLeod, Mathews, & Tata, 1986),

generated either through low- level sensory

cortex or subcortical structures such as the

amygdala, known to play a role in early

threat detection. In depression, an extensive

literature exists on the role of the monoami-

nergic neurotransmitters serotonin, norepi-

nephrine, and dopamine in subcortical and

subcortical– cortical networks involved in

mood, though for all that research, there

have been no definitive breakthroughs in

understanding the causes of depression.

Although negative emotions such as anxi-

ety and sadness are a normal occurrence in

response to adversity in all individuals, one

feature that distinguishes those with mood

and anxiety disorders is their inability to

regulate certain negative emotions effec-

tively when they arise. Indeed, it might well

be argued that the defining feature of many

mood and anxiety disorders is the extended

duration of emotional episodes rather than

their intensity (phobias and panic disor-

ders are obvious exceptions, though even

in these cases, feelings of panic and anxi-

ety typically last well beyond the immediate

trigger of the episode). Cognitive neurosci-

entists have argued that depression should

not be equated with the “down” state itself,

but rather with the tendency to “enter and

get stuck in this state. Thus, the neurobiol-

ogy of depression should be that of mood

reaction and regulation rather than the

mood state per se” (Holtzheimer & May-

berg, 2011, p. 1). Importantly, it is not just

negative emotions that are dysregulated in

mood disorders. “Anhedonia,” a markedly

reduced interest and pleasure in normally

rewarding activities, is one of the three core

features of major depression that may be

partly explained by an inability to engage

cognitively in rewarding situations and sus-

The Neural Basis of Emotion Dysregulation 63

tain positive emotions, a different type of

emotion regulation.

Although abnormalities in the neural

circuitry supporting adaptive regulation of

certain emotions may play a decisive role in

determining vulnerability to mood disorders

(Davidson, Pizzagalli, Nitschke, & Putnam,

2002), only recently have researchers explic-

itly examined this possibility. Below we

discuss the findings separately for anxiety,

which is symptomatic of a variety of disor-

ders and phobias; the more general negative

mood characteristic of depression; and the

dysregulation of positive emotions in anhe-

donia.

Emotion Dysregulation and Anxiety

Substantial research has demonstrated

that high- anxious individuals show greater

attentional capture by threat- relevant infor-

mation, with slowed reaction times and an

increased number of errors when perform-

ing tasks such as the emotional Stroop or the

dot- probe task, than low- anxious individuals

(MacLeod et al., 1986). A number of mod-

els of anxiety- related attentional bias have

proposed that an overly sensitive preatten-

tive threat detection system is responsible for

drawing attention toward threatening stim-

uli (see Cisler & Koster, 2010, for a review).

In line with this, elevated amygdala activa-

tion in response to threat- relevant informa-

tion is often measured in high- anxiety indi-

viduals, suggesting that attentional biases

may have their roots in hyperactive or low-

threshold threat detection at a subcortical

level. Adults assessed as having an inhibited

temperament as infants show heightened

and sustained amygdala responses to novel

social stimuli (Schwartz & Rauch, 2004;

Schwartz, Wright, Shin, Kagan, & Rauch,

2003), suggesting that such amygdala hyper-

activity might be stable across development.

Heightened amygdala activation is not

always found in high- anxiety individuals,

however, in part because amygdala engage-

ment may depend on the specific amygdala

nucleus and properties of the threatening

stimulus (Etkin et al., 2004). There are

also other candidate subcortical regions

that might underlie overly sensitive threat

detection in anxious individuals, such as the

bed nucleus of the stria terminalis (BNST),

which plays an important role in sustained,

as distinct from transient, forms of vigilance

(Somerville et al., 2012; Walker, Toufexis,

& Davis, 2003).

Nonetheless, it seems likely that anxiety

disorders involve more than just hypersen-

sitivity in bottom-up threat detection sys-

tems. There is now a large body of evidence

that highly anxious individuals, in par-

ticular those with anxiety disorders, show

deficits in prefrontal circuits that regulate

attention to and responding to threaten-

ing stimuli. Over and above an attentional

bias toward threatening information, highly

anxious individuals have greater difficulty

in disengaging from threat- relevant infor-

mation when required. In Posner spatial

cuing tasks (Posner, Snyder, & Davidson,

1980), the participant focuses on a central

fixation, and a cue flashed up in one of

two locations on either side of the fixation

point is followed rapidly by a target in one

of the two locations. When the cue is pre-

sented in a different location from the fol-

lowing target (invalid trials), response to the

target is slowed. Highly anxious individu-

als show even greater slowing when the cue

is threat- related than when it is of neutral

valence, an effect that is reliable across mul-

tiple clinical anxiety disorders and high trait

anxiety populations, but not in nonanxious

individuals (Bar- Haim, Lamy, Pergamin,

Bakermans- Kranenburg, & van IJzendoorn,

2007). Results such as this indicate that

weakened top-down attentional control, a

core feature of spontaneous emotion regula-

tion, might underpin some features of high

trait anxiety and anxiety disorders (Cisler &

Koster, 2010). Deficits in the performance

of working memory tasks in the presence of

sustained emotional distractors or anxiety

induction in anxious individuals (Shackman

et al., 2006) also point to weakened top-

down control of emotion, potentially involv-

ing the prefrontal network for cognitive

control and spontaneous emotion regulation

discussed earlier.

Human brain imaging studies have found

reduced prefrontal recruitment in high-

anxious individuals relative to low- anxious

individuals when faced with threat or

threat- relevant stimuli. For example, using a

perceptual discrimination task in the pres-

ence of fearful versus neutral facial expres-

sions, Bishop, Duncan, Brett, and Lawrence

(2004) found lower rACC and ventrolateral

64 BIOLOGICAL BASES

PFC activation in high- anxious than in low-

anxious individuals, and the opposite pat-

tern in the amygdala. This result is consis-

tent with a model in which rACC detects the

need for control over incoming information

that conflicts with task demands, and ven-

trolateral PFC is subsequently involved in

regulating attention toward task- relevant

information and away from threatening,

task- irrelevant information. The lower rACC

and ventrolateral PFC activation and higher

amygdala activation seen in high- anxious

individuals presumably reflects reduced

prefrontal control. This deficit in top-down

attentional control of task- irrelevant distrac-

tors might not be specific to threatening or

even emotional distractors: In a later study,

Bishop (2008) reported that high trait anx-

ious individuals showed greater interference

from nonemotional distractors, along with

reduced activation in dorsolateral PFC. Thus

elevated trait anxiety is associated with gen-

erally reduced lateral PFC- mediated top-

down control of attention, resulting in less

efficient attentional regulation of distract-

ing emotional information. Coupled with a

hypersensitive bottom-up threat detection

system, the consequence would be hypervig-

ilance to and an inability to disengage from

potentially threatening stimuli.

The picture of dysfunctional prefrontal

regulation in anxiety disorders (as opposed

to high trait anxiety) is not as clear- cut as

one might presume from this model, how-

ever. The patterns of observed prefron-

tal hypoactivity and hyperactivity differ

across anxiety disorders (Etkin & Wager,

2007; Shin & Liberzon, 2010). Of these,

the most consistent neuroimaging findings

have been reported for posttraumatic stress

disorder (PTSD). A number of studies have

shown impaired extinction of conditioned

responses to aversive stimuli in PTSD, and

hypoactivation in vmPFC/rACC has been

reported in response to both trauma- related

and non- trauma- related aversive stimuli, as

well as during extinction, other emotional

and cognitive tasks, and resting baseline

(Shin & Liberzon, 2010). Activation in this

region also negatively correlates with PTSD

symptom severity. All of these results suggest

that PTSD is characterized by a disrupted

ability to regulate previously conditioned

fear responses through the engagement of

vmPFC extinction circuitry. In contrast

with PTSD, neuroimaging studies of other

anxiety disorders have shown inconsistent

results, with both hyper- and hypoactivation

in vmPFC, though there are fewer such stud-

ies than those examining PTSD, and they

have used a variety of different experimental

paradigms (Etkin & Wager, 2007).

Dysregulation of Emotion

in Negative Mood and Depression

Brain imaging studies of depressed individu-

als have demonstrated abnormal patterns of

activation in many of the same prefrontal

brain regions thought to contribute to the

regulation of mood and emotion, though the

findings have not been consistent. A num-

ber of PET studies have indicated reduced

metabolism in dorsolateral PFC and dACC

in both the resting state and during expo-

sure to negative stimuli (Fitzgerald, Laird,

Maller, & Daskalakis, 2008). These results

are consistent with the notion that dysregu-

lation of negative mood in depression might

be due to underrecruitment of dorsal pre-

frontal brain regions important for the regu-

lation of negative emotions, yet the fact that

these studies did not directly measure emo-

tion regulation limits the inferences that can

be made.

Some PET resting state studies have also

reported elevated metabolism in depressed

versus nondepressed individuals in ventral

regions of the PFC, including ventrolateral

and orbitofrontal cortex (Savitz & Drevets,

2009), which is more difficult to recon-

cile with a deficit in emotion regulation. It

should be noted though that this region of

the PFC serves a more general role in emo-

tion processing than its posited role in top-

down emotion regulation, including flexible

updating of stimulus value, as well as moni-

toring of the autonomic state (Rolls, 2004).

In addition to top-down projections to the

amygdala, it also receives excitatory input

from both the amygdala and sensory corti-

ces. In the absence of top-down regulatory

signals, then, hyperactivity in ventral PFC

in depressed individuals might reflect more

bottom-up- driven elaborative or ruminative

processing of emotional information.

A number of fMRI studies have mea-

sured prefrontal cortical activation dur-

ing instructed emotion regulation tasks.

Beauregard, Paquette, and Levesque (2006)

The Neural Basis of Emotion Dysregulation 65

reported increased dorsal ACC activation in

depressed compared with healthy individu-

als when they were decreasing emotional

responses to sad films. No group differences

were found in the more anterior and lateral

PFC regions found previously in studies of

reappraisal in nondepressed samples. In a

study of reappraisal of negatively valenced

emotional pictures, Johnstone et al. (2007)

found that healthy individuals showed left-

lateralized activation of ventrolateral PFC,

whereas depressed individuals showed bilat-

eral activation. In the healthy group, vmPFC

activation was negatively correlated with

amygdala activation and found statistically

to mediate a negative association between

ventrolateral PFC and the amygdala, con-

sistent with a top-down regulation path-

way from ventrolateral PFC via vmPFC to

the amygdala. However, for the depressed

group, a positive correlation was found

between vmPFC and amygdala activation,

with no correlation between lateral PFC and

amygdala. One possible explanation for this

finding is that in depressed individuals, the

lack of regulatory input from left dorsal or

lateral prefrontal regions results in sustained

vmPFC activation, under either greater

bottom-up or right lateral PFC influence.

Both explanations would be consistent with

the elevated vmPFC metabolism in depres-

sion seen in some PET studies, perhaps

reflecting greater self- referential processing.

Results consistent with a model of

reduced lateral PFC top-down regulation of

amygdala in depression have now been seen

in a number of emotion regulation stud-

ies, although lateralization of this reduced

PFC involvement has not been consistently

found across studies. In a study with par-

tially remitted depressed patients, Erk et

al. (2010) demonstrated that although

depressed patients are able to down- regulate

their amygdala using distancing, a form of

reappraisal, the degree of down- regulation

was diminished with increasing scores of

depression (i.e., the more depressed the

patients were, the less they were able to

down- regulate the amygdala). This could be

explained by reduced activation of the right

dorsolateral PFC, which also showed signif-

icantly reduced coupling with the amygdala

in depressed patients.

Erk et al. (2010) also showed differences

between healthy and depressed individuals

in sustained effects of emotion regulation.

In healthy controls, regulation effects on

the amygdala could still be demonstrated

after the emotion regulation task; negative

pictures that had been paired with a down-

regulation instruction invoked not only

reduced amygdala activation compared to

an attend condition during the initial emo-

tion regulation task but also reduced amyg-

dala activation in a simple picture- watching

task 15 minutes later. Furthermore, the

degree of reduction in the second task was

correlated with dorsolateral PFC activa-

tion in the first task. In contrast, depressed

patients had no such lasting effect of emo-

tion regulation; activation in response to

previously down- regulated pictures was no

different than that in response to nonregu-

lated pictures. Together, these findings sug-

gest that depression is characterized not by

the negative mood itself but by the tendency

to get stuck in that mood (Holtzheimer &

Mayberg, 2011).

Kanske, Heissler, Schönfelder, and Wessa

(2012) recently described how remitted

patients with a diagnosis of depression

show a deficit in down- regulation of the

amygdala when reappraising socially nega-

tive pictures but not when using a distrac-

tion strategy. Additionally, they found that

down- regulation of the amygdala was bet-

ter in those patients who habitually used

reappraisal strategies, as measured with the

Emotion Regulation Questionnaire (ERQ;

Gross & John, 2003). This finding extends

the work of Abler, Erk, Herwig, and Walter

(2007), whose examination of patients with

concurrent depression demonstrated that

those who had higher reappraisal scores, as

measured with the ERQ, showed less antici-

patory amygdala activation to negative stim-

uli. Kanske et al.’s study (2012) shows that

neurobiological deficits during reappraisal

extend into remission, pointing to the pos-

sibility that impaired emotion regulation of

negative stimuli might be a trait marker of

depression, as suggested previously in behav-

ioral studies (Ehring, Fischer, Schnülle,

Bösterling, & Tuschen- Caffier, 2008).

Dysregulation of Positive Emotion:

Anhedonia

The dysregulation of emotion in depression

is not limited to negative mood and emo-

66 BIOLOGICAL BASES

tions. One of the core features of depres-

sion is anhedonia, a deficit in the experi-

ence of positive emotions and the ability

to take pleasure from previously rewarding

stimuli. Anhedonia is a particularly debili-

tating condition, because it removes the

pleasurable experiences that motivate much

of what we do in life. The neural basis of

anhedonia is not well understood, but it is

likely that it involves the frontostriatal net-

work, which includes connected regions of

the striatum, particularly the ventral stria-

tum,

and the PFC. Based on extensive ani-

mal and human research, the frontostriatal

network is regarded as a core system for the

learning of reward signals, the experience

of pleasure, and the motivation of reward-

seeking behaviors. Despite its role in positive

emotion, however, research linking the fron-

tostriatal network to anhedonia has been

mixed, with some studies reporting reduced

activity in the striatum (Epstein et al., 2006;

Keedwell, Andrew, Williams, Brammer, &

Phillips, 2005) and others showing no such

effect (Knutson, Bhanji, Cooney, Atlas, &

Gotlib, 2008; Schaefer, Putnam, Benca, &

Davidson, 2006).

One explanation for these inconsisten-

cies might be the model of anhedonia being

tested. Anhedonia has often been consid-

ered to reflect a tonically dampened posi-

tive emotion system, in which the general

capacity to experience pleasure is reduced

(Meehl, 1975). An alternative hypothesis is

that an inability to prolong the duration of

positive emotion, or increase the intensity

of a rewarding experience— both aspects of

emotion regulation— might underlie at least

some anhedonic symptoms (Tomarken &

Keener, 1998). The ventral striatum has bidi-

rectional connections with a number of pre-

frontal cortical regions, and brain imaging

studies have shown top-down modulation of

ventral striatal activation in humans (Del-

gado, Gillis, & Phelps, 2008; Staudinger,

Erk, & Walter, 2011).

Compared with the regulation of emo-

tional responses to negative stimuli, there

have been very few studies of top-down

regulation of positive emotions. Kim and

Hamann (2007) showed that regulation of

positive emotion engaged prefrontal regions

partially overlapping those involved in regu-

lating negative emotions, and that subcor-

tical (e.g., amygdala) effects of regulating

positive emotions were more pronounced

than those for negative emotions. In a recent

study of up- regulation of positive emotion in

response to pleasant pictures, Heller et al.

(2009) found that, compared with controls,

patients with depression were unable to sus-

tain activation in the ventral striatum across

an experimental session, and that the degree

to which ventral striatal activity was sus-

tained correlated with self- reported positive

emotion, as well as functional connectivity

between the ventral striatum and a region

in lateral PFC. In a follow- up study on the

same patients after 8 weeks of antidepres-

sant treatment, Heller et al. (2013) found

that those who demonstrated the greatest

increase in their ability to sustain ventral

striatal activation and frontostriatal con-

nectivity while up- regulating positive emo-

tion also showed the largest increases in

positive emotion. It is worth noting that this

study only involved antidepressant treat-

ment, and it is unclear whether those show-

ing greatest symptom improvement did so

as a consequence of increased frontostriatal

engagement. Future studies that examine the

neural impact of cognitive- behavioral thera-

pies on regulation of positive emotions will

shed further light on the causes and possible

treatments for anhedonia. In an example of

neurally guided emotion regulation therapy,

a recently published proof of concept study,

Linden et al. (2012) used neurofeedback

with fMRI to target this problem in depres-

sion. Eight patients with depression learned

to increase activation in brain regions

thought to be related to positive emotions,

such as the insula and the vMPFC, during

four neurofeedback sessions. Their depres-

sive symptoms were reduced significantly,

whereas a control group that underwent a

training procedure with the same cognitive

strategies, but without neurofeedback, did

not show clinical improvement.

Genes, Development,

and Emotion Regulation

Although much has been learned in recent

years about the neural underpinnings of

disorders of emotion regulation, we are a

long way from understanding the enormous

individual differences in our ability to regu-

late our moods and emotions. What are the

The Neural Basis of Emotion Dysregulation 67

causes of these individual differences? To

what extent do they reflect innate biologi-

cal differences? Are there aspects of develop-

ment that render some individuals more at

risk to psychopathology related to emotion

dysregulation?

It is well known that individual differ-

ences in emotional experience and regula-

tion are modulated by differences in genetic

makeup. One prominent example is genetic

variation within the promoter region of the

serotonin transporter gene (5-HTTLPR) in

which the long variant has been associated

with anxiety and neuroticism, as well as

with depression, particularly in combination

with stressful life events (Karg, Burmeister,

Shedden, & Sen, 2011). Hariri, Mattay, Tes-

sitore, Fera, and Weinberger (2003) showed

that the short variant of the 5-HTTLPR is

also associated with increased activation of

the amygdala in reaction to aversive stimuli,

a finding that has been replicated quite con-

sistently (Caspi, Hariri, Holmes, Uher, &

Moffitt, 2010).

Indirect evidence suggesting that genetic

differences in 5-HTTLPR might be asso-

ciated with regulation of emotion came

from findings that short allele carriers

(s- carriers) show decreased connectivity of

amygdala and the perigenual cingulate (a

ventral prefrontal region previously impli-

cated in extinction of aversive conditioning),

and that the lower this connectivity was

in s- carriers, the higher their anxious tem-

perament (Pezawas et al., 2005). Heinz et

al. (2005) found greater vmPFC– amygdala

coupling in s- carriers, however, a result that

is difficult to reconcile with the Pezewas

et al. (2005) results, although the locus of

prefrontal activation was different. Another

study using a sad mood induction and arte-

rial spin- labeling brain imaging (which mea-

sures blood perfusion) showed increased

amygdala activation in s- carriers not during

sad mood induction but during recovery, in

which emotion regulatory processes can be

assumed (Gillihan et al., 2010).

More direct evidence of the possible links

between genetic variation in the 5-HTTLPR

and emotion regulation comes from stud-

ies that used cognitive reappraisal tasks.

Schardt et al. (2010) found that, consis-

tent with prior studies, amygdala activa-

tion during a passive viewing condition was

increased in s- carriers. However, during

active emotion regulation there were no dif-

ferences in amygdala activation. Moreover,

it was shown that subjects with an s- allele

showed higher coupling of right amygdala

with the vmPFC when they regulated their

emotions. Although this appears to be coun-

terintuitive, it has to be noted that prior

studies investigating amygdala reactivity in

s- carriers used passive viewing conditions.

It seems that although s- carriers have an

increased reactivity to passive stimulation,

they can compensate with active regulation,

possibly mediated by increased connectivity

of vmPFC and amygdala relative to long-

allele carriers (l- carriers). This is consistent

with a study in which Lemogne et al. (2011)

found decreased amygdala activation and

increased connectivity of right amygdala

and subgenual ACC in s- carriers when they

compared labeling of affective pictures (a

simple form of emotion regulation) with

self- referential processing of those pictures.

A study by Friedel et al. (2009) has dem-

onstrated increased prefrontal activation

and PFC– amygdala connectivity in healthy

s- carriers, but no such effects in s- carriers

with depression, indicating that the ability

to regulate negative emotion may be a pro-

tective factor against elevated risks associ-

ated with the short allele. The question then

arises as to what enables some individuals,

but not others, to compensate in this way.

As a cautionary note, it also should be men-

tioned that within the long allele there exists

a rare variant (with an A to G exchange) that

behaves like a short allele with respect to

transcription of 5-HTTLPR. This was only

taken into account by some researchers (e.g.,

Friedel et al., 2009), so that results of other

studies have to be taken as preliminary.

Whereas it is clear that some aspects of

emotional reactivity might be tied to innate

individual differences in temperament, our

ability to regulate emotions flexibly and

appropriately is something that develops

over time. Emotion regulation draws on a

range of cognitive and attentional skills and

strategies that have differing developmental

profiles. In addition, the prefrontal brain

regions that have consistently been associ-

ated with emotion regulation are among

the latest parts of the brain to mature fully.

Accumulating evidence from brain imaging

studies points to differential engagement of

prefrontal brain regions in children and ado-

68 BIOLOGICAL BASES

lescents compared to adults when required

to modulate attention to emotional stimuli

(Monk et al., 2003; Nelson et al., 2003)

or when using explicit strategies to regu-

late emotions (Levesque et al., 2004). Some

researchers point to the mismatch between

development of subcortical brain regions

involved in emotion generation and prefron-

tal regions exerting top-down control as key

to understanding emotion dysregulation in

children and adolescents (Casey, Totten-

ham, Liston, & Durston, 2005). Because the

PFC and its connections with subcortical

limbic structures continue to mature from

childhood through adolescence into early

adulthood, there is a particular risk that

maladaptive prefrontal– limbic connectivity

and associated dysregulation of emotion will

develop, rendering individuals vulnerable to

psychopathology later in life.

Very few researchers have addressed the

neurobiology of childhood or adolescent

emotion regulation. Perlman et al. (2012)

examined emotion regulation in 14 depressed

adolescents (ages 13–17 years). Compared

to an age- matched healthy control group,

the depressed group showed increased

amygdala activation and less connectivity

between amygdala and medial PFC/insula

during the control condition. Frontal–

amygdala connectivity was correlated with

psychosocial function, hinting that those

depressed adolescents with less intact PFC–

amygdala regulatory circuitry were more

severely affected. No differences between

the depressed and nondepressed groups were

seen during the active regulation condition,

however, which might indicate that active

emotion regulation via cognitive reappraisal

is able to overcome differences in baseline

emotion reactivity, at least in the short term,

when explicitly prompted.

In a study of adult patients with depres-

sion, Frodl, Reinhold, Koutsouleris, Rei-

ser, and Meisenzahl (2010) have shown

that previous childhood stress is associated

with reductions in prefrontal gray matter,

and that prefrontal gray matter volume and

childhood neglect interact to predict adult

depression duration. A recent study (Burghy

et al., 2012) showed that elevated cortisol

levels associated with early life stress was

predictive of reduced vmPFC- amygdala rest-

ing state functional connectivity in females.

Furthermore, vmPFC- amygdala resting

state connectivity was inversely correlated

with anxiety symptoms but positively cor-

related with depressive symptoms in female

adolescents, pointing to one possible factor

in the development of PFC- subcortical emo-

tion regulation circuitry. The developmental

neurobiological profile of individual differ-

ences in emotion regulation has barely been

studied, yet it is likely to have far- reaching

consequences for our understanding of emo-

tion dysregulation throughout life.

Cortical Brain Stimulation

as a Treatment for Depression

Up to now we have considered psychologi-

cal self- regulation of emotion. However, it

is also possible to regulate emotions using

technical devices that alter activity in brain

regions that are involved in emotion regu-

lation. These are particularly important

when dysregulation of emotion is present as

a pathological condition. Three techniques

of brain stimulation— repetitive transcra-

nial magnetic stimulation (rTMS), a closely

related technique transcranial direct current

stimulation (tDCS), and deep brain stimula-

tion (DBS)—have recently been proposed as

methods offering a viable treatment for oth-

erwise untreatable depression.

Repetitive Transcranial

Magnetic Stimulation

rTMS involves generating trains of brief

bursts of a strong magnetic field close to

the scalp. When the magnetic field is ori-

ented perpendicular to the cortical surface,

electric currents are induced in the underly-

ing neural tissue to a depth of several mil-

limeters (a consequence of Faraday’s law of

electromagnetic induction). While the exact

mechanism of action of rTMS on networks

of neurons is not yet fully understood, dif-

ferent frequencies of rTMS can have either

short- or long- term facilitatory or disruptive

effects on cortical processing (Fitzgerald,

Fountain, & Daskalakis, 2006). In general,

low- frequency (< 1 Hz) rTMS is thought to

inhibit cortical processing, whereas high-

frequency (> 5 Hz) is thought to enhance

cortical processing. Supporting evidence

for this model of rTMS effects on cortical

function comes from PET studies following

The Neural Basis of Emotion Dysregulation 69

rTMS to lateral PFC, which show greater

blood flow and glucose metabolism fol-

lowing high- frequency rTMS and reduced

metabolism following low- frequency rTMS

(Speer et al., 2000). It is also possible that

rTMS can affect the neurotransmitter sys-

tems that have been linked to depression. In

rodent models, altered dopaminergic neu-

rotransmission in the striatum and altered

serotoninergic neurotransmission the amyg-

dala and cortex have also been observed

following rTMS, though there are concerns

about the applicability of these results to

humans for methodological and anatomical

reasons (Padberg & George, 2009).

For treatment of depression, rTMS has

typically been applied to dorsolateral PFC—

sometimes as low- frequency rTMS to right

dorsolateral PFC to inhibit cortical process-

ing, but most often as high- frequency rTMS

to left dorsolateral PFC to enhance process-

ing. Although results have been mixed, three

recent meta- analytic reviews have concluded

that high- frequency rTMS applied to left

dorsolateral PFC is an effective treatment

for depression. Schutter (2009) analyzed

30 double- blind sham- controlled high-

frequency rTMS studies, and concluded that

rTMS was significantly better than sham

and produced effects comparable in reli-

ability and magnitude of response to anti-

depressant drugs. In a meta- analysis of 34

studies, Slotema, Blom, Hoek, and Sommer

(2010) also found rTMS to be superior to

sham TMS, although the authors concluded

that rTMS was not as effective as electrocon-

vulsive treatment (ECT). A meta- analysis by

Allan, Herrmann, and Ebmeier (2011) of

31 randomized trials of TMS versus a sham

control yielded the same conclusion. Some

caution is needed, however, in that most if

not all the studies have not been truly blind

(i.e., the experimenter applying the stimula-

tion or sham knows which condition is being

applied) and sham TMS is perceptually quite

different from actual TMS.

Transcranial Direct Current

Stimulation

Although first applied prior to TMS, tDCS

has only relatively recently received an

upsurge in interest as a treatment for depres-

sion. It is easy to apply and, compared to

TMS, very inexpensive. tDCS consists of

passing a small direct electrical current of

1–2 milliamps (mA) between two electrodes

placed on the scalp. Most typically in treat-

ment for depression, the anode (the electrode

from which electrons flow) is placed on the

left dorsolateral PFC, and the cathode (the

electrode to which electrons flow) is placed

on the right PFC. Stimulation is then applied

for 10–20 minutes, with repeated treatment

sessions daily or on alternate days. Com-

pared with TMS, relatively more is known

about how tDCS affects neural activity.

When current flows parallel to the axon–

dendrite axis of pyramidal cells in the cor-

tex, neurons under the anode become more

depolarized, which makes them more excit-

able and increases neural firing. The oppo-

site occurs under the cathode, with neurons

becoming hyperpolarized, which leads to

a reduction in firing. Thus, tDCS with an

anode placed over the left dorsolateral PFC

will tend to increase activity in that region

of the brain. The effects of tDCS on corti-

cal excitability can last for a few hours after

application, and there is some evidence that

tDCS can also produce longer term effects

through synaptic changes to glutamate

receptors and possible effects on long- term

potentiation, though evidence is scarce at

present.

Early efforts to use tDCS to treat depres-

sion were unconvincing, possibly due to the

much smaller currents that were used, as

well as the mode and site of electrode place-

ments typically used. More recent studies

with greater consistency of target region (left

dorsolateral PFC), stimulation strength, and

timing have led to more promising results,

with a meta- analysis reporting significant

improvements in depression symptoms fol-

lowing tDCS versus sham (Allan et al., 2011),

though many studies are small and there are

fewer overall studies than those using rTMS.

Most recently, in a double- blind study, 64

depressed patients showed improvement in

mood when tDCS versus sham was used,

though the overall percentage of responders

did not differ between the two conditions

(Loo et al., 2012), highlighting the tentative

nature of results to date.

Both rTMS and tDCS have achieved their

most promising results for treatment of

depression when applied over left dorsolat-

eral PFC in an excitatory mode (e.g., high

frequency for rTMS and anode placement

70 BIOLOGICAL BASES

for tDCS). Although the exact mechanism of

action for both brain stimulation treatments

remains unknown, it is noteworthy that the

dorsolateral PFC is consistently activated in

brain imaging studies of reappraisal, and

plays an important role in working mem-

ory and executive control. The implication

is that lack of engagement of dorsolateral

PFC, specifically left dorsolateral PFC, in

depressed patients compromises their ability

to regulate their emotions, and that stimu-

lating these areas leads to an improvement

in emotion regulation through reappraisal

or executive control. Until researchers spe-

cifically test the effects of dorsolateral PFC

stimulation (either tDCS or rTMS) on regu-

lation of emotion, this hypothesis remains

speculative. One possibility to enhance the

effect of rTMS or tDCS is to use neuroim-

aging to determine which hemisphere of the

PFC is dysfunctional to direct the stimula-

tion protocol according to these findings

(Schönfeldt- Lecuona et al., 2010), possibly

using an emotion regulation task. Given that

prefrontal tDCS has been shown to improve

learning in working memory tasks (Brasil-

Neto, 2012) it is conceivable that tDCS could

be applied during the training of psychologi-

cal emotion regulation in order to boost the

learning of emotion regulation strategies.

Deep Brain Stimulation

DBS involves the delivery of a small electric

current directly to parts of the brain through

implanted wire electrodes, with stimulation

delivered via an implantable pulse genera-

tor. As an invasive surgical procedure, it has

so far been investigated as a treatment for

the most intractable and debilitating cases

of major depressive disorder in a number

of small, open- label (i.e., nonblind) stud-

ies. The most common site for stimula-

tion is the white matter in the subcallosal

cingulate region, chosen on the basis of its

connectivity with brain regions thought to

be important for antidepressant response

(Holtzheimer & Mayberg, 2011; Lozano et

al., 2008; Mayberg et al., 2005). These stud-

ies have shown remission rates of 40–60%

over an extended period (up to several years)

in patients with severe depression who have

failed to respond to any other treatments.

Given the relatively small sample sizes, it is

difficult to pinpoint exactly how subcallo-

sal DBS is achieving these promising results,

although Holtzheimer and Mayberg (2011)

suggest that modulation of a mood regula-

tion network may be the underlying mecha-

nism.

Conclusions

Research on how the human brain creates

and regulates our emotions is still in its

infancy, but it has already given us remark-

able insights into the complexity of the brain

systems responsible for shaping our moods

and emotions. In many ways human brain

imaging studies have validated the notion

that the neural systems supporting flexible

emotion regulation are a key component of

mental health. Knowledge of the role of spe-

cific corticolimbic networks in emotion dys-

regulation and psychopathology is now lead-

ing to new experimental treatments involving

brain stimulation and neurofeedback. This

progress notwithstanding, there are many

outstanding questions to be resolved. One

central question is the exact role of different

subregions of PFC in different types of emo-

tion (dys)regulation. For example, although

there is consistent evidence for vmPFC

involvement in extinction recall, the exact

role of vmPFC in more explicit, cognitive

types of emotion regulation such as reap-

praisal remains unclear. It is possible that

this question will be answered not by rela-

tively crude fMRI measures of the amount

of vmPFC activation but with more nuanced

techniques that can capture changes to the

way vmPFC encodes the hedonic value of

stimuli, perhaps under “direction” from lat-

eral PFC. Multivariate pattern analysis (cf.

Davis & Poldrack, 2013), for example, can

probe not only how much a brain region is

engaged during a task but also the extent to

which it represents different types of infor-

mation. Combining such methods with mea-

sures of whole- brain effective and functional

connectivity should lead to testable models

of emotion regulation networks.

Another unresolved question is how dif-

ferent emotion regulation disturbances map

onto different symptoms. In this chapter, we

have rather simplistically discussed anxiety

disorders and depression separately, even

though there is a large amount of comorbid-

ity between these and other disorders. Are

The Neural Basis of Emotion Dysregulation 71

there common or distinct emotion regula-

tion processes involved? To what extent is

emotion dysregulation distinct, or does it

overlap with more general disturbances in

top-down control? To address these fun-

damental questions will require larger

scale studies (including meta- analyses) that

combine data from different samples and

experimental tasks (e.g., nonemotional tasks

involving attentional control, working mem-

ory, and response inhibition).

Further research on the impact of genetic

variation and early life environment on the

development of the brain systems that allow

us to regulate our emotions will also be

important if we are to develop useful predic-

tors of vulnerability to disorders of emotion

regulation. Along similar lines, we know

almost nothing about how age- related neu-

ral decline affects emotion regulation. Some

of the brain regions showing the greatest

age- related atrophy, such as lateral PFC, are

a key component of emotion regulation cir-

cuitry. Do older individuals show the same

sorts of age- related decline in emotion regu-

lation as they do in cognitive function? Early

evidence suggests that the picture might not

be so straightforward (van Reekum et al.,

2011; Winecoff, LaBar, Madden, Cabeza, &

Huettel, 2011). Far more cross- sectional and

longitudinal research relating age, measures

of cortical integrity, cognitive function, and

emotion regulation capability is required to

answer these important questions.

Notes

1. In this chapter we have adopted a liberal con-

sideration of emotion and mood, using the

terms interchangeably. Although these terms

might be considered more or less distinct by

emotion theorists, the evidence for a clear dis-

tinction in terms of neurobiology is lacking.

In addition, from a clinical standpoint, mood

dysregulation is at least as important as emo-

tion dysregulation.

2. Most studies have not explicitly tested the

hemispheric lateralization of prefrontal acti-

vation, so caution must be exercised in infer-

ring preferential involvement of one hemi-

sphere in reappraisal of emotional stimuli.

3. Although the term ventral striatum is some-

times used interchangeably with nucleus

accumbens, the latter refers to a specific

nucleus, and the former refers to a subregion

of the striatum, which might contain a more

varied collection of neurons.

References

Abler, B., Erk, S., Herwig, U., & Walter, H.

(2007). Anticipation of aversive stimuli acti-

vates extended amygdala in unipolar depres-

sion. Journal of Psychiatric Research, 41(6),

511–522.

Allan, C. L., Herrmann, L. L., & Ebmeier, K.

P. (2011). Transcranial magnetic stimulation

in the management of mood disorders. Neuro-

psychobiology, 64(3), 163–169.

Bar- Haim, Y., Lamy, D., Pergamin, L.,

Bakermans- Kranenburg, M. J., & van IJzen-

doorn, M. H. (2007). Threat- related atten-

tional bias in anxious and nonanxious indi-

viduals: A meta- analytic study. Psychological

Bulletin, 133(1), 1–24.

Beauregard, M., Paquette, V., & Levesque, J.

(2006). Dysfunction in the neural circuitry of

emotional self- regulation in major depressive

disorder. NeuroReport, 17(8), 843–846.

Bilkei- Gorzo, A., Erk, S., Schurmann, B., Mauer,

D., Michel, K., Boecker, H., et al. (2012). Dyn-

orphins regulate fear memory: From mice to

men. Journal of Neuroscience, 32(27), 9335–

9343.

Bishop, S. J. (2008). Trait anxiety and impover-

ished prefrontal control of attention. Nature

Neuroscience, 12(1), 92–98.

Bishop, S. J., Duncan, J., Brett, M., & Lawrence,

A. D. (2004). Prefrontal cortical function

and anxiety: Controlling attention to threat-

related stimuli. Nature Neuroscience, 7(2),

184–188.

Blair, K. S., Smith, B. W., Mitchell, D. G. V.,

Morton, J., Vythilingam, M., Pessoa, L., et al.

(2007). Modulation of emotion by cognition

and cognition by emotion. NeuroImage, 35(1),

430–440.

Bouton, M. E. (2004). Context and behavioral

processes in extinction. Learning and Mem-

ory, 11(5), 485–494.

Brasil- Neto, J. P. (2012). Learning, memory, and

transcranial direct current stimulation. Fron-

tiers in Neuropsychiatric Imaging and Stimu-

lation, 3, 80.

Burghy, C. A., Stodola, D. E., Ruttle, P. L.,

Molloy, E. K., Armstrong, J. M., Oler, J. A.,

et al. (2012). Developmental pathways to

amygdala– prefrontal function and internaliz-

72 BIOLOGICAL BASES

ing symptoms in adolescence. Nature Neuro-

science, 15(12), 1736–1741.

Campbell- Sills, L., Ellard, K., & Barlow, D. (this

volume, 2014). Emotion regulation in anxiety

disorders. In J. J. Gross (Ed.), Handbook of

emotion regulation (2nd ed., pp. 393–412).

New York: Guilford Press.

Casey, B. J., Tottenham, N., Liston, C., & Dur-

ston, S. (2005). Imaging the developing brain:

What have we learned about cognitive devel-

opment? Trends in Cognitive Sciences, 9(3),

104–110.

Caspi, A., Hariri, A. R., Holmes, A., Uher, R., &

Moffitt, T. E. (2010). Genetic sensitivity to the

environment: The case of the serotonin trans-

porter gene and its implications for studying

complex diseases and traits. American Journal

of Psychiatry, 167(5), 509–527.

Cisler, J. M., & Koster, E. H. W. (2010). Mecha-

nisms of attentional biases towards threat in

anxiety disorders: An integrative review. Clin-

ical Psychology Review, 30(2), 203–216.

Clarke, R. J., & Johnstone, T. (2013). Prefrontal

inhibition of threat processing protects work-

ing memory from interference. Frontiers in

Human Neuroscience, 7, 228.

Corson, H. (1890). An introduction to the study

of Shakespeare. Boston: Heath. Retrieved

from http://archive.org/details/introduction-

tost01cors.

Davidson, R. J., Pizzagalli, D., Nitschke, J. B., &

Putnam, K. (2002). Depression: Perspectives

from affective neuroscience. Annual Review

of Psychology, 53(1), 545–574.

Davis, M. (2006). Neural systems involved

in fear and anxiety measured with fear-

potentiated startle. American Psychologist,

61(8), 741–756.

Davis, T., & Poldrack, R. A. (2013). Measuring

neural representations with fMRI: Practices

and pitfalls. Annals of the New York Acad-

emy of Sciences.

Delgado, M. R., Gillis, M. M., & Phelps, E. A.

(2008). Regulating the expectation of reward

via cognitive strategies. Nature Neuroscience,

11(8), 880–881.

Delgado, M. R., Nearing, K. I., LeDoux, J.

E., & Phelps, E. A. (2008). Neural circuitry

underlying the regulation of conditioned fear

and its relation to extinction. Neuron, 59(5),

829–838.

Ehring, T., Fischer, S., Schnülle, J., Bösterling,

A., & Tuschen- Caffier, B. (2008). Charac-

teristics of emotion regulation in recovered

depressed versus never depressed individuals.

Personality and Individual Differences, 44(7),

1574–1584.

Epstein, J., Pan, H., Kocsis, J. H., Yang, Y.,

Butler, T., Chusid, J., et al. (2006). Lack of

ventral striatal response to positive stimuli in

depressed versus normal subjects. American

Journal of Psychiatry, 163(10), 1784–1790.

Erk, S., Kleczar, A., & Walter, H. (2007).

Valence- specific regulation effects in a work-

ing memory task with emotional context.

NeuroImage, 37(2), 623–632.

Erk, S., Mikschl, A., Stier, S., Ciaramidaro, A.,

Gapp, V., Weber, B., et al. (2010). Acute and

sustained effects of cognitive emotion regula-

tion in major depression. Journal of Neurosci-

ence, 30(47), 15726–15734.

Erthal, F., De Oliveira, L., Mocaiber, I., Pereira,

M., Machado- Pinheiro, W., Volchan, E., et al.

(2005). Load- dependent modulation of affec-

tive picture processing. Cognitive, Affective,

and Behavioral Neuroscience, 5(4), 388–395.

Etkin, A., Egner, T., Peraza, D. M., Kandel, E.

R., & Hirsch, J. (2006). Resolving emotional

conflict: A role for the rostral anterior cingu-

late cortex in modulating activity in the amyg-

dala. Neuron, 51(6), 871–882.

Etkin, A., Klemenhagen, K. C., Dudman, J. T.,

Rogan, M. T., Hen, R., Kandel, E. R., et al.

(2004). Individual differences in trait anxiety

predict the response of the basolateral amyg-

dala to unconsciously processed fearful faces.

Neuron, 44(6), 1043–1055.

Etkin, A., & Wager, T. D. (2007). Functional

neuroimaging of anxiety: A meta- analysis of

emotional processing in PTSD, social anxiety

disorder, and specific phobia. American Jour-

nal of Psychiatry, 164(10), 1476–1488.

Fitzgerald, P. B., Fountain, S., & Daskalakis,

Z. J. (2006). A comprehensive review of the

effects of rTMS on motor cortical excitabil-

ity and inhibition. Clinical Neurophysiology,

117(12), 2584–2596.

Fitzgerald, P. B., Laird, A. R., Maller, J., & Das-

kalakis, Z. J. (2008). A meta- analytic study

of changes in brain activation in depression.

Human Brain Mapping, 29(6), 683–695.

Friedel, E., Schlagenhauf, F., Sterzer, P., Park, S.,

Bermpohl, F., Ströhle, A., et al. (2009). 5-HTT

genotype effect on prefrontal– amygdala cou-

pling differs between major depression and

controls. Psychopharmacology, 205(2), 261–

271.

Frijda, N. H. (1986). The emotions. Cambridge,

UK: Cambridge University Press.

Frodl, T., Reinhold, E., Koutsouleris, N., Reiser,

The Neural Basis of Emotion Dysregulation 73

M., & Meisenzahl, E. M. (2010). Interaction

of childhood stress with hippocampus and

prefrontal cortex volume reduction in major

depression. Journal of Psychiatric Research,

44(13), 799 – 807.

Ghashghaei, H. T., Hilgetag, C. C., & Barbas,

H. (2007). Sequence of information process-

ing for emotions based on the anatomic dia-

logue between prefrontal cortex and amyg-

dala. NeuroImage, 34(3), 905–923.

Gilbert, K. E. (2012). The neglected role of posi-

tive emotion in adolescent psychopathology.

Clinical Psychology Review, 32(6), 467–481.

Gillihan, S. J., Rao, H., Wang, J., Detre, J. A.,

Breland, J., Sankoorikal, G. M. V., et al.

(2010). Serotonin transporter genotype modu-

lates amygdala activity during mood regula-

tion. Social Cognitive and Affective Neurosci-

ence, 5(1), 1–10.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross, (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well- being. Journal of Personality and Social

Psychology, 85(2), 348–362.

Gyurak, A., & Etkin, A. (this volume, 2014). A

neurobiological model of implicit and explicit

emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 76–90). New York: Guilford Press.

Hariri, A. R., Mattay, V. S., Tessitore, A., Fera,

F., & Weinberger, D. R. (2003). Neocorti-

cal modulation of the amygdala response to

fearful stimuli. Biological Psychiatry, 53(6),

494–501.

Heinz, A., Braus, D. F., Smolka, M. N., Wrase,

J., Puls, I., Hermann, D., et al. (2005).

Amygdala– prefrontal coupling depends on a

genetic variation of the serotonin transporter.

Nature Neuroscience, 8(1), 20–21.

Heller, A. S., Johnstone, T., Light, S. N., Peter-

son, M. J., Kolden, G. G., Kalin, N. H., et al.

(2013). Relationships between changes in sus-

tained fronto- striatal connectivity and posi-

tive affect in major depression resulting from

antidepressant treatment. American Journal

of Psychiatry, 170(2), 197–206.

Heller, A. S., Johnstone, T., Shackman, A. J.,

Light, S. N., Peterson, M. J., Kolden, G. G.,

et al. (2009). Reduced capacity to sustain

positive emotion in major depression reflects

diminished maintenance of fronto- striatal

brain activation. Proceedings of the National

Academy of Sciences, 106(52), 22445–22450.

Holtzheimer, P. E., & Mayberg, H. S. (2011).

Stuck in a rut: Rethinking depression and its

treatment. Trends in Neurosciences, 34(1),

1–9.

Jackson, D. C., Malmstadt, J. R., Larson, C.

L., & Davidson, R. J. (2000). Suppression

and enhancement of emotional responses to

unpleasant pictures. Psychophysiology, 37(4),

515–522.

Johnstone, T., van Reekum, C. M., Urry, H. L.,

Kalin, N. H., & Davidson, R. J. (2007). Failure

to regulate: Counterproductive recruitment of

top-down prefrontal– subcortical circuitry in

major depression. Journal of Neuroscience,

27(33), 8877–8884.

Kalisch, R., Korenfeld, E., Stephan, K. E., Weis-

kopf, N., Seymour, B., & Dolan, R. J. (2006).

Context- dependent human extinction memory

is mediated by a ventromedial prefrontal and

hippocampal network. Journal of Neurosci-

ence, 26(37), 9503–9511.

Kanske, P., Heissler, J., Schönfelder, S., & Wessa,

M. (2012). Neural correlates of emotion reg-

ulation deficits in remitted depression: The

influence of regulation strategy, habitual regu-

lation use, and emotional valence. NeuroIm-

age, 61(3), 686–693.

Karg, K., Burmeister, M., Shedden, K., & Sen,

S. (2011). The serotonin transporter promoter

variant (5-HTTLPR), stress, and depression

meta- analysis revisited: Evidence of genetic

moderation. Archives of General Psychiatry,

68(5), 444–454.

Keedwell, P. A., Andrew, C., Williams, S. C. R.,

Brammer, M. J., & Phillips, M. L. (2005).

The neural correlates of anhedonia in major

depressive disorder. Biological Psychiatry,

58(11), 843–853.

Kim, S. H., & Hamann, S. (2007). Neural cor-

relates of positive and negative emotion regu-

lation. Journal of Cognitive Neuroscience,

19(5), 776–798.

Knutson, B., Bhanji, J. P., Cooney, R. E., Atlas, L.

Y., & Gotlib, I. H. (2008). Neural responses to

monetary incentives in major depression. Bio-

logical Psychiatry, 63(7), 686–692.

Lemogne, C., Gorwood, P., Boni, C., Pessiglione,

M., Lehéricy, S., & Fossati, P. (2011). Cogni-

tive appraisal and life stress moderate the

effects of the 5-HTTLPR polymorphism on

amygdala reactivity. Human Brain Mapping,

32(11), 1856–1867.

74 BIOLOGICAL BASES

Levesque, J., Joanette, Y., Mensour, B., Beaudoin,

G., Leroux, J. M., Bourgouin, P., et al. (2004).

Neural basis of emotional self- regulation in

childhood. Neuroscience, 129(2), 361–369.

Linden, D. E. J., Habes, I., Johnston, S. J., Lin-

den, S., Tatineni, R., Subramanian, L., et al.

(2012). Real- time self- regulation of emotion

networks in patients with depression. PLoS

ONE, 7(6), e38115.

Loo, C. K., Alonzo, A., Martin, D., Mitchell, P.

B., Galvez, V., & Sachdev, P. (2012). Transcra-

nial direct current stimulation for depression:

3-week, randomised, sham- controlled trial.

British Journal of Psychiatry, 200(1), 52–59.

Lozano, A. M., Mayberg, H. S., Giacobbe, P.,

Hamani, C., Craddock, R. C., & Kennedy,

S. H. (2008). Subcallosal cingulate gyrus

deep brain stimulation for treatment- resistant

depression. Biological Psychiatry, 64(6), 461–

467.

MacLeod, C., Mathews, A., & Tata, P. (1986).

Attentional bias in emotional disorders. Jour-

nal of Abnormal Psychology, 95(1), 15–20.

Mathers, C. D., Lopez, A. D., & Murray, C. J.

L. (2006). The burden of disease and mortal-

ity by condition: Data, methods, and results

for 2001. In A. D. Lopez, C. D. Mathers,

M. Ezzati, D. T. Jamison, & C. J. L. Murray

(Eds.), Global burden of disease and risk fac-

tors (pp. 45–241). New York: World Bank/

Oxford University Press.

Mayberg, H. S., Lozano, A. M., Voon, V.,

McNeely, H. E., Seminowicz, D., Hamani,

C., et al. (2005). Deep brain stimulation for

treatment- resistant depression. Neuron, 45(5),

651–660.

Meehl, P. E. (1975). Hedonic capacity: Some

conjectures. Bulletin of the Menninger Clinic,

39(4), 295–307.

Milad, M. R., & Quirk, G. J. (2002). Neurons

in medial prefrontal cortex signal memory for

fear extinction. Nature, 420(6911), 70–74.

Milad, M. R., & Quirk, G. J. (2012). Fear extinc-

tion as a model for translational neuroscience:

Ten years of progress. Annual Review of Psy-

chology, 63(1), 129–151.

Milad, M. R., Wright, C. I., Orr, S. P., Pitman,

R. K., Quirk, G. J., & Rauch, S. L. (2007).

Recall of fear extinction in humans activates

the ventromedial prefrontal cortex and hip-

pocampus in concert. Biological Psychiatry,

62(5), 446–454.

Mitchell, D. G. V. (2011). The nexus between

decision making and emotion regulation: A

review of convergent neurocognitive sub-

strates. Behavioural Brain Research, 217(1),

215–231.

Monk, C. S., McClure, E. B., Nelson, E. E.,

Zarahn, E., Bilder, R. M., Leibenluft, E., et al.

(2003). Adolescent immaturity in attention-

related brain engagement to emotional facial

expressions. NeuroImage, 20(1), 420–428.

Nelson, E. E., McClure, E. B., Monk, C. S.,

Zarahn, E., Leibenluft, E., Pine, D. S., et al.

(2003). Developmental differences in neuro-

nal engagement during implicit encoding of

emotional faces: An event- related fMRI study.

Journal of Child Psychology and Psychiatry

and Allied Disciplines, 44(7), 1015–1024.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 23–42). New York: Guilford

Press.

Padberg, F., & George, M. S. (2009). Repeti-

tive transcranial magnetic stimulation of the

prefrontal cortex in depression. Experimental

Neurology, 219(1), 2–13.

Perlman, G., Simmons, A. N., Wu, J., Hahn,

K. S., Tapert, S. F., Max, J. E., et al. (2012).

Amygdala response and functional connectiv-

ity during emotion regulation: A study of 14

depressed adolescents. Journal of Affective

Disorders, 139(1), 75–84.

Pezawas, L., Meyer- Lindenberg, A., Drab-

ant, E. M., Verchinski, B. A., Munoz, K. E.,

Kolachana, B. S., et al. (2005). 5-HTTLPR

polymorphism impacts human cingulate–

amygdala interactions: A genetic susceptibility

mechanism for depression. Nature Neurosci-

ence, 8(6), 828–834.

Phelps, E. A., Delgado, M. R., Nearing, K. I., &

LeDoux, J. E. (2004). Extinction learning in

humans: Role of the amygdala and vmPFC.

Neuron, 43(6), 897–905.

Posner, M. I., Snyder, C. R., & Davidson, B. J.

(1980). Attention and the detection of signals.

Journal of Experimental Psychology, 109(2),

160–174.

Ridderinkhof, K. R., Ullsperger, M., Crone, E.

A., & Nieuwenhuis, S. (2004). The role of the

medial frontal cortex in cognitive control. Sci-

ence, 306(5695), 443–447.

Rolls, E. T. (2004). The functions of the orbi-

tofrontal cortex. Brain and cognition, 55(1),

11–29.

Savitz, J., & Drevets, W. C. (2009). Bipolar and

major depressive disorder: Neuroimaging the

developmental- degenerative divide. Neuro-

The Neural Basis of Emotion Dysregulation 75

science and Biobehavioral Reviews, 33(5),

699–771.

Schaefer, H. S., Putnam, K. M., Benca, R. M.,

& Davidson, R. J. (2006). Event- related func-

tional magnetic resonance imaging measures

of neural activity to positive social stimuli in

pre- and post- treatment depression. Biological

Psychiatry, 60(9), 974–986.

Schardt, D. M., Erk, S., Nüsser, C., Nöthen, M.

M., Cichon, S., Rietschel, M., et al. (2010).

Volition diminishes genetically mediated

amygdala hyperreactivity. NeuroImage, 53(3),

943–951.

Scherer, K. R., Schorr, A., & Johnstone, T.

(2001). Appraisal processes in emotion: The-

ory, methods, research. New York: Oxford

University Press.

Schönfeldt- Lecuona, C., Lefaucheur, J.-P.,

Cardenas- Morales, L., Wolf, R. C., Kam-

mer, T., & Herwig, U. (2010). The value of

neuronavigated rTMS for the treatment of

depression. Neurophysiologie Clinique, 40(1),

37–43.

Schutter, D. J. L. G. (2009). Antidepressant effi-

cacy of high- frequency transcranial magnetic

stimulation over the left dorsolateral prefron-

tal cortex in double- blind sham- controlled

designs: A meta- analysis. Psychological Medi-

cine, 39(1), 65–75.

Schwartz, C. E., & Rauch, S. L. (2004). Temper-

ament and its implications for neuroimaging

of anxiety disorders. CNS Spectrums, 9(4),

284–291.

Schwartz, C. E., Wright, C. I., Shin, L. M.,

Kagan, J., & Rauch, S. L. (2003). Inhibited

and uninhibited infants “grown up”: Adult

amygdalar response to novelty. Science,

300(5627), 1952–1953.

Shackman, A. J., Sarinopoulos, I., Maxwell,

J. S., Pizzagalli, D. A., Lavric, A., & David-

son, R. J. (2006). Anxiety selectively disrupts

visuospatial working memory. Emotion, 6(1),

40–61.

Shin, L. M., & Liberzon, I. (2010). The neuro-

circuitry of fear, stress, and anxiety disorders.

Neuropsychopharmacology, 35(1), 169–191.

Slotema, C. W., Blom, J. D., Hoek, H. W., &

Sommer, I. E. C. (2010). Should we expand

the toolbox of psychiatric treatment methods

to include repetitive transcranial magnetic

stimulation (rTMS)? Journal of Clinical Psy-

chiatry, 71(7), 873–884.

Somerville, L. H., Wagner, D. D., Wig, G. S.,

Moran, J. M., Whalen, P. J., & Kelley, W. M.

(2012). Interactions between transient and

sustained neural signals support the genera-

tion and regulation of anxious emotion. Cere-

bral Cortex, 23(1), 49– 60.

Speer, A. M., Kimbrell, T. A., Wassermann, E.

M., Repella, J., Willis, M. W., Herscovitch,

P., et al. (2000). Opposite effects of high and

low frequency rTMS on regional brain activity

in depressed patients. Biological Psychiatry,

48(12), 1133–1141.

Staudinger, M. R., Erk, S., & Walter, H. (2011).

Dorsolateral prefrontal cortex modulates

striatal reward encoding during reappraisal of

reward anticipation. Cerebral Cortex, 21(11),

2578–2588.

Tomarken, A. J., & Keener, A. D. (1998). Fron-

tal brain asymmetry and depression: A self-

regulatory perspective. Cognition and Emo-

tion, 12(3), 387–420.

Urry, H. L., van Reekum, C. M., Johnstone, T.,

Kalin, N. H., Thurow, M. E., Schaefer, H.

S., et al. (2006). Amygdala and ventromedial

prefrontal cortex are inversely coupled during

regulation of negative affect and predict the

diurnal pattern of cortisol secretion among

older adults. Journal of Neuroscience, 26(16),

4415–4425.

Van Dillen, L. F., Heslenfeld, D. J., & Koole, S.

L. (2009). Tuning down the emotional brain:

An fMRI study of the effects of cognitive load

on the processing of affective images. Neuro-

Image, 45(4), 1212–1219.

van Reekum, C. M., Schaefer, S. M., Lapate, R.

C., Norris, C. J., Greischar, L. L., & David-

son, R. J. (2011). Aging is associated with

positive responding to neutral information but

reduced recovery from negative information.

Social Cognitive and Affective Neuroscience,

6(2), 177–185.

Wager, T. D., Davidson, M. L., Hughes, B. L.,

Lindquist, M. A., & Ochsner, K. N. (2008).

Prefrontal- subcortical pathways mediating

successful emotion regulation. Neuron, 59(6),

1037–1050.

Walker, D. L., Toufexis, D. J., & Davis, M.

(2003). Role of the bed nucleus of the stria

terminalis versus the amygdala in fear, stress,

and anxiety. European Journal of Pharmacol-

ogy, 463(1–3), 199–216.

Winecoff, A., LaBar, K. S., Madden, D. J.,

Cabeza, R., & Huettel, S. A. (2011). Cognitive

and neural contributors to emotion regulation

in aging. Social Cognitive and Affective Neu-

roscience, 6(2), 165–176.

Emotions take center stage in our lives

through the ways they influence how we

think and behave. Yet emotions are not

deterministic; just as much as they influ-

ence us, we have the ability to regulate and

change the way our emotional responses

unfold. Most research on emotion regula-

tion has focused on how people explicitly

(using deliberate, effortful means) accom-

plish the regulation of emotion (e.g., Och-

sner & Gross, 2005). We have previously

argued that it is useful to anchor emotion

regulatory processes along an implicit (non-

conscious, automatic) to explicit (deliberate,

effortful) dimension within a dual- process

framework (Gyurak, Gross, & Etkin, 2011).

In this chapter, we demonstrate the utility of

the implicit– explicit framework to organize

a wealth of neurobiological findings from

basic affective and clinical neuroscience.

We utilize this new expanded framework

to illustrate its benefits for understanding

healthy and disordered emotion regulatory

processes.

We present paradigmatic cases of explicit

and implicit regulation to highlight the par-

allels and differences between implicit and

explicit forms of regulation. We then explore

cases in which implicit and explicit regula-

tory processes blend together, to illustrate

the fluid boundaries between implicit and

explicit regulation in many emotion regula-

tory contexts. By anchoring this conceptual

framework in neurobiological findings, this

model of emotion regulation brings together

basic, clinical, neuroscientific, and trans-

lational research. Our goal in this chapter

is to demonstrate how an understanding

anchored at the implicit– explicit spectrum

informs an understanding of psychopathol-

ogy that cuts across traditional diagnostic

boundaries.

Component Processes

and Definition of Emotion Regulation

The Modal Model of Emotions

Using previous definitions (Gross & Thomp-

son, 2007; Gross, this volume) we define

“emotions” as interpersonal and transac-

tional (Keltner & Haidt, 2001) processes

that play out in the rich fabric of real or

imagined social relationships, for example,

feelings of embarrassment over a social faux

pas, or anger when one is slighted. Emotions

arise when individuals attend to a situation

and see it as relevant to their goals, either

in the short or long term (Levenson, 1999).

As emotions unfold, they engage loosely

coupled changes in the domains of subjec-

tive experience, behavior, and central and

peripheral physiology (Mauss, Levenson,

McCarter, Wilhelm, & Gross, 2005). Many

CHAPTER 5

A Neurobiological Model of Implicit

and Explicit Emotion Regulation

Anett Gyurak

Amit Etkin

Neurobiological Model of Implicit and Explicit Emotion Regulation 77

of the central and peripheral physiologi-

cal reactions have phylogenetic continuity

across species (LeDoux, 2012). Moreover,

these reactions simultaneously include pro-

cesses generally seen as “emotional” (e.g.,

a withdrawal response or a feeling), as well

as “cognitive” (e.g., an attentional focus on

a relevant stimulus; Pessoa, 2010). Finally,

emotions can be viewed as “push” forces

that predispose us to act in certain ways

(Frijda, 1987; Keltner & Gross, 1999; Lev-

enson, 2003).

Together, these features of emotion con-

stitute the modal model of emotion: a goal-

driven person– situation transaction that

structures attention, has particular meaning

to an individual, and gives rise to an evo-

lutionarily rooted coordinated yet flexible

multisystem response (Gross & Thompson,

2007; Gross, this volume). However, just

as emotions have many compulsory fea-

tures that are well- conserved evolutionarily,

emotions have also been understood to be

malleable since the work of William James

(1884). It is this latter aspect of emotion

that is most crucial for an analysis of emo-

tion regulation, because it is this feature that

makes any form of regulation possible.

Emotion Regulation

Following past work, we define “emotion

regulation” as functional processes that

influence the intensity, duration, and type

of emotion experienced (Gross & Thomp-

son, 2007). Emotion regulation permits

flexibility in emotional responding in accord

with one’s momentary as well as longer-

term goals. Emotion regulatory processes

may have their effects at one or more points

in the emotion generative process, and may

dampen, intensify, or simply maintain emo-

tions, depending on an individual’s current

implicit or explicit goals. Emotion regula-

tory processes may also change the degree to

which emotion response components cohere

as the emotion unfolds.

We conceptualize emotion regulation

as occurring along a spectrum from con-

scious, effortful, and controlled regulation

(which we call explicit) to unconscious, and

possibly effortless, or automatic regulation

(implicit). The history of explicit– implicit

process description in psychology has been

marked by arguments over terms and defini-

tions (Bargh, 1994; Moors & De Houwer,

2006). In general, attempts to create a clear

dichotomy capable of completely dividing

implicit and explicit processes have been

unsuccessful. Drawing on this body of lit-

erature, for the purposes of this review, we

define a spectrum, rather than discrete cat-

egories, and characterize explicit emotion

regulation as those processes that require

conscious effort for initiation, demand some

level of monitoring during implementation,

and are associated with some level of insight

and awareness. Implicit regulation, is evoked

automatically, run to completion with-

out monitoring, and can happen without

insight and awareness. As outlined below,

specific examples of types of emotion regu-

lation may vary with respect to the degree

of explicitness or implicitness and, as such,

this definition most clearly describes pro-

cesses at the extreme ends of this spectrum.

Our view is that there is scientific utility in

using the explicit– implicit spectrum: It is

more parsimonious to understand different

emotion regulatory paradigms currently in

the literature within this framework rather

than characterize each paradigm at the level

of constituent processes (level of monitoring,

awareness, etc.).

We view both implicit and explicit

forms of regulation as functional— as hav-

ing arisen to help navigate the rich social

world in which humans exist. The ability

to deploy either form of regulation flexibly

in a context- sensitive manner might be a

marker of mental health. Additionally, the

conscious, effortful operations of explicit

emotion regulatory processes are useful in a

variety of contexts for adjusting emotional

reactions. Because of its cognitively demand-

ing nature, however, explicit regulation is

not something in which one can effectively

engage all of the time. Rather, use of effi-

cient implicit emotion regulation processes,

which may run without awareness, is likely a

critical component to well-being and every-

day emotional functioning.

Most contexts in which emotions are reg-

ulated involve a variable mixture of implicit

and explicit processes. The degree to which

ongoing regulation is implicit or explicit

may also change depending on the individ-

ual, context, or time course of the emotion

or its regulation. For example, a particular

regulatory process may be explicit in healthy

78 BIOLOGICAL BASES

individuals (suppressing a testy response to

a colleague) but implicit in patients (expres-

sive suppression), in whom it may have been

automatized through overrepetition, to the

point that it has become habitual. Addition-

ally, explicit and implicit regulation change

in quick succession within one person over

time. For example, one might go from con-

sciously labeling one’s feelings of frustration

at work to reflexively looking at the positive

outcome that might result from putting in

the extra time.

Taken together, our proposal is that it is

most fruitful to view emotion regulation as

reflecting a spectrum of processes, rang-

ing from the mostly explicit to the mostly

implicit. In applying this framework and

systematically testing its components we

can gain important insights into the neu-

ral circuits that are critical for the dynamic

process of emotion regulation, and into the

utility of implicit and explicit processes and

their relevance for well-being and, by exten-

sion, psychopathology.

Core Neural Structures

of Emotion Regulation

Our focus in this chapter is on neurobiologi-

cally investigated paradigms of emotion reg-

ulation. This section provides a brief over-

view of the core structures in the prefrontal

cortex that are thought to be critical for

the monitoring and regulation of emotion.

Figure 5.1 introduces the lateral– medial

gradient along which explicit and implicit

processes can be usefully lined up along.

We then expand on these as we review each

paradigm below.

The Lateral Prefrontal Cortex

The dorsolateral (dlPFC) and ventrolateral

(vlPFC) prefrontal cortices are commonly

associated with emotion regulation (e.g.,

Kalisch, 2009). Along with their role in

cognitive control and executive function-

ing, these regions are typically described in

the context of deliberate, effortful, and con-

scious regulation of emotion (Gyurak et al.,

2011). However, as described earlier, emo-

tion regulation can occur more reflexively

and outside of our awareness, and this type

of regulation implicates more medial pre-

frontal regions and might be more directly

relevant to fear- and anxiety- related regula-

tion (Gyurak et al., 2011).

The Medial Prefrontal Cortex

Regions of the medial frontal lobes, includ-

ing the ventral portions of the anterior cin-

gulate cortex (vACC) and ventromedial

prefrontal cortex (vmPFC) have long been

implicated in emotional processes, specifi-

cally in regulation of emotions. We review

relevant evidence in turn below. In addi-

tion to emotion regulation, these regions

are important in fear extinction and recall-

ing inhibitory extinction memories a day

or more after training (Milad et al., 2009;

Phelps, Delgado, Nearing, & LeDoux,

2004). Similarly, the vACC/vmPFC is acti-

vated when exposure to a distant versus

close threat occurs, suggesting that it may

be involved in planning adaptive responses,

a regulatory function (Mobbs et al., 2007).

The vACC/vmPFC shows negative func-

tional connectivity with the amygdala in a

range of emotional tasks and has anatomical

connectivity to the amygdala (Myers- Schulz

& Koenigs, 2012). Finally, during explicit

emotion regulation, the vACC may also act

as an intermediary between dlPFC and the

amygdala (Ochsner & Gross, 2005).

Selected Empirical Findings

across the Spectrum

of Emotion Regulation

Below we review a number of neurobiologi-

cally investigated examples of emotion regu-

latory processes along the explicit– implicit

spectrum. Though these examples are

ordered roughly in the degree to which they

involve implicit or explicit processes, we

remind the reader of the fluid and relative

nature of implicit and explicit regulatory

processes. We review the relevance of each

example for increasing our understanding

of psychopathology. We start on the implicit

end.

Regulation of Emotional Conflict

Our first case of implicit emotion regula-

tion is based on the emotional conflict task

(Egner, Etkin, Gale, & Hirsch, 2008; Etkin,

Neurobiological Model of Implicit and Explicit Emotion Regulation 79

Egner, Peraza, Kandel, & Hirsch, 2006).

The task is the emotional analogue of the

classic Stroop paradigm (Stroop, 1935), and

takes advantage of a variant of the congru-

ency sequence effects originally reported by

Gratton, Coles, and Donchin (1992) in non-

emotional conflict tasks (Botvinick, Nys-

trom, Fissell, Carter, & Cohen, 1999). In the

emotional conflict task, participants are pre-

sented with photographs of emotional faces

(fearful or happy) with the words fear or

happy written over them. The task is to indi-

cate whether the facial expression is happy

or fearful by pressing a button and to do this

fast and accurately. The word written on the

photo either matches the facial expression

(no- conflict trials: happy face with the word

happy written over it, or fearful face with

the word fear written over it) or is incongru-

ent with the facial expression (conflict tri-

als: happy face with the word fear written

over it, or fearful face with the word happy

written over it). Because reading is automa-

tized (Stroop, 1935), during conflict tri-

als, participants need to enact control over

reading the word in favor of labeling the

emotional expression. Consistent with this,

it takes longer to respond to conflict trials

than to no- conflict trials; this slow-down in

response time due to emotional conflict has

been termed the congruency effect. Implicit

emotion regulation in this task is indexed

by trial-to-trial changes in the congruency

effect as a function of the congruency effect

on the previous trial (trial n – 1). Specifically,

conflict on trial n – 1 triggers an increase in

regulation, thereby reducing susceptibility

to emotional conflict on trial n. Consistent

with this, response times to incongruent tri-

als are usually faster after incongruent tri-

als (iI = current Incongruent preceded by an

incongruent trial) than after congruent trials

FIGURE 5.1. Putative foci for implicit and explicit forms of emotional regulation on a spectrum. Foci

plotted are approximate; x coordinate = –2 for visualization purposes on the medial slice.

Emotional conflict adaptation, x = –2, y = 44, z = 2; from Egner et al. (2008)

Reappraisal, calculated as the mean of the absolute values of all vLPFC and dlPFC

activation in Study 2a plotted on the right hemisphere for illustrative purposes, x = 42,

y = 27, z = 21; from Kalisch (2009)

Anticipation, x = –2, y = 40, z = 7; from Straube et al. (2009)

Habituation, x = –2, y = 44, z = 2; from Hare et al. (2008)

Extinction, x = –2, y = 23, z = –8; from Milad et al. (2009)

Verbal labeling (triangles in the medial and lateral prefrontal cortices), x = –2, y = 48,

z = 16 and, x = 24, y = –10, z = 44, respectively; from Lieberman et al. (2007)

80 BIOLOGICAL BASES

(cI = current Incongruent preceded by a con-

gruent trial). Implicit emotion regulation is

therefore quantified by contrasting response

times on iI with cI trials. This behavioral

slowdown effect was shown to occur outside

of awareness (Etkin, Prater, Hoeft, Menon,

& Schatzberg, 2010). The task qualifies as

an emotion regulation paradigm, because

the stimulus itself evokes behavioral adjust-

ment in the context of the goal of responding

fast and accurately to emotionally conflict-

ing stimuli. This task fits our definition of

implicit regulation because the process is

uninstructed, likely results from the stimu-

lus properties itself, and is effortless and

proceeds without awareness; despite care-

ful probing, participants do not report any

awareness of the key processes of the task

(Etkin et al., 2010).

Parallel imaging (Egner et al., 2008) and

lesion (Maier & di Pellegrino, 2012) studies

of regulation of nonemotional conflict sug-

gest that key elements of the neural circuitry

involved in implicit regulation of emotional

conflict is specific to the emotional content.

Specifically, neuroimaging studies suggest a

regulatory interplay between anterior cin-

gulate cortex (ACC) and emotion reactivity

regions in the limbic system in the emotional

conflict task: increased activation in the

vACC, and dampened reactivity in the amyg-

dala (Etkin et al., 2006; Etkin et al., 2010;

see Figure 5.1). In the nonemotional ana-

logue of the task, in which subjects judged

the gender of emotional faces, while trying

to ignore congruent or incongruent gender

labels, regulation was achieved through

a dissociable neural pathway, involving

increased activation in the dlPFC, and posi-

tive coupling to target- specific visual corti-

cal areas in the fusiform face area, and as

such, activation of the vACC and dampen-

ing of amygdalar reactivity was specific to

implicit emotion regulation (Egner et al.,

2008).

Applications of this task to clinical disor-

ders revealed a marked deficit both behav-

iorally and in neural network engagement as

a function of anxiety and depression (Etkin

et al., 2010; Etkin & Schatzberg, 2011). Spe-

cifically, nonmedicated patients with either

generalized anxiety disorder (GAD) or

comorbid depression and GAD were unable

to regulate the effect of emotional conflict

as compared to healthy controls. Further-

more, analysis of functional magnetic reso-

nance imaging (fMRI) data acquired during

the emotional conflict task revealed that

patients with GAD or depression failed to

engage the circuitry normally implicated

in this task. Specifically, patients failed to

activate the vACC during regulation of emo-

tional conflict and to dampen emotional

conflict evaluation- related activity in the

amygdala. These data indicate that regula-

tion of emotional conflict, as a prototypi-

cal exemplar of implicit emotion regulation,

captures the critical inability of patients to

manage emotional processing and engage in

task- related behavior.

Extinction and Habituation

Both extinction and habituation are basic

forms of learning that are important for

adaptive behavioral responding to emotional

challenges. Both of these qualify as emotion

regulation because they underlie the ability

to change emotional responding to fit situa-

tional demands. Both of these processes have

aspects that happen outside of conscious

awareness and, as such, share implicit emo-

tion regulatory elements but are likely to be

a blend of implicit and explicit processes in

humans, as detailed below (Delgado, Near-

ing, LeDoux, & Phelps, 2008; Dijksterhuis

& Smith, 2002; Lovibond, 2004).

Extinction involves repeated presenta-

tion of an innocuous stimulus (e.g., a blue

cross) that was previously associated with

an aversive stimulus (e.g., a loud noise) and

had acquired the ability to elicit a defensive

response (e.g., startle eyeblink) in the absence

of the aversive stimulus. Through repeated

presentation without the aversive outcome,

a new inhibitory memory is formed between

the innocuous stimulus and absence of the

aversive outcome, such that the conditioned

defensive reaction is no longer elicited. Even

though extinction can happen without the

individual being aware of the change in

contingency, consciously registering the

contingency changes during extinction has

been shown to facilitate extinction (for a

review, see Lovibond, 2004). This evidence

implicates the presence of both implicit and

explicit processes in extinction.

Importantly, the neural circuitry support-

ing extinction shares common elements with

the circuitry mapped out for the regulation

Neurobiological Model of Implicit and Explicit Emotion Regulation 81

of emotional conflict (i.e., vACC and amyg-

dala). Specifically, the vACC and adjacent

vmPFC reduce fear responses through inter-

connections with the amygdala and hippo-

campus during extinction learning and recall

of extinction memories (Ehrlich et al., 2009;

Milad & Quirk, 2002; Phelps, Delgado,

Nearing, & LeDoux, 2004). More success-

ful extinction is associated with decreased

conditioned stimulus (CS)-driven activa-

tion in the dorsal anterior cingulate cortex

(dACC) in human (Milad et al., 2009) and

animal models (Livneh & Paz, 2012). This

is consistent with a recent review of the role

of the dACC in evaluation and expression of

negative emotion (Etkin, Egner, & Kalisch,

2011) and suggest the presence of a second

pathway between the dACC and the amyg-

dala where activation might be actually det-

rimental to extinction of fear memories.

Clinical models document impaired

extinction behaviorally in posttraumatic

stress disorder (PTSD; Norrholm et al.,

2011; Wessa & Flor, 2007; for a review, see

Lissek et al., 2005). Behavioral symptoms

in GAD and specific anxiety disorders also

indicate an inability to inhibit dysfunctional

fear responses. In addition, the presence of

safety and avoidance behaviors in these dis-

orders might function to prevent the uncou-

pling of fear responses (Graham & Milad,

2011; Milad et al., 2009). Consistent with

this, heightened amygdala activation was

documented in PTSD during fear extinction

following fear conditioning (Milad et al.,

2009). However, there were no differences

in behavioral or neural patterns of extinc-

tion as a function of social anxiety (Pejic,

Hermann, Vaitl, & Stark, 2011), which

might suggest preservations of extinction in

social anxiety.

Habituation is the adaptive reduction of

the initial response to emotional stimuli that

carries no immediate reward or punishment

value to the individual. A typical paradigm

used in studying the neurobiological sub-

strates of habituation in humans is to repeat-

edly present emotionally salient stimuli (e.g.,

emotional faces) over several runs of the scan

and look at the time course of the neuronal

signal change from early to late trials (Hare

et al., 2008) within regions typically asso-

ciated with processing the stimuli. Behav-

ioral manipulations of attention to different

aspects of the stimulus have been shown to

alter the rate of habituation to nonemotional

stimuli (e.g., tones; Gruzelier & Eves, 1987),

suggesting that there are both implicit and

explicit processes at play in habituation.

Studies have shown that the signal from

the amygdala is reliably reduced as partici-

pants repeatedly encounter a salient but emo-

tionally nonrewarding or punishing stimu-

lus (Fisher et al., 2009; Hare et al., 2008).

The extent of habituation, however, appears

to be a function of the engagement of medial

PFC circuitry that overlaps with the circuit

associated with regulation of emotional

conflict (i.e., vACC). For example, during

habituation, engagement of the medial PFC

is related to lower amygdala responses (Hare

et al., 2008). A recent fMRI–PET (positron

emission tomography) study also showed

that higher density of serotonergic neurons

in the vACC—considered an indicator of the

capacity to modulate emotional arousal— is

related to better habituation to negative faces

and lower amygdala responses (Fisher et al.,

2009). Failure of habituation of the amyg-

dala has also been documented in severely

inhibited individuals (Blackford, Allen,

Cowan, & Avery, 2013) and in high trait

anxiety (Hare et al., 2008) as well as PTSD

(Shin et al., 2005). Furthermore, impaired

habituation of auditory startle responses (a

process mediated through the amygdala)

was found to be a marker of later develop-

ment of PTSD in a longitudinal study (Pole

et al., 2009).

Anticipatory Responding

to Emotional Stimuli

Anticipation of negative emotional events

prepares the individual to respond adaptively

and flexibly to actual emotional challenges

as they arise. This process has typically

been studied in experimental paradigms by

presenting cues that with some probability

predict the occurrence of a threatening or

negative event (e.g., electric shock, thermal

pain, negative image) (Drabant et al., 2011;

Nitschke et al., 2009; Straube, Schmidt,

Weiss, Mentzel, & Miltner, 2009). Anticipa-

tory responding fits our definition of emotion

regulation, because it allows the individual

to optimize and prepare future responding

in the face of an emotional challenge. The

conscious anticipatory component gives a

more explicit flavor to these paradigms, but

82 BIOLOGICAL BASES

in the absence of explicit instruction to regu-

late the response, the implicit component is

retained.

More importantly, these paradigms have

proved to be useful in mapping the neu-

ral circuits associated with anticipatory

responses and associated anxiety. These

results show the involvement of the vACC

and the broader ACC with typically higher

activation during anticipation (Butler et

al., 2005; Nitschke et al., 2009; Ploghaus,

Becerra, Borras, & Borsook, 2003;

Ploghaus et al., 1999; Straube et al., 2009),

and often tracking concomitant anxiety.

Sarinopoulos et al. (2010) reported that

anticipatory activation in the vACC follow-

ing uncertain cues was related to systematic

overestimation of the frequency with which

the cue was predictive of aversive images.

In terms of the relationship to anticipa-

tory responding, informative moderation

effects have been found. Specifically, dur-

ing moderate levels of threat (mildly pain-

ful electric shock), higher vACC activation

was related to higher anticipatory prepared-

ness, whereas during high levels of threat

of electric shocks, higher vACC activation

was related to lower anticipatory prepared-

ness (Straube et al., 2009), suggesting that

higher vACC activation indices anticipa-

tory preparedness, whereas deactivation

might track disengagement from the task,

a perhaps more explicit form of regulation.

vACC activation was also documented in

a virtual chasing game while participants

expected painful levels of electric shocks,

and this activation increased as a function

of anticipated pain (Mobbs et al., 2007).

Clinically, abnormalities in activation

to anticipatory cues preceding negative

anxiety- provoking images have been docu-

mented in GAD (Nitschke et al., 2009). Sim-

ilarly, patients with unipolar major depres-

sive disorder (Abler, Erk, Herwig, & Walter,

2007) also showed higher amygdala acti-

vation compared to healthy controls while

anticipating negative pictures.

Incidental Regulation

through Language

Goal- directed engagement of higher order

cognitive processes, such as language, in

emotional contexts can have “acciden-

tal” emotion regulatory consequences. In

experimental paradigms, participants are

instructed to label the emotion displayed

on a face (e.g., indicate whether the face is

angry or afraid), match the affect shown on

the face to another face showing the same

emotion, or match the gender of the face

(Hariri, Bookheimer, & Mazziotta, 2000;

Lieberman et al., 2007; Lieberman, Hariri,

Jarcho, Eisenberger, & Bookheimer, 2005).

There are important similarities between

verbal labeling as done in this task and cre-

ation of a verbal narrative that is supposed

to lessen emotional arousal seen in explicit

regulatory tasks. Because of these parallels,

the task fits our definition of emotion regu-

lation, as it results in the regulation of emo-

tional arousal in a goal- directed fashion.

Semantically labeling emotional stimuli, or

“putting feelings into words,” as these para-

digms are typically described, versus match-

ing the emotion on another face or labeling

the gender has a marked explicit compo-

nent, yet the regulation still happens in the

absence of an explicit goal to do so.

At the neural level, matching emotional

expressions on faces with words that label

affect results in lower amygdala activation,

as compared to matching expressions to

other expressions, matching the gender to

gender labels, or simply viewing the face.

Moreover, labeling the emotion of facial

expressions or focusing on physical rather

than emotional features of an emotionally

evocative scene results in increased activa-

tion in the lateral and medial prefrontal cor-

tices, despite the fact that emotion regulation

in this paradigm is unintentional or implicit

(Hariri et al., 2000; Lieberman et al., 2005).

Importantly, Lieberman and colleagues

(2007) documented that a vmPFC activation

mediated the relationship between lateral

PFC and decreased amygdala activity, sug-

gesting that similar to implicit emotion regu-

lation, it may be the medial PFC–amygdala

pathway that plays a critical role in dampen-

ing emotional reactivity in these tasks (see

Figure 5.1).

Variants of the affect- labeling task have

been used in pediatric anxiety and mood

disorder populations with or at-risk for psy-

chopathology (Beesdo et al., 2009; Monk

et al., 2007; Taylor, Eisenberger, Saxbe,

Lehman, & Lieberman, 2006). These stud-

ies show that among at-risk adolescents,

focusing attention on the physical features

of an emotional face (nose width) or label-

ing one’s subjective emotions while viewing

Neurobiological Model of Implicit and Explicit Emotion Regulation 83

an emotional face, normalized concomitant

neural activation in the PFC and amygdala.

Similarly, McClure and colleagues (2007)

found that the performance of children

with GAD did not differ from that of their

healthy counterparts in rating physical fea-

tures of negative emotional faces, and that

they recruited the same amygdala, dACC,

and vmPFC networks as their healthy ado-

lescent counterparts. However, in another

study, Taylor et al. (2006) found that chil-

dren from high- stress family environments

showed higher amygdala and dlPFC activa-

tion during an affect labeling of faces task

than children from low-risk families, who

showed lower amygdala activation during

affect labeling. Low-risk children did not

differ in dlPFC activation. Taken together,

these result shows that disordered and at-

risk children are capable of labeling as a

form of regulation behaviorally, and they

might do so largely through the normative

circuitry.

Instructed Regulation

of Emotional Responses

A paradigmatic case of explicit regulation

may be found in work by James Gross and

colleagues (e.g., Gross & Levenson, 1993;

McRae et al., 2010; Ochsner, Bunge, Gross,

& Gabrieli, 2002). As reviewed by Ochsner

and Gross (this volume), in a typical test of

explicit emotion regulation, participants are

presented with a task that involves process-

ing stimuli under two different conditions—

one in which participants are instructed to

react naturally (reactivity trial), and another

in which they are instructed to regulate

their emotional responses (regulation trial)

using a strategy specified by the researcher

that participants have had ample opportu-

nity to practice beforehand. Explicit emo-

tion regulation performance is indexed

by contrasting emotional responses in the

reactivity and regulation trials. These tasks

fit our definition of explicit emotion regu-

lation, because the process is effortful and

carried out with considerable awareness

and monitoring. Specifically, individuals are

(1) aware of the cues that elicit emotional

responses (i.e., images, films), (2) aware of

the emotion itself (i.e., they report reduc-

tion in accompanying feelings), and (3)

aware of the effect of the regulation on their

behavior (i.e., if prompted, they can report

having engaged in emotion regulation).

Often- studied forms of explicit regulation

are reappraisal, in which participants are

instructed to attempt to change the way they

think about the emotional event so that they

feel less negative emotions, and suppression,

in which participants are instructed not to

show how they feel.

Neuroimaging studies show that reap-

praisal results in a dynamic interchange

between frontal lobe areas implicated in

cognitive control and executive function,

and emotion reactivity areas (for reviews, see

Ochsner & Gross, 2005; Ochsner & Gross,

this volume; Kalisch, 2009). Specifically,

imaging studies indicate that attempts to

reappraise negative stimuli result in increased

activation in ventrolateral (vlPFC), dlPFC,

dACC—areas traditionally implicated in

non- emotional forms of cognitive control

(Kalisch, 2009). This frontal lobe activa-

tion in turn is related to reduced activation

in emotional reactivity- related areas (amyg-

dala and insula), suggesting that engage-

ment of control- related circuitry dampens

reactivity in these critical emotion reactiv-

ity regions (Banks, Eddy, Angstadt, Nathan,

& Phan, 2007; Goldin, McRae, Ramel, &

Gross, 2008; Ochsner et al., 2002; Wager,

Davidson, Hughes, Lindquist, & Ochsner,

2008). Furthermore, there appears to be a

temporal specificity in the engagement of

frontal lobe regions as a function of imple-

mentation stage (Paret et al., 2011). Specifi-

cally, Kalisch and colleagues (Kalisch, 2009;

Paret et al., 2011) propose that instructed

reappraisal can be partitioned into two

temporarily distinct phases: an early phase

of implementation that comprises strategy

selection and retrieval of reappraisal mate-

rial into working memory, and a later phase

of maintenance of performance- monitoring

processes. Corresponding shifts in the

recruitment of the lateral PFC are observed

as a function of these phases from posterior

to anterior parts of the lateral frontal cortex

(Paret et al., 2011).

Assessment of instructed emotion regula-

tory abilities in clinical populations, how-

ever, has produced mixed results. There

appears to be agreement that behavior-

ally, patients with mood and anxiety dis-

orders are not deficient in using regulation

when instructed to do so in the laboratory

(Ehring, Tuschen- Caffier, Schnülle, Fischer,

& Gross, 2010; Goldin, Manber, Hakimi,

84 BIOLOGICAL BASES

Canli, & Gross, 2009; Goldin, Manber-

Ball, Werner, Heimberg, & Gross, 2009),

but they might spontaneously use certain

beneficial forms of regulation such as reap-

praisal less frequently, or report feeling less

successful in regulating their emotions as

a result (Gruber, Harvey, & Gross, 2012).

By contrast, a variety of neural deficits have

been found in different patient groups. For

example, currently depressed patients acti-

vated bilateral PFC during reappraisal of

negative scenes, while healthy subjects did

so only unilaterally (Johnstone et al., 2007).

in another study, there was a lack of dlPFC

activation in patients with major depressive

disorder altogether, but activated dACC,

amygdala, and insular cortices (Beauregard,

Paquette, & Lévesque, 2006). Patients with

social anxiety disorder showed delayed but

overall enhanced engagement of dlPFC and

dACC when instructed to reappraise nega-

tive self- relevant thoughts (Goldin, Man-

ber-Ball, et al., 2009). By contrast, during

reappraisal of angry/contemptuous faces,

patients with social anxiety disorder failed

to activate dACC and anterior medial fron-

tal cortex (neither dlPFC nor vlPFC were

involved in this task; Goldin, Manber-Ball,

et al., 2009). Patients with GAD and social

phobia both failed to activate the dACC

when reappraising either positive or negative

pictures (no dlPFC or vlPFC was involved in

this task; Blair et al., 2012). Finally, trauma

exposed patients with borderline personality

disorder hypoactivated lateral and medial

PFC more during reappraisal of negative

scenes, relative to trauma- exposed healthy

controls. Taken together, these results

show a rather mixed set of abnormalities in

instructed emotion regulation, with differ-

ences likely due to different tasks, stimuli,

or instructions. Regardless, explicit regula-

tion at the behavioral level does not appear

to be perturbed in psychiatric disorder, even

if patients recruit different neural circuits.

Impairments may exist, however, in the

spontaneous and potentially more implicit

engagement of these effortful forms of regu-

lation.

Implications and Future

Research Directions

Our goal in this review was to provide a

unifying conceptual framework for emotion

regulation, highlighting and expanding our

prior model of an implicit– explicit emotion

regulatory spectrum. We have argued sev-

eral key points.

First, types of emotion regulation vary in

the degree to which they are implicit versus

explicit. We demonstrated that the rela-

tive degree of implicit or explicit features

depends on multiple factors, including the

stimulus, task, context, individual differ-

ences, psychopathology, and time. Com-

pounding this complexity, we showed that

many existing experimental paradigms

involve various admixtures of implicit and

explicit types of emotion regulation. Greater

attention should therefore be paid to the

implications of these design features in light

of a conceptualization of implicit regulation.

Studies need to address the relative degree to

which regulation is at any time implicit or

explicit in both existing and new paradigms.

Probing awareness about regulation is one

way to assess implicitness versus explicit-

ness. Other factors that influence whether

a particular regulatory task is implicit or

explicit are personality features, such as low

trait rumination, which might predispose

individuals to have more automatic tenden-

cies to use reappraisal, and they might do so

in a more implicit, automatic fashion (Ray et

al., 2005). Another example is pathological

worry in GAD (Borkovec, Alcaine, & Behar,

2004), which might parallel explicit forms

of regulation by virtue of engaging effort-

ful resources (e.g., prefrontal areas). This

in turn might influence the ability of people

with GAD engage explicit regulation in a

goal- directed fashion.

Additionally, several researchers have

pointed out the inherent difficulties involved

in differentiating emotional regulation from

emotional reactivity, with some questioning

the utility of emotion regulation as a scien-

tific construct altogether (Campos, Frankel,

& Camras, 2004; Cole, Martin, & Dennis,

2004). Neuroimaging studies get around

this problem and routinely include a con-

trasting control condition when the effects

of emotion regulation are compared to those

of canonical emotional reactivity trials (i.e.,

adaptation to emotional conflict is a contrast

between iI and cI conditions; reappraisal is

a contrast between uninstructed “watch”

trials and instructed regulation). However,

studies that purportedly measure the effects

of spontaneous use of effortful regulation

Neurobiological Model of Implicit and Explicit Emotion Regulation 85

often do not include a contrasting reactiv-

ity condition and do not carefully control

for the effects of reactivity. Future research

has to address emotional reactivity by sys-

tematically including a baseline unregulated

condition, in addition to assessing implicit

and explicit features. Future studies examin-

ing the explicit– implicit dimension system-

atically should also test the separability and

interactions between these circuits.

Second, we showed that there appears

broadly to be a medial– lateral differentiation

between implicit and explicit regulatory pro-

cesses (see Figure 5.1). That is, paradigmatic

forms of implicit emotion regulation (e.g.,

emotional conflict regulation) involve ven-

tromedial prefrontal regions in regulation,

while paradigmatic forms of explicit regula-

tion (e.g., reappraisal) involve mainly dlPFC

and vlPFC for regulation. Other forms of

regulation that contain a mixture of implicit

and explicit processes (e.g., language- based

incidental regulation) involve roles for both

lateral PFC and vmPFC. While we do not

consider this medial– lateral gradient to be

an absolute rule, neither would we be con-

fident in interpreting medial or lateral acti-

vation differences in patients as necessarily

reflecting deficits in implicit or explicit regu-

lation, respectively; this model provides a

useful framework for describing the range of

emotion regulation processes, anchored in

relevant neurocircuitry. Moreover, we would

readily concede that our framework is useful

for anchoring our theoretical understanding

of emotion regulation, but it is unlikely that

implicit and explicit modules per se exist at

the level of the brain. Future research might

parse the operations of implicit and explicit

regulation into circuit- level components

(e.g., working memory, interference resolu-

tion) and our understanding of the implicit–

explicit anchors might transform as our

understanding of the interactions between

participating brain areas develops. Our

goal was to illustrate the fluid boundaries

between implicit and explicit forms of regu-

lation, and move away from characterizing

implicit and explicit regulation in a dichoto-

mous fashion. New paradigms in which the

level of explicitness and implicitness is para-

metrically manipulated (e.g., in the form of

increased explicit regulatory effort in the

context of an otherwise implicit regulatory

process or by repetitively training explicit

regulation until it becomes automatized)

will allow us to ground implicit and explicit

regulation in neurobiology and further chart

the interactive and dynamic processes by

which the brain accomplishes regulation.

Our third point is that in striving for a

neurobiological understanding of emotion

regulation and developing these new para-

digms, it will be important to refine the

circuitry underlying implicit and explicit

regulation. The human brain is likely to

accomplish emotion regulation through an

economical process that relies on a distrib-

uted network of brain areas. Three brain

areas highlighted here as underlying implicit

and explicit forms of regulation (medial

PFC and dlPFC/vlPFC, respectively) have

been documented to be involved in a wide

array of processes besides emotion regula-

tion. In this vein, further research will likely

broaden our understanding of the relevant

circuitry and how these functions relate to

the variety of implicit and explicit regula-

tory mechanisms. Moreover, most studies

focused on corticoamygdalar circuitry, but

less attention has been paid to the role of the

insula and midbrain structures essential for

emotional processing (e.g., periaqueductal

gray). The role of these nodes in the emotion

regulatory circuitry with respect to implicit

and explicit features remains to be explored.

Another important element that has thus

far been unmapped in terms of implicit

and explicit regulation is the modulation

of approach tendencies and positive emo-

tions (e.g., reward). There is evidence that

approach might also be regulated in an

implicit and explicit fashion through some-

what dissociable circuitry (Kable & Glim-

cher, 2007; McClure, Laibson, Loewenstein,

& Cohen, 2004). For example, value-based

decision making about food while focusing

on the health aspect of the stimuli modu-

lates activation in medial prefrontal regions

that overlap with the vACC region mapped

to types of implicit regulation, such as emo-

tional conflict adaptation, and this modula-

tion seems to be orchestrated by the dlPFC,

which is involved in more explicit forms

of regulation (Hare, Malmaud, & Ran-

gel, 2011). Additionally, explicit regulation

of monetary rewards in a group of self-

assessed, successful regulators was related

to lower striatal activation and fewer risky

behavioral choices (Martin & Delgado,

2011), but without medial prefrontal or

dlPFC involvement. These findings in the

86 BIOLOGICAL BASES

realm of positive approach related will need

to be integrated into our explicit– implicit

framework through systematic studies that

manipulate explicitness and implicitness in

the context of positive emotions.

Our fourth point is that better definition

of implicit and explicit tasks at the process

level, and a refined understanding of the

neural circuits involved, will help concret-

ize how we can best improve these functions

using targeted, neurobiologically derived,

customized, and adaptive training meth-

ods (e.g., Vinogradov, Fisher, & de Villers-

Sidani, 2011). One question is whether tar-

geted training aimed at the dlPFC and vlPFC

will impart emotion regulatory benefits, and

whether these benefits will be evident in

implicit or explicit regulatory tasks.

As our fifth point, we presented evidence

that difficulties in emotion regulation in

psychiatric disorders cut across implicit and

explicit types. Specifically, we found behav-

ioral and neural deficits in implicit forms of

regulation: emotional adaptation; habitua-

tion; and documented, more subtle, largely

neural deficits in more explicit forms of reg-

ulation (affect labeling and instructed reap-

praisal). These results support clinical obser-

vations of pervasive emotion regulatory

symptoms in psychopathology and provide

neurobiological anchors for the observed

deficits that might track with treatment.

Conclusions

Strategies that individuals use to alter their

emotions affect not only their current emo-

tional experience but also broader emo-

tional, cognitive, and interpersonal func-

tioning. Thus, emotion regulation is of clear

importance for both basic and applied trans-

lational investigations. Implicit processes

are hidden for measurement reasons but

are now more tractable, thanks to neurosci-

ence methods. We have reached an exciting

point at which neurobiologically anchored

understanding of both implicit and explicit

processes is rapidly advancing. Implicit and

explicit processes arose to help us navigate

our social and emotional worlds, and it is

important that we conduct systematic stud-

ies on this domain. Our hope is that a uni-

fying framework will facilitate this process

and result in research advances for both

basic and translational affective neurosci-

ence fields.

References

Abler, B., Erk, S., Herwig, U., & Walter, H.

(2007). Anticipation of aversive stimuli acti-

vates extended amygdala in unipolar depres-

sion. Journal of Psychiatric Research, 41(6),

511–522.

Banks, S. J., Eddy, K. T., Angstadt, M., Nathan,

P. J., & Phan, K. L. (2007). Amygdala– frontal

connectivity during emotion regulation. Social

Cognitive and Affective Neuroscience, 2(4),

303–312.

Bargh, J. A. (1994). The four horsemen of auto-

maticity: Awareness, intention, efficiency, and

control in social cognition. In R. S. Wyer &

T. K. Srull (Eds.), Handbook of social cogni-

tion (2nd ed., Vol. 1, pp. 1–40). Hillsdale, NJ:

Erlbaum.

Beauregard, M., Paquette, V., & Lévesque, J.

(2006). Dysfunction in the neural circuitry of

emotional self- regulation in major depressive

disorder. NeuroReport, 17(8), 843–846.

Beesdo, K., Lau, J. Y. F., Guyer, A. E., McClure-

Tone, E. B., Monk, C. S., et al. (2009). Common

and distinct amygdala- function perturbations

in depressed vs. anxious adolescents. Archives

of General Psychiatry, 66(3), 275–285.

Blackford, J. U., Allen, A. H., Cowan, R. L.,

& Avery, S. N. (2013). Amygdale and hip-

pocampus fail to habituate to faces in indi-

viduals with an inhibited temperament. Social

Cognitive and Affective Neuroscience, 8(2),

143–150.

Blair, K. S., Geraci, M., Smith, B. W., Hollon, N.,

DeVido, J., Otero, M., et al. (2012). Reduced

dorsal anterior cingulate cortical activity dur-

ing emotional regulation and top-down atten-

tional control in generalized social phobia,

generalized anxiety disorder, and comorbid

generalized social phobia/generalized anxiety

disorder. Biological Psychiatry, 72(6), 476–

482.

Borkovec, T. D., Alcaine, O. M., & Behar, E.

(2004). Avoidance theory of worry and gener-

alized anxiety disorder. In R. G. Heimberg, C.

L. Turk, & D. S. Mennin (Eds.), Generalized

anxiety disorder: Advances in research and

practice (pp. 77–108). New York: Guilford

Press.

Botvinick, M., Nystrom, L. E., Fissell, K., Carter,

C. S., & Cohen, J. D. (1999). Conflict moni-

Neurobiological Model of Implicit and Explicit Emotion Regulation 87

toring versus selection- for- action in anterior

cingulate cortex. Nature, 402(6758), 179–181.

Butler, T., Pan, H., Epstein, J., Protopopescu,

X., Tuescher, O., Goldstein, M., et al. (2005).

Fear- related activity in subgenual anterior cin-

gulate differs between men and women. Neu-

roReport, 16(11), 1233–1236.

Campos, J. J., Frankel, C. B., & Camras, L.

(2004). On the nature of emotion regulation.

Child Development, 75(2), 377–394.

Cole, P. M., Martin, S. E., & Dennis, T. A.

(2004). Emotion regulation as a scientific con-

struct: Methodological challenges and direc-

tions for child development research. Child

Development, 75(2), 317–333.

Delgado, M. R., Nearing, K. I., LeDoux, J.

E., & Phelps, E. A. (2008). Neural circuitry

underlying the regulation of conditioned fear

and its relation to extinction. Neuron, 59(5),

829–838.

Dijksterhuis, A., & Smith, P. K. (2002). Affective

habituation: Subliminal exposure to extreme

stimuli decreases their extremity. Emotion,

2(3), 203–214.

Drabant, E. M., Kuo, J. R., Ramel, W., Blechert,

J., Edge, M. D., Cooper, J. R., et al. (2011).

Experiential, autonomic, and neural responses

during threat anticipation vary as a function

of threat intensity and neuroticism. NeuroIm-

age, 55(1), 401–410.

Egner, T., Etkin, A., Gale, S., & Hirsch, J. (2008).

Dissociable neural systems resolve conflict

from emotional versus nonemotional distract-

ers. Cerebral Cortex, 18(6), 1475–1484.

Ehring, T., Tuschen- Caffier, B., Schnülle, J.,

Fischer, S., & Gross, J. J. (2010). Emotion

regulation and vulnerability to depression:

Spontaneous versus instructed use of emotion

suppression and reappraisal. Emotion, 10(4),

563–572.

Ehrlich, I., Humeau, Y., Grenier, F., Ciocchi,

S., Herry, C., & Lüthi, A. (2009). Amygdala

inhibitory circuits and the control of fear

memory. Neuron, 62(6), 757–771.

Etkin, A., Egner, T., & Kalisch, R. (2011). Emo-

tional processing in anterior cingulate and

medial prefrontal cortex. Trends in Cognitive

Sciences, 15(2), 85–93.

Etkin, A., Egner, T., Peraza, D. M., Kandel, E.

R., & Hirsch, J. (2006). Resolving emotional

conflict: A role for the rostral anterior cingu-

late cortex in modulating activity in the amyg-

dala. Neuron, 51(6), 871–882.

Etkin, A., Prater, K. E., Hoeft, F., Menon, V.,

& Schatzberg, A. F. (2010). Failure of anterior

cingulate activation and connectivity with the

amygdala during implicit regulation of emo-

tional processing in generalized anxiety disor-

der. American Journal of Psychiatry, 167(5),

545–554.

Etkin, A., & Schatzberg, A. F. (2011). Common

abnormalities and disorder- specific compen-

sation during implicit regulation of emotional

processing in generalized anxiety and major

depressive disorders. American Journal of

Psychiatry, 168(9), 968–978.

Fisher, P. M., Meltzer, C. C., Price, J. C., Cole-

man, R. L., Ziolko, S. K., Becker, C., et al.

(2009). Medial prefrontal cortex 5-HT2A

density is correlated with amygdala reactiv-

ity, response habituation, and functional cou-

pling. Cerebral Cortex, 19(11), 2499–2507.

Frijda, N. H. (1987). The emotions. Cambridge,

UK: Cambridge University Press.

Goldin, P. R., Manber, T., Hakimi, S., Canli, T.,

& Gross, J. J. (2009). Neural bases of social

anxiety disorder: Emotional reactivity and

cognitive regulation during social and physical

threat. Archives of General Psychiatry, 66(2),

170–180.

Goldin, P. R., Manber-Ball, T., Werner, K.,

Heimberg, R., & Gross, J. J. (2009). Neural

mechanisms of cognitive reappraisal of nega-

tive self- beliefs in social anxiety disorder. Bio-

logical Psychiatry, 66(12), 1091–1099.

Goldin, P. R., McRae, K., Ramel, W., & Gross,

J. J. (2008). The neural bases of emotion regu-

lation: Reappraisal and suppression of nega-

tive emotion. Biological Psychiatry, 63(6),

577–586.

Graham, B. M., & Milad, M. R. (2011). The

study of fear extinction: Implications for anxi-

ety disorders. American Journal of Psychia-

try, 168(12), 1255–1265.

Gratton, G., Coles, M. G., & Donchin, E. (1992).

Optimizing the use of information: Strategic

control of activation of responses. Journal of

Experimental Psychology. General, 121(4),

480–506.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J, & Levenson, R. W. (1993). Emo-

tional suppression: Physiology, self- report,

and expressive behavior. Journal of Personal-

ity and Social Psychology, 64(6), 970–986.

Gross, J. J., & Thompson, R. A. (2007). Emo-

tion regulation: Conceptual foundations. In J.

88 BIOLOGICAL BASES

J. Gross (Ed.), Handbook of emotion regula-

tion (pp. 3–24). New York: Guilford Press.

Gruber, J., Harvey, A. G., & Gross, J. J. (2012).

When trying is not enough: Emotion regula-

tion and the effort- success gap in bipolar dis-

order. Emotion, 12(5), 997–1003.

Gruzelier, J., & Eves, F. (1987). Rate of habitu-

ation of electrodermal orienting responses: A

comparison of instructions to stop respond-

ing, count stimuli, or relax and remain indif-

ferent. International Journal of Psychophysi-

ology, 4(4), 289–291.

Gyurak, A., Gross, J. J., & Etkin, A. (2011).

Explicit and implicit emotion regulation: A

dual- process framework. Cognition and Emo-

tion, 25(3), 400–412.

Hare, T. A., Malmaud, J., & Rangel, A. (2011).

Focusing attention on the health aspects of

foods changes value signals in vmPFC and

improves dietary choice. Journal of Neurosci-

ence, 31(30), 11077–11087.

Hare, T. A., Tottenham, N., Galvan, A., Voss, H.

U., Glover, G. H., & Casey, B. J. (2008). Bio-

logical substrates of emotional reactivity and

regulation in adolescence during an emotional

go–no-go task. Biological Psychiatry, 63(10),

927–934.

Hariri, A. R., Bookheimer, S. Y., & Mazziotta,

J. C. (2000). Modulating emotional responses:

Effects of a neocortical network on the limbic

system. NeuroRreport, 11(1), 43– 48.

James, W. (1884). What is an emotion? Mind, 9,

188–205.

Johnstone, T., Van Reekum, C. M., Urry, H.

L., Kalin, N. H., & Davidson, R. J. (2007).

Failure to regulate: Counterproductive recruit-

ment of top-down prefrontal– subcortical cir-

cuitry in major depression. Journal of Neuro-

science, 27(33), 8877–8884.

Kable, J. W., & Glimcher, P. W. (2007). The

neural correlates of subjective value during

intertemporal choice. Nature Neuroscience,

10(12), 1625–1633.

Kalisch, R. (2009). The functional neuroanat-

omy of reappraisal: Time matters. Neurosci-

ence and Biobehavioral Reviews, 33(8), 1215–

1226.

Keltner, D., & Gross, J. J. (1999). Functional

accounts of emotions. Cognition and Emo-

tion, 13(5), 467–480.

Keltner, D., & Haidt, J. (2001). Social functions

of emotions at four levels of analysis. In W. G.

Parrott (Ed.), Emotions in social psychology:

Essential readings (pp. 175–184). New York:

Psychology Press.

LeDoux, J. (2012). Rethinking the emotional

brain. Neuron, 73(4), 653–676.

Levenson, R. W. (1999). The intrapersonal func-

tions of emotion. Cognition and Emotion,

13(5), 481–504.

Levenson, R. W. (2003). Blood, sweat, and

fears: The autonomic architecture of emotion.

Annals of the New York Academy of Sciences,

1000, 348–366.

Lieberman, M. D., Eisenberger, N. I., Crockett,

M. J., Tom, S. M., Pfeifer, J. H., et al. (2007).

Putting feelings into words: Affect label-

ing disrupts amygdala activity in response to

affective stimuli. Psychological Science, 18(5),

421–428.

Lieberman, M. D., Hariri, A. R., Jarcho, J.

M., Eisenberger, N. I., & Bookheimer, S. Y.

(2005). An fMRI investigation of race- related

amygdala activity in African- American and

Caucasian- American individuals. Nature

Neuroscience, 8(6), 720–722.

Lissek, S., Powers, A. S., McClure, E. B., Phelps,

E. A., Woldehawariat, G., Grillon, C., et al.

(2005). Classical fear conditioning in the

anxiety disorders: A meta- analysis. Behaviour

Research and Therapy, 43(11), 1391–1424.

Livneh, U., & Paz, R. (2012). Amygdala–

prefrontal synchronization underlies resis-

tance to extinction of aversive memories. Neu-

ron, 75(1), 133–142.

Lovibond, P. F. (2004). Cognitive processes in

extinction. Learning and Memory, 11(5),

495–500.

Maier, M. E., & di Pellegrino, G. (2012).

Impaired conflict adaptation in an emotional

task context following rostral anterior cingu-

late cortex lesions in humans. Journal of Cog-

nitive Neuroscience, 24(10), 2070–2079.

Martin, L. N., & Delgado, M. R. (2011). The

influence of emotion regulation on decision-

making under risk. Journal of Cognitive Neu-

roscience, 23(9), 2569–2581.

Mauss, I. B., Levenson, R. W., McCarter, L.,

Wilhelm, F. H., & Gross, J. J. (2005). The tie

that binds? Coherence among emotion expe-

rience, behavior, and physiology. Emotion, 5,

175–190.

McClure, S. M., Laibson, D. I., Loewenstein, G.,

& Cohen, J. D. (2004). Separate neural sys-

tems value immediate and delayed monetary

rewards. Science, 306(5695), 503–507.

McClure, E. B., Monk, C. S., Nelson, E. E.,

Parrish, J. M., Adler, A., Blair, R. J. R., et al.

(2007). Abnormal attention modulation of

fear circuit function in pediatric generalized

Neurobiological Model of Implicit and Explicit Emotion Regulation 89

anxiety disorder. Archives of General Psychia-

try, 64(1), 97–106.

McRae, K., Hughes, B., Chopra, S., Gabrieli, J.

D. E., Gross, J. J., & Ochsner, K. N. (2010).

The neural bases of distraction and reap-

praisal. Journal of Cognitive Neuroscience,

22(2), 248–262.

Milad, M. R., Pitman, R. K., Ellis, C. B., Gold, A.

L., Shin, L. M., Lasko, N. B., et al. (2009). Neu-

robiological basis of failure to recall extinction

memory in posttraumatic stress disorder. Bio-

logical Psychiatry, 66(12), 1075–1082.

Milad, M. R., & Quirk, G. J. (2002). Neurons

in medial prefrontal cortex signal memory for

fear extinction. Nature, 420(6911), 70–74.

Mobbs, D., Petrovic, P., Marchant, J. L., Has-

sabis, D., Weiskopf, N., Seymour, B., et al.

(2007). When fear is near: Threat imminence

elicits prefrontal– periaqueductal gray shifts in

humans. Science, 317(5841), 1079–1083.

Monk, C. S., Klein, R. G., Telzer, E. H., Schroth,

E. A., Mannuzza, S., Moulton, J. L., et al.

(2007). Amygdala and nucleus accumbens

activation to emotional facial expressions

in children and adolescents at risk for major

depression. American Journal of Psychiatry,

165(1), 90 –98.

Moors, A., & De Houwer, J. (2006). Automa-

ticity: A theoretical and conceptual analysis.

Psychological Bulletin, 132(2), 297–326.

Myers- Schulz, B., & Koenigs, M. (2012). Func-

tional anatomy of ventromedial prefrontal

cortex: Implications for mood and anxiety dis-

orders. Molecular Psychiatry, 17(2), 132–141.

Nitschke, J. B., Sarinopoulos, I., Oathes, D. J.,

Johnstone, T., Whalen, P. J., Davidson, R. J.,

et al. (2009). Anticipatory activation in the

amygdala and anterior cingulate in general-

ized anxiety disorder and prediction of treat-

ment response. American Journal of Psychia-

try, 166(3), 302–310.

Norrholm, S. D., Jovanovic, T., Olin, I. W.,

Sands, L. A., Karapanou, I., Bradley, B., et al.

(2011). Fear extinction in traumatized civil-

ians with posttraumatic stress disorder: Rela-

tion to symptom severity. Biological Psychia-

try, 69(6), 556–563.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. E. (2002). Rethinking feelings:

An FMRI study of the cognitive regulation of

emotion. Journal of Cognitive Neuroscience,

14(8), 1215–1229.

Ochsner, K. N., & Gross, J. J. (2005). The cogni-

tive control of emotion. Trends in Cognitive

Sciences, 9(5), 242–249.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 23–42). New York: Guilford

Press.

Paret, C., Brenninkmeyer, J., Meyer, B., Yuen,

K. S. L., Gartmann, N., Mechias, M.-L.,

et al. (2011). A test for the implementation–

maintenance model of reappraisal. Frontiers

in Psychology, 2, 216. [E-publication ahead of

print]

Pejic, T., Hermann, A., Vaitl, D., & Stark, R.

(2011). Social anxiety modulates amygdala

activation during social conditioning. Social

Cognitive and Affective Neuroscience, 8(3),

267–276.

Pessoa, L. (2010). Emergent processes in

cognitive– emotional interactions. Dialogues

in Clinical Neuroscience, 12(4), 433–448.

Phelps, E. A., Delgado, M. R., Nearing, K. I., &

LeDoux, J. E. (2004). Extinction learning in

humans: Role of the amygdala and vmPFC.

Neuron, 43(6), 897–905.

Ploghaus, A., Becerra, L., Borras, C., & Bor-

sook, D. (2003). Neural circuitry underly-

ing pain modulation: Expectation, hypnosis,

placebo. Trends in Cognitive Sciences, 7(5),

197–200.

Ploghaus, A., Tracey, I., Gati, J. S., Clare, S.,

Menon, R. S., Matthews, P. M., et al. (1999).

Dissociating pain from its anticipation in the

human brain. Science, 284(5422), 1979–1981.

Pole, N., Neylan, T. C., Otte, C., Henn-Hasse,

C., Metzler, T. J., & Marmar, C. R. (2009).

Prospective prediction of posttraumatic stress

disorder symptoms using fear potentiated

auditory startle responses. Biological Psychia-

try, 65(3), 235–240.

Ray, R. D., Ochsner, K. N., Cooper, J. C., Rob-

ertson, E. R., Gabrieli, J. D., & Gross, J. J.

(2005). Individual differences in trait rumina-

tion and the neural systems supporting cog-

nitive reappraisal. Cognitive, Affective, and

Behavioral Neuroscience, 5(2), 156–168.

Sarinopoulos, I., Grupe, D. W., Mackiewicz,

K. L., Herrington, J. D., Lor, M., Steege, E.

E., et al. (2010). Uncertainty during anticipa-

tion modulates neural responses to aversion in

human insula and amygdala. Cerebral Cortex,

20(4), 929–940.

Shin, L. M., Wright, C. I., Cannistraro, P. A.,

Wedig, M. M., McMullin, K., Martis, B., et

al. (2005). A functional magnetic resonance

imaging study of amygdala and medial pre-

90 BIOLOGICAL BASES

frontal cortex responses to overtly presented

fearful faces in posttraumatic stress disorder.

Archives of General Psychiatry, 62(3), 273–

281.

Straube, T., Schmidt, S., Weiss, T., Mentzel,

H.-J., & Miltner, W. H. R. (2009). Dynamic

activation of the anterior cingulate cortex dur-

ing anticipatory anxiety. NeuroImage, 44(3),

975–981.

Stroop, J. R. (1935). Studies of interference in

serial verbal reactions. Journal of Experimen-

tal Psychology, 18, 643–662.

Taylor, S. E., Eisenberger, N. I., Saxbe, D.,

Lehman, B. J., & Lieberman, M. D. (2006).

Neural responses to emotional stimuli are

associated with childhood family stress. Bio-

logical Psychiatry, 60(3), 296–301.

Vinogradov, S., Fisher, M., & de Villers- Sidani,

E. (2011). Cognitive training for impaired neu-

ral systems in neuropsychiatric illness. Neuro-

psychopharmacology, 37(1), 43–76.

Wager, T. D., Davidson, M. L., Hughes, B. L.,

Lindquist, M. A., & Ochsner, K. N. (2008).

Prefrontal– subcortical pathways mediating

successful emotion regulation. Neuron, 59(6),

1037–1050.

Wessa, M., & Flor, H. (2007). Failure of extinc-

tion of fear responses in posttraumatic stress

disorder: Evidence from second- order con-

ditioning. American Journal of Psychiatry,

164(11), 1684–1692.

Williams, L. M., Liddell, B. J., Kemp, A. H.,

Bryant, R. A., Meares, R. A., Peduto, A. S., et

al. (2006). Amygdala– prefrontal dissociation

of subliminal and supraliminal fear. Human

Brain Mapping, 27(8), 652–661.

PART III

COGNITIVE APPROACHES

Throughout our daily lives, we confront

decisions and situations that require self-

control. Generally, these are of relatively

minor consequence, such as when one resists

the urge to order dessert or spend money on

an expensive electronic gadget. However,

failure to control one’s impulses can also

have serious ramifications, as with eating

disorders, substance abuse, and compulsive

gambling (Dawe & Loxton, 2004). In this

chapter, we discuss the cognition– emotion

interactions that occur with temptations

and self- control as they are understood and

have been studied in psychology and neuro-

science.

Most often this work focuses on a set of

phenomena that together comprise delay

discounting and the class of choices that

require selecting between rewards available

at different points in time, known as inter-

temporal choices. Delay discounting refers

to the simple fact that people tend to prefer

to receive rewards sooner rather than later.

In an intertemporal choice, the subjective

value of each outcome is discounted in pro-

portion to the delay until its receipt, through

the process of delay discounting. One of the

advantages of focusing on delay discounting

is that it is possible to analyze how discount-

ing takes place with the use of discount

functions, which describe mathematically

how subjective value declines as a function

of delay.

There have been tremendous advances in

research on delay discounting over the past

10 years, spurred in part by experiments

using brain imaging as people engage in

intertemporal choices. To a first approxima-

tion, the processes involved in evaluating

outcomes have been distinguished by the

extent to which they rely on “emotion” ver-

sus “reason” (e.g., McClure, Laibson, Loew-

enstein, & Cohen, 2004; Hare, Camerer,

& Rangel, 2009; Figner et al., 2010). This

dichotomy roughly corresponds to the trad-

eoff between satisfying immediate desires

and adhering to abstract, long-term goals.

The terms used to describe these processes

have been diverse: hot and cold; automatic

and controlled; impulsive and deliberative;

passions and reason; visceral and abstract;

and doer and planner, among others (Posner

& Snyder, 1975; Shiffrin & Schneider, 1977;

Thaler & Shefrin, 1981; Chaiken & Trope,

1999; Lieberman, Gaunt, Gilbert, & Trope,

2002; Mischel, Ayduk, & Mendoza- Denton,

2003; Loewenstein, 1996).

The interaction between cognition and

emotion is common to emotion regulation

generally; delay discounting can therefore be

CHAPTER 6

Delay Discounting:

A Two‑Systems Perspective

Eric M. Miller

Christian Rodriguez

Bokyung Kim

Samuel M. McClure

94 COGNITIVE APPROACHES

thought of as one class of behavior in which

emotion regulation strategies are employed.

Indeed, the self- regulation strategies used in

the context of intertemporal choice can be

interpreted through the regulatory process

model proposed by Gross (1998). Specifi-

cally, regulation can occur at several points

in the decision- making process. First, we can

intervene before the decision takes place,

avoiding situations and circumstances that

are likely to require self- control. In inter-

temporal choice, one such strategy referred

to as precommitment involves committing

to one course of behavior ahead of time so

as to avoid unwanted temptations (Strotz,

1956). Second, we can regulate our valua-

tion processes at the time of decision mak-

ing, shifting our attention or reappraising

our perception of an alluring stimulus (e.g.,

Hutcherson, Plassman, Gross, & Rangel,

2012). Third, following the process of valu-

ation, we can attempt to suppress impulsive

choice tendencies by exerting top-down cog-

nitive regulation, a mechanism commonly

related to self- control (Hare et al., 2009).

Choice regulation by self- control implies

that we select an option that is consistent

with long-term goals even while we expe-

rience the temptation to choose a differ-

ent option (cf. Figner et al., 2010). In each

of these regulatory strategies, the interplay

between valuation and cognitive regula-

tion aligns closely with the functions of the

“hot” and “cold” systems described earlier.

As such, studying intertemporal choices as

a combination of these two factors provides

a useful framework for understanding the

mechanisms by which we regulate our deci-

sions.

In the remainder of this chapter we con-

sider the various cognitive and neural pro-

cesses that together compose delay dis-

counting, and emphasize the regulatory

mechanisms involved in controlling our

decision making. We begin with the brain,

and describe the large-scale distinction that

is commonly made between brain networks

linked to the behaviorally defined constructs

of valuation and self- control. We then sum-

marize available evidence suggesting that

these processes account for many aspects of

delay discounting behavior. Recent research

has been expanding on this framework, with

the goal of identifying the diversity of brain

processes involved in intertemporal choice.

Progress along these lines has come in part

from investigations of how different decision

processes interact in guiding behavior, high-

lighting important functions that seem to be

played by regions of the medial prefrontal

cortex. Finally, we return to emotion regu-

lation, and discuss some of the intentional

strategies that we can (and do) employ to

overcome temptations, described from the

perspective of the neural systems involved in

delay discounting.

Neural Systems Involved

in Delay Discounting

Our argument is that multiple systems con-

tribute to delay discounting. Although this

model provides a reasonable account of how

decision making might be thought to occur,

an important question should be addressed

at the outset: Is it necessary to posit the exis-

tence of multiple separate systems? Many

economic theories indicate that decision

making can be wholly explained by the max-

imization of a unitary function of expected

utility. Given that a single utility function

can reasonably account for decision making

in most contexts, why not settle for a more

parsimonious, single- system account? Our

answer is two pronged. First, as will be dis-

cussed, the variability in delay discounting

behavior observed within and between indi-

viduals is difficult to capture with a single-

system account, but it follows naturally from

a multiple systems model (van den Bos &

McClure, 2013). Second, to examine deci-

sion making with techniques such as func-

tional magnetic resonance imaging (fMRI)

provides strong evidence for qualitatively

different neural systems involved in delay

discounting (although some controversy still

remains; McClure et al., 2004; McClure,

Ericson, Laibson, Loewenstein, & Cohen,

2007; Kable & Glimcher, 2007; Peters &

Büchel, 2011). In many aspects of their func-

tion and relationship to behavior, these neu-

ral systems appear to be specialized for the

qualitatively different purposes of valuation

and top-down cognitive control.

Valuation

We face a tremendous number of choices

every day. Occasionally, these choices are

Delay Discounting 95

very significant, such as when we select

which college to attend or decide how to

invest our money. Such decisions warrant

careful deliberation and integration of the

various factors that contribute to the value

of each course of action. However, for the

vast majority of the choices that we face,

careful deliberation would be prohibitive.

If we stopped to think about all of the fac-

tors that determine what we should eat for

breakfast, which clothes to wear, and which

direction to drive to work, it would be diffi-

cult to accomplish anything during the day.

We refer to valuation processes as the

set of relatively automatic processes that

guide our behavior outside of our delibera-

tive control, facilitating the myriad choices

we face every day. In many instances, such

automatic judgments are accompanied by an

affective response (Kahneman, 2003). This

appears to be particularly true for delay

discounting. An immediate reward can be

extremely tempting, producing affectively

charged, high- arousal approach tendencies.

Influential theories of emotions posit that

one of the functions of these processes is to

signal assessments, such as danger, so as to

influence behavior without necessarily mak-

ing us fully aware of the source of the threat

(LeDoux, 2000). Generally, we make these

assessments reflexively, without intention or

deliberate control, and in a manner that is

obscure to our explicit understanding. The

subjective experiences generated by immedi-

ate outcomes share these properties.

At the neural level, a complex network

of brain structures, both cortical and sub-

cortical, underlies these automatic valua-

tion processes (Figure 6.1). A wealth of data

now indicate that positive motivational and

affective signals are encoded in and com-

municated by regions of the brain that are

targeted by midbrain dopamine neurons,

including the nucleus accumbens (NAcc) and

portions of the ventromedial prefrontal cor-

tex (vmPFC; e.g., Knutson, Fong, Bennett,

Adams, & Hommer, 2003). Other regions,

including the amygdala and insular cortex,

are also involved in affective processing,

particularly with regard to signaling salient

or aversive events (LaBar, Gatenby, Gore,

LeDoux, & Phelps, 1998; Wicker et al.,

2003). The NAcc and amygdala, core struc-

tures in these circuits, are evolutionarily

quite old and exist with relatively conserved

function in many animal species. Due partly

to this fact, the motivational processes sup-

ported by this network of brain regions are

thought to form a system that is separable

from deliberative thought and reasoning

that is likely to be specific to humans.

Dopaminergic projections (i.e., neuronal

connections that rely on the neurotransmit-

ter dopamine) into the NAcc are known to

FIGURE 6.1. Two systems in delay discounting. Reward prediction, affect, and automatic behavioral

responses are associated with the ventral striatum (nucleus accumbens), ventromedial PFC, and pos-

terior cingulate cortex. These functions are components of automatic valuation. By contrast, regions

in the dorsolateral and dorsomedial PFC, as well as the posterior parietal cortex, are associated with

cognitive control processes and self- control.

posterior parietal

cortex

lateral PFC

posterior cingulate

cortex

dorsal anterior

cingulate cortex

ventromedial

PFC

ventral striatum

substantia nigra/

VTA

96 COGNITIVE APPROACHES

be an especially crucial motivational sig-

nal. Some of the most compelling evidence

for this comes from studies in which rats

were given the opportunity to perform an

action to self- stimulate different regions of

their brains (Olds, 1977; Gallistel, Shizgal,

& Yeomans, 1981; Ikemoto & Panksepp,

1999). Rats in these studies are especially

motivated to self- stimulate regions of the

midbrain that evoke dopamine release into

the NAcc (Ikemoto & Panksepp, 1999). In

fact, self- stimulation to these brain regions

is so reinforcing that rats will self- stimulate

continuously (i.e., 2,000 times an hour, or

roughly once every 2 seconds), to the exclu-

sion of all other activities, until they are

too physically exhausted to continue (Olds,

1977). Rats also exert significant physical

effort and endure pain (electric shock) to

receive this stimulation (Olds, 1977). They

even prefer brain stimulation to rewards

such as food, when the stimulation is strong

enough (Shizgal & Conover, 1996).

Dopamine release in the NAcc seems to be

the crucial mediator of this self- stimulating

behavior. Pharmacologically inhibiting the

effects of dopamine release in the NAcc

greatly diminishes the rewarding proper-

ties of this stimulation, and direct release of

dopamine into the NAcc can substitute for

electrical stimulation (Wise, 1982). These

reward effects of dopamine also seem to

apply in humans. This is clearly demon-

strated by many drugs of abuse that directly

increase dopamine availability in the brain,

such as cocaine and methamphetamine

(Koob & Bloom, 1988). Together, these data

underscore the importance of dopamine and

the NAcc in motivating behavior (Ikemoto

& Panksepp, 1999; Berridge, Robinson, &

Aldridge, 2009).

Functional neuroimaging experiments in

humans have also demonstrated the involve-

ment of dopamine- associated brain regions

such as the NAcc and vmPFC in track-

ing value and signaling the expectation of

rewarding outcomes (Knutson et al., 2003;

McClure, Berns, & Montague, 2003; Del-

gado, 2007). Neural activity in these regions

can be measured using fMRI, and such mea-

surements have been shown to scale propor-

tionally with the magnitude of expected

reward (Knutson et al., 2003). In most situ-

ations, these dopamine- based value signals

are quite helpful, as they allow us to predict

value and guide our behavior on the basis of

these predictions (Schultz, Dayan, & Mon-

tague, 1997). However, when these pro-

cesses go awry, as is the case in addiction,

exaggerated value signals for things such as

drug- related cues can lead us to overvalue

and seek out maladaptive outcomes (Redish,

2004).

The brain contains a separate network

for encoding aversive signals and detecting

outcomes in our environment that ought

to be avoided. The amygdala has been the

brain structure most clearly implicated with

learning and detecting negative stimuli and

environmental states (although recent evi-

dence suggests that, at the spatial resolu-

tion afforded by fMRI, the amygdala may

respond more generally to salient events,

irrespective of valence; Hamann, Ely, Hoff-

man, & Kilts, 2002; Phelps, 2006). For

example, presenting human or animal sub-

jects with a stimulus that predicts an aver-

sive event, such as a shock, is associated

with increased amygdala activation, even if

the shock does not actually occur (Phillips

& LeDoux, 1992; Phelps et al., 2001). Simi-

larly, amygdala lesions in animals have been

shown to produce a number of odd behav-

ioral effects, including increased approach

behaviors in monkeys toward objects that

they would normally fear (Blanchard &

Blanchard, 1972). As might be expected,

although aversive signals from the amygdala

are generally necessary for adaptive behav-

ior, they can also go awry, as is the case in

social phobias (Phan, Fitzgerald, Nathan, &

Tancer, 2006).

A clear feature of both NAcc and amyg-

dala function is their automaticity. Amyg-

dala responses to fearful or salient stimuli

occur even when participants are unaware

of seeing them, such as when images are

shown so fast that they are only perceived

subliminally (Whalen et al., 1998). Sublimi-

nal responses are also found with respect

to rewards in the NAcc (Pessiglione et al.,

2008). Additionally, the NAcc is a com-

ponent of the basal ganglia, a subcortical

motor circuit that underlies the development

of habits (e.g., Jog, Kubota, Connolly, Hill-

egaart, & Graybiel, 1999). As such, it is well

positioned to facilitate the development of

new automatic behaviors.

Thus, there is strong evidence that both

the amygdala and NAcc underlie the auto-

Delay Discounting 97

matic and stereotyped behaviors that are

often accompanied by affective responses.

It is easy to see why such a system might

have evolved: The automatic generation of

value and behaviors allows quick and effort-

less formulation of responses to rewards or

threats in the environment. These systems

are therefore believed to allow us to get on

with our day, and, perhaps just as impor-

tantly, once helped us in ancestral environ-

ments to respond quickly enough to avoid

predators and obtain fleeting rewards.

Although rapid, effortless, adaptive

responses are a key benefit of this system,

it is at the same time limited by its reliance

on stereotyped behaviors. In the absence of

regulatory influences, our valuation system

seems to overgeneralize responses, leading

to behaviors that are inappropriate in some

circumstances (e.g., Hershberger, 1986).

Moreover, in the domain of delay discount-

ing, automatic valuation processes are inad-

equate for long-term planning. The system is

hypothesized to learn to produce behaviors

that are appropriate given what is occurring

in the immediate environment. For goals

that require planning over extended peri-

ods of time (weeks or years) valuation pro-

cesses are simply not equipped to determine

appropriate behaviors. Instead, in these

cases, decision making requires careful con-

sideration of goals and simulation of future

states. These goal- related functions are com-

monly referred to as cognitive control.

Cognitive Control

The top-down cognitive control system is

defined by deliberative, rule-based consider-

ation of different courses of action (Kahne-

man, 2003). By definition, the computations

involved in cognitive control occur within

our conscious awareness; this is the kind

of reasoning that we think about when we

consider our subjective mental life. These

capacities are particularly important when

we face unfamiliar circumstances for which

we do not have enough experience to know

the appropriate (automatic) response. We

also need to rely on cognitive control when

there is a high chance for error. Consider as

an example the famous Stroop task in which

you have to name the color in which a word

is written, while you suppress reading the

word (think of the word red written in green

ink; Cohen, Dunbar, & McClelland, 1990).

Without explicitly controlling behavior to

arrive at the appropriate response, people

are likely to commit errors by automatically

reading the word.

The brain structures associated with cog-

nitive control are distinct from those that

we previously attributed to valuation. These

structures include dorsolateral and anterior

(frontopolar) regions of the prefrontal cor-

tex, regions within the dorsomedial prefron-

tal cortex, as well as the posterior parietal

cortex (PPC). These brain regions are consis-

tently observed to be involved in a variety of

cognitive processes, such as working mem-

ory (e.g., Cohen et al., 1997), abstract rea-

soning (e.g., Kroger et al., 2002), and general

problem solving (e.g., Duncan et al., 2000).

There is broad consensus that these systems

are central to the brain’s ability to respond

flexibly to rapidly changing task demands,

as well as the pursuit of longer- term, goal-

directed behaviors, especially when faced

with competition from more salient stimuli

or automatic responses (Miller & Cohen,

2001). Although our brain’s cognitive con-

trol system involves an extensive network

of interconnected structures, it is possible

to illustrate some of its mechanistic features

by restricting our focus to two regions: the

dorsolateral prefrontal cortex (dlPFC) and

dorsal anterior cingulate cortex (dACC).

The dlPFC seems to be crucial for success-

ful planning and other executive functions.

Lesions of the dlPFC are associated with dys-

function in organization, planning, working

memory, and attention (Shallice & Burgess,

1991; Stuss & Levine, 2002). Similarly,

brain imaging experiments in healthy adults

have shown that the completion of tasks

that require planning and problem solving

is associated with greater activity in this

region (e.g., Baker et al., 1996). The dlPFC

is also associated with the maintenance and

manipulation of information stored in work-

ing memory, consistent with its hypoth-

esized role in integrating and manipulating

stored mental representations in rational

problem solving (Owen, McMillan, Laird,

& Bullmore, 2005). Finally, the dlPFC is

associated with the control of actions during

tasks that require people to override auto-

matic responses and instead respond based

on a higher- level rule (MacDonald, Cohen,

Stenger, & Carter, 2000).

98 COGNITIVE APPROACHES

The dACC also plays an important role in

high-level cognition. In particular, the dACC

has been shown to be especially important

for the online monitoring of performance, as

well as conflict and error detection (Carter

et al., 1995). According to a dominant the-

ory of dACC function, conflict detection in

the dACC acts as a gating mechanism that

signals when additional control is necessary

(Botvinick, Braver, Barch, Carter, & Cohen,

2001). According to this theory, the dACC

detects when our automatic processes are

leading us awry and modulates activity in

the dlPFC, leading to changes in behavior

(i.e., so that we respond appropriately in cir-

cumstances in which errors are likely). The

dACC’s purported roles in conflict monitor-

ing and dlPFC modulation are evident in

tasks that span a variety of domains, rang-

ing from simple motor responses to moral

and social decision making (MacDonald et

al., 2000; Greene, Nystrom, Engell, Darley,

& Cohen, 2004; Sanfey, Rilling, Aronson,

Nystrom, & Cohen, 2003).

The dlPFC and dACC are two regions in

a network of structures that encode contex-

tual information and facilitate deliberative

processing and planning. These are pre-

cisely the functions ascribed to cognitive

control. A critical limitation of this system

is that information processing is slow and

computationally expensive relative to auto-

matic valuation. Moreover, we can only

explicitly consider one thing at a time, so

processing in this system is serial (Kahne-

man, 2003). These constraints limit the set

of the decisions that are best addressed by

this system.

Intertemporal Choice

To this point, we have considered valuation

and cognitive control in relative isolation.

In many situations, we are presented with

choices for which we must arbitrate between

following our impulses to achieve immediate

gratification and choosing the actions that

we know will be more beneficial in the long

run. Intertemporal choice experiments tar-

get precisely this dilemma, asking people to

decide between smaller rewards (most com-

monly money) that are available sooner in

time and larger rewards that are available

after a longer delay. In such cases, it must be

determined whether the additional amount

to be gained is worth the wait. That is, as in

any value-based decision, the desirability of

the available rewards must be determined,

and a choice must be made on the basis of

these relative values (Rangel, Camerer, &

Montague, 2008). In intertemporal choice,

the desirability of each reward depends on

its magnitude, as well as the delay until its

receipt.

Although everyone would prefer to

receive reward sooner and in greater mag-

nitude when all else is kept equal, people

differ substantially in how they discount the

value of future compensation. For exam-

ple, people with chronic deficits in impulse

control, such as pathological gamblers and

cocaine addicts, tend to discount the value

of delayed reward far more than control

subjects (Bickel, Jarmolowicz, Mueller, Kof-

farnus, & Gatchalian, 2012). People suf-

fering from attention- deficit/hyperactivity

disorder (ADHD), a condition character-

ized by deficits in self- control, also discount

rewards more steeply than healthy controls

(Barkley, Edwards, Lanieri, Fletcher, &

Metevia, 2001). Discounting rates also tend

to decrease as people age from adolescence

into adulthood, consistent with the general

improvements in self- control that occur over

the course of development (Green, Fry, &

Myerson, 1994).

As already stated, from a mechanis-

tic point of view, making intertemporal

choices requires discounting the value of

outcomes based on their delay, and choos-

ing the option with greatest discounted val-

ues. Rationally, preferences generated in this

way should be consistent across time. If you

prefer outcome A over an outcome B that is

to occur some fixed amount of time after A

(say a week), then you should always prefer

A to B, whether A occurs today (and B in a

week) or A occurs in a year (and B in a year

and a week). If this were not the case, then

there would be some critical point in time at

which preferences must switch, so that you

initially prefer B but then reverse to prefer

A some time thereafter. Mathematically,

the only discount function that ensures con-

sistency of preference is one that declines

exponentially with delay (Frederick, Leow-

enstein, & O’Donoghue, 2003). This sounds

reasonable enough, but neither humans nor

animals demonstrate such consistency. In an

often-cited example, when deciding between

Delay Discounting 99

one apple available in a year and two apples

available in a year and a day, people gener-

ally prefer the latter. However, when the

choice is between one apple available today

and two apples available tomorrow, people

generally prefer the former (Thaler, 1981).

Such preference reversals indicate that

humans (and other animals) discount more

steeply over the near term than over the lon-

ger term; that is, people have a tendency to

respond impulsively to tempting rewards

that are immediately available.

Time- dependent preference reversals are

most often explained by positing that delay

discounting follows a hyperbolic discount

function (e.g., Ainslie, 1975; Kirby, 1997;

see Figure 6.2 for more detail). Mathemati-

cally, the hyperbolic function captures the

observation that discount rates decline with

time. However, this framework does little

to explain the broad range of discount rates

that people exhibit for different goods under

different circumstances. In a well-known

example, it was pointed out that it is hard

to imagine people being impulsive for writ-

ing paper or gasoline (Hoch & Loewen-

stein, 1991). Instead, hyperbolic discounting

seems to apply most when we are dealing

with goods that are somehow viscerally

arousing, as is commonly the case with

money and food (Loewenstein, 1996). Simi-

larly, we tend to be impulsive when we are

aroused, either because of some exogenous

emotionally charged event (e.g., Li, 2008) or

because of internal reasons such as hunger

(Giordano et al., 2002; Wang & Dvorak,

2010). While people appear to exhibit hyper-

bolic discounting under all of these condi-

tions, the nature of the discount function

varies substantially by circumstance (van

den Bos & McClure, 2013).

An alternative approach to describ-

ing intertemporal choice views discount-

ing behavior as resulting from the engage-

ment of separate evaluative systems, each

of which uses a different discount function

(e.g., Loewenstein, 1996; van den Bos &

McClure, 2013). The combined effect of

multiple distinct discount functions can pro-

duce hyperbolic- like behavior. The simplest

version of this account suggests that there

are two types of discounting systems: one

that values only goods that are immediately

available, and another system that discounts

more modestly over time (Laibson, 1997).

This corresponds well to the two processing

systems discussed earlier, with the automatic

valuation system exhibiting steep discount-

FIGURE 6.2. Value and preference reversal for smaller, sooner (SS) and larger, later (LL) reward. As

time progresses, and the delay until receipt of SS and LL decreases, delay discounting also decreases

and subjective value grows. (A) With exponential discounting, if LL is preferred to SS initially (solid

line greater than dashed line at Time 0), then this ordinal preference is necessarily maintained. (B)

However, with hyperbolic discounting, preference can reverse as the time to the SS reward approaches.

The gray bar indicates the period of time, just prior to the availability of SS, when preferences favor

the SS outcome.

Time

Smaller, sooner

Larger, later

Time

cilobrepyHlaitnenopxE

Value

100 COGNITIVE APPROACHES

ing and the cognitive control system placing

more equal weight on immediate and future

rewards (McClure et al., 2004, 2007).

A tremendous advantage of the two-

system model of discounting is that it pro-

vides a simple explanation for why people

are impulsive for certain goods and not oth-

ers (e.g., writing paper) for which there is

no associated affective response. Moreover,

it suggests alternative routes to meliorat-

ing impulsive tendencies. One can work to

dampen the emotional impact of a stimu-

lus, exert deliberative control for the sake of

satisfying longer- term goals, or undertake

behaviors to avoid situations in which temp-

tations hold sway. Many of these approaches

have been investigated in recent research,

and they coincide with different strategies

common to instances of emotion regulation.

Neuroscientific studies of intertemporal

choice provide support for the dissociation

between automatic and controlled systems

involved in the decision making. In one of

our early fMRI studies, people were pre-

sented with two types of monetary choices:

a choice between an immediately available

option or a larger, delayed option, and a

choice in which both options were available

only after delays (McClure et al., 2004).

According to the dual- process model of

discounting, one would expect that choices

involving an immediately available reward

would be more affectively arousing in

nature and therefore partially reflect the

function of the impulsive valuation system.

By contrast, choices involving only delayed

rewards would not have this property, and

would instead rely more heavily on delib-

erative processes to form judgments. The

brain activation that was observed while

subjects performed these two types of tri-

als was consistent with this proposed for-

mulation. A number of valuation- associated

brain structures, including the NAcc and

vmPFC, were activated during decisions that

involved choices with an immediately avail-

able option. In contrast, structures involved

in deliberative processing, including the

dACC and dlPFC, were more engaged dur-

ing decisions that involved two delayed out-

comes. Additionally, for choices that pit an

immediate reward against a delayed one,

relative brain activation in the regions that

comprise these two systems was predictive

of the choice that people ultimately made.

In other words, when structures in the auto-

matic valuation system were more active,

people tended to choose more impulsively,

but when structures in the cognitive control

system were more active, people were more

likely to choose the larger, delayed option.

Subsequent fMRI studies have further

elaborated and confirmed the dissociation

of these neural systems. For example, the

results from the experiment just described

were replicated in an experiment in which

thirsty subjects had to make choices between

quantities of juice delivered at different peri-

ods of time, demonstrating that this type of

dual processing is not specific to monetary

rewards (McClure et al., 2007). Moreover,

when deciding between foods, dlPFC activ-

ity tends to support the selection of healthier

options via suppressing responses in vmPFC

(Hare et al., 2009; discussed in greater

detail below). There are important indi-

vidual differences in discounting that are

well explained by this two- system frame-

work as well. Hariri and colleagues (2006)

showed that individual differences in NAcc

responses to winning money predict dis-

count rates. In other words, the more that

the automatic valuation system activates for

the receipt of rewards, the more impulsively

one tends to seek them. By contrast, individ-

ual differences in cognitive control predict

reduced discounting. People who perform

better on a working memory task and show

greater responses in anterior parts of the lat-

eral prefrontal cortex also tend to be more

patient in intertemporal choices (Shamosh et

al., 2008).

One important limitation of the results

that we have discussed up to this point is that

functional brain imaging provides data that

are correlational in nature. In other words,

fMRI provides information regarding which

regions of the brain are associated with a

particular cognitive process but reveals little

about whether these brain regions actually

cause the observed differences in behavior.

To address this limitation, two recent stud-

ies assessed the causal importance of these

structures through more direct manipula-

tions. The first manipulated intertemporal

decision making using repetitive transcra-

nial magnetic stimulation (rTMS; Figner et

al., 2010). In rTMS, electromagnetic pulses

are produced to disrupt activity in particular

regions of an otherwise typically functioning

Delay Discounting 101

brain. In this experiment, rTMS was admin-

istered the left and right dlPFC. After rTMS

administration, subjects completed a set of

intertemporal choice questions to assess the

extent to which the procedure would disrupt

the decision- making process. rTMS to the

left lateral prefrontal cortex caused people to

make more impatient choices, demonstrat-

ing that activation in this region causally

promotes goal- directed decision making. A

second study produced a similar effect by

enhancing dopamine function pharmaco-

logically by giving participants drugs that

increase dopaminergic activity (Pine, Shiner,

Seymour, & Dolan, 2010). Consistent with

the two- system framework, this study found

that discount rates were elevated as well.

Toward Multiple Interacting Systems

The two- system model we discussed earlier

was primarily derived from behavioral stud-

ies. We now know that many of the prop-

erties of this two- system model correspond

well with what is known about brain reward

systems (i.e., dopamine and the NAcc) and

regions linked to executive functions (i.e.,

dlPFC and dACC). However, additional

details of brain function urge a more com-

plex model, with more precise functions

ascribed to individual brain areas, inclusion

of additional systems in the delay discount-

ing processes, as well as a more complete

theory for how brain systems interact dur-

ing choice.

At least three lines of research support

a more refined, multiple- systems model of

delay discounting. First, work by Bechara,

Damasio, Damasio, and Lee (1999) exam-

ining the behavioral deficits associated with

lesions to the vmPFC indicates a role for

this structure in integrating cognitive and

emotional influences on behavior, suggest-

ing that this structure’s function is more

nuanced than allowed for in a two- system

model. Second, although the available evi-

dence suggests that the dACC plays a criti-

cal role in regulating the relative influence

of automatic and controlled processes in

decision making, no studies have clari-

fied exactly how this regulatory function is

implemented in complex scenarios such as

intertemporal choice. Finally, recent studies

suggest an important role for a brain region

that has received very little attention in the

literature on delay discounting— the hippo-

campus— in making intertemporal choices

(Peters & Büchel, 2011). As a whole, these

findings indicate the need to understand

how automatic and controlled processes are

integrated to produce coherent behavior,

and how this integration might be expanded

to include additional brain systems.

Value Integration in the vmPFC

A recent fMRI study dissociated the contri-

butions of the brain systems we have linked

to valuation and self- control in the context

of decision making relative to unhealthy

foods (Hare et al., 2009). In this study, sub-

jects were scanned as they chose between

food options that varied in health and taste

qualities. For example, potato chips are low

on health value but high on taste, and the

opposite is true for broccoli. Subjects were

classified as “self- controllers” or “non-self-

controllers” based on their food preferences

as expressed during the task. Self- controllers

were people who made their decisions based

on both health and taste, whereas non-

self- controllers made their decisions based

solely on taste. Activation in the vmPFC

was shown to be associated with the total

subjective value assigned to individual food

items, such that activity was correlated

with subjects’ rated preference for the item

at the time of choice. Additionally, for self-

controllers, vmPFC activation at the time of

choice was correlated with both the health

and the taste of the items, whereas for non-

self- controllers, vmPFC activation was cor-

related only with taste. Thus, this study indi-

cates that the vmPFC encodes the total value

assigned to individual food items.

Importantly, the separate factors that con-

tribute to total value could also be identified

in this study. The dlPFC showed elevated

activation when participants successfully

engaged self- control, so that dlPFC activity

was greatest when subjects chose to reject

liked but unhealthy foods. Additionally,

comparison of functional activity in the

dlPFC between self- controllers and non-self-

controllers on these trials indicated that self-

controllers displayed greater activation in

this region at the time of choice, providing

confirmatory evidence that activity in this

region facilitates controlled decision making.

102 COGNITIVE APPROACHES

Finally, the investigators found a relation-

ship between activation in the vmPFC and

dlPFC for decisions on liked but unhealthy

foods (i.e., those that should require the most

self- control). In particular, greater activity

in the dlPFC was associated with reduced

activity in the vmPFC on these trials. These

results indicate a means by which valuation

and self- control processes can interact dur-

ing decision making to facilitate successful

self- control. Critically, the vmPFC seems to

function as the site of interaction.

These findings fit into a larger body of

data indicating that the vmPFC is impor-

tant for integrating cognitive and emotional

influences on behavior. Some of the most

compelling evidence for this function comes

from studies of patients with lesions to the

vmPFC. These patients have normal execu-

tive functioning, with normal IQ and over-

all performance on tests of cognitive abili-

ties. They also express normal emotional

responses in tasks such as fear condition-

ing, in which an initially neutral stimulus

(e.g., a visual stimulus) is paired with some-

thing aversive (e.g., an unpleasant sound)

until participants learn to fear the stimulus

(Bechara et al., 1999). Where patients with

vmPFC lesions show striking deficits is in

situations in which cognition and emotion

must be combined to behave appropriately.

Damasio (1994) summarizes this by saying

that reason and emotion “intersect” at the

vmPFC.

This intersection is clearly illustrated by

behavioral deficits expressed by Elliot, a

famous patient with vmPFC impairment

(Eslinger & Damasio, 1985). Elliot had a

tumor surgically removed from his vmPFC,

compromising the function of neighboring

cortical areas. The consequences were disas-

trous. By all accounts, Elliot seemed normal

when in conversations. His IQ was signifi-

cantly above normal, he was appropriately

emotionally expressive, and he passed all

manner of neuropsychological tests. Despite

this, he made terrible financial decisions,

squandering all his money in poor business

decisions. He was unable to hold a job, and

he interacted poorly with others, eventually

leading to his wife divorcing him. Elliot’s

behavior seemed generally normal, but he

had trouble with specific types of choices.

For example, choosing a restaurant for din-

ner could be an onerous chore. He would

study the menu, considering prices and the

different types of food available. He would

even drive to the restaurants to assess their

ambiance. Despite this effort, he would still

be unable to decide. On open-ended neuro-

psychiatric tests, Elliot could provide many

reasonable solutions to complex problems,

only to exclaim at the end “and after all this,

I still wouldn’t know what to do!” (Dama-

sio, 1994, p. 49). Elliot’s problem lay in

linking automatic valuation and regulatory

control when necessary to make a decision.

Specifically, when decisions become too

complex to be handled by the limited capac-

ity of our cognitive control system, we seem

to rely on the combination of affective and

cognitive judgments— something like a gut

feeling— to make the decision. This seems to

be the function of the vmPFC.

Valuation and Control Interactions

Involving the dACC–dlPFC Network

The dlPFC and dACC, key components of

the cognitive control system discussed ear-

lier, have been extensively studied in cogni-

tive neuroscience and are primary regions

involved in deliberated choices. They are

critical nodes in a general- purpose cogni-

tive control network that guides behavior in

a wide variety of tasks, including intertem-

poral decision making (Ridderinkhof et al.,

2004). We understand the most about the

interactions between the dlPFC and dACC

from their function in perceptual decision-

making tasks. Although these perceptual

tasks are mechanistically different from

intertemporal choice, they provide useful

insight regarding the role these regions may

play in more complex decision scenarios.

Two experimental paradigms, the Erik-

sen flanker task and the Stroop task, have

revealed a wealth of mechanistic detail about

dACC and dlPFC function. In both tasks,

successful performance requires participants

to override a prepotent motor response in

order to respond accurately to the stimulus

presented. We discussed the Stroop task ear-

lier, and why deliberation and control are

necessary for appropriate behavior under the

conditions of this experiment. The flanker

task presents similar requirements. In this

task, participants are asked to identify the

central item among a set of distracter stim-

uli (e.g., respond “right” to > > > > > and

Delay Discounting 103

“left” to > > < > >). In incongruent trials, in

which the flanking stimuli support a differ-

ent response than the target stimulus (i.e., >

> < > >), cognitive control becomes essential.

People have a tendency to emit the incorrect

response, as evidenced by an elevated error

rate (Gratton, Coles, & Donchin, 1992).

Furthermore, even when people are able to

suppress the erroneous response, they are

slower to respond than when the flanking

stimuli support the correct answer. Thus, as

in the Stroop task, successful performance

on incongruent trials requires inhibition of

the automatic tendency to respond to the

predominant stimulus attribute.

Imaging and neurophysiological studies

indicate that the type of control required by

these tasks is primarily facilitated by con-

tributions from the dlPFC and the dACC

(Yeung, Botvinick, & Cohen, 2004; Kerns

et al., 2004; Botvinick et al., 2001). As dis-

cussed earlier, these regions play comple-

mentary roles. The dACC is believed to

monitor for the coactivation of incompatible

responses, essentially serving as a detector

for situations in which errors are likely and

control is necessary. The dlPFC is thought

to maintain the appropriate task goals

and to direct action selection accordingly.

When conflict is detected, the dACC shows

increased activity, which then activates

the dlPFC (Kerns et al., 2004). Consistent

with this account, increased activity in this

dACC–dlPFC network is commonly associ-

ated with improved performance during per-

ceptual decision making.

An analogous mechanism seems likely

to be at play in delay discounting. Imag-

ine, for example, that you are asked to

choose between two options that seem

equally appealing (say, $10 today or $20 in

a month). Response conflict is inevitable in

this circumstance, and dACC activity may

be anticipated to increase. Indeed, this has

been found in several studies of intertem-

poral choice (e.g., Marco- Pallarés, Moham-

madi, Samii, & Münte, 2010). In our own

work we find evidence that the dACC sig-

nals conflict as well. For example, Figure

6.3 shows an analysis (McClure et al., 2004)

that identifies the dACC as a region whose

activity scales with reaction time (a surro-

gate for choice difficulty, and hence conflict).

The consequences of increased dlPFC

activity following response conflict in delay

discounting remain somewhat unresolved.

On the one hand, a bulk of evidence suggests

that increased dlPFC activity promotes the

selection of larger, later rewards. In choices

between immediate and delayed rewards,

FIGURE 6.3. dACC activity in intertemporal choice. (A) Reanalysis of the data from McClure et al.

(2004) reveals that dACC responses scale with choice difficulty, as approximated by choice response

time. (B) Trials were split into three groups based on reaction time. Mean hemodynamic responses in

the dACC scale linearly with response time. Time of zero seconds is when participants submitted their

responses. The lag to the peak of the hemodynamic responses (~5–6s) is typical for this measurement

modality.

dACC

Short

Intermediate

Long

-0.1

0.0

0.1

0.2

0.3

0.4

0.5

-4 0 4 8

Time (s)

% Signal Change

104 COGNITIVE APPROACHES

increased dlPFC activity, particularly rela-

tive to NAcc responses, predicts selection of

the latter alternative (McClure et al., 2004,

2007). Furthermore, disruption of the dlPFC

by rTMS increases the proportion of choices

for the immediate rewards, particularly in

conditions where conflict is anticipated to be

high (Figner et al., 2010). These results sup-

port the hypothesis that when conflict arises,

the dACC may modulate the dlPFC, which

in turn implements self- control by directly

biasing choices toward future- oriented goals

or by modulating the integrated valuation

processes occurring in the vmPFC.

On the other hand, recent evidence from

perceptual decision- making experiments

(e.g., Philiastides, Auksztulewicz, Heekeren,

& Blankenburg, 2011), as well as theoreti-

cal proposals (Kable & Glimcher, 2009),

suggests that the dlPFC might instead facili-

tate the selection of the option assigned the

highest discounted value by the valuation

system. This evidence supports an alterna-

tive hypothesis in which the function of

cognitive control is not necessarily linked

to future- oriented goals independent of

automatic valuation processes. Instead, this

hypothesis suggests that automatic valua-

tion and controlled processes may interact

more generally to facilitate decision making.

However, both of these proposals are consis-

tent with the notion that the dACC–dlPFC

network is the basis of deliberative decision

making, guiding choices toward options

that maximize value, either specifically for

the long-term or generally. In either case, the

dACC–dlPFC network appears to influence

behavior through interactions with valua-

tion regions, particularly the vmPFC (Hare

et al., 2009).

Controlled Decisions and Memory

in the Hippocampus

The hippocampus is well known in cognitive

neuroscience primarily because of its role in

remembering specific life events, known as

episodic memories (Burgess, Maguire, &

O’Keefe, 2002). This is best exemplified

by patients such as HM, who are unable

to form new memories after losing hippo-

campal function (Scoville & Milner, 1957).

Episodic memory is also very important for

conceiving of the future (Schacter, Addis,

& Buckner, 2008); patients with hippo-

campal damage are unable to reason about

hypothetical future events, perhaps because

people rely on past experiences in order to

conceive of probable future occurrences.

For delay discounting, this function of the

hippocampus turns out to be very impor-

tant. Intuitively, bringing past experiences to

mind and envisioning future occurrences is

an integral part of controlled decision mak-

ing. Directed memory recall is guided in a

goal- directed manner by dlPFC inputs to

the hippocampus (Levy & Anderson, 2002).

Consequently, rewards promised at future

times linked to specific events (e.g., a $25

payment on December 23, during the holi-

days) elicit increased responses in the dlPFC

and hippocampus (Peters & Büchel, 2010).

Such tangible future episodes have profound

effects on delay discounting; the greater the

recruitment of the hippocampus for future

dates, the less the discounting of future

rewards. Similarly, when people are given

identical intertemporal choices, they are

more patient when future times are linked to

concrete events (e.g., a holiday) than when

they are expressed only with respect to the

delay until receipt (e.g., in 3 months; Peters

& Büchel, 2010). This suggests that con-

trolled processes interact not only with valu-

ation but also with cognitive functions such

as memory, underscoring the need to expand

existing two- system models of intertemporal

choice.

Emotion Regulation

in Intertemporal Choice

We face intertemporal dilemmas every day

and employ a host of strategies to overcome

temptations. In this section we discuss a few

of those strategies and relate them to the

brain systems and cognitive processes on

which they impinge.

The most famous strategy for avoiding

temptations is termed “precommitment,”

in which one commits to a course of action

prior to the actual time of choice to avoid

responding impulsively. One famous exam-

ple of precommitment involves a product

that banks used to offer, known as “Christ-

mas Clubs” (Strotz, 1956). Christmas Clubs

were savings accounts that offered no inter-

est and forbade withdrawals until just before

Christmas. They were popular; people will-

Delay Discounting 105

fully signed up to have access to their money

restricted for months at a time, with no

compensation, so that they could afford to

buy presents at the holidays. Analogous pro-

grams for precommitment continue to exist

today. For example, people pay money to

join weight loss programs that restrict their

calorie intake, and they join the military to

improve self- discipline. Furthermore, there

now exist websites where one can sign up

to be punished financially for not accom-

plishing some goal (e.g., stickk.com and

joesgoals.com).

Precommitment devices are extremely

effective. For example, people ordinarily

perform abysmally at saving for retirement.

However, savings rates increase dramatically

when retirement plans include a precommit-

ment to increase savings progressively by

committing a portion of future raises (Thaler

& Benartzi, 2004). Additionally, when we

understand that we have “weaknesses,” we

often take actions in anticipation of this fact.

Since precommitment requires anticipation

and planning about future situations, we

suspect that precommitment depends on the

involvement of the dlPFC and hippocampus,

because concretely contemplating the future

depends on these structures.

In the absence of precommitment, when

we confront tempting stimuli, a number of

strategies can be applied to curb our emo-

tions and help us respond appropriately.

For example, in a recent study, people were

scanned while they attempted cognitively

to regulate their cravings and to make deci-

sions about whether to eat unhealthy foods

(Hutcherson et al., 2012). As expected,

participants made more healthy decisions

when actively regulating their cravings, and

they showed less controlled decision mak-

ing when they focused on the pleasurable

aspects of the food options. Furthermore,

active regulation of cravings was associated

with decreased activity in regions of the

brain associated with automatic valuation,

whereas value- related activation increased

when these cravings were indulged. Thus,

active regulation of our emotional respond-

ing can facilitate controlled decision making

by suppressing the brain’s automatic value

responses.

Similarly, in one particularly revealing

study by Mischel, Shoda, and Rodriguez

(1989), children chose between receiving one

reward now and receiving two rewards at

some indeterminate time in the future. This

delay is ordinarily very difficult for children

to endure; however, Mischel et al. found that

instructing children to think of the abstract

qualities of the rewards (thereby reducing

their desirability) dramatically improved

their ability to wait for the better outcome.

Furthermore, children who were worse at

delaying gratification expressed greater

activation in reward- related regions when

attempting to suppress responses to an allur-

ing cue (when studied again as adults; Casey

et al., 2011). This provides further evidence

that suppression of reward- related activation

is an important factor in controlled decision

making during intertemporal choice.

A number of other strategies have been

shown to help regulate decision making dur-

ing intertemporal choice. For example, based

on the work by Peters and Büchel (2010)

discussed earlier, thinking of the future in

a more concrete manner can increase the

appeal of obtaining a delayed reward. Such a

change in the way future reward is construed

may compensate for the fact that future ben-

efits tend to be thought of in very general

terms that do not have the same appeal as

the much more precisely considered imme-

diate outcomes (Trope & Liberman, 2003).

Indeed, priming people to think more con-

cretely also makes them more patient (Fujita

& Han, 2009).

Another strategy that has been shown

to regulate decision making in intertempo-

ral choice is focusing one’s attention on the

future consequences of an action. Consider

the manipulation discovered by Magen,

Dweck, and Gross (2008). Usually, inter-

temporal choices are presented as decisions

between smaller, more immediate rewards

(i.e., $10 available right now) and larger,

delayed rewards (i.e., $20 available in a

month). Of course, it is equivalent to reex-

press this choice as either $10 now and noth-

ing in a month or nothing now but $20 in a

month. In this “explicit zero” framing, peo-

ple are significantly more patient. Recently,

we examined the mechanisms underlying

this effect. Based on our studies, we believe

that expressing the future consequences of

immediate reward forces people to think

about the future, thereby reducing a natural

present bias that leads to underconsideration

of future desires. In fact, priming people to

106 COGNITIVE APPROACHES

think about the future is sufficient to reduce

impulsivity in intertemporal choice (Radu,

Yi, Bickel, Gross, & McClure, 2011).

There are undoubtedly many ways that

one can reframe alluring immediate rewards

to reduce impulsivity. Furthermore, there are

numerous known influences on delay dis-

count rates that remain unexplained, such

as the “date-delay effect,” in which people

are more patient when future times are

expressed as exact dates (i.e., July 25 vs. 30

days from now), or the fact that people are

more patient when deciding between larger

rather than smaller rewards (e.g., Thaler,

1981; Read, Frederick, Orsel, & Rahman,

2005). We suspect that these effects work

through a common pathway that ultimately

suppresses reward- related activation in the

NAcc, as meliorating this myopic and impul-

sive signal could facilitate far- sighted behav-

ior. Dampening of NAcc responses can

occur either exogenously (i.e., by presenting

rewards in different ways) or endogenously

(i.e., by deliberatively reconstruing a tempt-

ing outcome). Identifying the precise mecha-

nisms by which these manipulations work

to reduce impulsivity is an exciting future

direction in this research domain.

Conclusions

Delay discounting encompasses a spectrum

of important behaviors in which emotion

regulation strategies have important con-

sequences, particularly for meliorating

impulsivity. Our aim has been to illustrate

cognitive approaches for understanding how

delay discounting occurs, with a particular

emphasis on two- systems models. These

models posit the existence of an automatic,

affect- laden set of processes that interact

with a more flexible, deliberate system to

govern our behavior.

Studying delay discounting from the pur-

view of neuroscience is exciting for a number

of reasons. First, neuroscience offers a com-

plementary empirical approach for establish-

ing the function of constructs such as valu-

ation and self- control in decision making.

Following on this, neuroscience contributes

additional details to a mechanistic under-

standing of delay discounting. For example,

we originally identified vmPFC and dACC

as components of automatic valuation and

controlled decision making, respectively,

based on analyses that sought to identify

qualities of these hypothesized cognitive

processes. Subsequent work has refined our

understanding of these structures. We now

have more detailed understanding of how

self- control works (via dACC–dlPFC inter-

actions) and how valuation and self- control

interact (in part, via the vmPFC). Our sus-

picion is that over the next several years the

nature of these kinds of processes will be

even better understood, and our conceptu-

alization of the overall architecture support-

ing intertemporal decision making will be

expanded to include additional brain sys-

tems and cognitive processes.

Although we have a basic understanding

of how emotion regulation impacts neu-

ral activation during intertemporal choice,

further research is necessary to refine our

understanding of how different regulatory

strategies function with respect to the brain.

This will give us a better understanding of

how known regulatory strategies work,

allow us to understand better individual

differences in impulsivity, and provide a

framework for developing ever more effec-

tive strategies to overcome problems with

self- control. Addiction, obesity, and other

self- control problems are rife in our society.

They can all be conceptualized through the

framework of intertemporal choice, and a

more detailed mechanistic understanding of

delay discounting can only facilitate efforts

to combat these problems.

References

Ainslie, G. (1975). Specious reward: A behavioral

theory of impulsiveness and impulse control.

Psychological Bulletin, 82, 463–496.

Baker, S. C., Rogers, R. D., Owen, A. M., Frith,

C. D., Dolan, R. J., Frackowiak, R. S. J., et al.

(1996). Neural systems engaged by planning:

A PET study of the Tower of London task.

Neuropsychologia, 34, 515–526.

Barkley, R. A., Edwards, G., Laneri, M., Fletcher,

K., & Metevia, L. (2001). Executive function-

ing, temporal discounting, and sense of time in

adolescents with attention deficit hyperactiv-

ity disorder (ADHD) and oppositional defiant

disorder (ODD). Journal of Abnormal Child

Psychology, 29, 541–556.

Bechara, A., Damasio, H., Damasio, A. R., &

Delay Discounting 107

Lee, G. P. (1999). Different contributions of

the human amygdala and ventromedial pre-

frontal cortex to decision- making. Journal of

Neuroscience, 19, 5473–5481.

Bergh, B. V. D., Dewitte, S., & Warlop, L. (2008).

Bikinis instigate generalized impatience in

intertemporal choice. Journal of Consumer

Research, 35, 85–97.

Berridge, K. C., Robinson, T. E., & Aldridge, J.

W. (2009). Dissecting components of reward:

“Liking,” “wanting,” and learning. Current

Opinion in Pharmacology, 9, 65–73.

Bickel, W. K., Jarmolowicz, D. P., Mueller, E.

T., Koffarnus, M. N., & Gatchalian, K. M.

(2012). Excessive discounting of delayed rein-

forcers as a trans- disease process contributing

to addiction and other disease- related vulner-

abilities: Emerging evidence. Pharmacology

and Therapeutics, 134, 287–297.

Blanchard, D. C., & Blanchard, R. J. (1972).

Innate and conditioned reactions to threat in

rats with amygdaloid lesions. Journal of Com-

parative and Physiological Psychology, 81,

281–290.

Botvinick, M. M., Braver, T. S., Barch, D. M.,

Carter, C. S., & Cohen, J. D. (2001). Conflict

monitoring and cognitive control. Psychologi-

cal Review, 108, 624–652.

Burgess, N., Maguire, E. A., & O’Keefe, J.

(2002). The human hippocampus and spatial

and episodic memory. Neuron, 35, 625–641.

Carter, C. S., Braver, T. S., Barch, D. M., Botv-

inick, M. M., Noll, D., & Cohen, J. D. (1995).

Anterior cingulate cortex, error detection, and

the online monitoring of performance. Sci-

ence, 280, 747–749.

Casey, B. J., Somerville, L. H., Gotlib, I. H.,

Ayduk, O., Franklin, N. T., Askren, M. K., et

al. (2011). Behavioral and neural correlates of

delay of gratification 40 years later. Proceed-

ings of the National Academy of Sciences,

108(36), 14998–15003.

Chaiken, S., & Trope, Y. (Eds.). (1999). Dual-

process theories in social psychology. New

York: Guilford Press.

Cohen, J. D., Dunbar, K., & McClelland, J. L.

(1990). On the control of automatic processes:

A parallel distributed processing account of

the Stroop effect. Psychological Review, 97,

332–361.

Cohen, J. D., Perlstein, W. M., Braver, T. S.,

Nystrom, L. E., Noll, D. C., Jonides, J., et al.

(1997). Temporal dynamics of brain activation

during a working memory task. Nature, 386,

604–608.

Damasio, A. (1994). Descartes’ error. New York:

Penguin Books.

Dawe, S., & Loxton, N. J. (2004). The role of

impulsivity in the development of substance

use and eating disorders. Neuroscience and

Biobehavioral Reviews, 28(3), 343–351.

Delgado, M. R. (2007). Reward- related responses

in the human striatum. Annals of the New

York Academy of Sciences, 1104, 70–88.

Duncan, J., Seitz, R. J., Kolodny, J., Bor, D.,

Herzog, H., Ahmed, A., et al. (2000). A neu-

ral basis for general intelligence. Science, 289,

457–460.

Eslinger, P. J., & Damasio, A. R. (1985). Severe

disturbance of higher cognition after bilateral

frontal lobe ablation: Patient EVR. Neurol-

ogy, 35, 1731–1741.

Figner, B., Knoch, D., Johnson, E. J., Krosch,

A. R., Lisanby, S. H., Fehr, E., & Weber, E.

U. (2010). Lateral prefrontal cortex and self-

control in intertemporal choice. Nature Neu-

roscience, 13, 538–539.

Frederick, S., Loewenstein, G., & O’Donoghue,

T. (2003). Time discounting and time prefer-

ence: A critical review. In G. Loewenstein, D.

Read, & R. Baumeister (Eds.), Decision and

time (pp. 13–86). New York: Russell Sage

Foundation.

Fujita, K., & Han, H. (2009). Moving beyond

deliberative control of impulses: The effect of

construal levels on evaluative associations in

self- control conflicts. Psychological Science,

20, 799–804.

Gallistel, C. R., Shizgal, P., & Yeomans, J. S.

(1981). A portrait of the substrate for self-

stimulation. Psychological Review, 88, 228–

273.

Giordano, L. A., Bickel, W. K., Loewenstein,

G., Jacobs, E. A., Marsch, L., & Badger, G. J.

(2002). Opioid deprivation affects how opioid-

dependent outpatients discount the value of

delayed heroin and money. Psychopharmacol-

ogy, 163, 174–182.

Gratton, G., Coles, M. G., & Donchin, E. (1992).

Optimizing the use of information: Strategic

control of activation of responses. Journal

of Experimental Psychology: General, 121,

480–506.

Green, L., Fry, A., & Myerson, J. (1994). Dis-

counting of delayed rewards: A life-span com-

parison. Psychological Science, 5, 33–36.

Greene, J. D., Nystrom, L. E., Engell, A. D., Dar-

ley, J. M., & Cohen, J. D. (2004). The neu-

ral bases of cognitive conflict and control in

moral judgment. Neuron, 44, 389–400.

108 COGNITIVE APPROACHES

Gross, J. J. (1998). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74, 224–237.

Hamann, S. B., Ely, T. D., Hoffman, J. M., &

Kilts, C. D. (2002). Ecstasy and agony: Acti-

vation of the human amygdala in positive

and negative emotion. Psychological Sci-

ence, 13(2), 135–141.

Hare, T. A., Camerer, C. F., & Rangel, A. (2009).

Self- control in decision- making involves mod-

ulation of the VMPFC valuation system. Sci-

ence, 324, 646–648.

Hariri, A. R., Brown, S. M., Williamson, D.

E., Flory, J. D., de Wit, H., & Manuck, S. B.

(2006). Preference for immediate over delayed

rewards is associated with magnitude of ven-

tral striatal activity. Journal of Neuroscience,

26, 13213–13217.

Hershberger, W. A. (1986). An approach through

the looking glass. Animal Learning and

Behavior, 14, 443–451.

Hoch, S. J., & Loewenstein, G. F. (1991). Time-

inconsistent preferences and consumer self-

control. Journal of Consumer Research, 17,

492–507.

Hutcherson, C. A., Plassmann, H., Gross, J. J.,

& Rangel, A. (2012). Cognitive regulation

during decision- making shifts behavioral con-

trol between ventromedial and dorsolateral

prefrontal value systems. Journal of Neurosci-

ence, 32(39), 13543–13554.

Ikemoto, S., & Panksepp, J. (1999). The role of

nucleus accumbens dopamine in motivated

behavior: A unifying interpretation with

special reference to reward- seeking. Brain

Research Reviews, 31, 6– 41.

Jog, M. S., Kubota, Y., Connolly, C. I., Hill-

egaart, V., & Graybiel, A. M. (1999). Building

neural representations of habits. Science, 286,

1745–1749.

Kable, J. W., & Glimcher, P. W. (2007). The neu-

ral correlates of subjective value during inter-

temporal choice. Nature Neuroscience, 10,

1625–1633.

Kable, J. W., & Glimcher, P. W. (2009). The neu-

robiology of decision: Consensus and contro-

versy. Neuron, 63(6), 733–745.

Kahneman, D. (2003). Maps of bounded ratio-

nality: Psychology for behavioral economics.

American Economic Review, 93, 1449–1475.

Kerns, J. G., Cohen, J. D., MacDonald, A. W.,

Cho, R. Y., Stenger, V. A., & Carter, C. S.

(2004). Anterior cingulate conflict monitor-

ing and adjustments in control. Science, 303,

1023–1026.

Kirby, K. N. (1997). Bidding on the future:

Evidence against normative discounting of

delayed rewards. Journal of Experimental

Psychology: General, 126, 54–70.

Knutson, B., Adams, C. M., Fong, G. W., &

Hommer, D. (2001). Anticipation of increas-

ing monetary reward selectively recruits

nucleus accumbens. Journal of Neuroscience,

21, RC159.

Knutson, B., Fong, G. W., Bennett, S. M.,

Adams, C. M., & Hommer, D. (2003). A

region of mesial prefrontal cortex tracks mon-

etarily rewarding outcomes: Characterization

with rapid event- related fMRI. NeuroImage,

18, 263–272.

Koob, G. F., & Bloom, F. E. (1988). Cellular and

molecular mechanisms of drug dependence.

Science, 242, 715–723.

Kroger, J. K., Sabb, F. W., Fales, C. L.,

Bookheimer, S. Y., Cohen, M. S., & Holyoak,

K. J. (2002). Recruitment of anterior dorso-

lateral prefrontal cortex in human reasoning:

A parametric study of relational complexity.

Cerebral Cortex, 12, 477–485.

LaBar, K. S., Gatenby, J. C., Gore, J. C., LeDoux,

J. E., & Phelps, E. A. (1998). Human amyg-

dala activation during conditioned fear acqui-

sition and extinction: A mixed-trial fMRI

study. Neuron, 20, 937–945.

Laibson, D. I. (1997). Golden eggs and hyper-

bolic discounting. Quarterly Journal of Eco-

nomics, 42, 861–871.

LeDoux, J. E. (2000). Emotion circuits in the

brain. Annual Review of Neuroscience, 23(1),

155–184.

Levy, B. J., & Anderson, M. C. (2002). Inhibitory

processes and the control of memory retrieval.

Trends in Cognitive Sciences, 6, 299–305.

Li, X. (2008). The effects of appetitive stimuli on

out-of-domain consumption impatience. Jour-

nal of Consumer Research, 34, 649–656.

Lieberman, M. D., Gaunt, R., Gilbert, D. T.,

Trope, Y. (2002). Reflection and reflexion:

A social cognitive neuroscience approach to

attributional inference. Advances in Experi-

mental Social Psychology, 34, 199–249.

Loewenstein, G. (1996). Out of control: Vis-

ceral influences on behavior. Organizational

Behavior and Human Decision Processes, 65,

272–293.

Loewenstein, G., & Prelec, D. (1992). Anoma-

Delay Discounting 109

lies in intertemporal choice: Evidence and an

interpretation. Quarterly Journal of Econom-

ics, 107, 573–597.

MacDonald, A. W., Cohen, J. D., Stenger, V.

A., & Carter, C. S. (2000). Dissociating the

role of the dorsolateral prefrontal and anterior

cingulate cortex in cognitive control. Science,

288, 1835–1838.

MacLean, P. D. (1990). The triune brain in evo-

lution: Role in paleocerebral functions. New

York: Plenum Press.

Magen, E., Dweck, C. S., & Gross, J. J. (2008).

The hidden-

ero effect: Representing a single

choice as an extended sequence reduces impul-

sive choice. Psychological Science, 19, 648–

649.

Marco-

allarés, J., Mohammadi, B., Samii,

A., & Münte, T. F. (2010). Brain activations

reflect individual discount rates in inter

emporal choice. Brain Research, 1320, 123–

129.

McClure, S. M., Berns, G. S., & Montague, P. R.

(2003). Temporal prediction errors in a passive

learning task activate human striatum. Neu-

ron, 38, 339–346.

McClure, S. M., Ericson, K. M., Laibson, D. I.,

Loewenstein, G., & Cohen, J. D. (2007). Time

discounting for primary rewards. Journal of

Neuroscience, 27, 5796–5804.

McClure, S. M., Laibson, D. I., Loewenstein, G.,

& Cohen, J. D. (2004). Separate neural sys-

tems value immediate and delayed monetary

rewards. Science, 306, 503–507.

Miller, E. K., & Cohen, J. D. (2001). An inte-

grative theory of prefrontal cortex function.

Annual Review of Neuroscience, 24, 167–

202.

Mischel, W., Ayduk, O., & Mendoza-

enton,

R. (2003). Sustaining delay of gratification

over time: A hot-cool systems perspective. In

G. Loewenstein, D. Read, & R. Baumeister

(Eds.), Decision and time (pp.

175–200). New

York: Russell Sage Foundation.

Mischel, W., Shoda, Y., & Rodriguez, M. L.

(1989). Delay of gratification in children. Sci-

ence, 244, 933–938.

Olds, J. (1977). Drives and reinforcements:

Behavioral studies of hypothalamic function.

New York: Raven Press.

Owen, A. M., McMillan, K. M., Laird, A. R., &

Bullmore, E. (2005). N-back working memory

paradigm: A meta-

nalysis of normative func-

tional neuroimaging studies. Human Brain

Mapping, 25, 46–59.

Pessiglione, M., Petrovic, P., Daunizeau, J.,

Palminteri, S., Dolan, R. J., & Frith, C. D.

(2008). Subliminal instrumental conditioning

demonstrated in the human brain. Neuron,

59, 561–567.

Peters, J., & Büchel, C. (2010). Episodic future

thinking reduces reward delay discount-

ing through an enhancement of prefrontal–

ediotemporal interactions. Neuron, 66,

138–148.

Peters, J. & Büchel, C. (2011). The neural mech-

anisms of inter-

emporal decision-

aking:

Understanding variability. Trends in Cogni-

tive Sciences, 15, 227–239.

Phan, K. L., Fitzgerald, D. A., Nathan, P. J., &

Tancer, M. E. (2006). Association between

amygdala hyperactivity to harsh faces and

severity of social anxiety in generalized social

phobia. Biological Psychiatry, 59(5), 424–

429.

Phelps, E. A. (2006). Emotion and cognition:

Insights from studies of the human amygdala.

Annual Review of Psychology, 57, 27–53.

Phelps, E. A., O’Connor, K. J., Gatenby, J. C.,

Gore, J. C., Grillon, C., & Davis, M. (2001).

Activation of the left amygdala to a cognitive

representation of fear. Nature Neuroscience,

4, 437–441.

Philiastides, M. G., Auksztulewicz, R., Heekeren,

H. R., & Blankenburg, F. (2011). Causal role

of dorsolateral prefrontal cortex in human

perceptual decision making. Current Biology,

21(11), 980–983.

Phillips, R. G., & LeDoux, J. E. (1992). Differen-

tial contribution of amygdala and hippocam-

pus to cued and contextual fear conditioning.

Behavioral Neuroscience, 106, 274–285.

Pine, A., Shiner, T., Seymour, B., & Dolan, R.

J. (2010). Dopamine, time, and impulsivity in

humans. Journal of Neuroscience, 30, 8888–

8896.

Posner, M. I., & Snyder, C. R. R. (1975). Atten-

tion and cognitive control. In R. L. Solso

(Ed.), Information processing and cognition

(pp.

55–85). Hillsdale, NJ: Erlbaum.

Radu, P. T., Yi, R., Bickel, W. K., Gross, J. J.,

& McClure, S. M. (2011). A mechanism for

reducing delay discounting by altering tem-

poral attention. Journal of the Experimental

Analysis of Behavior, 96, 363–385.

Rangel, A., Camerer, C. F., & Montague, P. R.

(2008). A framework for studying the neurobi-

ology of value-based decision-

aking. Nature

Reviews Neuroscience, 9, 545–556.

110 COGNITIVE APPROACHES

Read, D., Frederick, S., Orsel, B., & Rahman, J.

(2005). Four Score and Seven Years from Now:

The date/delay effect in temporal discounting.

Management Science, 51(9), 1326–1335.

Redish, A. D. (2004). Addiction as a computa-

tional process gone awry. Science, 306, 1944–

1947.

Ridderinkhof, K. R. (2004). The role of the

medial frontal cortex in cognitive control. Sci-

ence, 306(5695), 443–447.

Sanfey, A. G., Rilling, J. K., Aronson, J. A., Nys-

trom, L. E., & Cohen, J. D. (2003). The neural

basis of economic decision- making in the ulti-

matum game. Science, 300, 1755–1758.

Schacter, D. L., Addis, D. R., & Buckner, R. L.

(2008). Remembering the past to imagine the

future: The prospective brain. Nature Reviews

Neuroscience, 8, 657–661.

Schultz, W., Dayan, P., & Montague, P. R.

(1997). A neural substrate of prediction and

reward. Science, 275, 1593–1599.

Scoville, W. B., & Milner, B. (1957). Loss of

recent memory after bilateral hippocampal

lesions. Journal of Neurology, Neurosurgery,

and Psychiatry, 20, 11–21.

Shallice, T., & Burgess, P. W. (1991). Deficits

in strategy application following frontal lobe

damage in man. Brain, 114, 727–741.

Shamosh, N. A., DeYoung, C. G., Green, A. E.,

Reis, D. L., Johnson, M. R., Conway, A. R. A.,

et al. (2008). Individual differences in delay

discounting: Relation to intelligence, working

memory, and anterior prefrontal cortex. Psy-

chological Science, 19, 904–911.

Shiffrin, R. M., & Snyder, W. (1977). Controlled

and automatic processing: II. Perceptual learn-

ing, automatic attending, and a general theory.

Psychological Review, 84, 127–190.

Shizgal, P., & Conover, K. (1996). On the neural

computation of utility. Current Directions in

Psychological Science, 5, 37–43.

Simon, H. A. (1959). Theories of decision-

making in economics and behavioral science.

American Economic Review, 49, 253–283.

Strotz, R. (1956). Myopia and inconsistency in

dynamic utility maximization. Review of Eco-

nomic Studies, 23, 165–180.

Stuss, D. T., & Levine, B. (2002). Adult clinical

neuropsychology: Lessons from studies of the

frontal lobes. Annual Review in Psychology,

53, 401–433.

Thaler, R. H. (1981). Some empirical evidence on

time inconsistency. Review of Economic Stud-

ies, 23, 165–180.

Thaler, R. H., & Benartzi, S. (2004). Save More

Tomorrow

: Using behavioral economics to

increase employee saving. Journal of Political

Economy, 112, S164–S187.

Thaler, R. H., & Shefrin, H. (1981). An eco-

nomic theory of self- control. Journal of Politi-

cal Economy, 89, 392–406.

Trope, Y., & Liberman, N. (2003). Temporal con-

strual. Psychological Review, 110, 403–421.

van den Bos, W., & McClure, S. M. (2013).

Towards a general model of delay discount-

ing. Journal of the Experimental Analysis of

Behavior, 99, 58–73.

Wang, X. T., & Dvorak, R. D. (2010). Sweet

future: Fluctuating blood glucose levels affect

future discounting. Psychological Science, 21,

183–188.

Whalen, P. J., Rauch, S. L., Etcoff, N. L., McIn-

erney, S. C., Lee, M. B., & Jenike, M. A.

(1998). Masked presentations of emotional

facial expressions modulate amygdala activity

without explicit knowledge. Journal of Neuro-

science, 18, 411– 418.

Wicker, B., Keysers, C., Plailly, J., Royet, J. P.,

Gallese, V., & Rizzolatti, G. (2003). Both of

us disgusted in my insula: The common neu-

ral basis of seeing and feeling disgust. Neuron,

40, 655–664.

Wise, R. A. (1982). Neuroleptics and operant

behavior: The anhedonia hypothesis. Behav-

ioral and Brain Sciences, 5, 39 – 87.

Yeung, N., Botvinick, M. M., & Cohen, J. D.

(2004). The neural basis of error detection:

Conflict monitoring and the error- related

negativity. Psychological Review, 111(4), 931–

959.

111

You would be hard pressed to find a psy-

chologist, professional or budding, who is

not familiar with research on delay of grati-

fication (DG)—the ability to put off a small,

but immediate, reward in favor of receiving

a larger reward later (e.g., Mischel & Ayduk,

2011). In fact, more and more, this work is

being written about in the popular media

(e.g., Brooks, 2006; Lehrer, 2009), and thus

likely discussed in nonacademic circles, such

as parents, educators, and clinicians. What

makes DG, as a topic, so interesting? This

fascination is likely due to the longitudinal

studies linking performance on the classic

DG paradigm, during which a child tries

to wait for two treats instead of having one

right away, to a variety of critical outcomes

in later life, including drug use, social com-

petence, and even Scholastic Aptitude Test

(SAT) scores (e.g., Mischel, Shoda, & Rodri-

guez, 1989).

Although this early longitudinal research

popularized DG for the general public,

researchers have certainly expanded beyond

it. For example, research has linked DG to

other forms of cognitive control (e.g., Casey

et al., 2011; Eigsti et al., 2006), identified

mechanisms that underlie DG ability (e.g.,

Rodriguez, Mischel, & Shoda, 1989), and

examined how these processes play out in

adults, with whom treats are no longer entic-

ing rewards (e.g., Green, Fry, & Myerson,

1994). The bulk of this work, however, has

most often described and discussed DG as a

form of behavioral self- control and focused

on its cognitive and attentional underpin-

nings.

More recently, there has been a growing

body of research linking DG to affective

processes— emotional experience and emo-

tion regulation. In this chapter, we examine

these findings. To do so, we first provide

a brief overview of DG, including its mea-

surement across different age groups and a

description of the most studied mechanism

thought to underlie performance. Subse-

quently, we review four bodies of research

on DG and emotion that in many ways over-

lap. First, we discuss research on the devel-

opmental precursors of DG ability, focus-

ing on how caregivers’ emotion expression

and responsivity to child distress impact the

development of this competency in young

children (e.g., Rodriguez et al., 2005). Sec-

ond, we describe how an individual’s own

affective state impacts DG—more particu-

larly, the damaging effect of negative emo-

tion on one’s ability to put off long-term

rewards (e.g., Tice, Baumeister, & Zhang,

2004). Third, we draw on literature sug-

gesting that DG ability may serve an impor-

tant role in the regulation of emotion— as

CHAPTER 7

The Role of Emotion

and Emotion Regulation

in the Ability to Delay Gratification

Anna Luerssen

Ozlem Ayduk

112 COGNITIVE APPROACHES

a resource for individuals to utilize in emo-

tionally taxing situations (e.g., Ayduk et al.,

2000). Finally, we describe neuroimaging

research that has provided clues about the

links between affective processes and DG

(e.g., McClure, Laibson, Loewenstein, &

Cohen, 2004).

Review of DG

Early research on DG was conducted pri-

marily with preschool- age children using

what has become the classic DG paradigm,

referred to fondly as the “marshmallow

task” (see Mischel & Ayduk, 2011, for

review). First, the experimenter asks the

child whether they would prefer a smaller

or larger reward (e.g., one marshmallow or

two marshmallows). Most children prefer

the larger option, and once they say so, the

experimenter goes on to explain the task con-

tingencies. If, indeed, the child would like to

have the larger reward, he or she must wait

until the experimenter returns to the room,

ostensibly after setting up another task. The

child can have the smaller reward anytime,

however, by ringing a bell and bringing the

experimenter back. The experimenter leaves

the child alone with their options sitting on

a plate in front of them (e.g., one marshmal-

low on one side of the plate, two marshmal-

lows on the other side) and the amount of

time the child can wait is recorded— the pri-

mary measure of DG ability.

Longer wait-time scores on this task have

been linked to varied long-term outcomes

such as higher SAT scores, lower drug use,

and better social- cognitive competence

(e.g., Mischel et al., 1989; Shoda, Mischel,

& Peake, 1990). As such, researchers have

sought to understand what mechanisms

underlie the ability of children to wait (e.g.,

Rodriguez et al., 1989). Experimental and

individual- differences research has found

that attention deployment during the wait-

ing period is an important predictor of wait

time. The more time a child spends looking

at the rewards and the bell (i.e., hot- focused

attention), the harder it is for him or her to

wait. Alternatively, the more time a child

spends looking away from the rewards and

bell and instead focuses on other things in

the room (i.e., cool- focused attention), the

easier it is to wait. In this way, contempo-

rary researchers using the classic paradigm

often measure both wait time and attention

deployment in their evaluation of DG per-

formance.

Although the classic paradigm is the most

studied DG measure, it was designed for pre-

school children and expanded for children

up to 11 years of age (Rodriguez et al., 1989).

Prior to preschool (before approximately age

4), children typically have neither the cogni-

tive capacity to understand the contingencies

of the task nor the ability to wait extended

periods of time alone. Alternatively, for ado-

lescents and adults, cookies and marshmal-

lows may not be tempting in the way they

are for children. Moreover, the experimental

situation with a capped wait time may not

tax adults’ self- regulatory competencies suf-

ficiently. For these reasons the classic task is

unlikely to be diagnostic of individual differ-

ences in DG ability after childhood. Given

that researchers have wanted to study DG in

other age groups, they developed a variety of

tasks better suited to these populations.

Researchers evaluating DG ability in very

young children often employ variations of

either the gift delay or snack delay tasks,

both developed by Kochanska and Knaack

(2003). These tasks require the child to

exert impulse control before obtaining a

desired reward. In a standard gift delay

task, for example, the experimenter pres-

ents a wrapped gift to the child, then has to

leave the room and asks the child to wait to

open it until he or she returns. The child’s

behavior is scored with codes ranging from

not touching or peeking inside the bag to

opening the gift completely. In a typical

snack delay task, children have to wait for

the experimenter to ring a bell before tak-

ing M&M’s “hidden” under a clear cup.

There are a series of trials that vary in the

time delay before the experimenter rings the

bell (e.g., 10–30 seconds). Halfway through

the delay, the experimenter lifts the cup but

does not ring the bell. The child’s behavior

is observed and coded as waiting, touching,

or eating the M&M’s before the bell rings,

with the assumption that these behaviors

reflect decreasing levels of DG ability.

Choice delay tasks are used with adoles-

cents and adults, though many studies also

employ these tasks with children. In a stan-

dard choice delay task, the participant is

asked to make a series of choices between

Delay and Emotion 113

a smaller, immediate reward and a larger,

delayed reward (e.g., $5 today vs. $10 in 1

week) (e.g., Seeman & Schwarz, 1974; Wert-

heim & Schwarz, 1983). The sizes of the

small and large options, as well as the delay

intervals, are varied between trials. In some

studies, researchers calculate participants’

temporal or delay discounting rate—how

quickly larger rewards become unappeal-

ing when a delay is required to obtain them.

For more on choice delay tasks, see Miller,

Rodriguez, Kim, and McClure (this volume).

While we do not claim that these tasks

perfectly parallel the classic paradigm, in

this review we include research using these

measures, with the assumption that there is

at least a moderate degree of overlap in the

psychological conditions between them. In

summary, researchers have developed a vari-

ety of tasks to evaluate DG ability. In child-

hood, the classic paradigm or “marshmal-

low task” is the predominant measure, with

both wait time and attention deployment

scored. Other measures have been developed

for young children and for use with adoles-

cents and adults. In the subsequent review,

we link performance on these measures to

emotion and emotion regulation.

Caregiver Emotion and Responsivity

Given the connection between DG perfor-

mance and such varied and critical long-

term outcomes, the question of how this

ability develops becomes important. Of par-

ticular relevance for our discussion of DG

and emotion is whether there is an associa-

tion between affective environments in early

childhood and the successful development of

DG ability later on.

Researchers have found that caregiver

variables, including caregiver emotion and

caregiver responsivity to children’s emotion,

are important correlates of subsequent DG

development. These variables are often inter-

related or measured interchangeably— with

the nature of caregivers’ expressed emotion

serving as a common signal of whether the

caregiver is responsive to the child’s emo-

tion. In one such study, Eiden, Edwards, and

Leonard (2007) coded parental affect from

videos of the parent and child interacting

at home when the child was age 2. DG was

measured 1 year later with a composite of

performance on age- appropriate DG tasks,

including the snack and gift delay tasks.

Children of parents who displayed lower lev-

els of positive affect were worse at DG 1 year

later. In a similar study, maternal responsive-

ness to a child’s verbal communications was

coded during home visits when the child was

age 24 months. The more responsive his or

her mother was, the more patient and task-

oriented the child was on a gift delay task

1 year later (Olson, Bates, & Bayles, 1990).

Houck and Lecuyer- Maus (2004) had

similar results when evaluating the associa-

tion between maternal responsivity and DG

behavior in a narrower context— during

child limit setting. During laboratory ses-

sions at child ages 12, 24, and 36 months,

parents were asked to prevent their child

from touching and playing with an attractive

toy. The researchers coded four limit- setting

approaches, which varied in the degree of

parent responsivity to the child’s emotion.

Children of parents who predominantly

used a power-based limit- setting approach,

characterized by little responsivity and high

negative affect, waited the least amount of

time during the DG task, significantly less

than children whose parents’ approaches

were more responsive to the child’s feelings.

Rodriguez and colleagues (2005) also

evaluated the role of maternal responsiv-

ity in their study linking behaviors during

the Strange Situation paradigm (used to

measure caregiver– child attachment) when

the child was 18 months old to DG ability

at age 4 (Rodriguez et al., 2005). Mater-

nal responsiveness during the free-play and

reunion episodes was coded using facial and

vocal expression, position and body contact,

and expression of affection, among other

variables. In addition, during the reunion

episode, the researchers identified instances

when a mother disengaged from her child

specifically following the child’s expression

of negative affect. Children of unresponsive

and disengaged mothers waited marginally

less time for a larger reward, and spent more

time directing their attention toward the

rewards and bell during the waiting period,

which, again, is an important mechanism

underlying DG ability (Rodriguez et al.,

1989).

In fact, children’s attachment style with

their caregivers, a more general reflection of

caregiver emotion and responsivity (Shaver

114 COGNITIVE APPROACHES

& Mikulincer, 2011), has also been cor-

related with DG performance. For exam-

ple, in one study, children who were more

securely attached to their caregivers waited

the longest on the classic DG task (Jacob-

sen, Huss, Fendrich, Kruesi, & Ziegenhain,

1997). The greatest difference in wait time

was found between children who displayed

a secure attachment pattern and those who

displayed a disorganized attachment pat-

tern (characterized by fearful and disorga-

nized responses during the reunion phase).

For more on attachment and emotion, see

Shaver and Mikulincer (this volume).

A variety of studies have corroborated

the finding that a caregiver’s hostile, over-

controlling behavior is associated with poor

DG ability. Jacobsen (1998) coded expressed

emotion during a 5-minute speech in which

mothers were asked to describe what their

child was like. Children of mothers who

expressed criticism (resentment of the child’s

behavior or characteristics) waited less time

on the classic DG paradigm. In another

study, researchers coded caregivers’ behav-

ior for directives (commands) during a free-

play time, along with take-overs (completing

the game themselves) and contingent posi-

tive affect (responding to the child’s correct

response with affect signaling approval) dur-

ing a teaching– learning task (Silverman &

Ippolito, 1995). Children of mothers who

used directives and engaged in take-overs

performed worse on age- appropriate ver-

sions of the DG task, including the snack

and gift delay tasks, 6 months later. Chil-

dren whose mothers engaged in contingent

positive affect were better at DG.

Other studies have provided evidence that

a caregiver’s approach to emotion more gen-

erally relates to DG development. Brophy-

Herb, Stansbury, Bocknek, and Horodyn-

ski (2011) evaluated the relation between

children’s DG and a variety of parental

emotion- related socialization behaviors

(ERSBs)—parenting behaviors thought to

be critical for a child’s socioemotional devel-

opment. ERSBs were scored during parent–

child interactions and with questionnaires.

These included positive emotional respon-

sivity and general expressivity in the home,

among other measures. Higher scores on

the ERSB composite factor (more emotion-

related socialization) positively predicted

performance on age- appropriate versions of

the DG task, including the snack and gift

delay tasks.

Collectively, these studies suggest that

caregiver emotion and responsivity are asso-

ciated with the development of DG ability

in childhood. But why exactly is a home life

characterized by caregiver positive affect,

limited hostility, and clear awareness and

sensitivity to a child’s emotion related to

superior DG? How do these affective vari-

ables relate to the development of the ability

to put off immediate gratification in order

to achieve long-term goals? Though there

have been little to no studies exploring this

question of mechanism, researchers have put

forth a few hypotheses, as described below.

Children’s negative affect, emerging

in the context of stress or frustration, is

likely short- circuited by responsive caregiv-

ers. These caregivers attend to their child’s

emotional needs and may provide support,

for example, through soothing or distract-

ing behavior (e.g., Garner, 2006; Jahromi

& Stifter, 2007). This external source of

emotion regulation may serve dual func-

tions. In the immediate, it helps to mitigate

children’s negative affective states. As fur-

ther described in the next section, negative

emotion can destabilize DG (e.g., Mischel,

Ebbesen, & Zeiss, 1972).

At a more global level, the external forms

of regulation provided by responsive care-

givers serve an important modeling func-

tion. Children of responsive caregivers may

have more opportunities to observe and

learn successful emotion regulation strate-

gies that they themselves can employ at an

appropriate age (e.g., Eisenberg, Fabes, &

Murphy, 1996; Garner, 2006). These skills

may be useful for successful DG, which is

in itself a frustrating task. In contrast, chil-

dren who lack such regulatory models may

not develop these skills, therefore becoming

more vulnerable to DG failure.

Caregivers’ own affective profiles may

serve to intensify these processes. Whereas

warm caregivers who score high in posi-

tive affect likewise engender positive affect

in their children, caregivers who score high

in negative affect regularly respond to their

children’s emotions and behaviors in nega-

tive ways, thereby maintaining or even

escalating their children’s negative affect

(Malatesta, Culver, Tesman, & Shepard,

1989). Over time, a caregiver’s character-

Delay and Emotion 115

istic affective tone serves as a model for

the development of a child’s own affective

profile— teaching the child which emotional

responses are appropriate across a range of

situations (e.g., Eisenberg et al., 1999, 2003;

Garner, 1995). Children with more chronic

negative affect may be regularly diverting

resources from DG goals, toward the regula-

tion of their negative affect.

In summary, warm and responsive care-

givers may raise children with high posi-

tive affect and low negative affect, who are

armed with a host of regulation strategies,

whereas cold and distant caregivers may

raise children with low positive affect and

high negative affect, who have fewer regu-

latory strategies. Future research should

evaluate these hypotheses more directly, for

example, by linking parental emotion and

regulatory profiles to the types of affective

reactions and regulatory strategies employed

by children during the DG task. For more on

the role of family on emotion, see Thompson

(this volume).

Affective State and DG

Does an individual’s prior affective state

impact his or her DG ability? For example,

how might children perform if they started

the classic DG task right after learning that

they received a failing grade on a test? What

if they had earned the top score in their

class? As briefly mentioned in the previous

section, researchers have found that negative

affect, in particular, is associated with poor

performance on both laboratory measures

of DG and during real-world DG scenarios,

such as dietary restraint. The evidence on

positive affect is more mixed: Some studies

indicate that positive affect helps DG; others

find that it hurts DG; and still others find

that it does not exert an impact all that dif-

ferent from neutral emotional states.

Negative Affect

Analyses conducted with various laboratory

measures have collectively supported the

prediction that negative emotion is associ-

ated with poor DG performance. In an early

study, researchers hypothesized that behav-

iors, or even thoughts, that successfully dis-

tract the child from the frustrating nature of

the classic DG task will help the child wait

for the larger reward (Mischel et al., 1972).

Indeed, children directed to think “fun”

thoughts during the task (e.g., playing with

toys) did wait longer. However, the con-

tent of the distraction was found to matter.

Directing children to think “sad” thoughts

(e.g., crying with no one to help you) actu-

ally hurt wait time. Children performed at

the same poor level when directed to think

sad thoughts, as when they were directed to

focus their attention on the rewards them-

selves, that is, hot attentional focus.

Similar results have been found with

choice delay tasks (e.g., Schwarz & Pollack,

1977). For example, in one study, 9-year-old

participants drew a picture, and then went

through either a positive affect induction—

receiving feedback that the drawing was

good and would be featured in an art

exhibit, or a negative affect induction—

receiving feedback that the drawing was

not good and would not be featured (See-

man & Schwarz, 1974). Subsequently, they

were asked a series of choice delay questions.

Participants in the negative affect condition

chose large, delayed rewards significantly

less often than participants in the positive

affect condition. In a similar study, partici-

pants, ages 3 to 5 years, directed to think

sad thoughts were more likely to choose an

immediate, mediocre reward over a desir-

able, delayed reward than were children in

either neutral or positive affect conditions

(Moore, Clyburn, & Underwood, 1976).

Similar results have been found with adults

(Gray, 1999). In one study, participants in

a negative affective state (exposed to aver-

sive pictures; in a state of heightened stress

about upcoming midterms) showed a prefer-

ence for short-term gains at the expense of

long-term gains, thus performing worse on

the task overall.

Individual- difference studies have cor-

roborated this body of experimental work.

For example, developmental researchers

have argued that temperament (biologically

based personality differences; see Rothbart,

Sheese, & Posner, 2007, for review) is com-

prised of three factors: arousal, emotion, and

self- regulation. These researchers found that

temperamental levels of negative affectivity

are inversely related to temperamental levels

of self- regulation (Derryberry & Rothbart,

1988). Relatedly, in studies with toddlers,

116 COGNITIVE APPROACHES

more frequent negative affect during the

separation (Rodriguez et al., 2005; Sethi,

Mischel, Aber, Shoda, & Rodriguez, 2000)

and reunion (Rodriguez et al., 2005) phases

of the Strange Situation procedure is associ-

ated with more hot attentional focus (look-

ing toward the rewards and bell) during the

classic DG task at ages 4 and 5. Moreover,

in a choice delay task, mild and moderately

depressed adults were more likely to choose

immediate, less desirable rewards over large,

delayed rewards than individuals who were

not depressed (Wertheim & Schwarz, 1983).

Similar effects have been found in more

real-world DG scenarios. For example,

dietary restraint, like laboratory measures of

DG, requires an individual to put off short-

term gratification (e.g., the pleasure derived

from eating delicious foods), for the sake of

a long-term goal (e.g., losing weight, being

healthy). Because restrained eaters are con-

stantly trying to delay gratification to obtain

a thinner and healthier body, how their eating

changes in response to their current affective

state can inform our understanding of how

affective states impact DG performance more

generally. According to the restraint theory

of Herman and Polivy (1975), negative affect

increases eating in restrained eaters (the rea-

sons for which we evaluate below).

In an experimental evaluation of this

prediction, Frost, Goolkasian, Ely, and

Blanchard (1982) had participants, who var-

ied on degree of dietary restraint, go through

either a negative, positive, or neutral affect

induction. During this affect induction, a

bowl of M&M’s was placed in front of par-

ticipants, and they were told to eat freely

from the bowl. Restrained eaters in the nega-

tive affect condition ate more M&M’s than

nonrestrained eaters in the same condition,

and ate more than restrained eaters in both

the positive and neutral affect conditions.

Though there was not a significant differ-

ence in the eating behavior of nonrestrained

eaters across conditions, they appeared to eat

the least when in a negative affective state.

Baucom and Aiken (1981) had similar

results. Their participants, obese and non-

obese, restrained and nonrestrained eaters,

were asked to solve a task and received either

success feedback (a positive affect induction)

or failure feedback (a negative affect induc-

tion). Participants were then asked to com-

plete an ostensible taste test study in which

they tried different crackers and rated their

flavor preferences. Among restrained eat-

ers, participants who received failure feed-

back ate significantly more crackers than

those who received success feedback. In

contrast, nonrestrained eaters ate margin-

ally fewer crackers after failure feedback

than after success feedback. This pattern

of results held for both obese and nonobese

participants. The link between negative

affect and weakened dietary restraint was

also found among participants experiencing

clinical depression (characterized by strong

negative affect; Polivy & Herman, 1976).

In this study, restrained eaters reported a

considerable weight gain since the onset of

their depression (~6 lbs on average), while

nonrestrained eaters reported a considerable

weight loss (~5 lbs on average), with the dif-

ference between them highly significant.

Collectively, both experimental and

individual- difference studies, involving

classic laboratory measures and more eco-

logically valid study designs, suggest that

negative affect is associated with worse DG

performance. A variety of theories have been

posited to explain this association. The most

common account argues that negative affec-

tive states are incredibly distressing, and as

such, relief from them may take precedence

over long-term goals (e.g., Heatherton &

Baumeister, 1991). Energy or resources ini-

tially directed toward putting off immedi-

ate gratification may be diverted and used

toward emotion regulation instead. With

fewer resources aimed specifically at the DG

attempt, the ability to wait thus suffers (see

Baumeister, Vohs, & Tice, 2007, for review).

For example, restrained eaters, when put into

a negative affective state, may need to divert

the self- regulatory resources they typically

use to restrict their caloric intake, to regu-

late their emotions, resulting in more eating.

Note, however, that some researchers have

argued that individuals who report dieting

may in fact be worse at self- regulation more

generally (see Pratt & Wardle, 2012, for

review).

Moreover, in some DG scenarios a proxi-

mal source of affect relief is available— the

smaller, but immediately available, option.

For example, a child might experience a

reduction in his or her sad feelings as a

Delay and Emotion 117

result of thinking sad thoughts by enjoy-

ing an immediately available, albeit small,

treat. At a more global level, this suggests

that negative affect may change the subjec-

tive reinforcement values of immediate and

delayed rewards (e.g., Baucom & Aiken,

1981; Schwarz & Pollack, 1977; Seeman &

Schwarz, 1974). For individuals in a negative

affective state, the value of the more immedi-

ate option, though objectively smaller, may

increase, because it has the potential to ame-

liorate negative affect. On the other hand,

the value of the long-term goal, or delayed

option, is likely to decrease, because it serves

less of a purpose in removing the negative

affect and may even exacerbate it by adding

additional frustration.

Positive Affect

Although the link between DG and nega-

tive affect seems well established, the find-

ings on positive affect are more mixed. Some

researchers find that, like negative affect,

positive affect is associated with poor DG

performance. For example, Cools, Schotte,

and McNally (1992) exposed participants to

a neutral film, a comedy (i.e., positive affect

induction), or a horror film (i.e., negative

affect induction). Participants were given a

bag of popcorn during the movie and told

to eat as much as they liked. In the neutral

condition, participants higher in dietary

restraint ate less popcorn than those lower

in dietary restraint. In both the comedy

and horror film conditions, however, par-

ticipants higher in dietary restraint ate more

popcorn.

In many other studies, however, partici-

pants in a positive affective state performed

better at DG tasks than those in a negative

affective state. As previously described, chil-

dren who received positive feedback regard-

ing the quality of their drawings chose

larger, delayed rewards more often than

those who received negative feedback (See-

man & Schwarz, 1974). Similarly, children

completing the classic DG task performed

better when asked to think fun, distract-

ing thoughts than when they were directed

to think about the rewards (Mischel et al.,

1972). On a choice delay task, children

in the positive affect condition tended to

choose larger, delayed rewards even more

often than those in the neutral affect condi-

tion, though these results were not statisti-

cally significant (Moore et al., 1976). Stud-

ies have also shown that putting restrained

eaters in a positive or neutral affective state,

in comparison to a negative affective state, is

associated with greater DG ability (Baucom

& Aiken, 1981; Frost et al., 1982). Positive

affective states did not consistently improve

DG performance more than neutral states,

however (Frost et al., 1982).

In summary, the majority of evidence sug-

gests that being in a positive affective state

does not hurt DG the way being in a nega-

tive affective state does, and in some cases it

may even help DG. Although some research-

ers’ findings implied that there are specific

conditions under which positive affect may

thwart DG, we suspect that positive affect

is likely to serve a facilitative function under

most conditions. This assumption is con-

sistent with studies linking positive affect

to improved self- regulation more generally

(e.g., Shmueli & Prochaska, 2012; Tice,

Baumeister, Shmueli, & Muraven, 2007;

Tice et al., 2004).

Although there is need for more research

to firmly establish the facilitative impact of

positive affect on DG, what mechanisms

might explain such an effect? As previously

described, positive affect has been found

to restore self- regulatory resources (Tice

et al., 2007), suggesting that individuals

in a positive affective state may have addi-

tional resources available for DG. More-

over, research in support of Fredrickson’s

broaden- and-build theory of positive emo-

tion, has found that positive affect increases

one’s attentional focus, which may help

transcend the here and now, and thus DG

(see Fredrickson, 2001, for review; cf. Gable

& Harmon-Jones, 2011). Relatedly, positive

affect appears to mitigate the adverse effects

of negative affect (e.g., Fredrickson, 2001;

Fredrickson & Levenson, 1998), and per-

haps by extension the damaging effect nega-

tive affect has on DG performance. Finally,

it is possible that positive affect has informa-

tional value—affirming that things are safe

or certain (see Schwarz, 2011, for review),

which may lead individuals to be more will-

ing to wait for the delayed rewards during a

DG task. Future work should examine these

hypotheses directly.

118 COGNITIVE APPROACHES

Emotion Regulation and DG

Since the initial studies, researchers have

readily assumed that DG tasks induce emo-

tion, and thus by extension, require emotion

regulation— the process of changing the way

we think, feel, and express emotions (e.g.,

Gross & Thompson, 2007). Does the way

an individual deals with these task- induced

emotions impact his or her ability to wait for

the larger reward? What about the reverse?

Is there an association between an individu-

al’s DG ability and how adept he or she is at

regulating emotions? Indeed, a large body of

research demonstrates that one’s DG ability

is predictive of emotion regulation behaviors

in a variety of emotionally taxing situations.

Whether, and how, children regulate their

emotions during DG tasks likely impacts per-

formance. Here we refer to emotions stimu-

lated by the task itself, above and beyond

affective states that precede task onset (as

described in the previous section). For exam-

ple, if a child feels frustration and anger that

he or she cannot have the two marshmallows

immediately, does down- regulating negative

affect help or hurt efforts to wait? On the

flip side, if a child’s predominant affective

reaction to the DG situation is eagerness and

excitement, does down- regulating such posi-

tive emotions facilitate or undermine DG?

Unfortunately, there has been little to no

research that provides clear-cut answers

to these questions. This shortage may be

due, in part, to the difficulty of disentan-

gling emotional reactivity during DG tasks

(e.g., how frustrated– excited the individual

feels) and emotion regulation (e.g., how

well an individual can regulate frustration–

excitement if it indeed emerges). One of the

few studies evaluating emotion during DG

demonstrates this conundrum. Researchers

found that children, ages 4–7, who expressed

more anger and sadness during three age-

appropriate DG tasks, including the gift

delay task and a modified version of the clas-

sic task, also focused their attention more

on the rewards (an important mechanism

underlying poor DG performance; Santucci

et al., 2008). If more expressed negative

emotion reflects less emotion regulation, the

results would suggest that regulating nega-

tive emotion during the DG task should help

performance. It is also possible, however,

that children who performed better were

not regulating their negative emotion; rather

they were less emotionally reactive— and

this is why they displayed fewer expressions

of anger and sadness. These possibilities

need to be disentangled in future research.

Although research that examines emotion

regulation during the DG task is scarce, a

growing body of work shows that individu-

als strong in DG ability are better able to

regulate their emotions across a variety of

situations. In fact, this literature suggests

that individuals at risk for emotion regu-

latory difficulties may be protected from

negative life outcomes if they are also good

at DG. To illustrate, in one set of studies,

researchers evaluated the link between DG

and emotion regulation outcomes in people

with high rejection sensitivity (RS; Ayduk et

al., 2000). These are individuals who anx-

iously expect, readily perceive, and overreact

to social rejection (e.g., Downey & Feldman,

1996). Prior research indicates that individu-

als with high RS respond to perceived social

rejection with dysregulated emotion, includ-

ing jealousy (Downey & Feldman, 1996),

depressed affect (Ayduk, Downey, & Kim,

2001), and hostility directed toward the

source of rejection (Ayduk, Downey, Testa,

Yen, & Shoda, 1999).

Ayduk and colleagues (2000) hypoth-

esized that individuals with high RS and

strong DG ability would be better able to

focus on their longer- term goals, such as

relationship maintenance, during perceived

rejection, and thus be more likely to regu-

late their reactive emotional responses. In

support of this prediction, inner-city middle

school students with high RS were rated by

their teachers as more aggressive and less

socially accepted than those with low RS,

but only if they had poor DG ability, as

measured with the classic paradigm 2 years

earlier. In fact, participants with high RS

and good DG were rated as marginally less

aggressive and better liked than their peers

with low RS. Correspondingly, in a sample

of middle- aged participants, those with high

RS were rated by their parents as worse at

emotion regulation than were those with low

RS (e.g., more likely to go to pieces under

stress), but again, only if they performed

poorly on the classic DG task as preschool-

ers (Ayduk et al., 2000).

A similar pattern of results was found

with respect to borderline personality disor-

Delay and Emotion 119

der (BPD) symptoms (Ayduk et al., 2008). A

core feature of this disorder is extreme affec-

tive lability that bears a resemblance to that

of high RS, including intense hostility and

depression. Ayduk and colleagues hypoth-

esized, and found, that although there was

a positive association between RS and BPD

symptoms, this association was weaker in

individuals with good DG ability, as mea-

sured with the classic DG task in childhood.

A host of other studies corroborate these

findings— that individuals with good DG

ability seem better able to regulate their

emotions in a wide range of situations. For

example, researchers have found that good

DG ability is related to lower verbal and

physical aggression (Mischel et al., 1989),

along with less cheating behavior (Mischel

& Gilligan, 1964). Another study found that

adolescents rated by observers as less likely

to wait for a larger, but delayed, payment for

study participation were also rated higher in

hostility (Funder & Block, 1989). Kochan-

ska, Murray, and Harlan (2000) found that

among toddlers (i.e., 22–33 months olds),

effortful control (of which DG is a com-

ponent) was related to better regulation of

anger, both concurrently and prospectively.

Relatedly, inhibitory control ability (similar

to effortful control) among preschoolers,

in part measured by a gift delay task, posi-

tively correlated with emotion regulation in

controlling both positive and negative affect

(Carlson & Wang, 2007). For more infor-

mation on emotion regulation and effortful–

inhibitory control, see Eisenberg, Hofer,

Sulik, and Spinrad (this volume).

Studies with clinical populations yield

similar results. In one study, early adoles-

cents with externalizing disorder (character-

ized by hostility and aggression) performed

worse on a modified DG task that involved

a series of choices between pressing a button

immediately, which provided a 40% chance

of winning a nickel, or waiting to press a

button, which provided an 80% chance of

winning a nickel (Krueger, Caspi, Moffitt,

White, & Stouthamer- Loeber, 1996). Math-

ias and colleagues (2011) found that adoles-

cent girls’ preference for small, immediate

rewards on a choice delay task was associ-

ated with higher self- reported depression,

aggression, impulsivity, and suicide intent.

In another study, male parolees were pre-

sented with a choice between a small mon-

etary reward available after a short, fixed

delay and a large monetary reward avail-

able after a longer delay (Cherek, Moeller,

Dougherty, & Rhoades, 1997). The number

of times parolees chose the immediate, small

reward was correlated with the number of

aggressive responses they made in another

paradigm. In a follow- up study, parolees

who were imprisoned for violent crimes (e.g.,

aggravated assault, manslaughter) displayed

a preference for small, immediate rewards

significantly more than parolees imprisoned

for nonviolent crimes (e.g., theft, forgery)

(Cherek & Lane, 1999).

Collectively these studies show that there

is a strong association between DG and emo-

tion regulation, and they may suggest that

both forms of regulation are drawing on a

domain- general regulatory competence or

resource that can be utilized in a wide vari-

ety of situations. In the next section we pres-

ent evidence in support of this thesis with

work evaluating the neural underpinnings of

both emotion regulation and DG processes.

Emotion Regulation and DG

in the Brain

Why does an individual’s DG ability relate to

how well they can regulate their emotions?

One theory suggests that DG and emotion

regulation are related because both reflect

an individual’s more general self- regulation

ability (e.g., Cohen & Lieberman, 2010;

Heatherton & Wagner, 2011)—how well

the individual is able to overcome prepotent,

automatic, or stimulus- driven responses

(e.g., Metcalfe & Mischel, 1999). Accord-

ing to this theory, the ability to overcome an

automatic response, be it to grab a marsh-

mallow (in the case of DG) or to become

angry and lash out (in the case of emotion

regulation), is served by a regulatory “con-

trol center” that varies among individuals

in its efficiency or strength. Performance

on tasks diagnostic of self- regulatory ability

in one domain (e.g., DG) are therefore pre-

dictive of self- regulatory ability in another

domain (e.g., emotion regulation), in that

both utilize and reflect the power of this

more general regulatory ability.

This control center may emerge at a

neural level, with common brain regions

or networks serving self- regulation of all

120 COGNITIVE APPROACHES

types, including, but not limited to, DG

and emotion regulation. From this perspec-

tive, individual differences in self- regulation

reflect the relative or effective recruitment of

these regions. Neuroimaging work support-

ing this thesis has found that dorsolateral

(dlPFC) and ventrolateral (vlPFC) regions of

the lateral prefrontal cortex (lPFC) are acti-

vated during both DG and emotion regula-

tion tasks (e.g., Cohen & Lieberman, 2010;

Kober et al., 2010; Ochsner, Bunge, Gross,

& Gabrieli, 2002). This lPFC activation

is associated with the down- regulation of

activity in subcortical regions, such as those

implicated in emotional reactivity in the case

of emotion regulation (e.g., amygdala; Kober

et al., 2010), and reward- related reactivity in

the case of DG (e.g., ventral striatum; Och-

sner, Bunge, Gross, & Gabrieli, 2002).

For example, in one study participants pre-

sented with aversive pictures were directed

to regulate their negative emotion by either

increasing or decreasing it (Ochsner et al.,

2004). When engaging in both forms of

emotion regulation, the dlPFC and vlPFC

became active. Moreover, up- regulation

of negative emotion was associated with

increases in amygdala activation, while

down- regulation of negative emotion was

associated with decreases in amygdala acti-

vation. In another study, participants viewed

negative pictures and were instructed to cog-

nitively reappraise (i.e., emotion regulation),

or just attend to the pictures (Ochsner et al.,

2002). During reappraisal, the lPFC became

more active and the amygdala became less

active. In fact, there was an inverse corre-

lation between vlPFC and amygdala activa-

tion. These results suggest that, during reap-

praisal, vlPFC may down- regulate activity

in the amygdala, a region, again, known for

its role in emotion processing. For further

review on the neural bases of emotion regu-

lation, see Ochsner and Gross (this volume).

DG studies have similarly found the

lPFC is important for self- regulation. For

example, in choice delay tasks, both dlPFC

(Christakou, Brammer, & Rubia, 2011;

McClure et al., 2004) and vlPFC (McClure

et al., 2004) activation is associated with

delayed, rather than immediate, choices.

Additionally, participants who showed low

levels of dlPFC activation more quickly dis-

counted delayed rewards (i.e., worse DG

performance; Hariri et al., 2006). In a more

naturalistic study, cigarette smokers viewed

pictures of cigarettes known to induce crav-

ings (Kober et al., 2010). During the NOW

condition, participants were directed to

focus on the immediate consequences of

consuming the substance (how great that

cigarette would taste; i.e., immediate gratifi-

cation), while during the LATER condition,

participants were directed to focus on the

long-term consequences (risk for heart dis-

ease; i.e., delayed gratification). There was

greater activation of the dlPFC and vlPFC

during LATER trials than during NOW tri-

als. Moreover, dlPFC activation was associ-

ated with decreased activation in the ventral

striatum. In fact, ventral striatal activation

mediated the relationship between dlPFC

activation and self- reported craving. This

suggests that the dlPFC may down- regulate

reward- related activity in the ventral stria-

tum, which then may decrease the subjective

craving experience.

Together these studies show that the lPFC,

including both dorsolateral and ventrolat-

eral subregions, serve an important role

in both DG and emotion regulation tasks.

These results suggest that the lPFC may

be a critical component of a general self-

regulation control center, or network, in the

brain. A recent review conducted by Cohen

and Lieberman (2010) supports this theory.

They found that vlPFC activity, in particu-

lar, was associated with self- regulation in a

variety of domains, including emotion regu-

lation and DG, as well as motor response

inhibition, suppressing risky behavior, mem-

ory inhibition, and thought suppression.

Imaging studies also have the poten-

tial to clarify the relative contributions of

both emotional reactivity and regulation

to behavioral indices of DG. For example,

Casey and colleagues (2011) found that

participants with good DG ability showed

greater right lPFC activation when inhibit-

ing responses to appetitive stimuli (happy

faces). During these same trials, those with

good DG also showed less ventral striatum

activation. Importantly, there was no rela-

tionship between the lPFC and the ventral

striatum, suggesting that activation in each

region independently related to DG. These

results imply that DG ability may as much

reflect diminished emotional reactivity to

rewards, here social rewards in the form of

smiling faces, as regulatory control. Future

Delay and Emotion 121

work is needed, however, to more fully dis-

entangle how and when these regions work

independently versus inversely in predicting

DG performance.

Before concluding this section, it is neces-

sary that we mention a few caveats. First, it is

important to note that the lPFC, a relatively

large region of the brain, has been related

to diverse functions above and beyond self-

regulation. Additionally, though we have

focused on the lPFC in this review, we by

no means suggest that this is the only region

involved in self- regulation. For example, acti-

vation in the medial prefrontal (e.g., Kober

et al., 2010; Ochsner et al., 2002, 2004),

anterior cingulate (e.g., Hariri, Mattay, Tes-

sitore, Fera, & Weinberger, 2003; Ochsner

et al., 2004) posterior cingulate (e.g., Witt-

man, Leland, & Paulus, 2007), and parietal

(e.g., McClure et al., 2004) cortices is also

related to self- regulation in many studies,

including some of those mentioned earlier.

These regions are activated somewhat less

consistently, however, and may thus reflect

more specific aspects of regulation, forms

of regulation, or even the particulars of the

tasks used.

Concluding Remarks

In this chapter, we have reviewed research

showing that emotion and emotion regu-

lation are strongly connected to DG. Our

analysis focused on four subtopics: (1)

the link between early caregiver emotion/

responsivity and DG; (2) the role of affec-

tive state in DG; (3) the association between

emotion regulation and DG abilities; and (4)

the common neural foundations of emotion

regulation and DG. We found that children

best able to DG typically have been raised by

caregivers who have high positive affect and

low negative affect (especially hostility), and

are responsive and attentive to their chil-

dren’s emotional needs. A negative affective

state has been found to hinder successful

DG attempts, both in laboratory contexts

and in a real-world DG scenario— dietary

restraint. DG ability appears to support

individuals’ attempts to navigate emotion-

ally evocative situations. Finally, the litera-

ture indicates that both DG and emotion

regulation activate or rely on common brain

regions, including the lPFC. These findings

suggest that performance on both emotion

regulation and DG tasks may reflect an indi-

vidual’s domain- general regulatory ability,

with regulatory control largely influenced

by the lPFC.

Though there has been important research

on DG and emotion, many questions remain

unanswered. Throughout our review we have

highlighted a variety of important directions

for future research. For example, given that

prior results have been mixed, more studies

must be conducted to clarify the role of posi-

tive emotion in DG performance. Relatedly,

how emotion regulation functions within

DG tasks needs to be better understood. In

one study, reconstruing temptations as a

test of willpower was found to improve self-

regulation (Magen & Gross, 2007; see Leroy,

Grégoire, Magen, Gross, & Mikolajczak,

2012, for similar results). Therefore, reap-

praising one’s frustration during DG tasks

may similarly help performance. However,

it is also possible that letting task- induced

emotions flow freely to reserve regulatory

resources would actually enhance DG per-

formance. Therefore, whether emotion regu-

lation attempts help or hurt DG is an open

question that awaits further research.

In addition to emotional reactivity and

regulation, other factors, such as environ-

mental conditions, may also relate to DG.

For example, Kidd, Palmeri, and Aslin

(2013) evaluated performance on a classic

DG task in children previously exposed to

a reliable experimenter (one who promised

new art supplies and delivered them), and

those exposed to an unreliable experimenter

(one who failed to deliver said art supplies).

Children previously exposed to the unreli-

able environment were less likely to wait

for the larger rewards— here, a practical

and rational decision. These findings sug-

gest that DG ability may as much reflect the

reliability of the environments in which chil-

dren live as their self- regulatory abilities.

Most of the neuroimaging studies evalu-

ating DG reported here have utilized choice

delay tasks in adult populations. Future

studies should focus analysis on child pop-

ulations given that prefrontal regions are

among the last to mature (e.g., Casey, Gal-

van, & Hare, 2005) and may not be reliably

utilized by children in their efforts to exert

self- regulation. Finally, much of the research

outlined here is correlational. More experi-

122 COGNITIVE APPROACHES

mental research is needed to answer ques-

tions about the causal connection between

emotion, emotion regulation, and DG.

References

Ayduk, O., Downey, G., & Kim, M. (2001).

Rejection sensitivity and depressive symptoms

in women. Personality and Social Psychology

Bulletin, 27(7), 868– 877.

Ayduk, O., Downey, G., Testa, A., Yen, Y., &

Shoda, Y. (1999). Does rejection elicit hostil-

ity in rejection sensitive women? Social Cogni-

tion, 17(2), 245–271.

Ayduk, O., Mendoza- Denton, R., Mischel, W.,

Downey, G., Peake, P. K., & Rodriguez, M.

(2000). Regulating the interpersonal self: Stra-

tegic self- regulation for coping with rejection

sensitivity. Journal of Personality and Social

Psychology, 79(5), 776–792.

Ayduk, O., Zayas, V., Downey, G., Cole, A. B.,

Shoda, Y., & Mischel, W. (2008). Rejection

sensitivity and executive control: Joint predic-

tors of borderline personality features. Journal

of Research in Personality, 42(1), 151–168.

Baucom, D. H., & Aiken, P. A. (1981). Effect of

depressed mood on eating among obese and

nonobese dieting and nondieting persons.

Journal of Personality and Social Psychology,

41(3), 577–585.

Baumeister, R. F., Vohs, K. D., & Tice, D. M.

(2007). The strength model of self- control.

Current Directions in Psychological Science,

16(6), 351–355.

Brooks, D. (2006, May 7). Marshmallows and

public policy. Retrieved from www.nytimes.

com/2006/05/07/opinion/07brooks.html?n

=top%2fopinion%2feditorials%20and%20

op%2ded%2fop%2ded%2fcolumnists%2fda

vid%20brooks.

Brophy-Herb, H. E., Stansbury, K., Bocknek,

E., & Horodynski, M. A. (2011). Modeling

maternal emotion- related socialization behav-

iors in a low- income sample: Relations with

toddlers’ self- regulation. Early Childhood

Research Quarterly, 27, 352–364.

Carlson, S. M., & Wang, T. S. (2007). Inhibitory

control and emotion regulation in preschool

children. Cognitive Development, 22(4), 489–

510.

Casey, B. J., Galvan, A., & Hare, T. A. (2005).

Changes in cerebral functional organization

during cognitive development. Current Opin-

ion in Neurobiology, 15(2), 239–244.

Casey, B. J., Somerville, L. H., Gotlib, I. H.,

Ayduk, O., Franklin, N. T., Askren, M. K., et

al. (2011). Behavioral and neural correlates of

delay of gratification 40 years later. Proceed-

ings of the National Academy of Sciences

USA, 108(36), 14998–15003.

Cherek, D. R., & Lane, S. D. (1999). Laboratory

and psychometric measurements of impul-

sivity among violent and nonviolent female

parolees. Biological Psychiatry, 46(2), 273–

280.

Cherek, D. R., Moeller, F. G., Dougherty, D.

M., & Rhoades, H. (1997). Studies of violent

and nonviolent male parolees: II. Laboratory

and psychometric measurements of impulsiv-

ity. Biological Psychiatry, 41(5), 523–529.

Christakou, A., Brammer, M., & Rubia, K.

(2011). Maturation of limbic corticostriatal

activation and connectivity associated with

developmental changes in temporal discount-

ing. NeuroImage, 54(2), 1344–1354.

Cohen, J. R., & Lieberman, M. D. (2010). The

common neural basis of exerting self- control

in multiple domains. In R. R. Hassin, K. N.

Ochsner, Y. Trope, R. R. Hassin, K. N. Och-

sner, & Y. Trope (Eds.), Self control in society,

mind, and brain (pp. 141–160). New York:

Oxford University Press.

Cools, J., Schotte, D. E., & McNally, R. J.

(1992). Emotional arousal and overeating in

restrained eaters. Journal of Abnormal Psy-

chology, 101(2), 348–351.

Derryberry, D., & Rothbart, M. K. (1988).

Arousal, affect, and attention as components

of temperament. Journal of Personality and

Social Psychology, 55(6), 958–966.

Downey, G., & Feldman, S. I. (1996). Implica-

tions of rejection sensitivity for intimate rela-

tionships. Journal of Personality and Social

Psychology, 70(6), 1327–1343.

Eiden, R. D., Edwards, E. P., & Leonard, K.

E. (2007). A conceptual model for the devel-

opment of externalizing behavior problems

among kindergarten children of alcoholic

families: Role of parenting and children’s self-

regulation. Developmental Psychology, 43(5),

1187–1201.

Eigsti, I., Zayas, V., Mischel, W., Shoda, Y.,

Ayduk, O., Dadlani, M. B., et al. (2006). Pre-

dicting cognitive control from preschool to

late adolescence and young adulthood. Psy-

chological Science, 17(6), 478–484.

Eisenberg, N., Fabes, R. A., & Murphy, B. C.

(1996). Parents’ reactions to children’s nega-

tive emotions: Relations to children’s social

Delay and Emotion 123

competence and comforting behavior. Child

Development, 67(5), 2227–2247.

Eisenberg, N., Fabes, R. A., Shepard, S. A., Guth-

rie, I. K., Murphy, B. C., & Reiser, M. (1999).

Parental reactions to children’s negative emo-

tions: Longitudinal relations to quality of chil-

dren’s social functioning. Child Development,

70(2), 513–534.

Eisenberg, N., Hofer, C., Sulik, J. & Spinrad, T.

L. (this volume, 2014). Self- regulation, effort-

ful control, and their socioemotional corre-

lates. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp. 157–172). New

York: Guilford Press.

Eisenberg, N., Valiente, C., Morris, A. S., Fabes,

R. A., Cumberland, A., Reiser, M., et al.

(2003). Longitudinal relations among parental

emotional expressivity, children’s regulation,

and quality of socioemotional functioning.

Developmental Psychology, 39(1), 3–19.

Fredrickson, B. L. (2001). The role of positive

emotions in positive psychology: The broaden-

and-build theory of positive emotions. Ameri-

can Psychologist, 56(3), 218–226.

Fredrickson, B. L., & Levenson, R. W. (1998).

Positive emotions speed recovery from the

cardiovascular sequelae of negative emo-

tions. Cognition and Emotion, 12(2), 191–

220.

Frost, R. O., Goolkasian, G. A., Ely, R. J., &

Blanchard, F. A. (1982). Depression, restraint,

and eating behavior. Behaviour Research and

Therapy, 20(2), 113–121.

Funder, D. C., & Block, J. (1989). The role of

ego- control, ego- resiliency, and IQ in delay of

gratification in adolescence. Journal of Per-

sonality and Social Psychology, 57(6), 1041–

1050.

Gable, P. A., & Harmon-Jones, E. (2011). Atten-

tional consequences of pregoal and postgoal

positive affects. Emotion, 11(6), 1358–1367.

Garner, P. W. (1995). Toddlers’ emotion regula-

tion behaviors: The roles of social context and

family expressiveness. Journal of Genetic Psy-

chology, 156(4), 417– 430.

Garner, P. W. (2006). Prediction of prosocial and

emotional competence from maternal behav-

ior in African American preschoolers. Cul-

tural Diversity and Ethnic Minority Psychol-

ogy, 12(2), 179–198.

Gray, J. R. (1999). A bias toward short-term

thinking in threat- related negative emotional

states. Personality and Social Psychology Bul-

letin, 25(1), 65–75.

Green, L., Fry, A. F., & Myerson, J. (1994). Dis-

counting of delayed rewards: A life-span com-

parison. Psychological Science, 5(1), 33–36.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp. 3–24). New York: Guilford Press.

Hariri, A. R., Brown, S. M., Williamson, D.

E., Flory, J. D., de Wit, H., & Manuck, S. B.

(2006). Preference for immediate over delayed

rewards is associated with magnitude of ven-

tral striatal activity. Journal of Neuroscience,

26(51), 13213–13217.

Hariri, A. R., Mattay, V. S., Tessitore, A., Fera,

F., & Weinberger, D. R. (2003). Neocortical

modulation of the amygdala response to fear-

ful stimuli. Biological Psychiatry, 53, 494–

501.

Heatherton, T. F., & Baumeister, R. F. (1991).

Binge eating as escape from self- awareness.

Psychological Bulletin, 110(1), 86–108.

Heatherton, T. F., & Wagner, D. D. (2011). Cog-

nitive neuroscience of self- regulation failure.

Trends in Cognitive Sciences, 15(3), 132–139.

Herman, C. P., & Polivy, J. (1975). Anxiety,

restraint, and eating behavior. Journal of

Abnormal Psychology, 84(6), 666–672.

Houck, G. M., & Lecuyer- Maus, E. A. (2004).

Maternal limit setting during toddlerhood,

delay of gratification, and behavior problems

at age five. Infant Mental Health Journal,

25(1), 28– 46.

Jacobsen, T. (1998). Delay behavior at age six:

Links to maternal expressed emotion. Journal

of Genetic Psychology, 159(1), 117–120.

Jacobsen, T., Huss, M., Fendrich, M., Kruesi, M.

J. P., & Ziegenhain, U. (1997). Children’s abil-

ity to delay gratification: Longitudinal rela-

tions to mother– child attachment. Journal of

Genetic Psychology, 158(4), 411–426.

Jahromi, L. B., & Stifter, C. A. (2007). Individ-

ual differences in the contribution of maternal

soothing to infant distress reduction. Infancy,

11(3), 255–269.

Kidd, C., Palmeri, H., & Aslin, R. N. (2013).

Rational snacking: Young children’s decision-

making on the marshmallow task is moder-

ated by beliefs about environmental reliability.

Cognition, 126, 109–114.

Kober, H., Mende- Siedlecki, P., Kross, E. F.,

Weber, J., Mischel, W., Hart, C. L., et al.

(2010). Prefrontal– striatal pathway underlies

cognitive regulation of craving. Proceedings

of the National Academy of Sciences USA,

107(33), 14811–14816.

Kochanska, G., & Knaack, A. (2003). Effort-

124 COGNITIVE APPROACHES

ful control as a personality characteristic of

young children: Antecedents, correlates, and

consequences. Journal of Personality, 71(6),

1087–1112.

Kochanska, G., Murray, K. T., & Harlan, E. T.

(2000). Effortful control in early childhood:

Continuity and change, antecedents, and

implications for social development. Develop-

mental Psychology, 36(2), 220–232.

Krueger, R. F., Caspi, A., Moffitt, T. E., White,

J., & Stouthamer- Loeber, M. (1996). Delay of

gratification, psychopathology, and personal-

ity: Is low self- control specific to externaliz-

ing problems? Journal of Personality, 64(1),

107–129.

Lehrer, J. (2009, May 18). Don’t!: The

secret of self- control. The New Yorker.

Retrieved from www.newyorker.com/

reporting/2009/05/18/090518fa_fact_lehrer.

Leroy, V., Grégoire, J., Magen, E., Gross, J. J.,

& Mikolajczak, M. (2012). Resisting the

sirens of temptation while studying: Using

reappraisal to increase focus, enthusiasm, and

performance. Learning and Individual Differ-

ences, 22(2), 263–268.

Magen, E., & Gross, J. J. (2007). Harnessing

the need for immediate gratification: Cogni-

tive reconstrual modulates the reward value of

temptations. Emotion, 7(2), 415–428.

Malatesta, C. Z., Culver, C., Tesman, J. R., &

Shepard, B. (1989). The development of emo-

tion expression during the first two years of

life. Monographs of the Society for Research

in Child Development, 54(1–2), 1–104.

Mathias, C. W., Dougherty, D. M., James, L.

M., Richard, D. M., Dawes, M. A., Ache-

son, A., et al. (2011). Intolerance to delayed

reward in girls with multiple suicide attempts.

Suicide and Life- Threatening Behavior, 41(3),

277–286.

McClure, S. M., Laibson, D. I., Loewenstein, G.,

& Cohen, J. D. (2004). Separate neural sys-

tems value immediate and delayed monetary

rewards. Science, 306(5695), 503–507.

Metcalfe, J., & Mischel, W. (1999). A hot/

cool- system analysis of delay of gratifica-

tion: Dynamics of willpower. Psychological

Review, 106(1), 3–19.

Miller, E. M., Rodriguez, C., Kim, B., &

McClure, S. M. (this volume, 2014). Delay

discounting: A two- systems perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 93–110). New York: Guil-

ford Press.

Mischel, W., & Ayduk, O. (2011). Willpower in

a cognitive- affective processing system: The

dynamics of delay of gratification. In K. D.

Vohs & R. F. Baumeister (Eds.), Handbook of

self- regulation: Research, theory, and applica-

tions (2nd ed., pp. 83–105). New York: Guil-

ford Press.

Mischel, W., Ebbesen, E., & Zeiss, A. (1972).

Cognitive and attentional mechanisms in

delay of gratification. Journal of Personality

and Social Psychology, 21(2), 204–218.

Mischel, W., & Gilligan, C. (1964). Delay of grat-

ification, motivation for the prohibited gratifi-

cation, and responses to temptation. Journal

of Abnormal and Social Psychology, 69(4),

411–417.

Mischel, W., Shoda, Y., & Rodriguez, M. L.

(1989). Delay of gratification in children. Sci-

ence, 244(4907), 933–938.

Moore, B. S., Clyburn, A., & Underwood, B.

(1976). The role of affect in delay of gratifica-

tion. Child Development, 47(1), 273–276.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. (2002). Rethinking feelings:

An fMRI study of the cognitive regulation of

emotion. Journal of Cognitive Neuroscience,

14(8), 1215–1229.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 23–42). New York: Guilford

Press.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D., et al.

(2004). For better or for worse: Neural sys-

tems supporting the cognitive down-and up-

regulation of negative emotion. NeuroImage,

23, 483– 499.

Olson, S. L., Bates, J. E., & Bayles, K. (1990).

Early antecedents of childhood impulsivity:

The role of parent– child interaction, cogni-

tive competence, and temperament. Journal of

Abnormal Child Psychology, 18(3), 317–334.

Polivy, J., & Herman, C. P. (1976). Clinical

depression and weight change: A complex rela-

tion. Journal of Abnormal Psychology, 85(3),

338–340.

Pratt, F. J., & Wardle, J. (2012). Dietary restraint

and self- regulation in eating behavior. Inter-

national Journal of Obesity, 36, 665– 674.

Rodriguez, M., Ayduk, O., Aber, J. L., Mischel,

W., Sethi, A., & Shoda, Y. (2005). A con-

textual approach to the development of self-

regulatory competencies: The role of maternal

unresponsivity and toddlers’ negative affect

Delay and Emotion 125

in stressful situations. Social Development,

14(1), 136 –157.

Rodriguez, M. L., Mischel, W., & Shoda, Y.

(1989). Cognitive person variables in the delay

of gratification of older children at risk. Jour-

nal of Personality and Social Psychology,

57(2), 358–367.

Rothbart, M. K., Sheese, B. E., & Posner, M. I.

(2007). Executive attention and effortful con-

trol: Linking temperament, brain networks,

and genes. Child Development Perspectives,

1(1), 2 –7.

Santucci, A. K., Silk, J. S., Shaw, D. S., Gentzler,

A., Fox, N. A., & Kovacs, M. (2008). Vagal

tone and temperament as predictors of emo-

tion regulation strategies in young children.

Developmental Psychobiology, 50(3), 205–

216.

Schwarz, J. C., & Pollack, P. R. (1977). Affect

and delay of gratification. Journal of Research

in Personality, 11(2), 147–164.

Schwarz, N. (2011). Feelings-

nformation the-

ory. In P. A. M. Van Lange, A. W. Kruglanski,

& E. T. Higgins (Eds.), Handbook of theories

of social psychology (pp.

289–308). Thousand

Oaks, CA: Sage.

Seeman, G., & Schwarz, J. C. (1974). Affective

state and preference for immediate versus

delayed reward. Journal of Research in Per-

sonality, 7(4), 384–394.

Sethi, A., Mischel, W., Aber, J. L., Shoda, Y., &

Rodriguez, M. L. (2000). The role of strate-

gic attention deployment in development of

self-

gulation: Predicting preschoolers’ delay

of gratification from mother–

oddler inter-

actions. Developmental Psychology, 36(6),

767–777.

Shaver, P. R., & Mikulincer, M. (this volume,

2014). Adult attachment and emotion regula-

tion. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp.

237–250). New

York: Guilford Press.

Shaver, P. R., & Mikulincer, M. (2011). Attach-

ment theory. In P. A. M. Van Lange, A. W.

Kruglanski, & E. T. Higgins (Eds.), Handbook

of theories of social psychology (pp.

160–179).

Thousand Oaks, CA: Sage.

Shmueli, D., & Prochaska, J. J. (2012). A test

of positive affect induction for countering

self- control depletion in cigarette smokers.

Psychology of Addictive Behaviors, 26(1),

157–161.

Shoda, Y., Mischel, W., & Peake, P. K. (1990). Pre-

dicting adolescent cognitive and self-

egulatory

competencies from preschool delay of gratifica-

tion: Identifying diagnostic conditions. Devel-

opmental Psychology 26(6), 978–986.

Silverman, I. W., & Ippolito, M. F. (1995).

Maternal antecedents of delay ability in young

children. Journal of Applied Developmental

Psychology, 16(4), 569–591.

Thompson, R. A. (this volume, 2014). Socializa-

tion of emotion and emotion regulation in the

family. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp.

173–186). New

York: Guilford Press.

Tice, D. M., Baumeister, R. F., Shmueli, D., &

Muraven, M. (2007). Restoring the self: Posi-

tive affect helps improve self-

egulation fol-

lowing ego depletion. Journal of Experimen-

tal Social Psychology, 43(3), 379–384.

Tice, D. M., Baumeister, R. F., & Zhang, L.

(2004). The role of emotion in self-

egulation:

Differing role of positive and negative emo-

tions. In P. Philippot & R. S. Feldman (Eds.),

The regulation of emotion (pp.

213–226).

Mahwah, NJ: Erlbaum.

Wertheim, E. H., & Schwarz, J. C. (1983).

Depression, guilt, and self-

anagement of

pleasant and unpleasant events. Journal of

Personality and Social Psychology, 45(4),

884–889.

Wittman, M., Leland, D. S., & Paulus, M. P.

(2007). Time and decision making: Differ-

ential contribution of the posterior insular

cortex and the striatum during a delay dis-

counting task. Experimental Brain Research,

179(4), 643–653.

126

A few months ago, I had to take a long,

12-hour international flight in order to get

home. Having more than enough time to

spend, I started looking around me. While

some people were sleeping (in extremely cre-

ative body postures), or watching movies

(with delight that they finally had enough

time to watch Tolkien’s full trilogy), others

appeared quite alert and fearful, especially

when the captain announced that the plane

had started its final descent. While appear-

ing fearful, luckily these individuals were

able to choose between different regulatory

options to control their fear. For example,

they could choose whether they want to deal

with their flight phobia by disengagement,

closing their window shades while immers-

ing themselves in unrelated yet demand-

ing conversations. Alternatively, they could

choose to look out the window while

explaining some facts, including a decline in

crash statistics since autopilots took charge.

Emotion regulatory choices are an inte-

gral part of our daily lives in a dynamically

changing affective world. By emotion regu-

lation choice I mean the choices individuals

make as to how they should regulate their

emotions in a particular context when regu-

lation is warranted and more than one regu-

latory option is active. Furthermore, given

the abundance of knowledge on explicit

emotion regulation strategies and the rela-

tive lack of evidence on implicit emotion reg-

ulation, I limit this chapter to deliberate and

explicit forms of emotion regulation choice.

Can we consistently predict the regulatory

choices individuals make to deal with their

emotions? Are there specific emotional,

cognitive, and motivational influences that

systematically affect these regulatory prefer-

ences? What are the major factors underly-

ing the regulatory choice process? And what

are the broad implications of regulatory

choices? In this chapter I try to answer these

important questions. Specifically, I begin by

introducing the importance of emotion reg-

ulation choice and its relative lack of empiri-

cal investigation. I then introduce a recent

conceptual model to explain dominant emo-

tional, cognitive, and motivational determi-

nants, and underlying mechanisms of emo-

tion regulation choice between dominant

cognitive emotion regulation categories. I

close by describing broad implications and

future directions.

The Importance of Emotion

Regulation Choice

The different ways individuals can go about

controlling their emotions has attracted

scholars for centuries. Nevertheless, emo-

tion regulation has become an independent

CHAPTER 8

Emotion Regulation Choice:

Theory and Findings

Gal Sheppes

Emotion Regulation Choice 127

field only recently (Gross, 1998, 2007, 2010;

Koole, 2009; Tamir, 2011). From its early

days a central question in this field has been

whether different forms of emotion regula-

tion have different consequences. However,

in a first generation of studies, different

forms of emotion regulation have generally

been considered to be either adaptive or mal-

adaptive.

Of two well-known examples, consider

first Nolen- Hoeksema’s influential response

styles theory contrasting maladaptive rumi-

nation with distraction (Nolen- Hoeksema,

1991; see Nolen- Hoeksema, Wisco, & Lyu-

bomirsky, 2008, for reviews). Multiple stud-

ies have widely established that ruminating

on negative attributes of one’s self rather

than distracting attention away from them

is strongly related to the development, main-

tenance, and recurrence of depressive epi-

sodes. As a second example, consider Gross’s

canonical process model and supporting evi-

dence from multiple studies showing the rel-

ative superiority of reappraising the mean-

ing of negative events over suppression of

affective expressions, with respect to a wide

range of affective, cognitive, and social indi-

cators of adaptive functioning (Gross, 2002;

see Gross & Thompson, 2007, for reviews).

The centrality of the alleged dichotomy

between “adaptive” and “maladaptive”

forms of emotion regulation is captured by

a recent meta- analysis that summarizes a

decade of work on the relationship between

some regulation strategies (rumination, sup-

pression) and psychopathology, and other

strategies (reappraisal, problem solving) and

resilience (Aldao, Nolen- Hoeksema, & Sch-

weizer, 2010).

There is no doubt that the first generation

of studies has enormously advanced the field

of emotion regulation. However, with its

rapid growth a second generation of studies

to emerge has begun to find inconsistencies

in the formerly unconditional maladaptive–

adaptive label given to different strategies.

For example, the ostensibly maladaptive

strategy of rumination was found to have

both adaptive and maladaptive forms (Wat-

kins, 2008). For example, rumination was

found to be advantageous in situations in

which a single goal needs to be maintained

in the face of distractors (Altamirano,

Miyake, & Whitmer, 2010). Similarly, the

ostensibly maladaptive strategy of suppres-

sion was shown to be beneficial in extremely

adverse situations (e.g., Bonanno & Kelt-

ner, 1997). At the same time, the ostensibly

adaptive strategy of distraction was found to

be maladaptive when long-term adjustment

is required (Kross & Ayduk, 2008), and the

ostensibly adaptive strategy of reappraisal

was found to be less effective when dealing

with particularly high- intensity emotional

situations (Sheppes, Catran, & Meiran,

2009; Sheppes & Meiran, 2007, 2008).

The main conclusion derived from the

second generation of studies is that emotion

regulation strategies have different conse-

quences in different contexts. This means

that healthy adaptation is the result of flex-

ibly choosing between regulation strategies

to adapt to differing situational demands

(e.g., Bonanno, 2005; Kashdan & Rotten-

berg, 2010; see Troy & Mauss, 2011, for

reviews). To illustrate, Kashdan and Rot-

tenberg (2010) argue that different forms

of psychopathology can be characterized by

different ways in which flexible regulation

choice breaks down, and Troy and Mauss’s

(2011) and Bonanno’s (2005) influential

accounts highlight how flexible regulation

choice promotes resilience in the face of

stress and trauma.

Although emotion regulation choice is now

viewed as a crucial element in healthy adap-

tation, until recently it has only been studied

indirectly. Two forms of important yet indi-

rect evidence come from correlational stud-

ies involving self- report questionnaires that

assess individual differences in people’s fre-

quency of use of different regulatory strate-

gies across situations (e.g., Aldao & Nolen-

Hoeksema, 2012a; Garnefski et al., 2001;

Gross & John, 2003; John & Gross, 2007)

and from laboratory experiments that evalu-

ate spontaneous use of emotion regulation

strategies in emotion- inducing situations

(e.g., Aldao & Nolen- Hoeksema, 2012b;

Ehring, Tuschen- Caffier, Schnülle, Fischer,

& Gross, 2010; Gruber, Harvey, & Gross,

2012). While showing important links to

well-being and various forms of psychopa-

thology (see Aldao et al., 2010, for a review),

these studies do not assess the factors that

influence individuals predominantly to pre-

fer using one particular regulatory strategy

over another. Even more conventional stud-

ies of emotion regulation have not exam-

ined which regulation strategies are chosen

128 COGNITIVE APPROACHES

in different emotional contexts, because

the experimental design involved directly

instruct participants to use regulation strat-

egies in different situations. Consider, for

example, the most direct and convincing evi-

dence of the importance of flexible regula-

tion patterns, which has shown that the abil-

ity to alternate flexibly between enhancing

and suppressing emotion strongly predicts

healthy adaptation (Bonanno, Papa, Lal-

ande, Westphal, & Coifman, 2004) over an

extended time period (Westphal, Seivert, &

Bonanno, 2010), and that flexible regulation

can protect people from complicated grief

patterns in bereavement (Gupta & Bonanno,

2011). In these and other studies, the regu-

lation strategies employed by participants

were determined by the experimenter, leav-

ing the important topic of determinants and

consequences of emotion regulation choice

unexplored.

Conceptualizing Emotion

Regulation Choice

Recently my colleagues and I developed a

conceptual framework to explain (1) major

determinants and (2) underlying mecha-

nisms of emotion regulation choice (Sheppes,

Scheibe, Suri, Radu, Blechert, & Gross,

2012). A central working hypothesis in this

framework is that healthy individuals would

be sensitive to the central costs and benefits

associated with the implementation of each

regulatory option under different contexts.

With this working hypothesis in mind, cer-

tain emotional, cognitive, and motivational

contextual factors are likely to bias regula-

tory choices in ways that are congruent with

the differential consequences of implement-

ing these strategies under these conditions.

In illuminating the underlying mechanisms

of emotion regulation choice a further argu-

ment suggests that healthy regulation choice

should require in some contexts an ability to

recruit deliberate executive control processes

that can override contrasting associative

emotional processes. This interplay of higher

control processes that can override opposing

associative processes is at the heart of many

models of self- regulation (e.g., Muraven &

Baumeister, 2000). Moreover, the regula-

tion choice process gives a central weight to

differences between strategies’ underlying

engagement– disengagement dimension rela-

tive to other potent factors, such as cogni-

tive effort. To help us better appreciate the

broader context of this emotion regulation

choice conceptual framework I elaborate it

below.

The starting point of this conceptual

framework is that individuals’ limited cog-

nitive capacity poses permanent processing

constraints. These constraints result in a

constant competition between emotion gen-

eration and emotion regulation processes

(Gross, Sheppes, & Urry, 2011a, 2011b)

for dominance over behavior. Our concep-

tual account draws on major information-

processing theories (e.g., Hübner, Stein-

hauser, & Lehle, 2010; Pashler, 1998) and

the process model of emotion regulation

(Gross & Thompson, 2007) to suggest that

regulating one’s emotions involves recruit-

ing deliberate executive control mechanisms

that try to modify the nature of emotional

information processing at two major cogni-

tive stages (Sheppes & Gross, 2011, 2012),

which include an early attentional selection

stage and a late semantic meaning stage.

Specifically, regulation can be achieved via

early disengagement from emotional pro-

cessing at the attention selection stage, or via

an engagement with emotional processing

that is modulated at a late semantic meaning

stage (e.g., Johnston & Heinz, 1978; Lehle

& Hübner, 2008). This conceptual frame-

work focuses on two particular regulatory

strategies that are frequently used in every-

day life and have their major influence in

each of these two cognitive stages of infor-

mation processing.

Incoming emotional information can

be regulated at an early attentional selec-

tion processing stage by disengaging from

emotional information processing before

it undergoes elaborated processing. A clas-

sic early selection strategy is distraction,

which involves disengaging attention from

emotional processing before it is represented

in working memory by producing neutral

thoughts that are independent from and not

in conflict with emotional information (e.g.,

van Dillen & Koole, 2007).

Engagement with incoming emotional

information that passes the early atten-

tional selection stage can still be regulated

at a late semantic meaning processing stage

before it affects behavior. A classic late

Emotion Regulation Choice 129

selection regulation strategy is reappraisal,

which involves engaging with and elaborat-

ing emotional information prior to changing

its meaning in a late processing stage (e.g.,

Gross, 2002). In reappraisal, the neutral

reinterpretation is semantically dependent

and in direct conflict with the original emo-

tional information. According to our con-

ceptual framework, these underlying char-

acteristics of disengagement distraction and

engagement reappraisal result in a differen-

tial cost– benefit tradeoff (Sheppes & Gross,

2012). Specifically, the benefits of block-

ing emotional information early, before it

gathers force via distraction, are that emo-

tionally high- intensity information can be

successfully modulated. Cognitively, this

successful modulation involves relatively

simple processes, because the generation of

regulatory neutral thoughts in distraction

is independent from and does not conflict

with the original emotional information.

Nevertheless, the major cost of distraction

is that because it does not allow processing,

evaluating, and remembering of emotional

information, motivationally it is less benefi-

cial for one’s long-term goals and adaptation

(see Wilson & Gilbert, 2008, for a review).

Specifically, distraction does not allow one

to attend to emotional events that are being

repeatedly encountered and be provided

with adequate explanation, a requirement

that is at the heart of many long-term goals

in which an individual has to face difficul-

ties in order to adapt.

The underlying characteristics of engage-

ment reappraisal result in a different set of

costs and benefits. Specifically, the elabo-

rated semantic processing that occurs prior

to late modulation should be emotionally

costly, because it can less successfully block

high- intensity emotional information. Cog-

nitively, reappraisal engages relatively com-

plex processes, because the generation of

alternative construals is dependent on and

in conflict with the original emotional infor-

mation. Nevertheless, the major benefit of

engaging with emotional information is that

motivationally it allows one to process, eval-

uate, and remember emotional information,

which are crucial for long-term goals and for

adaptation.

Direct empirical support for the costs and

benefits of employing (rather than freely

choosing) distraction and reappraisal comes

from behavioral and electrophysiological

studies. Specifically, several behavioral stud-

ies showed that employing early disengage-

ment distraction in high- sadness emotion-

ally intense situations resulted in successful

regulation (Sheppes & Meiran, 2007), and

did not result in an increased expenditure

of cognitive resources (Sheppes et al., 2009;

Sheppes & Meiran, 2008). At the same time,

distraction’s lack of emotional processing

was demonstrated in an impaired memory

for emotional information (Sheppes & Mei-

ran, 2007, 2008), and distraction’s motiva-

tional costs were evident in a lack of long-

term attenuation of the intensity or quality

of important autobiographical, negative

emotional events (Kross & Ayduk, 2008).

By contrast, these studies showed that while

employing late engagement reappraisal in

low- sadness emotionally intense situations

was successful, high- sadness emotionally

intensity situations resulted in less success-

ful modulation and in an increased expendi-

ture of cognitive resources. The elaborated

emotional processing was demonstrated in

intact memory for emotional information

(see also Dillon, Ritchey, Johnson, & LaBar,

2007; Richards & Gross, 1999, 2000), and

reappraisal’s motivational benefits evinced

in adaptation to distressing events that are

important for one’s long-term goals and

functioning.

In two recent electrophysiological stud-

ies, my colleagues and I took advantage of

the excellent temporal resolution of electro-

encephalography (EEG) and event- related

potentials (ERPs) to provide further sup-

port for the differential underlying cognitive

mechanisms and consequences of employ-

ing distraction and reappraisal (Blechert,

Sheppes, Di Tella, Williams, & Gross, 2012;

Thiruchselvam, Blechert, Sheppes, Ryd-

strom, & Gross, 2011). Recent ERP stud-

ies in emotion regulation showed that dis-

traction (e.g., Dunning & Hajcak, 2009;

Hajcak, Dunning, & Foti, 2009) and reap-

praisal (e.g., Foti & Hajcak, 2008; Hajcak

& Nieuwenhuis, 2006) modulate the late

positive potential (LPP)—an electrocortical

component that is enhanced during emo-

tionally arousing viewing and that reflects

enhanced attentional and semantic meaning

processing of emotionally salient informa-

tion (Hajcak, MacNamara, & Olvet, 2010).

Consistent with the framework, we found

130 COGNITIVE APPROACHES

that implementing distraction resulted in

a strong modulation of an initial phase of

the LPP that represents early disengage-

ment of emotional information before it is

represented in working memory, and reap-

praisal only modulated the late phase of the

LPP representing engagement and elabo-

rated meaning prior to late modulation

(Thiruchselvam et al., 2011). In that same

study, we also tested our prediction that,

motivationally, distraction relative to reap-

praisal cannot be in accord with major long-

term goals. Specifically, distraction does not

allow attending to and explaining emotional

information, which result in subsequent

attenuation of emotional responses relative

to novel emotional situations (Wilson &

Gilbert, 2008). To that end, our participants

were reexposed to emotional materials they

had previously distracted or reappraised.

Consistent with our prediction, we found

that emotional materials with a distraction

but not reappraisal history demonstrated

an enhanced LPP during reexposure, which

represents an extended influence of negative

emotional processing beyond the regulatory

episode. Prolonged influence of emotional

events is considered maladaptive, with many

long-term goals that require dealing with

emotional events that are repeatedly encoun-

tered (see also MacNamara, Ochsner, &

Hajcak, 2011). In a similar vein, we recently

showed that repeated reappraisal efforts

with biologically significant emotional stim-

uli (i.e., angry facial expressions) resulted

in a gradual change to the basic evaluation

and thus representation of these emotional

stimuli (Blechert et al., 2012).

Emotional, Cognitive,

and Motivational Determinants

of Emotion Regulation Choice

In a recent set of studies my colleagues and I

have evaluated central determinants of emo-

tion regulation choice (Sheppes, Scheibe,

Suri, & Gross, 2011; Sheppes et al., 2012).

Prior to discussing these studies I wish

briefly to describe the novel paradigm we

developed to enable the evaluation of emo-

tion regulation choice. In short, partici-

pants that come to the laboratory initially

undergo a learning phase, followed by a

training phase in which they are taught the

differences between distraction and reap-

praisal, as well as how to implement each. In

the actual task, participants are exposed to

series of trials that involve a brief presenta-

tion of an emotional stimulus followed by a

choice screen, where they decide their pre-

ferred regulatory strategy. Following a short

preparation period, the emotional stimulus

reappears and participants are instructed

to implement their chosen strategy and to

rate how they feel. In general, participants

are instructed to choose freely between dis-

traction and reappraisal, and to base their

choice on the strategy they think will make

them feel less negative. The main dependent

measure is the proportion of choice of each

regulatory option. To evaluate adherence of

participants’ reports of their chosen regula-

tory strategies (achieved via which button

they pressed during the choice screen), we

either asked participants to talk out loud

about their chosen strategies during strat-

egy implementation or we administered a

surprise memory test for emotional materi-

als that were presented (see Sheppes et al.,

2011). These two methods have proven to

be satisfactory. Specifically, adherence levels

were evident in high agreement between par-

ticipants’ button responses and their talk-

out-loud protocols, and in the finding that

in trials on which participants indicated that

they chose to distract, memory was worse

(and not significantly different from chance)

than that in trials of participants who indi-

cated that they chose to reappraise (Sheppes

et al., 2011).

The first determinant of regulation choice

examined is emotional intensity, which is a

key dimension of variation across emotional

contexts (Sheppes et al., 2011). Based on the

emotion regulation choice conceptual frame-

work, we predicted that under low- negative

emotionally intense situations, individuals

would prefer to choose late selection engage-

ment reappraisal over early selection disen-

gagement distraction, because reappraisal

can both successfully modulate emotional

responding and provide long-term affec-

tive adaptation. However, we predicted that

under high- negative intensity situations,

participants would switch, to prefer choos-

ing early disengagement distraction over

reappraisal, because only distraction can

successfully block emotional information

early before it gathers force.

Emotion Regulation Choice 131

To test our predictions, we manipulated

emotional intensity with emotional images

or unpredictable electric stimulation and

had participants choose between distraction

and reappraisal (Sheppes et al., 2011). The

results strongly supported our predictions in

both emotional contexts. Specifically, par-

ticipants preferred to reappraise their emo-

tional reactions to low- negative- intensity

pictures and to a threat of low- intensity

electric shocks, but they preferred to dis-

tract from their emotional reactions to high-

negative- intensity pictures and to a threat of

high- intensity electric shocks.

In a follow- up study we wanted to exam-

ine the robustness of the effect of emotional

intensity on regulation choice (Sheppes

et al., 2012). To that end, we examined

whether individuals would keep their regu-

latory preferences under different emotional

intensities even when offered a potent rein-

forcement (monetary incentive) to engage

in a counter preference regulatory option.

Although we found that monetary incentives

influenced regulatory choices in the expected

direction, the basic preference to reappraise

low- intensity emotional situations and to

distract high- intensity emotional situations

remained evident, even when participants

were paid high monetary amounts to choose

the contrasting strategy. These results sug-

gest that emotional intensity strongly influ-

ences regulatory preferences.

The second determinant we examined was

the cognitive complexity of generating an

emotion regulation strategy (Sheppes et al.,

2012). Emotion regulation can be viewed as

involving several sequential cognitive pro-

cesses that involve generation, implementa-

tion, and maintenance (Kalisch, 2009; Och-

sner & Gross, 2008). Generation involves

finding an adequate regulatory option that

can replace emotional information pro-

cessing. Implementation involves activat-

ing a regulatory strategy, and maintenance

involves holding it in an active state as long

as regulation is required. Because generation

operates early in the sequence of an emo-

tion regulation episode, it is likely to affect

emotion regulation choice. In distraction,

the generation process is simple, because the

neutral thoughts that are produced can be

of any content as long as they are absorbing.

However, in reappraisal, the generation pro-

cess is complex, because the formation of an

alternative neutral reinterpretation depends

on the original emotional information. To

examine this disparity we showed that when

the generation process was simplified, by

providing participants concrete regulatory

options for distraction and reappraisal,

reappraisal was more frequently chosen.

The third determinant of emotion regula-

tion choice involved investigating the influ-

ence of motivational goals (Sheppes et al.,

2012). An important motivational goal

for choosing a regulatory strategy involves

evaluating whether an emotional stimulus

will be encountered once or multiple times.

While an emotional stimulus that is encoun-

tered once can be regulated with strategies

such as distraction, which provide short term

relief, emotional stimuli that are encoun-

tered multiple times can be better regulated

with strategies such as reappraisal, which

involves engaging with emotional process-

ing that results in gradual adaptation (e.g.,

Wilson & Gilbert, 2008; Blechert et al.,

2012). As we therefore expected and found,

when participants were told that they would

encounter emotional stimuli more than

once, they preferred to reappraise more than

they did when they expected to encounter an

emotional stimulus once.

Underlying Mechanisms of Emotion

Regulation Choice

The previous section established that cen-

tral emotional, cognitive, and motivational

factors strongly influence individuals’ pref-

erences between two regulation strategies

that modulate emotional responding at an

early attentional stage (distraction) or a late

semantic meaning stage (reappraisal). In this

section I turn to the issue of the mechanisms

at the core of emotion regulation choice.

According to our conceptual framework,

emotion regulation choice should involve a

general ability of deliberate executive con-

trol processes to override competing asso-

ciative emotional processes. In line with cen-

tral models of self control (e.g., Muraven &

Baumeister, 2000), an ability to recruit cen-

tral control processes that can moderate the

influence of drives and emotions is crucial

for daily functioning. In addition, the actual

regulatory choice process is heavily influ-

enced by the engagement– disengagement

132 COGNITIVE APPROACHES

dimension where people are weighting their

preference to employ early attentional disen-

gagement from emotional processing (dis-

traction) versus engagement with emotional

processing prior to late modulation at the

semantic meaning processing stage (reap-

praisal).

Provision of supporting evidence for the

involvement of deliberate executive con-

trol processes that override associative

emotional processes in emotion regulation

choice is important given a potential alterna-

tive, more parsimonious account. According

to this more parsimonious account, emotion

regulation choice can be fully explained by

a direct influence from simple associative

emotional processes (e.g., Bradley, Codis-

poti, Cuthbet, & Lang, 2001). Specifically,

according to an associative emotional pro-

cess account, as negative emotional intensity

increases, it directly activates a basic defen-

sive system to shift from an engagement (or

sensory intake) preference, which leads to

preferring reappraisal, to a disengagement

(or sensory rejection) preference, which may

result in an increased preference to distract.

Alternatively, according to the emotion reg-

ulation choice account, individuals can use

deliberate executive processes in preferring

to reappraise in low- negative intensity situa-

tions and to distract in high- negative inten-

sity situations. Because both accounts lead

to the same regulatory choice prediction in

negative emotional situations, in order to

determine between them we investigated

down- regulation of positive emotional situa-

tions— an emotional context where the two

accounts diverge. Specifically, the associative

emotional process account would argue that

as positive emotional intensity increases, it

directly activates a basic appetitive system

that would lead to an increased preference

to engage. By contrast, the emotion regula-

tion choice account would predict that the

operation of deliberate control processes,

whose goal is to provide down- regulation of

positive emotional situations, would involve

overriding the associative tendency to

engage, resulting in an increased preference

to disengage as positive emotional intensity

increases. The results, which showed par-

ticipants’ clear tendency to disengage via

distraction as positive emotional intensity

increased, clearly support the involvement

of deliberate executive control processes

that override opposing associative emotional

processes originating from the appetitive

system (Sheppes et al., 2012).

While these results support the involve-

ment of deliberate executive control pro-

cesses in emotion regulation choice, an

important question remains: What are the

dimensions that receive central weight in the

choice between distraction and reappraisal?

One central dimension in my conceptual

account is engagement– disengagement, in

which people who prefer to reappraise may

wish to engage in emotional processing,

and when they want to distract may want

to disengage from emotional processing.

However, in a second potential key dimen-

sion, the amount of cognitive effort people

wish to exert (e.g., Chajut & Algom, 2003;

Kool, McGuire, Rosen, & Botvinick, 2010;

Muraven & Baumeister, 2000), when people

prefer to reappraise they are willing to exert

considerable effort, and when they want

to distract they wish to preserve cognitive

effort. Accordingly, when people prefer to

distract in high- negative emotionally intense

situations, do they prefer to disengage from

emotional processing or do they prefer to

reserve their cognitive resources and go with

the easy regulatory option?

To determine between these two options,

we had participants choose between two

types of distractions that involve making

mathematical computations (e.g., see Erber

& Tesser, 1992; van Dillen & Koole, 2007

for similar operationalization of atten-

tional distractions): One regulatory option

was cognitively simple and involved minor

disengagement from emotional processing

(subtract 2’s) and a second regulatory option

was cognitively effortful yet highly disen-

gaged from emotional processing (subtract

7’s). The logic was that if the cognitive effort

dimension is central in regulatory choice,

then one should expect that the preference to

use the more simple subtract 2’s distraction

would increase as negative emotional inten-

sity increases. However, if the engagement–

disengagement dimension is central in

regulatory choice, we should expect that

the preference to use the more disengaging

(despite it being also more effortful) subtract

7’s distraction would increase as negative

emotional intensity increases.

Results strongly supported the centrality

of the engagement– disengagement dimen-

sion, where participants preferred to disen-

gage from emotional processing in the high-

Emotion Regulation Choice 133

intensity condition despite the fact that this

regulatory option was clearly more effort-

ful (Sheppes et al., 2012). In addition, when

participants were performing the subtract

7’s option, their actual mathematical perfor-

mance was interfered with less by the inten-

sity of emotional stimuli relative to perform-

ing subtract 2’s. This result indicates that

the more effortful subtract 7’s option indeed

resulted in a stronger disengagement from

emotional processing relative to subtracting

2’s.

In a complementary fashion we wished to

show that the engagement– disengagement

dimension is central within the reappraisal

category. Although, reappraisal is gener-

ally considered to be an engagement strat-

egy (Gross & Thompson, 2007; Sheppes &

Gross, 2011), there is also a considerable

variation in this broad regulation category

(Ochsner et al., 2004; McRae, Ciesielski,

& Gross, 2012). Specifically, in a classic

situation- focused reappraisal, engagement

with emotional processing is central in

order to reinterpret the meaning of ongo-

ing events. However, other forms of reap-

praisal, such as reality challenge, involve a

disengagement element in which emotional

consequences are simply not considered and

the basic authenticity of the event is being

questioned. In a regulation choice study we

showed that whereas participants preferred

to engage via situation- focused reappraisal

under a low- intensity condition, they pre-

ferred to disengage via reality challenge

reappraisal under a high- intensity condition

(Sheppes et al., 2012).

Broader Implications

In the two previous sections, I tried to estab-

lish key emotional, cognitive, and motiva-

tional determinants, and underlying mech-

anisms of emotion regulation choice. In

this section I zoom out in order to provide

broader implications of emotion regulation

choice. In doing so I concentrate on impli-

cations for emotion regulation science, deci-

sion making, and clinical science.

Implications for Emotion Regulation

Emotion regulation choice provides an

important extension to the general field

of emotion regulation. Previous studies of

emotion regulation have almost exclusively

focused on the consequences of implement-

ing different emotion regulation strategies

(Gross, 2007; see Koole, 2009, for reviews).

Multiple studies have instructed participants

to engage with different emotion regulation

strategies and have examined the costs and

benefits associated with successful imple-

mentation. Understanding the consequences

of employing different regulation strategies

is a crucial and important step toward an

understanding of the basic elements of emo-

tion regulation strategies. Nevertheless, the

emotion regulation choice findings extend

this work by illuminating a step that pre-

cedes the implementation of emotion regu-

lation. Specifically, when an emotion regu-

lation goal has been activated, individuals

need to select a regulation strategy out of

all the available options. Our conceptual

account has highlighted some emotional,

cognitive, and motivational factors that can

strongly influence the regulatory choices

individuals are inclined to make in any par-

ticular context.

Combining the recent knowledge on emo-

tion regulation choice with existing knowl-

edge on the consequences of implement-

ing emotion regulation strategies leads to

important conceptual extensions. For exam-

ple, individuals’ regulatory preferences as

indexed by their regulatory choices should

be considered when evaluating individuals’

ability to implement different strategies.

Specifically, initiating a particular strategy

may require not only generation, implemen-

tation, and maintenance but also overrid-

ing a default regulatory preference. To give

laboratory and real-life analogues, it may be

that when participants in the laboratory or

patients in the clinic are asked to engage via

reappraisal when dealing with high- intensity

situations, in addition to generating, imple-

menting, and maintaining reinterpretation

of an emotional situation, they also need to

override their strong default preference to

disengage via distraction.

Implications for Decision Making

Emotion regulation choice is an instance

of general choice behavior, and as such

it is important to place it under the broad

umbrella of general decision making. Classic

examples of choice behavior involve decid-

ing between different external outcomes in

134 COGNITIVE APPROACHES

one’s environment. For example, in intertem-

poral choice paradigms, such as temporal

discounting (Reynolds, 2006), individuals

choose between receiving smaller monetary

rewards sooner (e.g., $5 today) and receiv-

ing bigger monetary rewards later (e.g.,

$8 tomorrow). Other examples of choice

behavior involve deciding between differ-

ent internal processes to deal with external

demands, such as the mathematical strate-

gies children choose in order to solve math

problems (Siegler, 2005) or the strategies

adults choose to solve chess problems (de

Groot, 1978). Emotion regulation choice is

a special case of decision making, because it

involves choosing between internal cognitive

processes to control one’s internal emotional

environment.

Although emotion regulation choice

appears to be unique in some ways, it shares

with other theories basic assumptions about

strategy choice. Like classic theories in deci-

sion sciences (e.g., Payne, Bettman, & John-

son, 1988, 1993), the emotion regulation

choice account argues that individuals are

sensitive to central factors (emotional, cog-

nitive, and motivational factors in the case

of emotion regulation choice) when mak-

ing their regulatory selections. In addition,

just as other models highlight the role of

learning (e.g., Rieskmap, 2006; Rieskmap

& Otto, 2006), in the emotion regulation

choice account regulatory decisions are to

some extent based on prior knowledge, with

the consequences of implementing different

strategies in different contexts.

Implications for Clinical Psychology

Emotion regulation choice also has impor-

tant clinical implications. Central concep-

tual accounts argue that psychological well-

being requires flexibly adapting emotion

regulation strategies to fit with differing situ-

ational demands (Gross, 2007; Kashdan &

Rottenberg, 2010; Watkins, 2011). The flip

side of flexible regulatory choice is a rigid

and maladaptive regulation choice that may

be related to various forms of psychopathol-

ogy.

The recent empirical evidence maps emo-

tional, cognitive, and motivational determi-

nants of regulation choice in healthy adults;

thus, deviations from healthy regulatory

choice can be used to understand different

forms of psychopathology.

Consider first the emotional intensity one

is facing. As previously described, healthy

individuals prefer to use reappraisal in low-

intensity emotional situations and distrac-

tion in high- intensity situations. Regulatory

preferences that deviate from the flexible

regulation choice observed in healthy indi-

viduals might be related to different psy-

chopathologies. Specifically, deviation

from a preference to choose to disengage

from very high- intensity stimuli is expected

from individuals who are prone to develop

major depression. According to the response

style theory, rumination involves engag-

ing with strong emotional experiences, and

repeatedly thinking about their causes and

consequences in an abstract and repeti-

tive way (e.g., Nolen- Hoeksema, 1991; see

Nolen- Hoeksema et al., 2008, for reviews).

Although rumination has been proven to be

related to onset maintenance and relapse of

depression, depressed individuals who pre-

fer to use positive distractions when dealing

with strong emotional experiences show a

better prognosis (e.g., Nolen- Hoeksema &

Morrow, 1991, 1993). Emotion regulation

choice is likely to be an important target in

the context of depression, because empirical

studies have shown that although depressed

individuals are able to implement distrac-

tion effectively when instructed to do so

(e.g., Joormann & Siemer, 2004; Joormann,

Siemer, & Gotlib, 2007), they hold a favor-

able view of rumination, believing that it

helps them understand better the reasons

for depressed mood. Nevertheless, an over-

generalized preference to engage with emo-

tional contents may also depend on impaired

ability to shift attention away from negative

contents (e.g., Joormann & Gotlib, 2008).

Another type of deviation from the healthy

regulatory choice patterns involves diverg-

ing from engagement with low- intensity

emotional stimuli. Common to several anxi-

ety disorders is a tendency to overgeneral-

ize a disengagement or avoidance regulatory

response (for reviews, see Campbell- Sills &

Barlow, 2007; Foa & Kozak, 1986). Avoid-

ance usually starts in response to high-

intensity emotional stimuli, but over time,

it ends up spilling over to seemingly low-

intensity stimuli. As pointed in our concep-

tual model, while disengagement strategies

are helpful in providing short-term relief,

they are maladaptive in the long run and can

perpetuate anxiety and fears.

Emotion Regulation Choice 135

The cognitive factor highlighted is the

ease with which a regulation strategy is gen-

erated. Specifically, aiding the generation

process resulted in increased reappraisal

choice. These results are relevant for many

cognitive- behavioral therapies in which

patients are encouraged to reappraise strong

emotional events (e.g., Campbell- Sills &

Barlow, 2007). While the final objective is

to have patients generate their own regula-

tion strategies, therapists should be mindful

that their patients might need aid in gener-

ating alternative ways to think about upset-

ting events, until they can gradually build

their skill. Complementarily, one can expect

that with continued practice in reappraisal,

patients would improve its generation and

choose to use it more frequently when it’s

adaptive.

The motivational factor highlighted indi-

viduals’ goals when choosing to regulate

their emotions. It was shown that when

participants expect to encounter emotional

events repeatedly, they increase reappraisal

choice, which offers long-term benefits. The

ability to override regulatory preferences

that offer short-term relief (i.e., distraction)

in favor of regulatory preferences that offer

long-term benefits (i.e., reappraisal) is likely

to require self- control, and impairments

in self- control ability have been linked to

various psychopathologies, including addic-

tions and eating disorders such as bulimia

(for comprehensive reviews, see Heatherton

& Baumeister, 1991; Vohs & Baumeister,

2011).

Future Directions

Despite promising preliminary results and

clear, broad implications, research in emo-

tion regulation choice has only begun to

develop. In closing I wish to point out sev-

eral potential future research directions.

First, to date, researchers have examined

the influence of only one emotional (emo-

tional intensity), one cognitive (generation

of a strategy), and one motivational (short-

vs. long-term goals) determinant of emotion

regulation choice. While these factors are

important, future studies should evaluate

the influence of the many additional factors

that likely influence regulatory preference.

To give just one example, the availability

of cognitive resources is likely to influence

individuals’ regulatory choices. Specifically,

a temporary state of self- control resource

depletion (e.g., Baumeister, Vohs, & Tice,

2007; Muraven & Baumeister, 2000) is

likely to lead individuals to prefer strategies

such distraction, which provide short-term

relief. Therefore, studying how various novel

factors affect regulatory choice is an impor-

tant future research direction.

Second, while distraction and reappraisal

are considered classic disengagement and

engagement strategies (Parkinson & Tot-

terdell, 1999), and they are widely used in

everyday life, studies of choices between

other emotion regulation strategies are

urgently needed. In everyday life, individu-

als choose from many more regulatory

options that should be studied in the future.

Several promising avenues involve allowing

people to choose from regulatory options

that are considered less adaptive in certain

contexts (e.g., suppression and rumination).

Another option involves investigating how

individuals switch their regulatory choices

when dealing with dynamic and prolonged

emotional events that constitute many of

our daily experiences (see Aldao & Nolen-

Hoeksema, 2012c, for a related discussion).

Relatedly, a crucial test of the applicability of

the emotion regulation choice paradigm and

its supporting results should involve study-

ing regulatory choices in daily emotional

experiences, such as when patients wait to

receive potentially stressful news in medi-

cal settings, or when clients face a stimulus

about which they feel anxious. Although

distraction and reappraisal are widely used

in real-life situations, it remains unclear

whether we would observe somewhat simi-

lar preferences when individuals spontane-

ously choose between regulatory options in

daily emotional situations.

Third, the goals of this study were gener-

ally to characterize the influence of differ-

ent factors on emotion regulatory choice.

Nevertheless, it is quite clear that studying

individual differences in emotion regula-

tion choice is crucial. Recent relevant studies

have shown that individual differences in the

ability to modify emotions are tightly linked

to long-term adaptation (e.g., Bonanno et

al., 2004; Westphal et al., 2010). Therefore,

future studies should evaluate how mul-

tiple individual differences can moderate

the influence of central factors on emotion

regulation choice. One promising venue,

136 COGNITIVE APPROACHES

which I mentioned in discussing the clinical

implications, involves studying impairments

in regulatory preferences of individuals with

mood, anxiety, and personality disorders,

whose psychopathology revolves around

emotion dysregulation.

Fourth, according to the emotion regula-

tion choice account, healthy individuals are

sensitive to central costs and benefits of dif-

ferent regulation strategies when trying to

choose between regulatory options, and in

general these individuals showed adaptive

regulatory choice profiles. Nevertheless,

multiple demonstrations in general decision-

making studies have shown important limi-

tations in human reasoning (e.g., Tversky &

Kahneman, 1974); therefore, future studies

should investigate situations in which indi-

viduals’ regulatory choices would not nec-

essarily lead them to the best outcome. In

a related vein, while conscious regulation

strategies have been a major focus in the

field of emotion regulation, and an integral

part of many cognitive- behavioral thera-

pies targeting emotion dysregulation (e.g.,

Linehan, 1993), many emotion regulation

choices are likely to be determined implicitly

and without deliberate control.

Finally, until now, emotion regulation

choice has been investigated separately from

studies on the consequences of implement-

ing regulation strategies. Future studies

should make stronger connections between

the developing studies on emotion regula-

tion choice and the well- established studies

on the consequences of regulation imple-

mentation. For example, studies should

evaluate whether the effectiveness of imple-

menting a given strategy is moderated by an

ability to override default regulatory choice

preferences. At the same time, future studies

in emotion regulation choice should utilize

multiple levels of analysis that combine the

concurrent assessment of the effectiveness of

a chosen regulatory strategy.

Acknowledgments

This chapter draws on and updates previous

reviews by Sheppes and Gross (2011, 2012) and

two recent empirical manuscripts (Sheppes et al.,

2011, 2012). The writing of this chapter was sup-

ported by the Israel Science Foundation (Grant

No. 1393/12).

References

Aldao, A., & Nolen- Hoeksema, S. (2012a).

When are adaptive strategies most predictive

of psychopathology? Journal of Abnormal

Psychology, 121, 276–281.

Aldao, A., & Nolen- Hoeksema, S. (2012b). The

influence of context on the implementation of

adaptive emotion regulation strategies. Behav-

iour Research and Therapy, 50, 493–501.

Aldao, A., & Nolen- Hoeksema, S. (2012c). One

versus many: Capturing the use of multiple

emotion regulation strategies in response to

an emotion- eliciting stimulus. Cognition and

Emotion. [E-publication ahead of print]

Aldao, A., Nolen- Hoeksema, S., & Schweizer,

S. (2010). Emotion regulation strategies

across psychopathology: A meta- analytic

review. Clinical Psychology Review, 30, 217–

237.

Altamirano, L. J., Miyake, A., & Whitmer, A.

J. (2010). When mental flexibility facilitates

cognitive control: Beneficial side effects of

ruminative tendencies on goal maintenance.

Psychological Science, 21, 1377–1382.

Baumeister, R. F., Vohs, K. D., & Tice, D.

M. (2007). The strength model of self-

control. Current Directions in Psychological

Science, 16, 396–403.

Blechert, J., Sheppes, G., Di Tella, C., Williams,

H., & Gross, J. J. (2012). See what you think:

Reappraisal modulates behavioral and neural

responses to social stimuli. Psychological Sci-

ence, 4, 356–363.

Bonanno, G. A. (2005). Resilience in the face of

potential trauma. Current Directions in Psy-

chological Science, 14, 135–138.

Bonanno, G. A., & Keltner, D. (1997). Facial

expressions of emotion and the course of con-

jugal bereavement. Journal of Abnormal Psy-

chology, 106, 126 –137.

Bonanno, G. A., Papa, A., Lalande, K., West-

phal, M., & Coifman, K. (2004). The impor-

tance of being flexible: The ability to both

enhance and suppress emotional expression

predicts long term adjustment. Psychological

Science, 15, 482–487.

Bradley, M. M., Codispoti, M., Cuthbert, B. N.,

& Lang, P. J. (2001). Emotion and motivation

I: Defensive and appetitive reactions in picture

processing. Emotion, 1, 276–298.

Bradley, M. M., Codispoti, M., Sabatinelli, D.,

& Lang, P. J. (2001). Emotion and motivation

II: Sex differences in picture processing. Emo-

tion, 1, 300–319.

Emotion Regulation Choice 137

Campbell- Sills, L., & Barlow, D. H. (2007).

Incorporating emotion regulation into con-

ceptualizations and treatments of anxiety and

mood disorders. In J. J. Gross (Ed.), Hand-

book of emotion regulation (pp.

542–559).

New York: Guilford Press.

Chajut, E., & Algom, D. (2003). Selective atten-

tion improves under stress: Implications for

theories of social cognition. Journal of Per-

sonality and Social Psychology, 85, 231–248.

de Groot, A. D. (1978). Thought and choice in

chess (2nd ed.). The Hague: Mouton.

Dillon, D. G., Ritchey, M., Johnson, B. D., &

LaBar, K. S. (2007). Dissociable effects of con-

scious emotion regulation strategies on explicit

and implicit memory. Emotion, 7, 354–365.

Dunning, J. P., & Hajcak, G. (2009). See no

evil: Directed visual attention modulates the

electrocortical response to unpleasant images.

Psychophysiology, 46, 28–33.

Ehring, T., Tuschen-

affier, B., Schnülle, J.,

Fischer, S., & Gross, J. J. (2010). Emotion

regulation and vulnerability to depression:

Spontaneous versus instructed use of emotion

suppression and reappraisal. Emotion, 10,

563–572.

Erber, R., & Tesser, A. (1992). Task effort

and the regulation of mood: The absorption

hypothesis. Journal of Experimental Social

Psychology, 28, 339–359.

Foa, E. B., & Kozak, M. J. (1986). Emotional pro-

cessing of fear: Exposure to corrective infor-

mation. Psychological Bulletin, 99, 20–35.

Foti, D., & Hajcak, G. (2008). Deconstructing

reappraisal: Descriptions preceding arous-

ing pictures modulate the subsequent neural

response. Journal of Cognitive Neuroscience,

20, 977–988.

Garnefski, N., Kraaij, V., & Spinhoven, P.

(2001). Negative life events, cognitive emotion

regulation and emotional problems. Personal-

ity and Individual differences, 30, 1311–1327.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J. (2001). Emotion regulation in adult-

hood: Timing is everything. Current Direc-

tions in Psychological Science, 10, 214–219.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39, 281–291.

Gross, J. J. (Ed.). (2007). Handbook of emotion

regulation. New York: Guilford Press.

Gross, J. J. (2010). The future’s so bright, I gotta

wear shades. Emotion Review, 2, 212–216.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85, 348–362.

Gross, J. J., Sheppes, G., & Urry, H. L. (2011a).

Emotion generation and emotion regulation: A

distinction we should make (carefully). Cogni-

tion and Emotion, 25, 765–781.

Gross, J. J., Sheppes, G., & Urry, H. L. (2011b).

Taking one’s lumps while doing the splits: A

big tent perspective on emotion generation and

emotion regulation. Cognition and Emotion,

25, 789–793.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp.

3–24). New York: Guilford Press.

Gruber, J., Harvey, A. G., & Gross, J. J. (2012).

When trying is not enough: Emotion regula-

tion and the effort-

uccess gap in bipolar dis-

order. Emotion, 12(5), 997–1003.

Gupta, S., & Bonanno, G. A. (2011). Compli-

cated grief and deficits in emotional expressive

flexibility. Journal of Abnormal Psychology,

120, 635–643.

Hajcak, G., Dunning, J. P., & Foti, D. (2009).

Motivated and controlled attention to emo-

tion: Time-

course of the late positive poten-

tial. Clinical Neurophysiology, 120, 505–510.

Hajcak, G., MacNamara, A., & Olvet, D. M.

(2010). Event-

elated potentials, emotion, and

emotion regulation: An integrative review.

Developmental Neuropsychology, 35, 129–

155.

Hajcak, G., & Nieuwenhuis, S. (2006). Reap-

praisal modulates the electrocortical response

to negative pictures. Cognitive, Affective, and

Behavioral Neuroscience, 6, 291–297.

Heatherton, T. F., & Baumeister, R. F. (1991).

Binge eating as escape from self-

wareness.

Psychological Bulletin, 110, 86–108.

Hübner, R., Steinhauser, M., & Lehle, C. (2010).

A dual-stage two-phase model of selective

attention. Psychological Review, 117, 759–

784.

John, O. P., & Gross, J. J. (2007). Individual

differences in emotion regulation. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp.

351–372). New York: Guilford Press.

Johnston, W. A., & Heinz, S. P. (1978). Flexibil-

ity and capacity demands of attention. Journal

of Experimental Psychology: General, 107,

420–435.

Joormann, J., & Gotlib, I. H. (2008). Updating

138 COGNITIVE APPROACHES

the contents of working memory in depres-

sion: Interference from irrelevant negative

material. Journal of Abnormal Psychology,

117, 182–192.

Joormann, J., & Siemer, M. (2004). Memory

accessibility, mood regulation and dysphoria:

Difficulties in repairing sad mood with happy

memories? Journal of Abnormal Psychology,

113, 179–188.

Joormann, J., Siemer, M., & Gotlib, I. H. (2007).

Mood regulation in depression: Differential

effects of distraction and recall of happy mem-

ories on sad mood. Journal of Abnormal Psy-

chology, 116, 484–490.

Kalisch, R. (2009).The functional neuroanatomy

of reappraisal: Time matters. Neuroscience

Biobehavioral Reviews, 33, 1215–1226.

Kashdan, T. B., & Rottenberg, J. (2010). Psy-

chological flexibility as a fundamental aspect

of health. Clinical Psychology Review, 30,

865–878.

Kool, W., McGuire, J. T., Rosen, Z., & Botv-

inick, M. M. (2010). Decision making and

the avoidance of cognitive demand. Journal

of Experimental Psychology: General, 139,

665–682.

Koole, S. L. (2009). The psychology of emotion

regulation: An integrative review. Cognition

and Emotion, 23, 4– 41.

Kross, E., & Ayduk, O. (2008). Facilitating

adaptive emotional analysis: Distinguishing

distanced- analysis of depressive experiences

from immersed- analysis and distraction. Per-

sonality and Social Psychology Bulletin, 34,

924–938.

Lehle, C., & Hübner, R. (2008). On-the-fly

adaptation of selectivity in the flanker task.

Psychonomic Bulletin and Review, 15, 814–

818.

Linehan, M. M. (1993). Skills training manual

for treating borderline personality disorder.

New York: Guilford Press.

MacNamara, A., Ochsner, K. N., & Hajcak, G.

(2011). Previously reappraised: The lasting

effect of description type on picture- elicited

electrocortical activity. Social, Cognitive, and

Affective Neuroscience, 6, 348–358.

Mancebo, M. C., Eisen, J. L., Grant, J. E., & Ras-

mussen, S. A. (2005). Obsessive– compulsive

personality disorder and obsessive– compulsive

disorder: Clinical characteristics, diagnostic

difficulties, and treatment. Annals of Clinical

Psychiatry, 17, 197–204.

McRae, K., Ciesielski, B. R. G., & Gross, J. J.

(2012). Unpacking cognitive reappraisal:

Goals, tactics and outcomes. Emotion, 12,

250–255.

Muraven, M., & Baumeister, R. F. (2000). Self-

regulation and depletion of limited resources:

Does self- control resemble a muscle? Psycho-

logical Bulletin, 126, 247–259.

Nolen- Hoeksema, S. (1991). Responses to

depression and their effects on the duration of

depressive episodes. Journal of Abnormal Psy-

chology, 100, 569–582.

Nolen- Hoeksema, S., & Morrow, J. (1991). A

prospective study of depression and post-

traumatic stress symptoms following a natural

disaster: The 1989 Loma Prieta Earthquake.

Journal of Personality and Social Psychology,

61, 115–121.

Nolen- Hoeksema, S., & Morrow, J. (1993).

Effects of rumination and distraction on

naturally- occurring depressed mood. Cogni-

tion and Emotion, 7, 561–570.

Nolen- Hoeksema, S., Wisco, B. E., & Lyubomir-

sky, S. (2008). Rethinking rumination. Per-

spectives on Psychological Science, 3, 400–

424.

Ochsner, K. N., & Gross, J. J. (2008). Cogni-

tive emotion regulation: Insights from social

cognitive and affective neuroscience. Current

Directions in Psychological Science, 17, 153–

158.

Ochsner, K. N., Ray, R. D., Robertson, E. R.,

Cooper, J. C., Chopra, S., Gabrieli, J. D. E.,

et al. (2004). For better or for worse: Neural

systems supporting the cognitive down- and

up- regulation of negative emotion. NeuroIm-

age, 23(2), 483– 499.

Parkinson, B., & Totterdell, P. (1999). Classify-

ing affect regulation strategies. Cognition and

Emotion, 13, 277–303.

Pashler, H. (1998). The psychology of attention.

Cambridge, MA: MIT Press.

Payne, J. W., Bettman, J. R., & Johnson, E. J.

(1988). Adaptive strategy selection in decision

making. Journal of Experimental Psychol-

ogy: Learning, Memory, and Cognition, 14,

534–552.

Payne, J. W., Bettman, J. R., & Johnson, E. J.

(1993). The adaptive decision maker. New

York: Cambridge University Press.

Reynolds, B. (2006). A review of delay-

discounting research with humans: Relations

to drug use and gambling. Behavioural Phar-

macology, 17, 651– 667.

Richards, J. M., & Gross, J. J. (1999). Compo-

Emotion Regulation Choice 139

sure at any cost?: The cognitive consequences

of emotion suppression. Personality and Social

Psychology Bulletin, 25, 1033–1044

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79, 410–424.

Rieskamp, J. (2006). Perspectives on probabi-

listic inferences: Reinforcement learning and

an adaptive network compared. Journal of

Experimental Psychology: Learning, Mem-

ory, and Cognition, 32, 1355–1370.

Rieskamp, J., & Otto, P. E. (2006). SSL: A the-

ory of how people learn to select strategies.

Journal of Experimental Psychology: Gen-

eral, 135, 207–236.

Sheppes, G., Catran, E., & Meiran, N. (2009).

Reappraisal (but not distraction) is going to

make you seat: Physiological evidence for self

control effort. International Journal of Psy-

chophysiology, 71, 91–96.

Sheppes, G., & Gross, J. J. (2011). Is timing

everything?: Temporal considerations in emo-

tion regulation. Personality and Social Psy-

chology Review, 15, 319–331.

Sheppes, G., & Gross, J. J. (2012). Emotion regu-

lation effectiveness: What works when. In H.

A. Tennen & J. M. Suls (Eds.), Handbook of

psychology (2nd ed., pp. 391–406). Indianap-

olis, IN: Wiley- Blackwell.

Sheppes, G., & Meiran, N. (2007). Better late

than never?: On the dynamics of on-line regu-

lation of sadness using distraction and cogni-

tive reappraisal. Personality and Social Psy-

chology Bulletin, 33, 1518–1532.

Sheppes, G., & Meiran, N. (2008). Divergent

cognitive costs for online forms of reappraisal

and distraction. Emotion, 8, 870–874.

Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J.

(2011). Emotion- regulation choice. Psycholog-

ical Science, 22, 1391–1396.

Sheppes, G., Scheibe, S., Suri, G., Radu, P.,

Blechert, J., & Gross, J. J. (2012). Emotion

regulation choice: A conceptual framework

and supporting evidence. Journal of Experi-

mental Psychology: General. [E-publication

ahead of print]

Siegler, R. S. (2005). Children’s learning. Ameri-

can Psychologist, 60, 769–778.

Tamir, M. (2011). The maturing field of emotion

regulation. Emotion Review, 3, 3 –7.

Thiruchselvam, R., Blechert, J., Sheppes, G.,

Rydstrom, A., & Gross, J. J. (2011). The tem-

poral dynamics of emotion regulation: An

EEG study of distraction and reappraisal. Bio-

logical Psychology, 87, 84–92.

Troy, A. S., & Mauss, I. B. (2011). Resilience in

the face of stress: Emotion regulation ability

as a protective factor. In S. Southwick, B. Litz,

D. Charney, & M. Friedman (Eds.), Resiliency

and mental health (pp. 30–44). Cambridge,

UK: Cambridge University Press.

Tversky, A., & Kahneman, D. (1974). Judgment

under uncertainty: Heuristics and biases. Sci-

ence, 185, 1124–1131.

van Dillen, L. F., & Koole, S. L. (2007). Clear-

ing the mind: A working memory model of

distraction from negative mood. Emotion, 7,

715–723.

Vohs, K. D., & Baumeister, R. (Eds.). (2011).

Handbook of self- regulation: Research, the-

ory, and applications (2nd ed.). New York:

Guilford Press.

Vohs, K. D., Baumeister, R. F., Schmeichel, B. J.,

Twenge, J. M., Nelson, N. M., & Tice, D. M.

(2008). Making choices impairs subsequent

self- control: A limited resource account of

decision making, self- regulation, and active

initiative. Journal of Personality and Social

Psychology, 94, 883–898.

Watkins, E. R. (2008). Constructive and uncon-

structive repetitive thought. Psychological

Bulletin, 134, 163–206.

Watkins, E. (2011). Dysregulation in level of goal

and action identification across psychological

disorders. Clinical Psychology Review, 31,

260–278.

Westphal, M., Seivert, N. H., & Bonanno, G.

A. (2010). Expressive flexibility. Emotion, 10,

92–100.

Wilson, T. D., & Gilbert, D. T. (2008). Explain-

ing away: A model of affective adaptation.

Perspectives on Psychological Science, 3,

370–386.

140

Emotion and Decision Making

Definition of the Field

Recent years have seen a notable increase

in interest in examining the processes that

underlie human decision making, with one

of the more energetic new directions being

that of how emotions can impact our deci-

sions and choices (Sanfey, 2007). Though a

relatively recent development, this research

area has already uncovered some compelling

findings with regard to the emotional and

social factors involved in how we make deci-

sions. Indeed, it is now commonly argued

that the principal way in which actual

decision- making behavior deviates from the

choices prescribed by economic models of

decision making may be in large part due

to emotional factors that weigh heavily on

our actual decision but are seldom taken

into account by the standard models. Hence,

greater knowledge of the exact role that

emotions play in decision making is invalu-

able in building complete, accurate, models

of choice.

The Role of Emotion

in Decision Making

Historically, the study of how we make

decisions has been tremendously influenced

by economic theories grounded in math-

ematical models of behavior. These models

typically strive to outline what the correct

decision might be when selecting from a

specified choice set, with these models gen-

erally assuming that decisions are based on a

“rational,” cognitive evaluation of their con-

sequences (Sanfey, 2007). While the explicit

and analytically tractable solutions have

certainly been of use in examining how we

make decisions, and in particular perhaps

how we should make decisions, factors such

as emotions, mood, and social cues have

typically been excluded from these models.

However, in recent decades there has been a

welcome increased focus on the roles these

factors play in decision making, and experi-

mental evidence has begun to clarify greatly

how emotions impact our decision behavior.

Emotions can affect individual’s goals,

attitudes, and social decision making (For-

gas, 2003; Zajonc, 2000). For example,

unpleasant emotions are associated with

lower confidence and a more risk- averse

and vigilant processing style (Clark & Isen,

1982; Isen & Daubman, 1984).

On the other hand, pleasant emotions

have been associated with higher confi-

dence, more optimistic framing, and greater

cooperation (Forgas, Bower, & Moylan,

1990). More related to economic decisions

is the work done by researchers in the field

of neuroeconomics. One of the first well-

CHAPTER 9

Emotion Regulation and Decision Making

Alessandro Grecucci

Alan G. Sanfey

Emotion Regulation and Decision Making 141

characterized demonstrations of the rela-

tionship between emotions and economic

choices famously showed that damage to

particular neural areas can radically bias

decision making, with the lesioned areas

of interest thought to contribute important

emotional information to choice (Damasio,

1994; Sanfey, Rilling, Aronson, Nystrom,

& Cohen, 2003). Continuing in this vein,

many other basic decision- making studies

have now shown that physiological indi-

ces, such as skin conductance, correlate

with other decision- relevant information,

such as imminent losses in a gambling task

(Bechara, Damasio, Tranel, & Damasio,

1997) and anger during negative interper-

sonal interactions (Van’t Wout, Kahn, San-

fey, & Aleman, 2006).

Other studies have looked at how emo-

tional responses to the stimuli themselves

can directly impact decision making. For

example, in a functional magnetic resonance

imaging (fMRI) experiment, Sanfey et al.

(2003) showed that activation of the anterior

insula, known to be associated with disgust

and anger (Phillips et al., 1997), correlated

with the rejection of inequitable financial

offers made by an opponent in an economic

task known as the Ultimatum Game. The

interpretation given was that insula activa-

tion reflected negative emotional reactiv-

ity in response to the unfair offers (Sanfey

et al., 2003). This hypothesis was tested

in a follow- up study (Van’t Wout et al.,

2006), which showed that skin conductance

responses, a measure for emotional arousal,

were higher for unfair offers, and this mea-

sure discriminated between acceptances and

rejections of these offers.

Researchers have also carefully manipu-

lated emotions either before or during choices

to demonstrate the causality of the relation-

ship (Lerner, Small, & Loewenstein, 2004;

Winkielman, Berridge, & Willbarger, 2005;

Harlé & Sanfey, 2007; Andrade & Ariely,

2009; Sokol- Hessner, Camerer, & Phelps,

2013). Recent research in this vein suggests

that task- irrelevant mood states may bias

decision making (Harlé, Chang, Van’t Wout,

& Sanfey, 2012). For example, Harlé and

Sanfey (2007) showed that negative emotion

is associated more with lower acceptance

rates of unfair monetary. What rational mod-

els consider suboptimal (i.e., turning down

monetary gain) therefore appears likely to

reflect the activation of emotional variables

that can be additionally increased by subtle

incidental mood states (Harlé & Sanfey,

2007), and, given that the role of emotions in

human social and individual decision mak-

ing has been widely demonstrated (Slovic,

Finucane, Peters, & MacGregor, 2004),

suggests that the existing models of behav-

ior need to incorporate affective factors to

arrive at a more comprehensive accounting

of human decision- making behavior.

As a result of this understanding,

researchers have begun to incorporate emo-

tional influences into decision process mod-

els by assuming the reciprocal modulation

of affective and more deliberative modes of

thought (Harlé & Sanfey, 2007). One useful

framework to interpret the role of emotions

in decision making suggests that our choices

may be best understood as the operation of

multiple underlying systems that interact to

form our decisions (Sanfey & Chang, 2008).

There is a long tradition in psychology for

a dual- systems approach in the understand-

ing of cognitive processes, and one aspect of

dual systems that is relevant for this chap-

ter is the distinction between emotion- based

and cognitive- based judgments. Emotions

are rapid and automatic responses to spe-

cific stimuli (Sanfey & Chang, 2008); how-

ever, in some circumstances we are required

to adopt more flexible and context- specific

solutions. At a neural level, emotional pro-

cesses activate brainstem reward processing

regions, such as the basal ganglia; ventral

parts of the brain, such as the ventromedial

frontal, orbitofrontal, and anterior cingulate

cortex; and amygdala and insular cortex

(Dalgleish, 2004; Sanfey & Chang, 2008).

Deliberative processing engages anterior

and dorsolateral and posterior regions of

the brain (Duncan, Emslie, Williams, John-

son, & Freer, 1996; Smith & Jonides, 1999;

Miller & Cohen, 2001; Stuss & Knight,

2002), whereas automatic processes acti-

vate more parietal and subcortical systems.

It seems evident that emotions play a role

in decision making in general; however,

it is still largely unknown how these pro-

cesses interact with deliberative systems and

whether they can be controlled in a “top-

down” fashion (Grecucci, Giorgetta, Bonini,

& Sanfey, 2013a, 2013b). One proposal on

how the two systems may interact comes

from Evans (2009) who conceptualized the

142 COGNITIVE APPROACHES

conflict between these two styles of thinking

as a “cognitive control problem,” referring

to the fundamental question of the mecha-

nism by which control over the answer is

ultimately allocated, and suggested how this

conflict could be resolved. Evans pointed out

that when confronted with a decision, auto-

matic processing produces default intuitive

responses, unless slower and more reflective

deliberative processing intervenes. Impor-

tantly, such an intervention may or may not

lead to a different decision that in turn may

or may not be the correct one. However,

the linkage between emotions and decision

making may be more complex and multi-

faceted, as suggested by the “fourfold clas-

sification of emotions and decision- making”

model of Pfister and Böhm (2008), accord-

ing to which emotions provide information

about pleasure and pain during preference

construction, enable rapid choices under

time pressure, lead attention on relevant

aspects of a decision problem, and may gen-

erate commitment concerning morally and

socially significant decisions.

Emotion Regulation

and Decision Making

Overview

One useful approach to investigate how

emotion and cognition interact is to exam-

ine whether regulatory strategies applied to

decision- making tasks have the ability to

alter subjects’ decisions by modulating the

ongoing emotions (Van’t Wout, Chang, &

Sanfey, 2010). Emotion regulation refers to a

set of different strategies by which individu-

als influence which emotions they have, when

they have them, and how they experience

and express them. Emotions can intervene

in different ways in our decisions, starting

from the assessment of potential alternative

options, the evaluation of a choice, the vari-

ous possible outcomes, and so on. Although

there is surprisingly little empirical work

on the link between top-down control of

emotions and the act of decision making,

the experimental use of emotion regulation

strategies has great potential to elucidate

this relationship (Van’t Wout et al., 2010),

that is, to clarify how emotions and decision

making interact. Broadly speaking, emo-

tion regulation strategies applied to deci-

sion making have two notable advantages as

compared to basic emotion regulation stud-

ies: (1) It provides the opportunity to see

how these regulatory strategies can actually

affect behavioral responses themselves and

not only emotional perception per se, and (2)

it allows for the study of complex emotions

that are often difficult to elicit via standard

sets of simple perceptual stimuli.

Though there has been much important

recent progress on understanding emotion

regulation, most studies to date have mainly

measured the ability to regulate negative

emotions induced by the viewing of images

of valenced and arousing scenes (see Och-

sner & Gross, 2008, for a review). How-

ever, in daily life we are confronted with an

often bewildering range of decisions, each

containing an evaluation of gains, losses,

and associated risks, and usually laden with

emotional value. Therefore, investigating

whether emotion regulation strategies can

have an effect on actual decisions provides

an exciting opportunity to extend emotion

regulation research beyond the modulation

of emotional responses per se.

The effectiveness of emotion regulation

strategies is dependent on both the specific

type of stimulus and the emotion to be regu-

lated (Grecucci, 2012; Ochsner & Gross,

2008), and the emotions elicited by decision-

making situations are substantially differ-

ent than those experienced while passively

viewing emotional images (Van’t Wout et al.,

2010). In addition to the benefits of better

understanding the processes of emotional

regulation by examining these mechanisms

in concert with decision making, the field of

decision making itself also stands to benefit

from this research program. Decision mak-

ing and emotion regulation are linked by the

role that emotion plays in both (Mitchell,

2011), and emotions appear to play a fun-

damental role in choices associated with

reward or punishment. Moreover, psychiat-

ric disorders are often associated with emo-

tion regulation deficits and abnormal deci-

sion making (Mitchell, 2011). For example,

neuropsychological studies have shown that

damage in brain areas implicated in emo-

tional regulation (i.e., ventromedial cortex)

often result in suboptimal decision making

(Koenigs & Tranel, 2007; Moretti, Drag-

one, & di Pelegrino, 2009). A recent line of

research has studied how emotion regulation

Emotion Regulation and Decision Making 143

strategies can affect decision making directly

and bias our decision- making behavior as

presented in the following sections.

Individual Decision Making

One useful organizational distinction when

talking about decision making is to separate

the field into two main branches: individual

decision making and social decision mak-

ing. This categorization is not trivial, and

it has particular implications for emotion

regulation, because the affective experience

associated with these two kinds of decision

can be quite different. Individual decision

making refers to situations in which the

decision makers assess the available options,

then choose the best course of action for

themselves based on their own value and

beliefs, for example, when choosing to play

a risky bet. Factors typically considered here

include risk evaluation, reward, loss aver-

sion, regret, and quantity evaluation. Social

decision scenarios also require that these

factors be taken into account, but what dis-

tinguishes these situations is the presence of

another (involved) agent. A good example of

this is making decisions in a business nego-

tiation context. These contexts additionally

involve evaluations of motivations such as

fairness, equity, cooperation, and in general

more socially driven emotions. Here, we

first examine the experimental evidence of

emotion regulation on individual decision

making, before turning our attention to the

social contexts.

The Modulation of Risk Evaluation

and Risk‑Seeking Behavior

One method to study the interaction between

emotion and decision making is examin-

ing risky choices, for example, when there

is uncertainty about the exact outcome of

the decision and, typically, a safe, relatively

low payout or low-cost option is weighed

against an option with both higher costs

and benefits. A canonical example would

be a choice between a sure gain of $10 and

a risky choice, with a 50% chance of pay-

ing out $25. The importance of studying

the effect of emotion regulation strategies

in modulating risky behaviors becomes par-

ticularly salient when considering that many

pathological behaviors stem from seemingly

irrational evaluation of the risk associated

with a given choice (pathological gambling,

substance abuse, etc.).

Two recent studies have manipulated

people’s emotion regulation strategies when

making risky decisions. One study from

Heilman, Crişan, Houser, Miclea, and

Miu (2010) used cognitive reappraisal (an

antecedent- focused strategy that changes the

meaning of the situation), expressive sup-

pression (a response- focused strategy that

involves inhibiting behavioral expressions

of emotions), and a control baseline condi-

tion in a between- subjects design (Study 1).

Subjects were required to apply these strat-

egies while playing the Balloon Analogue

Risk Task (BART; Lejuez et al., 2002),

as well as the Iowa Gambling Task (IGT;

Bechara, Damasio, Damasio, & Anderson,

1994). The BART provides a vivid measure

of risk taking by giving players the opportu-

nity to progressively earn money by pump-

ing up computerized balloons (Lejuez et al.,

2002). While each additional pump provides

an extra monetary payoff, the balloons can

explode without warning, in which case the

participant loses everything. Therefore, the

task assesses the degree to which players are

prepared to risk an extra pump (for an extra

reward) at the risk of a total loss (Lejuez et

al., 2002). The well-known IGT is a comput-

erized card- searching game that measures

the degree to which individuals shift from

choices with large immediate gains (which,

however, are also associated with even larger

losses in the long term) toward the more pru-

dent and eventually more rewarding choices

with small, immediate gains (Bechara et al.,

1994).

Heilman et al. (2010) found that when

compared with the control group, the group

of reappraisers reported fewer negative emo-

tions and demonstrated reduced risk aver-

sion; that is, they made more risky deci-

sions in the BART task, operationalized as

a greater number of pumps on average per

unexploded balloon. In the IGT, reapprais-

ers demonstrated improved performance in

the prehunch/hunch period of the task, in

which players are endeavoring to discover

the exact traits of the various cards; there-

fore, they yielded significantly higher earn-

ings at the end of the game. Importantly,

suppressors and controls showed no sig-

nificant difference in both tasks in terms

144 COGNITIVE APPROACHES

of emotional ratings and decision- making

behavior. Overall, then, this study showed

that cognitive reappraisal appears to lead to

increased risk taking by reducing the expe-

rience of negative emotions elicited by the

decision scenario.

Another study (Martin & Delgado, 2011)

explored how emotion regulation strategies

influence participants’ preferences when

choosing between two monetary options:

a gamble (risky option) and a guaranteed

amount (safe option). Here, participants

engaged in imagery- focused regulation strat-

egies during the presentation of a cue that

preceded an economic decision. The emotion

regulation strategies placed subjects in the

following experimental conditions: “Look,”

“Relax,” or “Excite.” When instructed to

“Relax,” participants were asked to imagine

a calming scene; when in the “Excite” condi-

tion, participants were to imagine an excit-

ing scene, in order to increase their reactiv-

ity. After the imagery phase, participants

made a choice between a risky and a safe

monetary lottery while undergoing fMRI.

Participants who successfully used the emo-

tion regulation strategy “Relax” made fewer

risky choices in comparison to the “Look”

condition. The “Excite” condition was not

effective in producing any change in deci-

sion behavior. To better understand the

effect of the “Relax” strategy on decision

making, the authors divided participants

into two groups on the basis of their success

at implementing the strategy. Regulators

were then compared with nonregulators,

and the former showed a significant pro-

portion of fewer risky choices as compared

with “Look” trials, suggesting that emotion

regulation strategies are able to modulate

risky decisions (Martin & Delgado, 2011).

Moreover, at the neural level, responses in

the striatum, a key region associated with

risky choice, were attenuated during deci-

sion making when participants adopted the

“Relax” emotion regulation strategy (Mar-

tin & Delgado, 2011). In contrast, partici-

pants who did not effectively use emotion

regulation strategies (i.e., the nonregulator

group) failed to show neural differences

during decision making. In conclusion, the

authors argued that imagery- focused strate-

gies “can foster more goal- directed behavior

and promote safer, compared with riskier,

decision- making.”

Anticipation and Processing of Losses:

The Regulation of Loss Aversion

Kahneman and Tversky (1979) famously

codified the notion that losses loom larger

than their equivalent gains, terming this

phenomenon “loss aversion.” Experimental

studies over the past 30 years indicate that

people demonstrate loss aversion for objects

(Kahneman, Knetsch, & Thaler, 1990) and

money (Tversky & Kahneman, 1992). Two

studies from Sokol- Hessner and his col-

leagues (2009, 2013) showed that applying

emotion regulation strategies to decision

making can affect the experience of loss

aversion. In the first study (Sokol- Hessner et

al., 2009), participants were asked to reap-

praise, by taking a different perspective,

about a choice between a binary gamble

and a guaranteed amount. Outcomes were

displayed following the decision phase (e.g.,

“You won” or “You lost”). For half of the

trials, participants applied an “Attend”

strategy, which considered each choice in

isolation, and for the other half, a “Regu-

late” strategy, which emphasized choices in

their broader context, such as “thinking like

a trader.” In other words, they were asked to

imagine themselves to be experienced pro-

fessional stock traders. Risk aversion and

loss aversion indices were then computed,

based on participants’ actual choice behav-

ior. The authors were able to show that the

“Regulate” strategy had a strong effect in

decreasing individuals’ initial levels of loss

aversion but not risk aversion. Importantly,

to identify the degree of change in loss aver-

sion according to differences in regulation

success, subjects were divided into “regu-

lators” and “nonregulators.” Reduced loss

aversion was also associated with reduced

physiological arousal responses to loss out-

comes, further showing that the reappraisal

strategy was also associated with decreased

emotional reaction to bad outcomes.

In the second study, using a similar para-

digm, Sokol- Hessner et al. (2013) found

that success in regulating loss aversion by

using emotion regulation strategies (reap-

praisal), was associated with a reduction

in amygdala responses to losses but not to

gains. Moreover, the application of the reap-

praisal strategy increased the baseline activ-

ity in prefrontal cortices and the striatum, in

line with previous studies (Ochsner, Bunge,

Emotion Regulation and Decision Making 145

Gross, & Gabrieli, 2002; Banks, Eddy, Ang-

stadt, Nathan, & Phan, 2007; Eippert et al.,

2007; Delgado, Gillis, & Phelps, 2008; Del-

gado, Nearing, LeDoux, & Phelps, 2008).

These results support the idea that different

modes of thinking can alter both choices and

arousal responses related to loss aversion.

Regulation of Rewards, Expected Values,

and Prediction Error

Another line of research has involved the

study of rewards in an economic decision-

making context. A reward can be defined as

“an object or event that generates approach

and consummatory behavior, represents

positive outcomes of decisions and may

engage positive emotions” (cf. Schultz, 2009,

p. 323). In other words, rewards are positive

outcomes that occur after specific events.

The importance of studying emotion reg-

ulation strategies of reward stems from the

fact that dysregulation of reward seems to

be associated with pathological addiction

syndromes (Heinz, 2002; Robinson & Ber-

ridge, 2003; Volkow & Wise, 2005; Wrase

et al., 2007). At the neural level, when the

reward is greater than expected, there is a

positive prediction error (greater ventral

striatal activity), and when the reward is

less than expected (or missing altogether),

there is a negative prediction error (less ven-

tral striatal activity) (Hollerman & Schultz,

1998; McClure, Berns, & Montague, 2003;

Staudinger, Erk, Abler, & Walter, 2009).

Prediction errors have been interpreted as

“teaching” signals, helping participants

to adapt their behavior so as to maximize

future rewards acquisition (Sutton, 1988;

Montague, Hyman, & Cohen, 2004;

Staudinger et al., 2009).

Two studies from Staudinger and col-

leagues (2009; Staudinger, Erk, & Walter,

2011) addressed the question of whether

emotion regulation might also impact reward

processing. In the first study, Staudinger

et al. (2009), the authors used a monetary

incentive delay (MID) task (Knutson, Tay-

lor, Kaufman, Peterson, & Glover, 2005)

to investigate whether regulation strategies

affect the neural processing of reward and

its associated motivated behavior. Subjects

were scanned with fMRI while playing the

MID task, in which subjects observed an

abstract cue indicating the amount of money

to be won (€0.50, €0.10), followed by a wait-

ing period. A target (square or triangle) was

then presented, after which subjects became

eligible to win the announced amount of

money. Immediately afterwards, a feed-

back display informed the subjects whether

they had actually won (€0.50, €0.10) or

not (€0.00). Subjects in one condition were

asked to rethink an emotion- eliciting situ-

ation in nonemotional terms by distancing

themselves from feelings and behaving as

neutral observers (distancing; Gross, 2002).

In another condition (“Permit”) they were

allowed to experience their feelings. Dis-

tancing significantly lowered subjects’ per-

ceived feelings. More importantly, a modu-

lation of expected value and its associated

prediction error was observed in the right

ventral striatum of subjects while applying

the distancing strategy. The comparison of

the “Distance” and “Permit” conditions

showed a significant activation in the right-

hemispheric frontoparietal network (includ-

ing the rostral cingulate zone, lateral orbi-

tofrontal cortex [OFC] and inferior parietal

lobe/temporal parietal junction). Interest-

ingly, reappraisal success was positively cor-

related with activation in the rostral cingu-

late zone and the lateral OFC (Staudinger et

al., 2009). The authors were therefore able

to show that emotion regulation strategies

generally impact reward coding, and also

modulate expected value and prediction

error encoding in the ventral striatum.

In the second study, Staudinger and col-

leagues (2011) used a similar task but

explored whether emotion regulation would

also be effective in decreasing the moti-

vation to obtain a reward. The authors

found reduced positive evaluative feelings

for larger gains (€1) during the “Distance”

instruction (from 4.08 to 2.50 points), as

well as a slowdown in reaction times, which

they interpreted as a lowered motivation to

obtain the reward. At a neural level, using

psychophysiological interaction analyses,

they found that the dorsolateral prefrontal

cortex played a fundamental role in exerting

direct modulatory control over the striatum

by promoting low- reward responses. In the

same fashion, another experiment showed

that imagery- based strategies successfully

modulate reward expectation in a monetary

reward– conditioning procedure (Delgado,

Nearing, et al., 2008).

146 COGNITIVE APPROACHES

Overall, these experiments showed that

emotion regulation strategies applied to indi-

vidual decisions have the power to alter our

choices. Emotions such as risk perception,

reward, and loss evaluation are modulated

by the usage of different kind of strategies

(cognitive or relaxation- based imagery), and

this alters our decision behavior toward safer

behavior (Martin & Delgado, 2011), toward

less sensitivity to outcomes (Sokol- Hessner

et al., 2013), and toward lower motivation

to obtain an economic reward (Staudinger et

al., 2011).

Social Decision Making

Despite the extensive literature on emotional

“self- regulation” (see Ochsner & Gross,

2008), evidence of emotion regulation in

social interactive situations is still relatively

scant. Indeed, interest in such “social regu-

lation” has been explored only recently in

a study examining the emotion regulation

of subjects looking at pictures depicting

social versus nonsocial scenes. Studying the

mechanisms involved in the regulation of

real social situations is particularly impor-

tant when considering the failures to regu-

late interpersonal interactions exhibited in

psychiatric disorders such as borderline per-

sonality disorder or social anxiety disorder

(Grecucci, 2012, p. 135); Ochsner, 2008;

Ochsner & Gross, 2008). Recent experi-

ments on emotion regulation and social deci-

sion making hold the promise to elucidate

the mechanisms subserving interpersonal

emotion regulation (Grecucci, Giorgetta,

Bonini, & Sanfey, 2013). Moreover, emo-

tions elicited in social interactions may well

be of a qualitatively different nature than

those experienced while making individual

decisions about monetary gains, rewards, or

risky choices.

Anger

A potentially useful approach to measuring

socially driven emotions is to adopt tasks

derived from “game theory.” Game theory is

the study of mathematical models of conflict

and cooperation between decision makers

(Myerson, 1991), and offers useful models

for the psychological investigation of social

exchange (Sanfey & Dorris, 2009). One of

the more well-known tasks in this field is

the Ultimatum Game (UG; Guth, Schmitt-

berger, & Schwarz, 1982), in which two

players must agree on the division of a sum of

money provided by the experimenter (Van’t

Wout et al., 2010). One player, the proposer,

makes an offer as to how this money should

be split. The responder must then make a

decision to either accept or reject this offer.

If the offer is accepted, then the money is

split as proposed, but if the responder rejects

the offer, then neither player receives any-

thing. A central focus of the literature has

been the well- replicated result that low offers

(i.e., less than 30% of the total amount) are

rejected approximately 50% of the time

(Camerer, 2003). That is, UG choices are

not purely driven by financial self- interest,

but also incorporate affective information

about the social interaction, with evidence

that negative emotions play an important

role in punishment behavior (Pillutla &

Murnighan, 1996; Xiao & Houser, 2005).

Put simply, the UG gives us the opportunity

to elicit anger reactions in subjects via real

social interactions, then to measure their

willingness to punish the perpetrator (and,

of course, themselves) by examining rejec-

tion rates of these unequal offers.

One study from Van’t Wout and col-

leagues (2010) showed that participants

who were asked to reappraise their emotions

accepted a greater number of unfair offers

(i.e., $1 or $2 offered from a pot of $10)

than participants who did not use any regu-

lation strategy (Experiment 1). Importantly,

in another condition, subjects were asked

to use a response- focused strategy, namely,

suppression of any negative emotions toward

the proposer; however, this strategy was not

effective in altering the decision- making of

subjects. Moreover, when acting later in the

experimental session as proposers them-

selves (Experiment 2), participants who had

used reappraisal strategies made more gen-

erous offers to their previously unfair part-

ners than those who had use the strategy of

suppression, demonstrating an interesting

“follow- on” effect of reappraisal.

Following this line of research, Grecucci,

Giorgetta, Van’t Wout, Bonini, and Sanfey

(2013) applied a similar paradigm to that of

Van’t Wout et al. (2010) but also employed

fMRI to explore the neural bases of regulated

Emotion Regulation and Decision Making 147

interpersonal decisions. In addition they

studied the effects of both up- and down-

regulation in participants. This allowed

them to explore whether the negative emo-

tions induced by an inequitable proposal can

be both reduced and increased depending

on the strategy, and, importantly, whether

this regulation in turn affects the decision to

punish the other player for his or her unfair

treatment. When using a down- regulation

strategy (rethink the situation as less nega-

tive), a greater number of unfair offers were

accepted (i.e., fewer punishment behaviors).

Up- regulation, on the other hand, yielded a

greater number of rejections of unfair offers

(i.e., more punishment behaviors), with both

strategy conditions compared with a base-

line “Look” condition. Subjective ratings

analyses clarified that subjects’ anger about

the unfair proposed division was the main

emotion regulated by the reappraisal strat-

egies. At the neural level, significant acti-

vations during reappraisal were observed

in the dorsolateral prefrontal cortex and

cingulate gyrus, but only for unfair offers.

“Regulated” decisions activated the left infe-

rior frontal gyrus for up- regulation and the

middle frontal gyrus for down- regulation

strategies, respectively. The insula, one key

region that was active when participants

were treated unfairly (Sanfey et al., 2003),

showed less activation for down- regulation

and more activation for up- regulation. In

conclusion, these studies provide strong

evidence that interpersonal emotions (e.g.,

anger when treated unfairly) can be success-

fully modulated by emotion regulation strat-

egies. And, as an important consequence,

these studies also clearly show that emotion

regulation can alter our social behavior (in

this case, punishment of unfair behavior),

with these effects observed in within- subject

interactions. This has important implica-

tions for the regulation of social behavior in

interactive contexts.

Selfishness

Another recent study by the same group

(Grecucci, Giorgetta, Bonini, et al., 2013)

used a similar socioeconomic game, namely,

the Dictator Game, to measure emotional

responses to both the altruistic and selfish

behavior of others. The Dictator Game is

similar to the UG, with the important excep-

tion that responders cannot reject the divi-

sion of money made by the proposer; that

is, they must accept whatever the proposer

decides to give them from the experimenter-

provided pot. Here, subjects were trained to

reappraise the other player (a form of “men-

talizing”) in one condition, and to distance

from the situation (“distancing”) in another.

This kind of reappraisal comprised refram-

ing the intention and behavior of the other

player in either a more or less negative way.

Following both altruistic and selfish divi-

sions of money, emotional ratings were col-

lected separately for arousal and valence.

Reappraisal strategies increased the valence

ratings (less negative perception) for self-

ish offers ($1, $2, $3, from a total of $10),

and subjective ratings also indicated that the

main emotion involved when receiving such

offers was “disappointment” (but also to

some extent “anger” and “disgust”) in rela-

tion to the selfish proposers, while distanc-

ing did not produce any change compared

with the “Look” condition. This study

provisionally demonstrates that disappoint-

ment regarding selfish behavior can be suc-

cessfully modulated by mentalizing strate-

gies (reappraisal of the intention of others),

whereas distancing from others (an interper-

sonal strategy that is typical of social and

generalized anxiety disorders) is not effec-

tive in modulating these reactions.

Overall, these experiments have begun

to show that emotions in reaction to com-

plex social motivations such as inequity and

selfishness can be successfully modulated by

emotion regulation strategies, and that these

strategies can lead to changes in observed

decision behaviors.

Conclusion

Our aim in this chapter has been to review

the extant studies that have used regula-

tory strategies to moderate affective inputs

to the decision- making process. Though

relatively few in number to date, there has

been encouraging success with these type of

manipulations, and overall these studies pro-

vide compelling evidence that emotion regu-

lation strategies can have a strong impact

on not only perceptions of stimuli, but also

148 COGNITIVE APPROACHES

real, consequential, decisions in both social

and nonsocial contexts. This turn can lead

to interesting hypotheses about how our

daily decisions can be modulated by emo-

tion regulation strategies. Though it seems

evident that emotional factors play a role in

decision- making situations, the mechanisms

integrating affective and more deliberative

information in decision making are still

relatively understudied. Recent experiments

have demonstrated changes in decision

making following both incidental emotion

induction (Harlé & Sanfey 2007; Bonini et

al., 2011) and neurophysiological disruption

via transcranial magnetic stimulation (Van’t

Wout, Kahn, Sanfey, & Aleman, 2005;

Knoch, Pascual- Leone, Meyer, Treyer, &

Fehr, 2006), but emotion regulation studies

of decision making have already extended

these findings in important ways by dem-

onstrating that emotions directly related to

the choice situation itself can be controlled

through top-down effort, leading to changes

in how the choice sets are represented and

the associated decisions themselves. More-

over, these studies are important because

they extend the range of emotions that can

be affected by emotion regulation strategies.

Neuroanatomical Bases of Emotion

Regulation of Decision Making

Overall, the brain regions implicated in the

aforementioned studies can be grouped into

two main functional clusters: the regions

that implement the regulation strategies,

and the regions regulated by the strategies.

For the former, regions acting as “regula-

tors” are primarily the dorsolateral (dlPFC)

and ventrolateral (vlPFC) portions of the

prefrontal cortex, and in some cases also

the ventromedial regions. The dlPFC and

vlPFC have been implicated in active cogni-

tive control and inhibition (Miller & Cohen,

2001; Smith & Jonides, 1999), and may

underlie the generation and maintenance

of reappraisal strategies (Ochsner et al.,

2002, 2004). Importantly, the ventral part

of the prefrontal cortex is well- connected

with brain structures such as the insula, the

amygdala, and the striatum. One hypothesis

derived from these activations is that the pre-

frontal cortex actively modulates the activity

in more emotional regions under conditions

of emotional regulation (Grecucci, Gior-

getta, Bonini, et al., 2013a, 2013b). Interest-

ingly, dlPFC and vlPFC have been previously

reported as active when reappraising emo-

tional pictures (Ochsner et al., 2004). One

interpretation might therefore be that dlPFC

is involved in modulating both behavioral

and emotional outputs in order to satisfy

contextual demands (Mitchell, 2011).

Interestingly, there is an overlap between

“decision- making” and “regulatory” brain

areas. Indeed, the role of the lateral prefron-

tal cortex in decision making has been con-

ceptualized along four main lines: (1) nega-

tive feedback encoding; (2) motor response

inhibition; (3) stimulus– response reconfigu-

ration; and (4) attention to behaviorally sig-

nificant stimuli (Mitchell, 2011). The same

considerations apply to the role of the lat-

eral PFC in emotion regulation. For exam-

ple, Mitchell hypothesized that the lateral

prefrontal cortex is involved in modulating

behavioral and emotional output given par-

ticular contextual demands. Another key

region connected to both emotion regulation

and decision making is the cingulate cortex,

which may best be interpreted in terms of

performance monitoring. One of these mon-

itoring functions is the detection of response

conflict between top-down “deliberative”

signals and bottom- up “emotional” signals.

Other relevant regions for these processes

are the temporoparietal junction (TPJ) and

the inferior parietal lobe (IPL). Activation

of the right TPJ/IPL is in line with previous

reappraisal studies (Ochsner et al., 2002;

Delgado, Nearing, et al., 2008; Staudinger

et al., 2009) and might indicate allocation

and dislocation of attention (Corbetta &

Shulman, 2002).

The regions modulated by the strategies are

generally connected with the emotions elic-

ited in the tasks. For example, tasks involving

risk assessment found reduced activity in the

ventral striatum (Martin & Delgado, 2011);

tasks involving reward found alterations in

the activity of OFC, cingulate cortex, and

the ventral striatum (Staudinger et al., 2009,

2011); experiments involving the experience

of monetary loss found reduced amygdala

activity (Sokol- Hessner et al., 2013); and

social decision- making tasks such as the UG

yielded reduced activity in the insula, known

to be associated with anger and feelings of

disgust (Grecucci, Giorgetta, Bonini, et al.,

2013a). See Table 9.1 for a summary.

149

TABLE 9.1. Emotion Regulation and Decision Making Studies and Their Main Findings

Emotion or emotion-

related behavior

Decision-making

task

Emotion

regulation strategy Behavioral effect Main regulated regions

Regulating

regions Reference

Risky behavior Balloon Analogue

Risk Task; Iowa

Gambling Task

Suppression,

reappraisal

Reduced risk aversion;

increased monetary

performance

— — Heilman et al.

(2010)

Risk perception Gambling Imagery-focused

regulation

Reduced risky choices Ventral striatum Martin and Delgado

(2011)

Loss aversion Gambling Reappraisal Reduced loss aversion Amygdala dlPFC, vmPFC Sokol-Hessner et al.

(2009, 2013)

Reward Monetary Incentive

Delay Task

Distancing Attenuation of expected value;

modulation of prediction

error; attenuation of pleasant

anticipation of gains

Ventral striatum, rostral

cingulate, orbitofrontal

cortex, putamen

dlPFC, CC,

IPL/TPJ

Staudinger et al.

(2009, 2011)

Anger Ultimatum Game Reapprasial,

suppression

Reduced rejection rates Insula dlPFC, CC Van’t Wout et al.

(2010); Grecucci,

Giorgetta, Van’t

Wout, et al. (2013)

Responses to selfish

behavior of others

Dictator Game Reapprasial,

distancing

Less negative emotions Insula, Striatum,

posterior cingulate

dIPFC, TPJ Grecucci, Giorgetta,

Bonini, and Sanfey

(2013a, 2013b)

Note. dlPFC, dorsolateral prefrontal cortex; vmPFC, ventromedial PFC; CC, cingulate cortex; IPL, inferior parietal lobe; TPJ, temporoparietal junction.

150 COGNITIVE APPROACHES

Concluding Remarks

and Future Directions

In this chapter, we have reviewed the cur-

rent experimental evidence concerning emo-

tion regulation as applied to decision mak-

ing. While relatively few experiments to

date have explicitly used regulation strate-

gies in the context of decision and choice,

the results thus far are encouraging and

point to the usefulness of regulation in

potentially modifying decision making. The

experimental findings are consistent with a

key role of emotional regulatory process in

decision making. For example, expressing

emotions when bargaining in the UG has

effects on the subsequent punishment behav-

ior (Xiao & Houser, 2005). Individual and

social decision- making experiments have

shown that emotions connected to relevant

decision factors such as loss, risk, reward,

interpersonal anger, and moral disgust can

be successfully regulated by various strate-

gies. Notably, not all the strategies result

in equally successful changes in subjects’

decision- making behavior. While rein-

terpretative strategies such as reappraisal

appear effective at altering decision mak-

ing and associated emotions, the same does

not necessarily apply to expressive strate-

gies such as suppression (Heilman et al.,

2010; Van’t Wout et al., 2010) or distancing

(Grecucci, Giorgetta, Bonini, et al., 2013;

but see Staudinger et al., 2009, for a posi-

tive result). Although researchers are now

beginning to investigate the role of regula-

tion in decision making, several factors still

need to be understood and explored. For

example, there are many different types of

decision making that have been hitherto

unexamined in terms of how regulation may

impact choice, such as impulsivity, temporal

discounting, charitable donations, assess-

ments of uncertainty and so on. Moreover,

some (e.g., Sokol- Hessner et al., 2009)

have argued that ability to regulate may be

related to more efficient decision- making

behavior. One interesting question is there-

fore whether individual differences in the

way we treat and regulate our emotions are

predictive of more optimal choices and the

better avoidance of detrimental behaviors.

To date, researchers have focused their

attention primarily on the effect of nega-

tive emotions on decision making. However,

positive emotions may also have a large

impact on decision making, and future stud-

ies could productively examine these affec-

tive influences. Another intriguing finding

is that, in some studies, augmented activity

in the more “decision- related” brain areas

has been reported. At least two studies have

reported a baseline shift in dlPFC (Grecucci

et al., 2013; Sokol- Hessner et al., 2013). The

exact interpretation of this shift is a matter

for future research studies, but one specula-

tive account is that this may be involved in

increased intentional control (Sokol- Hessner

et al., 2013) or more flexibility in satisfying

contextual demands (Grecucci, 2012; Gre-

cucci, Giorgetta, Van’t Wont, et al., 2013).

One important point that remains unsolved

is how emotion regulation strategies affect

decisions. Do regulatory strategies alter deci-

sions themselves, without impacting emo-

tions? Or does emotion regulation influence

decision- making processes by altering the

emotion, which in turn alters decision mak-

ing? Even if the latter seems to be the more

plausible explanation, the two hypotheses

have rarely been tested in the same experi-

ment. Finally, recent studies of experimental

psychopathology are providing important

insights into how emotional dysregulation

(excessive anxiety or depression, etc.) affects

our decisions. These studies may provide

further proof of the importance of regula-

tory mechanisms (and their failure) in deci-

sion making.

Overall, studying the processes and mech-

anisms involved in how emotions are regu-

lated in concert with actual decision- making

behavior offers an appealing template for

future research. Demonstrating how regula-

tion can actually impact both behavior and

subsequent choice outcomes extends the cur-

rent research topic in interesting directions

and also has the potential to outline practi-

cal strategies that can be usefully employed

in real-life situations.

References

Andrade, E. B., & Ariely, D. (2009). The endur-

ing impact of transient emotions on decision-

making. Organizational Behavior and Human

Decision Processes, 109(1), 1–8.

Banks, S. J., Eddy, K. T., Angstadt, M., Nathan,

P. J., & Phan, K. L. (2007). Amygdala– frontal

Emotion Regulation and Decision Making 151

connectivity during emotion regulation. Social

Cognitive and Affective Neuroscience, 2(4),

303–312.

Bechara, A., Damasio, A. R., Damasio, H., &

Anderson, S. W. (1994). Insensitivity to future

consequences following damage to human

prefrontal cortex. Cognition, 50, 7–15.

Bechara, A., Damasio, H., Tranel, D., & Dama-

sio, A. R. (1997). Deciding advantageously

before knowing the advantageous strategy.

Science, 275(5304), 1293–1295.

Bonini, N., Hadjichristidis, C., Mazzocco, K.,

Demattè, M. L., Zampini, M., Sbarbati, A.,

et al. (2011). Pecunia olet: The role of inciden-

tal disgust in the Ultimatum Game. Emotion,

11(4), 965–969.

Camerer, C. F. (2003). Behavioral game theory.

New York: Russell Sage Foundation.

Clark, M. S., & Isen, A. M. (1982). Towards

understanding the relationship between feel-

ing states and social behavior. In A. H. Has-

torf & A. M. Isen (Eds.), Cognitive social psy-

chology (pp.

73–108). New York: Elsevier.

Corbetta, M., & Shulman, G. L. (2002). Control

of goal-

irected and stimulus driven attention

in the brain. Nature Review Neuroscience, 3,

201–215.

Dalgleish, T. (2004). The emotional brain.

Nature Review Neuroscience, 5, 583–589.

Damasio, A. (1994). Descartes’ error: Emotion,

reason, and the human brain. New York: Put-

nam.

Delgado, M. R., Gillis, M., & Phelps, E. A.

(2008). Regulating the expectation of reward

via cognitive strategies. Nature Neuroscience,

11(8), 880–881.

Delgado, M. R., Nearing, K. I., LeDoux, J. E., &

Phelps, E. A. (2008). Neural circuitry underly-

ing the regulation of conditioned fear and its

relation to extinction. Neuron, 59, 829–838.

Duncan, J., Emslie, H., Williams, P., Johnson,

R., & Freer, C. (1996). Intelligence and the

frontal lobe: The organization of goal-

irected

behavior. Cognitive Psychology, 30, 257–303.

Eippert, F., Veit, R., Weiskopf, N., Erb, M.,

Birbaumer, N., & Anders, S. (2007). Regula-

tion of emotional responses elicited by threat-

elated stimuli. Human Brain Mapping, 28(5),

409–423.

Evans, J. St. B. T. (2009). How many dual-

rocess

theories do we need: One, two or many? In J. St.

B. T. Evans & K. Frankish (Eds.), In two minds:

Dual processes and beyond (pp.

31–54). New

York: Oxford University Press.

Forgas, J. P. (1995). Mood and judgment: The

affect infusion model (AIM). Psychological

Bulletin, 73(117), 39–66.

Forgas, J. P. (2003). Affective influences on atti-

tudes and judgments. In R. J. Davidson, K. J.

Scherer, & H. H. Goldsmith (Eds.), Hand-

book of affective sciences (pp.

596–618). New

York: Oxford University Press.

Forgas, J. P., Bower, G. H., & Moylan, S. J.

(1990). Praise or blame?: Affective influences

on attributions for achievement. Journal of

Personality and Social Psychology, 59, 809–

818.

Grecucci, A. (2012). Il Conflitto Epistemologico.

Psicoanalisi e Neuroscienze dei Processi anti-

conoscitivi. Francavilla, Italy: Edizioni Psi-

conline.

Grecucci, A., Giorgetta, C., Bonini, N., & San-

fey, A. (2013a). Living emotions, avoiding

emotions: behavioral investigation of the regu-

lation of socially driven emotions. Frontiers in

Psychology, 3(616).

Grecucci, A., Giorgetta, C., Bonini, N., &

anfey, A. (2013b). Reappraising social emo-

tions: The role of inferior frontal gyrus,

temporo-

arietal junction and insula in inter-

personal regulation. Frontiers in Human

Neuroscience.

Grecucci, A., Giorgetta, C., Van’t Wout, M.,

Bonini, N., & Sanfey, A. G. (2013). Reapprais-

ing the ultimatum: An fMRI study of emotion

regulation and decision-

aking. Cerebral

Cortex, 23(2), 399–410.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39, 281–291.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp.

3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85(2), 348–362.

Guth, W., Schmittberger, R., & Schwarz, B.

(1982). An experimental analysis of ultima-

tum bargaining. Journal of Economic and

Behavioral Organization, 3, 376–388.

Harlé, K., & Sanfey, A. G. (2007). Incidental

sadness biases social economic decisions in the

ultimatum game. Emotion, 7(4), 876–881.

Harlé, K. M., Chang, L. J., Van’t Wout, M., &

Sanfey, A. G. (2012). The neural mechanisms

of affect infusion in social economic decision-

152 COGNITIVE APPROACHES

making: A mediating role of the anterior

insula. NeuroImage, 61(1), 32–40.

Heilman, R. M., Crişan, L. G., Houser, D.,

Miclea, M., & Miu, A. C. (2010). Emotion

regulation and decision- making under risk

and uncertainty. Emotion, 10(2), 257–265.

Heinz, A. (2002). Dopaminergic dysfunc-

tion in alcoholism and schizophrenia—

Psychopathological and behavioral correlates.

European Psychiatry, 17, 9–16.

Hollerman, J. R., & Schultz, W. (1998). Dopa-

mine neurons report an error in the temporal

prediction of reward during learning. Nature

Neuroscience, 1, 304–309.

Isen, A. M., & Daubman, K. A. (1984). The

influence of affect on categorization. Jour-

nal of Personality and Social Psychology, 47,

1206–1217.

Kahneman, D., Knetsch, J. L., & Thaler, R. H.

(1990). Experimental tests of the endowment

effect and the Coase theorem. Journal of Polit-

ical Economy, 98, 1325–1348.

Kahneman, D., & Tversky, A. (1979). Prospect

theory: An analysis of decision under risk.

Econometrica, 47, 263–291.

Knoch, D., Pascual- Leone, A., Meyer, K., Treyer,

V., & Fehr, E. (2006). Diminishing reciprocal

fairness by disrupting the right prefrontal cor-

tex. Science, 314, 829–832.

Knutson, B., Taylor, J., Kaufman, M., Peterson,

R., & Glover, G. (2005). Distributed neural

representation of expected value. Journal of

Neuroscience, 25, 4806–4812.

Koenigs, M., & Tranel, D. (2007). Irrational

economic decision- making after ventromedial

prefrontal damage: Evidence from the Ulti-

matum Game. Journal of Neuroscience, 27,

951–956.

Lejuez, C. W., Read, J. P., Kahler, C. W., Rich-

ards, J. B., Ramsey, S. E., Stuart, G. L., et al.

(2002). Evaluation of a behavioral measure of

risk taking: The Balloon Analogue Risk Task

(BART). Journal of Experimental Psychology:

Applied, 8, 75–84.

Lerner, J. S., Small, D. A., & Loewenstein, G. F.

(2004). Heart strings and purse strings: Car-

ryover effects of emotions on economic deci-

sions. Psychological Science, 15(5), 337–341.

Martin, L. N., & Delgado, M. R. (2011). The

influence of emotion regulation on decision-

making under risk. Journal of Cognitive Neu-

roscience, 23(9), 2569–2581.

McClure, S. M., Berns, G. S., & Montague, P. R.

(2003). Temporal prediction errors in a passive

learning task activate human striatum. Neu-

ron, 38, 339–346.

Miller, E. K., & Cohen, J. D. (2001). An inte-

grative theory of prefrontal cortex function.

Annual Review of Neuroscience, 24, 167–

202.

Mitchell, D. G. V. (2011). The nexus between

decision- making and emotion regulation:

A review of convergent neurocognitive sub-

strates. Behavioral Brain Research, 217, 215–

231.

Montague, P. R., Hyman, S. E., & Cohen, J. D.

(2004). Computational roles for dopamine in

behavioural control. Nature, 431, 760–767.

Moretti, L., Dragone, D., & di Pellegrino, G.

(2009). Reward and social valuation deficits

following ventromedial prefrontal damage.

Journal of Cognitive Neuroscience, 21(1),

128–140.

Myerson, R. B. (1991). Game theory: Analysis of

conflict. Cambridge, MA: Harvard University

Press.

Ochsner, K. (2008). The social- emotional pro-

cessing stream: Five core constructs and their

translational potential for schizophrenia and

beyond. Biological Psychiatry, 64(1), 48– 61.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. (2002). Rethinking feelings: An

fMRI study of the cognitive regulation of emo-

tion. Journal of Cognitive Neuroscience, 14,

1215–1229.

Ochsner, K. N., & Gross, J. J. (2008). Cogni-

tive emotion regulation: Insights from social

cognitive and affective neuroscience. Current

Directions in Psychological Science, 17, 153–

158.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D., et al.

(2004). For better or for worse: Neural sys-

tems supporting the cognitive down- and up-

regulation of negative emotion. NeuroImage,

23(2), 483–499.

Pfister, H.-R., & Böhm, G. (2008). The multi-

plicity of emotions: A framework of emotional

functions in decision making. Judgment and

Decision Making, 3(1), 5–17.

Phillips, M. L., Drevets, W. C., Rauch, S. L., &

Lane, R. (2003). Neurobiology of emotion

perception: II. Implications for major psychi-

atric disorders. Biological Psychiatry, 54(5),

515–528.

Phillips, M. L., Young, A. W., Senior, C., Bram-

mer, M., Andrew, C., Calder, A. J., et al.

(1997). A specific neural substrate for perceiv-

ing facial expressions of disgust. Nature, 389,

495–498.

Pillutla, M. M., & Murnighan, J. K. (1996).

Unfairness, anger, and spite: Emotional rejec-

Emotion Regulation and Decision Making 153

tions of ultimatum offers. Organization

Behavior and Human Decision Process, 68,

208–224.

Robinson, T. E., & Berridge, K. C. (2003).

Addiction. Annual Review of Psychology, 54,

25–53.

Sanfey, A. G. (2007). Social decision- making:

Insights from game theory and neuroscience.

Science, 318(5850), 598–602.

Sanfey, A. G., & Chang, L. J. (2008). Multiple

systems in decision making. Annals of the

New York Academy of Sciences, 1128, 53–62.

Sanfey, A. G., & Dorris, M. (2009). Games in

humans and non-human primates: Scanners

to single units. In P. W. Glimcher, C. F. Cam-

erer, E. Fehr, & R. A. Poldrack (Eds.), Neu-

roeconomics (pp. 63–80). London: Academic

Press.

Sanfey, A. G., Rilling, J. K., Aronson, J. A., Nys-

trom, L. E., & Cohen, J. D. (2003). The neural

basis of economic decision- making in the ulti-

matum game. Science, 300, 1755–1758.

Schultz, W. (2009). Midbrain dopamine neurons:

A retina of the reward system? In P. W. Glim-

cher, C. F. Camerer, E. Fehr, & R. A. Poldrack

(Eds.), Neuroeconomics (p. 323). London:

Academic Press.

Slovic, P., Finucane, M. L., Peters, E., & Mac-

Gregor, D. G. (2004). Risk as analysis and risk

as feelings: Some thoughts about affect, rea-

son, risk, and rationality. Risk Analysis, 24(2),

311–322.

Smith, E. E., & Jonides, J. (1999). Storage and

executive processes in the frontal lobes. Sci-

ence, 283(5408), 1657–1661.

Sokol- Hessner, P., Camerer, C. F., & Phelps, E.

A. (2013). Emotion regulation reduces loss

aversion and decreases amygdala responses to

losses. Social Cognitive and Affective Neuro-

science, 8(3), 341–350.

Sokol- Hessner, P., Hsu, M., Curley, N. G., Del-

gado, M. R., Camerer, C. F., & Phelps, E.

A. (2009). Thinking like a trader selectively

reduces individuals’ loss aversion. Proceeding

of the National Academy of Sciences, 106(13),

5035–5040.

Staudinger, M. R., Erk, S., Abler, B., & Walter,

H. (2009). Cognitive reappraisal modulates

expected value and prediction error encod-

ing in the ventral striatum. NeuroImage, 47,

713–721.

Staudinger, M. R., Erk, S., & Walter, H. (2011).

Dorsolateral prefrontal cortex modulates

striatal reward encoding during reappraisal of

reward anticipation. Cerebral Cortex, 21(11),

2578–2588.

Stuss, D. T., & Knight, R. T. (2002). Principles

of frontal lobe function. New York: Oxford

University Press.

Sutton, R. (1988). Learning to predict by the

methods of temporal differences. Machine

Learning, 3, 9–44.

Tversky, A., & Kahneman, D. (1992). Advances

in prospect theory: Cumulative representation

of uncertainty. Journal of Risk and Uncer-

tainty, 5, 297–323.

Van’t Wout, M., Chang, L. J., & Sanfey, A. G.

(2010). The influence of emotion regulation on

social interactive decision- making. Emotion,

10(6), 815–821.

Van’t Wout, M., Kahn, R. S., Sanfey, A. G., &

Aleman, A. (2005). Repetitive transcranial

magnetic stimulation over the right dorsolat-

eral prefrontal cortex affects strategic decision-

making. NeuroReport, 16, 1849–1852.

Van’t Wout, M., Kahn, R. S., Sanfey, A. G.,

& Aleman, A. (2006). Affective state and

decision- making in the ultimatum game.

Experimental Brain Research, 169(4), 564–

568.

Volkow, N. D., & Wise, R. A. (2005). How can

drug addiction help us understand obesity?

Nature Neuroscience, 8, 555–560.

Winkielman, P., Berridge, K. C., & Wilbarger,

J. L. (2005). Unconscious affective reactions

to masked happy versus angry faces influ-

ence consumption behavior and judgments of

value. Personality and Social Psychology Bul-

letin, 31(1), 121–135.

Wrase, J., Schlagenhauf, F., Kienast, T., Wusten-

berg, T., Bermpohl, F., Kahnt, T., et al. (2007).

Dysfunction of reward processing correlates

with alcohol craving in detoxified alcoholics.

NeuroImage, 35, 787–794.

Xiao, E., & Houser, D. (2005). Emotion expres-

sion in human punishment behavior. Proceed-

ings of the National Academy of Sciences,

102, 7398–7401.

Zajonc, R. B. (2000). Feelings and thinking:

Closing the debate over the independence of

affect. In J. P. Forgas (Ed.), Feeling and think-

ing: The role of affect in social cognition

(pp. 31–58). New York: Cambridge University

Press.

PART IV

DEVELOPMENTAL

CONSIDERATIONS

157

In this chapter, we focus on the nature and

development of temperamentally based

effortful control (EC) processes and the

role of effortful self- regulation in children’s

socioemotional development. First we con-

sider definitional and conceptual issues.

Then we briefly summarize the normative

development of self- regulation (including

EC), followed by review of research illustrat-

ing the importance of individual differences

in children’s self- regulatory skills (including

effortful control) for their socioemotional

development. We conclude by discussing a

few current conceptual and methodological

issues and gaps in the research.

Conceptual Issues

Our discussion of EC must be considered

in the broader context of conceptions of

children’s self- regulation. In the work with

children, there has been a strong focus

on self- regulatory processes involved in

the modulation of emotion— an aspect of

regulation labeled as emotion regulation.

Definitions of this construct vary consider-

ably (Gross, this volume). Our definition

of emotion- related self- regulation includes

many of the elements of others’ definitions

but is broader in some respects and narrower

in others. For us, it refers to processes used

to manage and change whether, when, and

how (e.g., how intensely) one experiences

emotions and emotion- related motivational

and physiological states, as well as how

emotions are expressed behaviorally. Thus,

it includes processes used to change one’s

own emotional state, to prevent or initiate

emotional responding (e.g., by selecting or

changing situations), to modify the signifi-

cance of an event for the self, and to modu-

late the behavioral expression of emotion

(e.g., through verbal or nonverbal cues). Our

definition is consistent with Gross’s (this

volume) model, in which emotion regulation

includes situation selection, situation modi-

fication, attentional deployment, cognitive

change, and response modulation.

We have used the term emotion- related

self- regulation because many of the pro-

cesses frequently involved in emotional self-

regulation (see below) are also used for the

self- regulation in the absence of emotion.

Although we fully acknowledge that emo-

tional control/regulation often is externally

imposed, especially early in life, we believe

it is useful to differentiate between inter-

CHAPTER 10

Self‑Regulation, Effortful Control,

and Their Socioemotional Correlates

Nancy Eisenberg

Claire Hofer

Michael J. Sulik

Tracy L. Spinrad

158 DEVELOPMENTAL CONSIDERATIONS

nally generated self- regulatory processes

and those processes that the child does not

execute (e.g., parental soothing of an infant;

Eisenberg et al., 2004; Eisenberg, Spinrad,

& Eggum, 2010). Thus, we tend to use the

term self- regulation only for internally gen-

erated regulatory processes (although in the

past we used the term regulation), similar

to Gross’s (this volume) distinction between

intrinsic and extrinsic regulatory processes.

There are other variations in how the term

regulation or even self- regulation is used.

Some people use it to refer to a host of pro-

cesses that have a controlling effect on cog-

nition, attention, or behavior. As we discuss

later, we believe that it is useful to make a

distinction between more and less volitional

processes involved in regulation/control.

Although it is clear that many nonvolitional

processes have important modulating (even,

in a sense, regulating) effects on attention,

cognition, behavior, and physiological

responding, it would be useful to differenti-

ate the two types of processes semantically.

A term such as potentially volitional self-

regulatory processes would be more precise

than self- regulation in referring to volitional

processes; however, such terminology is

quite awkward. We ask readers to focus less

on the use of the word self- regulation than

on the distinctions we address.

Because it is extremely difficult to differen-

tiate emotion from its regulation, we believe

it is useful to focus on the processes used

to manage attention, emotion, and associ-

ated behavior rather than on the amount of

emotion experienced or expressed. In this

respect, we find EC to be a useful construct.

Effortful Control

EC, the regulatory component of tempera-

ment, is defined as “the efficiency of execu-

tive attention, including the ability to inhibit

a dominant response and/or to activate a

subdominant response, to plan, and to detect

errors” (Rothbart & Bates, 2006, p. 129). It

involves the ability to deploy attention will-

fully (often called attention focusing and

shifting, and including cognitive distraction)

and to inhibit or activate behavior willfully

(inhibitory control and activational control,

respectively). Some executive functioning

(EF) skills— especially effortful deployment

of attention, integration of information

to which one attends, and planning— are

involved in EC; thus, EF and EC are par-

tially overlapping constructs. In our view,

EC and, as a result, aspects of EF, include

an array of processes or capabilities that can

be used to manage emotion and behavior;

however, EC is not completely analogous to

emotional self- regulation because EC can

be used for other purposes (e.g., to focus

on schoolwork). Moreover, self- regulation

capacities likely include more than just EC;

for example, self- regulation may include the

motivation to utilize EC/EF in the service of

goals (Eisenberg & Zhou, in press). We view

the skills inherent in EC as building blocks

for the development of self- regulation, emo-

tional and otherwise, across the lifespan,

and thus, as the core of internally based,

volitional self- regulation. Therefore, despite

some distinctions between EC and self-

regulation, the constructs are overlapping

and we tend to use the terms interchange-

ably in this chapter.

The fact that EC is effortful or willful

does not mean that the individual is always

aware that he or she is modulating emotion

or behavior. Some aspects of EC, especially

after rehearsal and practice, may often be

automatic and executed without much con-

scious awareness in contexts with relevant

trigger cues (Mischel & Ayduk, 2011);

however, if needed, the individual is able to

shift into a more volitional mode of func-

tioning. Effortful regulatory processes are

distinguished from less voluntary reactive

processes (see below) by the ease with which

they can be volitionally controlled.

Any particular form of self- regulation (or

EC) is not necessarily good or bad in terms

of its consequences. Nonetheless, we believe

that effortful self- regulatory processes are

more likely than some less volitional aspects

of control (see below) to result in adaptive

outcomes in normative contexts, or at least

in desired goals, be they actually adaptive or

not. This is because effortful capacities can

be applied at will and adapted flexibly to

the demands of specific contexts. Of course,

individuals may also use EC in a manner

that is not adaptive. For example, EC can be

used to achieve socially inappropriate goals,

such as a youth planning and carrying out a

series of well- regulated actions to humiliate

a peer or to steal items to impress friends.

Moreover, an effortful mode of regulation

Self‑Regulation, Effortful Control, and Their Socioemotional Correlates 159

could be adaptive in the short run but not

in the long run, or vice versa. In part, the

adaptiveness of EC depends on the goals

that an individual is striving to achieve and

the social context.

Control and Regulation: Is Control

Always Regulation?

Like a number of other investigators (e.g.,

Block & Block, 1980), we have argued that

well- regulated people are neither overly con-

trolled nor undercontrolled; rather, they can

respond flexibly to varying demands with

a range of responses, depending on the cir-

cumstances. Optimally self- regulated chil-

dren can effortfully initiate or inhibit behav-

iors when appropriate or when required to

achieve goals, but they can also be sponta-

neous (uncontrolled) when control is not

needed. Thus, their regulation is flexible and

generally (although not always) adaptive.

Because of the importance of both will-

fulness and flexibility in EC, it is useful to

try to differentiate EC from less voluntary

over- or undercontrolled processes. Some

control is nearly always automatic and

nonvolitional, and often it is emotionally

based; such control is likely less flexible and

often is less adaptive than volitional self-

regulation. An example is children who have

been labeled “behaviorally inhibited.” They

tend to be wary and overly constrained in

novel or stressful situations and have dif-

ficulty modulating (e.g., relaxing) their

inhibition (Kagan & Fox, 2006). Although

they may appear to be self- regulated, their

inhibition or constraint is relatively involun-

tary or so automatic that it is difficult for

them to modulate effortfully (Eisenberg &

Morris, 2002). In addition, the impulse to

approach people or inanimate objects in the

environment (sometimes called surgency;

Rothbart & Bates, 2006) often may be rela-

tively involuntary. For example, individuals

may be “pulled” toward rewarding or posi-

tive situations or stimuli, and this pull may

be nonvolitional; such people generally are

viewed as “impulsive.” We have labeled such

overly inhibited and impulsive behavior as

two aspects of reactive control—reactive

overcontrol and undercontrol— based on the

distinction by Rothbart and Bates (2006)

between effortful and reactive tempera-

mental processes. The constructs of reactive

undercontrol and overcontrol are somewhat

similar to what the Block and Block (1980)

labeled as the extremes of ego control (i.e.,

ego undercontrol and overcontrol), which is

defined as the “threshold or operating char-

acteristic of an individual with regard to

the expression or containment of impulses,

feelings, and desires” (p. 43). In the Blocks’

model, ego resiliency provides control and

modulation of impulses (i.e., ego control).

We consider EC, but not reactive control,

to be part of volitional self- regulation. As

noted previously, we certainly acknowledge

that reactive control processes influence and

even have controlling or “regulatory” effects

on individuals’ functioning, but we prefer

not to equate these effects with volitional

self- regulation (see Compas, Connor-Smith,

Saltzman, Thomsen, & Wadsworth, 2001,

for a similar distinction when defining cop-

ing; also see Carver, 2005, for a review

of similar perspectives, including dual-

processing models).

Rothbart and colleagues (e.g., Derryberry

& Rothbart, 1997) linked what we have

labeled reactive overcontrol and undercon-

trol processes to reactive emotional pro-

cesses—fear versus desire, hope, and relief,

respectively—and their associated moti-

vational systems, defensive and appetitive,

respectively. Although we agree that these

associations between behavioral inhibi-

tion or impulsivity and emotion/motivation

exist, we wish to differentiate between emo-

tional reactivity and the aspects of behavior

relevant to control that typically are associ-

ated with emotion. It is quite possible that

children who display behavioral inhibition

(reactive overcontrol) do not experience fear

or anxiety every time they display overly

inhibited behavior. Such behavior, although

probably originally based on fear or a reac-

tion to novelty (Kagan & Fox, 2006), seems

to become a habitual style of response to

novel or potentially stressful contexts. More-

over, highly inhibited children often look

controlled (restrained) in their behavior but

tend to be prone to fear and anxiety; thus,

control of overt behavior is not the same

as control in regard to emotional reactivity

(although both are elements of temperamen-

tal reactivity). Similarly, impulsive behavior

that may be linked with both desire/posi-

tive affect (e.g., Rothbart, Ahadi, Hershey,

& Fisher, 2001) and anger in some contexts

160 DEVELOPMENTAL CONSIDERATIONS

might, in other contexts, not be linked to any

clear emotion. Thus, emotional reactivity of

a particular sort is not strictly paired with

impulsivity, and it is worthwhile to differ-

entiate between impulsivity and emotional

reactivity, and among associated motiva-

tions in specific interactions. In support of

this argument, in factor analyses, disposi-

tional negative emotionality tends to load

on one factor, whereas reactive processes

that involve avoidance or approach behavior

(e.g., shyness, impulsivity) tend to load on

a separate surgency factor (Rothbart et al.,

2001).

A disadvantage to invoking the distinction

between effortful self- regulation and reac-

tive control is that it is difficult to catego-

rize some aspects of regulation/control. For

example, it is difficult to know whether the

child who is constrained in a new context is

self- regulated (i.e., voluntarily constrained)

or overly controlled (behaviorally inhibited).

In our view, a major challenge for the field is

differentiating between these two contribu-

tors to constrained behavior.

Although impulsivity and EC are fairly

consistently negatively related (Aksan &

Kochanska, 2004; Valiente et al., 2003), the

two constructs have been found to load on

different latent constructs (Eisenberg et al.,

2004, 2013; Valiente et al., 2003). The rela-

tion between EC and reactive overcontrol

is less consistent (e.g., Aksan & Kochan-

ska, 2004; Spinrad et al., 2007), and there

is a need for research testing the relation

between reactive over- and undercontrol.

A comparison with Ursache, Blair, and

Raver’s (2012) definition helps to highlight

some of the subtle differences in definitions

(some other definitions differ from ours

in numerous, more obvious ways, includ-

ing some of those mentioned earlier). They

defined self- regulation as

the primarily volitional management of

arousal or activity in attention, emotion, or

stress response systems in ways that facilitate

the use of EF abilities in the service of goal-

directed actions. . . . EF is the top-down or voli-

tional component of self- regulation. . . .This

volitional component, however, is reciprocally

related to and dependent on bottom- up, less

volitional, and more automatic regulation of

responses to the environment through atten-

tion, emotion, and stress response systems.

(p. 123)

We would argue that some responses that

are relatively automatic usually can be voli-

tional if necessary, so the critical distinction

is whether a capacity can easily become voli-

tional if needed for adaptation, not whether

it can be automatic. In addition, Ursache et

al. seem to include what we have labeled as

reactive control in the construct of regulation

(“the bottom- up, less volitional” aspects).

Although we prefer to confine the term self-

regulation to the aspects that can be voli-

tional when needed, as a semantic way to

differentiate between volitional and reactive

control processes, we agree that both pro-

cesses occur. We also agree that the relation

between more effortful and less volitional

processes is bidirectional; moreover, reactive

over- and undercontrol systems likely affect

one another and are affected by emotions

(Derryberry & Rothbart, 1997). Not com-

pletely in accord with Ursache et al. (2012),

we (Eisenberg & Zhou, in press) suggested

that aspects of EF related to inhibition (e.g.,

in regard to thoughts or behavior and the

ability to shift attention) overlap with the

construct of self- regulation (as well as the

construct of EC), whereas other parts of

EF, such as working memory, facilitate self-

regulation but are separate capacities from

both self- regulation and EC.

In summary, numerous conceptual issues

are unresolved regarding the definition of

self- regulation and the relations among vari-

ous processes that have controlling/regulat-

ing effects. We believe that more rather than

less conceptual differentiation is useful, even

if in reality the various processes are inter-

connected in complex and intricate ways.

The Normative Development

of Self-Regulation/EC

Because EC is viewed as providing the build-

ing blocks for self- regulation, its develop-

ment is of importance to many aspects of

children’s functioning. Children begin to

regulate their own emotions and emotion-

related behavior in the first few years of

life, and there are improvements in regula-

tion skills across childhood and adolescence

(see Eisenberg, Spinrad, et al., 2010). Even

young children have been found to modulate

their distress using a variety of methods. For

example, by 6 months of age, infants some-

Self‑Regulation, Effortful Control, and Their Socioemotional Correlates 161

times reduce their own distress in response

to novelty by looking away from the novel

object and by using self- soothing strate-

gies (Crockenberg & Leerkes, 2004). Such

behaviors appear to be effective in reduc-

ing arousal in the first year of life because

they are associated with lower negativity in

frustrating situations (Stifter & Braungart,

1995). Stifter and Braungart found that

self- soothing was the most preferred regu-

latory strategy at both 5 and 20 months of

age. In contrast, Mangelsdorf, Shapiro, and

Marzolf (1995) found that (1) 6-month-old

infants tended to use gaze aversion as their

primary regulatory strategy, (2) 12-month-

olds engaged in more self- soothing (e.g.,

thumb sucking and hair twirling) than did

18-month-olds, and (3) 12- and 18-month-

old toddlers used more behavioral avoid-

ance and self- distracting strategies than did

6-month-olds.

There appears to be a decline in the use

of self- soothing between 24 and 48 months,

coupled with the emergence of new and more

complex use of objects and interactions to

regulate emotional state (see Diener & Man-

gelsdorf, 1999, for a review). By 24 months

of age, self- distraction may be the most

common and successful regulatory strategy

in fearful and frustrative situations (Grol-

nick, Bridges, & Connell, 1996). Advances

in cognitive, sociocognitive, motor, and

language development that occur between

2 and 5 years of age contribute to the emer-

gence of more sophisticated, diverse, and

successful models of self- regulation and EF

skills (Garon, Bryson, & Smith, 2008), such

that many children are relatively skilled at

managing impulses by age 4 or 5 (Mischel

& Ayduk, 2011; Posner & Rothbart, 2000;

Rothbart, 2011).

Researchers who have focused on the

development of EC processes such as atten-

tion shifting and attention focusing or the

ability to inhibit behavior voluntarily (rather

than as specific reactions to distress or

frustration) have also noted developmental

changes in their use. Eight- to 10-month-

olds demonstrate some capacity to focus

their attention (Kochanska, Coy, Tjebkes,

& Husarek, 1998), and voluntary control

of attention increases somewhat between

9 and 18 months of age (Ruff & Rothbart,

1996). Around 12 months of age, infants

develop the ability to inhibit predominant

responses. For example, Diamond (1991)

found that infants were able to inhibit pre-

dominant response tendencies when reach-

ing for objects (e.g., move around an object),

an ability believed to involve the execution

of intentional behavior, planning, and the

resistance of more automatic or reactive

action tendencies.

According to Posner and Rothbart (2000),

a transition in the development of execu-

tive attention and the effortful inhibition of

behavior can be seen around 30 months of

age. Much of the relevant work involved the

use of a Stroop-like task that required tod-

dlers to switch attention and inhibit behav-

ior. Children show significant improvement

in performance on such a task between 24

and 30 months of age and often perform

with high accuracy by 36 to 38 months

of age, and this ability has been positively

related to adults’ ratings of EC (Rothbart

& Bates, 2006). In addition, with the matu-

ration of attentional mechanisms, the abil-

ity to inhibit motor behavior effortfully

greatly improves between 22 and 44 months

(Kochanska, Murray, & Harlan, 2000;

Rothbart & Bates, 2006) and is fairly good

by age 4 (Posner & Rothbart, 2000). Wil-

loughby, Wirth, Blair, and Family Life Proj-

ect Investigators (2012) found substantial

improvements in a latent factor of EF abili-

ties in children between ages 3 and 5 years,

with the average child improving more than

one standard deviation in EF skills over any

12-month period. Moreover, there appears

to be a further increase in the use of inter-

nal mental or cognitive regulatory strategies

in the school years. Nonetheless, the capac-

ity for EC continues to improve in adoles-

cence and may even continue to develop at a

slower pace into adulthood (Murphy, Eisen-

berg, Fabes, Shepard, & Guthrie, 1999; Wil-

liams, Ponesse, Schachar, Logan, & Tan-

nock, 1999; also see Eisenberg, Spinrad, et

al., 2010).

The Relation of EC

to Socioemotional Development

Children who differ in their self- regulatory

capacities are expected to differ in aspects

of socioemotional functioning involving

self- regulation. Based on the distinction

between reactive control and EC, Eisen-

162 DEVELOPMENTAL CONSIDERATIONS

berg and Morris (2002) constructed a heu-

ristic model including descriptions of three

styles of control— overcontrolled, undercon-

trolled, and optimally controlled— to gen-

erate predictions regarding the relations of

various aspects of EC and reactive control

to children’s socioemotional adjustment and

development. In this heuristic model, the

authors described different constellations of

self- regulation/reactive control expected to

cluster together for some children and the

expected socioemotional correlates of each

constellation.

In the model, overcontrolled individuals

are those high in involuntary reactive con-

trol (e.g., high in behavioral inhibition) and

low in reactive undercontrol (impulsivity),

average in the ability to inhibit behavior

effortfully as needed (inhibitory control),

low in effortful attentional regulation (e.g.,

the abilities to shift and focus attention

effortfully), and low in the ability to activate

behavior effortfully as needed (i.e., effort-

ful activational control). Volitional shifting

or focusing attention is expected to be use-

ful in reducing the negative emotions, such

as fear, associated with highly inhibited

behavior. Individuals with this constellation

are expected to be prone to internalizing

problems (e.g., depression, anxiety, social

withdrawal) and relatively low in social

competence, especially if they are also pre-

disposed to experience negative emotions.

These children might also lack the ability

to be relaxed, socially interactive, and spon-

taneous in all but very familiar settings,

which also is likely to undermine their social

attractiveness and peer status.

In contrast, undercontrolled individuals

are those high in reactive approach tenden-

cies (i.e., impulsive); low in reactive overcon-

trol; and low in all types of EC, including

attentional, inhibitory, and activation con-

trol. People with this style of control are

predicted to be relatively low in social com-

petence and prone to externalizing behav-

ior problems such as aggression, defiance,

and antisocial behaviors (e.g., delinquency).

These children would also be expected to

be low in empathy, prosocial behavior, and

moral development, because of deficits in

social cognition and regulated behavior.

Finally, optimally regulated individuals—

those who are most flexible and appropriate

in their regulation— are those fairly high in

all modes of EC and, in regard to reactive

control, are neither overcontrolled (inhib-

ited) nor undercontrolled (impulsive). These

individuals are expected to be well adjusted,

socially competent (including moral and

prosocial), and resilient when faced with

stress because they typically regulate their

behavior in a goal- directed manner but can

also be spontaneous and unconstrained.

Consistent with the heuristic model, EC

and self- regulation more generally have been

related in predictable ways to a variety of

children’s developmental outcomes. Next

we provide a selective summary of studies

on the relation of EC and/or other measures

of self- regulation to some positive and nega-

tive outcomes expected to be affected by

EC and/or reactive control, including social

competence, social cognition, (mal)adjust-

ment, school- related outcomes, internaliza-

tion of parental rules/demands and guilt,

empathy/sympathy, and prosocial behavior.

Social Competence

In a number of studies with preschoolers,

children, and adolescents, EC has been asso-

ciated with relatively high levels of social

competence (see Eisenberg, Smith, & Spin-

rad, 2011, for a review). Children’s abilities

to modulate their attentional resources likely

lead to optimal levels of emotional arousal in

stressful contexts and, thus, accurate infor-

mation processing linked to understanding

the causes of emotion, effective planning,

and action suited to the situation. Moreover,

the abilities to inhibit and activate behavior

effortfully allow children to implement or

inhibit behaviors as is adaptive in a given

context, hence facilitating socially appropri-

ate responses. Consistent with these argu-

ments, EC (assessed with EF and/or delay

of gratification tasks) in the preschool years

has been found to predict parent- reported

social competence 6 months later (Lengua,

Honorado, & Bush, 2007), as well as socio-

emotional competencies in adolescence and

adulthood (Mischel & Ayduk, 2011). Eisen-

berg and colleagues (2011) have found sup-

port for the positive relation between EC

and social competence in multiple longi-

tudinal samples, and this relation has also

been observed in other cultures (e.g., Hofer,

Eisenberg, & Reiser, 2010; Zhou, Eisenberg,

Wang, & Reiser, 2004).

Self‑Regulation, Effortful Control, and Their Socioemotional Correlates 163

EC (or aspects thereof) frequently has

been examined as a mediator of the rela-

tion of parenting to social competence.

For example, Mintz, Hamre, and Hat-

field (2011) found that mothers’ reports of

54-month-olds’ inhibitory control, but not

attentional focusing, partially mediated the

relation between early maternal sensitiv-

ity (prompt and appropriate responses to

the child, nonintrusive, positive regard for

child) and observed and teacher- rated social

and relational competence, as well as social

and relational competence in first grade.

Similarly, EC has been found to mediate

the relation between maternal support and

children’s social competence concurrently

(at 18 and 30 months), albeit not over time

(Spinrad et al., 2007). In addition, other

competencies appear to mediate the rela-

tion of self- regulation to social competence.

For example, the positive relation between

EC and peer popularity appears to be medi-

ated by ego- resiliency (personality resil-

iency; the ability to cope with and rebound

from stress), both in longitudinal work with

American 6- to 8-year-olds (Spinrad et al.,

2006) and concurrently with French ado-

lescents (Hofer et al., 2010). Children with

high EC are expected to be able to bounce

back easily in new or stressful situations,

and this resiliency is expected to improve

their social competence.

Social Cognition

Children who can avoid emotional over-

arousal and focus their attention are more

likely than less regulated children to focus

on relevant information about emotions

and the environment in social interactions

and, hence, develop a better understand-

ing of emotions. In support of these ideas,

preschoolers’ self- regulation has predicted

their understanding of emotion 2 years later

(Schultz, Izard, Ackerman, & Youngstrom,

2001), and emotion understanding mediates

the relation of self- regulation to adaptive

social behavior (Izard, Schultz, Fine, Young-

strom, & Ackerman, 1999). It is also likely

that emotion understanding fosters, as well

as stems from, emotion- related regulation.

Denham and Burton (2003) suggested that

emotion understanding gives children labels

for their internal feelings, which can then be

made conscious. Such conscious emotional

awareness allows children to immediately

attach feelings to events, which can then

facilitate successful and appropriate regula-

tion. Researchers have found that children

who are able to understand and communi-

cate about emotions, and who know how to

manage emotions, are better able to regulate

themselves (Denham & Burton, 2003).

With the development of EF, children also

improve on theory of mind (ToM) tasks,

which involve an understanding of others’

internal mental representations. Researchers

have identified inhibitory control as espe-

cially relevant to the development of ToM

because it enables children to suppress irrele-

vant perspectives (Carlson, Moses, & Clax-

ton, 2004). In a number of studies using a

variety of observed and reported measures,

inhibitory control has been positively related

to ToM skills in preschool and kindergar-

ten children (Blair & Razza, 2007; Carlson

et al., 2004). Moreover, inhibitory control

appears to precede the development of ToM

in the preschool years (e.g., Flynn, 2007). In

brief, self- regulated children appear to have

an advantage in regard to emotional under-

standing and ToM skills.

Maladjustment

Children with adjustment problems tend to

have difficulties managing and controlling

their attention, behavior, and emotions in a

willful and flexible manner. These difficul-

ties can result in processing information and

modulating emotions and behaviors in ways

that hinder adaptive functioning (Eisenberg,

Spinrad, et al., 2010). In addition, because

children with high EC are probably better

able to avoid negative interactions and mod-

ulate negative emotions such as sadness and

anger, it is not surprising that low EC has

been related to maladjustment (for reviews,

see Eisenberg et al., 2011; Eisenberg, Spin-

rad, et al., 2010).

Consistent with our heuristic model,

many investigators have found negative rela-

tions between EC and externalizing prob-

lems in preschoolers, elementary schoolchil-

dren, and adolescents (Eisenberg, Spinrad,

et al., 2010). For example, Kochanska and

Knaack (2003) reported negative associa-

tions between EC (assessed with a battery

of behavioral measures) and externalizing

problems, concurrently and across time,

164 DEVELOPMENTAL CONSIDERATIONS

in young children (Kochanska & Knaack,

2003). In multiple longitudinal samples,

Eisenberg and colleagues have found nega-

tive relations of teacher- reported, parent-

reported, and observed measures of EC

with children’s externalizing behaviors

(Eisenberg et al., 2011; Eisenberg, Spinrad,

et al., 2010). For example, Eisenberg et al.

(2009) found that change in at-risk elemen-

tary schoolchildren’s externalizing over the

4 years— whether pure externalizing prob-

lems or co- occurring with internalizing

problems— was related to change in EC over

the same period. Such associations appear to

continue throughout adolescence, including

in European samples (Hofer et al., 2010). For

example, Bakker, Ormel, Verhulst, and Old-

ehinkel (2011) found that parent- reported

EC at age 13½ appeared to buffer Dutch

adolescents against externalizing problems

at age 16 in families with high adversity.

EC also appears to act as a mediator or

moderator when predicting maladjustment

(e.g., Hofer et al., 2010; Spinrad et al., 2007).

For example, Hardaway, Wilson, Shaw, and

Dishion (2012) found that inhibitory control

at age 4 mediated the positive and negative

relations, respectively, between chaos in

the home and positive parental behavior at

age 3 to externalizing behaviors at age 5½.

Moreover, EC appears to reduce the positive

relation of inconsistent discipline and physi-

cal punishment to 8- to 12-year-olds’ exter-

nalizing problems (Lengua, 2008) and the

relation of adolescents’ proneness to frustra-

tion to externalizing problems (Oldehinkel,

Hartman, Ferdinand, Verhulst, & Ormel,

2007).

Theoretically, as delineated in the afore-

mentioned model, reactive control and low

EC are related to internalizing problems:

Children with internalizing problems are

often overcontrolled and struggle with the

flexible control of their emotions, cognition,

attention, and behaviors. Although the lit-

erature is not highly consistent (Eisenberg,

Spinrad, et al., 2010), a number of studies

support a negative relation between EC and

internalizing problems. For example, moth-

ers’ reports of preschoolers’ attention focus-

ing and inhibitory control have been mod-

estly, negatively related with internalizing

problems at 5½ years old, even when items

that overlapped between the constructs of

self- regulation and internalizing problems

were removed from the scales (Lemery,

Essex, & Smider, 2002). Similarly, negative

relations between EC and depressive symp-

toms have been reported for 11- to 18-year-

olds (Verstraeten, Vasey, Raes, & Bijttebier,

2008). Moreover, EC seems to moderate the

relation between affectivity and internaliz-

ing problems. In one study, adolescents’ low

positive and high negative affectivity pre-

dicted more depressive symptoms for youth

with low EC (Verstraeten et al., 2008); in

another study, EC buffered the relation of

fearfulness to adolescents’ internalizing

problems (Oldehinkel et al., 2007).

School‑Related Outcomes

The role of EC in school- related outcomes

has aroused increasing interest (Eisenberg,

Valiente, & Eggum, 2010; Ursache et al.,

2012), and both direct and indirect rela-

tions between EC and school- related out-

comes have been predicted. Consistent with

our heuristic model, because children high

in EC are expected to manage their atten-

tion, behavior, and emotion flexibly, they

are predicted to have an advantage when

learning. Moreover, the effects of EC on

academic outcomes are hypothesized to be

mediated by children’s adjustment, quality

relationships with peers and teachers, and

school engagement (Eisenberg, Valiente, et

al., 2010).

In fact, EC predicts a variety of school-

related outcomes, both academic and social,

concurrently and longitudinally (Allan &

Lonigan, 2011; Eisenberg, Valiente, et al.,

2010; Ursache et al., 2012). In recent work,

mediators of these relations have been exam-

ined. For example, in a 1-year longitudinal

study with 3- to five-year-olds, Silva et al.

(2011) found that a high- quality teacher–

child relationship midyear (i.e., low conflict

and high closeness) mediated the positive

relation between high EC measured early in

the year and positive school attitudes mea-

sured at the end of the year with reports

of school liking and avoidance. In another

study with multiple reporters, high social

competence and low externalizing prob-

lems at ages 6–10 fully mediated the positive

relation between high EC at ages 4–8 and

high academic achievement at ages 10–14

(Valiente et al., 2011). In brief, optimally

regulated children tend to have better school

Self‑Regulation, Effortful Control, and Their Socioemotional Correlates 165

outcomes, and these relations appear to be

both direct and indirect.

Internalization of Parental Rules/

Demands and Guilt

EC and related measures of emotion- related

regulation or control have also been linked

to a variety of measures of moral develop-

ment, including compliance, internalization

of rules, and conscience. Committed com-

pliance—when children appear to comply

willingly and even enthusiastically with

adults’ expectations/requests—is thought to

reflect children’s rudimentary internaliza-

tion of their mothers’ commands. In addi-

tion, when toddlers comply with their moth-

ers’ rules when left alone, they are believed

to have internalized the rules (Kochanska,

Coy, & Murray, 2001).

Toddlers who exhibit more committed

compliance tend to have higher EC than

their less compliant peers (e.g., Kochanska

et al., 2001). In addition, EC at 30 and 42

months predicts higher committed compli-

ance 1 year later, even after researchers con-

trol for earlier levels of committed compli-

ance (although these findings did not hold

in models accounting for time- invariant

covariates; Spinrad et al., 2012). Infants’

attention regulation (components of EC)

predicts later committed compliance (Hill &

Braungart- Rieker, 2002; Kochanska et al.,

1998). In addition, Kochanksa and Knaack

(2003) have found a positive relation, often

across time, between EC and the develop-

ment of conscience (i.e., moral self, refrains

from cheating on a task, and moral reason-

ing) during the toddler, preschool, and early

school years (Kochanska & Knaack, 2003).

There are few data on the relation between

conscience and EC in schoolchildren. How-

ever, parent reports of children’s EC have

been related to reports of their 7-year-olds’

guilt (Rothbart, Ahadi, & Hershey, 1994).

More research is needed to clarify the rela-

tion of EC to conscience and other aspects

of moral development in older elementary

school- age children and adolescents.

Empathy/Sympathy

and Prosocial Behavior

Eisenberg and Fabes (1992) hypothesized

that individuals high in effortful emotion-

related self- regulation tend to experience

sympathy (an other- oriented response to

another’s emotion or condition) rather than

personal distress (i.e., a self- focused, aver-

sive response to another’s emotional state or

condition). Personal distress is believed to be

associated with empathic overarousal (pos-

sibly due to underregulation), which in turn

can lead to a self-focus and self- concerned

behavioral response (rather than concern for

others; see Eisenberg, Wentzel, & Harris,

1998). Consistent with this premise, Guthrie

et al. (1997) found that children rated high

on EC exhibited greater facial sadness (but

not distress)—presumed to reflect sympa-

thy/empathy— during an empathy- inducing

film than did less regulated peers. Children’s

postfilm reports of sadness and sympathy

during the film were also positively related

to parents’ ratings of EC. Conversely, chil-

dren low in parent- rated EC were prone to

experience personal distress (e.g., anxiety

and tension) during the film.

Children’s EC (or aspects thereof) also has

been positively related to self- or other- report

measures of dispositional empathy/sympathy

in children (Eisenberg et al., 1998; Panfile

& Laible, 2012; Rothbart et al., 1994; also

see Eisenberg, Fabes, & Spinrad, 2006). In

an 8-year longitudinal study, relatively high

levels of EC and growth in EC were related

to high sympathy, although this pattern was

somewhat stronger for boys than for girls

(Eisenberg et al., 2007). Similar concurrent

relations have been found in studies in which

adults reported on their own sympathy and

regulation, although sometimes the associa-

tion was not significant until the effects of

individual differences in negative emotion-

ality were controlled (see Eisenberg et al.,

1998). In addition, EC has been negatively

related to children’s and adults’ reports of

personal distress (Bandstra, Chambers,

McGrath, & Moore, 2011; see Eisenberg et

al., 1998, 2006).

Consistent with the empirical relation

between EC and sympathy, adults’ ratings of

elementary school children’s effortful atten-

tional control and/or a behavioral measure

of persistence have been correlated with

peers’ ratings (e.g., Eisenberg et al., 1997)

or teachers’ ratings (Diener & Kim, 2004)

of prosocial behavior. Thus, people who

are skilled at regulating their emotion and

behavior are not only more likely to feel con-

166 DEVELOPMENTAL CONSIDERATIONS

cern for others but also they are relatively

likely to help them.

Conclusions and Future Directions

The study of emotion regulation and related

processes has progressed tremendously in

the last decade. Yet definitional and meth-

odological issues need to be addressed, and

there are gaps in the literature, as well as

new directions to exploit.

Terminology

Currently, there is considerable variation in

what behavioral scientists mean when they

use words such as regulation, self- regulation,

and emotion regulation. The term regulation

is used so broadly by different investigators

that it is often hard to understand what is

meant. Even though there may be somewhat

of a continuum, we suggest that researchers

clearly distinguish volitional self- regulatory

processes (e.g., EC) from other, less voli-

tional processes that also “regulate” behav-

ior (e.g., reactive control). It is also impor-

tant for researchers to distinguish between

self- regulation and external regulation.

Distinguishing between EC and EF

Despite the fact that EF and EC typically

have been examined in two separate litera-

tures, researchers have begun to recognize

that there is considerable overlap between

these constructs (Eisenberg & Zhou, in

press). The integration of these two bodies

of knowledge has great potential to be mutu-

ally informative. For example, considerable

attention has been given to the factor struc-

ture of EF (Garon et al., 2008), whereas sim-

ilar work on EC is only now beginning (e.g.,

Allan & Lonigan, 2011; Sulik et al., 2010).

The conceptualization of EF as compris-

ing interrelated but independent abilities—

working memory, response inhibition, and

set shifting— has led to the understanding

that task performance may be differentially

related to these abilities and consequently to

a more fine- grained analysis of what indi-

vidual tasks are measuring (Best & Miller,

2010). For example, working memory, which

is considered an important aspect of EF but

not EC, has been examined as a contribu-

tor to performance on EF tasks. In contrast,

working memory has generally not been

considered a contributor to performance on

measures of EC, even though it likely plays an

important role for very young children and

in tasks with more complex working mem-

ory demands. Finally, researchers studying

EF have made the distinction between hot

(i.e., emotional, for example, in delay tasks)

and cold (i.e., cognitive, for example, in typi-

cal EF measures such as flanker or Stroop

tasks) aspects of EF, which may have impor-

tant implications for emotion- related self-

regulation (e.g., Willoughby, Kupersmidt,

Voegler- Lee, & Bryant, 2011). However, we

would argue that it is not EF that is hot or

cold, but that EF may function somewhat

differently in hot and cold contexts (Eisen-

berg & Zhou, in press; see also Kim, Nor-

dling, Yoon, Boldt, & Kochanska, 2013).

Researchers studying EF can also benefit

from theoretical distinctions made in the

EC literature. For example, temperament

researchers have begun to study the devel-

opment and correlates of activational con-

trol, which is the ability to activate behavior

willfully. This is an aspect of EC that has

no corresponding construct in the field of EF

but merits further study due to the impor-

tance of up- regulating emotional reactions

in certain situations— for example, show-

ing gratitude when receiving a disappointing

gift—as well as its likely role in persistence

on unpleasant tasks and the achievement of

long-term goals.

Design of Research Studies

There is growing recognition of the bidi-

rectional nature of the relations between

temperament and environmental influences.

Researchers have come to understand that

although temperament has a biological

basis, it is also susceptible to environmental

influences. This may be especially true for

EC, which develops more slowly than more

emotionally reactive aspects of tempera-

ment. Conversely, there is also evidence that

children’s characteristics may affect parent-

ing behavior (e.g., Eisenberg, Vidmar, et al.,

2010). Longitudinal designs in which tem-

poral hypotheses can be tested are becoming

more common and can help to clarify the

degree to which the early environment influ-

ences children’s temperament and vice versa.

Self‑Regulation, Effortful Control, and Their Socioemotional Correlates 167

Although such research designs have clear

strengths, even well- designed correlational

studies cannot definitively test causal rela-

tions. There is still a need for experimental

studies, such as intervention and prevention

trials that promote self- regulatory skills in

children, to determine how these skills are

causally related to self- regulation processes

and other child outcomes. School-based

prevention trials have demonstrated effects

on self- regulation in low- income preschool-

ers (Diamond, Barnett, Thomas, & Munro,

2007), but more research is needed to deter-

mine whether gains are maintained over long

periods of time, the extent to which increases

in EC are causally related to a number of dif-

ferent child outcomes, whether such effects

can be achieved in other age groups, and

whether the intervention effects generalize

to other populations (e.g., middle- income

children or children in other cultures). Simi-

larly, experimental studies that modify par-

enting behavior are needed to understand

the causal effects of parenting on the devel-

opment of EC.

Genetically informed research designs

could also contribute to an understanding

of the influences on, and effects of, chil-

dren’s self- regulation. Not only can twin,

adoption, or sibling studies be used to assess

the role of genetics and environment in self-

regulation (see Rothbart & Bates, 2006), but

they also can be used to assess environmen-

tal influences, especially when genetic influ-

ences are held constant. For example, one

could examine factors related to differences

between identical twins (who are genetically

the same) in EC. A relatively new and prom-

ising area of research is the use of measured

genes in studies of EC (Kochanska, Kim,

Barry, & Philibert, 2011; Voelker, Sheese,

Rothbart, & Posner, 2009). More work is

needed in this area to determine whether

such effects are replicable, but such work

may help investigators target interventions

and understand the biological mechanisms

underlying the development of emotion and

self- regulation.

The Measurement of Emotion‑Related

Self‑Regulation

It is now common for studies of self-

regulation to include a number of behavioral

measures, allowing researchers to study

the relations among tasks and to measure

more accurately the underlying construct.

However, a limitation of the majority of

these measures is that performance quickly

reaches a ceiling in early school- age chil-

dren. One challenge for EC researchers is to

establish measures that can be used across

a relatively wide age range to establish con-

tinuity in measurement. In particular, mea-

sures appropriate for adolescents and adults

are needed, and it would be advantageous if

these measures also could be used with chil-

dren. There is now evidence that it is pos-

sible to develop tasks appropriate for a wide

age range, including adolescents and adults,

making it possible to measure more accu-

rately the development of EC beyond early

childhood (Lagattuta, Sayfan, & Monsour,

2011; Tottenham, Hare, & Casey, 2011).

Although there has been recent progress

in this area, further work is still needed

because a single laboratory measure of EC

is relatively unreliable, and a battery of

tasks is recommended in order to assess the

construct more accurately (Kochanska &

Knaack, 2003).

Psychophysiological methods have been

underutilized in the existing research, even

though it is possible to assess many psycho-

physiological variables inexpensively and

noninvasively. Of particular interest for

the assessment of EC is respiratory sinus

arrhythmia (RSA), a cardiac measure of

parasympathetic nervous system function.

There is now a consistent body of evidence

linking resting RSA to EC (e.g., Marcovitch

et al., 2010). RSA reactivity— a change in

RSA in response to task demands— has also

been found in some studies to correlate with

EC and EF, but the exact nature of this rela-

tion is still not clear. Although RSA reactiv-

ity may also be a promising as a means of

assessing emotion- related regulation, fur-

ther research is needed to determine how

task demands relate to the interpretation of

this measure (Obradović, Bush, & Boyce,

2011).

Process Models of Emotion‑Related

Self‑Regulation

Finally, there is a need to understand how EC

supports emotion- related self- regulation. EC

likely plays a supporting role in a wide vari-

ety of emotion regulation strategies, includ-

168 DEVELOPMENTAL CONSIDERATIONS

ing reappraisal, attentional strategies such as

distraction or avoidance, choosing or modi-

fying situations, and inhibiting emotionally

motivated behavior. Although there is ample

evidence that EC is related to successful

emotion regulation, we know relatively little

about the extent to which the effectiveness

of specific emotion regulation strategies is

dependent on individual differences in EC,

or whether specific aspects of EC such as

activational control, inhibitory control, and

attention focusing are differentially related

to emotion- related self- regulation.

Conclusion

In summary, although the study of children’s

self- regulation is flourishing, there is much

yet to be explored and understood. A multi-

method approach, influenced by conceptual

work in developmental, clinical, personality,

social, and neurophysiological psychology,

including greater integration of research and

theory in the adult and child literatures, is

likely to be productive in future attempts to

expand our knowledge.

Acknowledgments

Work on this chapter was supported by grants

from the National Institute of Child Health and

Human Development to Nancy Eisenberg, Tracy

L. Spinrad, and Carlos Valiente.

References

Aksan, N., & Kochanska, G. (2004). Links

between systems of inhibition from infancy

to preschool years. Child Development, 75,

1477–1490.

Allan, N. P., & Lonigan, C. J. (2011). Examin-

ing the dimensionality of effortful control in

preschool children and its relation to academic

and socioemotional indicators. Developmen-

tal Psychology, 47, 905–915.

Bakker, M. P., Ormel, J., Verhulst, F. C., &

Oldehinkel, A. J. (2011). Adolescent family

adversity and mental health problems: The

role of adaptive self- regulation capacities: The

TRAILS study. Journal of Abnormal Child

Psychology, 39, 341–350.

Bandstra, N. F., Chambers, C. T., McGrath,

P. J., & Moore, C. (2011). The behavioural

expression of empathy to others’ pain versus

others’ sadness in young children. PAIN, 152,

1074–1082.

Best, J. R., & Miller, P. H. (2010). A develop-

mental perspective on executive function.

Child Development, 81, 1641–1660.

Blair, C., & Razza, R. P. (2007). Relating effort-

ful control, executive function, and false belief

understanding to emerging math and literacy

ability in kindergarten. Child Development,

78, 647–663.

Block, J. H., & Block, J. (1980). The role of ego-

control and ego- resiliency in the organization

of behavior. In W. A. Collins (Ed.), Minne-

sota Symposia on Child Psychology (Vol. 13,

pp. 39–101). Hillsdale, NJ: Erlbaum.

Carlson, S. M., Moses, L. J., & Claxton, L. J.

(2004). Individual differences in executive

functioning and theory of mind: An investiga-

tion of inhibitory control and planning ability.

Journal of Experimental Child Psychology,

87, 299–319.

Carver, C. S. (2005). Impulse and constraint:

Perspectives from personality psychology,

convergence with theory in other areas, and

potential for integration. Personality and

Social Psychology Review, 9, 312–333.

Compas, B. E., Connor-Smith, J. K., Saltzman,

H., Thomsen, A. H., & Wadsworth, M. E.

(2001). Coping with stress during childhood

and adolescence: Problems, progress, and

potential in theory and research. Psychologi-

cal Bulletin, 127, 87–127.

Crockenberg, S. C., & Leerkes, E. M. (2004).

Infant and maternal behaviors regulate infant

reactivity to novelty at 6 months. Develop-

mental Psychology, 40, 1123–1132.

Denham, S. A., & Burton, R. (2003). Social and

emotional prevention and intervention pro-

gramming for preschoolers. New York: Klu-

wer Academic/Plenum Press.

Derryberry, D., & Rothbart, M. K. (1997). Reac-

tive and effortful processes in the organization

of temperament. Development and Psychopa-

thology, 9, 633–652.

Diamond, A. (1991). Neuropsychological insights

into the meaning of object concept develop-

ment. In S. Carey & R. Gelman (Eds.), The

epigenesis of mind: Essays on biology and cog-

nition (pp. 67–110). Hillsdale, NJ: Erlbaum.

Diamond, A., Barnett, W. S., Thomas, J., &

Munro, S. (2007). The early years: Preschool

program improves cognitive control. Science,

318, 1387–1388.

Self-Regulation, Effortful Control, and Their Socioemotional Correlates 169

Diener, M. L., & Kim, D. (2004). Maternal and

child predictors of preschool children’s social

competence. Journal of Applied Developmen-

tal Psychology, 25, 3–24.

Diener, M. L., & Mangelsdorf, S. C. (1999).

Behavioral strategies for emotion regulation in

toddlers: Associations with maternal involve-

ment and emotional expressions. Infant

Behavior and Development, 22, 569–583.

Eisenberg, N., Edwards, A., Spinrad, T. L., Sal-

lquist, J., Eggum, N. D., & Reiser, M. (2013,

February 11). Are effortful and reactive con-

trol unique constructs in young children?

Developmental Psychology.

Eisenberg, N., & Fabes, R. A. (1992). Emotion,

regulation, and the development of social

competence. In M. S. Clark (Ed.), Review of

personality and social psychology. Vol 14.

Emotion and Social Behavior (pp.

119–150).

Newbury Park, CA: Sage Publications.

Eisenberg, N., Fabes, R. A., & Spinrad, T. L.

(2006). Prosocial development. In W. Damon

& R. M. Lerner (Series Eds.), & N. Eisenberg

(Vol. Ed.), Handbook of child psychology, Vol

3. Social, emotional, and personality develop-

ment (pp.

646–718). New York: Wiley.

Eisenberg, N., Guthrie, I. K., Fabes, R. A., Reiser,

M., Murphy, B. C., Holgreen, R., et al. (1997).

The relations of regulation and emotionality

to resilience and competent social functioning

in elementary school children. Child Develop-

ment, 68, 295–311.

Eisenberg, N., Michalik, N., Spinrad, T. L.,

Hofer, C., Kupfer, A., Valiente, C., et al.

(2007). Relations of effortful control and

impulsivity to children’s sympathy: A longi-

tudinal study. Cognitive Development, 22,

54 4 –567.

Eisenberg, N., & Morris, A. S. (2002). Children’s

emotion-

elated regulation. In R. Kail (Ed.),

Advances in child development and behavior

(pp.

190–229). Amsterdam: Academic Press.

Eisenberg, N., Smith, C. L., & Spinrad, T. L.

(2011). Effortful control: Relations with emo-

tion regulation, adjustment, and socializa-

tion in childhood. In R. F. Baumeister & K.

D. Vohs (Eds.), Handbook of self-

egulation:

Research, theory, and applications (pp.

263–

283). New York: Guilford Press.

Eisenberg, N., Spinrad, T. L., & Eggum, N. D.

(2010). Emotion-

related self- regulation and its

relation to children’s maladjustment. Annual

Review of Clinical Psychology, 6, 495–525.

Eisenberg, N., Spinrad, T. L., Fabes, R. A., Rei-

ser, M., Cumberland, A., Shepard, S. A., et al.

(2004). The relations of effortful control and

impulsivity to children’s resiliency and adjust-

ment. Child Development, 75, 25–46.

Eisenberg, N., Valiente, C., & Eggum, N. D.

(2010). Self-

egulation and school readiness.

Early Education and Development, 21, 681–

698.

Eisenberg, N., Valiente, C., Spinrad, T. L., Cum-

berland, A., Liew, J., Reiser, M., et al. (2009).

Longitudinal relations of children’s effortful

control, impulsivity, and negative emotional-

ity to their externalizing, internalizing, and

co-

ccurring behavior problems. Develop-

mental Psychology, 45, 988–1008.

Eisenberg, N., Vidmar, M., Spinrad, T. L.,

Eggum, N. D., Edwards, A., Gaertner, B., et

al. (2010). Mothers’ teaching strategies and

children’s effortful control: A longitudinal

study. Developmental Psychology, 46, 1294–

1308.

Eisenberg, N., Wentzel, M., & Harris, J. D.

(1998). The role of emotionality and regula-

tion in empathy-

elated responding. School

Psychology Review, 27, 506–521.

Eisenberg, N., & Zhou, Q. (in press). Concep-

tions of executive functioning and regulation:

When and to what degree do they overlap? In J.

A. Griffin, L. S. Freund, & P. McCardle (Eds.),

Executive function in preschool age children:

Integrating measurement, neurodevelopment

and translational research. Washington, DC:

American Psychological Association.

Flynn, E. (2007). The role of inhibitory control

in false belief understanding. Infant and Child

Development, 16, 53–69.

Garon, N., Bryson, S. E., & Smith, I. M. (2008).

Executive function in preschoolers: A review

using an integrative framework. Psychological

Bulletin, 134, 31–60.

Grolnick, W. S., Bridges, L. J., & Connell, J. P.

(1996). Emotion regulation in two-year-olds:

Strategies and emotional expression in four

contexts. Child Development, 67, 928.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp.

3–20). New York:

Guilford Press.

Guthrie, I. K., Eisenberg, N., Fabes, R. A., Mur-

phy, B. C., Holmgren, R., Mazsk, P., et al.

(1997). The relations of regulation and emo-

tionality to children’s situational empathy-

elated responding. Motivation and Emotion,

21, 87–108.

Hardaway, C. R., Wilson, M. N., Shaw, D. S., &

170 DEVELOPMENTAL CONSIDERATIONS

Dishion, T. J. (2012). Family functioning and

externalizing behaviour among low- income

children: Self- regulation as a mediator. Infant

and Child Development, 21, 67–84.

Hill, A. L., & Braungart- Rieker, J. M. (2002).

Four-month attentional regulation and its pre-

diction of three-year compliance. Infancy, 3,

261–273.

Hofer, C., Eisenberg, N., & Reiser, M. (2010).

The role of socialization, effortful control,

and ego resiliency in French adolescents’ social

functioning. Journal of Research on Adoles-

cence, 20, 555–582.

Izard, C. E., Schultz, D., Fine, S. E., Youngstrom,

E., & Ackerman, B. P. (1999). Temperament,

cognitive ability, emotion knowledge, and

adaptive social behavior. Imagination, Cogni-

tion and Personality, 19(4), 305–330.

Kagan, J., & Fox, N. A. (2006). Biology, culture,

and temperamental biases. In W. Damon & R.

M. Lerner (Series Eds.) & N. Eisenberg (Vol.

Ed.), Handbook of child psychology: Vol. 3.

Social, emotional, and personality develop-

ment (6th ed., pp. 167–225). Hoboken, NJ:

Wiley.

Kim, S., Nordling, J. K., Yoon, J. E., Boldt, L. J.,

& Kochanska, G. (2013). Effortful control in

“hot” and “cool” tasks differentially predicts

children’s behavior problems and academic

performance. Journal of Abnormal Child Psy-

chology, 41(1), 43–56.

Kochanska, G., Coy, K. C., & Murray, K. T.

(2001). The development of self- regulation in

the first four years of life. Child Development,

72, 1091–1111.

Kochanska, G., Coy, K. C., Tjebkes, T. L., &

Husarek, S. J. (1998). Individual differences in

emotionality in infancy. Child Development,

69, 375–390.

Kochanska, G., Kim, S., Barry, R. A., & Philib-

ert, R. A. (2011). Children’s genotypes inter-

act with maternal responsive care in predict-

ing children’s competence: Diathesis– stress or

differential susceptibility? Development and

Psychopathology, 23, 605–616.

Kochanska, G., & Knaack, A. (2003). Effort-

ful control as a personality characteristic of

young children: Antecedents, correlates, and

consequences. Journal of Personality, 71,

1087–1112.

Kochanska, G., Murray, K. T., & Harlan, E. T.

(2000). Effortful control in early childhood:

Continuity and change, antecedents, and

implications for social development. Develop-

mental Psychology, 36, 220–232.

Lagattuta, K. H., Sayfan, L., & Monsour, M.

(2011). A new measure for assessing execu-

tive function across a wide age range: Chil-

dren and adults find happy–sad more difficult

than day–night. Developmental Science, 14,

481–489.

Lemery, K. S., Essex, M. J., & Smider, N. A.

(2002). Revealing the relation between tem-

perament and behavior problem symptoms

by eliminating measurement confounding:

Expert ratings and factor analyses. Child

Development, 73, 867–882.

Lengua, L. J. (2008). Anxiousness, frustration,

and effortful control as moderators of the

relation between parenting and adjustment in

middle- childhood. Social Development, 17,

554 –577.

Lengua, L. J., Honorado, E., & Bush, N. R.

(2007). Contextual risk and parenting as pre-

dictors of effortful control and social compe-

tence in preschool children. Journal of Applied

Developmental Psychology, 28, 40–55.

Liew, J., Eisenberg, N., Spinrad, T. L., Eggum,

N. D., Haugen, R. G., Kupfer, A., et al. (2011).

Physiological regulation and fearfulness as

predictors of young children’s empathy- related

reactions. Social Development, 20, 111–134.

Mangelsdorf, S. C., Shapiro, J. R., & Marzolf,

D. (1995). Developmental and temperamental

differences in emotion regulation in infancy.

Child Development, 66, 1817–1828.

Marcovitch, S., Leigh, J., Calkins, S. D., Leerks,

E. M., O’Brien, M., & Blankson, A. N. (2010).

Moderate vagal withdrawal in 3.5-year-old

children is associated with optimal perfor-

mance on executive function tasks. Develop-

mental Psychobiology, 52, 603–608.

Mintz, T. M., Hamre, B. K., & Hatfield, B. E.

(2011). The role of effortful control in medi-

ating the association between maternal sen-

sitivity and children’s social and relational

competence and problems in first grade. Early

Education and Development, 22, 360–387.

Mischel, W., & Ayduk, O. (2011). Willpower in

a cognitive- affective processing system: The

dynamics of delay of gratification. In K. D.

Vohs & R. F. Baumeister (Eds.), Handbook of

self- regulation: Research, theory, and applica-

tions (2nd ed., pp. 83–105). New York: Guil-

ford Press.

Murphy, B. C., Eisenberg, N., Fabes, R. A.,

Shepard, S., & Guthrie, I. K. (1999). Consis-

tency and change in children’s emotionality

and regulation: A longitudinal study. Merill–

Palmer Quarterly, 46, 413–444.

Self‑Regulation, Effortful Control, and Their Socioemotional Correlates 171

Obradović, J., Bush, N. R., & Boyce, W. T.

(2011). The interactive effect of marital con-

flict and stress reactivity on externalizing and

internalizing symptoms: The role of labora-

tory stressors. Development and Psychopa-

thology, 23, 101–114.

Oldehinkel, A. J., Hartman, C. A., Ferdinand,

R. F., Verhulst, F. C., & Ormel, J. (2007).

Effortful control as modifier of the association

between negative emotionality and adoles-

cents’ mental health problems. Development

and Psychopathology, 19, 523–539.

Panfile, T. M., & Laible, D. J. (2012). Attach-

ment security and child’s empathy: The medi-

ating role of emotion regulation. Merrill–

Palmer Quarterly, 58, 1–21.

Posner, M. I., & Rothbart, M. K. (2000). Devel-

oping mechanisms of self- regulation. Devel-

opment and Psychopathology, 12, 427–441.

Rothbart, M. K. (2011). Becoming who we are:

Temperament and personality in develop-

ment. New York: Guilford Press.

Rothbart, M. K., Ahadi, S. A., & Hershey, K.

L. (1994). Temperament and social behavior

in childhood. Merill–Palmer Quarterly, 40,

21–39.

Rothbart, M. K., Ahadi, S. A., Hershey, K., &

Fisher, P. (2001). Investigations of tempera-

ment at three to seven years: The children’s

behavior questionnaire. Child Development,

72, 1394–1408.

Rothbart, M. K., & Bates, J. E. (2006). Tempera-

ment. In W. Damon & R. M. Lerner (Series

Eds.) & N. Eisenberg (Vol. Ed.), Handbook

of child psychology: Vol. 3. Social, emo-

tional, and personality development (6th ed.,

pp. 99–166). Hoboken, NJ: Wiley.

Ruff, H. A., & Rothbart, M. K. (1996). Atten-

tion in early development: Themes and varia-

tions. London: Oxford University Press.

Schultz, D., Izard, C. E., Ackerman, B. P., &

Youngstrom, E. A. (2001). Emotion knowl-

edge in economically disadvantaged children:

Self- regulatory antecedents and relations to

social difficulties and withdrawal. Develop-

ment and Psychopathology, 13, 53 – 67.

Silva, K. M., Spinrad, T. L., Eisenberg, N., Sulik,

M. J., Valiente, C., Huerta, S., et al. (2011).

Relations of children’s effortful control and

teacher– child relationship quality to school

attitudes in a low- income sample. Early Edu-

cation and Development, 22, 434–460.

Spinrad, T. L., Eisenberg, N., Cumberland, A.,

Fabes, R. A., Valiente, C., Shepard, S., et al.

(2006). Relation of emotion- related regulation

to children’s social competence: A longitudinal

study. Emotion, 6, 498–510.

Spinrad, T. L., Eisenberg, N., Gaertner, B., Popp,

T., Smith, C. L., Kupfer, A., et al. (2007). Rela-

tions of maternal socialization and toddlers’

effortful control to children’s adjustment and

social competence. Developmental Psychol-

ogy, 43, 1170–1186.

Spinrad, T. L., Eisenberg, N., Silva, K. M.,

Eggum, N. D., Reiser, M., Edwards, A., et al.

(2012). Longitudinal relations among mater-

nal behaviors, effortful control and young

children’s committed compliance. Develop-

mental Psychology, 48, 552–566.

Stifter, C. A., & Braungart, J. M. (1995). The

regulation of negative reactivity in infancy:

Function and development. Developmental

Psychology, 31, 448–455.

Sulik, M. J., Huerta, S., Zerr, A. A., Eisenberg,

N., Spinrad, T. L., Valiente, C., et al. (2010).

The factor structure of effortful control and

measurement invariance across ethnicity and

sex in a high-risk sample. Journal of Psychopa-

thology and Behavioral Assessment, 32, 8–22.

Tottenham, N., Hare, T. A., & Casey, B. J.

(2011). Behavioral assessment of emotion

discrimination, emotion regulation, and cog-

nitive control in childhood, adolescence, and

adulthood. Frontiers in Developmental Psy-

chology, 2, 1–9.

Ursache, A., Blair, C., & Raver, C. C. (2012).

The promotion of self- regulation as a means of

enhancing school readiness and early achieve-

ment in children at risk for school failure.

Child Development Perspectives, 6, 122–128.

Valiente, C., Eisenberg, N., Haugen, R., Spinrad,

T. L., Hofer, C., Liew, J., et al. (2011). Chil-

dren’s effortful control and academic achieve-

ment: Mediation through social functioning.

Early Education and Development, 22, 411–

433.

Valiente, C., Eisenberg, N., Smith, C. L., Reiser,

M., Fabes, R. A., Losoya, S., et al. (2003).

The relations of effortful control and reactive

control to children’s externalizing problems: A

longitudinal assessment. Journal of Personal-

ity, 71, 1172–1196.

Verstraeten, K., Vasey, M. W., Raes, F., & Bijt-

tebier, P. (2008). Temperament and risk for

depressive symptoms in adolescence: Media-

tion by rumination and moderation by effort-

ful control. Journal of Abnormal Child Psy-

chology, 37, 349–361.

Voelker, P., Sheese, B. E., Rothbart, M. K., &

Posner, M. I. (2009). Variations in catechol-

172 DEVELOPMENTAL CONSIDERATIONS

O-methyltransferase gene interact with par-

enting to influence attention in early develop-

ment. Neuroscience, 164, 121–130.

Williams, B. R., Ponesse, J. S., Schachar, R. J.,

Logan, G. D., & Tannock, R. (1999). Develop-

ment of inhibitory control across the life span.

Developmental Psychology, 35, 205–213.

Willoughby, M. T., Kupersmidt, J., Voegler- Lee,

M., & Bryant, D. (2011). Contributions of hot

and cool self- regulation to preschool disruptive

behavior and academic achievement. Develop-

mental Neuropsychology, 36, 162–180.

Willoughby, M. T., Wirth, R. J., Blair, C. B.,

& Family Life Project Investigators. (2012).

Executive function in early childhood: Longi-

tudinal measurement invariance and develop-

mental change. Psychological Assessment, 24,

418–431.

Zhou, Q., Eisenberg, N., Wang, Y., & Reiser,

M. (2004). Chinese children’s effortful con-

trol and dispositional anger/frustration: Rela-

tions to parenting styles and children’s social

functioning. Developmental Psychology, 40,

352–366.

173

The development of emotion regulation is

one of the central goals of early socialization

because of its importance to social compe-

tence, academic achievement, and psycho-

logical well-being (Saarni, 1999). It is also

important to parent– child relationships (Cas-

sidy, 1994). Parents typically overestimate

how much young children can manage their

feelings, especially when their judgments are

compared with what research has shown

about the development of self- regulatory

ability (Newton & Thompson, 2010). In a

recent national survey, for example, many

parents reported that children under the age

of 3 could control their emotions when frus-

trated, and most thought that children of this

age could competently share and take turns

with other children (Newton & Thompson,

2010). This may help to explain why paren-

tal efforts to foster emotional self- control in

offspring are so concerted and multifaceted.

Their efforts include proactive strategies to

manage the everyday emotional demands

that children face, direct interventions to

regulate children’s emotions, parents’ evalu-

ations of children’s emotional displays, sanc-

tions on unregulated emotional displays,

and conversation in which emotional control

strategies are discussed and the benefits of

self- management are described. The social-

ization of emotion regulation in the family is

particularly interesting, therefore, as a pro-

cess of considerable importance to parents

but also as one in which parents’ efforts are

leading, sometimes significantly, children’s

developing behavioral and neurobiological

capacities.

As the study of the development of emo-

tion regulation has expanded, research on

the socialization of emotion regulation has

changed. Emotion regulation was conven-

tionally viewed in terms of the top-down

imposition of cognitive or neurobiological

control on basic emotional processes, and

socialization was perceived primarily as

helping children acquire the understand-

ing, self- control strategies, motivation, and

competence needed to enact these control

processes. In recent years, however, devel-

opmental researchers have recognized that

emotion regulation also involves bottom-

up processes, such as how basic emotion

appraisals originating in limbic structures

influence higher control processes (Thomp-

son, 2011). From this view, therefore, the

socialization of emotion regulation involves

family processes that influence the growth

of emotional reactivity and the demands

this imposes on emotional self- control. This

chapter addresses both top-down and bot-

tom- up facets of the socialization of emo-

tion regulation, because each is important

to how family experiences affect children’s

emotional self- control.

CHAPTER 11

Socialization of Emotion

and Emotion Regulation in the Family

Ross A. Thompson

174 DEVELOPMENTAL CONSIDERATIONS

The chapter begins with a definition of

emotion regulation that highlights its rel-

evance to understanding these socialization

processes. Next, the discussion turns to

family processes that influence bottom- up

aspects of emotion regulation, with partic-

ular attention to experiences of stress that

can shape the neurobiology of emotion. In

the third section, the socialization of emo-

tion regulation as a top-down process is con-

sidered with respect to the diverse parental

influences that affect how children inter-

pret and appraise their feelings, learn about

strategies of emotion management, achieve

competence in controlling their feelings, and

acquire cultural and gender expectations

for emotion regulation (for a more extended

discussion of these influences, see Morris,

Silk, Steinberg, Myers, & Robinson, 2007;

Thompson & Meyer, 2007). In the fourth

section I integrate these perspectives with

respect to the broader security of parent–

child attachment, then conclude the chapter

with final reflections.

Defining Emotion Regulation

Definitions of emotion regulation are built

on broader conceptualizations of emotion

(see Gross, this volume). A developmental

approach to emotion regulation highlights

the changes that occur over time in multiple

components of emotion and their interac-

tion, and how these emotion components

unfold through biological maturation, social

influences, the growth of self- referential

processes, and many other developmental

influences (Thompson, 1990, 1994, 2011).

The following definition of emotion regula-

tion reflects this developmental approach:

Emotion regulation consists of the extrinsic

and intrinsic processes responsible for moni-

toring, evaluating, and modifying emotional

reactions, especially their intensive and tem-

poral features, to accomplish one’s goals

(Thompson, 1994, pp. 27–28). Incorporated

within this definition are several assump-

tions about emotion and emotion regula-

tion.

First, emotion regulation processes target

positive as well as negative emotions and can

entail diminishing, heightening, or simply

maintaining one’s current level of emotional

arousal in particular circumstances. Emo-

tion regulation usually alters the dynamics

of emotion rather than changing its quality.

In other words, individuals alter the inten-

sity, escalation (i.e., latency to onset and rise

time), or duration of an emotional response,

speed its recovery, or reduce or enhance the

lability or range of emotional responding in

particular situations depending on the indi-

vidual’s goals for that situation (Thompson,

1990). We usually think of emotionally well-

regulated people as those who are capable

of altering how long, how intensely, or how

quickly they feel as they do, rather than

transforming the valence of emotion (e.g.,

changing anger into happiness).

Second, consistent with broader under-

standing of emotional development, emotion

regulation can occur through the influence

of other people or through the individual’s

own efforts. Both extrinsic and intrinsic

processes of emotion regulation are impor-

tant. From birth, children’s emotional lives

are managed by others, and this remains so

throughout life. Moreover, extrinsic influ-

ences on emotion regulation can be either

facilitative (i.e., those that assist the child

in emotional self- control) or hindering (i.e.,

those that impair the child’s emotional self-

control), with the latter occurring often in

contexts of family disruption. In addition,

extrinsic influences on emotion regulation

can be either deliberate (i.e., intentionally

managing the child’s emotions) or unin-

tended (i.e., not meant to have the effects on

children’s emotions that they do).

Third, consistent with a functionalist

approach to emotion, strategies of emotion

regulation are rarely inherently optimal or

maladaptive. Rather, emotion regulation

strategies must be evaluated in relation to

the individual’s goals for the situation. This

functionalist orientation is especially impor-

tant for developmental analysis. A toddler’s

petulant crying or an adolescent’s sullenness

may be intuitively interpreted by others as

revealing deficient skills in emotion regu-

lation until one realizes that the toddler’s

crying causes parents to accede and the ado-

lescent’s sullenness causes peers to provide

support, each of which may be the child’s

goal (even if these emotional reactions have

other, negative consequences). It is impor-

tant, however, to recognize that a person

can have multiple goals in a situation requir-

ing emotion regulation (e.g., managing fear

Socialization of Emotion and Emotion Regulation in the Family 175

and defending oneself when in the presence

of a bully). These alternative goals may con-

flict, which further complicates evaluating

whether specific emotion regulation strate-

gies are adaptive.

This functionalist orientation is also

important for understanding emotion regu-

latory processes relevant to developmental

psychopathology. Children with anxiety

disorders are typically viewed as deficient

in emotion regulation, for example, but

their hypervigilance to threatening events,

fear- oriented cognitions, and sensitivity to

internal visceral cues of anxiety are part of

a constellation of self- regulatory strategies

for anticipating and avoiding encounters

with fear- provoking events. In light of their

genetic vulnerability and family processes

that heighten risk for anxious pathology,

these emotion regulatory strategies may be

the most adaptive options available to the

child (Thompson, 2000). Characterizing

such children simply as emotionally dysreg-

ulated seems oversimplified. To be sure, the

same emotion regulatory strategies that pro-

vide immediate relief can exact long-term

costs that make anxious children vulnerable

to continued pathology. This double- edged

sword is typical of emotional regulatory

processes for many forms of developmental

psychopathology (Thompson & Goodman,

2010). Understanding emotion regulation

for children at risk requires comprehend-

ing the emotional goals the child is seeking

to achieve and interpreting his or her self-

regulatory efforts in light of these goals.

Fourth, consistent with a developmental

analysis, emotion regulation includes under-

standing how people monitor and evaluate,

as well as modify, their emotions. Children’s

developing capacities for emotional self-

awareness and for appraising their feelings

in light of personal and cultural expectations

are core features of developing emotion reg-

ulation (Saarni, 1999). Emotion monitoring

and evaluation function nonconsciously as

well as consciously to affect self- regulation.

A preschooler arriving at child care after

witnessing her parents’ morning argument

may not be consciously monitoring how

upset she is, for example, but the argument

might affect her emotional self- control when

she is later provoked by a peer. In this situa-

tion, antecedent emotional arousal creates a

lowered emotional threshold for subsequent

negative arousal that impairs the child’s

emotion management.

Emotion regulation can be studied at

multiple levels of analysis, from genetic and

neurobiological processes to developing cog-

nition and personality, to family processes

and overarching cultural values. A devel-

opmental analysis highlights that although

psychologists tend to regard “emotion regu-

lation” as if it were a single, coherent per-

sonality construct or developmental process,

the growth of emotion regulation is actually

based on a multidimensional network of

loosely allied processes arising from within

and outside the child. Developmental study

of emotion regulation requires that theo-

rists keep the broader view in mind even as

they are studying specific components of the

growth of emotion regulation, such as its

socialization in the family.

The developmental study of emotion

regulation requires distinct methodologi-

cal strategies. Studies of emotion regulation

in adults or adolescents typically rely on

respondent self- report, commonly through

questionnaires, to index individual differ-

ences in emotion self- regulation. Infants

and young children are not very informative

reporters. Thus, developmental researchers

must use other procedures. These include

detailed observations of emotional reac-

tions in carefully structured experimental

situations, often with convergent behavioral

and psychophysiological measures, some-

times accompanied by the reports of moth-

ers and other secondary sources concern-

ing the child’s emotional qualities. These

methods are informative, but behavioral

measures (whether of infants or adults) are

also complicated by the following interpre-

tive difficulties: (1) behavior that reflects the

influence of emotion regulatory processes

is multidetermined; (2) emotional reactions

and emotional regulatory influences are not

easily distinguished behaviorally; and (3)

the situational context can have a profound

effect on children’s emotional reactions

(Cole, Martin, & Dennis, 2004). Studying

emotion regulation in vivo in this manner

is thus conceptually and methodologically

more difficult than enlisting self- report.

Adding further complexity to the study

of emotion regulation is the functional-

ist requirement of understanding the goals

motivating self- regulatory efforts. Although

176 DEVELOPMENTAL CONSIDERATIONS

these goals are usually assumed in studies

of adults (e.g., diminishing negative affect

and enhancing positive emotion), behavioral

studies of emotion regulation with chil-

dren require carefully designed assessments

in which the goals for managing emotion

are either explicit or incorporated into the

design (e.g., observing children as they cope

with a disappointing gift). In short, because

of the special methodological challenges it

presents, developmental research into emo-

tion regulation is not for the fainthearted.

Family Influences on Emotional

Reactivity and Self-Regulation

Two conclusions from recent research have

changed how developmental researchers

understand the growth of emotion regula-

tion (Thompson, 2011; Thompson, Lewis,

& Calkins, 2008). First, as noted earlier,

neurobiological systems that are higher and

lower on the neuroaxis exert mutual regu-

latory influences related to emotion. “Top-

down” regulatory control (e.g., projections

from the prefrontal cortex to the amygdala)

is important, but so is the “bottom- up”

regulatory influence (e.g., from the limbic

system to higher cortical regions). Second,

these higher and lower neurobiological sys-

tems are shaped by the quality of early expe-

rience, particularly family interactions.

The view that emotion regulation involves

bidirectional influences between higher and

lower systems is consistent with current work

in the neuroscience of emotion. Neuroimag-

ing studies show that responses to emotion

tasks are widely distributed throughout the

brain, including areas commonly regarded as

relevant to affective activation (including the

amygdala, hypothalamus, brainstem, and

striatum) and areas often viewed as impor-

tant to emotion regulation (including medial

and lateral prefrontal cortex and anterior

cingulate). Neuroimaging studies show that

cortical and limbic areas are coactive in

responses to emotion probes (Kober et al.,

2008; Ochsner et al., 2009), and that lim-

bic systems exert influence over cortical

systems in affective arousal, as well as the

reverse. Amygdala activation is associated,

for example, with enhanced perceptual sen-

sitivity to cues of danger, consistent with its

role in affective learning and appraisals that

influence higher- order emotion processing

(Barrett & Bar, 2009; Ochsner et al., 2009;

Woltering & Lewis, 2009).

Consistent with the view that early expe-

riences shape brain architecture, research

has shown that experience is important to

the functioning of higher and lower brain

regions relevant to emotion. The best evi-

dence concerns the development of stress

responding, which involves neural systems

shared with emotion. Developmental stud-

ies with humans and animals indicate that

children growing up in adverse conditions

develop altered autonomic nervous system

functioning that causes them to become

more sensitive to environmental demands,

more likely to become biologically and

emotionally reactive (or underresponsive)

to challenge, and less capable of adaptive

self- regulation (Loman & Gunnar, 2010;

Lupien, McEwen, Gunnar, & Heim, 2009).

These consequences have been documented

in the limbic– hypothalamic– pituitary–

adrenocortical (LHPA) axis (which is rel-

evant to affect and stress responding),

the parasympathetic system, and multiple

areas of the prefrontal cortex, indicating

that early stress can have diverse and per-

vasive effects on emotion and emotion reg-

ulation (Blair, 2010; El- Sheikh & Erath,

2011). Importantly, early family experiences

have been the model for early adversity in

this research literature, related both to the

stresses directly imposed by parental behav-

ior (e.g., experiences of abuse or chronic

neglect) and the failure of caregivers to buf-

fer the effects of other stresses on children.

Children with a history of abuse, for exam-

ple, exhibit multiple indications of difficulty

in emotion processing relevant to their mal-

treatment: They are hypersensitive to adult

expressions of anger, have a lower threshold

for detecting anger in maternal vocal expres-

sions, and have more difficulty attentionally

disengaging from perceived angry cues when

these responses are measured both behavior-

ally and neurobiologically (see Pollak, 2008,

for a review). Hypersensitivity to anger and

threat is probably an adaptive emotional

regulatory strategy in contexts in which chil-

dren cannot avert an adult attack but may be

capable of anticipating it and flee, avoid, or

otherwise prepare for it. But it comes with

a cost: Children who are hyperreactive to

cues of threat are less likely to be capable

Socialization of Emotion and Emotion Regulation in the Family 177

of managing their arousal, as this research

indicates. Moreover, outside the home,

hyperreactivity to potential threat is likely

to be a liability in dealing with other adults

and peers, whose social cues are more likely

to be misinterpreted and imbued with hos-

tile intent (Thompson & Goodman, 2010).

It is important to note that these deficien-

cies in emotion regulation are not pervasive,

and abused children are not hyperreactive

to cues of adult sadness or happiness (Pol-

lak, 2008). Rather, children’s self- regulatory

problems are related to the circumstances

of their family adversity, consistent with a

functionalist view of emotion regulation.

The research does not permit an evalu-

ation of the nature, severity, or chronicity

of early stresses in the family that prompt

these neurobiological and behavioral adap-

tations. There is some evidence that the

association between family stress and its

effects on behavioral functioning increment

in a dose– response fashion (Repetti, Robles,

& Reynolds, 2011). Nor is there clear evi-

dence concerning the extent to which early

experiences have privileged influence on the

growth of neurobiological and behavioral

systems related to emotion and its regula-

tion, or whether later experiences of adver-

sity have comparable effects. There is reason

to believe, however, that early experiences

may be especially important because of the

plasticity of immature brain systems related

to emotion and stress (Goldsmith, Pollak, &

Davidson, 2008). Taken together, however,

this research indicates that one way emo-

tion regulation is socialized in the family

is through children’s exposure to the emo-

tional demands and stresses of family life,

especially in the context of the (lack of)

support that exists for children’s competent

management of the emotional demands on

them. These experiences shape the func-

tioning of lower and higher neurobiological

systems associated with emotional arousal

and its regulation, and equip children with

response propensities that are likely to influ-

ence their emotional responding outside of

the home.

Such a conclusion is consistent with con-

siderable behavioral research conducted in

the context of less extreme family contexts.

In the following sections, I discuss develop-

mental studies of emotion regulation that

are consistent with the foregoing account of

neurobiological growth in two areas: par-

ents’ direct interventions to manage chil-

dren’s emotions, and effects of the broader

emotional climate of the family.

Parents’ Interventions

to Manage Emotion

From birth, parents exert considerable effort

to manage the emotions of their infants and

young children by soothing distress, provok-

ing positive emotion, and allaying fear. They

proactively seek to make the everyday emo-

tional demands on children manageable and

predictable by organizing the child’s daily

routine, scheduling meals and naps, choos-

ing appropriate child care arrangements,

and in other ways. Parents also seek to alter

children’s direct appraisals of emotionally

evocative situations, such as distracting chil-

dren away from potentially frightening or

distressing events, assisting in solving prob-

lems that children find frustrating, striving

to alter the children’s interpretations of neg-

atively arousing experiences (e.g., “It’s just a

game”), and through social referencing. By

directly intervening in these ways, parents

act as external regulators of young children’s

emotions.

Beyond their immediate consequences,

these parental interventions have broader

consequences for early emotion and emo-

tion regulation. With respect to parental

soothing of infant distress, for example,

Lamb (1981) has argued that such distress

relief sequences are easily learned by infants

and contribute to the emergence of rudi-

mentary expectations that the parent’s

arrival will relieve distress. By 6 months of

age, for example, distressed infants begin

quieting in anticipation of the arrival of

their mother when they hear her approach-

ing footsteps; infants also protest loudly if

mother approaches but does not pick them

up to soothe them (Gekoski, Rovee- Collier,

& Carulli- Rabinowitz, 1983; Lamb & Mal-

kin, 1986). The parent’s sensitive respond-

ing thus contributes to anticipatory soothing

(an early self- regulatory response) before the

parent’s arrival. Similarly, the mother’s sen-

sitivity during episodes of animated, face-

to-face play with the baby contributes to the

growth of early capacities for self- regulation

as the infant learns how to maintain man-

ageable arousal in the context of social play

178 DEVELOPMENTAL CONSIDERATIONS

with the caregiver (Feldman, Greenbaum, &

Yirmiya, 1999; Gianino & Tronick, 1988).

Parents who provide support to very

young children facing emotional challenges

have children who are more emotionally

competent. Calkins and Johnson (1998)

found that 18-month-olds who became

more distressed during frustration tasks had

mothers who were independently observed

to be more interfering when interacting with

their offspring, while children who could

use problem solving and distraction during

frustration had mothers who had earlier

offered greater support, suggestions, and

encouragement. In another study, mothers

who insisted that their toddlers approach

and confront potentially fearful objects in

the laboratory had children who exhibited

greater stress, as indexed by postsession cor-

tisol levels (Nachmias, Gunnar, Mangels-

dorf, Parritz, & Buss, 1996). These findings

suggest that parental assistance is important

not only for managing immediate emotional

behavior but also for the development of

children’s emotional self- control through

the child’s expectation that distress is man-

ageable and that adults can assist in manag-

ing emotionally challenging situations.

These studies focus primarily on paren-

tal interventions that buffer children’s emo-

tional arousal and support self- regulatory

capacity. As the research on stress indicates,

however, parental behavior may not always

be so supportive, and when this occurs there

is greater risk for problems with emotional

reactivity and self- regulation. Another

research literature supporting this view con-

cerns parental expressed emotion, which is

an index of parental attitudes of criticism

or emotional overinvolvement in the child’s

problems that can undermine competent

emotional functioning (e.g., Hooley & Rich-

ters, 1995). Although expressed emotion has

been examined most extensively in clinical

studies of schizophrenia, depression, and

bipolar disorder, because of its relevance to

the maintenance or relapse of clinical symp-

tomatology, developmental studies have

found that expressed emotion is associated

with the onset of psychological problems

in children (Caspi et al., 2004). For exam-

ple, one study found expressed emotion to

be particularly prevalent in homes with a

depressed parent (Rogosch, Cicchetti, &

Toth, 2004). In the context of expressed

emotion, therefore, parental responses that

are critical of a child’s emotional behavior

can contribute to the child’s risk of devel-

oping psychopathology involving emotion

dysregulation. Risk is enhanced because

the parent’s critical demeanor is stressful,

undermines opportunities for the child to

learn more adaptive forms of emotional cop-

ing, and creates a more difficult family emo-

tional climate for troubled children.

Direct parental interventions to manage

children’s emotions decline in frequency in

early childhood as young children acquire

their own self- regulatory strategies. How-

ever, direct interventions remain an impor-

tant source of extrinsic influence on emo-

tion regulation throughout life as they are

supplemented by other socialization influ-

ences. Adults commonly rely on the support

of family and friends when facing emotional

stresses. Social support is thus a significant

buffer of psychosocial stress, and social iso-

lation is a risk factor for stress- related prob-

lems (Thompson, Flood, & Goodvin, 2006).

Emotional Climate of Family Life

The emotional climate of family life can

make emotion management easier or more

difficult because of the emotional demands

that children encounter in the home. As sug-

gested by the research on expressed emotion,

when children must cope with frequent,

intensive negative emotion from other fam-

ily members, particularly when it is directed

at them, it can contribute to their hypersen-

sitivity to threat and undermine emotion

regulation capacities. The family emotional

climate is also relevant to emotion regula-

tion because of the models of emotion reg-

ulation to which children are exposed and

how the family environment shapes chil-

dren’s developing schemas for emotion and

its management (e.g., Are emotions threat-

ening? Empowering? Uncontrollable?).

Another illustration of the importance

of the family emotional climate for devel-

oping child emotional reactivity and self-

regulation is research on marital conflict

(Davies & Woitach, 2008). According to

the Cummings and Davies (2010) emo-

tional security hypothesis, children seek to

reestablish the emotional security they have

lost in families with marital conflict, even

when parental conflict is not directed at

Socialization of Emotion and Emotion Regulation in the Family 179

them. They do so by intervening in parental

arguments to end them, monitoring parental

moods to anticipate the outbreak of argu-

ments, and otherwise striving to manage

their emotions in a conflicted home environ-

ment. As a consequence, they show height-

ened sensitivity to parental distress and

anger, tend to become overinvolved in their

parents’ emotional conflicts, have difficulty

managing the strong emotions that conflict

arouses in them (in a manner resembling the

“emotional flooding” described by emotion

theorists), and exhibit signs of early devel-

opment of internalizing problems. Research

derived from this view has found that grade

school children who witness the most

intense marital conflict not only exhibit the

greatest enmeshment in family conflict but

also go to greater efforts to avoid conflict,

while also showing more signs of internal-

izing symptomatology (Davies & Forman,

2002; see also Davies, Harold, Goeke-

Morey, & Cummings, 2002). An impor-

tant facet of the family emotional life is, of

course, parents’ emotional expressiveness

(Halberstadt, Crisp, & Eaton, 1999; Hal-

berstadt & Eaton, 2003). A series of stud-

ies by Eisenberg and her colleagues showed

that children’s social competence is affected

by how mothers convey positive or nega-

tive feelings in the home—and this associa-

tion is mediated by differences in children’s

self- regulatory behavior (Eisenberg et al.,

2001, 2003; Valiente, Fabes, Eisenberg, &

Spinrad, 2004). These findings suggest that

a family climate characterized by moderate

to high amounts of positive emotion among

family members contributes to the growth of

emotion regulation, perhaps because emo-

tional demands are manageable within the

home and children are exposed to models of

skillful emotion self- regulation.

With respect to the influence of negative

emotional expressiveness in the family, sev-

eral studies report that negative maternal

expressions of emotion are associated with

children’s lack of self- regulation and cop-

ing, but others have found a positive asso-

ciation (Eisenberg, Cumberland, & Spinrad,

1998; Eisenberg et al., 2001, 2003; Valiente

et al., 2004). Viewed in the context of the

research on expressed emotion and mari-

tal conflict, the effects of negative parental

emotional expressiveness may depend on

whether emotions are directed toward the

child or not, the frequency and intensity of

these emotions, and whether negative emo-

tions are negative dominant (e.g., anger and

hostility) or negative submissive (e.g., sad-

ness and distress), with the former more

likely to elicit the child’s fear or defensive-

ness. One can see how emotion regulatory

skills might be enhanced (rather than under-

mined) by a child’s exposure to nonhostile

negative emotions of moderate intensity in

contexts in which negative feelings can be

safely expressed and managed, in contrast

with exposure to a more hostile, threatening

family emotional environment.

An important influence on the emotional

climate of the family— which also affects

how parents evaluate and respond to the

emotions of offspring— is parental beliefs

about emotion and its expression. These

beliefs can be considered part of a parent’s

“meta- emotion philosophy,” which includes

the adult’s awareness of her or his own emo-

tions, an understanding and acceptance of

the child’s emotions, and the parent’s own

approach to managing the child’s feelings

(Gottman, Katz, & Hooven, 1997; Hooven,

Gottman, & Katz, 1995). Based on paren-

tal interviews, Gottman and his colleagues

distinguish between “emotion coaching”

and “emotion dismissing” parenting styles.

Emotion- coaching parents are attentive

to their own emotions and the child’s feel-

ings, and do not believe that feelings should

be stifled. They consider the child’s emo-

tional expressions an occasion to validate

the child’s feelings, and an opportunity to

teach the child about emotions, expression,

and coping. Thus, emotion- coaching par-

ents foster the growth of emotion regula-

tion in offspring by offering warm support

and specific guidance for managing feel-

ings. Dismissive parents tend to ignore their

own emotions or belittle the importance of

emotions, and they may not constructively

attend to their children’s feelings. They view

emotions (especially negative ones) as poten-

tially harmful and believe that parents are

responsible for promptly subduing negative

outbursts in offspring and teaching their

children that negative emotions are fleeting

and unimportant.

Several studies testing this provocative

formulation have yielded supportive but

mixed results (Katz, Maliken, & Stettler,

2012). One study indicated that emotion

180 DEVELOPMENTAL CONSIDERATIONS

coaching and emotion dismissing interact

complexly as influences on children’s emo-

tion regulation (Lunkenheimer, Shields,

& Cortina, 2007; see also Gottman, Katz,

& Hooven, 1996; Ramsden & Hubbard,

2002). Research in my laboratory confirmed

that the association between maternal rep-

resentations of emotion and children’s emo-

tion regulation was mediated by mothers’

constructive emotion- related socialization

practices (Thompson, Virmani, Waters,

Meyer, & Raikes, 2013). Mothers’ emotion-

ally supportive representations (i.e., atten-

tion to her feelings; her focus on construc-

tive emotion self- regulation) were associated

with children’s constructive emotion regu-

lation (e.g., problem- focused and emotion-

focused strategies) primarily through their

association with positive, supportive emo-

tion regulation socialization behaviors (i.e.,

maternal problem- solving encouragement,

emotion- focused comfort, validation of chil-

dren’s feelings, and positive family expres-

sivity).

Taken together, the emotional climate of

family life influences the development of

emotion regulation through both the emo-

tional demands and supports it provides

that affect children’s developing emotional

reactivity. In studies of the development of

stress reactivity, the effects of marital con-

flict, and the consequences of parental posi-

tive and negative emotional expressivity, it

is clear that skills in emotion management

develop, in part, in reaction to the emo-

tional demands with which children must

daily cope. The research on parental meta-

emotion philosophy highlights one source of

variability in the family emotional climate,

and it also identifies the basis for parental

coaching of emotion regulatory strategies

in offspring. In the next section, I consider

these and other kinds of top-down regula-

tory influences.

Family Influences on Emotion

Self-Regulatory Strategies

As prefrontal regions of the brain progres-

sively mature, these higher brain systems

enable children to become more capable

of deliberately managing their feelings,

impulses, and behavior. Growth in children’s

capacities to understand and enact cogni-

tive and attentional strategies to manage

emotional reactions accompanies the devel-

opment of these neurobiological control

processes. These top-down influences on

emotion regulation highlight another avenue

for socialization influences in the family. In

direct and indirect ways, parents guide how

children learn to appraise their feelings,

confront the demands of emotion regulation

at home or in other social settings, acquire

specific skills for managing their feelings,

understand cultural expectations for emo-

tional self- control, and represent emotion

processes relevant to self- regulation. In con-

trast to the family influences (e.g., marital

conflict) that shape developing emotional

reactivity and usually have unintended

effects on children’s emotion regulation,

these socialization influences are usually

deliberate. In coaching, conversation, and

other modes of family interaction, parents

encourage the development of well- regulated

emotion and children’s understanding, moti-

vation, and competence to accomplish this.

Because these socialization processes

extend throughout life and mediate cultural

and gender differences in emotion manage-

ment, individuals reach adulthood with

emotion self- regulation skills that have been,

to a large extent, socially constructed. In the

following sections, two general socialization

influences on developing emotion regulation

are considered: parental evaluations of chil-

dren’s emotions, and parent– child conversa-

tion about emotion and its regulation.

Parental Evaluations

of Children’s Emotions

Emotion regulation can be facilitated or

impaired by how others evaluate one’s feel-

ings. Sympathetic, constructive responses

affirm that one’s feelings are justified and

provide social support in understanding and

advice that help people cope with difficult

situations. However, denigrating, critical, or

dismissive responses contain implicit mes-

sages that demean the appropriateness of the

feelings or their expression, or the compe-

tence of the person feeling this way. Indeed,

others’ dismissiveness can exacerbate the

negative emotions that one is trying to man-

age (in part by arousing further emotion), as

well as diminish opportunities for acquiring

more adaptive modes of emotion regulation.

Socialization of Emotion and Emotion Regulation in the Family 181

For children, these parental evaluations also

become internalized guides for how children

judge their own emotional reactions.

Developmental studies indicate that

children cope more adaptively with their

emotions in immediate circumstances and

acquire more constructive emotion regula-

tory capacities when parents respond accept-

ingly and supportively to their negative emo-

tional displays. By contrast, outcomes are

more negative when parents are denigrating,

punitive, or dismissive, or when the child’s

negative emotions elicit parents’ personal

distress (for reviews, see Denham, 1998;

Denham, Bassett, & Wyatt, 2007; Eisen-

berg et al., 1998). In a socioeconomically

disadvantaged sample, for example, mothers

who reported exerting more positive control

(using warmth and approval) over their sons

at age 1½ had children who were observed to

manage their negative emotions more con-

structively (e.g., by using self- distraction) at

age 3½ (Gilliom, Shaw, Beck, Schonberg, &

Lukon, 2002). Eisenberg, Fabes, and Mur-

phy (1996) found that mothers’ self- reported

problem- solving responses to their grade

school children’s negative emotions were

associated with independent reports of their

children’s constructive coping with prob-

lems (e.g., seeking support, problem solving,

and positive thinking), while mothers’ puni-

tive and minimizing reactions to children’s

emotions were negatively associated with

children’s constructive coping and positively

associated with avoidant coping. Research

in my laboratory indicates that parents who

accepted and validated young children’s feel-

ings during conversations about recent dif-

ficult events had children who were more

willing to talk about these experiences and

as a result more likely to learn about their

emotions and how to manage them (Waters,

Virmani, Thompson, Meyer, Raikes, &

Jochem, 2010). These studies indicate that

how parents respond to children’s emotions,

and the behaviors that result, predict chil-

dren’s emotion- related coping in later assess-

ments.

Parent–Child Conversation and

Developing Emotion Representations

From an early age, parents actively coach

children on strategies of emotion regula-

tion when they encourage offspring to “use

words to say how you feel,” take a deep

breath, or think of something nice when

emotionally aroused. Research in my labo-

ratory indicates that in conversation with

their preschoolers about recent emotional

events, mothers directly suggest strategies of

emotional self- control and explicitly endorse

certain strategies over others (Thompson,

Waters, Meyer, Raikes, Jochem, & Virmani,

2009). They do so in light of their expecta-

tions for age- appropriate emotional behav-

ior in social settings (Cassano & Zeman,

2010).

Parent–child conversations have, however,

broader significance for the growth of emo-

tion regulation. Consistent with the work

of Gottman and his colleagues (1997) on

parental coaching, conversation shapes chil-

dren’s broader representations of emotion.

Understanding the causes and consequences

of their feelings, comprehending gender

and cultural expectations for emotional

expression, learning the social functions

of emotional behavior, and other aspects

of emotion understanding are advanced

by parent– child conversation (Thompson,

2006a, 2006b). These broader aspects of

emotion understanding are important to

developing an informed comprehension of

emotion regulation. As their conceptual

skills mature, children begin to appreciate,

especially through conversations with par-

ents, that they can enlist internal constitu-

ents of emotion to manage external emotion

(e.g., redirecting attention; cognitive reap-

praisal; mental distraction), that one need

not always show what one feels, and that

mental processes (e.g., expectations, memo-

ries, thoughts) affect how one feels.

Parent–child conversation has further sig-

nificance for emotion regulation, moreover,

as a means of guiding children’s immediate

appraisals of events. By managing infor-

mation the child receives about potentially

stressful events (e.g., describing an antici-

pated dental visit as “teeth tickling”) or

introducing alternative interpretations of an

event (e.g., eliciting sympathy for a physi-

cally challenged person the child fears or

finds amusing), parents influence emotion-

related appraisals that facilitate emotion

regulation. In an experimental probe, Mor-

ris et al. (2011) found that mothers’ use of

attention refocusing and cognitive reframing

was associated with less sadness and anger

182 DEVELOPMENTAL CONSIDERATIONS

in children who received a disappointing

gift in her presence (see Kliewer, Fearnow,

& Miller, 1996, for similar results with

mothers and fathers). Comparable to how

parent– child conversations influence mem-

ory through attentional redirection, there-

fore, these conversations can influence emo-

tion through reorienting appraisal processes

(Thompson, 2006b).

It is important to note that conversations

with peers and siblings are also important

catalysts to the growth of emotion regula-

tion in childhood. Young children talk about

their feelings more frequently with friends

and siblings than they do with their moth-

ers, and these conversations also contrib-

ute to developing emotional understanding

(Brown, Donelan- McCall, & Dunn, 1996).

Peer conversations are important; there is

evidence that adaptive strategies of emotion

regulation with peers are not the same as

those with family members and adult inter-

actions (Thompson & Waters, 2010). Vent-

ing distress does not typically elicit as much

support from peers as from parents, for

example. Thus, as children travel between

different social settings, they must develop

competence in applying different norms for

emotional behavior and accepted strategies

for emotion regulation.

An Integrative Perspective:

Parent–Child Attachment Security

The preceding discussion focused on imme-

diate and longer- term socialization processes

by which children become competent at

managing their emotions. But what happens

and who does it are both important in emo-

tion socialization. Most of the socialization

influences on emotion regulation discussed

in this chapter occur in a relational context,

and the quality of the parent– child relation-

ship colors the influence of parents’ direct

interventions, appraisals of children’s emo-

tions, coaching, and conversations about

emotion and its regulation. In this section,

I discuss the significance of the security of

the parent– child relationship, and in doing

so reintegrate the bottom- up and top-down

processes discussed earlier.

According to attachment researchers,

differences in the security of child– parent

attachment may be especially significant for

the growth of emotion regulation (Cassidy,

1994; Thompson, 1994; see also Shaver &

Mikulincer, this volume). Young children

in secure relationships have more sensitive

mothers who are accepting of children’s

positive and negative feelings, and open to

talking about intense, disturbing, or con-

fusing feelings with them. Consequently,

like the offspring of emotion- coaching par-

ents, securely attached children are likely

to become more emotionally self-aware,

acquire deeper emotion understanding, and

develop a more flexible capacity to manage

their emotions appropriate to circumstances.

Moreover, the security of the parent– child

relationship provides a continuing resource

of support on which the child can rely. By

contrast, young children in insecure rela-

tionships have mothers who are less sensitive

and more inconsistently responsive to their

feelings, and less likely to be comfortable

talking with them about difficult emotional

experiences. These children are likely to

have a more limited understanding of emo-

tion and to become more easily emotionally

dysregulated, especially in stressful circum-

stances, because of the lack of support in the

parent– child relationship.

There is research evidence in support of

this view. In a longitudinal study of chil-

dren’s first 3 years, Kochanska (2001)

reported that over time, insecurely attached

children, compared with secure children,

exhibited progressively greater fear and/or

anger, and diminished joy, in standardized

assessments. Even by age 1, the mothers of

secure infants commented on both positive

and negative emotions when interacting

with their children, while the mothers of

insecurely attached infants rarely discussed

their feelings or commented primarily about

negative emotions (Goldberg, MacKay-

Soroka, & Rochester, 1994). By early child-

hood, securely attached preschoolers talked

more about emotions in everyday conversa-

tions with their mothers, and their mothers

were more richly elaborative than mothers

of insecurely attached preschoolers in their

discussions of emotion with them. This may

help to explain why secure children are more

advanced in emotion understanding (Laible

& Thompson, 1998; Raikes & Thompson,

2006). There is also evidence that children

in secure relationships are better at manag-

ing negative emotions. Gilliom and his col-

Socialization of Emotion and Emotion Regulation in the Family 183

leagues (2002) reported that boys who were

securely attached at age 1½ were observed

to use more constructive anger manage-

ment strategies at age 3½. In a study of the

responses of 18-month-olds to moderate

stressors, Nachmias and colleagues (1996)

reported that postsession cortisol elevations,

indicating stressful responding, were found

only in temperamentally inhibited toddlers

in insecure relationships with their mothers.

For inhibited toddlers in secure relationships,

the mother’s presence helped to buffer the

physiological effects of challenging events.

In another study, Contreras, Kerns, Weimer,

Gentzler, and Tomich (2000) reported that

by middle childhood, attachment security

was significantly associated with children’s

constructive coping with stress, and the

extent of coping mediated the association

between attachment and children’s peer

competence. Research in our laboratory has

also shown that mothers in secure relation-

ships with their children are more accurate

in judging what their children are feeling

and potentially are thus more capable of

providing helpful guidance about managing

those feelings (Waters et al., 2010).

These findings indicate that the rela-

tional context in which emotion regulation

develops is important not only for the spe-

cific ways that parents respond to children’s

feelings but also for the relational support

that shapes the growth of emotion self-

regulation.

Conclusions

In the broadest sense, the research surveyed

in this chapter confirms how significantly

social influences shape the growth of emo-

tional experience and emotion regulation.

This literature underscores the multifaceted

ways that socialization processes in the fam-

ily affect children’s emotional reactivity and

self- regulation.

Viewed in terms of bottom- up influences,

family processes shape children’s emotional

reactivity through the everyday emotional

demands to which children must adapt,

anticipate, and cope. These influences are

most apparent in studies of at-risk children,

for whom the challenges of family dysfunc-

tion, marital conflict, and even maltreatment

underscore how emotional development and

self- regulation conform to the functional

requirements of managing difficult every-

day emotional demands at home. Viewed in

terms of top-down influences, family pro-

cesses also shape children’s understanding

of emotion, and their motivation and com-

petence to manage their feelings. These pro-

cesses contribute to significant individual

differences in children’s emotional apprais-

als, goals for emotion regulation, and strate-

gies for self- control.

Although study of the socialization of

emotion regulation has long been a topic of

vigorous research interest, a considerable

research agenda remains. Continuing work

in this field is justified not only for theoreti-

cal reasons, but also for its importance to

understanding the challenges faced by chil-

dren at risk for problems of emotion- related

psychopathology.

References

Barrett, L. F., & Bar, M. (2009). See it with

feeling: Affective predictions during object

perception. Philosophical Transactions of the

Royal Society B: Biological Sciences, 364,

1325–1334.

Blair, C. (2010). Stress and the development of

self- regulation in context. Child Development

Perspectives, 4, 181–188.

Brown, J. R., Donelan- McCall, N., & Dunn, J.

(1996). Why talk about mental states?: The

significance of children’s conversations with

friends, siblings, and mothers. Child Develop-

ment, 67, 836–849.

Calkins, S. D., & Johnson, M. C. (1998). Tod-

dler regulation of distress to frustrating

events: Temperamental and maternal corre-

lates. Infant Behavior and Development, 21,

379–395.

Caspi, A., Moffitt, T. E., Morgan, J., Rutter,

M., Taylor, A., Arseneault, L., et al. (2004).

Maternal expressed emotion predicts chil-

dren’s antisocial behavior problems: Using

monozygotic- twin differences to identify envi-

ronmental effects on behavioral development.

Developmental Psychology, 40, 149–161.

Cassano, M. C., & Zeman, J. L. (2010). Parental

socialization of sadness regulation in middle

childhood: The role of expectations and gen-

der. Developmental Psychology, 46, 1214–

1226.

Cassidy, J. (1994). Emotion regulation: Influ-

184 DEVELOPMENTAL CONSIDERATIONS

ences of attachment relationships [Special

issue]. Monographs of the Society for Research

in Child Development, 59(2–3, Serial No.

240), 228–249.

Cole, P., Martin, S., & Dennis, T. (2004). Emo-

tion regulation as a scientific construct: Meth-

odological challenges and directions for child

development research. Child Development,

75, 317–333.

Contreras, J. M., Kerns, K. A., Weimer, B. L.,

Gentzler, A. L., & Tomich, P. L. (2000). Emo-

tion regulation as a mediator of associations

between mother– child attachment and peer

relationships in middle childhood. Journal of

Family Psychology, 14, 111–124.

Cummings, E. M., & Davis, P. T. (2010). Chil-

dren and marital conflict: An emotional secu-

rity perspective. New York: Guilford Press.

Davies, P. T., & Forman, E. M. (2002). Chil-

dren’s patterns of preserving emotional secu-

rity in the interparental subsystem. Child

Development, 73, 1880 –1903.

Davies, P. T., Harold, G. T., Goeke-Morey, M.

C., & Cummings, E. M. (2002). Child emo-

tional security and interparental conflict.

Monographs of the Society for Research in

Child Development, 67(Serial No. 270),

1–127.

Davies, P. T., & Woitach, M. J. (2008). Chil-

dren’s emotional security in the interparental

relationship. Current Directions in Psycho-

logical Science, 17, 269–274.

Denham, S. (1998). Emotional development in

young children. New York: Guilford Press.

Denham, S., Bassett, H. H., & Wyatt, T. (2007).

The socialization of emotional competence. In

J. Grusec & P. Hastings (Eds.), Handbook of

socialization (pp. 614–637). New York: Guil-

ford Press.

Eisenberg, N., Cumberland, A., & Spinrad, T. L.

(1998). Parental socialization of emotion. Psy-

chological Inquiry, 9, 241–273.

Eisenberg, N., Fabes, R. A., & Murphy, B. C.

(1996). Parents’ reactions to children’s nega-

tive emotions: Relations to children’s social

competence and comforting behavior. Child

Development, 67, 2227–2247.

Eisenberg, N., Gershoff, E. T., Fabes, R. A.,

Shepard, S. A., Cumberland, A. J., Losoya, S.

H., et al. (2001). Mothers’ emotional expres-

sivity and children’s behavior problems and

social competence: Mediation through chil-

dren’s regulation. Developmental Psychology,

37, 475–490.

Eisenberg, N., Valiente, C., Morris, A. S., Fabes,

R. A., Cumberland, A., Reiser, M., et al.

(2003). Longitudinal relations among parental

emotional expressivity, children’s regulation,

and quality of socioemotional functioning.

Developmental Psychology, 39, 3–19.

El- Sheikh, M., & Erath, S. A. (2011). Family

conflict, autonomic nervous system function-

ing, and child adaptation: State of the science

and future directions. Development and Psy-

chopathology, 23, 703–721.

Feldman, R., Greenbaum, C. W., & Yirmiya, N.

(1999). Mother– infant affect synchrony as an

antecedent of the emergence of self- control.

Developmental Psychology, 35, 223–231.

Gekoski, M., Rovee- Collier, C., & Carulli-

Rabinowitz, V. (1983). A longitudinal analy-

sis of inhibition of infant distress: The origins

of social expectations? Infant Behavior and

Development, 6, 339–351.

Gianino, A., & Tronick, E. (1988). The mutual

regulation model: The infant’s self and inter-

active regulation and coping and defensive

capacities. In T. Field, P. McCabe, & N.

Schneiderman (Eds.), Stress and coping (Vol.

2, pp. 47–68). Hillsdale, NJ: Erlbaum.

Gilliom, M., Shaw, D. S., Beck, J. E., Schonberg,

M. A., & Lukon, J. L. (2002). Anger regula-

tion in disadvantaged preschool boys: Strat-

egies, antecedents, and the development of

self- control. Developmental Psychology, 38,

222–235.

Goldberg, S., MacKay- Soroka, S., & Rochester,

M. (1994). Affect, attachment, and maternal

responsiveness. Infant Behavior and Develop-

ment, 17, 335–339.

Goldsmith, H. H., Pollak, S. D., & Davidson,

R. J. (2008). Developmental neuroscience per-

spectives on emotion regulation. Child Devel-

opment Perspectives, 2, 132–140.

Gottman, J. M., Katz, L. F., & Hooven, C.

(1996). Parental meta- emotion philosophy

and the emotional life of families: Theoretical

models and preliminary data. Journal of Fam-

ily Psychology, 10, 243–268.

Gottman, J. M., Katz, L. F., & Hooven, C.

(1997). Meta- emotion: How families commu-

nicate emotionally. Mahwah, NJ: Erlbaum.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Halberstadt, A. G., Crisp, V. W., & Eaton, K. L.

Socialization of Emotion and Emotion Regulation in the Family 185

(1999). Family expressiveness: A retrospective

and new directions for research. In P. Philip-

pot & R. S. Feldman (Eds.), The social context

of nonverbal behavior (pp. 109–155). New

York: Cambridge University Press.

Halberstadt, A. G., & Eaton, K. L. (2003). A

meta- analysis of family expressiveness and

children’s emotion expressiveness and under-

standing. Marriage and Family Review, 34,

35–62.

Hooley, J. M., & Richters, J. E. (1995). Expressed

emotion: A developmental perspective. In D.

Cicchetti & S. Toth (Eds.), Emotion, cogni-

tion, and representation (pp. 133–166). Roch-

ester, NY: University of Rochester Press.

Hooven, C., Gottman, J. M., & Katz, L. F.

(1995). Parental meta- emotion structure pre-

dicts family and child outcomes. Cognition

and Emotion, 9, 229–264.

Katz, L. F., Maliken, A. C., & Stettler, N. M.

(2012). Parental meta- emotion philosophy: A

review of research and theoretical framework.

Child Development Perspectives, 6, 417– 422.

Kliewer, W., Fearnow, M. D., & Miller, P. A.

(1996). Coping socialization in middle child-

hood: Tests of maternal and paternal influ-

ences. Child Development, 67, 2339–2357.

Kober, H., Barrett, L. F., Joseph, J., Bliss-

Moreau, E., Lindquist, K., & Wager, T. D.

(2008). Functional grouping and cortical–

subcortical interactions in emotion: A meta-

analysis of neuroimaging studies. NeuroIm-

age, 42, 998–1031.

Kochanska, G. (2001). Emotional development

in children with different attachment histories:

The first three years. Child Development, 72,

474–490.

Laible, D. J., & Thompson, R. A. (1998). Attach-

ment and emotional understanding in pre-

school children. Developmental Psychology,

34(5), 1038–1045.

Lamb, M. (1981). Developing trust and per-

ceived effectance in infancy. In L. Lipsitt (Ed.),

Advances in infancy research (Vol. 1, pp. 101–

127). New York: Ablex.

Lamb, M., & Malkin, C. (1986). The develop-

ment of social expectations in distress– relief

sequences: A longitudinal study. International

Journal of Behavioral Development, 9, 235–

249.

Loman, M. M., & Gunnar, M. R. (2010). Early

experience and the development of stress reac-

tivity and regulation in children. Neuroscience

and Biobehavioral Reviews, 34, 867–876.

Lunkenheimer, E. S., Shields, A. M., & Cortina,

K. S. (2007). Parental emotion coaching and

dismissing in family interaction. Social Devel-

opment, 16, 232–248.

Lupien, S. J., McEwen, B. S., Gunnar, M. R., &

Heim, C. (2009). Effects of stress through-

out the lifespan on the brain, behaviour and

cognition. Nature Reviews Neuroscience, 10,

434–445.

Morris, A. S., Silk, J. S., Morris, M. D. S., Stein-

berg, L., Aucoin, K. J., & Keyes, A. W. (2011).

The influence of mother– child emotion regu-

lation strategies on children’s expression of

anger and sadness. Developmental Psychol-

ogy, 47, 213–225.

Morris, A. S., Silk, J. S., Steinberg, L., Myers, S.

S., & Robinson, L. R. (2007). The role of the

family context in the development of emotion

regulation. Social Development, 16, 361–388.

Nachmias, M., Gunnar, M., Mangelsdorf, S.,

Parritz, R. H., & Buss, K. (1996). Behavioral

inhibition and stress reactivity: The moderat-

ing role of attachment security. Child Devel-

opment, 67, 508–522.

Newton, E. K., & Thompson, R. A. (2010).

Parents’ views of early social and emotional

development: More and less than meets the

eye. Zero to Three, 31, 10–15.

Ochsner, K. N., Ray, R. R., Hughes, B., McRae,

K., Cooper, J. C., Weber, J., et al. (2009).

Bottom-up and top-down processes in emo-

tion generation: Common and distinct neu-

ral mechanisms. Psychological Science, 20,

1322–1331.

Pollak, S. D. (2008). Mechanisms linking early

experience and the emergence of emotions:

Illustrations from the study of maltreated chil-

dren. Current Directions in Psychological Sci-

ence, 17, 370–375.

Raikes, H. A., & Thompson, R. A. (2006). Fam-

ily emotional climate, attachment security,

and young children’s emotion understand-

ing in a high-risk sample. British Journal of

Developmental Psychology, 24, 989–1004.

Ramsden, S. R., & Hubbard, J. A. (2002). Fam-

ily expressiveness and parental emotion coach-

ing: Their role in children’s emotion regulation

and aggression. Journal of Abnormal Child

Psychology, 30, 657–667.

Repetti, R. L., Robles, T. F., & Reynolds, B.

(2011). Allostatic processes in the family.

Development and Psychopathology, 23, 921–

938.

Rogosch, F., Cicchetti, D., & Toth, S. (2004).

186 DEVELOPMENTAL CONSIDERATIONS

Expressed emotion in multiple subsystems of

the families of toddlers with depressed moth-

ers. Development and Psychopathology, 16,

689–709.

Saarni, C. (1999). The development of emo-

tional competence. New York: Guilford Press.

Shaver, P. R., & Mikulincer, M. (this volume,

2014). Adult attachment and emotion regula-

tion. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp. 237–250). New

York: Guilford Press.

Thompson, R. A. (1990). Emotion and self-

regulation. In R. A. Thompson (Ed.), Socio-

emotional development: Nebraska Sympo-

sium on Motivation (Vol. 36, pp. 383–483).

Lincoln: University of Nebraska Press.

Thompson, R. A. (1994). Emotion regulation:

A theme in search of definition. Monographs

of the Society for Research in Child Develop-

ment, 59(2–3, Serial No. 240), 25–52.

Thompson, R. A. (2000). Childhood anxiety dis-

orders from the perspective of emotion regula-

tion and attachment. In M. W. Vasey & M.

R. Dadds (Eds.), The developmental psycho-

pathology of anxiety (pp. 160–182). Oxford,

UK: Oxford University Press.

Thompson, R. A. (2006a). The development of

the person: Social understanding, relation-

ships, self, conscience. In W. Damon & R. M.

Lerner (Eds.), N. Eisenberg (Vol. Ed.), Hand-

book of child psychology: Vol. 3. Social, emo-

tional, and personality development (6th ed.,

pp. 24–98). New York: Wiley.

Thompson, R. A. (2006b). Conversation and

developing understanding: Introduction to

the special issue. Merrill– Palmer Quarterly,

52(1), 1–16.

Thompson, R. A. (2011). Emotion and emotion

regulation: Two sides of the developing coin.

Emotion Review, 3(1), 53–61.

Thompson, R. A., Flood, M. F., & Goodvin,

R. (2006). Social support and developmental

psychopathology. In D. Cicchetti & D. Cohen

(Eds.), Developmental psychopathology: Vol.

III. Risk, disorder, and adaptation (2nd ed.,

pp. 1–37). New York: Wiley.

Thompson, R. A., & Goodman, M. (2010).

Development of emotion regulation: More

than meets the eye. In A. Kring & D. Sloan

(Eds.), Emotion regulation and psychopathol-

ogy (pp. 38–58). New York: Guilford Press.

Thompson, R. A., Lewis, M., & Calkins, S. D.

(2008). Reassessing emotion regulation. Child

Development Perspectives, 2(3), 124–131.

Thompson, R. A., & Meyer, S. (2007). The

socialization of emotion regulation in the fam-

ily. In J. J. Gross (Ed.), Handbook of emotion

regulation (pp. 249–268). New York: Guilford

Press.

Thompson, R. A., Virmani, E., Waters, S. F.,

Meyer, S., & Raikes, A. (2013). The develop-

ment of emotion self- regulation: The whole and

the sum of the parts. In K. Barrett, N. A. Fox,

G. A. Morgan, D. J. Fidler, & L. A. Daunhauer

(Eds.), Handbook of self- regulatory processes

in development (pp. 5–26). New York: Taylor

& Francis.

Thompson, R. A., & Waters, S. F. (2010). The

development of emotion regulation: Parent and

peer influences. In R. Sanchez- Aragon (Ed.),

Emotion regulation: A crossing from culture

to the development of personal relationships

(pp. 125–157). Mexico City: National Auton-

omous University of Mexico.

Thompson, R. A., Waters, S. F., Meyer, S. C.,

Raikes, A., Jochem, R. A., & Virmani, E.

A. (2009, April). Conversational catalysts to

developing understanding of emotion regula-

tion. In L. J. Levine (Chair), How kids keep

their cool: Pathways to effective emotion reg-

ulation. Symposium presented at the biennial

meeting of the Society for Research in Child

Development, Denver, CO.

Valiente, C., Fabes, R. A., Eisenberg, N., & Spin-

rad, T. L. (2004). The relations of parental

expressivity and support to children’s coping

with daily stress. Journal of Family Psychol-

ogy, 18, 97–106.

Waters, S., Virmani, E., Thompson, R. A.,

Meyer, S., Raikes, A., & Jochem, R. (2010).

Emotion regulation and attachment: Unpack-

ing two constructs and their association.

Journal of Psychopathology and Behavioral

Assessment, 32(1), 37– 47.

Woltering, S., & Lewis, M. D. (2009). Devel-

opmental pathways of emotion regulation in

childhood: A neuropsychological perspective.

Mind, Brain, and Education, 3, 160–169.

187

Adolescents’ emotional lives are distinct

from those of children or adults: They react

more strongly to emotion- eliciting situa-

tions (e.g., Miller & Shields, 1980; Stroud

et al., 2009), experience negative and mixed

emotions more frequently (e.g., Larson &

Asmussen, 1991; Larson & Lampman-

Petraitis, 1989; Riediger, Schmiedek, Wag-

ner, & Lindenberger, 2009; Riediger, Wrzus,

& Wagner, 2012), and fluctuate more rap-

idly in their emotional states (e.g., Larson,

Moneta, Richards, & Wilson, 2002). Emo-

tion regulation is assumed to play a key

role in these characteristics of adolescents’

emotional experiences (e.g., Opitz, Gross,

& Urry, 2012). It has also been proposed to

be a central component of adolescents’ more

general socioemotional adaptation, that is,

their ability to adjust to the socioemotional

challenges they face (e.g., Silk, Steinberg,

& Morris, 2003; Yap, Allen, & Sheeber,

2007). Studying emotion regulation is there-

fore essential for understanding the develop-

mental phase of adolescence.

In line with the widely accepted definition

by Gross (e.g., 1999), we conceive of emo-

tion regulation as comprising those delib-

erate and automatic processes that allow

individuals to influence which emotional

experiences they have, when they have

them, and how they experience and express

them. This chapter provides an overview

of the current status of research on adoles-

cent emotion regulation in Western societ-

ies. To set the stage, we briefly characterize

the developmental period of adolescence and

the relevance of emotion regulation for ado-

lescents’ socioemotional adjustment. The

main part of the chapter integrates evidence

on three questions that are important for

the understanding of emotion regulation in

adolescence: Which factors contribute to the

development of emotion regulation skills in

that life phase? Does adolescents’ motiva-

tions to regulate their feelings differ from

those of other age groups? Which strategies

do adolescents use to regulate their emo-

tions, and how adaptive and effective are

these strategies? We conclude with an out-

look on important future research direc-

tions.

Setting the Stage

The life phase “adolescence” refers to the

transition from being a child to being an

independent adult. It can roughly be defined

as beginning with the physical changes of

puberty and ending with the assumption of

adult social roles. Thus, the particular age

range of adolescence varies widely between

individuals, depending on the onset of

puberty and life circumstances. Empirical

CHAPTER 12

Emotion Regulation in Adolescence

Michaela Riediger

Kathrin Klipker

188 DEVELOPMENTAL CONSIDERATIONS

investigations often approximate adoles-

cence as a period within the time window

from about 10 to about 25 years of age.

In Western industrialized societies, the life

phase of adolescence has undergone a major

expansion in recent history. Throughout the

past century, the average onset of pubertal

processes has occurred progressively earlier,

particularly in girls. Nowadays, hormonal

changes of female puberty begin between 9

and 12 years of age, and most of the physical

changes of puberty are typically completed

by the midteens. The acceleration of puberty

onset has coincided with a progressive delay

of assuming adult roles in Western societ-

ies. This is often postponed until around the

early 20s (for an overview, see Dahl, 2004).

Adolescence is characterized by vast

changes in multiple domains of functioning

(for an overview, see, e.g., Eccles, Temple-

ton, Barber, & Stone, 2003). Puberty- related

hormonal changes, for example, lead to

sexual maturation, the development of sec-

ondary gender characteristics, and dramatic

changes in body size and composition. Ado-

lescence is also a phase of profound psycho-

logical change, such as marked growth in

cognitive functioning or moral reasoning.

Furthermore, many aspects of social experi-

ence change as adolescents move away from

their family and toward their peers. Impor-

tantly, there is large variability in the timing

of these various changes, both between ado-

lescents (e.g., regarding the onset of puberty)

and within adolescents (i.e., development in

one domain of functioning does not neces-

sarily imply parallel development in another;

e.g., Dahl, 2004).

During adolescence, emotionally chal-

lenging situations typically become more

frequent and intense. In Western industri-

alized societies, for example, this derives

from an increased potential for conflict with

parents, from adolescents’ greater sensitivity

to peer- related social interactions, or from

early romantic and sexual experiences. In

addition, the physical changes of puberty

make social demands regarding adolescents’

behavior more challenging. Social environ-

ments expect adolescents who look like

adults to behave like adults (Dahl, 2004).

Furthermore, cognitive growth during

adolescence provides the basis for greater

engagement with emotion- relevant aspects

of one’s own and others’ existence and future

(e.g., Thorne, 2004). These challenges can

stipulate the development of skills that are

necessary for identity formation, autonomy

increase, and other developmental tasks of

adolescence (Erikson, 1968). This, however,

is only true as long as the challenges do not

overtax the individual (Yap et al., 2007).

Temporary increases in affective reactivity

(which we address in greater detail when

discussing neurophysiological aspects of

emotion regulation in adolescence) may

amplify adolescents’ vulnerability to being

overwhelmed by the emotional challenges

they face (e.g., Gunnar, Wewerka, Frenn,

Long, & Griggs, 2009; Miller & Shields,

1980; Stroud et al., 2009; Sumter, Bokhorst,

Miers, Van Pelt, & Westenberg, 2010). In

fact, increases during adolescence in inter-

nalizing (e.g., depressiveness) and external-

izing (e.g., aggressiveness) problems, as well

as in various forms of psychopathology (e.g.,

Allen & Sheeber, 2009; Shortt, Stoolmiller,

Smith-Shine, Mark Eddy, & Sheeber, 2010;

Silk et al., 2003) demonstrate that develop-

mental demands of adolescence may over-

stretch the adaptational capacity of vulner-

able individuals.

Emotion regulation has been proposed

to play a core role in adolescents’ ability to

weather the developmental challenges they

face (e.g., McLaughlin, Hatzenbuehler,

Mennin, & Nolen- Hoeksema, 2011; Silk et

al., 2007; Yap et al., 2007). Both over- and

underregulation of emotion are assumed

to imply risks for adolescents’ socioemo-

tional adaptation, that is, for their ability to

adjust to the socioemotional challenges they

encounter. Available evidence indeed links

emotion regulation skills to higher social

competence, more prosocial behavior, bet-

ter academic achievements, and fewer inter-

nalizing and externalizing problems (e.g.,

Bell & Calkins, 2000; Buckley & Saarni,

2009; Silk et al., 2003; Zeman, Cassano,

Perry- Parrish, & Stegall, 2006). Emotion

regulation has also been related to more

peer acceptance, higher peer status, and a

lower likelihood of experiencing chronic

victimization and bullying by peers (for an

overview, see Buckley & Saarni, 2009). In

terms of adolescent psychopathology, emo-

tion regulation has been implicated in the

development of diverse problems, including

anxiety, depressive or conduct disorders,

as well as eating disorders in females (e.g.,

Emotion Regulation in Adolescence 189

McLaughlin et al., 2011; Silk et al., 2007;

Sim & Zeman, 2006; Yap et al., 2007).

To date, the vast majority of studies are

cross- sectional (but see, e.g., McLaughlin et

al., 2011). Thus, whether emotion dysregu-

lation is a risk factor for, or a consequence

of adaptational problems in adolescence

cannot yet be conclusively anwered. There

also is substantial variability across studies

in the particular aspects of emotion regula-

tion investigated. Taken together, however,

ample evidence links emotion regulation

skills to socioemotional adjustment in ado-

lescence. Insight into the development of

emotion regulation skills during adolescence

can thus have important practical implica-

tions. This chapter reviews three fundamen-

tal research topics in this respect that refer to

influences on emotion regulation in adoles-

cence, emotion regulation motivations, and

the ways and effectiveness of adolescents’

attempts to regulate emotions.

Influences on Emotion Regulation

The development of emotion regulation

skills in adolescence is shaped by the interac-

tion of multiple influences. We focus on two

examples in this chapter, namely, individu-

als’ neurophysiological development and

their familial context. A discussion of other

factors— such as genetic disposition, gen-

der, personality, temperament, attachment

style, or influences from developments dur-

ing infancy and childhood— is beyond the

scope of this chapter (but see, e.g., Shaver &

Mikulincer, and Mesquita, De Leersnyder,

& Albert, this volume; Bariola, Gullone, &

Hughes, 2011).

Neurophysiology

and Emotion Regulation

Advances in neuroimaging technologies have

led to a recent upsurge of interest in the role

of neurophysiological development in emo-

tion regulation during adolescence. Research

has shown that similar brain regions are acti-

vated when participants regulate emotions

and when they control cognitive operations

(Mauss, Bunge, & Gross, 2007; Mohanty et

al., 2007; Ochsner & Gross, 2005). Thus,

neurophysiologically oriented research typi-

cally ascribes the exertion of cognitive con-

trol an essential role for effective emotion

regulation (Gray & Braver, 2007; Ochsner

& Gross, 2005, this volume). Cognitive con-

trol encompasses the various processes that

are necessary for successful goal pursuit,

which include maintaining a current goal

in working memory or shielding it from dis-

traction (Best & Miller, 2010). Intentional

emotion regulation can be conceived of as an

instance of such goal- directed behavior (e.g.,

to not express one’s anger). Indeed, several

studies with participants from various age

groups indicate associations between mea-

sures of cognitive control and the effective-

ness of emotion regulation (e.g., Compton et

al., 2008; Hoeksma, Oosterlaan, & Schip-

per, 2004; Robinson, 2007). For example,

Schmeichel and Demaree (2010; Schmeichel,

Volokhov, & Demaree, 2008) demonstrated

that undergraduates with higher working

memory capacity (a facet of cognitive con-

trol) were better able to suppress negative

emotional expressions and to reappraise

stimuli in an unemotional manner.

Cognitive control capacities become

increasingly complex and efficient through-

out childhood and adolescence and into

young adulthood (for review, see Yurgelun-

Todd, 2007). Maturation of the prefrontal

cortex has been associated with the devel-

opment of these skills (e.g., Casey, Getz,

& Galvan, 2008; Casey et al., 2010; Dahl,

2001, 2004; Steinberg, 2008). Structural

maturation includes a decrease in gray mat-

ter. This is reflective of synaptic pruning,

that is, the elimination of unused neural

connections, which possibly enables more

focal activation of these brain regions. These

structural developments are also associated

with functional changes. Studies examining

performance on tasks requiring cognitive

control (e.g., Stroop or flanker tasks), for

example, suggest an age- related increase in

the activation of the dorsolateral prefrontal

cortex during childhood and adolescence,

and a further age- related increase from ado-

lescence to young adulthood in the focaliza-

tion and efficiency of selective recruitment

of cognitive control areas (for reviews, see

Casey et al., 2008; Steinberg, 2008). Behav-

ioral studies show that these structural and

functional changes are associated with per-

formance improvements in a variety of cog-

nitive tasks from childhood to late adoles-

cence (e.g., Best & Miller, 2010; Forman,

190 DEVELOPMENTAL CONSIDERATIONS

Mäntylä, & Carelli, 2011; Ordaz, Davis, &

Luna, 2010).

The pattern of improving cognitive control

associated with maturation of the prefrontal

cortex suggests that self- regulation compe-

tence in general, and emotion regulation

competence in particular, should improve

from childhood to adulthood (Casey et al.,

2010). However, the well- documented peak

in impulsivity and risky/reckless behavior

in adolescents and emerging adults demon-

strates limitations in the ability or willing-

ness to resist temptations and peer influence

(see also Luerssen & Ayduk, Grecucci &

Salfey, and Cole, this volume) and suggests

a nonlinear development of self- regulation

competence (Steinberg, 2008). The tempo-

rary increase in negative emotionality (e.g.,

Ciarrochi, Heaven, & Supavadeeprasit,

2008) and affective instability (e.g., Larson

et al., 2002) during adolescence gives rise

to the assumption that a similar nonlinear

development is characteristic of emotion

regulation skills as well.

Several contemporary positions on ado-

lescent brain development conclude that an

exclusive focus on prefrontal cognitive con-

trol areas is insufficient for understanding

the neurophysiological correlates of ado-

lescent emotion regulation. These models

propose that it is also necessary to take into

consideration subcortical regions involved in

the processing of emotional information, as

well as the coordination between these and

prefrontal regions (e.g., Casey et al., 2010;

Dahl, 2001; Steinberg, 2008). Central to

these models is the assumption that struc-

tural and functional maturation of these

various brain systems do not occur in par-

allel. For example, subcortical regions criti-

cal to affective processing are assumed to

mature earlier in adolescence than cortical

regions subserving cognitive control. The

differential timing of maturation in differ-

ent brain regions is expected to result in a

temporarily increased disjunction between

younger adolescents’ affective experiences

and their emotion regulation abilities. This

disjunction is smaller during childhood,

when both systems are still developing, and

becomes smaller again during adulthood,

when both systems have fully matured.

The assumption of differential develop-

mental timing in prefrontal and subcortical

regions is consistent with nonhuman pri-

mate and human postmortem studies but

needs further empirical confirmation (e.g.,

Steinberg, 2008). Furthermore, Pfeifer and

Allen (2012) recently criticized this assump-

tion as being based on an overly simplifying

conception of structure– function mappings

in the brain. Development of the prefrontal

cortex, for example, may also be associated

with more emotional understanding and

complexity, which in turn could be related

to emotional experiences. In addition, while

neurophysiological maturation undeniably

plays a central role in emotion regulation in

adolescence, external influences, to which

we turn next, are also important for those

learning processes.

Familial Contexts

and Emotion Regulation

Emotion regulation abilities are funda-

mentally shaped by the continual interac-

tions between individuals and their social

environments. On the one hand, demands

on emotion regulation skills are often par-

ticularly high in social situations (Bell &

Calkins, 2000). Individuals are required

to comply with sociocultural norms and

expectations regarding appropriate emo-

tional experiences and expressions in social

situations. Furthermore, attainment of situ-

ational goals would often not be possible if

individuals were not able to regulate their

emotions effectively (e.g., to control their

anxiety or anger appropriately; Thompson,

1994).

On the other hand, social contexts also

present important influences that facilitate

or hinder emotion regulation skills (Bariola

et al., 2011). Most of the available research

focuses on the respective role of familial con-

texts. Morris, Silk, Steinberg, Myers, and

Robinson (2007), for example, propose that

family contexts influence the development

of emotion regulation during childhood

and adolescence in three important ways:

through observation learning (e.g., when

parents’ own emotion regulation serves

as a social role model for their offspring),

through parenting practices and explicit

instruction (e.g., when parents coach emo-

tion regulation strategies), and through the

emotional climate in the family (e.g., when

parental behaviors and attitudes toward

the offspring’s emotional expressions and

Emotion Regulation in Adolescence 191

experiences reinforce or discourage emotion

regulation).

Empirical research on the role of paren-

tal influences on the emotion regulation of

offspring has typically focused on families

with infants or children (see Thompson, this

volume). Fewer investigations are available

on the role of familial contexts for emotion

regulation in adolescence. This work sug-

gests that parents’ emotion– socialization

behaviors continue to be important when

their children become adolescents. This is

the case even though adolescents’ orienta-

tion toward more autonomy increases the

relative importance of extrafamilial influ-

ences, such as peers, media, neighborhood,

or culture, as socialization agents of emotion

regulation (Bariola et al., 2011). Shortt and

colleagues (2010), for example, found that

maternal emotion coaching (e.g., approach-

ing the adolescent when he or she is upset

to talk about the situation and experienced

emotions) was associated with fewer diffi-

culties of their 10- to 13-year-old children

in regulating anger. Better anger control, in

turn, was associated with fewer external-

izing problems of the adolescent. Maternal

emotion coaching in this study also pre-

dicted fewer externalizing problems of the

adolescent 3 years later (i.e., at ages 13–16).

Sheeber, Allen, Davis, and Sorensen (2000)

found that maternal approval or affirma-

tion of adolescent depressive behaviors was

predictive of longer episodes of negative

affect on the part of the adolescent (ages

12–19 years). The authors assumed that this

reflects a poorer ability to regulate negative

affect. Yap, Allen, and Ladouceur (2008)

found a relationship between self- reported

maternal tendencies to be restrictive and

unaccepting of positive affective displays

and adolescents’ use of maladaptive emotion

regulation strategies in conflict situations.

More restrictive maternal tendencies were

associated with a higher tendency among

early adolescents to use maladaptive strate-

gies, such as venting or dysregulated expres-

sion of negative affect, which in turn were

associated with more depressive symptoms.

Evidence also suggests that emotion–

socialization styles in the family need to be

adjusted to the age and developmental status

of the offspring. Direct intervention in the

form of soothing or directive instructions

is effective in children at younger ages. For

adolescents, however, indirect influences,

such as talking about possible emotion

regulation strategies, fit better with their

cognitive and self- regulation competen-

cies, and their increased need for autonomy

(Bell & Calkins, 2000; Morris et al., 2007).

Thus, parental balancing of the adolescent’s

opposing needs for autonomy on the one

hand, and for guidance and structure on the

other is particularly important for emotion–

socialization in adolescence. Imbalance in

either direction can have potentially disad-

vantageous effects on adolescents’ socio-

emotional adaptation. Adolescents who

remain overly dependent on their parents

appear to be at a higher risk of internaliz-

ing problems (e.g., depression; for review,

see Morris et al., 2007). Lack of emotion

regulation skills has been proposed to play a

mediating role in this regard (for review, see

Bell & Calkins, 2000). In contrast, adoles-

cents who lack or refuse emotional guidance

from their parents seem to be at a higher risk

for externalizing problems (e.g., rule break-

ing and delinquency, substance use, aggres-

sion). These behaviors, again, have been

associated with a lack of skills to regulate

emotions, particularly anger (for review, see

Morris et al., 2007).

Interaction between Internal

and External Factors

Evidence suggests that a complex set of

internal and external factors contributes to

the development of emotion regulation skills

during adolescence. We illustrated this using

the examples of individuals’ neurophysi-

ological development, which represents an

essential internal factor, and their famil-

ial context, which can provide significant

external influences on emotion regulation.

Importantly, the effects of these internal and

external factors are not unidirectional. They

reciprocally shape each other. Familial influ-

ences on emotion regulation competence,

for example, are modulated by the propen-

sity of adolescents to experience and express

intense affect. The latter, as discussed ear-

lier, can in turn be related to a temporary

dissociation of neurophysiological changes

yielding increased emotional reactivity at

a time when control functions have not

yet fully developed. In a parent– adolescent

interaction study, Schulz, Waldinger,

192 DEVELOPMENTAL CONSIDERATIONS

Hauser, and Allen (2005) indeed showed

that parents were less positively engaged and

showed more hostility when their adolescent

children fully expressed their emotions than

when they controlled their emotion expres-

sions. Other studies also indicate that par-

ents may have difficulties in coping with

adolescents’ uninhibited displays of intense

emotions, and that these parental difficulties

can shape emotion coaching and the emo-

tional climate in the family, and thus feed

back to the adolescent (e.g., Dishion, Nel-

son, & Bullock, 2004).

Taken together, the research reviewed so

far suggests that interactions among a com-

plex set of internal and external factors are

associated with the development of emotion

regulation skills during adolescence. Struc-

tural and functional changes of the pre-

frontal cortex subserving cognitive control

abilities might facilitate cognitive emotion

regulation skills throughout adolescence.

Simultaneous increases in affective reac-

tivity associated with the development of

subcortical regions, however, might over-

tax these evolving regulatory abilities. Such

neurobiological factors could interact with

aspects of the individual’s social context in

promoting or hindering the development of

emotion regulation skills.

Emotion Regulation Motivation

To date, only little attention has been paid to

the fact that emotion regulatory behaviors

are preceded and fundamentally shaped by

motivational processes (see John & Eng, this

volume). One reason for this is that most

investigators seem to assume that emotion

regulation is inevitably “prohedonic,” that

is, always directed at optimizing one’s well-

being. Only recently has awareness arisen

that occasional exceptions are possible, that

is, that emotion regulation can sometimes be

“contrahedonic.” People may occasionally

be inclined to dwell on or intensify negative

emotional experiences, such as anger or sad-

ness, or to lessen positive ones, such as pride

or amusement (e.g., Erber & Wang Erber,

2000; Riediger et al., 2009; Tamir, 2009).

Various experience- sampling studies

reported by Riediger and colleagues demon-

strated adolescent peaks in the prevalence of

contra- hedonic motivation in samples rang-

ing in age from 12 years to late adulthood

(Riediger et al., 2009; Riediger, Wrzus, &

Wagner, 2013). Participants reported their

momentary emotional experiences, on aver-

age 54 times over 3 weeks, and whether they

momentarily wanted to influence their feel-

ings. Contrahedonic motivation (wanting

to maintain or enhance negative affect, or

to dampen positive affect) was considerably

less prevalent than prohedonic motivation

(wanting to maintain or enhance positive

affect, or to dampen negative affect) in all

investigated age groups. There were, how-

ever, pronounced age differences. Adoles-

cents reported contrahedonic motivation

most frequently, namely, in about 25% of

the measurement occasions. There were

steep decreases in the prevalence of contra-

hedonic motivation between the adolescent

and the young adult subsamples, and a fur-

ther decline throughout the adult subsam-

ples into old age. Prohedonic motivation,

in contrast, showed an opposite prevalence

pattern. It was least prevalent among adoles-

cent and young adult participants, and most

prevalent in later adulthood (Riediger et al.,

2009, 2013).

Furthermore, analyses of associations

with within- person fluctuations in work-

ing memory capacity indicated that contra-

hedonic motivation was more cognitively

demanding than prohedonic motivation. The

more contrahedonic motivation participants

reported, the lower their momentary work-

ing memory capacity. Prohedonic motiva-

tion, in contrast, was only weakly associated

with fluctuations in working memory. This

was the case irrespective of participants’

ages. Therefore, despite the pronounced

age- related differences in the prevalence

of different affect regulation motivations,

their cognitive requirements appeared to be

independent of the individual’s age (Riedi-

ger, Wrzus, Schmiedek, Wagner, & Linden-

berger, 2011).

Two complementary theoretical perspec-

tives on possible reasons for contrahedonic

motivation are currently being discussed in

the literature. From an instrumental perspec-

tive, it has been argued that there may be sit-

uations in which negative affect is useful, or

when positive affect is disadvantageous for

the individual (e.g., Tamir, 2009). Anger, for

example, can help to assert one’s interests in

an argument, whereas expressions of joy can

be inappropriate when attending a funeral.

Contrahedonic orientation may therefore

Emotion Regulation in Adolescence 193

derive from people being (consciously or

unconsciously) strategic in seeking affec-

tive states that are instrumental in a given

context (Ford & Tamir, 2012). Supporting

this position, Riediger and colleagues (2009)

found contrahedonic motivation to be less

strongly related to people’s current emo-

tional experiences than prohedonic orienta-

tions. That is, while participants tended to

report that they wanted to maintain positive

affect when it was high, to enhance positive

affect when it was low, and to dampen nega-

tive affect when it was high, contrahedonic

orientations were less strongly associated

with participants’ momentary affect. This

is consistent with the idea that contrahe-

donic motivation may serve instrumental

functions that are not necessarily related to

the individual’s current affect. The authors

speculated that the relatively higher preva-

lence of contrahedonic motivation in adoles-

cence might reflect an instrumental value in

tackling the developmental tasks of that life

phase. Repudiating prevailing hedonic con-

ventions, for example, might put adolescents

in situations where they have to deal with

negative emotional experiences. This, in

turn, might help them to establish emotional

autonomy from their parents, affirm a sense

of maturity, develop their sense of identity,

or refine their self- regulatory competencies.

To date, however, these assumptions have

not yet been empirically verified.

A complementary account of possible

reasons for contrahedonic motivation is the

mixed- affect perspective. It proposes that

contrahedonic motivation may also arise

when apparently negative emotional states

are accompanied or followed by positive

experiences, that is, when the emotional

episode is mixed (Andrade & Cohen, 2007;

Riediger et al., 2009). Such mixed affective

experiences might motivate individuals, for

example, to seek or maintain a given nega-

tive affective state because of the positive

aspects they associate with it. In fact, the

experience sampling studies by Riediger

and colleagues demonstrated that mixed

affective experiences in everyday life were

related to participants’ being more likely to

report contrahedonic orientations. In addi-

tion, these studies also showed pronounced

age- related differences in the prevalence of

mixed- affective experiences that followed

the same pattern as those of contrahedonic

motivation: Both mixed affective experi-

ences and contrahedonic motivation were

most prevalent among adolescent partici-

pants and least prevalent among older adults

(Riediger et al., 2009, 2013).

Importantly,

this pattern of age- related differences was

not restricted to participants’ self- report; it

was also reflected in implicit representations

of affect valence, as assessed with implicit

association tests. Compared to adults from

various age groups, adolescents associated

positive affect least distinctively with pleas-

antness (vs. unpleasantness) and unhappi-

ness least distinctively with unpleasantness

(vs. pleasantness). The older the participants,

however, the more differentiated their repre-

sentations of the valence of affective states.

Furthermore, the less differentiated people’s

mental representations of affect valence, the

more likely they were to report mixed affect

and contrahedonic motivation in their every-

day lives (Riediger et al., 2013). Although

causal conclusions are not possible given the

correlational nature of these studies, these

findings are in line with the mixed affective

perspective. Thus, the comparatively higher

prevalence of mixed affective experiences in

adolescence could be among the factors that

contribute to a comparatively higher preva-

lence of self- reported contrahedonic moti-

vation in that age group. This seems to be

associated with relatively more undifferenti-

ated mental representations of the valence of

affective states in adolescence.

Emotion Regulation Strategies

The research reviewed so far demonstrates

that internal and external influences on

emotion regulation abilities undergo pro-

found changes during childhood, adoles-

cence, and into young adulthood, and that

adolescents’ emotion regulation motivation

differs from those of adults. But what are

the consequences? Are there age- related dif-

ferences in the strategies individuals use to

regulate their emotions, or in their emotion

regulation effectiveness? An integrated and

interpretable body of research addressing

this question has yet to emerge. Only few

studies have investigated cross- sectional age

differences within or across developmen-

tal periods, and longitudinal evidence on

change within persons over time is scarce.

These studies differ widely in their concep-

tualization of regulatory strategies. This is

194 DEVELOPMENTAL CONSIDERATIONS

partly due to the fact that these studies were

conducted either in the research tradition

of emotion regulation or (more frequently)

in that of coping, with the latter including

emotion regulation as one of many ways of

dealing with stress (Compas, 2009; Gross,

1999). Despite considerable overlap in

research interests, there has been little cross-

talk between these two traditions.

Research within the emotion regula-

tion tradition has most typically proceeded

from the process model of emotion regula-

tion (e.g., Gross, 1999), which distinguishes

antecedent- focused strategies (directed at

changing the emotional input prior to the

actual emotional experience) from response-

focused strategies (directed at modifying

emotional responses after they have been

elicited). Most research has centered around

two prototypical examples, namely, “cog-

nitive reappraisal” (i.e., changing one’s

thinking about an emotion- eliciting situa-

tion or about the capacity to manage it) as

an instance of antecedent- focused emotion

regulation, and “expressive suppression”

(i.e., inhibiting the outward expression of

an emotional experience) as an instance of

response- focused emotion regulation.

More research on regulatory strategies

in adolescence has been conducted within

the coping research tradition, which views

emotion regulation as one of various ways

of dealing with stress. These studies, how-

ever, often referred to different classifica-

tion systems of regulatory strategies, mak-

ing an integration of findings difficult. Two

widely used classification systems are the

primary– secondary control model (e.g.,

Rothbaum, Weisz, & Snyder, 1982) and

the ways-of- coping model (e.g., Lazarus &

Folkman, 1984). The primary– secondary

control model distinguishes regulatory strat-

egies according to their underlying goals.

The aim of primary coping is to influence

characteristics of the stress- eliciting condi-

tions, whereas the aim in secondary coping

is to adapt oneself to the conditions as they

are. The ways-of- coping model, in contrast,

distinguishes regulatory strategies according

to their respective target. Problem- focused

coping refers to modifying the source of

stress, whereas emotion- focused coping

refers to modifying the elicited emotional

response. Primary and secondary coping, as

well as problem- focused coping, partly over-

lap with Gross’s (1999) conceptualization

of antecedent- focused emotion regulation.

Central to these strategies is that they are

directed at factors influencing the process

of emotion generation. Emotion- focused

coping, in contrast, overlaps with response-

focused emotion regulation in Gross’s model,

as both conceptualizations refer to strategies

directed at modifying an emotional response

after it has been activated.

Use of Emotion Regulation Strategies

Zimmer- Gebeck and Skinner (2011) inte-

grated findings from 58 studies compar-

ing coping strategies within the age range

from childhood to adolescence. Overall, the

authors concluded that age differences in

regulatory behaviors are characterized by

two trends.

First, there appears to be an age- graded

increase in regulatory capacities. This is

reflected in not only an increased under-

standing of emotional situations (Labouvie-

Vief, DeVoe, & Bulka, 1989) but also a

broader and more sophisticated repertoire

of regulatory strategies. For example, from

childhood to adolescence, instrumental

action in response to stressors appears to

become gradually supplemented by planful

problem solving. Furthermore, distraction

tactics seem to become more diverse and

increasingly include cognitive distraction,

in addition to behavioral distraction. Also,

compared to children, adolescents appear

to be better able to attend to and reflect on

their own emotional states. They also seem

to use progressively more sophisticated cog-

nitive strategies to deal with emotions, such

as positive self-talk and reappraisal.

The second developmental trend from

childhood to adolescence, according to the

analysis by Zimmer- Gebeck and Skinner

(2011), reflects age- related improvement in

tailoring regulatory attempts to the situa-

tion. That is, adolescents seem to become

increasingly able to engage in those regu-

latory strategies that are most effective in

dealing with particular kinds of stressors.

For example, evidence suggests increasing

use of both problem solving to deal with

modifiable difficulties (e.g., in school or

sports) and distraction to deal with uncon-

trollable stressors (e.g., parental illness)

from childhood to adolescence. Another

example derives from a longitudinal study

on anger regulation among friends. Salisch

Emotion Regulation in Adolescence 195

and Vogelgesang (2005) observed a decline

from older childhood to adolescence in indi-

viduals’ self- reported use of confrontation

and harming, redirection of attention, and

ignoring and self-blame when dealing with

situations involving anger toward a friend.

The authors also found an increase in par-

ticipants’ use of explanation and reconcilia-

tion in such situations.

Zimmer- Gembeck and Skinner (2011)

also emphasized that the apparent improve-

ment in emotion regulatory competence

does not necessarily need to be linear. Some

of the reviewed evidence points to tempo-

rarily increased struggles with regulation in

response to stressors during the transition

from late childhood to early adolescence.

Compared to older adolescents, for exam-

ple, younger adolescents have occasionally

shown lower levels of help- seeking behaviors

and effort expenditure in domains in which

this would be helpful (e.g., regarding school-

related stressors). The authors also reviewed

evidence of a temporary rise in the use of

potentially more maladaptive regulation

strategies during early adolescence, such as

cognitive escape, rumination, verbal aggres-

sion, or venting.

Most of the extant research investigated

the age range from childhood to adolescence.

Only a few available studies compare the use

of regulatory strategies in adolescence and

adulthood. Overall, this research suggests

continued change into young adulthood

(e.g., Blanchard- Fields & Coats, 2008; Gar-

nefski, Legerstee, Kraaij, van den Kommer,

& Teerds, 2002). Garnefski and colleagues,

for example, found that adolescents around

13 years of age reported using various cog-

nitive change strategies (e.g., positive reap-

praisal or refocus on planning) significantly

less frequently than did adults of various age

groups.

Effects of Emotion Regulation

Strategies: Adaptiveness

and Effectiveness

Most studies on the effects of emotion regu-

lation strategies proceed from the idea that it

is meaningful to conceive of an adolescent’s

regulatory style as a trait. These studies

characterize adolescents according to their

overarching tendency to use particular types

of regulatory strategies more than others.

The focus is on the adaptiveness of different

regulatory styles, as characterized by their

association with self- or other- reports of

various indicators of psychological adjust-

ment, such as emotional or behavioral prob-

lems, psychosomatic health, subjective well-

being, and social or academic competence.

Within the research tradition on emotion

regulation, investigations of the adaptive-

ness of specific regulatory strategies have

most typically focused on reappraisal and

expressive suppression. Investigations with

young adults suggest that habitual use of

reappraisal is associated with a healthier

profile of socioemotional adjustment than is

habitual use of expressive suppression, and

that the latter is also associated with greater

cognitive and physiological costs (for an

overview, see Gross, 2002). Investigations in

adolescent samples are rare, but they have

yielded similar patterns of findings (Betts,

Gullone, & Allen, 2009; Hughes, Gullone,

Dudley, & Tonge, 2010).

More research on the adaptiveness of

regulatory styles in adolescence has been

conducted in the research tradition on cop-

ing. Compas and colleagues (2001) reviewed

63 of these studies and concluded that the

majority of the studies demonstrate that

problem- focused and engagement coping

(which overlap with antecedent- focused

emotion regulation) were associated with

better psychological adjustment during

childhood and adolescence. The specific

subtypes most consistently associated with

better adjustment included the generation

of positive and hopeful thoughts (i.e., cog-

nitive reappraisal), careful analysis of the

stressful situation, and selective attention

to positive aspects of the situation. In con-

trast, disengagement and emotion- focused

coping (which overlap largely with response-

focused emotion regulation) were associated

with poorer psychological adjustment in

most studies. However, it was not focusing

on one’s emotions in general that was related

to lower psychological adjustment. Rather,

these effects were due to disengagement

from the stressor or from one’s emotions

(e.g., expressive suppression, avoidance,

or withdrawal), negative cognitions about

the self and the situation, and unregulated

release or ventilation of emotions.

Compas and colleagues (2001) also

emphasized that notable differences in

results across studies may be associated with

the nature of the investigated stressor, par-

196 DEVELOPMENTAL CONSIDERATIONS

ticularly its controllability. This is consistent

with the view that an adaptive regulatory

style may not be characterized primarily by

more frequent use of particular regulation

strategies relative to others, but by a high

level of flexibility (e.g., Gross, 1999). This

flexibility should be evident in positive asso-

ciations between socioemotional adaptation

and adolescents’ ability to tailor specific

regulation attempts to the nature (e.g., the

controllability) of a given situation. While

this claim seems intuitively appealing, future

research needs to strengthen the empirical

foundation supporting it.

The research on the adaptiveness of affect

regulation styles takes a person- centered

(i.e., trait- oriented) approach. Another

approach is process- centered (i.e., state-

oriented) and focuses on how effective indi-

viduals actually are in influencing their emo-

tional experiences in intended ways. Hardly

any evidence is available on the effectiveness

of emotion regulation in adolescence. This

is probably due to the methodological chal-

lenges involved in operationalizing emo-

tion regulation effectiveness. In fact, there

is an ongoing debate whether and to what

degree it is possible to disentangle emotion

regulation from the respective emotional

experience. While some researchers regard

emotion regulation as being experientially

and structurally indistinguishable from the

emotional experience, others claim that

it is possible and meaningful to differenti-

ate between emotion and emotion regula-

tion (for an overview of positions, see, e.g.,

Matarazzo, 2008).

In line with the latter position, emotion

regulation effectiveness in adolescence has

recently been addressed from two different

perspectives. One focuses on the effective-

ness of particular emotion regulation strat-

egies in adolescence. Here, adolescents’ use

of regulatory strategies is not conceived of

as a trait but as a process that can fluctuate

within persons over time. The covariation

of this process with fluctuations in affec-

tive experiences is of particular interest.

Reijntjes, Stegge, Terwogt, Kamphuis, and

Telch (2006), for example, experimentally

manipulated experiences of social rejec-

tion during an ostensible computer game in

10- to 13-year-olds. Contrary to what one

would expect from research on the adaptive-

ness of regulatory styles, problem- focused

engagement in this study was unrelated to

mood improvement after social rejection.

In contrast, better mood improvement was

associated with more behavioral distrac-

tion and less passive behaviors. Silk and col-

leagues (2003) used experience sampling in

12- to 17-year-old participants to investigate

the role of regulatory strategies for mood

dynamics after participants had encoun-

tered negative events in their daily lives.

When adolescents used disengagement-

related strategies in response to subjectively

severe negative events, or when they reacted

involuntarily (e.g., by ruminating or act-

ing impulsively), they maintained higher

levels of negative affect over time, suggest-

ing limited effectiveness of these strategies.

Engagement in primary and secondary con-

trol attempts, however, was unrelated to

the dynamics of negative affect. The latter,

again, is not consistent with what one would

expect based on the majority of studies on

associations between regulatory styles and

more general outcomes of socioemotional

adaptation. Differences in findings across

studies on the effectiveness versus the adap-

tiveness of regulatory strategies might be

attributable to differences in assessment

approaches (process- vs. person- centered)

and/or in the investigated emotion- eliciting

situations. Future research is necessary to

better integrate the findings from these two

lines of research.

A second perspective on emotion regula-

tion effectiveness in adolescence focuses on

respective age- related differences. In two

recent investigations (McRae et al., 2012;

Silvers et al., 2012), participants between 10

and 23 years of age were presented neutral

and aversive picture stimuli from the Inter-

national Affective Picture System (IAPS).

Viewing instructions varied across studies

but generally included a reappraisal condi-

tion (e.g., thinking about the picture in a

way that makes one feel less negative) and

a comparison condition (e.g., reacting natu-

rally to the picture, but not reappraising).

After viewing each picture, participants

rated their current negative affect. Regula-

tion effectiveness was determined as the rel-

ative decrease in negative affect after view-

ing aversive stimuli in the reappraisal versus

the comparison condition. Silvers and col-

leagues observed an age- related increase in

regulation effectiveness from late childhood

Emotion Regulation in Adolescence 197

to late adolescence that tapered off in young

adulthood. McRae and colleagues (2012),

in contrast, found relative age invariance in

regulation effectiveness from ages 10 to 17

years, but an increase in effectiveness from

late adolescence to young adulthood. These

inconsistencies in findings might be due to

methodological differences between the

studies. Procedures in both studies varied,

for example, in the selection of stimuli for

the analyses, and in whether or not partici-

pants were trained in the reappraisal task.

More empirical investigations are necessary

to clarify and expand the empirical picture

on emotion regulation effectiveness through-

out adolescence.

Wrapping Up and Looking Forward

Adolescence is characterized by an upsurge

in the frequency and intensity of emotional

challenges, in a time of life when individuals

have to manage such challenging situations

more and more independently. This provides

developmental stimulation, but it can also

increase vulnerability to adaptational dif-

ficulties. Emotion regulation has been pro-

posed to play an important role in how ado-

lescents adapt to these challenges. Empirical

investigations of this claim vary considerably

regarding their operationalizations of what

“better” emotion regulation entails. System-

atic comparisons of implications of different

facets of emotion regulation for adolescents’

socioemotional adaptation are still lacking.

In addition, causal relations between emo-

tion regulation and developmental adapta-

tion need more systematic investigation in

the future. Another open task for the future

is a more rigorous investigation of possible

interindividual differences in adaptational

outcomes of emotion regulation. There are,

for example, indications that outcomes may

differ between male and female adolescents

(Bowie, 2010; Perry- Parrish & Zeman,

2011).

In addition to assuming implications of

emotion regulation for adolescents’ socio-

emotional adjustment in general, it has also

been proposed that emotion regulation is

involved in the unique emotional lives of

adolescents in particular. Compared to chil-

dren and adults, adolescents report more

negative, more mixed, and more rapidly

varying affective states. Empirical evidence

that directly links emotion regulation to the

characteristic emotional experiences of ado-

lescents is rare. Providing such evidence rep-

resents an important undertaking for future

studies. Knowledge about emotion regula-

tion in adolescence can thus have important

practical implications. We believe that an

integration of findings from three research

areas— influences on the development of

emotion regulation, emotion regulation

motivation, and emotion regulation strate-

gies— is crucial for a better understanding of

adolescents’ emotion regulation. This chap-

ter has reviewed contemporary positions

within each of these areas of inquiry.

A complex set of internal and external

factors contribute to the development of

emotion regulation skills during adoles-

cence. A temporal dissociation in the matu-

ration of prefrontal and subcortical brain

regions, for example, is assumed to result in

a temporary decrease in emotion regulation

capacity when cognitive control capacities

have not yet sufficiently improved to provide

adequate control of the progressively more

active emotion system. It seems plausible

that this may be one of the factors contribut-

ing to the unique quality of emotional expe-

riences observed during adolescence. How-

ever, predictions about relations between

neurophysiological changes during adoles-

cence and adolescents’ development of emo-

tion regulation abilities are still in need of

systematic empirical verification. So far, lit-

tle is known about the possibility that differ-

ent emotion regulation strategies might vary

in terms of how much cognitive control they

require, and that people can recruit external

resources when internal resources are insuf-

ficient for effective emotion regulation (e.g.,

by asking somebody else to distract one-

self from emotion- eliciting thoughts when

attempts of self- initiated distraction are not

successful, Opitz et al., 2012). Furthermore,

emotion regulation skills in adolescence are

also influenced (i.e., facilitated or impaired)

by many other factors, such as varying

degrees of parental structure and supervi-

sion. Future research needs to provide more

empirical evidence on the interplay of these

various internal and external factors to

arrive at a more integrated understanding of

influences on emotion regulation in adoles-

cence.

198 DEVELOPMENTAL CONSIDERATIONS

In comparison to adults from various

age groups, adolescents have been found to

report more contrahedonic and less prohe-

donic motivation. This suggests that part

of the negative emotionality that is charac-

teristic of adolescence may be intentionally

sought and maintained by the individual.

Many questions, however, still remain open.

For example, future research will need to

employ well- controlled experiments to dis-

entangle the causal mechanisms involved in

these associations. This will also contribute

to a better understanding of the reasons for

adolescent patterns of pro- and contrahe-

donic orientations. Another open question

pertains to potential functions of contrahe-

donic motivation, for example, related to the

development of autonomy, self- regulatory

skills, or other aspects of socioemotional

development of adolescents. Finally, rela-

tions between adolescents’ emotion regula-

tion motivation and their actual engagement

in emotion regulatory behaviors, as well as

the effectiveness of these emotion regula-

tion attempts, need to be explored in future

investigations.

Available research on age- related differ-

ences in the use, adaptiveness, and effective-

ness of adolescents’ strategies for regulating

their emotions differs widely in the con-

ceptual frameworks employed. This leads

to difficulty in deriving a cohesive picture

about possible developmental changes dur-

ing adolescence and adjacent developmental

periods. Tentatively, however, this research

suggests an age- related increase in regulation

competence from childhood to adolescence,

as reflected in an increasingly sophisticated

understanding of emotional situations and a

broadening repertoire of regulatory strate-

gies. This appears to coincide with an age-

related increase in the ability to tailor regu-

latory strategies to the specific requirements

of the emotion- eliciting situation. Future

research should further clarify the complex

empirical picture on adolescent development

in the use and adaptiveness of regulatory

strategies. Meta- analyses of the available

empirical evidence would be helpful in this

respect. Furthermore, more empirical evi-

dence is needed on differences in the actual

effectiveness of regulatory attempts between

children, adolescents, and adults.

The three themes on emotion regulation

development in adolescence reviewed in this

chapter currently represent relatively inde-

pendent bodies of research. A more explicit

integration of these various research per-

spectives will help us to arrive at a more

integrated and interpretable picture of the

development of emotion regulation during

adolescence. In addition, future research is

necessary to address various limitations of

the currently available research. For exam-

ple, more longitudinal evidence is necessary

to portray developmental changes within

persons as they move from childhood to

adolescence and young adulthood. Such por-

trayals should also take into account more

explicitly the possibility of nonlinear trends

in development, such as temporary pertur-

bations or deviations from growth trajecto-

ries. Furthermore, in addition to adolescents’

chronological ages, the role of their pubertal

status (which can vary substantially by age)

should be taken into consideration more

comprehensively, because affective pro-

cesses during adolescence are strongly asso-

ciated with puberty- related developments

(Steiner, Dunn, & Born, 2003). Finally,

multimethodological enrichment of research

approaches would be desirable to overcome

the methodological limitations associated

with the currently prevailing dominance of

self- report approaches in most research on

emotion regulation in adolescence.

Note

1. Note that research on age differences in the

frequency of mixed affect during adulthood

has yielded inconclusive findings. Results

from these studies range from age- related

decrease, to age invariance, to age- related

increase in the propensity to experience mixed

affect. Heterogeneity between studies regard-

ing the operationalization of mixed affect may

be among the reasons for the inconclusiveness

of findings with this measure (for a review, see

Riediger & Rauers, in press).

References

Allen, N., & Sheeber, L. (Eds.). (2009). Adoles-

cent emotional development and the emer-

gence of depressive disorders. New York:

Cambridge University Press.

Andrade, E. B., & Cohen, J. B. (2007). On the

Emotion Regulation in Adolescence 199

consumption of negative feelings. Journal of

Consumer Research, 34, 283–300.

Bariola, E., Gullone, E., & Hughes, E. K. (2011).

Child and adolescent emotion regulation:

The role of parental emotion regulation and

expression. Clinical Child and Family Psy-

chology Review, 14, 198–212.

Bell, K. L., & Calkins, S. D. (2000). Relation-

ships as inputs and outputs of emotion regula-

tion. Psychological Inquiry, 11, 160–163.

Best, J. R., & Miller, P. H. (2010). A develop-

mental perspective on executive function.

Child Development, 81, 1641–1660.

Betts, J., Gullone, E., & Allen, J. S. (2009). An

examination of emotion regulation, tempera-

ment, and parenting style as potential predic-

tors of adolescent depression risk status: A

correlational study. British Journal of Devel-

opmental Psychology, 27, 473–485.

Blanchard- Fields, F., & Coats, A. H. (2008). The

experience of anger and sadness in everyday

problems impacts age differences in emotion

regulation. Developmental Psychology, 44,

1547–1556.

Bowie, B. H. (2010). Understanding the gender

differences in pathways to social deviancy:

Relational aggression and emotion regulation.

Archives of Psychiatric Nursing, 24, 27–37.

Buckley, M., & Saarni, C. (2009). Emotion regu-

lation: Implications for positive youth devel-

opment. In R. Gilman, E. S. Huebner, & M.

J. Furlong (Eds.), Handbook of positive psy-

chology in schools (pp. 107–118). New York:

Routledge.

Casey, B., Getz, S., & Galvan, A. (2008). The

adolescent brain. Developmental Review, 28,

62 –77.

Casey, B., Jones, R. M., Levita, L., Libby, V.,

Pattwell, S. S., Ruberry, E. J., et al. (2010).

The storm and stress of adolescence: Insights

from human imaging and mouse genetics.

Developmental Psychobiology, 52, 225–235.

Ciarrochi, J., Heaven, P. C., & Supavadeeprasit,

S. (2008). The link between emotion identifi-

cation skills and socio- emotional functioning

in early adolescence: A 1-year longitudinal

study. Journal of Adolescence, 31, 565–582.

Cole, S. W. (this volume, 2014). Emotion regula-

tion and gene expression. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 571–585). New York: Guilford Press.

Compas, B. E. (2009). Coping, regulation, and

development during childhood and adoles-

cence. New Directions for Child and Adoles-

cent Development, 2009, 87–99.

Compas, B. E., Connor-Smith, J. K., Saltzman,

H., Thomsen, A. H., & Wadsworth, M. E.

(2001). Coping with stress during childhood

and adolescence: Problems, progress, and

potential in theory and research. Psychologi-

cal Bulletin, 127, 87–127.

Compton, R. J., Robinson, M. D., Ode, S.,

Quandt, L. C., Fineman, S. L., & Carp, J.

(2008). Error- monitoring ability predicts daily

stress regulation: Research article. Psychologi-

cal Science, 19, 702–708.

Dahl, R. E. (2001). Affect regulation, brain

development, and behavioral/emotional health

in adolescence. CNS Spectrums, 6, 60–72.

Dahl, R. E. (2004). Adolescent brain develop-

ment: A period of vulnerabilities and oppor-

tunities. Annals of the New York Academy of

Sciences, 1021, 1–22.

Dishion, T. J., Nelson, S. N., & Bullock, B. M.

(2004). Premature adolescent autonomy: Par-

ent disengagement and deviant peer process in

the amplification of problem behavior. Jour-

nal of Adolescence, 27, 515–530.

Eccles, J. S., Templeton, J., Barber, B., & Stone,

M. (2003). Adolescence and emerging adult-

hood: The critical passage ways to adulthood.

In M. H. Bornstein, L. Davidson, C. L. M.

Keyess, & K. A. Moore (Eds.), Well-being:

Positive development across the life course

(pp. 383–406). Mahwah, NJ: Erlbaum.

Erber, R., & Wang Erber, M. (2000). The self-

regulation of moods: Second thoughts on the

importance of happiness in everyday life. Psy-

chological Inquiry, 11, 142–148.

Erikson, E. E. (1968). Identity: Youth and crisis.

New York: Norton.

Ford, B. Q., & Tamir, M. (2012). When getting

angry is smart: Emotional preferences and

emotional intelligence. Emotion, 12, 685–

689.

Forman, H., Mäntylä, T., & Carelli, M. G.

(2011). Time keeping and working memory

development in early adolescence: A 4-year

follow- up. Journal of Experimental Child

Psychology, 108, 170 –179.

Garnefski, N., Legerstee, J., Kraaij, V., van den

Kommer, T., & Teerds, J. (2002). Cognitive

coping strategies and symptoms of depression

and anxiety: A comparison between adoles-

cents and adults. Journal of Adolescence, 25,

603–611.

Gray, J. R., & Braver, T. S. (2007). Integration of

emotion and cognitive control: A neurocom-

putational hypothesis of dynamic goal regula-

tion. In S. C. Moore & M. Oaksford (Eds.),

200 DEVELOPMENTAL CONSIDERATIONS

Emotional cognition: From brain to behavior

(pp. 289–316). Amsterdam: Benjamins.

Grecucci, A., & Sanfey, A. G. (this volume,

2014). Emotion regulation and decision mak-

ing. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed.). New York: Guilford

Press.

Gross, J. J. (1999). Emotion regulation: Past,

present, and future. Cognition and Emotion,

13, 551–573.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39, 281–291.

Gunnar, M. R., Wewerka, S., Frenn, K., Long,

J. D., & Griggs, C. (2009). Developmental

changes in hypothalamus– pituitary– adrenal

activity over the transition to adolescence:

Normative changes and associations with

puberty. Development and Psychopathology,

21, 69–85.

Hoeksma, J. B., Oosterlaan, J., & Schipper,

E. M. (2004). Emotion regulation and the

dynamics of feelings: A conceptual and meth-

odological framework. Child Development,

75, 354–360.

Hughes, E. K., Gullone, E., Dudley, A., & Tonge,

B. (2010). A case control study of emotion

regulation and school refusal in children and

adolescents. Journal of Early Adolescence, 30,

691–706.

Labouvie- Vief, G., DeVoe, M., & Bulka, D.

(1989). Speaking about feelings: Conceptions

of emotion across the life span. Psychology

and Aging, 4, 425– 437.

Larson, R., & Asmussen, L. (1991). Anger,

worry, and hurt in early adolescence: An

enlarging world of negative emotions. In M.

E. Colton & S. Gore (Eds.), Adolescent stress:

Causes and consequences (pp. 21–41). New

York: de Gruyter.

Larson, R., & Lampman- Petraitis, C. (1989).

Daily emotional states as reported by children

and adolescents. Child Development and Psy-

chopathology, 60, 1250–1260.

Larson, R., Moneta, G., Richards, M. H., &

Wilson, S. (2002). Continuity, stability, and

change in daily emotional experience across

adolescence. Child Development, 73, 1151–

1165.

Lazarus, R. S., & Folkman, S. (1984). Coping

and adaption. In W. D. Gentry (Ed.), Hand-

book of behavioral medicine (pp. 282–325).

New York: Guilford Press.

Luerssen, A., & Ayduk, O. (this volume, 2014).

The role of emotion and emotion regulation in

the ability to delay gratification. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp. 111–125). New York: Guilford Press.

Matarazzo, O. (2008). Use and effectiveness of

three modalities of emotion regulation after

negative life events: Rumination, distraction

and social sharing. In A. B. Turley & G. C.

Hofmann (Eds.), Life style and health research

progress (pp. 87–138). Hauppauge, New York:

Nova Biomedical Books.

Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007).

Automatic emotion regulation. Social and Per-

sonality Psychology Compass, 1, 146 –167.

McLaughlin, K. A., Hatzenbuehler, M. L., Men-

nin, D. S., & Nolen- Hoeksema, S. (2011).

Emotion dysregulation and adolescent psy-

chopathology: A prospective study. Behaviour

Research and Therapy, 49, 544–554.

McRae, K., Gross, J. J., Weber, J., Robertson,

E. R., Sokol- Hessner, P., Ray, R. D., et al.

(2012). The development of emotion regula-

tion: An fMRI study of cognitive reappraisal

in children, adolescents and young adults.

Social Cognitive and Affective Neuroscience,

7, 11–22.

Mesquita, B., De Leersnyder, J., & Albert, D.

(this volume, 2014). The cultural regulation

of emotions. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 284–302).

New York: Guilford Press.

Miller, E. M., & Shields, S. A. (1980). Skin con-

ductance response as a measure of adolescents’

emotional reactivity. Psychological Reports,

46, 587–590.

Mohanty, A., Engels, A. S., Herrington, J. D.,

Heller, W., Ho, M. H., Banich, M. T., et al.

(2007). Differential engagement of anterior

cingulate cortex subdivisions for cognitive and

emotional function. Psychophysiology, 44,

343–351.

Morris, A. S., Silk, J. S., Steinberg, L., Myers, S.

S., & Robinson, L. R. (2007). The role of the

family context in the development of emotion

regulation. Social Development, 16, 361–388.

Ochsner, K. N., & Gross, J. J. (2005). The cogni-

tive control of emotion. Trends in Cognitive

Sciences, 9, 242–249.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 23–42). New York: Guilford

Press.

Emotion Regulation in Adolescence 201

Opitz, P. C., Gross, J. J., & Urry, H. L. (2012).

Selection, optimization, and compensation

in the domain of emotion regulation: Appli-

cations to adolescence, older age, and major

depressive disorder. Social and Personality

Psychology Compass, 6, 142–155.

Ordaz, S., Davis, S., & Luna, B. (2010). Effects

of response preparation on developmental

improvements in inhibitory control. Acta Psy-

chologica, 134, 253–263.

Perry-

arrish, C., & Zeman, J. (2011). Relations

among sadness regulation, peer acceptance,

and social functioning in early adolescence:

The role of gender. Social Development, 20,

135–153.

Pfeifer, J. H., & Allen, N. B. (2012). Arrested

development? Reconsidering dual-

ystems

models of brain function in adolescence and

disorders. Trends in Cognitive Sciences, 16,

322–329.

Reijntjes, A., Stegge, H., Terwogt, M. M., Kam-

phuis, J. H., & Telch, M. J. (2006). Emotion

regulation and its effects on mood improve-

ment in response to an in vivo peer rejection

challenge. Emotion, 6, 543–552.

Riediger, M., & Rauers, A. (in press). Do everyday

affective experiences differ throughout adult-

hood? A review of ambulatory-

ssessment evi-

dence. In P. Verhaeghen & C. Hertzog (Eds.),

The Oxford handbook of emotion, social

cognition, and everyday problem solving dur-

ing adulthood. New York: Oxford University

Press.

Riediger, M., Schmiedek, F., Wagner, G., & Lin-

denberger, U. (2009). Seeking pleasure and

seeking pain: Differences in pro- and contra-

edonic motivation from adolescence to old

age. Psychological Science, 20, 1529–1535.

Riediger, M., Wrzus, C., Schmiedek, F., Wagner,

G. G., & Lindenberger, U. (2011). Is seeking

bad mood cognitively demanding? Contra-

hedonic orientation and working- memory

capacity in everyday life. Emotion, 11, 656–

665.

Riediger, M., Wrzus, C., & Wagner, G. G.

(2013). Happiness is pleasant, or is it? Rep-

resentations of affect valence are associated

with contra-

edonic motivation and mixed

affect in daily life. Manuscript submitted for

publication.

Robinson, M. D. (2007). Gassing, braking, and

self-

egulating: Error self-

egulation, well-

being, and goal-

elated processes. Journal of

Experimental Social Psychology, 43, 1–16.

Rothbaum, F., Weisz, J. R., & Snyder, S. S.

(1982). Changing the world and changing the

self: A two-

rocess model of perceived control.

Journal of Personality and Social Psychology,

42, 5–37.

Salisch, M. V., & Vogelgesang, J. (2005). Anger

regulation among friends: Assessment and

development from childhood to adolescence.

Journal of Social and Personal Relationships,

22, 837–855.

Schmeichel, B. J., & Demaree, H. A. (2010).

Working memory capacity and spontaneous

emotion regulation: High capacity predicts

self-

nhancement in response to negative feed-

back. Emotion, 10, 739–744.

Schmeichel, B. J., Volokhov, R. N., & Demaree,

H. A. (2008). Working memory capacity and

the self-

gulation of emotional expression

and experience. Journal of Personality and

Social Psychology, 95, 1526–1540.

Schulz, M. S., Waldinger, R. J., Hauser, S. T., &

Allen, J. P. (2005). Adolescents’ behavior in

the presence of interparental hostility: Devel-

opmental and emotion regulatory influences.

Development and Psychopathology, 17, 489–

507.

Shaver, P. R., & Mikulincer, M. (this volume,

2014). Adult attachment and emotion regula-

tion. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp.

237–250). New

York: Guilford Press.

Sheeber, L., Allen, N., Davis, B., & Sorensen, E.

(2000). Regulation of negative affect during

mother–

child problem-

solving interactions:

Adolescent depressive status and family pro-

cesses. Journal of Abnormal Child Psychol-

ogy, 28, 467–479.

Shortt, J. W., Stoolmiller, M., Smith-Shine, J. N.,

Mark Eddy, J., & Sheeber, L. (2010). Mater-

nal emotion coaching, adolescent anger regu-

lation, and siblings externalizing symptoms.

Journal of Child Psychology and Psychiatry,

51, 799–808.

Silk, J. S., Steinberg, L., & Morris, A. S. (2003).

Adolescents’ emotion regulation in daily life:

Links to depressive symptoms and problem

behavior. Child Development, 74, 1869–1880.

Silk, J. S., Vanderbilt-

driance, E., Shaw, D. S.,

Forbes, E. E., Whalen, D. J., Ryan, N. D., et

al. (2007). Resilience among children and ado-

lescents at risk for depression: Mediation and

moderation across social and neurobiological

contexts. Development and Psychopathology,

19, 841–865.

202 DEVELOPMENTAL CONSIDERATIONS

Silvers, J. A., McRae, K., Gabrieli, J. D., Gross,

J. J., Remy, K. A., & Ochsner, K. N. (2012).

Age- related differences in emotional reactiv-

ity, regulation, and rejection sensitivity in ado-

lescence. Emotion, 12(6), 1235–1247.

Sim, L., & Zeman, J. (2006). The contribution

of emotion regulation to body dissatisfaction

and disordered eating in early adolescent girls.

Journal of Youth and Adolescence, 35, 219–

228.

Steinberg, L. (2008). A social neuroscience per-

spective on adolescent risk- taking. Develop-

mental Review, 28, 78–106.

Steiner, M., Dunn, E., & Born, L. (2003). Hor-

mones and mood: From menarche to meno-

pause and beyond. Journal of Affective Disor-

ders, 74, 67–83.

Stroud, L. R., Foster, E., Papandonatos, G. D.,

Handwerger, K., Granger, D. A., Kivlighan,

K. T., et al. (2009). Stress response and the

adolescent transition: Performance versus peer

rejection stressors. Development and Psycho-

pathology, 21, 47–68.

Sumter, S., Bokhorst, C., Miers, A., Van Pelt,

J., & Westenberg, P. (2010). Age and puberty

differences in stress responses during a public

speaking task: Do adolescents grow more sen-

sitive to social evaluation? Psychoneuroendo-

crinology, 35, 1510–1516.

Tamir, M. (2009). What do people want to feel

and why? Pleasure and utility in emotion regu-

lation. Current Directions in Psychological

Science, 18, 101–105.

Thompson, R. A. (1994). Emotion regulation:

A theme in search of definition. Monographs

of the Society for Research in Child Develop-

ment, 59, 25–52.

Thompson, R. A. (this volume, 2014). Socializa-

tion of emotion and emotion regulation in the

family. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp. 173–186). New

York: Guilford Press.

Thorne, A. (2004). Putting the person into social

identity. Human Development, 47, 361–365.

Yap, M. B., Allen, N. B., & Ladouceur, C. D.

(2008). Maternal socialization of positive

affect: The impact of invalidation on adolescent

emotion regulation and depressive symptom-

atology. Child Development, 79, 1415–1431.

Yap, M. B., Allen, N. B., & Sheeber, L. (2007).

Using an emotion regulation framework to

understand the role of temperament and fam-

ily processes in risk for adolescent depressive

disorders. Clinical Child and Family Psychol-

ogy Review, 10, 180–196.

Yurgelun- Todd, D. (2007). Emotional and cog-

nitive changes during adolescence. Current

Opinion in Neurobiology, 17, 251–257.

Zeman, J., Cassano, M., Perry- Parrish, C., &

Stegall, S. (2006). Emotion regulation in chil-

dren and adolescents. Journal of Developmen-

tal and Behavioral Pediatrics, 27, 155–168.

Zimmer- Gembeck, M. J., & Skinner, E. A.

(2011). Review: The development of coping

across childhood and adolescence: An integra-

tive review and critique of research. Interna-

tional Journal of Behavioral Development,

35, 1–17.

203

Developmental psychologists have docu-

mented age- related changes in the regulation

of emotions across childhood that paral-

lel biological maturation. As children and

adolescents acquire and develop abilities

to control impulses and gain awareness of

themselves and others, they begin to achieve

mastery over their environments and become

increasingly effective at describing and regu-

lating their emotions. Brain maturation and

patterns of neurological functioning related

to emotional processes continue to develop

throughout childhood and adolescence.

Greater inhibitory control, for example, is

reflected in increased activity in the prefron-

tal cortex from childhood into the early 20s

(e.g., McRae et al., 2012). In the latter half

of the lifespan, however, the role of biologi-

cal development in emotional experience and

regulation is relatively understudied. Physi-

ological functioning is gradually degraded

with age, and it has long been assumed that

such changes affect emotional functioning.

A growing literature, however, suggests that

aging is associated with relatively positive

emotional experience in everyday life. As the

understanding of emotional aging improves,

it is becoming increasingly clear that older

people typically engage in strategies that

maintain positive emotional experiences

and limit negative ones. It is also becoming

clear that circumstances that restrict strat-

egy usage may have especially dire outcomes

for older adults.

For our purposes herein, we define emo-

tion regulation as efforts to experience rela-

tively low levels of negative affect and elicit

relatively high levels of positive affect (see

Gross, this volume, for a more complete

description of emotion regulation). The

study of age differences in emotion regula-

tion has grown, although direct comparisons

across the lifespan remain limited. Similarly,

studies that focus on thoughts and behav-

iors that enable people to avoid or mitigate

exposure to distressing events rarely link

such strategies to affective outcomes. Only

a few studies, which we describe below,

examine age differences in regulation when

people are intentionally increasing (i.e., up-

regulating or amplifying) or decreasing (i.e.,

down- regulating) their positive and negative

emotional states.

We focus our review on normal aging as

opposed to disease- related aging, and on the

general experience of positive and negative

affect as opposed to discrete emotions. We

begin with a brief overview of age differ-

ences in physiological processes involved in

emotional experience. We then describe the

scope of the existing literature examining

age and affective well-being. Next, we pres-

CHAPTER 13

Emotion Regulation and Aging

Susan Turk Charles

Laura L. Carstensen

204 DEVELOPMENTAL CONSIDERATIONS

ent socioemotional selectivity theory (SST)

and strength and vulnerability integration

(SAVI), both of which guide our understand-

ing of emotional development in adulthood.

SST has received considerable empirical

support since it was proposed in the early

1990s (see Charles & Carstensen, 2010). Its

core tenets concern the ways that time hori-

zons influence goals. SST initially addressed

emotion somewhat indirectly, based on the

premise that as people become increasingly

focused (selectivity) on emotionally mean-

ingful goals, well-being likely benefits. As

evidence for social selection accrued along

with evidence that emotional well-being is

relatively high in later life, we began to con-

sider selection as a highly effective form of

antecedent emotion regulation (Carstensen,

Fung, & Charles, 2003). SAVI, in contrast,

was proposed relatively recently. It aims to

integrate the relatively positive profile of

emotional well-being with concurrent evi-

dence of repercussions for older adults who

experience sustained and inescapable expo-

sure to toxic situations. We review empirical

findings that are consistent with the premise

that motivational shifts lead to differences

in attention, memory, social partner prefer-

ences, and problem- solving strategies that

serve to maintain or optimize emotional

experience. Next, we discuss situations pos-

ited by SAVI, in which benefits of age may

be less pronounced and may even reverse in

direction. We then review areas that we pre-

viously highlighted as especially important

and how they have been addressed since the

previous edition of this volume. We conclude

that the emerging literature suggests that age

differences in emotional experience, cogni-

tive processes, and physiological functioning

operate in concert to yield relatively well-

preserved if not enhanced emotional well-

being in later life.

Emotion and the Aging

Physiological System

Emotional experience, like all psychological

phenomena, is inextricably linked to physi-

ological functioning. Aging in three bio-

logical systems— the central nervous system

(specifically the brain), the cardiovascular

system, and the neuroendocrine system— is

relevant for emotional aging.

Age Changes in Brain Structure

and Functioning

Researchers have documented normative

age- related changes in both brain structure

and functioning. Brain volume decreases

with age, with reductions in the synaptic

density of white matter and a consequent

slowing of neural processing that accom-

panies demyelination (e.g., Westlye et al.,

2010). These age- related decreases are

observed after the fourth decade of life, and

exhibit an accelerating decline beginning in

the early to mid-60s (Westyle et al., 2010).

Brain activation in response to emotional

stimuli shifts throughout childhood and into

early adulthood toward less activation in the

amygdala and greater activation of the pre-

frontal cortex, findings that researchers use

to explain developmental increases in emo-

tion regulation abilities (McRae et al., 2012).

The same difference in relative activity of

these brain regions is found in comparisons

of younger and older adults, a phenomenon

referred to as the posterior– anterior shift in

aging (PASA; Davis, Dennis, Dasellar, Fleck,

& Cabeza, 2008). In memory and percep-

tual studies, with and without emotional

stimuli, older adults show greater activity in

the prefrontal regions and reduced activity

in medial and temporal regions compared to

younger adults (Davis et al., 2008).

Age Changes in Cardiovascular

and Neuroendocrine Functioning

Cardiovascular and neuroendocrine

responses also change with age. Although

the overall pattern of cardiovascular reactiv-

ity to stressors is the same, aging is related

to relative differences in the degree of this

reactivity. Specifically, older age is related to

a smaller increase in heart rate in response

to stressors but greater increases in blood

pressure reactivity (see review by Uchino,

Birmingham, & Berg, 2010). The reduced

heart rate reactivity most likely represents

age- related reductions in heart rate variabil-

ity (HRV) that are normative and begin in

adolescence, and that are a risk factor for

mortality (Zulfigar, Jurivich, Gao, & Singer,

2010).

The neuroendocrine response also varies

with age (Björntorp, 2002). The perception

of a real or imagined threat mobilizes the

Emotion Regulation and Aging 205

body for action through a series of reac-

tions along the hypothalamic– pituitary–

adrenal (HPA) axis that results in the release

of cortisol by the adrenal glands. In both

human and animal models, cortisol reactiv-

ity in response to psychological and physi-

cal stressors is prolonged with age, such that

more time is necessary to return to baseline

levels (see review by Björntorp, 2002).

Age Differences

in Emotional Experience

Early theories positing that emotional well-

being and regulation would parallel age-

related biological decline were so pervasive

that researchers did not bother to test them.

In the last few decades, however, researchers

have dispelled many myths about inevitable

depression and despair in late life. Older age

is not associated with high levels of emo-

tional distress in examinations of people

ranging from ages 18 to 84 years (Kobau,

Safran, Zack, Moriarty, & Chapman,

2004). Rates of anxiety and major depres-

sive disorder are lower among adults age 65

years and older than in younger cohorts (see

review by Piazza & Charles, 2006; Villa-

mil, Huppert, & Melzer, 2006). Reports of

subdromal depression— feeling sad, blue, or

depressed within the past 30 days— decrease

linearly across increasingly older age groups

(Kobau et al., 2004).

This age- related decrease in self- reported

negative affect is observed longitudinally in

normal populations as well (e.g., Carstensen,

Pasupathi, Mayr, & Nesselroade, 2000;

Carstensen et al., 2011), although patterns

vary across studies when examining peo-

ple over age 60. Findings from a number

of cross- sectional studies suggest that the

experience of negative emotion continues

to decline after age 60 (e.g., Grühn, Kotter-

Grühn, & Röcke, 2010; Stone, Schwartz,

Broderick, & Deaton, 2010). This decrease

has also been found over time among

cohorts of younger, middle- aged, and older

adults followed across 20 years (Charles,

Reynolds, & Gatz, 2001). In one experi-

ence sampling study, the decrease in nega-

tive emotional experience peaked and then

stabilized somewhere between ages 60 and

70 (Carstensen et al., 2011). Other studies

have found slight age- related increases in

depressive symptoms in advanced old age

(e.g., after age 80 in one study; Teachman,

2006), although levels were still lower than

those observed in young adults. In another

study, adjusting for functional limitations

and chronic illness eliminated the upturn

in negative affect among the octogenarians

(e.g., Kunzmann, Little, & Smith, 2000).

Findings from studies that examine posi-

tive affect are mixed but overall point to

considerable stability. Although age- related

linear decreases (about half a point on a

5-point Positive Affect Scale) were observed

among people from a large, multinational

sample of people ranging in age from their

20s to 80s (Diener & Suh, 1998), this pattern

has not been found in other studies. Using

the same scale, a large longitudinal study

found age- related stability across 20 years

among younger and middle- aged adults, and

a small decline only among people age 65

and older who began the study (Charles et

al., 2001). Another large U.S. national sur-

vey observed slightly higher levels of positive

affect with age in a sample of people rang-

ing in age from 25 to 74 years (Mroczek

& Kolarz, 1997). Two other large surveys

found that reports of daily happiness and

enjoyment (in a U.S. sample) and reports of

joviality and serenity (in a German sample)

exhibited an age- related U-shaped pattern,

decreasing among successively older adults

from ages 18 to the mid-50s, but increasing

thereafter, such that people in their 70s and

80s had levels of these emotions similar to

those of people in their late teens and early

20s (Grühn et al., 2010; Stone et al., 2010);

people in their 50s reported the lowest levels

of these positive emotions in both the U.S.

and German samples.

Taking the findings on negative and posi-

tive affect together, overall well-being does

not follow the physiological trajectories

of linear decline across adulthood. One

potential explanation for these findings is

that age- related reductions in physiologi-

cal ability may paradoxically lead to flat-

tened, or diminished, emotional experiences

that are easier to regulate. Studies provide

little evidence, however, for this hypoth-

esis. Older adults report less negative emo-

tion in daily life, but the reported intensity

of both positive and negative emotions is

similar across age groups (Carstensen et al.,

2000, 2011). In other words, when older

206 DEVELOPMENTAL CONSIDERATIONS

people do experience emotions, the inten-

sity is similar to that of younger people.

Older and middle- aged adults report similar

levels of emotional experience when asked

to relive emotionally charged events or to

engage in a confrontation with their spouses

(Levenson, Carstensen, & Gottman, 1994;

Magai, Consedine, Krivoshekova, Kudadjie-

Gyamfi, & McPherson, 2006; Story et al.,

2007). Some studies in which people react

to film clips have revealed higher subjective

ratings of intensity in older adults than in

younger adults in response to scenes elicit-

ing sadness, especially when scenes were

particularly salient for older people, for

example, in a depiction of a person realiz-

ing that she has Alzheimer’s disease (Kun-

zmann & Grühn, 2005; Kunzmann & Rich-

ter, 2009; Kliegel, Jäger, & Phillips, 2007;

Seider, Shiota, Whalen, & Levenson, 2011).

Older adults also reported greater reports

of intensity to film clips depicting injustice

(Charles, 2005; Phillips, Henry, Hosie, &

Milne, 2008). Other film-based studies have

not observed age differences (Tsai, Leven-

son, & Carstensen, 2000).

Socioemotional Selectivity Theory

SST, a lifespan theory of motivation that

addresses how and why emotional well-

being changes across the lifespan, posits that

at conscious and subconscious levels, human

monitor time, continuously adjusting their

time horizons as they move through life (see

Carstensen, 1992, 2006; Carstensen, Isaa-

cowitz, & Charles, 1999). This accounting

of time influences the relative importance

of two constellations of goals that dominate

human thought and behavior. One set of

goals includes knowledge and information-

based goals, and is prioritized when time is

perceived as expansive. The other goal con-

stellation includes a focus on emotional life,

encompassing motivations to derive mean-

ing in actions and to invest in activities for

their emotional significance.

Because time perspective is strongly related

to place in the life cycle, growing older

comes with an increasing awareness of the

ephemeral nature of existence: As a result,

emotional goals increase in relative impor-

tance to knowledge- related goals as people

age. People become increasingly selective in

their goals as they age, so that experiences

are more emotionally meaningful and satis-

fying. This selection process falls under the

rubric of antecedent- focused emotion regu-

lation, whereby people engage in actions to

avoid the experience of distress and to main-

tain or enhance the experience of positive

emotions. Accordingly, people allocate more

effort to maintaining emotional balance,

attempting to improve important relation-

ships, and setting aside relatively trivial mat-

ters. Of course, experience grows with age

as well, so older people are well- positioned

to manage social relationships and have the

skills to solve important conflicts. Accord-

ing to SST, motivational shifts that also

operate at a subconscious level influence

cognitive processing in which people favor

positive material and disattend to negative

information. Goals always direct attention

and memory, and with age, cognition comes

to operate in the service of emotion regula-

tion.

Strength and Vulnerability

Integration

SAVI endorses SST and its tenet that aware-

ness of time left to live directs priorities,

such that a focus on emotional experience,

and specifically positive emotional experi-

ences above negative ones, gradually comes

to influence thought and action (Charles,

2010; Charles & Piazza, 2009). People act

on these motivations based on their accrued

knowledge about themselves and their social

environment, and their experience from

time lived. As a result, aging is associated

with motivational shifts— both conscious

and subconscious— that direct attention,

influence memorial processing, and change

preferences in ways that allow people to

circumvent negative experiences. If they

cannot avoid these experiences altogether,

cognitive- behavioral emotion regulation

strategies allow them to decrease their expo-

sure and mitigate relatively minor stressors

in their day-to-day lives.

According to SAVI, older adults more

often engage in emotion regulation strategies

(i.e., thoughts and behaviors whose aim is to

reduce negative affect and maintain or even

enhance positive affect) than do younger

adults who fail to shy away from negative

Emotion Regulation and Aging 207

situations, presumably because there is

informational value in negative experiences

that prepares people for the future. When

confronted with minor events, older adults

appraise them as less stressful (e.g., Charles

& Carstensen, 2008). When older adults

cannot employ strengths of aging to avoid or

mitigate their exposure to a negative event,

however, they experience distress. During

these demanding and highly arousing situ-

ations, SAVI posits that the age- related ben-

efits disappear or even reverse in direction.

Because age is related to biological changes

that present greater threats to a less robust

physiological system, SAVI posits that high

levels of physiological reactivity and conse-

quent recovery in response to sustained neg-

ative arousal are more costly to older adults.

Age, Cognitive Functioning,

and Antecedent-Focused

Emotion Regulation

Emotional Salience

and Emotion Regulation

Brains do not operate like computers, treat-

ing all information equally. Rather, cogni-

tive resources are directed to goal- relevant

information. SST posits that older adults

place more importance and prominence on

emotional than on nonemotional aspects

of stimuli they encounter in the labora-

tory or in their daily lives, and they do so

without explicit awareness of their actions.

Laboratory studies using incidental memory

paradigms reveal that the proportion of

emotional versus nonemotional informa-

tion increases linearly as a function of age

(Carstensen & Turk- Charles, 1994), and

emotional details are recalled better than

perceptual details of stories (e.g., Mather,

Johnson, & De Leonardis, 1999). In addi-

tion, the salience of emotion is greater with

age when people recall autobiographical

information (Alea, Bluck, & Semegon,

2004). Overall, this pattern of findings sug-

gests that older adults pay attention to emo-

tionally relevant information that in and of

itself may aid emotion regulation.

Rather than “positivity bias” we coined

the term positivity effect to describe the

age- related pattern of change (Carstensen &

Mikels, 2005; Mather & Carstensen, 2005).

Age differences are as frequently driven by a

preference for negative material in the young

as a preference for positive material in the

old. The positivity effect refers to the age-

related pattern of change.

Brain Activity and the Positivity Effect

Studies of brain activity during the process-

ing of emotional information support the

positivity effect. Mather et al. (2004) specu-

late that subconscious changes in motivation

influence activation of the amygdala, con-

sistent with their finding that older adults

show greater amygdalar activity when view-

ing positive rather than negative images.

Other brain regions also show age differ-

ences in activation depending on the emo-

tional valence of the information (Samanez-

Larkin et al., 2007). In a study examining

brain activity in response to decision mak-

ing, older adults exhibited less activation in

insula and caudate regions than did younger

adults when they anticipated loss, but

similar activation when anticipating gains

(Samanez- Larkin et al., 2007).

The general PASA in processing infor-

mation discussed previously (St. Jacques,

Bessette- Symons, & Cabeza, 2009) may

serve emotion regulation goals. For exam-

ple, one study revealed that older adults

display less amygdalar activity and greater

activation of areas associated with emotion

regulation (prefrontal cortex) when viewing

negative images compared to positive images

relative to younger adults (Leclerc & Kens-

inger, 2011). Another study revealed age

differences in connectivity of the amygdala

to other brain regions, consistent with age-

related increases in emotion regulation pro-

cesses (St. Jacques, Dolcos, & Cabeza, 2009,

2010). Specifically, older adults showed more

activity in a brain region associated with

emotion regulation (ventral anterior cingu-

late cortex), and less activity in areas asso-

ciated with perceptual processing (visual

cortex) than did the younger adults (St.

Jacques et al., 2010). Age- related reductions

in activities related to perceptual processing

are consistent with the well- established age-

related reductions in facial emotion recogni-

tion in the literature (e.g., Lambrecht, Krei-

felts, & Wildgruber, 2012). Similar patterns

emerge with brain activation and consequent

memory for these pictures (St. Jacques et al.,

2009). Older adults exhibit greater activity

208 DEVELOPMENTAL CONSIDERATIONS

in frontal regions associated with emotional

control (bilateral dorsolateral prefrontal cor-

tex) and less activity in regions associated

with later memory encoding (hippocampus

and bilateral ventrolateral prefrontal corti-

ces) for negative stimuli relative to neutral

stimuli than do younger adults. Behavioral

data again reflected these findings: Older

adults were less likely than younger adults

to remember the negative stimuli relative to

the neutral stimuli (St. Jacques et al., 2009).

Age‑Related Changes in Attention

and Working Memory

The positivity effect explains how chronic

activation of emotion- related goals directs

cognitive resources systematically toward

positive and away from negative stimuli—

often without conscious awareness. Older

adults focus their attention on more posi-

tive and less negative stimuli than do

younger adults in studies of simple atten-

tion, as assessed by reaction times (Mather

& Carstensen, 2003) and eye gaze (e.g.,

Isaacowitz, Toner, Goren, & Wilson, 2008;

Nikitin & Freund, 2011).

SST predicts that top-down motivational

changes with age lead to changes in atten-

tion and memory that serve emotion regu-

lation goals, such that performance may be

better for emotional information than for

nonemotional information. One such exam-

ple lies in working memory, which is vital

for emotional functioning and planning,

because working memory allows an individ-

ual to focus on the potential for rewards and

enhances goal- seeking behavior (Davidson,

Jackson, & Kalin, 2000). In a test of SST,

the working memory performance of older

and younger adults was examined on tasks

in which participants compared images

based on either their brightness intensity

or emotional intensity (Mikels, Larkin,

Reuter- Lorenz, & Carstensen, 2005). Find-

ings reveal the usual age- related decrement

in working memory for visual brightness but

no age difference in working memory for

affective arousal. Moreover, the lack of age

differences was driven by older adults’ bet-

ter performance for positive stimuli than for

negative stimuli compared to younger adults

(Mikels et al., 2005). Other studies suggest

that emotion regulation is less cognitively

taxing for older adults than for younger

adults (e.g., Scheibe & Blanchard- Fields,

2009). In one study, Scheibe and Blanchard-

Fields asked younger and older adults to

perform a working memory task after hav-

ing been induced into a negative mood and

asked to down- regulate or maintain current

mood, or were provided no specific instruc-

tions. Although the performance of younger

adults deteriorated when they were asked to

down- regulate their emotions, the perfor-

mance of older adults did not vary from that

in the other conditions. Similarly, another

study found that emotional suppression was

related to worse memory for younger adults

but not for older adults (Emery & Hess,

2011).

Evidence That Memory Supports

Emotion Regulation

Antecedent- focused emotion regulation

strategies prevent or reduce exposure to

events and thoughts that threaten well-

being. To the extent that memories influence

current mood states, thoughts, and behav-

ior (see review by Levine & Pizarro, 2004),

memory can be a powerful regulation strat-

egy. This shift in valence toward positive

information with age has been documented

in studies examining memory for both life

events and laboratory stimuli. Memory

about past events is more positive for older

compared to younger adults (Kennedy,

Mather, & Carstensen, 2004). Even when

asked about prior negative events, older

adults report them as having been more

positive than do younger adults (Schryer &

Ross, 2012).

Laboratory studies underscore the shift

toward older people remembering events

more positively. In a study in which younger,

middle- aged, and older adults viewed posi-

tive, negative, and neutral images, and were

later asked to recall and to recognize these

previously viewed images from a larger set

of images, younger adults recalled similar

levels of positive and negative stimuli, and

they recognized a greater proportion of neg-

ative images than positive images (Charles,

Mather, & Carstensen, 2003). Older adults

displayed no such negative bias in their recog-

nition, and they recalled significantly fewer

negative than positive images (Charles et

al., 2003). This age- associated shift toward

positive emotion and away from negative

Emotion Regulation and Aging 209

information has been replicated in a num-

ber of studies from many laboratories (e.g.,

Petrican, Moscovitch, & Schimmack, 2008;

Piguet, Connally, Krendl, Huot, & Corkin,

2008; see reviews by Reed & Carstensen,

2012; Scheibe & Carstensen, 2010).

Cognitive Appraisal of Negative Events

Older adults not only focus their attention

on less negative aspects of the environment

but they also appraise ambiguous or unpleas-

ant events more benignly than do younger

adults. Older adults perceive daily stressors

as less severe and less threatening than do

younger adults in a sample ranging from

25 to 74 years (Charles & Almeida, 2007).

They appraise aversive stimuli less nega-

tively than do younger adults, and are more

likely to focus their thoughts away from the

negative content (Charles & Carstensen,

2008). Even when asked about their diag-

nosis and treatment of cancer, older adults

report lower levels of threat appraisals (e.g.,

the amount of tension people experience in

response to their illness) and are more likely

than younger adults to frame the event as

a challenge rather than a threat (Hart &

Charles, 2013).

The Positivity Effect Is Malleable

SST maintains that—all things being equal—

chronically activated goals differ for older

and younger people. However, because posi-

tivity reflects top-down motivational shifts

as opposed to bottom- up brain- driven shifts,

the effect is theoretically malleable. Younger

people sometimes pursue emotional goals,

and older adults sometimes pursue informa-

tional goals. In circumstances where stakes

are high, younger and older people may

pursue goals that direct attention toward or

away from emotional material accordingly.

Indeed, Löckenhoff and Carstensen (2007)

examined whether experimental instruc-

tions provided to participants would elimi-

nate age differences. In an initial phase of

the study, participants were simply asked

to review information about a variety of

alternative health care plans. In this condi-

tion, older people focused more on positive

than on negative characteristics. In a second

condition, researchers explicitly asked older

adults to focus on informational aspects of

the plans; that is, they gave the participants

a specific goal, namely, to pursue informa-

tion. And in this condition, age differences

were eliminated. Reed and Carstensen

(2013) recently reviewed the positivity effect

literature and concluded that positivity pref-

erences are strongest during controlled pro-

cessing when motivations are hypothesized

to play a strong role (for discussion, see

Kensinger, 2004).

Whether or not positivity in cognitive pro-

cessing is adaptive or maladaptive depends

on the task. Certainly there are situations

where selective attention to positivity may

disadvantage performance. Decision mak-

ing likely benefits from evenhanded process-

ing of advantages and disadvantages associ-

ated with options. Focusing on the positive

interpersonal qualities of a charming con-

man could have disastrous financial conse-

quences. Ignoring negative information or

appraising a situation as less negative than

it is may lead to short-term benefits to well-

being but longer term problems that lead

to distress (Scheibe & Carstensen, 2010).

Focusing on positive aspects and avoiding

negative realities of fiscal concerns may lead

to “optimistic, but not necessarily realistic,

financial planning” (Weierich et al., 2011,

p. 197). Ignoring negative information may

contribute to misremembering negative

information as more positive than it actually

was (Shamaskin, Mikels, & Reed, 2010).

Finally, there is some evidence that not

only emotional valence but also arousal con-

tribute to age differences in positivity. Grühn

and Scheibe (2008) found that older people

perceived positive pictures in the Interna-

tional Affective Picture System (IAPS) as

more positive and less arousing than did

younger adults. Keil and Freund (2009) later

observed that older adults prefer less arous-

ing positive and negative images and words

than do younger adults, and Streubel and

Kunzmann (2011) reported that the subjec-

tive experience of positivity in older adults

is reduced under high arousal. Using experi-

ence sampling data, Scheibe, English, Tsai,

and Carstensen (2013) recently examined

the effect of age differences in the value

placed on high- versus low- arousal states

and concluded that older people placed more

value on low- arousal positive states and were

more successful in achieving them than their

younger counterparts. Taken together, these

210 DEVELOPMENTAL CONSIDERATIONS

findings suggest that older adults may orient

to positive material that is more calming and

peaceful than to positive material associated

with excitement and surgency.

Social Partners

and Emotion Regulation

This review has focused largely on age-

related changes in cognitive processes that

serve emotion regulation goals. SST also

makes specific predictions about how age-

related behaviors, and explicitly changes in

social partner preferences and interaction

patterns, serve emotion regulatory goals.

Older adults have smaller and more care-

fully pruned social networks that contain

larger percentages of emotionally close

social partners than do those of younger

adults (Lang & Carstensen, 1994). Younger

peoples’ networks, by way of contrast, often

include many social partners who were not

chosen freely but have been incorporated

because of relationships to work or offspring

(Lang & Carstensen, 1994; Lansford, Sher-

man, & Antonucci, 1998). Thus, the social

networks of older adults may be easier to

navigate emotionally. Because most strong

emotions occur in social contexts, careful

selection of social partners is arguably a

highly effective strategy. When faced with

interpersonal conflict in their networks,

older adults engage in more conflict avoid-

ance, with the goal of preserving harmony in

their relationships, than do middle- aged and

younger adults (Blanchard- Fields, Mienal-

towski, & Seay, 2007).

Responding to Negative Events

The previously discussed literature points

to older adults using— either knowingly or

not— thoughts and behaviors that fall under

the category of antecedent- focused emo-

tion regulation strategies. Some researchers

argue, however, that older adults’ greater

well-being reflects not actions by the older

adults but instead age- related differences

in environmental demands (see review by

Lawton, 2001). According to this view, the

end of child- rearing responsibilities and the

onset of retirement decreases the frequency

of negative events more in the lives of older

than younger adults (see review by Lawton,

2001; but see Villamil et al., 2006). On the

other hand, older people face many chal-

lenges that younger people are less likely to

face, such as chronic health problems, loss of

loved ones, and age discrimination.

Although questions about environmental

demands are important and there is some

evidence that changes in life circumstances

may contribute to the decreased number of

stressors older adults report in their daily

lives (e.g., Charles & Almeida, 2007), there

is evidence that older adults are also active

agents in influencing their well-being. Com-

pared to younger people, older adults report

better control over their emotions (Gross

et al., 1997), enhanced abilities to regulate

emotions in general (Kessler & Staudinger,

2009), as well as more success at calming

strategies and other thoughts to control their

feelings of anger (Phillips, Henry, Hosie, &

Milne, 2008). Although the veracity of sub-

jective reports alone may be questioned, they

are consistent with low levels of psychiatric

disease and reported experience, and behav-

ioral evidence in the literature. For exam-

ple, when people ranging in age from 18 to

94 years reported the emotions they were

experiencing at five random times each day

throughout the course of a week, the proba-

bility of continuing to feel a negative emotion

from one reporting interval to the next was

lower with advancing age (Carstensen et al.,

2000). Researchers have discussed how older

adults select and are adept at using emotion

regulation strategies given their decrements

in others area of their lives, such as cognitive

functioning (Urry & Gross, 2010).

Questions remain, however, as to how

well older adults regulate their emotions

when they cannot avoid or mitigate expo-

sure to a negative event. SAVI posits that

when older adults cannot avoid experienc-

ing high and sustained levels of emotional

distress, this arousal reduces any age- related

benefits previously observed for regulation

abilities. One study explicitly compared age

differences in affective outcomes in two situ-

ations: one in which people disengaged from

a negative event and another in which they

did not (Charles, Piazza, Luong, & Almeida,

2009). When older adults encountered an

unpleasant situation in which they chose to

avoid further conflict, they reported lower

levels of affective reactivity than did younger

adults. When they engaged in a conflict, no

Emotion Regulation and Aging 211

age differences in reactivity were apparent

(Charles et al., 2009).

Other studies also suggest that high lev-

els of arousal reduce age- related benefits

in emotional outcomes and may even show

age- related decrements. When older and

younger adults report stressors of equally

high severity, older adults display greater

affective reactivity than do younger adults

(Mroczek & Almeida, 2004). Longitudinal

data confirm this age- related pattern, in that

when people report experiencing a stressor,

affective reactivity increases with age (Sli-

winski, Almeida, Smyth, & Stawski, 2009).

The studies described earlier use informa-

tion gathered from the daily lives of adults.

Researchers attempting to capture emo-

tion regulation in the laboratory face the

challenge of devising paradigms that elicit

responses sufficiently strong to demand

active and sustained regulatory efforts.

Although use of weak stimuli, such as pic-

tures of facial expressions, has become

commonly accepted, we strongly question

the validity of this approach when research-

ers are interested in participants’ efforts to

regulate emotional responses actively. Stron-

ger inductions are possible with film clips,

personal memories, music, and interactions

with confederates or spouses. Of course, a

tradeoff exists between carefully controlled

elicitors and responsivity. Only a handful of

such studies that focus on age differences in

regulation effectiveness have been published

to date.

In one study, subjective reports of distress

were compared across groups of younger (18

to 40 years old) and older adults (60 to 88

years old) who watched emotional film clips

with instructions to react naturally, suppress

all facial expressions, or positively refocus

on a pleasant memory if they felt any nega-

tive emotions (Phillips et al., 2008). Results

indicate that older adults reported less

intense negative affect in the positive reap-

praisal condition compared to the other con-

ditions. When comparing across age groups,

older and younger adults had similar ratings

in the positive reappraisal condition, but

younger adults reported less negative affect

than older adults in the conditions where

they were instructed to react naturally or to

suppress their facial expressions.

Another study examined the baseline,

reactivity, and recovery ratings of nega-

tive affect in older (60 to 75 years old)

and younger (20 to 30 years old) adults in

response to a film clip that elicited disgust

(Scheibe & Blachard- Fields, 2009). After

having viewed the film clips, participants

were given instructions to attempt to change

the negative feelings into positive ones or to

continue feeling their negative emotions and

not try to change them, or they were given no

instructions. Results indicated no significant

age differences in the reported affect during

the recovery period. However, older adults

showed less deterioration in performance on

one of the three trials of a n-back task fol-

lowing the induction, suggesting that fewer

resources were required for regulation.

A third study examined three types of

regulation strategies in older (60–69 years),

middle- aged (40–49 years) and younger

adults (20–29 years) in response to emo-

tional film clips (Shiota & Levenson, 2009).

The three strategies were detached appraisal,

in which participants were told to watch

objectively in order to feel less negative emo-

tion; positive reappraisal, in which they

were told to think about positive aspects of

what they were viewing so that they would

feel less negative emotion; or emotional sup-

pression, in which they were asked to hide

negative facial expressions. When compar-

ing subjective reports across different con-

ditions within each age group, researchers

found that detached appraisal resulted in

significantly lower levels of distress among

the younger adults, marginally signifi-

cant lower levels of distress in middle- aged

adults, but the same level of distress in older

adults when compared to the “just watch”

condition. Only older adults showed sig-

nificantly lower levels of subjective distress

in the positive reappraisal condition com-

pared to the “just watch” condition. When

examining mean levels of the target emo-

tions (sadness or disgust) across age groups,

subgroups reporting the lowest mean levels

were the youngest and middle- aged adults

in the detached appraisal group (3.25 and

4.08, respectively), and the two groups with

the highest reported target emotions were

the middle- aged and oldest adults in the

positive reappraisal groups (5.42 and 5.20,

respectively).

One recent study compared younger (18-

to 30-year-olds) and older (60- to 80-year-

olds) participants’ responses as they viewed

212 DEVELOPMENTAL CONSIDERATIONS

negative and neutral images in three condi-

tions: a “just watch” condition, in which

they were told simply to look at the image; a

condition in which each image was preceded

by a string of digits they need to remember

immediately after their 10-second exposure

to the image; and a condition in which they

were instructed to reinterpret the picture in

such a way that they would feel less negative

affect (Tucker, Feuerstein, Mende- Siedlecki,

Ochsner, & Stern, 2012). After each image,

participants rated how much negative emo-

tion they felt. Findings indicate that younger

adults reported less negative reactivity in

the reappraisal condition than did the older

adults, but age groups were similar in levels

of reactivity in the distraction condition.

In summary, few studies have examined

emotion regulation strategies that target

decreasing subjective distress when people

are exposed to unpleasant stimuli under con-

trolled laboratory conditions. Findings from

the handful of existing studies do not point to

consistent evidence for age- related improve-

ments or impairment in emotion regulation.

As we note below, however, we believe that

more of this type of research is needed.

Physical Costs of Emotion Regulation

SAVI further posits that circumstances

marked by higher levels of sustained arousal

will have greater physiological consequences

for older adults. Support for this tenet comes

from literature examining both cardiovas-

cular and HPA reactivity responses to emo-

tional events in younger and older adults.

For example, blood pressure reactivity is

more pronounced in older adults relative

to younger adults in response to stressors

of daily life and laboratory- based stressors

such as social evaluative threat (Ong, Roth-

stein, & Uchino, 2012; Uchino et al., 2010)

and when dealing with cognitively com-

plex stressors of daily life (Wrusz, Müller,

Wagner, Lindenberger, & Riediger, 2013).

In addition, the effect of a more prolonged

negative experience— loneliness— is more

strongly related to blood pressure recovery

in older than in younger adults (Ong et al.,

2012).

Age- related changes in HPA reactivity

have been studied less frequently. Although

researchers document prolonged HPA reac-

tivity in animal studies, they have conducted

fewer studies using human samples (Björn-

torp, 2002). Still, findings suggest that nega-

tive affect is related more strongly to cortisol

output for older than for younger adults.

For example, one study found that high lev-

els of negative affect were related to higher

level of daily cortisol output for relatively

older participants (54 to 74 years old), but

unrelated to this biomarker for people 53

and younger (Piazza, Charles, Stawski, &

Almeida, 2013).

When Avoiding Negative

Emotions Does Not Occur:

Aging with Negative Affect

SAVI posits that affective well-being remains

relatively stable and may increase with age,

with one important caveat. When older

people find themselves in unavoidable cir-

cumstances that elicit sustained physiologi-

cal arousal, the consequences for well-being

will be exacerbated. Researchers have long

discussed the powerful role of the environ-

ment in shaping emotion- related outcomes

and how age is related to different life cir-

cumstances. These circumstances are pos-

ited to explain why not all groups of older

adults show continuing, positive trajecto-

ries of emotional experience. Loss of social

belonging, prolonged caregiving, and neuro-

logical dysregulation may result in an upturn

in depressive symptoms and negative affect

in the last decades of life (Charles, 2010).

For example, in the last years of life—often

characterized by neurological and physi-

ological dysregulation— there are reliable

declines in emotional well-being. Indeed,

Gerstorf and colleagues (2010) found that

terminal decline is better predicted by close-

ness to death than by chronological age. On

the one hand, age and closeness to death

are strongly coupled in the population, but

Gerstorf and his colleagues found that years

from birth may be less important than the

circumstances that define the years to death

in predicting emotional well-being.

In addition, experiencing chronically high

levels of trait- negative affect also makes peo-

ple more vulnerable to emotional distress

with age. For example, two studies have

found that declines in subjective reports of

negative affect do not continue into old age

for those high in neuroticism (Charles et al.,

2001; Ready, Akertedt, & Mroczek, 2012).

Emotion Regulation and Aging 213

Future Directions and Conclusions

Empirical findings amassed over the past 30

years have dramatically changed the land-

scape of research on emotion and aging.

Among healthy adults, emotional experi-

ences and emotion regulation do not decline

across adulthood but are instead well-

maintained and, in some ways, improve. We

review below the aims for future studies we

recommended 5 years ago.

We stated that future studies will need to

link hypothesized emotion regulation strat-

egies (e.g., attention allocation) directly to

emotion regulation. This area has begun to

receive some attention (e.g., Isaacowitz &

Blanchard- Fields, 2012), but more work and

conceptual clarity are needed. SST, for exam-

ple, focuses on selection as the key mecha-

nism involved in greater well-being with age,

and views selective attention and memory

as consequences of changes in goals. In the

theoretical context of SST, the positivity

effect, rather than being a coping strategy,

reflects goal- directed attention. Whether or

not older people also deplore positive atten-

tion in response to distress remains an open

question. SAVI posits that when selection

is not possible, age advantages disappear

or even reverse. Further study is needed to

examine how emotion regulation strategies

and effectiveness change with age, relative

to the way age reflects both birth cohort

and age- associated experience. In addi-

tion, we mentioned the need to study mul-

tiple response- focused regulation strategies

and include conditions specifying main-

tenance, exacerbation, and attenuation of

emotional experience in the investigations.

As we reviewed earlier, several studies have

begun to address different types of strategies

among people of different ages (e.g., Shiota

& Levenson, 2009). We hope that research-

ers will continue to investigate age differ-

ences in online emotion regulation tasks.

We mentioned the need to examine the

importance of the arousal of emotional stim-

uli when studying age differences (Wurm,

Labouvie- Vief, Aycock, Rebucal, & Koch,

2004), as well as the complexity of emo-

tional stimuli (Charles, 2005). Researchers

who take into account the role of arousal

in processing and regulating emotions find

that more arousing conditions may be more

challenging for older adults (e.g., Ong et al.,

2012). It will be important to consider both

valence and arousal. We mentioned the need

to examine discrete emotions in the previ-

ous edition of this volume, and provided

the example that no large study to date has

reported increases in levels of anger with age,

but one study did observe age differences in

reports of depressive symptoms (e.g., Teach-

man, 2006) although others have not. A

growing number of studies has examined

discrete emotions (Grühn et al., 2010) and

especially emotion recognition (e.g., Slessor,

Miles, Bull, & Phillips, 2010), yet theories

still focus mostly on positive and negative

valence and arousal when examining emo-

tion regulation processes (see Charles &

Carstensen, 2010).

One methodological issue that frequently

arises in lifespan developmental research is

the issue of cohort effects. Cross- sectional

research points to potentially interesting

developmental phenomena, but only longi-

tudinal research can confirm developmen-

tal processes postulated by socioemotional

selectivity theory. Researchers have made

great strides in longitudinal investigation of

more complex emotional stimuli in the past

5 years (e.g., Carstensen et al., 2011; Ger-

storf et al., 2010; Sliwinski et al., 2009) and

the maintenance of large longitudinal data-

sets promises to illuminate the field in this

important area.

Methodological innovations in the past

5 years have advanced the field in several

ways. For example, functional imaging of

brain activity has illuminated associations

between behavior and brain activity, and

promises to provide insights into the neuro-

logical correlates of age differences. As this

area grows, the study of emotion and aging

will continue to benefit. A second innova-

tion that will shape the future of psycho-

logical science is the growing area of health

psychology and new techniques allowing

for affordable assessments of cardiovascu-

lar, neuroendocrine, and immunological

responses in the laboratory and in daily life.

With these studies of physiological stabil-

ity and reactivity, researchers will be able

to examine how thoughts and behaviors are

related to physiological arousal and reactiv-

ity accompanying emotional experience. In

addition, smart phones provide the ability to

assess cognitive functioning rapidly, along

with momentary sampling of emotion across

214 DEVELOPMENTAL CONSIDERATIONS

the course of the days, which provides more

online collection of cognitive and emotional

experiences (see Riediger, Schmiedek, Wag-

ner, & Lindenberger, 2009).

Finally, psychologists have long recog-

nized the importance of the environment

in shaping behavior (see review by Hess,

2005), but we need to continue to recognize

the importance of context when interpret-

ing age differences. Although notable excep-

tions exist, such as studies examining age

differences in social cognition (e.g., Hess,

2005) and in health- related contexts (e.g.,

Consedine & Magai, 2006), further stud-

ies are needed to understand how similar

behaviors or cognitions may have different

outcomes according to age- specific contexts.

Perceptions are guided by experiences, and

these experiences may alter the meaning and

interpretation of emotional stimuli. A pic-

ture of a surgical procedure, for example,

may elicit more sadness in older adults but

more disgust in younger adults (e.g., Kun-

zmann & Grühn, 2005). The death of a par-

ent is often an imagined event for a college

student and a long past reality for an older

adult. To this end, the study of emotions and

aging is an examination of how cognition

and behavior shape, and are shaped by, the

interplay between physiological processes

and the environment across the lifespan.

In conclusion, emotions arouse physi-

ological systems and direct attention, and

they motivate people to action. Emotions

are critical for successful adaptation across

the lifespan, but developmental processes

alter multiple facets of emotional experi-

ence, including cognitive appraisals, behav-

ioral responses, physiological reactivity, and

environmental context. Research on emo-

tion and aging has revealed that shifts in

cognitive processing can offset physiologi-

cal decline, such that even though biologi-

cal functioning peaks relatively early in life,

emotional experience remains vital and well

maintained into late adulthood.

Acknowledgments

This work was supported by National Institute

on Aging Grant No. R37-AGO8816 to Laura L.

Carstensen.

References

Alea, N., Bluck, S., & Semegon, A. B. (2004).

Young and older adults’ expression of emo-

tional experience: Do autobiographical nar-

ratives tell a different story? Journal of Adult

Development, 11, 235–250.

Björntorp, P. (2002). Alterations in the ageing

corticotropic stress- response axis. In Novartis

Foundation Symposium (Ed.), Novartis Foun-

dation Symposium 242—Endocrine facets of

ageing (pp. 46–58). London: Wiley.

Blanchard- Fields, F., Mienaltowski, A., & Seay,

R. B. (2007). Age differences in everyday

problem- solving effectiveness: Older adults

select more effective strategies for interper-

sonal problems. Journals of Gerontology: Psy-

chological Science, 62, P61–P64.

Carstensen, L. L. (1992). Social and emotional

patterns in adulthood: Support for socio-

emotional selectivity theory. Psychology and

Aging, 7, 331–338.

Carstensen, L. L. (2006). The influence of a

sense of time on human development. Science,

312, 1913–1915.

Carstensen, L. L., Isaacowitz, D. M., & Charles,

S. T. (1999). Taking time seriously: A theory

of socioemotional selectivity. American Psy-

chologist, 54, 165–181.

Carstensen, L. L., Fung, H., & Charles, S.

(2003). Socioemotional selectivity theory and

the regulation of emotion in the second half

of life. Motivation and Emotion, 27, 103–123.

Carstensen, L. L., & Mikels, J. A. (2005). At the

intersection of emotion and cognition: Aging

and the positivity effect. Current Directions in

Psychological Science, 14, 117–121.

Carstensen, L. L., Pasupathi, M., Mayr, U., &

Nesselroade, J. R. (2000). Emotional experi-

ence in everyday life across the adult lifespan.

Journal of Personality and Social Psychology,

79, 644–655.

Carstensen, L. L., Turan, B., Scheibe, S., Ram,

N., Ersner- Hershfield, H., Samanez- Larkin,

G. R., et al. (2011). Emotional experience

improves with age: Evidence based on over 10

years of experience sampling. Psychology and

Aging, 26, 21–33.

Carstensen, L. L., & Turk- Charles, S. (1994).

The salience of emotion across the adult lifes-

pan. Psychology and Aging, 9, 259–264.

Charles, S. T. (2005). Viewing injustice: Age dif-

ferences in emotional experience. Psychology

and Aging, 20, 159–164.

Emotion Regulation and Aging 215

Charles, S. T. (2010). Strength and Vulnerabil-

ity Integration (SAVI): A model of emotional

well-being in later adulthood. Psychological

Bulletin, 136, 1068–1091.

Charles, S. T., & Almeida, D. M. (2007).

Genetic and environmental effects on daily

life stressors: More evidence for greater varia-

tion in later life. Psychology and Aging, 22,

231–240.

Charles, S. T., & Carstensen, L. L. (2008).

Unpleasant situations elicit different emo-

tional responses in younger and older adults.

Psychology and Aging, 23, 495–504.

Charles, S. T., & Carstensen, L. L. (2010).

Social and emotional aspects of aging. Annual

Review of Psychology, 61, 383– 409.

Charles, S. T., Mather, M., & Carstensen, L. L.

(2003). Aging and emotional memory: The

forgettable nature of negative images for older

adults. Journal of Experimental Psychology:

General, 132, 310–324.

Charles, S. T., & Piazza J. R. (2009). Age differ-

ences in affective well-being: Context matters.

Social and Personality Psychology Compass,

3, 1–14.

Charles, S. T., Piazza, J., Luong, G., & Almeida,

D. M. (2009). Now you see it, now you don’t:

Age differences in affective reactivity to social

tensions. Psychology and Aging, 24, 645–653.

Charles, S. T., Reynolds, C. A., & Gatz, M.

(2001). Age- related differences and change

in positive and negative affect over 23 years.

Journal of Personality and Social Psychology,

80, 136–151.

Consedine, N. S., & Magai, C. (2006). Emotion

development in adulthood: A developmental

functionalist review and critique. In C. Hoare

(Ed.), The Oxford handbook of adult develop-

ment and learning (pp. 209–244). New York:

Oxford University Press.

Davidson, R. J., Jackson, D. C., & Kalin, N.

H. (2000). Emotion, plasticity, context, and

regulation: Perspectives from affective neuro-

science [Special issue]. Psychological Bulletin,

126, 890–909.

Davis, S. W., Dennis, N. A., Daselaar, S. M.,

Fleck, M. S., & Cabeza, R. (2008). Que

PASA?: The posterior– anterior shift in aging.

Cerebral Cortex, 18, 1201–1209.

Diener, E., & Suh, E. M. (1998). Subjective

well-being and age: An international analysis.

Annual Review of Gerontology and Geriat-

rics, 17, 304–324.

Emery, L., & Hess, T. M. (2011). Cognitive con-

sequences of expressive regulation in older

adults. Psychology and Aging, 26, 388–396.

Gerstorf, D., Ram, N., Mayraz, G., Hidajat,

M., Lindenberger, U., Wagner, G. G., et al.

(2010). Late-life decline in well-being across

adulthood in Germany, the United Kingdom,

and the United States: Something is seriously

wrong at the end of life. Psychology and

Aging, 25, 577–485.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., Carstensen, L. L., Pasupathi, M.,

Tsai, J., Götestam Skorpen, C., & Hsu, A.

Y. C. (1997). Emotion and aging: Experi-

ence, expression, and control. Psychology and

Aging, 12, 590–599.

Grühn, D., Kotter-Grühn, D., & Röcke, C.

(2010). Discrete affects across the lifespan:

Evidence for multidimensionality and multidi-

rectionality of affective experiences in young,

middle- aged and older adults. Journal of

Research in Personality, 44, 492–500.

Grühn, D., & Scheibe, S. (2008). Age- related

differences in valence and arousal ratings of

pictures from the International Affective Pic-

ture System (IAPS): Do ratings become more

extreme with age? Behavior Research Meth-

ods, 40, 512–521.

Hart, S. L., & Charles, S. T. (2013). Age- related

patterns in negative affect and appraisals

about colorectal cancer over time. Health Psy-

chology, 32, 302–310.

Hess, T. M. (2005). Memory and aging in con-

text. Psychological Bulletin, 131, 383–406.

Isaacowitz, D. M., & Blanchard- Fields, F.

(2012). Linking process and outcome in the

study of emotion and aging. Perspectives on

Psychological Science, 7, 3 –17.

Isaacowitz, D. M., Toner, K., Goren, D., & Wil-

son, H. R. (2008). Looking while unhappy:

Mood congruent gaze in young adults, posi-

tive gaze in older adults. Psychological Sci-

ence, 22, 147–159.

Keil, A., & Freund, A. M. (2009). Changes in the

sensitivity to appetitive and aversive arousal

across adulthood. Psychology and Aging, 24,

668–680.

Kensinger, E. A. (2004). Remembering emotional

experiences: The contribution of valence and

arousal. Reviews in the Neurosciences, 15(4),

231–307.

216 DEVELOPMENTAL CONSIDERATIONS

Kennedy, Q., Mather, M., & Carstensen, L. L.

(2004). The role of motivation in the age-

related positivity effect in autobiographical

memory. Psychological Science, 15, 208–214.

Kessler, E., & Staudinger, U. M. (2009). Affec-

tive experience in adulthood and old age: The

role of affective arousal and perceived affect

regulation. Psychology and Aging, 24, 349–

362.

Kliegel, M., Jäger, T., & Phillips, L. H. (2007).

Emotional development across adulthood:

Differential age- related emotional reactivity

and emotion regulation in a negative mood

induction procedure. International Journal

of Aging and Human Development, 64, 217–

244.

Kobau, R., Safran, M. A., Zack, M. M., Mori-

arty, D. G., & Chapman, D. (2004). Sad,

blue, or depressed days, health behaviors

and health- related quality of life, Behavioral

Risk Factor Surveillance System, 1995–2000.

Health and Quality of Life Outcomes, 2, 40.

Kunzmann, U., & Grühn, D. (2005). Age differ-

ences in emotional reactivity: The sample case

of sadness. Psychology and Aging, 20, 47–59.

Kunzmann, U., Little, T. D., & Smith, J. (2000).

Is age- related stability of subjective well-being

a paradox?: Cross- sectional and longitudinal

evidence from the Berlin aging study. Psychol-

ogy and Aging, 15, 511–526.

Kunzmann, U., & Richter, D. (2009). Emotional

reactivity across the adult life span: The cogni-

tive pragmatics make a difference. Psychology

and Aging, 24, 879–889.

Lambrecht, L., Kreifelts, B., & Wildgruber, D.

(2012). Age- related decrease in recognition

of emotional facial and prosodic expressions.

Emotion, 12, 529–539.

Lang, F. R., & Carstensen, L. L. (1994). Close

emotional relationships in late life: Further

support for proactive aging in the social

domain. Psychology and Aging, 9, 315–324.

Lansford, J. E., Sherman, A. M., & Antonucci, T.

C. (1998). Satisfaction with social networks:

An examination of socioemotional selectivity

theory across cohorts. Psychology and Aging,

13, 544–552.

Lawton, M. P. (2001). Emotion in later life. Cur-

rent Directions in Psychological Science, 10,

120–123.

Leclerc, C. M., & Kensinger, E. A. (2011). Neural

processing of emotional pictures and words: A

comparison of young and older adults. Devel-

opmental Neuropsychology, 26, 519–538.

Levenson, R. W., Carstensen, L. L., & Gottman,

J. M. (1994). The influence of age and gender

on affect, physiology, and their interrelations:

A study of long-term marriages. Journal of

Personality and Social Psychology, 67, 56–68.

Levine, L. J., & Pizarro, D. A. (2004). Emotion

and memory research: A grumpy overview.

Social Cognition, 22, 530–554.

Löckenhoff, C. E., & Carstensen, L. L. (2007).

Aging, emotion, and health- related decision

strategies: Motivational manipulations can

reduce age differences. Psychology and Aging,

22, 134–146.

Magai, C., Consedine, N. S., Krivoshekova, Y.

S., Kudadjie- Gyamfi, E., & McPherson, R.

(2006). Emotion experience and expression

across the adult life span: Insights from a mul-

timodal assessment study. Psychology and

Aging, 21, 303–317.

Mather, M., Canli, T., English, T., Whitfield, S.,

Wais, P., Ochsner, K., et al. (2004). Amygdala

responses to emotionally valenced stimuli in

older and younger adults. Psychological Sci-

ence, 15, 259–263.

Mather, M., & Carstensen, L. L. (2003). Aging

and attentional biases for emotional faces.

Psychological Science, 14, 409–415.

Mather, M., & Carstensen, L. L. (2005). Aging

and motivated cognition: The positivity effect

in attention and memory. Trends in Cognitive

Sciences, 9, 496–502.

Mather, M., Johnson, M. K., & De Leonardis,

D. M. (1999). Stereotype reliance in source

monitoring: Age differences and neuropsycho-

logical test correlates. Cognitive Neuropsy-

chology, 16, 437–458.

McRae, K., Gross, J. J., Weber, J., Robertson,

E. R., Solkol- Hessner, P., Ray, R. D., et al.

(2012). The development of emotion regula-

tion: An fMRI study of cognitive reappraisal

in children, adolescents and young adults.

Scan, 7, 11–22.

Mikels, J. A., Larkin, G. R., Reuter- Lorenz, P.,

& Carstensen, L. L. (2005). Divergent trajec-

tories in the aging mind: Changes in working

memory for affective versus visual information

with age. Psychology and Aging, 20, 542–553.

Mroczek, D. K., & Almeida, D. M. (2004). The

effect of daily stress, personality, and age on

daily negative affect. Journal of Personality,

72, 355–378.

Mroczek, D. K., & Kolarz, C. M. (1998). The

effect of age on positive and negative affect: A

developmental perspective on happiness. Jour-

nal of Personality and Social Psychology, 75,

1333–1349.

Emotion Regulation and Aging 217

Nikitin, J., & Freund, A. M. (2011). Age and

motivation predict gaze behavior for facial

expressions. Psychology and Aging, 26, 695–

700.

Ong, A. D., Rothstein, J. D., & Uchino, B. N.

(2012). Loneliness accentuates age differences

in cardiovascular responses to social evalua-

tive threat. Psychology and Aging, 27, 190–

198.

Petrican, R., Moscovitch, M., & Schimmack,

U. (2008). Cognitive resources, valence, and

memory retrieval of emotional events in older

adults. Psychology and Aging, 23, 585–594.

Phillips, L. H., Henry, J. D., Hosie, J. A., &

Milne, A. B. (2008). Effective regulation of

the experience and expression of negative

affect in old age. Journals of Gerontology B:

Psychological Sciences and Social Sciences,

63, P138–P145.

Piazza, J., & Charles, S. T. (2006). Mental health

and the baby boomers. In S. K. Whitbourne

& S. L. Willis (Eds.), The baby boomers at

midlife: Contemporary perspectives on mid-

dle age (pp. 111–148). Mahwah, NJ: Erlbaum.

Piazza, J. R., Charles, S. T., Stawski, R. S., &

Almeida, D. M. (2013). Age and the asso-

ciation between negative affective states and

diurnal cortisol. Psychology and Aging, 28,

47–56.

Piguet, O., Connally, E., Krendl, A. C., Huot,

J. R., & Corkin, S. (2008). False memory in

aging: Effects of emotional valence on word

recognition accuracy. Psychology and Aging,

23, 85–92.

Ready, R. E., Akerstedt, A. M., & Mroczek, D.

K. (2012). Emotional complexity and emo-

tional well-being in older adults: Risks of neu-

roticism. Aging and Mental Health, 16, 17–26.

Reed, A., & Carstensen, L. L. (2012) The theory

behind the age- related positivity effect. Fron-

tiers in Cognitive Science, 3, 1–9.

Riediger, M., Schmiedek, F., Wagner, G., & Lin-

denberger, U. (2009). Seeking pleasure and

seeking pain: Differences in prohedonic and

contra- hedonic motivation from adolescence

to old age. Psychological Science, 20, 1529–

1535.

Samanez- Larkin, G. R., Gibbs, S. E. B., Khanna,

K., Nielsen, L., Carstensen, L. L., & Knutson,

B. (2007). Anticipation of monetary gain but

not loss in healthy older adults. Nature Neuro-

science, 10, 787–791.

Scheibe, S., & Blanchard- Fields, F. (2009).

Effects of regulating emotions on cognitive

performance: What is costly for young adults

is not so costly for older adults. Psychology

and Aging, 24, 217–223.

Scheibe, S., & Carstensen, L. L. (2010). Emo-

tional aging: Recent findings and future

trends. Journals of Gerontology B: Psycho-

logical and Social Sciences, 65, 135–144.

Scheibe, S., English, T., Tsai, J. L., & Carstensen,

L. L. (2013). Striving to feel good: Ideal affect,

actual affect, and their correspondence across

adulthood. Psychology and Aging, 28, 160–

171.

Schryer, E., & Ross, M. (2012). Evaluating the

valence of remembered events: The impor-

tance of age and self- relevance. Psychology

and Aging, 27, 237–242.

Seider, B. H., Shiota, M. N., Whalen, P., & Lev-

enson, R. W. (2011). Greater sadness reactiv-

ity in late life. Social Cognitive and Affective

Neuroscience, 6, 186–194.

Shamaskin, A. M., Mikels, J. A., & Reed, A. E.

(2010). Getting the message across: Age differ-

ences in the positive and negative framing of

health care messages. Psychology and Aging,

25, 746–751.

Shiota, M. N., & Levenson, R. W. (2009).

Effects of aging on experimentally instructed

detached reappraisal, positive reappraisal, and

emotional behavioral suppression. Psychology

and Aging, 24, 890–900.

Slessor, G., Miles, L. K., Bull, R., & Phillips, L.

H. (2010). Age- related changes in detecting

happiness: Discriminating between enjoyment

and nonenjoyment smiles. Psychology and

Aging, 25, 246–250.

Sliwinski, M. J., Almeida, D. M., Smyth, J., &

Stawski, R. S. (2009). Intraindividual change

and variability in daily stress processes: Find-

ings from two measurement- burst diary stud-

ies. Psychology and Aging, 24, 828–840.

St. Jacques, P., Dolcos, F., & Cabeza, R. (2009).

Effects of aging on functional connectivity of

the amygdala during subsequent memory for

negative pictures: A network analysis of fMRI

data. Psychological Science, 20, 74–84.

St. Jacques, P., Dolcos, F., & Cabeza, R. (2010).

Effects of aging on functional connectivity of

the amygdala during negative evaluation: A

network analysis of fMRI data. Neurobiology

of Aging, 31, 315–331.

St. Jacques, P. L., Bessette- Symons, B., & Cabeza,

R. (2009). Functional neuroimaging studies of

aging and emotion: Fronto- amygdalar differ-

ences during emotional perception and epi-

sodic memory. Journal of the International

Neuropsychological Society, 15, 819–825.

218 DEVELOPMENTAL CONSIDERATIONS

Stone, A. A., Schwartz, J. E., Broderick, J. E.,

& Deaton, A. (2010). A snapshot of the age

distribution of psychological well-being in the

United States. Proceedings of the National

Academy of Sciences USA, 107(22), 9985–

9990.

Story, T. N., Berg, C. A., Smith, T. W., Beveridge,

R., Henry, N. J. M., & Pearce, G. (2007). Age,

marital satisfaction, and optimism as predic-

tors of positive sentiment override in middle-

aged and older married couples. Psychology

and Aging, 22, 719 –727.

Streubel, B., & Kunzmann, U. (2011). Age dif-

ferences in emotional reactions: Arousal and

age- relevance count. Psychology and Aging,

26, 966–978.

Teachman, B. A. (2006). Aging and negative

affect: The rise and fall and rise of anxiety and

depressive symptoms. Psychology and Aging,

21, 201–207.

Tsai, J. L., Levenson, R. W., & Carstensen, L.

L. (2000). Autonomic, expressive and subjec-

tive responses to emotional films in younger

and older adults of European American and

Chinese descent. Psychology and Aging, 15,

684–693.

Tucker, A. M., Feuerstein, R., Mende- Siedlecki,

P., Ochsner, K. N., & Stern, Y. (2012). Dou-

ble dissociation: Circadian off-peak times

increase emotional reactivity; Aging impairs

emotion regulation via reappraisal. Emotion,

12, 869–874.

Uchino, B. N., Birmingham, W., & Berg, C. A.

(2010). Are older adults less or more physi-

ologically reactive?: A meta- analysis of age-

related differences in cardiovascular reactivity

to laboratory tasks. Journals of Gerontology

B: Psychological Sciences and Social Sciences,

65, P154–P162.

Urry, H. L., & Gross, J. J. (2010). Emotion regu-

lation in older age. Current Directions in Psy-

chological Science, 19, 352–357.

Villamil, E., Huppert, F. A., & Melzer, D. (2006).

Low prevalence of depression and anxiety is

linked to statutory retirement ages rather than

personal work exit: A national survey. Psycho-

logical Medicine, 36, 999–1009.

Weierich, M. R., Kensinger, E. A., Munnell, A.

H., Sass, S. T., Dickerson, B. D., Wright, C.

I., et al. (2011). Older and wiser?: An affec-

tive science perspective on age- related chal-

lenges in financial decision making. Scan, 6,

195–206.

Westlye, L. T., Walhovd, K., B., Dale, A. M.,

Bjørnerud, A., Due-Tønnessen, P., Engvig, A.,

et al. (2010). Life-span changes of the human

brain white matter: Diffusion tensor imaging

(DTI) and volumetry. Cerebral Cortex, 20,

2055–2068.

Wrzus, C., Müller, V., Wagner, G. G., Linden-

berger, U., & Riediger, M. (2013). Affective

and cardiovascular responding to unpleasant

events from adolescence to old age: Complex-

ity of events matters. Developmental Psychol-

ogy, 49, 384 –397.

Wurm, L. H., Labouvie- Vief, G., Aycock, J.,

Rebucal, K. A., & Koch, H. E. (2004). Perfor-

mance in auditory and visual emotional Stroop

tasks: A comparison of older and younger

adults. Psychology and Aging, 19, 523–535.

Zulfiqar, U., Jurivich, D. A., Gao, W., & Singer,

D. H. (2010). Relation of high heart rate vari-

ability to healthy longevity. American Journal

of Cardiology, 105, 1181–1185.

PART V

SOCIAL ASPECTS

221

To survive and reproduce, organisms must

take in more energy than they expend,

a principle of behavioral ecology called

economy of action (Krebs & Davies, 1993).

Social baseline theory (SBT), a framework

based on this principle, organizes decades

of observed links between social relation-

ships, health, and well-being, in order to

understand how humans utilize each other

as resources to optimize individual energy

expenditures. This general strategy helps us

manage the costs of our very long period of

ontogenetic development and, we argue, the

many behavioral and psychological capa-

bilities of our uniquely powerful and costly

brain (Smith, 2003). Below, we review evi-

dence that social relationships serve the

energy- saving functions that we claim and

describe the reasons SBT refers to social

proximity as a “baseline” condition. For

this chapter we place special emphasis on the

role of social proximity in the regulation of

emotion. In our view, the social regulation

of emotion serves, in the aggregate and on

average, to decrease the cost of coping with

many of life’s difficulties (Cohen & Hober-

man, 1983; Cohen & McKay, 1984)—a

function that involves the brain’s ability

to use both internal and external informa-

tion to make “bets” about how to deploy its

own resources in light of expected returns.

This perspective (1) highlights the impor-

tance of emotion as a source of information

about current and predicted resources, and

(2) entails a view of psychological measure-

ment that extends beyond the individual to

systemic processes within dyads and groups

(Schilbach et al., in press).

Social Proximity and the Economy

of Action

The economy of action suggests that adap-

tations to prevailing environmental con-

ditions must, at the very least, ensure that

more energy is acquired than lost (Krebs

& Davies, 1993). The alternative— more

energy out than in—leads ultimately to

death. But because environments are rife

with danger and competition, the economy

of action tends toward optimization, where

resources are both acquired and conserved

whenever possible. For example, foraging

animals optimize energy intake per unit

of time by abandoning even plentiful food

sources if the amount of energy (e.g., calo-

ries) acquired is not optimal (MacArthur

& Pianka, 1966; Schmidhempel, Kacelnik,

& Houston, 1985). Optimization strategies

CHAPTER 14

Social Baseline Theory

and the Social Regulation of Emotion

James A. Coan

Erin L. Maresh

222 SOCIAL ASPECTS

are likely mediated through changes in sen-

sory perception. So simply wearing a heavy

backpack can make distances appear far-

ther away and hills seem steeper (Stefanucci,

Proffitt, Banton, & Epstein, 2005). Indeed,

it is increasingly apparent that perception is

influenced by not only the properties of sen-

sory stimuli but also emotions— emotions

that are themselves embodied instantia-

tions of prevailing circumstances, goals,

and physiological states (Stefanucci, Proffitt,

Clore, & Parekh, 2008).

SBT is rooted in the proposition that, for

humans, social proximity and interaction

powerfully optimize energy expenditures

(e.g., actual and perceived effort) devoted to

navigating potentially dangerous environ-

ments. Moreover, the best evidence suggests

these effects are mediated through rela-

tively automatic, bottom- up, unconditioned

perceptual mechanisms that modulate—

and regulate— emotional responding, as

opposed to mechanisms often associated

with the self-regulation of emotion (e.g., the

dorsolateral [dlPFC] and ventromedial pre-

frontal cortex [vmPFC]). SBT invokes the

economy of action here, too, by suggesting

that perceptual mechanisms of the central

nervous system are “inexpensive”

when

compared to more effortful, self- regulatory,

vigilant, “future- thinking” processes associ-

ated with the operation of the PFC—a dif-

ference that leads to both phylogenetic and

ontogenetic pressures to achieve regulatory

ends by perceptual and hence social means.

We suggest that the ability to depend on oth-

ers for as many costly processes as possible

leads to (1) decreased overall cost in deal-

ing with an uncertain and potentially deadly

environment, and (2) pressure— throughout

the lifespan and over the course of evolu-

tion— to form and maintain close social

relationships.

Before going any further, we would like to

emphasize three important points. First, our

view of social emotion regulation does not

imply that any and all effects an individual’s

behavior may have on the emotional behav-

ior of another constitute regulatory effects.

If one individual insults or compliments

another, either behavior could cause the

receiver to activate an emotional response.

This would not, however, constitute an

instance of emotion regulation. An indi-

vidual regulates another’s emotions when

his or her behavior (which might encompass

social history with the other person, an offer

of aid, or simply close physical proximity)

influences another’s emotional response to

some additional current or potential stimu-

lus or situation. Second, we acknowledge

that people vary in the extent to which they

both seek out and derive benefit from social

contact (leading to individual differences in

the broad processes described here). But on

average and in the aggregate, it is probably

the case that for humans and other social

mammals, proximity to social resources

reduces the net cost of survival. Third,

although most of the empirical evidence we

review entails the regulatory impact of social

proximity and interaction on the regulation

of negative affect, we do not intend to argue

that negative affect is the only broad form of

emotional responding that can be regulated.

Indeed, below we address some instances of

the social regulation of positive emotion.

Our Social Baseline

There is little doubt that supportive social

behaviors can modify or quell our subjec-

tive, behavioral, and physiological responses

to stress (Holt- Lunstad, Smith, & Lay-

ton, 2010). Such effects are likely rooted

in human phylogeny. Indeed, Beckes and

Coan (2011) and others (Berscheid, 2003;

Brewer & Caporeal, 1990) have suggested

that the dominant ecology to which humans

are adapted is not any one terrain, diet, or

climate, but rather each other. One of the

defining features of human beings— our

adaptability— is yoked to our ability to

cooperate with others, an ability that was

likely shaped by periods of great environ-

mental instability (Richerson, Bettinger,

& Boyd, 2005). Cooperative behavior was

likely selected as a means of managing the

energy costs of our exceedingly expensive

bodies, brains, and activities (Hill et al.,

2011; McNally, Brown, & Jackson, 2012;

Moll & Tomasello, 2007). So the first sense

in which SBT refers to a social baseline is

that social relatedness and its psychological

correlates constitute the normal, baseline

ecology of the functional human brain. That

is, the human brain is designed to operate

within a relatively predictable network of

social relationships characterized by famil-

Social Baseline Theory 223

iarity, shared intentionality, and interdepen-

dence (Tomasello, Carpenter, Call, Behne,

& Moll, 2005).

The other sense in which SBT refers to

the social “baseline” results from work

using functional magnetic resonance imag-

ing (fMRI; Coan, Schaefer, & Davidson,

2006), which suggests that social proximity

and interaction regulate many aspects of the

brain’s response to potential threats. Spe-

cifically, the authors subjected 16 married

women to the threat of mild electric shock

under three conditions, counterbalanced

across subjects: while alone in the scanner,

while holding a stranger’s hand, and while

holding her husband’s hand. The brain was

maximally active while facing the threat

alone, exhibiting a set of responses repli-

cating a large body of work on the brain’s

response to threat, fear, stress, and pain

(Bishop, Duncan, Brett, & Lawrence, 2004;

Brooks, Nurmikko, Bimson, Singh, & Rob-

erts, 2002; Dedovic et al., 2005; Stark et al.,

2003). As levels of contact with perceived

social resources increased, however, many

of these activations either decreased in inten-

sity or vanished altogether.

For example, although both spouse and

stranger handholding caused decreased

threat responding in regions associated

with the regulation of bodily arousal and

the mobilization of behavioral action

plans—such as the ventral anterior cingu-

late cortex, supramarginal and postcentral

gyri, and posterior cingulate— only spouse

hand- holding was specifically associated

with additional attenuation in circuits asso-

ciated with effortful emotion regulation

and threat- related homeostatic functions,

such as the right dlPFC and superior col-

liculus. Most strikingly, women inhabiting

the highest quality relationships realized

dramatic attenuations in all the aforemen-

tioned threat- responsive regions in addition

to those supporting subjective suffering and

the release of stress hormones, such as the

right anterior insula and hypothalamus.

Putting it all together, there appeared to be

a relatively linear, monotonic decrease in

the degree of threat- related neural process-

ing as one progressed from being alone to

being with anyone (stranger or spouse), to

being with a spouse, to being with a spouse

in a very high- quality relationship. This sug-

gests that the perception of threat decreases

as a function of not only proximity to social

resources but also the perceived quality of

those resources.

From the perspective of SBT, the alone

condition used in the hand- holding para-

digm described earlier is not a “baseline”

condition against which the experimental

hand- holding conditions are compared. On

the contrary, the reverse is true—the hand-

holding conditions are closer to the environ-

mental conditions to which the human brain

is adapted, and the alone condition is far-

ther away. This conclusion forms part of the

basis of SBT—that social resources decrease

the perceived cost of managing a threaten-

ing environment, providing a primary and

largely unconditional opportunity for econ-

omizing both neural and behavioral activity.

Importantly, these effects are not depen-

dent upon physical touch per se. For

example, there is less hypothalamic activ-

ity during social rejection among individu-

als asked to imagine an attachment figure

(Karremans, Heslenfeld, van Dillen, & Van

Lange, 2011). Moreover, imagining a strong

attachment figure seems to have resulted in

not more but less activity in frontal regions

supporting self- regulatory effort, suggesting

that even imagining the presence of a secure

attachment figure may regulate one’s emo-

tions in such a way as to conserve perceived

resources.

Social Systems Regulate

the Emotions of Individuals

Critically, what we experience and catego-

rize as emotion powerfully impacts the way

we perceive and engage with the world (Ste-

fanucci, Gagnon, & Lessard, 2011). Emo-

tional processes carry vital, often implicit,

and embodied information about the good-

ness and badness of things (Clore & Tamir,

2002)—information that modifies percep-

tion and guides action (Barrett & Bar, 2009;

Schwarz & Clore, 1983). It follows that

emotions are indicators of, among other

things, the tension between perceived per-

sonal resources and perceived environmen-

tal demands (Moore, Vine, Wilson, & Free-

man, 2012; Tomaka, Blascovich, Kelsey,

& Leitten, 1993). In this way, emotion is

probably at or near the center of decisions

that economize activity (Bechara, 2011;

224 SOCIAL ASPECTS

Stefanucci et al., 2008). Accordingly, SBT

suggests that the brain uses affective, expe-

riential, conceptual, and contextual knowl-

edge— in effect, emotion (Barrett, 2006;

Lindquist & Barrett, 2008)—to bias percep-

tion in ways that guide actions toward more

favorable outcomes (Beckes & Coan, 2011;

Coan, 2008).

Emotion has been identified by others

as a key link between social relationships

and health. For example, the social buffer-

ing hypothesis suggests that social relation-

ships can provide support that is tangible,

such as material support when facing loss

of income, appraisal- based support, such as

when familiar others reduce the incidence

or intensity of threat- related appraisals, or

emotional support, such as when famil-

iar others repair threats to self- esteem or

increase a sense of felt belonging (Cohen &

McKay, 1984). It has been suggested further

that social relationships grow into part of

the brain’s understanding of itself and its

available resources (Beckes, Coan, & Has-

selmo, 2012). Moreover, as it makes predic-

tions about the potential cost of coping with

a given situation, the brain follows Bayes-

ian rules of inference (Friston, 2010; Knill

& Pouget, 2004), in which judgments about

the level of personal resources to deploy are

based on (1) the current situation (particu-

larly constraints, risks, and opportunities),

(2) predicted possible future situations, (3)

situational goals, (4) current energy states,

and (5) expected future energy states (Sali-

nas, 2011).

For example, hills appear to be less steep

when standing next to a friend (Schnall,

Harber, Stefanucci, & Proffitt, 2008), and

this effect is correlated with friendship dura-

tion: the longer the friendship, the less steep

the hill appears to be. The perception that

the hill is less steep serves as a marker that

one has, in effect, more bioenergetic capi-

tal in one’s budget— capital that can either

be spent more freely walking up the hill, or

conserved over time. Diverse studies hint

at similar conclusions regarding the brain’s

Bayesian properties. For example, Kraus,

Huang, and Keltner (2010) have observed

that more frequent physical touching among

professional basketball players corresponds

with increased late- season performance,

even after accounting for player status, pre-

season expectations, and early season per-

formance. Others have observed that one of

the best predictors of collective IQ is not the

IQs of individual group members but rather

the degree to which each member is sensitive

to social cues expressed on the face (Wool-

ley, Chabris, Pentland, Hashmi, & Malone,

2010). From the perspective of SBT, each

of these findings is attributable to the way

social resources help to conserve costly vigi-

lance and self- regulation efforts, either by

imposing less interference with motor and

perceptual activity (in the case of players in

the NBA), or by devoting those resources to

solving other kinds of problems (in the case

of collective IQ). But the question of why

social resources economize human neural

and behavioral activity remains. We pro-

pose at least two broad, distal mechanisms

by which this is accomplished: risk distribu-

tion and load sharing.

Risk Distribution

In group settings, many species adjust the

level of their energy expenditure in accor-

dance with the size of the group they inhabit

(Krause & Ruxton, 2002). This benefit

of group living is called risk distribution

(Coan, 2008), in that environmental risk is

probabilistically distributed across the group

rather than being concentrated on one indi-

vidual. A clear example of this can be seen

in optimal foraging theory, which proposes

that animals forage in a way that maximizes

energy intake per unit of time (MacArthur

& Pianka, 1966). For example, animals

that forage must spend a certain amount

of energy maintaining vigilance for preda-

tors. Foraging in a larger group decreases

the burden of vigilance on any one member,

and indeed, in many species, the number of

individuals that are vigilant for predators

at any given time decreases as group size

increases (Elgar, 1989; Roberts, 1996). With

regard to the social regulation of emotion,

we can construe threat vigilance as a form

of negative affect— or at least as the result

of a negative affect process that reflects the

demand for vigilance. If true, then social

proximity can be viewed as decreasing vigi-

lance behavior via the regulation of negative

affect. Evidence for this can even be seen

in the modulation by group size of physi-

Social Baseline Theory 225

ological indicators of stress in nonhuman

animals. For example, salivary cortisol con-

centration in sheep is higher when the flock

size is smaller (Michelena et al., 2012). Risk

distribution suggests further that the num-

ber of proximal conspecifics decreases nega-

tive affect, because doing so conserves effort

that would otherwise be spent either on vigi-

lance, self- regulation, or both. This is exem-

plified in humans in the hand- holding study

discussed earlier, by the finding that holding

any hand—even that of a stranger— reduces

neural activity related to threat (Coan et

al., 2006), especially in regions supporting

responses to acute threats (Mobbs et al.,

2007).

Interestingly, the individual benefits of

group living described earlier often benefit

the group as well, such that as each individ-

ual’s vigilance effort decreases, total group

vigilance actually increases (Bertram, 1978;

Pulliam, Pyke, & Caraco, 1982) and time

to detect predators decreases (Siegfried &

Underhill, 1975). It is important to note,

however, that group living introduces certain

risks and stressors as well, such as increased

competition for resources, increased likeli-

hood of disease transmission, and increased

conspicuousness (Alexander, 1974). Groups

therefore iteratively move toward an optimal

size given the availability of food and other

resources (Higashi & Yamamura, 1993).

Note that risk distribution concerns only the

number of members in a group and makes

no reference to the nature and quality of the

relationships between the group members.

Coan (2008) has speculated that the brain

is sensitive to risk distribution as a general

purpose strategy that employs Bayesian- like

calculations to assess the cost- effectiveness

of affective behaviors at any given time.

Load Sharing

Load sharing builds on the benefits of risk

distribution by adding information that

increases certainty about the availability of

a given social resource— namely, familiar-

ity, reliability, and interdependence. The

presence of an individual with whom one

has established a close relationship not only

probabilistically reduces one’s risk of envi-

ronmental threat but also signals access to a

person who will use his or her own resources

on one’s behalf, thus further reducing the

need to expend one’s own energy, and com-

mensurably decreasing the need, for exam-

ple, for negative affect. In other words, a

close companion can be trusted to share an

interest in one’s well-being. He or she may

provide additional vigilance not only in some

general sense but also specifically, with one’s

own welfare in mind (Davis, 1984). A close

companion may share resources (e.g., Rog-

ers & DeBoer, 2001), help care for young

(e.g., Ehrenberg, Gearing- Small, Hunter, &

Small, 2001), and help when one is sick or

injured (e.g., Townsend & Franks, 1995).

These additional benefits provide a much

greater opportunity for economizing neural

and behavioral activity, as can be seen in

the enhanced effect of holding hands with

a close friend or a spouse (Coan, Beckes, &

Allen, 2013; Coan et al., 2006).

SBT maintains that load sharing impacts

decisions about personal resource budget-

ing in part by altering the way the brain

encodes what constitutes the “self,” with

implications for the level of resources the

self is able to access. This is consistent with

the observation that the neural representa-

tions of threats directed at the self are highly

correlated with those directed at friends,

implying a kind of “involuntary breach of

individual separateness” (Langer, 1974,

p. 129) that does not seem to generalize to

strangers (Beckes et al., 2012). In this way,

an individual’s social support system can be

construed as an extension of the self and,

in turn, of how one perceives and interacts

with the world.

Capitalization

Importantly, social proximity and interac-

tion serve not only to down- regulate negative

emotions, but also to maintain and increase

positive, approach- related emotions. Admit-

tedly, our research has focused on the

social regulation of response to threat, but

we believe the basic ideas behind SBT are

generalizable to positive emotions as well.

People frequently expend energy to induce,

maintain, or even dampen experiences of

positive emotion, and this is reflected in

neural activity in prefrontal areas similar to

those seen in the self- regulation of negative

emotion (Kim & Hamann, 2007). Social

226 SOCIAL ASPECTS

relationships may act to conserve effortful

positive self- regulation, possibly by reducing

reliance on prefrontal activity and increas-

ing activity in reward circuits. Interestingly,

neural activity in the medial PFC decreases

in mothers observing pictures of their chil-

dren, and in adults observing pictures of

their romantic partner, as compared to

when they are observing pictures of a friend

(Bartels & Zeki, 2000, 2004). Moreover,

positive responses by a relational partner to

one’s own positive news, a process known

as capitalization, may be a mechanism by

which social relationships enhance positive

emotions in ways that are less individually

effortful. Capitalization increases daily posi-

tive affect over and above the impact of the

positive event itself (Gable, Reis, Impett, &

Asher, 2004; Langston, 1994). Furthermore,

capitalization may strengthen trust and pro-

social behavior, even when one is interacting

with a stranger (Reis et al., 2010). Following

the SBT model, then, receiving supportive,

positive feedback from a partner may sig-

nal an increase in both personal and social

resources. It is interesting to note that the

perceived responsiveness of one’s partner

during positive events may be more strongly

linked with the relationship’s well-being

and longevity than perceived responsiveness

during negative events (Gable, Gonzaga, &

Strachman, 2006).

Importantly, SBT views all forms of

social emotion regulation as systemic

and dynamic, challenging the widely held

assumption that the basic unit of analysis in

human psychology is the single individual

(Beckes & Coan, 2011). By extending the

unit of analysis to the dyad or group, social

interaction and proximity emerge as adap-

tive strategies rooted in the sharing of efforts

that, left only to each individual member of

a dyad or group, would be redundant, costly,

and inefficient. Ultimately, it may be that

dyads or groups benefit from social emo-

tion regulation at least as much as the indi-

viduals who inhabit them (McComb, Moss,

Durant, Baker, & Sayialel, 2001). In consid-

ering mechanisms for these dyadic or group

effects, social emotion regulation can be

mediational, reflecting a direct intervention

on an emotional process by social resources,

or moderational, modifying the perception

of potentially emotional situations. In the

following sections, we briefly describe and

propose potential mechanisms for the dis-

tinction.

Mediating Mechanisms of Social

Emotion Regulation

As mediators of emotion regulation (Baron

& Kenny, 1986), social resources serve as a

proximal mechanism through which emo-

tion regulation effects are achieved. Attach-

ment theory provides the quintessential

example of socially regulated emotion in

its description of mother– child attachment

interactions, in which infants seek attach-

ment figures during periods of distress and

are soothed by their caregiver’s presence

(Ainsworth, Blehar, Waters, & Wall, 1978;

Bowlby, 1969/1982). A common example

might be a child’s vaccination procedure,

where the child— distressed at the prospect

of receiving a shot—calls for the mother’s

support. In response, the mother may engage

in soothing behaviors like hand- holding and

offering reassuring words in a calm tone of

voice. Here, the mother’s behavior provides

an obvious mechanism through which the

child’s distress is attenuated. Specifically,

the child identifies a potential threat (the

needle), and this threat causes two reactions,

distress and the seeking of support from the

mother. In turn, the mother’s support behav-

ior exerts a down- regulatory influence on

the distress response.

The mother– child dynamic is a par-

ticularly powerful example of how social

resources can mediate emotion regulation

in part because the child in the example is

developmentally limited in his or her self-

regulatory abilities, a limitation that is itself

rooted in the slow development of neural

systems that will eventually serve the child’s

self- regulatory needs (Coan, 2008). That

the mother’s soothing works is obvious and

well documented (Cassidy & Shaver, 2008).

Less obvious is that the child is relatively

incapable of emotion regulation without

the mother. Thus, we can view the mother

and child as an interactive system that is

intimately linked in an emotion activation–

regulation dynamic. Importantly, however,

the mother– child behavioral and experiential

dynamics described by attachment theorists

play out similarly within adult relationships

(Mikulincer & Shaver, 2007), where stress-

ful situations motivate social proximity, and

Social Baseline Theory 227

social proximity lowers autonomic arousal,

attenuates hypothalamic– pituitary– adrenal

(HPA) axis activity, and improves immune

function (Baron, Cutrona, Hicklin, Russell,

& Lubaroff, 1990; Heinrichs, Baumgart-

ner, Kirschbaum, & Ehlert, 2003; Uchino,

Cacioppo, & Kiecolt- Glaser, 1996). Of

interest with regard to adult relationships

is that, unlike mother– infant dyads, two or

more adults each possess fully developed and

functioning brains. Thus, although children

require maternal support for emotion regu-

lation, adults appear to utilize each other for

similar purposes more strategically.

A major focus of our work has been the

identification of proximal neural mechanisms

linking social relationships to decreased

threat responding and, in turn, increased

health and well-being. Although many can-

didate mechanisms have been postulated,

few or none have been definitively identified.

Recently, Eisenberger and colleagues (2011)

provided what they characterized as media-

tional evidence for the social regulation of

emotion by portions of the vmPFC. In this

work, participants were shown pictures of

a romantic partner, pictures of strangers, or

pictures of objects, while receiving painful

stimulation. Putative pain- related activa-

tions in regions such as the dorsal anterior

cingulate cortex (dACC) and anterior insula

were less active while participants viewed

images of a romantic partner. Moreover, the

vmPFC was more active while participants

viewed romantic partners, even during pain

stimuli, and vmPFC activation was positively

associated with relationship duration and

perceived partner support, while negatively

associated with both subjective pain ratings

and pain- related neural activity. In a simi-

lar study, Younger, Aron, Parke, Chatterjee,

and Mackey (2010) collected brain images

from 15 participants as they experienced

moderate levels of thermal pain while they

viewed pictures of their romantic partner,

pictures of attractive strangers, or engaged

in a distraction task, hypothesizing that pic-

tures of romantic partners would attenuate

pain processing via putative “reward sys-

tems.” Indeed, viewing pictures of roman-

tic partners both reduced subjective pain

reports and attenuated circuits associated

with pain processing. Moreover, subjective

pain reports were inversely correlated dur-

ing romantic partner picture viewing with

the activation of neural circuits associated

with reward processing (e.g., the caudate

nucleus, the nucleus accumbens) and effort-

ful self- regulation (e.g., the dlPFC).

Thus, emerging evidence for proximal

mechanisms supporting socially medi-

ated emotion regulation appears to include

regions associated with both the automatic

and effortful self-regulation of emotion

(vmPFC and dlPFC, respectively), as well

as putative reward circuits (e.g., the nucleus

accumbens). However, our laboratory has

not been able to produce similar results, in

our original study of hand- holding by mar-

ried couples (Coan et al., 2006), in a more

recent study of hand- holding by platonic

friends (Coan et al., 2013), or in a study of

the regulation of threat responses in chil-

dren by the presence of adult caregivers

(Conner et al., 2012). Indeed, in the latter

study, we observed decreased activation spe-

cifically in the vmPFC and ventrolateral PFC

(vlPFC), where we used a region of interest

(ROI) approach for the purpose of address-

ing the question of prefrontal mediation of

social support. Ultimately, we have thus far

failed to reliably identify any regions of the

brain that are normatively more active under

threat conditions during supportive presence

or hand- holding than while alone. More-

over, none of the regions identified by Eisen-

berger et al. (2011) and Younger et al. (2010)

are negatively correlated with any of the

threat- responsive circuits apparently down-

regulated in our work by hand- holding.

What may account for these apparently

inconsistent results? The answer, we think,

has to do with the difference between touch

and picture viewing. Specifically, there is

ample evidence that touch acts as an uncon-

ditioned or primary stimulus in social ani-

mals, not least humans (Francis et al., 1999),

who may also use touch to exchange impor-

tant social information (Gazzola et al.,

2012; Morrison, Löken, & Olausson, 2010).

By contrast, picture viewing likely involves

associative learning, particularly involv-

ing the expected value of the photographic

image—a task often mediated through

vmPFC activity (Kable & Glimcher, 2007).

Thus, vmPFC activity may be necessary

when utilizing photographs of loved ones to

regulate emotion. But a careful reading of

Younger et al. (2010) reveals that, in addi-

tion to showing their participants pictures

228 SOCIAL ASPECTS

of loved ones, they instructed participants to

“focus on the picture and think about the

displayed person” (p. 2), effectively encour-

aging self-mediated rather than socially

mediated emotion regulation. Ultimately,

we would argue that both the Eisenberger et

al. (2011) and Younger et al. (2010) experi-

ments manipulated self- regulatory systems

and are not best understood as examples of

socially mediated emotion regulation at all.

Moderating Mechanisms of Social

Emotion Regulation

Strictly speaking, the hand- holding study

discussed earlier may also provide an

example of socially moderated emotion

regulation, in part because the provision

of social support preceded the presentation

of threat cues, thus potentially altering the

perception of those threat cues and obviat-

ing the activation of portions of the threat

response. This illustrates one of the many

ways in which social proximity and interac-

tion can be viewed as moderating emotional

responses and self- regulation needs, acting

as third variables that modify the conditions

under which emotional responses and self-

regulation strategies are either called upon

or maximally effective. Taking the example

of the vaccination procedure discussed ear-

lier, it may be the case that, as in our hand-

holding experiments, the mother holds the

child’s hand not in response to the child’s

obvious distress but in anticipation of the

child’s potential distress. In this case, mater-

nal hand- holding may cause relaxation of

the child’s vigilance processing, rendering

the appearance of the needle less threaten-

ing when it does arrive.

Past social experiences also impact an

individual’s self- regulation requirements

and capabilities (Allen, Moore, Kuperminc,

& Bell, 1998; Prinstein & La Greca, 2004;

Weaver et al., 2004). For example, ongo-

ing current daily social support may mod-

erate the perception of threats encountered

while alone, which may in turn reduce the

perceived need for engaging self- regulation

capabilities (Eisenberger, Taylor, Gable,

Hilmert, & Lieberman, 2007). Similarly,

mental representations of loved ones may be

used as methods by which one can exert self-

regulatory strategies related to distraction

or reappraisal. Any or all of these possibili-

ties can be modeled by SBT, such that past

social experiences or even prevailing social

conditions alter an individual’s perception of

potential threats and rewards in his or her

immediate environment even when he or she

is alone at the occasion of measurement.

A number of researchers have argued

that early childhood experiences critically

influence the ways in which individuals

view social relationships later in life. For

humans and many other species, filial bond-

ing—bonding with siblings and caregivers—

occurs rapidly, unconditionally, and during a

period of neural development that may hold

powerful consequences for subsequent func-

tioning (Bowlby, 1969/1982; Coan, 2008).

In infants, the PFC is particularly under-

developed in comparison to that of adults,

and its development takes approximately

two decades to complete. The human brain

in general grows exponentially during just

the first 2 years of life (Franceschini et al.,

2007)—growth reflected in the brain’s con-

sumption of glucose, which continues to be

approximately double that of adults until 10

years of age (Chugani, 1998). Throughout

this early development, the brain is in effect

adapting itself to environmental contingen-

cies through a process of axonal, dendritic,

and synaptic “pruning”—a process that is

itself dependent upon neural activity associ-

ated with environmental stimulation (Can-

cedda et al., 2004; Reichardt, 2006). Put

another way, the brain in early development

adheres roughly to the colloquialism “use it

or lose it”; environmental demands shape a

developing brain prepared for a wide range

of behavioral possibilities. By the process of

pruning, the brain’s responses to prevail-

ing contextual demands become more fixed

and hence more rapid—it becomes adapted

ontogenetically to its expected environment

(Hebb, 1949; Posner & Rothbart, 2007).

During this development, interactions

between social experiences, self- regulatory

activity and socially bound activations in

medial prefrontal, temporoparietal, and

posterior temporal cortices, as well as in

the amygdala, ventral tegmentum, nucleus

accumbens, periaqueductal gray and else-

where, may shape expectations about the

availability of social resources, opportuni-

ties for affiliation, expectations about the

reliability of close relational partners, and so

on (Lieberman, 2007). This in turn is likely

Social Baseline Theory 229

to shape individual differences in the way

social resources are approached and main-

tained, perhaps especially in situations that

blend social proximity with potential stress-

ors. Indeed, it is just this sort of experience-

based developmental divergence that early

attachment researchers described as mani-

festing in “working models” of attachment

figures, a theoretical perspective expressed

in more recent terms as attachment styles

(Ainsworth et al., 1978; Main, 1996; Miku-

lincer & Shaver, 2007).

A large and growing body of research has

documented effects consistent with early psy-

chosocial brain development. For example,

primates are highly sensitive to early proxim-

ity to and interaction with caregivers (Har-

low, 1958). In rats, maternal grooming may

influence the methylation of glucocorticoid

receptor genes throughout the hippocampus

and possibly elsewhere, influencing in turn

the stress reactivity of the pups throughout

their lives and even into subsequent genera-

tions (Weaver et al., 2004). Evidence sug-

gests a similar methylation process may

occur in humans (McGowan et al., 2009;

van IJzendoorn, Bakermans- Kranenburg, &

Ebstein, 2011). Hofer (2006) has proposed

that early interactions with caregivers slowly

evolve from the indirect regulation of sen-

sorimotor, thermal, and nutrient functions

via responses to expressed emotion. At first

the infant is totally dependent upon caregiv-

ers for access to primary reinforcers (food,

water, warmth, touch). The only way for the

infant to access these resources is to get the

caregiver’s attention with expressed emo-

tion. A predictable pattern emerges where

the infant cries out when a basic resource is

needed, followed by the caregiver’s response,

after which the infant stops crying. As the

infant develops, his or her emotional reper-

toire expands to include preferences beyond

simple metabolic or thermal needs, but the

process of caregiver responsiveness contin-

ues in much the same way, until it can be

said that the emotional feelings and expres-

sions are themselves the targets of the care-

giver’s responses.

Attachment theorists have had perhaps

the most to say about how social experiences

contribute to individual differences in the

social regulation of emotion (Mikulincer &

Shaver, 2005; Mikulincer, Shaver, & Pereg,

2003). Specifically, attachment theory posits

the existence of trait-like expectations— the

aforementioned attachment styles—regard-

ing the availability of social resources.

Dominant views of attachment style can

be expressed as two independent axes rep-

resenting tendencies toward social anxi-

ety and social avoidance. Individuals low

in both are said to be secure, in that their

appraisals of potential threats and views of

emotional disclosure tend to be less negative

(Mikulincer & Florian, 1998; Mikulincer &

Orbach, 1995). Critically, such individuals

are likelier to seek out, utilize, and benefit

from emotional support from others (Fraley

& Shaver, 2000; Larose, Bernier, Soucy, &

Duchesne, 1999; Rholes, Simpson, & Grich

Stevens, 1998). Secure individuals may even

benefit more from capitalization attempts:

Shallcross, Howland, Bemis, Simpson, and

Frazier (2011) found that insecurely attached

individuals more often underestimated

the responsiveness of their partners when

sharing a positive event than did securely

attached individuals. Although neuroscien-

tific investigations of attachment style are

rare, Gillath, Bunge, Shaver, Wendelken,

and Mikulincer (2005) have observed that

greater trait attachment anxiety is associ-

ated with more activity in the dACC and

temporal pole, areas associated with alarm

and negative affect— and decreased activity

in the orbitofrontal cortex— when partici-

pants are asked to think about a threatening

relationship scenario.

Future Directions

We feel these perspectives on social relation-

ships and social emotion regulation have

implications that extend both to basic and

applied domains of psychological science,

and that the ecological framework of SBT

may be useful for understanding a number

of important new findings. Clinically, we

have recently noted that SBT holds implica-

tions for how we understand the frontolim-

bic dysfunction and emotional dysregula-

tion that characterize borderline personality

disorder (Hughes, Crowell, Uyeji, & Coan,

2012), and we believe that SBT may be rel-

evant to the development and maintenance

of other psychopathologies as well. For

example, although speculative, it is possible

that the disruptions in social relationships

230 SOCIAL ASPECTS

that characterize autism spectrum disorders

result in an overreliance on self- regulation,

leading to chronic depletion and the use of

self- regulatory strategies associated with

small children. We suggest further that SBT

may be useful for understanding emerging

approaches to relationship therapy that are

proving to be efficacious for a number of

problems traditionally treated by individu-

ally oriented psychotherapies alone (Mon-

son et al., 2012; Naaman, Radwan, & John-

son, 2009).

Ultimately, we emphasize that human life

is in many ways defined by social relation-

ships. According to SBT, a key function of

social relationships is the social regulation

of emotion. Emotions provide rapid, embod-

ied information about current states and

contextual demands (Clore & Tamir, 2002),

guiding decision making and modifying per-

ception (Bechara, 2011; Stefanucci et al.,

2008). The modification of perception via

emotional responding is itself yoked to the

management of bioenergetic resources for the

purpose of economizing action (Stefanucci

et al., 2011). Because emotion is powerfully

regulated by social proximity (Coan et al.,

2013; Coan et al., 2006), all of the above is

controlled by proximity to social resources

(Schnall et al., 2008). Thus, the impact of

social relationships ripples through virtu-

ally everything humans do, because social

relationships are tightly linked to emotional

processes, and emotional processes inform,

bias, and direct many, if not most, of the

brain’s activities. This may not always work

in ways that are broadly socially desirable.

For example, the social regulatory pro-

cesses described throughout this chapter

may contribute to phenomena such as social

loafing (Karau & Williams, 1993), and the

“outsourcing” of health behaviors (Fitzsi-

mons & Finkel, 2011). The impact of social

relationships— manifest as perceived prox-

imity, interaction, and history— is thus likely

to be felt within any specific subdomain of

psychological science, suggesting that any

such subdomain that does not account for

social processes will be limited in impor-

tant ways. On the other hand, the extent to

which social processes impact psychological

phenomena opens wide the possibilities for

new testable hypotheses and exciting pro-

grams of research.

Note

1. Accumulating evidence from a diverse col-

lection of laboratories suggests the psycho-

logical functions supported by the cortex—

including the PFC—are computationally, and

hence bioenergetically, expensive, especially

relative to more computationally basic per-

ceptual processes (Dietrich, 2009; Halford,

Wilson, & Phillips, 1997, 1998). At the very

least, psychological processes supported by

the PFC are often subjectively experienced

as effortful (Muraven & Baumeister, 2000;

Sheppes, Catran, & Meiran, 2009). Sus-

tained prefrontally mediated behaviors (e.g.,

attention, self- control, vigilance, behavioral

inhibition) cause subjective exhaustion and a

steady decrease in the ability to perform those

very behaviors (Baumeister, Vohs, & Tice,

2007; Vohs & Heatherton, 2000). Because

the brain maintains a fairly constant meta-

bolic rate regardless of task (Sokoloff, Man-

gold, Wechsler, Kennedy, & Kety, 1955), an

extended reliance on prefrontally mediated

processes may reduce resources (e.g., blood)

available to other regions. Indeed, there is

evidence of intrabrain competition for blood,

even within the cortex (Dietrich, 2009).

Although open to serious criticism (Kurzban,

2010), it may yet be possible that the PFC

even places a higher metabolic demand on

the brain’s resources. For example, the ratio

of glia to neurons— a ratio that covaries with

metabolic demand— is higher in the PFC of

humans than in other primates (Sherwood

et al., 2006). The PFC is among the last neu-

ral systems to develop fully (Fuster, 2002)

and among the first to show functional defi-

cits in the case of extreme emotional stress,

malnourishment, intoxication, addiction,

old age, and even exercise (Arnsten, 2009;

Del Giorno, Hall, O’Leary, Bixby, & Miller,

2010; Goldstein & Volkow, 2011; Lipina &

Colombo, 2009; Paxton, Barch, Racine, &

Braver, 2008). All of this is despite a general

consensus that the human PFC is one of the

defining characteristics of human phylogeny

(Ehrlich & Ehrlich, 2008)—a resource shaped

over evolutionary development that allows

humans a level of abstraction, creativity, vigi-

lance, self- control, and anticipatory judgment

that is unprecedented in the animal kingdom

and largely responsible for the globally domi-

nant status that humans enjoy.

Social Baseline Theory 231

References

Ainsworth, M. D. S., Blehar, M. C., Waters, E.,

& Wall, S. (1978). Patterns of attachment: A

psychological study of the strange situation.

Hillsdale, NJ: Erlbaum.

Alexander, R. D. (1974). The evolution of social

behavior. Annual Review of Ecology and Sys-

tematics, 5, 325–383.

Allen, J. P., Moore, C., Kuperminc, G., & Bell,

K. (1998). Attachment and adolescent psycho-

social functioning. Child Development, 69(5),

1406–1419.

Arnsten, A. F. T. (2009). Stress signalling path-

ways that impair prefrontal cortex structure

and function. Nature Reviews Neuroscience,

10(6), 410– 422.

Baron, R. M., & Kenny, D. A. (1986). The

moderator– mediator variable distinction in

social psychological research: Conceptual,

strategic, and statistical considerations. Jour-

nal of Personality and Social Psychology,

51(6), 1173–1182.

Baron, R. S., Cutrona, C. E., Hicklin, D., Rus-

sell, D. W., & Lubaroff, D. M. (1990). Social

support and immune function among spouses

of cancer patients. Journal of Personality and

Social Psychology, 59(2), 344–352.

Barrett, L. F. (2006). Solving the emotion para-

dox: Categorization and the experience of

emotion. Personality and Social Psychology

Review, 10, 20–46.

Barrett, L. F., & Bar, M. (2009). See it with

feeling: Affective predictions during object

perception. Philosophical Transactions of the

Royal Society B: Biological Sciences, 364,

1325–1334.

Bartels, A., & Zeki, S. (2000). The neural basis

of romantic love. NeuroReport, 11(17), 3829–

3834.

Bartels, A., & Zeki, S. (2004). The neural corre-

lates of maternal and romantic love. NeuroIm-

age, 21(3), 1155–1166.

Baumeister, R. F., Vohs, K. D., & Tice, D. M.

(2007). The strength model of self- control.

Current Directions in Psychological Science,

16(6), 351–355.

Bechara, A. (2011). The somatic marker hypoth-

esis and its neural basis: Using past experiences

to forecast the future in decision making. In

M. Bar (Ed.), Predictions in the brain: Using

our past to generate a future (pp. 122–133).

New York: Oxford University Press.

Beckes, L., & Coan, J. A. (2011). Social baseline

theory: The role of social proximity in emo-

tion and economy of action. Social and Per-

sonality Psychology Compass, 5, 976–988.

Beckes, L., Coan, J. A., & Hasselmo, K. (2012).

Familiarity promotes the blurring of self and

other in the neural representation of threat.

Social Cognitive and Affective Neuroscience.

[E-publication ahead of print]

Berscheid, E. (2003). The human’s greatest

strength: Other humans. In U. M. Staudinger

(Ed.), A psychology of human strengths: Fun-

damental questions and future directions for a

positive psychology (pp. 37–47). Washington,

DC: American Psychological Association.

Bertram, B. C. R. (1978). Living in groups: Pred-

ators and prey. In J. R. Krebs & N. B. Davies

(Eds.), Behavioural ecology: An evolutionary

approach (pp. 64–96). Oxford, UK: Black-

well.

Bishop, S., Duncan, J., Brett, M., & Lawrence,

A. D. (2004). Prefrontal cortical function and

anxiety: Controlling attention to threat- related

stimuli. Nature Neuroscience, 7, 184–188.

Bowlby, J. (1982). Attachment and loss: Vol. 1.

Attachment (2nd ed.). New York: Basic Books.

(Original work published 1969)

Brewer, M. B., & Caporeal, L. R. (1990). Selfish

genes vs. selfish people: Sociobiology as origin

myth. Motivation and Emotion, 14, 237–243.

Brooks, J. C. W., Nurmikko, T. J., Bimson, W.

E., Singh, K. D., & Roberts, N. (2002). fMRI

of thermal pain: Effects of stimulus laterality

and attention. NeuroImage, 15, 293–301.

Cancedda, L., Putignano, E., Sale, A., Viegi, A.,

Berardi, N., & Maffei, L. (2004). Acceleration

of visual system development by environmen-

tal enrichment. Journal of Neuroscience, 24,

4840–4848.

Cassidy, J., & Shaver, P. R. (2008). Handbook

of attachment: Theory, research, and clinical

applications (2nd ed.). New York: Guilford

Press.

Chugani, H. T. (1998). A critical period of brain

development: Studies of cerebral glucose uti-

lization with PET. Preventive Medicine, 27,

184–188.

Clore, G. L., & Tamir, M. (2002). Affect as

embodied information. Psychological Inquiry,

13, 37–45.

Coan, J. A. (2008). Toward a neuroscience

of attachment. In J. Cassidy & P. R. Shaver

(Eds.), Handbook of attachment: Theory,

research, and clinical applications (2nd ed.,

pp. 241–265). New York: Guilford Press.

232 SOCIAL ASPECTS

Coan, J. A., Beckes, L., & Allen, J. P. (2013).

Childhood maternal support and social capital

moderate the regulatory impact of social rela-

tionships in adulthood. International Journal

of Psychophysiology, 88(3), 224–231.

Coan, J. A., Schaefer, H. S., & Davidson, R. J.

(2006). Lending a hand: Social regulation of

the neural response to threat. Psychological

Science, 17, 1032–1039.

Cohen, S., & Hoberman, H. M. (1983). Positive

events and social supports as buffers of life

change stress. Journal of Applied Social Psy-

chology, 13(2), 99–125.

Cohen, S., & McKay, G. (1984). Social support,

stress, and the buffering hypothesis: A theo-

retical analysis. Handbook of Psychology and

Health, 4, 253 –267.

Conner, O. L., Siegle, G. J., McFarland, A. M.,

Silk, J. S., Ladouceur, C. D., Dahl, R. E., et

al. (2012). Mom—It helps when you’re right

here!: Attenuation of neural stress markers in

anxious youths whose caregivers are present

during fMRI. PloS ONE, 7(12), e50680.

Davis, L. S. (1984). Alarm calling in Richard-

son’s ground squirrels (Spermophilus richard-

sonii). Zeitschrift für Tierpsychologie, 66(2),

152–164.

Dedovic, K., Renwick, R., Mahani, N. K.,

Engert, V., Lupien, S. J., & Pruessner, J. C.

(2005). The Montreal Imaging Stress Task:

Using functional imaging to investigate the

effects of perceiving and processing psychoso-

cial stress in the human brain. Journal of Psy-

chiatry and Neuroscience, 30, 319–325.

Del Giorno, J. M., Hall, E. E., O’Leary, K. C.,

Bixby, W. R., & Miller, P. C. (2010). Cogni-

tive function during acute exercise: A test of

the transient hypofrontality theory. Journal of

Sport and Exercise Psychology, 32(3), 312–

323.

Dietrich, A. (2009). The transient hypofrontal-

ity theory and its implications for emotion

and cognition. In T. McMorris, P. D. Tompo-

rowski, & M. Audiffren (Eds.), Exercise and

cognitive function (pp. 69–90). Hoboken, NJ:

Wiley- Blackwell.

Ehrenberg, M. F., Gearing- Small, M., Hunter,

M. A., & Small, B. J. (2001). Childcare task

division and shared parenting attitudes in

dual- earner families with young children.

Family Relations, 50(2), 143–153.

Ehrlich, P. R., & Ehrlich, A. H. (2008). The

dominant animal: Human evolution and the

environment. Washington, DC: Island Press.

Eisenberger, N. I., Master, S. L., Inagaki, T. K.,

Taylor, S. E., Shirinyan, D., Lieberman, M.

D., et al. (2011). Attachment figures activate a

safety signal- related neural region and reduce

pain experience. Proceedings of the National

Academy of Sciences, 108, 11721–11726.

Eisenberger, N. I., Taylor, S. E., Gable, S. L.,

Hilmert, C. J., & Lieberman, M. D. (2007).

Neural pathways link social support to attenu-

ated neuroendocrine stress responses. Neuro-

Image, 35(4), 1601–1612.

Elgar, M. A. (1989). Predator vigilance and

group-size in mammals and birds—A critical

review of the empirical evidence. Biological

Reviews of the Cambridge Philosophical Soci-

ety, 64(1), 13–33.

Fitzsimons, G. M., & Finkel, E. J. (2011). Out-

sourcing self- regulation. Psychological Sci-

ence, 22(3), 369–375.

Fraley, R. C., & Shaver, P. R. (2000). Adult

romantic attachment: Theoretical develop-

ments, emerging controversies, and unan-

swered questions. Review of General Psychol-

ogy, 4, 132–154.

Franceschini, M. A., Thaker, S., Themelis, G.,

Krishnamoorthy, K. K., Bortfeld, H., Dia-

mond, S. G., et al. (2007). Assessment of

infant brain development with frequency-

domain near- infrared spectroscopy. Pediatric

Research, 61, 546–551.

Francis, S., Rolls, E. T., Bowtell, R., McGlone,

F., O’Doherty, J., Browning, A., et al. (1999).

The representation of pleasant touch in the

brain and its relationship with taste and olfac-

tory areas. NeuroReport, 10, 453–459.

Friston, K. (2010). The free- energy principle: A

unified brain theory? Nature Reviews Neuro-

science, 11(2), 127–138.

Fuster, J. M. (2002). Frontal lobe and cogni-

tive development. Journal of Neurocytology,

31(3), 373–385.

Gable, S. L., Gonzaga, G. C., & Strachman, A.

(2006). Will you be there for me when things

go right?: Supportive responses to positive

event disclosures. Journal of Personality and

Social Psychology, 91(5), 904 –917.

Gable, S. L., Reis, H. T., Impett, E. A., & Asher,

E. R. (2004). What do you do when things go

right?: The intrapersonal and interpersonal

benefits of sharing positive events. Journal

of Personality and Social Psychology, 87(2),

228–245.

Gazzola, V., Spezio, M. L., Etzel, J. A., Castelli,

F., Adolphs, R., & Keysers, C. (2012). Primary

Social Baseline Theory 233

somatosensory cortex discriminates affective

significance in social touch. Proceedings of the

National Academy of Sciences, 109, E1657–

E1666.

Gillath, O., Bunge, S. A., Shaver, P. R., Wen-

delken, C., & Mikulincer, M. (2005).

Attachment- style differences in the ability to

suppress negative thoughts: Exploring the neu-

ral correlates. NeuroImage, 28, 835–847.

Goldstein, R. Z., & Volkow, N. D. (2011). Dys-

function of the prefrontal cortex in addiction:

Neuroimaging findings and clinical implica-

tions. Nature Reviews Neuroscience, 12(11),

652– 669.

Halford, G. S., Wilson, W. H., & Phillips, S.

(1997). Abstraction: Nature, costs, and ben-

efits. International Journal of Educational

Research, 27(1), 21–35.

Halford, G. S., Wilson, W. H., & Phillips, S.

(1998). Processing capacity defined by rela-

tional complexity: Implications for compara-

tive, developmental, and cognitive psychol-

ogy. Behavioral and Brain Sciences, 21(6),

803–831.

Harlow, H. F. (1958). The nature of love. Ameri-

can Psychologist, 13, 673–685.

Hebb, D. O. (1949). The organization of behav-

ior. New York: Wiley.

Heinrichs, M., Baumgartner, T., Kirschbaum,

C., & Ehlert, U. (2003). Social support and

oxytocin interact to suppress cortisol and sub-

jective responses to psychosocial stress. Bio-

logical Psychiatry, 54(12), 1389–1398.

Higashi, M., & Yamamura, N. (1993). What

determines animal group size?: Insider–

outsider conflict and its resolution. American

Naturalist, 142(3), 553–563.

Hill, K. R., Walker, R. S., Bozicevic, M., Eder, J.,

Headland, T., Hewlett, B., et al. (2011). Co-

residence patterns in hunter– gatherer societies

show unique human social structure. Science,

331(6022), 1286–1289.

Hofer, M. A. (2006). Psychobiological roots of

early attachment. Current Directions in Psy-

chological Science, 15, 84–88.

Holt- Lunstad, J., Smith, T. B., & Layton, J. B.

(2010). Social relationships and mortality risk:

A meta- analytic review. PLoS Medicine, 7,

e1000316.

Hughes, A. E., Crowell, S. E., Uyeji, L., & Coan,

J. A. (2012). A developmental neuroscience of

borderline pathology: Emotion dysregulation

and social baseline theory. Journal of Abnor-

mal Child Psychology, 40, 21–33.

Kable, J. W., & Glimcher, P. W. (2007). The neu-

ral correlates of subjective value during inter-

temporal choice. Nature Neuroscience, 10,

1625–1633.

Karau, S. J., & Williams, K. D. (1993). Social

loafing: A meta- analytic review and theoreti-

cal integration. Journal of Personality and

Social Psychology, 65(4), 681–706.

Karremans, J. C., Heslenfeld, D. J., van Dillen, L.

F., & Van Lange, P. A. (2011). Secure attach-

ment partners attenuate neural responses

to social exclusion: An fMRI investigation.

International Journal of Psychophysiology,

81(1), 44–50.

Kim, S. H., & Hamann, S. (2007). Neural cor-

relates of positive and negative emotion regu-

lation. Journal of Cognitive Neuroscience,

19(5), 776–798.

Knill, D. C., & Pouget, A. (2004). The Bayesian

brain: The role of uncertainty in neural coding

and computation. Trends in Neurosciences,

27(12), 712–719.

Kraus, M. W., Huang, C., & Keltner, D. (2010).

Tactile communication, cooperation, and per-

formance: An ethological study of the NBA.

Emotion, 10, 745–749.

Krause, J., & Ruxton, G. (2002). Living in

groups. New York: Oxford University Press.

Krebs, J. R., & Davies, N. B. (1993). An intro-

duction to behavioural ecology (3rd ed.). Mal-

den, MA: Blackwell.

Kurzban, R. (2010). Does the brain consume

additional glucose during self- control tasks?

Evolutionary Psychology, 8(2), 244–259.

Langer, S. K. (1974). Mind: An essay on human

feeling (Vol. 2). Baltimore: Johns Hopkins

University Press.

Langston, C. A. (1994). Capitalizing on and cop-

ing with daily-life events: Expressive responses

to positive events. Journal of Personality and

Social Psychology, 67(6), 1112–1125.

Larose, S., Bernier, A., Soucy, N., & Duchesne,

S. (1999). Attachment style dimensions, net-

work orientation and the process of seeking

help from college teachers. Journal of Social

and Personal Relationships, 16, 225–247.

Lieberman, M. D. (2007). Social cognitive neu-

roscience: A review of core processes. Annual

Review of Psychology, 58, 259–289.

Lindquist, K. A., & Barrett, L. F. (2008). Con-

structing emotion. Psychological Science, 19,

898–903.

Lipina, S. J., & Colombo, J. A. (2009). Poverty

and brain development during childhood: An

234 SOCIAL ASPECTS

approach from cognitive psychology and neu-

roscience. Washington, DC: American Psy-

chological Association.

MacArthur, R. H., & Pianka, E. R. (1966). On

optimal use of a patchy environment. Ameri-

can Naturalist, 100, 603–609.

Main, M. (1996). Introduction to the special sec-

tion on attachment and psychopathology: 2.

Overview of the field of attachment. Journal

of Consulting and Clinical Psychology, 64,

237–243.

McComb, K., Moss, C., Durant, S. M., Baker, L.,

& Sayialel, S. (2001). Matriarchs as reposito-

ries of social knowledge in African elephants.

Science, 292, 491–494.

McGowan, P. O., Sasaki, A., D’Alessio, A. C.,

Dymov, S., Labonté, B., Szyf, M., et al. (2009).

Epigenetic regulation of the glucocorticoid

receptor in human brain associates with child-

hood abuse. Nature Neuroscience, 12, 342–

348.

McNally, L., Brown, S. P., & Jackson, A. L.

(2012). Cooperation and the evolution of intel-

ligence. Proceedings of the Royal Academy B:

Biological Sciences, 279(1740), 3027–3034.

Michelena, P., Pillot, M. H., Henrion, C., Toulet,

S., Boissy, A., & Bon, R. (2012). Group size

elicits specific physiological response in herbi-

vores. Biology Letters, 8(4), 537–539.

Mikulincer, M., & Florian, V. (1998). The rela-

tionship between adult attachment styles and

emotional and cognitive reactions to stressful

events. In J. A. Simpson & W. S. Rholes (Eds.),

Attachment theory and close relationships

(pp. 143–165). New York: Guilford Press.

Mikulincer, M., & Orbach, I. (1995). Attach-

ment styles and repressive defensiveness: The

accessibility and architecture of affective

memories. Journal of Personality and Social

Psychology, 68, 917–925.

Mikulincer, M., & Shaver, P. R. (2005). Attach-

ment theory and emotions in close relation-

ships: Exploring the attachment- related

dynamics of emotional reactions to relational

events. Personal Relationships, 12, 149–168.

Mikulincer, M., & Shaver, P. R. (2007). Attach-

ment in adulthood: Structure, dynamics, and

change. New York: Guilford Press.

Mikulincer, M., Shaver, P. R., & Pereg, D.

(2003). Attachment theory and affect regula-

tion: The dynamics, development, and cogni-

tive consequences of attachment- related strat-

egies. Motivation and Emotion, 27, 77–102.

Mobbs, D., Petrovic, P., Marchant, J. L., Has-

sabis, D., Weiskopf, N., Seymour, B., et al.

(2007). When fear is near: Threat imminence

elicits prefrontal– periaqueductal gray shifts in

humans. Science, 317(5841), 1079–1083.

Moll, H., & Tomasello, M. (2007). Cooperation

and human cognition: The Vygotskian intelli-

gence hypothesis. Philosophical Transactions

of the Royal Society B: Biological Sciences,

362(1480), 639–648.

Monson, C. M., Fredman, S. J., Macdonald, A.,

Pukay- Martin, N. D., Resick, P. A., & Schnurr,

P. P. (2012). Effect of cognitive- behavioral

couple therapy for PTSD: A randomized con-

trolled trial. Journal of the American Medical

Association, 308, 700–709.

Moore, L. J., Vine, S. J., Wilson, M. R., & Free-

man, P. (2012). The effect of challenge and

threat states on performance: An examination

of potential mechanisms. Psychophysiology,

49(10), 1417–1425.

Morrison, I., Löken, L. S., & Olausson, H.

(2010). The skin as a social organ. Experimen-

tal Brain Research, 204, 305–314.

Muraven, M., & Baumeister, R. F. (2000). Self-

regulation and depletion of limited resources:

Does self- control resemble a muscle? Psycho-

logical Bulletin, 126(2), 247–259.

Naaman, S., Radwan, K., & Johnson, S. (2009).

Coping with early breast cancer: Couple

adjustment processes and couple- based inter-

vention. Psychiatry: Interpersonal and Bio-

logical Processes, 72(4), 321–345.

Paxton, J. L., Barch, D. M., Racine, C. A., &

Braver, T. S. (2008). Cognitive control, goal

maintenance, and prefrontal function in

healthy aging. Cerebral Cortex, 18(5), 1010–

1028.

Posner, M. I., & Rothbart, M. K. (2007).

Research on attention networks as a model

for the integration of psychological science.

Annual Review of Psychology, 58, 1–23.

Prinstein, M. J., & La Greca, A. M. (2004).

Childhood peer rejection and aggression as

predictors of adolescent girls’ externalizing

and health risk behaviors: A 6-year longitudi-

nal Study. Journal of Consulting and Clinical

Psychology, 72, 103–112.

Pulliam, H. R., Pyke, G. H., & Caraco, T. (1982).

The scanning behavior of juncos: A game–

theoretical approach. Journal of Theoretical

Biology, 95(1), 89–103.

Reichardt, L. F. (2006). Neurotrophin- regulated

signalling pathways. Philosophical Transac-

tions of the Royal Society B: Biological Sci-

ences, 361, 1545–1564.

Reis, H. T., Smith, S. M., Carmichael, C. L.,

Social Baseline Theory 235

Caprariello, P. A., Tsai, F. F., Rodrigues, A.,

et al. (2010). Are you happy for me?: How

sharing positive events with others provides

personal and interpersonal benefits. Journal

of Personality and Social Psychology, 99(2),

311–329.

Rholes, W. S., Simpson, J. A., & Grich Stevens,

J. (1998). Attachment orientations, social sup-

port, and conflict resolution in close relation-

ships. In J. A. Simpson & W. S. Rholes (Eds.),

Attachment theory and close relationships

(pp. 166–188). New York: Guilford Press.

Richerson, P. J., Bettinger, R. L., & Boyd, R.

(2005). Evolution on a restless planet: Were

environmental variability and environmental

change major drivers of human evolution? In

F. M. Wuketits & C. Antweiler (Eds.), Hand-

book of evolution: The evolution of living sys-

tems (Vol. 2, pp. 223–242). New York: Wiley.

Roberts, G. (1996). Why individual vigilance

declines as group size increases. Animal

Behaviour, 51, 1077–1086.

Rogers, S. J., & DeBoer, D. D. (2001). Changes

in wives’ income: Effects on marital happi-

ness, psychological well-being, and the risk

of divorce. Journal of Marriage and Family,

63(2), 458–472.

Salinas, E. (2011). Prior and prejudice. Nature

Neuroscience, 14, 943–945.

Schilbach, L., Timmermans, B., Reddy, V., Cos-

tall, A., Bente, G., Schlicht, T., et al. (in press).

Toward a second- person neuroscience. Behav-

ioral and Brain Sciences.

Schmidhempel, P., Kacelnik, A., & Houston, A.

I. (1985). Honeybees maximize efficiency by

not filling their crop. Behavioral Ecology and

Sociobiology, 17(1), 61– 66.

Schnall, S., Harber, K. D., Stefanucci, J. K., &

Proffitt, D. R. (2008). Social support and

the perception of geographical slant. Journal

of Experimental Social Psychology, 44(5),

1246–1255.

Schwarz, N., & Clore, G. L. (1983). Mood,

misattribution, and judgments of well-being:

Informative and directive functions of affec-

tive states. Journal of Personality and Social

Psychology, 45, 513–523.

Shallcross, S. L., Howland, M., Bemis, J., Simp-

son, J. A., & Frazier, P. (2011). Not “capitaliz-

ing” on social capitalization interactions: The

role of attachment insecurity. Journal of Fam-

ily Psychology, 25(1), 77–85.

Sheppes, G., Catran, E., & Meiran, N. (2009).

Reappraisal (but not distraction) is going to

make you sweat: Physiological evidence for

self- control effort. International Journal of

Psychophysiology, 71(2), 91–96.

Sherwood, C. C., Stimpson, C. D., Raghanti, M.

A., Wildman, D. E., Uddin, M., Grossman, L.

I., et al. (2006). Evolution of increased glia–

neuron ratios in the human frontal cortex.

Proceedings of the National Academy of Sci-

ences, 103(37), 13606–13611.

Siegfried, W. R., & Underhill, L. G. (1975).

Flocking as an anti- predator strategy in doves.

Animal Behaviour, 23, 504–508.

Smith, E. A. (2003). Human cooperation: Per-

spectives from behavioral ecology. In P. Ham-

merstein (Ed.), Genetic and cultural evolution

of cooperation (pp. 401–427). Cambridge,

MA: MIT Press.

Sokoloff, L., Mangold, R., Wechsler, R. L., Ken-

nedy, C., & Kety, S. S. (1955). The effect of

mental arithmetic on cerebral circulation and

metabolism. Journal of Clinical Investigation,

34(7, Pt. 1), 1101–1108.

Stark, R., Schienle, A., Walter, B., Kirsch, P.,

Sammer, G., Ott, U., et al. (2003). Hemody-

namic responses to fear and disgust- inducing

pictures: An fMRI study. International Jour-

nal of Psychophysiology, 50, 225–234.

Stefanucci, J. K., Gagnon, K. T., & Lessard, D.

A. (2011). Follow your heart: Emotion adap-

tively influences perception. Social and Per-

sonality Psychology Compass, 5, 296–308.

Stefanucci, J. K., Proffitt, D. R., Banton, T., &

Epstein, W. (2005). Distances appear different

on hills. Attention, Perception, and Psycho-

physics, 67, 1052–1060.

Stefanucci, J. K., Proffitt, D. R., Clore, G. L.,

& Parekh, N. (2008). Skating down a steeper

slope: Fear influences the perception of geo-

graphical slant. Perception, 37, 321–323.

Tomaka, J., Blascovich, J., Kelsey, R. M., & Leit-

ten, C. L. (1993). Subjective, physiological,

and behavioral effects of threat and challenge

appraisal. Journal of Personality and Social

Psychology, 65, 248–260.

Tomasello, M., Carpenter, M., Call, J., Behne,

T., & Moll, H. (2005). Understanding and

sharing intentions: The origins of cultural

cognition. Behavioral and Brain Sciences, 28,

675– 690.

Townsend, A. L., & Franks, M. M. (1995). Bind-

ing ties: Closeness and conflict in adult chil-

dren’s caregiving relationships. Psychology

and Aging, 10(3), 343–351.

Uchino, B. N., Cacioppo, J. T., & Kiecolt- Glaser,

J. K. (1996). The relationship between social

support and physiological processes: A review

236 SOCIAL ASPECTS

with emphasis on underlying mechanisms and

implications for health. Psychological Bulle-

tin, 119, 488–531.

van IJzendoorn, M. H., Bakermans- Kranenburg,

M. J., & Ebstein, R. P. (2011). Methylation

matters in child development: Toward devel-

opmental behavioral epigenetics. Child Devel-

opment Perspectives, 5, 305–310.

Vohs, K. D., & Heatherton, T. F. (2000). Self-

regulatory failure: A resource- depletion

approach. Psychological Science, 11(3), 249–

254.

Weaver, I. C. G., Cervoni, N., Champagne, F. A.,

D’Alessio, A. C., Sharma, S., Seckl, J. R., et al.

(2004). Epigenetic programming by maternal

behavior. Nature Neuroscience, 7, 847–854.

Woolley, A. W., Chabris, C. F., Pentland, A.,

Hashmi, N., & Malone, T. W. (2010). Evi-

dence for a collective intelligence factor in the

performance of human groups. Science, 330,

686–688.

Younger, J., Aron, A., Parke, S., Chatterjee, N.,

& Mackey, S. (2010). Viewing pictures of a

romantic partner reduces experimental pain:

Involvement of neural reward systems. PloS

ONE, 5, e13309.

237

In the past 30 years, attachment theory

(Bowlby, 1973, 1980, 1969/1982) has

become one of the most influential concep-

tual frameworks for understanding emotion

regulation. Although Bowlby did not devote

much attention to abstract theorizing about

emotion itself (he included only a single brief

chapter about it in Volume 1 of his Attach-

ment and Loss trilogy), his writings were

motivated by clinical and ethological obser-

vations of humans and other primates who

were experiencing, expressing, and regu-

lating emotions such as affection, anxiety,

anger, grief, and despair. He was especially

interested in the anxiety- buffering func-

tion of close relationships and the capacity

for dysfunctional relationships to generate

negative emotions, and, in the extreme, to

precipitate debilitating forms of psychopa-

thology. Bowlby (1973, 1980) described and

conceptualized the relatively stable individ-

ual differences in emotion regulation that

emerge from prolonged reliance on particu-

lar attachment figures, people who provide

either adequate or inadequate protection,

safety, support, and guidance concerning

emotions and emotion regulation.

With the accumulation of empirical

knowledge about what Bowlby called the

“attachment behavioral system” and about

individual differences in attachment orienta-

tions in childhood and adulthood, Bowlby’s

ideas (as elaborated and tested initially by

Ainsworth, Blehar, Waters, & Wall, 1978)

have been expanded, tested, and organized

by social– personality psychologists into a

theoretical model of the attachment system

in adulthood (e.g., Mikulincer & Shaver,

2007a; Shaver & Mikulincer, 2002). The

model focuses on the emotion- regulatory

function of the attachment system and

explains many of the emotional corre-

lates and consequences of normative and

individual- differences aspects of attach-

ment system functioning. In this chapter, we

elaborate on these normative and individual-

differences aspects, and review studies that

have examined the links between attachment

system activation and emotion regulation,

and the ways in which individual differences

in attachment are reflected in patterns of

coping with attachment- irrelevant stressful

events and attachment- related stressors (e.g.,

a partner’s hurtful behavior, the breakup of

a relationship, the death of a relationship

partner).

Attachment Theory: Basic Concepts

Bowlby (1969/1982) claimed that human

beings are born with an innate psychobio-

logical system (the attachment behavioral

system) that motivates them to seek proxim-

CHAPTER 15

Adult Attachment and Emotion Regulation

Phillip R. Shaver

Mario Mikulincer

238 SOCIAL ASPECTS

ity to significant others (attachment figures)

in times of need. This system accomplishes

basic regulatory functions (protection from

threats and alleviation of distress) in human

beings of all ages, but it is most directly

observable during infancy and early child-

hood (Bowlby, 1988). According to Bowlby

(1969/1982), attachment figures can pro-

vide a physical and emotional safe haven

that facilitates the down- regulation of nega-

tive affective states, and a secure base that

encourages positive affective states condu-

cive to exploration and learning, thus sup-

porting the development of knowledge and

skills.

Bowlby (1973) also described important

individual differences in attachment system

functioning shaped by the responsiveness

and supportiveness of attachment figures.

Interactions with attachment figures who

are responsive in times of need facilitate

the optimal functioning of the attachment

system and promote a sense of attachment

security. This deep and pervasive sense of

security is based on implicit beliefs that

the world is generally safe, that attachment

figures are helpful when called upon, and

that it is possible to explore the environ-

ment curiously and to engage enjoyably with

other people without undue fear. This sense

of security is rooted in positive mental repre-

sentations of self and others, which Bowlby

called internal working models.

Unfortunately, when attachment figures

are not reliably available and supportive,

and when they fail to provide adequate

relief from distress, children who are depen-

dent on them may form negative work-

ing models of self and others and develop

defensive secondary attachment strategies

that involve hyperactivation or deactiva-

tion of the attachment system (e.g., Cassidy

& Kobak, 1988). Hyperactivation (which

Bowlby, 1982, called “protest”) is charac-

terized by intense efforts to attain proximity

to attachment figures and insistent attempts

to induce a relationship partner, viewed as

insufficiently available or responsive, to

provide more satisfying and reassuring care

and support. Hyperactivating strategies

include clinging, controlling, and coercive

behaviors; cognitive and behavioral efforts

to establish physical contact and a sense

of “oneness”; and up- regulation of nega-

tive affective states (Shaver & Mikulincer,

2002). In contrast, deactivation involves the

inhibition of proximity- seeking inclinations

and actions, suppression or discounting of

threats that might activate the attachment

system, down- regulation of both negative

and positive affective states, and determi-

nation to handle stressors alone (a defen-

sive stance that Bowlby [1969/1982] called

“compulsive self- reliance”). People who rely

on these strategies tend to maximize auton-

omy and distance from relationship partners

and experience discomfort with closeness

and intimacy.

When testing this theory in studies of

adults, most researchers have focused on the

organized pattern of relational expectations,

emotions, and behavior that results from a

history of interactions with attachment

figures— often called “attachment style” by

social psychologists (e.g., Fraley & Shaver,

2000). Psychometric research (e.g., Bren-

nan, Clark, & Shaver, 1998) has shown that

attachment styles can be measured in terms

of two independent dimensions: attachment

anxiety and attachment- related avoidance.

A person’s position on the attachment anxi-

ety dimension indicates the degree to which

he or she worries that a partner will not be

responsive in times of need. A person’s posi-

tion on the avoidance dimension indicates

the extent to which he or she distrusts rela-

tionship partners’ goodwill and their will-

ingness and capacity to help without causing

further distress. People who score low on

both dimensions are said to be secure with

respect to attachment. A person’s location

in the continuous two- dimensional anxiety-

by- avoidance space can be measured with

reliable and valid self- report scales (e.g.,

Brennan et al., 1998) and is associated in

theoretically predictable ways with many

aspects of psychological adjustment (see

Mikulincer & Shaver, 2007a, for a review).

Attachment styles begin to develop in

interactions with primary caregivers during

early childhood, as a large body of research

demonstrates (see Cassidy & Shaver, 2008,

for an anthology of reviews), but Bowlby

(1988) claimed that relational experiences

throughout life can move a person from

one region to another in the anxiety- by-

avoidance conceptual space. Moreover,

although attachment style is often mea-

sured as a single global orientation toward

close relationships, a person’s orientation to

Attachment and Emotion Regulation 239

attachment is rooted in a complex cognitive

and affective associative neural network that

includes both secure and insecure episodic

and semantic memories and mental repre-

sentations (Mikulincer & Shaver, 2007a).

Indeed, a growing body of research shows

that attachment style can change, subtly

or dramatically, depending on current con-

text and recent relational experiences (see

Mikulincer & Shaver, 2007b, for a review).

For example, we have found that priming

thoughts of an available and supportive

attachment figure leads people who score

relatively high on scales tapping attach-

ment insecurities momentarily to behave

like more secure people (e.g., Mikulincer &

Shaver, 2001).

In the next two sections, we present both

theoretical ideas and empirical evidence

concerning the link between attachment

and emotion regulation. In the first section,

we focus on normative aspects of this link

and the emotion regulation functions of

the attachment behavioral system. That is,

we discuss and review empirical evidence

concerning the normative activation of the

attachment system in response to threats

and the down- regulation of distress caused

by optimal functioning of the system. In the

second section, we focus on individual dif-

ferences and review empirical evidence con-

cerning the up- regulation of negative affect

caused by anxious attachment, and the

ways in which avoidant attachment leads to

down- regulation of both negative and posi-

tive affective states.

Normative Aspects of the Link

between Attachment

and Emotion Regulation

According to attachment theory (Bowlby,

1969/1982), the attachment system evolved

because it increased the likelihood that off-

spring would survive until they were old

enough to reproduce and also taught chil-

dren how to regulate emotions effectively.

This system is automatically activated by

external threats or internal sources of dis-

tress and, when it functions appropriately,

leads to emotional security. Its optimal

functioning is associated with a relational

if–then script, which Waters and Waters

(2006) called a secure- base script, para-

phrased by us as follows: “If I encounter

an obstacle and/or become distressed, then

I can approach a significant other for help.

He or she is likely to be available and sup-

portive. I will experience relief and comfort

as a result of proximity to this person, and

I can then return to other activities.” Once

activated, this script can, by itself, mitigate

distress, promote optimism and hope, and

help a person cope effectively with life’s

inevitable difficulties (Mikulincer, Shaver,

Sapir-Lavid, & Avihou-Kanza, 2009).

Adult attachment researchers have

designed experimental procedures to exam-

ine these normative regulatory properties

of the attachment system. For example, in

a series of experiments, Mikulincer, Gil-

lath, and Shaver (2002) showed that men-

tal representations of attachment figures

(e.g., names of security- enhancing attach-

ment figures) are automatically activated in

a person’s mind when he or she is exposed

to threatening stimuli, even if that exposure

is unconscious (i.e., primed subliminally).

Specifically, when a threat- related word

(e.g., death) was presented subliminally on

a computer screen, participants were faster

to detect the name of one of their attachment

figures when it appeared on the screen and

slower to name the color in which such names

were printed on the screen— an indication

that the names had been automatically and

unconsciously activated in memory (Miku-

lincer et al., 2002). In other words, threats,

even when arising unconsciously, can auto-

matically activate mental representations

of security providers. Similar findings have

been obtained in experiments examining

automatic activation of representations of

symbolic sources of security, such as a per-

son’s pet or God, following a threat (Gran-

qvist, Mikulincer, Gurwitz, & Shaver, 2012;

Zilcha-Mano, Mikulincer, & Shaver, 2011).

In another set of studies of what we call

security priming, Mikulincer, Hirschberger,

Nachmias, and Gillath (2001) showed that

activation of representations of security-

enhancing attachment figures can automati-

cally infuse a previously neutral stimulus

with positive affect. For example, subliminal

presentation of the names of people who were

nominated by study participants as attach-

ment figures, compared with others who

were not nominated as attachment figures,

led to greater liking of previously unfamil-

240 SOCIAL ASPECTS

iar stimuli. Moreover, subliminal exposure

to names of attachment figures eliminated

the detrimental effects that threats other-

wise had on liking for previously neutral

stimuli. These effects of security priming on

positive affect have been replicated in sub-

sequent studies (see Mikulincer & Shaver,

2007b, for a review). In addition, Eisen-

berger and colleagues (2011; Master et al.,

2009) found that viewing a photograph of

one’s romantic partner (vs. a stranger or an

object) reduced one’s subjective experience

of pain while receiving thermal stimulation

at levels slightly higher than the pain thresh-

old. Moreover, Selcuk, Zayas, Günaydin,

Hazan, and Kross (2012) found that both

explicit and implicit priming of attachment

figure representations speeded up emotional

recovery and reduced negative thoughts

after recalling an upsetting experience.

Considering all such findings, we con-

clude that people automatically search

for internal representations of security-

enhancing attachment figures during times

of stress, and mental activation of these

representations produces positive emotions

(e.g., relief, satisfaction, gratitude, love) that

facilitate effective coping and restore emo-

tional equanimity. That is, actual or sym-

bolic interactions with available and sup-

portive attachment figures, and the resulting

sense of safety, can be viewed as psycho-

logical resources for dealing with problems

and adversities, and sustaining well-being

and mental health (Mikulincer & Shaver,

2007a).

Attachment-Related Individual

Differences in Emotion Regulation

Theoretical Account

According to Bowlby (1973), disruptions in

the sense of attachment security are viewed

as risk factors for emotional problems and

psychopathology. Although secondary

attachment strategies (anxious hyperacti-

vation and avoidant deactivation) are ini-

tially adaptive, in the sense that they adjust

a child’s behavior to the requirements of

an inconsistently available or consistently

distant or unavailable attachment figure,

they are maladaptive when used in later

relationships in which support seeking and

relational interdependence could be reward-

ing and help a person maintain a sense of

well-being even in stressful conditions or

difficult periods of life (Shaver & Miku-

lincer, 2002). Moreover, these attachment

strategies encourage repeated activation

and suppression of negative emotions and

continued reliance on negative or distorted

mental representations of self and others,

which can erode and destroy mental health

(Mikulincer & Shaver, 2007a).

The early attachment experiences of inse-

cure people (whether anxious, avoidant,

or both) often involve unstable and inad-

equate distress regulation (Bowlby, 1973),

which interferes with the development of

inner resources needed for coping success-

fully with stressors. This impairment is

particularly likely during prolonged, highly

demanding stressful experiences that require

active support seeking and actual confronta-

tion with a problem (Berant, Mikulincer, &

Shaver, 2008). In such cases, anxious hyper-

activating strategies can become extreme,

damaging not only a person’s own mental

health but that of key relationship partners.

Moreover, avoidant defenses can collapse,

resulting in a marked decline in psychologi-

cal well-being.

When regulating their emotions, avoid-

ant people attempt to block or inhibit any

emotional state that is incongruent with

the goal of keeping their attachment system

deactivated (Mikulincer & Shaver, 2007a).

These inhibitory efforts are directed mainly

at fear, anxiety, anger, sadness, shame, guilt,

and distress, because these emotions are

associated with threats and feelings of vul-

nerability. In addition, anger often implies

emotional involvement or investment in a

relationship, and such involvement is incon-

gruent with avoidant people’s preference

for independence and self- reliance (Cassidy,

1994). Avoidant individuals also attempt

to block or inhibit emotional reactions to

potential or actual threats to attachment

figure availability (rejection, betrayal, sepa-

ration, loss), because such threats are direct

triggers of attachment system activation.

Like secure people, avoidant ones attempt to

down- regulate threat- related emotions. But

whereas secure people’s regulatory attempts

usually promote communication, compro-

mise, and relationship maintenance, avoid-

ant people’s efforts are aimed mainly at

keeping the attachment system deactivated,

Attachment and Emotion Regulation 241

regardless of the deleterious effects this can

have on a relationship.

Deactivating strategies cause people to

avoid noticing their own emotional reac-

tions. Avoidant individuals often deny or

suppress emotion- related thoughts and

memories, divert attention from emotion-

related material, suppress emotion- related

action tendencies, or inhibit or mask ver-

bal and nonverbal expressions of emotion

(Mikulincer & Shaver, 2007a). By averting

the conscious experience and expression of

unpleasant emotions, avoidant individuals

make it less likely that emotional experi-

ences will be integrated into their cognitive

structures and that such feelings and mental

structures will be used effectively in informa-

tion processing and social behavior. Bowlby

(1980) described this strategy as “defensive

exclusion” and the creation of “segregated

mental systems.”

Unlike secure and avoidant people, who

tend to view negative emotions as goal-

incongruent states that should either be

managed effectively or suppressed, anx-

iously attached individuals tend to perceive

these emotions as congruent with attach-

ment goals, and they may seek to sustain and

even exaggerate them. Attachment- anxious

people are guided by an unfulfilled wish

to cause attachment figures to pay more

attention and provide more reliable protec-

tion and support (Cassidy & Kobak, 1988;

Mikulincer & Shaver, 2007a). Therefore,

they tend to exaggerate the presence and

seriousness of threats and to overemphasize

their sense of helplessness and vulnerability,

because signs of weakness and neediness can

sometimes elicit attachment figures’ atten-

tion and care (Cassidy & Berlin, 1994).

How is anxious hyperactivation sustained?

One method is to exaggerate the appraisal

process, perceptually heightening the threat-

ening aspects of even fairly benign events,

to hold pessimistic beliefs about one’s ability

to manage distress, and to attribute threat-

related events to uncontrollable causes or

global personal inadequacies (Mikulincer &

Shaver, 2007a). Another method is to attend

to internal indicators of distress (Cassidy

& Kobak, 1988). This includes hypervigi-

lant attention to the physiological aspects

of emotional states, heightened recall of

threat- related experiences, and rumination

on real and potential threats (Mikulincer

& Shaver, 2007a). Another hyperactivating

strategy is to intensify negative emotions by

favoring an approach, counterphobic ori-

entation toward threatening situations or

making self- defeating decisions and taking

ineffective actions that are likely to end in

failure. All of these strategies create a self-

amplifying cycle of distress even after a

threat objectively recedes.

Empirical Evidence

There is now a large body of evidence sup-

porting the hypothesized links between

attachment- related avoidance and emotional

inhibition, and between attachment anxiety

and distress intensification. In particular,

theory- congruent findings have been found

in studies of responses to both attachment-

irrelevant stressful events and attachment-

related stressors (e.g., a partner’s hurtful

behavior, a relationship breakup, or the

death of a relationship partner).

Attachment Orientations and Responses

to Stressful Events

Several studies have examined attachment

style differences in the ways people appraise,

cope with, and emotionally and physiologi-

cally react to attachment- irrelevant stress-

ful events (i.e., events that have no direct

implications for one’s close relationships or

attachment figures). These attachment style

differences have been examined in response

to a wide variety of stressful experiences,

such as combat training (e.g., Mikulincer

& Florian, 1995), transition to college (e.g.,

Lopez & Gormley, 2002), abortion (e.g.,

Cozzarelli, Sumer, & Major, 1998), infertil-

ity (e.g., Amir, Horesh, & Lin-Stein, 1999),

pregnancy (e.g., Mikulincer & Florian,

1999), workload (e.g., Raskin, Kummel, &

Bannister, 1998), financial problems (e.g.,

Bartley, Head, & Stansfeld, 2007), and job

loss (e.g., Hobdy et al., 2007). They have

also been examined in studies that did not

focus on a specific stressful event but asked

participants to report on any major stress-

ors recently experienced (e.g., Holmberg,

Lomore, Takacs, & Price, 2011). In addi-

tion, the link between attachment orienta-

tions and stress- related reactions has been

examined in response to several laboratory-

induced stressors, such as aversive noise (e.g.,

242 SOCIAL ASPECTS

Quirin, Pruessner, & Kuhl, 2008), the Trier

Social Stress Test (e.g., Smeets, 2010), and

difficult cognitive tasks (e.g., Kidd, Hamer,

& Steptoe, 2011).

With regard to the cognitive appraisal

of stressful events, attachment anxiety has

been associated with distress- intensifying

appraisals— in which stressful events are

appraised as threats rather than challenges

and one’s coping resources are viewed

as deficient (e.g., Cozzarelli et al., 1998;

Mikulincer & Florian, 1998). For avoidant

attachment, however, the findings are more

complex. Whereas avoidant attachment is

associated with appraising stressful events

in more threatening terms, it is not associ-

ated with appraisals of coping resources

(e.g., Williams & Riskind, 2004). This dis-

sociation might reflect avoidant individuals’

reluctance to recognize that they are vulner-

able and weak, and therefore need to rely

on others for assistance and support (Miku-

lincer & Shaver, 2007a).

There is also theoretically consistent evi-

dence concerning attachment- related dif-

ferences in self- reports of ways of coping

with stressful events. Whereas attachment

anxiety is associated with emotion- focused

coping, such as wishful thinking, self-blame,

and distress- related rumination, avoidant

attachment is associated with reliance on

distancing strategies, such as stress denial,

diversion of attention, and behavioral or

cognitive disengagement (e.g., Holmberg et

al., 2011; Zhang & Labouvie- Vief, 2004).

Several adult attachment studies have

involved asking participants to report on

their psychological distress or well-being

during and following stressful events.

Overall, findings indicate that attach-

ment insecurities— anxiety, avoidance, or

both—are associated with self- reports of

heightened distress and deteriorated well-

being (see Mikulincer & Shaver, 2007a, for

a review). Moreover, some of the studies

compared the emotional reactions of secure

and insecure people undergoing stressful

experiences with those of controls, reveal-

ing that stressful events arouse distress

mainly among insecurely attached people.

For secure people, there is often no notable

difference in emotion between neutral and

stressful situations (e.g., Amir et al., 1999).

That is, secure people seem to be relatively

calm under stressful conditions.

Recent studies have found that attachment-

related differences in coping are reflected in

physiological responses to stressful events.

For example, two experiments (Diamond,

Hicks, & Otter- Henderson, 2006; Maunder,

Lancee, Nolan, Hunter, & Tannenbaum,

2006) exposed participants to various labo-

ratory stressors (e.g., recalling a stressful sit-

uation, performing demanding math tasks)

and found that self- reports of avoidant

attachment were associated with heightened

physiological reactivity: decreased heart rate

variability, increased skin conductance, and

heightened blood pressure. With regard to

attachment anxiety, Maunder et al. found

that attachment- anxious people reported

higher levels of distress but did not exhibit

heightened physiological reactivity, perhaps

suggesting, as mentioned earlier, that anx-

ious people exaggerate their own distress.

In addition, four studies have assessed

attachment style differences in the activ-

ity of the hypothalamic– pituitary– adrenal

(HPA) axis, which can be measured by

salivary cortisol levels during and following

a laboratory- induced stressor. One study

found that avoidant attachment was associ-

ated with increased levels of salivary corti-

sol (Kidd et al., 2011); another study (Qui-

rin et al., 2008) found a positive association

between attachment anxiety and heightened

cortisol reactivity; and two studies found no

significant association between attachment

orientations and cortisol levels (Ditzen et

al., 2008; Smeets, 2010). These inconsisten-

cies might have been due, in part, to varia-

tions in the laboratory- induced stressors

(e.g., aversive noise, the Trier Social Stress

Test) and participants’ age (young adults,

midlife adults). More systematic research is

needed to determine the presence or absence

of links between attachment insecurities

and HPA dysregulation following stressful

events.

There is also preliminary evidence that

an association between attachment inse-

curities and psychological distress follow-

ing stressful events can be observed in

brain responses. Using event- related func-

tional magnetic resonance imaging (fMRI),

Lemche et al. (2006) found that self- reports

of attachment anxiety or avoidance were

associated with heightened activation in

bilateral amygdalae to a stressful stimulus.

That is, less secure people tended to react to

Attachment and Emotion Regulation 243

stress with increased amygdala activity— a

neural indication of distress- related arousal.

Considering longer- term neural effects

of attachment insecurities, Quirin, Gil-

lath, Pruessner, and Eggert (2010) found

that self- reports of attachment anxiety and

avoidance were associated with reduced

hippocampal cell density, which was asso-

ciated with poorer emotion regulation. In

particular, attachment- related avoidance

was associated with bilateral hippocampal

cell reduction, and attachment anxiety was

significantly related to reduced cell concen-

tration in the left hippocampus. These find-

ings are compatible with a neurotoxic model

of stress- induced cell reduction in the hip-

pocampus, contributing to poorer emotion

regulation abilities in individuals with inse-

cure attachment orientations.

Attachment Orientations and Responses

to a Partner’s Hurtful Behaviors

Explicit or implicit signs of a partner’s disap-

proval, criticism, rejection, or betrayal can

evoke hurt feelings, arouse hostility toward

a partner, and even destroy a relationship.

However, the ways people react to these

relational stressors seem to depend on their

attachment orientation. There is accumu-

lating evidence that insecure people tend to

react more intensely than secure people—

cognitively, emotionally, and behavior-

ally— to actual or imagined partner disap-

proval, criticism, rejection, or betrayal (e.g.,

Besser & Priel, 2009, 2010; Carnelley, Israel,

& Brennan, 2007). For example, Dewitte,

De Houwer, Goubert, and Buysse (2010)

found that whereas attachment anxiety was

related to greater physiological arousal and

stronger negative affect following relational

stress, attachment- related avoidance pre-

dicted withdrawal responses.

Using Rusbult, Verette, Whitney, Slovik,

and Lipkus’s (1991) typology of accom-

modation responses to a partner’s negative

behavior, several studies (e.g., Gaines et al.,

1997; Scharfe & Bartholomew, 1995) found

that, compared with insecure people, secure

ones were more likely to rely on “voice”

(an active, relational approach to solving a

problem) and “loyalty” (understanding the

temporary nature of a partner’s behavior

and working with him or her to improve)—

the two more accommodative responses to a

partner’s transgressions. Moreover, whereas

secure individuals tended to respond to rejec-

tion threats by adopting approach- oriented

goals that improved relationship quality,

less secure people tended to respond to such

threats by decreasing approach motivation

and emphasizing avoidance goals (Park,

2010). In a test of responses to a hurtful

interaction, Perunovic and Holmes (2008)

found that more secure individuals reported

inhibition of negative impulses and the

adoption of relationship- enhancing behav-

ior even under time pressure, implying that

for them accommodation was automatic.

Dewitte and De Houwer (2008; Dewitte,

Koster, De Houwer, & Buysse, 2007) used

a classic dot-probe task and found that

both attachment anxiety and avoidance

were associated with attentional avoid-

ance of signs of a partner’s hurtful behavior

(attachment- threat words and angry faces).

In addition, using the same dot-probe task,

Dewitte, De Houwer, Koster, and Buysse

(2007) found that attachment anxiety was

associated with hypervigilance regarding

attachment figures’ names in both threaten-

ing and positive relational situations. This

finding is conceptually similar to Miku-

lincer et al.’s (2002) finding of faster cogni-

tive processing of attachment figure’s names

regardless of context.

Attachment insecurities also tend to

inhibit forgiveness— one of the most effec-

tive accommodation responses for improv-

ing relationship quality and reestablishing

relational harmony following a partner’s

negative behavior (e.g., Burnette, Taylor,

Worthington, & Forsyth, 2007; Yárnoz-

Yaben, 2009). Mikulincer, Shaver, and

Slav (2006) found that less secure people

were more inclined to report intense feel-

ings of vulnerability or humiliation and a

strong sense of relationship deterioration

when “forgiving” a partner. In other words,

attachment insecurities were associated

with a more negative conception and experi-

ence of forgiveness. Burnette, Davis, Green,

Worthington, and Bradfield (2009) provided

evidence concerning potential mediators

of such effects: Whereas the link between

attachment anxiety and forgiveness was

mediated by excessive rumination on rela-

tional injuries, the link between attachment-

related avoidance and forgiveness was medi-

ated by lack of empathy.

244 SOCIAL ASPECTS

Beyond these associations between dispo-

sitional measures of attachment insecurities

and deficient forms of forgiveness, there is

increasing evidence that state-like senses of

security or insecurity can alter the tendency

to forgive a hurtful partner. For example,

Finkel, Burnette, and Scissors (2007) exper-

imentally enhanced attachment anxiety or

measured weekly fluctuations in attachment

anxiety for 6 months and found that height-

ened attachment anxiety reduced forgiveness

of a partner’s offenses. In addition, Han-

non, Rusbult, Finkel, and Kumashiro (2010)

found that, following an act of betrayal, the

offending partner’s provision of a sense of

security to the injured partner (by genu-

inely expressing interest in being responsive

to the victim’s needs) promoted forgiveness

and restoration of relational harmony. Kar-

remans and Aarts (2007) found that sub-

liminal security priming (with the name

of a loving other), compared with neutral

priming, elicited more automatic forgiveness

responses to interpersonal transgressions.

Following this line of reasoning, Cassidy,

Shaver, Mikulincer, and Lavy (2009) showed

that experimentally heightening the sense of

attachment security can reduce detrimental

effects of dispositional attachment insecu-

rities on cognitive and emotional reactions

to hurtful experiences. Participants wrote a

description of an incident in which a close

relationship partner criticized, disapproved,

rejected, or ostracized them. They then com-

pleted a computerized task in which they

were repeatedly exposed subliminally (for

22 milliseconds on each occasion) to either

a security- enhancing prime word (love,

secure, affection) or a neutral prime word

(lamp, staple, building). Immediately after

the priming trials, participants were asked

to think again about the hurtful event they

had described and to rate how they would

react to such an event if it happened in the

future— for example, how rejected they

would feel, and how they would feel about

themselves.

In the neutral priming condition, the find-

ings confirmed the usual deactivating and

hyperactivating strategies of avoidant and

anxious people. Whereas avoidance scores

were associated with more defensive/hostile

reactions, attachment anxiety was associ-

ated with more intense feelings of rejec-

tion, more crying, and more negative emo-

tions. These typical correlational findings

were dramatically reduced in size (most

approached zero) in the security- priming

condition. In other words, security priming

reduced the tendency of avoidant people to

rely on cool hostility or denial, and the ten-

dency of anxious people to react histrioni-

cally to a partner’s hurtful behaviors. Over-

all, research indicates that (1) people who

are dispositionally secure can deal construc-

tively with hurtful relational events, and (2)

contextual activation of the sense of security

can soften the typical maladaptive responses

of dispositionally insecure people.

Responses to Separations

and Relationship Breakups

Several studies have shown that attach-

ment orientations predict the intensity and

duration of distress following a romantic

relationship breakup (e.g., Sbarra, 2006;

Sbarra & Emery, 2005), divorce (Birn-

baum, Orr, Mikulincer, & Florian, 1997),

wartime separation from a marital partner

(e.g., Medway, Davis, Cafferty, Chappell, &

O’Hearn, 1995), or temporary separations

from a romantic partner (e.g., Diamond,

Hicks, & Otter- Henderson, 2008). In these

studies, distress intensification was a com-

mon response of anxiously attached people,

whereas attachment security was associated

with faster emotional recovery and adjust-

ment. For example, Sbarra (2006) collected

daily emotion data for 4 weeks from a sam-

ple of young adults who had recently experi-

enced a romantic relationship breakup and

found that attachment anxiety was associ-

ated with slower recovery from sadness and

anger. In a 21-day diary study, Diamond et

al. (2008) found that attachment anxiety was

associated with sleeping problems, physical

symptoms, and higher levels of salivary cor-

tisol during and following days of physical

separation from a romantic partner brought

about by work- related travel. Using fMRI

to observe brain responses to the recall of a

painful separation, Gillath, Bunge, Shaver,

Wendelken, and Mikulincer (2005) found

that attachment anxiety was associated with

higher activation of the left anterior tempo-

ral pole and left hippocampus (areas associ-

ated with recall of sad thoughts) and lower

activation of the orbitofrontal cortex (an

area associated with emotional control).

Attachment and Emotion Regulation 245

For avoidant individuals, the findings

depended on the nature of the separation

(Mikulincer & Shaver, 2007a). Avoidance

was associated with higher levels of distress

following divorce and wartime separations

but lower levels of distress and greater relief

following temporary separations from, or

permanent breakups with, dating part-

ners. It seems that avoidant people who

can handle the distress of brief separations

or the dissolution of casual bonds are less

successful in dealing with major separations

requiring reorganization of relational rou-

tines, goals, and plans. This fits with other

evidence, including that from experiments

(e.g., Mikulincer, Dolev, & Shaver, 2004),

indicating that avoidant defenses collapse

under pressure.

There is also evidence that people with

different attachment orientations differ in

the ways they cope with separation. For

example, following divorce (Birnbaum et

al., 1997) and temporary separations from a

dating partner (Feeney, 1998), attachment-

anxious individuals were more likely to rely

on emotion- focused coping strategies, and

avoidant individuals, on distancing strate-

gies. Similar coping strategies were noted by

Davis, Shaver, and Vernon (2003) in a sur-

vey of more than 5,000 Internet respondents

who described romantic relationship break-

ups. Avoidant respondents were less likely

to seek support and more likely to cope

with the breakup alone, while avoiding new

romantic involvements. Anxious respon-

dents reacted with angry protests, height-

ened sexual attraction to the former partner,

intense preoccupation with the lost partner,

a damaged sense of identity, and interference

with school and work activities. In addition,

as a means of coping with separation, both

anxious and avoidant individuals used alco-

hol and drugs, which is not generally an

effective coping strategy.

Studies that induced thoughts about hypo-

thetical or actual separations also provide

important information about attachment-

related differences in regulating the distress

resulting from these thoughts. For example,

using a thought suppression task, Fraley

and Shaver (1997) showed that avoidant

people were highly effective in suppressing

separation- related thoughts, as indicated

by less frequent thoughts of loss following

the suppression task and lower skin con-

ductance during the task. However, Miku-

lincer et al. (2004) found that avoidant peo-

ple’s ability to suppress separation- related

thoughts was disrupted when a cognitive

load— remembering a 7-digit number— was

added to the experimental task. Under a high

cognitive load, avoidant individuals sud-

denly evinced high availability of thoughts

of separation and negative self- traits. That

is, the suppressed material resurfaced in

experience and behavior when a high cogni-

tive demand was imposed. We suspect that

a similar resurfacing occurs when a high

emotional demand is imposed, as in the

studies reviewed earlier that dealt with life-

threatening traumatic events (e.g., Berant et

al., 2008). Recently, Ehrenthal, Friederich,

and Schauenburg (2011) found that avoidant

attachment was associated with impaired

blood pressure recovery following recall of a

painful separation, further emphasizing the

fragility of avoidant defenses.

Reactions to the Death of a Close

Relationship Partner

Few studies have directly examined associa-

tions between attachment orientations and

grief reactions following the death of a close

relationship partner. However, these stud-

ies have consistently found that attachment

anxiety is associated with complicated grief

reactions (e.g., Fraley & Bonanno, 2004;

Jerga, Shaver, & Wilkinson, 2011). For

example, Field and Sundin (2001) found that

anxious attachment, assessed 10 months

after the death of a spouse, predicted higher

levels of psychological distress 14, 25, and

60 months after the loss, and Fraley and

Bonanno (2004) found that attachment

anxiety assessed 4 months after the loss of

a spouse predicted higher levels of anxiety,

depression, grief, trauma- related symptoms,

and alcohol consumption 18 months follow-

ing the loss.

With regard to avoidant attachment,

researchers have generally found no signifi-

cant association between this attachment

pattern and depression, grief, or distress

following the death of a relationship part-

ner (e.g., Field & Sundin, 2001; Fraley &

Bonanno, 2004). However, Wayment and

Vierthaler (2002) found that avoidance was

associated with increased somatic symp-

tom levels following the death of a spouse.

246 SOCIAL ASPECTS

Recently, Jerga et al. (2011) found that

avoidant attachment was positively associ-

ated with prolonged grief symptoms but not

with typical or normative grief symptoms.

That is, people who are generally avoidant

in close relationships experience long-term

difficulties adjusting to the death of a rela-

tionship partner, even though they do not

necessarily experience more intense typical

grief symptoms.

Jerga et al. (2011) also found that

relationship- specific avoidance was nega-

tively associated with both typical and

prolonged grief symptoms. However, other

findings indicated that this association dis-

appeared when measures of relationship

closeness and strength were statistically con-

trolled, suggesting that avoidant individuals

may maintain relatively weak and emotion-

ally distant relationships with the deceased,

which in turn leaves them with less to grieve

about. In other words, it may not be avoid-

ant attachment per se that protects avoidant

individuals from grief symptoms; it may be

the weakness of the emotional bonds they

have to contend with when a relationship

partner dies.

Conclusions

In summarizing recent research on adult

attachment patterns and its implications

for emotion regulation, we have shown

that attachment security is associated with

appraisals and regulation efforts that are

compatible with a balanced, open mind,

generally low levels of stress and distress,

and constructive approaches to relationship

maintenance. The two major dimensions

of insecure attachment are associated with

characteristic strategies for dealing with

painful experiences in previous attachment

relationships.

Avoidance and attachment system deac-

tivation are reactions to important relation-

ships in which attachment figures, often

beginning with one or both parents, reacted

negatively to expressions of need, vulner-

ability, and negative emotions. To cope

with that powerfully painful relationship

influence, avoidant people have learned to

downplay threats (i.e., trying not to appraise

events as threatening), suppress or deny feel-

ings of vulnerability and negative emotions,

and view themselves as superior, autono-

mous, and properly unemotional. This does

not keep them from reacting to relationship

partners with frustration, hostility, and

denigration or from boosting their own self-

esteem in the face of relationship losses by

focusing disproportionately on their own

strengths and other people’s weaknesses.

Attachment anxiety and attachment

system hyperactivation are reactions to

important relationships in which attach-

ment figures, often beginning with one or

both parents, reacted inconsistently to a

person’s expressions of need, vulnerability,

and negative emotions, sometimes providing

support but at other times being frustrating

or inattentive (often because of their own

self- focused anxiety). This caregiver regi-

men causes a person to believe that constant

vigilance, worry, and expressions of need,

vulnerability, and retaliatory anger pay off,

because they sometimes do capture a rela-

tionship partner’s attention. Unfortunately,

they can also alienate a person from his or

her initially favorable and loving relation-

ship partners and evoke exactly what the

anxious person fears: rejection or abandon-

ment. Thus, what began as a response to a

partial reinforcement schedule of attention

and support, and what became a pattern of

noisy negativity, seems to the anxious per-

son to lead to outcomes that confirm his or

her expectations and worst fears.

These different patterns of emotional

reaction and defense have been documented

in a remarkable variety of studies using

experimental, interview, and observational

research methods. They are now being illu-

minated further by neuroscientific stud-

ies. They provide strong specific support

for Bowlby and Ainsworth’s attachment

theory and its extension into the realm of

adult relationships (Mikulincer & Shaver,

2007a). However, more research is needed

if we are to understand better (1) the spe-

cific hyperactivating or deactivating strate-

gies a particular insecure person will use in

particular situations, (2) the link between

attachment orientations and the relative

balance of implicit and explicit emotion-

regulation attempts, and (3) the ways people

scoring high on both attachment anxiety

and avoidance regulate their emotions. In

addition, future studies should attempt to

integrate Bowlby’s (1988) notion that effec-

Attachment and Emotion Regulation 247

tive therapeutic interventions amount to

providing a secure base and help with emo-

tion regulation— precisely what was missing

in a client’s previous attachment relation-

ships—with the findings we have reviewed

here concerning normative and individual-

differences aspects of links between attach-

ment orientations and emotion regulation

strategies. Further development and evalua-

tion of attachment- related therapeutic inter-

ventions will foster greatly improved lives

and close relationships.

References

Ainsworth, M. D. S., Blehar, M. C., Waters, E.,

& Wall, S. (1978). Patterns of attachment:

Assessed in the Strange Situation and at home.

Hillsdale, NJ: Erlbaum.

Amir, M., Horesh, N., & Lin-Stein, T. (1999).

Infertility and adjustment in women: The

effects of attachment style and social support.

Journal of Clinical Psychology in Medical Set-

tings, 6, 463– 479.

Bartley, M., Head, J., & Stansfeld, S. (2007). Is

attachment style a source of resilience against

health inequalities at work? Social Science and

Medicine, 64, 765–775.

Berant, E., Mikulincer, M., & Shaver, P. R.

(2008). Mothers’ attachment style, their men-

tal health, and their children’s emotional vul-

nerabilities: A seven-year study of children

with congenital heart disease. Journal of Per-

sonality, 76, 31–66.

Besser, A., & Priel, B. (2009). Emotional

responses to a romantic partner’s imaginary

rejection: The roles of attachment anxiety,

covert narcissism, and self-

valuation. Journal

of Personality, 77, 287–325.

Besser, A., & Priel, B. (2010). Grandiose narcis-

sism versus vulnerable narcissism in threaten-

ing situations: Emotional reactions to achieve-

ment failure and interpersonal rejection.

Journal of Social and Clinical Psychology, 29,

874–902.

Birnbaum, G. E., Orr, I., Mikulincer, M., &

Florian, V. (1997). When marriage breaks up:

Does attachment style contribute to coping

and mental health? Journal of Social and Per-

sonal Relationships, 14, 643–654.

Bowlby, J. (1973). Attachment and loss: Vol. 2.

Separation: Anxiety and anger. New York:

Basic Books.

Bowlby, J. (1980). Attachment and loss: Vol.

3. Sadness and depression. New York: Basic

Books.

Bowlby, J. (1982). Attachment and loss: Vol. 1.

Attachment (2nd ed.). New York: Basic Books.

(Original work published 1969)

Bowlby, J. (1988). A secure base: Clinical appli-

cations of attachment theory. London: Rout-

ledge.

Brennan, K. A., Clark, C. L., & Shaver, P. R.

(1998). Self-

eport measurement of adult

attachment: An integrative overview. In J. A.

Simpson & W. S. Rholes (Eds.), Attachment

theory and close relationships (pp. 46–76).

New York: Guilford Press.

Burnette, J. L., Davis, D. E., Green, J. D.,

Worthington, E. L., & Bradfield, E., Jr.

(2009). Insecure attachment and depressive

symptoms: The mediating role of rumination,

empathy, and forgiveness. Personality and

Individual Differences, 46, 276–280.

Burnette, J. L., Taylor, K., Worthington, E. L., Jr.,

& Forsyth, D. R. (2007). Attachment working

models and trait forgivingness: The mediat-

ing role of angry rumination. Personality and

Individual Differences, 42, 1585–1596.

Carnelley, K. B., Israel, S., & Brennan, K. (2007).

The role of attachment in influencing reac-

tions to manipulated feedback from romantic

partners. European Journal of Social Psychol-

ogy, 37, 968–986.

Cassidy, J. (1994). Emotion regulation: Influence

of attachment relationships [Special issue].

Monographs of the Society for Research in

Child Development, 59, 228–249.

Cassidy, J., & Berlin, L. J. (1994). The insecure/

ambivalent pattern of attachment: Theory and

research. Child Development, 65, 971–981.

Cassidy, J., & Kobak, R. R. (1988). Avoidance

and its relationship with other defensive pro-

cesses. In J. Belsky & T. Nezworski (Eds.),

Clinical implications of attachment (pp.

300–

323). Hillsdale, NJ: Erlbaum.

Cassidy, J., & Shaver, P. R. (Eds.). (2008). Hand-

book of attachment: Theory, research, and

clinical applications (2nd ed.). New York:

Guilford Press.

Cassidy, J., Shaver, P. R., Mikulincer, M., &

Lavy, S. (2009). Experimentally induced secu-

rity influences responses to psychological

pain. Journal of Social and Clinical Psychol-

ogy, 28, 463–478.

Cozzarelli, C., Sumer, N., & Major, B. (1998).

Mental models of attachment and coping with

abortion. Journal of Personality and Social

Psychology, 74, 453 – 467.

248 SOCIAL ASPECTS

Davis, D., Shaver, P. R., & Vernon, M. L. (2003).

Physical, emotional, and behavioral reactions

to breaking up: The roles of gender, age, emo-

tional involvement, and attachment style. Per-

sonality and Social Psychology Bulletin, 29,

871–884.

Dewitte, M., & De Houwer, J. (2008). Adult

attachment and attention to positive and nega-

tive emotional face expressions. Journal of

Research in Personality, 42, 498–505.

Dewitte, M., De Houwer, J., Goubert, L., &

Buysse, A. (2010). A multi-modal approach to

the study of attachment- related distress. Bio-

logical Psychology, 85, 149–162.

Dewitte, M., De Houwer, J., Koster, E. H. W.,

& Buysse, A. (2007). What’s in a name?:

Attachment- related attentional bias. Emotion,

7, 535–545.

Dewitte, M., Koster, E. H. W., De Houwer, J.,

& Buysse, A. (2007). Attentive processing

of threat and adult attachment: A dot-probe

study. Behaviour Research and Therapy, 45,

1307–1317.

Diamond, L. M., Hicks, A. M., & Otter-

Henderson, K. A. (2006). Physiological evi-

dence for repressive coping among avoidantly

attached adults. Journal of Social and Per-

sonal Relationships, 23, 205–229.

Diamond, L. M., Hicks, A. M., & Otter-

Henderson, K. A. (2008). Every time you go

away: Changes in affect, behavior, and physi-

ology associated with travel- related separa-

tions from romantic partners. Journal of Per-

sonality and Social Psychology, 95, 385–403.

Ditzen, B., Schmidt, S., Strauss, B., Nater, U.

M., Ehlert, U., & Heinrichs, M. (2008).

Adult attachment and social support inter-

act to reduce psychological but not cortisol

responses to stress. Journal of Psychosomatic

Research, 64, 479–486.

Ehrenthal, J. C., Friederich, H. C., & Schauen-

burg, H. (2011). Separation recall: Psy-

chophysiological response- patterns in an

attachment- related short-term stressor. Stress

and Health, 27, 251–255.

Eisenberger, N. I., Master, S. L., Inagaki, T. K.,

Taylor, S. E., Shirinyan, D., Lieberman, M.

D., et al. (2011). Attachment figures activate a

safety signal- related neural region and reduce

pain experience. Proceedings of the National

Academy of Sciences USA, 108, 11721–11726.

Feeney, J. A. (1998). Adult attachment and

relationship- centered anxiety: Responses to

physical and emotional distancing. In J. A.

Simpson & W. S. Rholes (Eds.), Attachment

theory and close relationships (pp. 189–219).

New York: Guilford Press.

Field, N. P., & Sundin, E. C. (2001). Attachment

style in adjustment to conjugal bereavement.

Journal of Social and Personal Relationships,

18, 347–361.

Finkel, E. J., Burnette, J. L., & Scissors, L. E.

(2007). Vengefully ever after: Destiny beliefs,

state attachment anxiety, and forgiveness.

Journal of Personality and Social Psychology,

92, 871–886.

Fraley, R., & Bonanno, G. A. (2004). Attachment

and loss: A test of three competing models on

the association between attachment- related

avoidance and adaptation to bereavement.

Personality and Social Psychology Bulletin,

30, 878–890.

Fraley, R. C., & Shaver, P. R. (1997). Adult

attachment and the suppression of unwanted

thoughts. Journal of Personality and Social

Psychology, 73, 1080–1091.

Fraley, R. C., & Shaver, P. R. (2000). Adult

romantic attachment: Theoretical develop-

ments, emerging controversies, and unan-

swered questions. Review of General Psychol-

ogy, 4, 132–154.

Gaines, S. O. Jr., Reis, H. T., Summers, S., Rus-

bult, C. E., Cox, C. L., Wexler, M. O., et al.

(1997). Impact of attachment style on reactions

to accommodative dilemmas in close relation-

ships. Personal Relationships, 4, 93–113.

Gillath, O., Bunge, S. A., Shaver, P. R., Wen-

delken, C., & Mikulincer, M. (2005).

Attachment- style differences in the ability to

suppress negative thoughts: Exploring the neu-

ral correlates. NeuroImage, 28, 835–847.

Granqvist, P., Mikulincer, M., Gurwitz, V., &

Shaver, P. R. (2012). Experimental findings

on God as an attachment figure: Normative

processes and moderating effects of internal

working models. Journal of Personality and

Social Psychology, 103, 804–818.

Hannon, P. A., Rusbult, C. E., Finkel, E. J.,

& Kumashiro, M. A. (2010). In the wake of

betrayal: Perpetrator amends, victim forgive-

ness, and the resolution of betrayal incidents.

Personal Relationships, 17, 253–278.

Hobdy, J., Hayslip, B., Kaminski, P. L., Crowley,

B. J., Riggs, S., & York, C. (2007). The role of

attachment style in coping with job loss and

the empty nest in adulthood. International

Journal of Aging and Human Development,

65, 335–371.

Holmberg, D., Lomore, C. D., Takacs, T. A., &

Price, E. L. (2011). Adult attachment styles

Attachment and Emotion Regulation 249

and stressor severity as moderators of the

coping sequence. Personal Relationships, 18,

502–517.

Jerga, C., Shaver, P. R., & Wilkinson, R. B.

(2011). Attachment insecurities and identifica-

tion of at-risk individuals following the death

of a loved one. Journal of Social and Personal

Relationships, 28, 891–914.

Karremans, J. C., & Aarts, H. (2007). The role

of automaticity in the inclination to forgive

close others. Journal of Experimental Social

Psychology, 43, 902–917.

Kidd, T., Hamer, M., & Steptoe, A. (2011).

Examining the association between adult

attachment style and cortisol responses to

acute stress. Psychoneuroendocrinology, 36,

771–779.

Lemche, E., Giampietro, V. P., Surguladze, S.

A., Amaro, E. J., Andrew, C. M., Williams, S.

C., et al. (2006). Human attachment security

is mediated by the amygdala: Evidence from

combined fMRI and psychophysiological mea-

sures. Human Brain Mapping, 27, 623–635.

Lopez, F. G., & Gormley, B. (2002). Stability

and change in adult attachment style over

the first-year college transition: Relations to

self- confidence, coping, and distress patterns.

Journal of Counseling Psychology, 49, 355–

364.

Master, S. L., Eisenberger, N. I., Taylor, S. E.,

Naliboff, B. D., Shirinyan, D., & Lieberman,

M. D. (2009). A picture’s worth: Partner pho-

tographs reduce experimentally induced pain.

Psychological Science, 20, 1316–1318.

Maunder, R. G., Lancee, W. J., Nolan, R. P.,

Hunter, J. J., & Tannenbaum, D. (2006). The

relationship of attachment insecurity to subjec-

tive stress and autonomic function during stan-

dardized acute stress in healthy adults. Journal

of Psychosomatic Research, 60, 283–290.

Medway, F. J., Davis, K. E., Cafferty, T. P., Chap-

pell, K. D., & O’Hearn, R. E. (1995). Family

disruption and adult attachment correlates

of spouse and child reactions to separation

and reunion due to Operation Desert Storm.

Journal of Social and Clinical Psychology, 14,

97–118.

Mikulincer, M., Dolev, T., & Shaver, P. R.

(2004). Attachment- related strategies during

thought- suppression: Ironic rebounds and vul-

nerable self- representations. Journal of Per-

sonality and Social Psychology, 87, 940–956.

Mikulincer, M., & Florian, V. (1995). Appraisal

of and coping with a real-life stressful situa-

tion: The contribution of attachment styles.

Personality and Social Psychology Bulletin,

21, 406–414.

Mikulincer, M., & Florian, V. (1998). The rela-

tionship between adult attachment styles and

emotional and cognitive reactions to stressful

events. In J. A. Simpson & W. S. Rholes (Eds.),

Attachment theory and close relationships

(pp. 143–165). New York: Guilford Press.

Mikulincer, M., & Florian, V. (1999). Maternal–

fetal bonding, coping strategies, and mental

health during pregnancy: The contribution of

attachment style. Journal of Social and Clini-

cal Psychology, 18, 255–276.

Mikulincer, M., Gillath, O., & Shaver, P. R.

(2002). Activation of the attachment system

in adulthood: Threat- related primes increase

the accessibility of mental representations of

attachment figures. Journal of Personality and

Social Psychology, 83, 881–895.

Mikulincer, M., Hirschberger, G., Nachmias, O.,

& Gillath, O. (2001). The affective component

of the secure base schema: Affective priming

with representations of attachment security.

Journal of Personality and Social Psychology,

81, 305–321.

Mikulincer, M., & Shaver, P. R. (2001). Attach-

ment theory and intergroup bias: Evidence

that priming the secure base schema attenu-

ates negative reactions to out- groups. Jour-

nal of Personality and Social Psychology, 81,

97–115.

Mikulincer, M., & Shaver, P. R. (2007a). Attach-

ment in adulthood: Structure, dynamics, and

change. New York: Guilford Press.

Mikulincer, M., & Shaver, P. R. (2007b). Boost-

ing attachment security to promote mental

health, prosocial values, and inter-group toler-

ance. Psychological Inquiry, 18, 139–156.

Mikulincer, M., Shaver, P. R., Sapir-Lavid, Y.,

& Avihou-Kanza, N. (2009). What’s inside

the minds of securely and insecurely attached

people?: The secure- base script and its associa-

tions with attachment- style dimensions. Jour-

nal of Personality and Social Psychology, 97,

615–633.

Mikulincer, M., Shaver, P. R., & Slav, K. (2006).

Attachment, mental representations of others,

and gratitude and forgiveness in romantic rela-

tionships. In M. Mikulincer & G. S. Goodman

(Eds.), Dynamics of romantic love: Attach-

ment, caregiving, and sex (pp. 190–215). New

York: Guilford Press.

Park, L. E. (2010). Responses to self- threat:

Linking self and relational constructs with

approach and avoidance motivation. Social

250 SOCIAL ASPECTS

and Personality Psychology Compass, 4, 201–

221.

Perunovic, M., & Holmes, J. G. (2008). Auto-

matic accommodation: The role of personal-

ity. Personal Relationships, 15, 57–70.

Quirin, M., Gillath, O., Pruessner, J. C., & Egg-

ert, L. D. (2010). Adult attachment insecurity

and hippocampal cell density. Social Cogni-

tive and Affective Neuroscience, 5, 39– 47.

Quirin, M., Pruessner, J. C., & Kuhl, J. (2008).

HPA system regulation and adult attachment

anxiety: Individual differences in reactive and

awakening cortisol. Psychoneuroendocrinol-

ogy, 33, 581–590.

Raskin, P. M., Kummel, P., & Bannister, T.

(1998). The relationship between coping

styles, attachment, and career salience in part-

nered working women with children. Journal

of Career Assessment, 6, 403–416.

Rusbult, C. E., Verette, J., Whitney, G. A.,

Slovik, L. F., & Lipkus, I. (1991). Accommo-

dation processes in close relationships: Theory

and preliminary empirical evidence. Journal of

Personality and Social Psychology, 60, 53–78.

Sbarra, D. A. (2006). Predicting the onset of emo-

tional recovery following nonmarital relation-

ship dissolution: Survival analyses of sadness

and anger. Personality and Social Psychology

Bulletin, 32, 298–312.

Sbarra, D. A., & Emery, R. E. (2005). The emo-

tional sequelae of nonmarital relationship

dissolution: Analysis of change and intrain-

dividual variability over time. Personal Rela-

tionships, 12, 213–232.

Scharfe, E., & Bartholomew, K. (1995). Accom-

modation and attachment representations in

couples. Journal of Social and Personal Rela-

tionships, 12, 389–401.

Selcuk, E., Zayas, V., Günaydin, G., Hazan, C.,

& Kross, E. (2012). Mental representations of

attachment figures facilitate recovery follow-

ing upsetting autobiographical memory recall.

Journal of Personality and Social Psychology,

103, 362–378.

Shaver, P. R., & Mikulincer, M. (2002).

Attachment- related psychodynamics. Attach-

ment and Human Development, 4, 133–161.

Smeets, T. (2010). Autonomic and hypothalamic–

pituitary– adrenal stress resilience: Impact of

cardiac vagal tone. Biological Psychology, 84,

290–295.

Waters, H. S., & Waters, E. (2006). The attach-

ment working models concept: Among other

things, we build scriptlike representations

of secure base experiences. Attachment and

Human Development, 8, 185–198.

Wayment, H. A., & Vierthaler, J. (2002). Attach-

ment style and bereavement reactions. Journal

of Loss and Trauma, 7, 129–149.

Williams, N. L., & Riskind, J. H. (2004). Adult

romantic attachment and cognitive vulnerabil-

ities to anxiety and depression: Examining the

interpersonal basis of vulnerability models.

Journal of Cognitive Psychotherapy, 18, 7–24.

Yárnoz-Yaben, S. (2009). Forgiveness, attach-

ment, and divorce. Journal of Divorce and

Remarriage, 50, 282–294.

Zhang, F., & Labouvie- Vief, G. (2004). Stabil-

ity and fluctuation in adult attachment style

over a 6-year period. Attachment and Human

Development, 6, 419– 437.

Zilcha-Mano, S., Mikulincer, M., & Shaver, P.

R. (2011). Pets as safe havens and secure bases:

The moderating role of pet attachment orien-

tations. Journal of Research in Personality,

45, 345–357.

251

Research and theory in the domain of atti-

tudes and evaluation are relevant to emotion

due to their many overlaps and parallels.

Most fundamentally, they share at their core

the concept of valence. Attitudes encode the

valence of an object: that is, goodness or

badness, desirability or undesirability, plea-

sure or pain. Valence is similarly integral to

the concept of emotion; some theories argue

that all emotions, at their core, can be dis-

tilled to whether they are positive or nega-

tive (e.g., Russell, 2003; Watson & Tellegen,

1985). Valence’s function is to guide appro-

priate action. In the case of attitudes, that

functionality lies in the ability of valence

to provide a rapid, default assessment of an

object’s value; we need not constantly judge

the world anew.

Yet this tool that may even be lifesaving in

times of peril can also be a liability. Reflex-

ively acting in accordance with one’s feelings

is not always appropriate; indeed, the feeling

itself may be deemed problematic. For exam-

ple, prejudiced group attitudes and evalua-

tions may conflict with social norms or one’s

values, leading to reconciliatory processes of

justification or suppression (Crandall, Eshle-

man, & O’Brien, 2002). We also argue that

evaluation entails a process of affect regula-

tion in and of itself. Even in the absence of

a particular desire to change one’s evalua-

tion, regulation is occurring. Increasingly,

contemporary perspectives on attitudes view

evaluations as the product of dynamic pro-

cesses that are shaped by the demands of the

immediate situation. Relatively stable men-

tal representations underlie the very earli-

est evaluative processing; however, in a way

that can be viewed as fundamentally self-

regulatory (e.g., Carver & Scheier, 1982),

evaluations are sensitive to various goals and

standards for thoughts, feelings, and behav-

ior.

Regarding the volitional self- regulation

of evaluation, it will be uncontroversial

to note that people are not merely pas-

sive receivers of their psychological experi-

ences; valence may be not only experienced

but also assessed and modified. Though

evaluation has some characteristics of cued

responding grounded by preexisting struc-

ture, people do not respond to the same cue

in an invariable fashion. One may generally

dislike something (say, golf) but temper that

affective response, or even reverse it, when

the situation demands. For example, when

offered the opportunity to golf with a work

supervisor, one might be motivated to deem-

phasize the object’s disliked features and

emphasize its liked ones (e.g., defining golf

more by its aesthetic value than by, say, its

early- morning tee times), or reevaluate its

features (e.g., considering how golf’s diffi-

culty might constitute a virtue rather than

CHAPTER 16

Attitudes, Evaluation,

and Emotion Regulation

Christopher R. Jones

Tabitha Kirkland

William A. Cunningham

252 SOCIAL ASPECTS

an annoyance). Evaluations are often shaped

to conform to appropriate action. As such,

when considering the use of attitudes to

guide behavior, the regulation of affect is

important. One type of evaluative regulation

entails the inhibition and reshaping of “gut

reactions” of liking in accordance with their

perceived appropriateness. Beyond this, we

emphasize processes within even quite rapid

and spontaneous evaluations (those very gut

reactions) that evidence self- regulatory flex-

ibility in experienced object- directed affect.

Relatedly, Gross and Barrett (2011) sug-

gest the possibility that emotion generation

and regulation can be considered the same

process: Information may be simultane-

ously processed as affectively relevant and

informed by top-down processes that take

contextual cues (e.g., situational appropri-

ateness) into account. Similarly, Todd, Cun-

ningham, Anderson, and Thompson (2012)

have suggested that emotion can be simulta-

neously shaped and regulated through early

attentional biases. In making this argument,

we hope to highlight the potential for greater

integration between the literatures on affect

regulation and attitudes, which as yet have

stood largely separate.

At the outset, some clarification of our

usage of the terms attitude and evaluation

will be useful. Some prominent definitions

have defined attitudes generally: predisposi-

tions to respond positively or negatively to

an object (e.g., Allport, 1935; Eagly & Chai-

ken, 1993), or as a constellation of affec-

tive, cognitive, and behavioral responses

associated with an object (Zanna & Rem-

pel, 1988). In contrast, in a more specific

and limited definition, Fazio (2007) defines

attitudes as associations in memory between

objects and summated valenced information

about those objects. This approach is the

one we take here, defining attitudes as repre-

sentational, which means that attitudes sig-

nify valenced information stored in memory

that has the potential to be activated. We do,

however, distinguish representational atti-

tudes from evaluation— a process by which

valence is constructed in both bottom- up

and top-down fashion. In this way, we inte-

grate a representational definition, with the

approach to attitudes typically considered

most antithetical to it: the constructivist

approach (e.g., Schwarz & Bohner, 2001).

This approach tends not to deny the exis-

tence of mental representations but chooses

to deemphasize them, focusing instead on

contextual factors that shape experiences of

liking and disliking. In summary, we use the

term attitude to refer to a structural entity

in memory, and the term evaluation to refer

to an appraisal process informed by an atti-

tude that unfolds over time in a particular

context. Thus, evaluation can be considered

a process of affect regulation in the moment,

fostering context appropriateness. Given our

terminology, attitudes may also be subject to

self- regulation, such as when one attempts to

change how much one generally likes some-

thing. We primarily focus on the former.

It is the interplay of attitudes and evalua-

tion that provides true functionality. A rigid

retrieval system would be insensitive to con-

text and beholden to even limited past expe-

rience. A fully constructed system would be

slow, inefficient, and too unresponsive to

lessons learned. Instead, we have both capa-

bilities. The transformation of attitudes into

evaluations is a form of emotion regulation

in which situational factors can play a role

even in immediate responses. We argue that

an attitude is a triggered affective response

shaped into a contextually appropriate eval-

uation via a process of iterative reprocessing

(Cunningham & Zelazo, 2007). This updat-

ing occurs as the situation unfolds; thus,

affect regulation is critical to all stages of

the attitude- to- evaluation transformation—

from the processes typically considered

automatic to the processes that are typically

considered controlled. Thus, although the

effortful inhibition of evoked attitudes is a

major topic, our conceptualization of regu-

lation goes beyond this to include a variety

of processes that shape adaptive responding.

This broader view of emotion regulation

is consistent with evolving views on self-

regulation generally, in which inhibition is

not a sine qua non (e.g., Fujita, 2011).

In this chapter, we review contemporary

attitude theories that entail an emphasis

on regulation. Following a discussion of

two foundational models to most recent

approaches, we focus in detail on contem-

porary treatments of attitude and evaluation

that illustrate the self- regulatory shaping

of rapid response. We highlight the itera-

tive reprocessing (IR) model (Cunningham

& Zelazo, 2007), which not only addresses

such processes descriptively but also provides

a perspective from neuroscience regarding

their underlying brain substrates. We use the

Attitudes and Emotion Regulation 253

IR model as a framework to address differ-

ences in theory and empirical controversy

that characterize this literature.

Two Foundational Attitude Models

Models of attitudes commonly empha-

size some distinction between implicit and

explicit attitudes or evaluative processes.

Undoubtedly, this is in large part due to

the introduction of reaction- time-based

implicit attitude measures, such as evalu-

ative priming (Fazio, Jackson, Dunton,

& Williams, 1995) and the Implicit Asso-

ciation Test (IAT; Greenwald, McGhee, &

Schwarz, 1998). Researchers had long hoped

to find a solution to the problem of dishon-

est responding to attitude measures out of

social desirability concerns. These implicit

measures offered the best solution to date by

engaging participants in a task that might

reveal attitudes without actually calling on

participants to express them.

Interestingly, the new implicit attitude

measures appear to diverge from explicit

measures (self- report) particularly when

participants’ self- presentational concerns

are high (e.g., Fazio et al., 1995; Olson,

Fazio, & Hermann, 2007), yet the mea-

sures also diverge even when participants’

incentives to misrepresent themselves are

minimal. For example, Karpinski and Hil-

ton (2001) found null relations between

IAT and self- report measures of preference

for insects versus flowers and apples versus

candy bars, seemingly noncontroversial atti-

tude objects. Furthermore, it appeared that

social influence (not necessarily intentional

misrepresentation) was especially evident on

the implicit measure rather than the explicit

measure. That is, the IAT suggested a greater

affinity for the healthy (i.e., socially val-

ued) alternative than was evident in explicit

behavior. This example highlights the find-

ing that dissociations between implicit and

explicit measures are common and complex

(for a meta- analytic review, see Hofmann,

Gawronski, Gschwendner, Le, & Schmitt,

2005), and that these dissociations cannot

be attributed exclusively to misrepresenta-

tion on self- report measures or measurement

error and lack of structural fit (Payne, Burk-

ley, & Stokes, 2008).

Models need to account for these disso-

ciations, and incorporating some distinction

between implicit and explicit attitudes or

evaluations is a common way of doing so.

However, something like this distinction has

been long recognized. For example, Hov-

land, Janis, and Kelley (1953, cited in Petty

& Briñol, 2006, p. 740) distinguished atti-

tudes (“implicit responses” that are “some-

times unconscious”) from opinions (“verbal

answers that one covertly expresses”). The

recent accumulated evidence from implicit

measures can be understood as validation

of the long- appreciated observation that

rapid, unintentional responses (what one

might call “gut reactions”) can differ a great

deal from carefully considered evaluations.

Accounting fully for the processes that dis-

tinguish them is a central issue in contem-

porary attitude theory and obviously impor-

tant for self- regulation. We first discuss two

influential models that have been recently

built upon to explain differences between

immediate and subsequent responses.

The MODE Model

The acronym MODE refers to Motiva-

tion and Opportunity as DEterminants of

whether the attitude- to- behavior process

is relatively spontaneous or deliberative in

nature. The MODE model (Fazio, 1990;

Olson & Fazio, 2009) posits a single atti-

tude representation, and defines an attitude

as the association in memory between an

object and a summary evaluation thereof (see

Fazio, 2007). The model is largely agnostic

about the nature of attitude representation.

It is readily understood in terms of a “schema

plus tag” model, in which summary evalu-

ations are a special form of tag associated

with an attitude object. However, it is also

consistent with more recent dynamic and

connectionist models if the term summary

is understood to refer to distributed infor-

mation in memory (Eiser, Fazio, Stafford,

& Prescott, 2003). Regardless, the MODE

model is primarily concerned with how and

when attitudes determine behavior.

The MODE model predicts whether the

attitude- to- behavior process is relatively

spontaneous or deliberative in nature. The

model notes that the primary function of

attitudes is to provide a rapid assessment

of objects in the environment to facilitate

appropriate behavior in a timely fashion.

Attitudes can be activated automatically,

and the likelihood of automatic attitude

254 SOCIAL ASPECTS

activation is a function of the associative

strength between the attitude object and the

associated evaluation (see Fazio, 2001). If

there is little motivation for further consid-

eration of the object, for whatever reason, or

low opportunity (e.g., time pressure or cog-

nitive load) to do so, attitudes should guide

behavior in a spontaneous, largely auto-

matic fashion, in which they promote con-

gruent behaviors afforded by the situation.

Controlled deliberation about the attitude

and behavior is likely only when the motiva-

tion and opportunity to do so are present.

This deliberation might lead to the alteration

or rejection of an attitude and the behavior

it facilitates, but it could also affirm it. In

fact, the model suggests that affirmation

is most typical, because the activated atti-

tude fosters biased processing. Alteration or

rejection of the attitude depends on various

factors, including contextual influences on

the object’s utility, social influence, object

reappraisal, and so on.

In summary, the MODE model posits a

single attitude associated with each discrete

representation of an attitude object that may

be retrieved from memory, often automati-

cally. That attitude is likely to shape sub-

sequent judgment and behavior; however,

the attitude’s influence is especially likely

to be direct for spontaneous behaviors.

When the motivation and opportunity to

deliberate are present, the attitude might

be disregarded, adjusted for reasons includ-

ing context or apparent appropriateness, or

validated by deliberation. The MODE mod-

el’s implications for emotion regulation are

straightforward. The model applies directly

to circumstances in which one wishes to

control automatic emotional responses to a

particular object. It points to motivation and

opportunity as broad categories encompass-

ing many specific variables and emphasizes

that any major impediment to motivation or

ability drastically reduces the likelihood of

deliberative regulation.

To account for discrepancies between

implicit and explicit attitudes, the MODE

perspective suggests that implicit measures

largely reflect automatically activated atti-

tudes, while explicit measures capture delib-

erative evaluations, which may or may not

reflect attitudes for the reasons described.

Another way of explaining these differences

is to evoke two different attitude representa-

tions to which the measures are differentially

sensitive. The notion of an implicit attitude

is often attributed to Greenwald and Banaji

(1995), who wrote: “Implicit attitudes are

introspectively unidentified (or inaccurately

identified) traces of past experience that

mediate favorable or unfavorable feeling,

thought, or action toward social objects”

(p. 8). It was not until Wilson, Lindsey, and

Schooler’s (2000) dual- attitudes model,

however, that a major process model of dual

attitudes was articulated.

The Dual‑Attitudes Model

In the original conception of “implicit atti-

tudes,” such attitudes, by definition, were

considered to be unknown to the evaluator

(Greenwald & Banaji, 1995). The absence

of awareness is most directly the facet of

automaticity (see Bargh, 1994) referred to

by the term implicit. However, the term has

been used in a wide variety of ways, lead-

ing some to argue that because implicit de

facto has become a catchall descriptor of

(relatively) automatic processes, it should be

understood as such (De Houwer & Moors,

2007). Wilson and colleagues (2000), for

example, do not define implicit attitudes as

being characterized by unawareness. They

suggested that “people are often aware,

at least fleetingly, of [implicit attitudes]”

(p. 105). What, then, is an implicit attitude

in this model?

According to the dual- attitudes model

(Wilson et al., 2000), implicit attitudes are,

in a word, old (or prior). That is, when an

attitude representation changes, it is not

fully supplanted by a new, altered attitude.

Rather, both representations can coexist in

memory. Thus, an implicit attitude is a prior,

often deeply ingrained attitude. By virtue of

its precedence and having been rehearsed,

the implicit attitude is strongly associated

with the attitude object. Thus, it will likely

be automatically activated upon encounter-

ing an attitude object. Similar to the MODE

model, the dual- attitudes model posits that

“capacity and motivation” are required to

retrieve the newer, explicit attitude effort-

fully. Retrieval of the explicit attitude is

expected to lead to its application, especially

for controlled behaviors. The simultaneous

activation of implicit and explicit attitudes

may also demonstrate unintended influ-

ence of the implicit attitude, especially on

unmonitored or uncontrollable nonverbal

Attitudes and Emotion Regulation 255

responses (e.g., Dovidio, Kawakami, John-

son, Johnson, & Howard, 1997).

Wilson et al. (2000) further distinguish

a typology of four kinds of implicit atti-

tudes, which have different characteristics

due to their differing origins. Briefly, an

implicit attitude might arise from repres-

sion, in which an anxiety- provoking implicit

attitude is expelled from consciousness

and is thus implicit in the sense of being

unknown. Another implicit attitude arises

from motivated overriding, when an attitude

is unwanted and effortfully suppressed. A

third implicit attitude arises from automatic

overriding, when the process of overrid-

ing such an implicit attitude itself becomes

automatized through repetition. In this case,

capacity and motivation are not actually

required for the explicit rather than implicit

attitude to predominate. Finally, the dual-

attitudes model suggests that implicit atti-

tudes may differ from explicit attitudes sim-

ply by virtue of having an entirely separate

neurocognitive substrate (i.e., independent

systems; see Lieberman, 2007, for such a

view) but does not elaborate much on this

possibility, which distinguishes some more

recent models.

In some ways, the implications of the

dual- attitudes model for emotion regulation

are similar to those of the MODE model.

Certainly, the necessity of motivation and

ability/capacity for any sort of controlled

emotion regulation is again highlighted.

The different types of implicit attitudes

described, however, are uniquely relevant.

The case of repression, though its very exis-

tence is controversial, poses an interesting

problem. In this case, one’s own affective

reactions to an object are anxiety provok-

ing, instigating defensive reactions that sup-

press and exclude them from consciousness.

Motivated overriding essentially describes a

phenomenon of successful affective regula-

tion, but it does not elaborate much about

how this occurs, especially under difficult

circumstances, with the exception that

automatizing a regulatory response may

occur through repetition. This is an interest-

ing possibility in the realm of emotion regu-

lation.

Summary of Historical Perspectives

To summarize, these models in their early

incarnations posited implicit or activated

attitudes that were largely unregulated.

Schema-plus-tag or implicit- attitude- as-

habitual- response conceptualizations of

attitude share the consequence of rapid

responses that are quite inflexible and

context- free. Affective regulation is then

possible if and only if one is motivated and

able to suppress, adjust, enhance, or replace

(i.e., effortfully retrieve an explicit atti-

tude) an evaluation. However, the strong

form of this view is inconsistent with find-

ings that are indicative of self- regulatory

responding even in rapid responses evident

on implicit measures. For example, Lowery,

Hardin, and Sinclair (2001) demonstrated

that racial attitudes as measured by an IAT

were sensitive to social tuning— that is, they

were influenced by the presumed attitudes

of other individuals present. Increasingly,

recent models address adaptive flexibility in

processes occurring during the construction

of an evaluation. Notably, a similar devel-

opment has occurred in theorizing about

stereotyping. Automatic stereotype activa-

tion was often viewed as inevitable (Bargh,

1999; Devine, 1989) and could only be over-

ridden by controlled processes. Subsequent

research in this domain suggested a much

more optimistic view of flexibility and self-

regulation at the earliest stages of process-

ing (e.g., Jones & Fazio, 2010; Moskowitz,

Gollwitzer, Wasel, & Schaal, 1999; Sassen-

berg & Moskowitz, 2005). In contemporary

attitude models, we see a greater emphasis

on malleability in rapid responses. This mal-

leability can be viewed as demonstrating the

fundamentally regulatory nature of evalua-

tion. We turn now to recent models includ-

ing several variations on this theme.

Contemporary Attitude Models

The Associative–Propositional

Evaluation Model

Probably the most influential contemporary

approach to attitudes and evaluation is the

associative– propositional evaluation (APE)

model, which originally was introduced

to explain the complex literature on the

impact of interventions that form or change

attitudes on implicit and explicit measures

(Gawronski & Bodenhausen, 2006). Since

then, the APE model has been broadened to

address attitudes and evaluation more gener-

ally (see Gawronski & Bodenhausen, 2011).

256 SOCIAL ASPECTS

The APE model describes two interactive

but distinct types of processes that under-

lie evaluation: associative and propositional

processes.

Associative processes activate

associated representations from memory.

This activation is presumed to follow the

principles of contiguity and similarity; con-

tiguity refers to the spatiotemporal proxim-

ity of stimuli that determines the structure

of memory, whereas similarity refers to the

fit between encountered objects and men-

tal representations. Propositional processes

involve the validation of information acti-

vated by associative processes. Unlike asso-

ciative processes, propositional processes

entail subjective assessments of truth values

(i.e., veridicality of information). They are

posited to operate according to principles of

logical consistency, though in the sense of

perceived coherence rather than formal logic

per se. Associative processes are argued to

underlie implicit evaluations, and propo-

sitional processes are argued to underlie

explicit evaluations. Thus, if implicit evalua-

tions are perceived as valid, they will be used

for explicit evaluations; if they are not, they

are modified.

The APE model suggests that, following

connectionist models of associative memory,

information associated with a given atti-

tude object is distributed across a network

of weighted connections. The activation

of a given piece of information associated

with an object is typically probabilistic, in

a manner that maximizes the likelihood of

the most relevant information being acti-

vated, which can be viewed as regulatory.

The particularities of the input stimulus, as

well as incidentally active information due

to recency of use, determine which subset of

associations is activated. This allows for dif-

ferent implicit evaluations as a function of

context, consistent with malleability often

observed on implicit attitude measures (e.g.,

Barden, Maddux, Petty, & Brewer, 2004).

These implicit evaluations provide the grist

for propositional processing. If the propo-

sitional implications of an implicit evalu-

ation are inconsistent with other salient

propositions, an aversive state of cognitive

dissonance is evoked. Cognitive dissonance,

induced by the simultaneous activation of

conflicting information, is an aversive state

of arousal that motivates efforts to allevi-

ate it (Festinger, 1957). Various methods of

restoring balance and consistency have long

been recognized, such as rejecting one of the

propositions or introducing another propo-

sition that reconciles or trivializes the appar-

ent conflict.

Importantly, associative and proposi-

tional processes are argued to be interactive.

In addition to the bottom- up processes in

which activated associations determine the

kinds of propositions that are evoked, there

are also top-down processes that create

or activate further associations (see Gaw-

ronski & Bodenhausen, 2011, for details).

The APE model is useful for explaining the

highly varied patterns of results that have

been observed when implicit and explicit

measures follow manipulations meant to

form or change attitudes. Earlier models,

particularly those that emphasize the sta-

bility of implicit evaluations (e.g., Wilson

et al., 2000), have trouble explaining cir-

cumstances in which implicit measures are

more sensitive to manipulation than explicit

measures (e.g., Gawronski & LeBel, 2008;

Karpinski & Hilton, 2001). The APE model,

in contrast, can explain when information

will recruit associative versus propositional

processes.

Some types of interventions are likely to

have direct effects on associative processes

(Gawronski & Bodenhausen, 2011). For

example, evaluative conditioning, a phenom-

enon in which an attitude toward an object

forms or changes due to its co- occurrence

with one or more valenced objects, is

likely to have these types of direct associa-

tive effects (for reviews, see De Houwer,

Thomas, & Baeyens, 2001; Jones, Olson, &

Fazio, 2010). The repeated pairing of objects

during conditioning procedures facilitates

association formation and strengthening

for obvious reasons. Other types of inter-

ventions are likely to have direct effects

on propositional processes. Inductions of

cognitive inconsistency (e.g., Gawronski

& Strack, 2004) impact propositional pro-

cesses directly but may leave relevant asso-

ciations intact. Events might also directly

influence both associative and propositional

processes. For example, a persuasive mes-

sage could change the propositions that are

considered and also create new associations

in memory.

Finally, events might directly influence

one process and indirectly influence the

Attitudes and Emotion Regulation 257

other. Any change in associative structure

can potentially influence the propositions

that are generated and assessed, the path

taken to reduce cognitive dissonance, and so

forth. The propositions an individual con-

siders can create or change the associative

strength of associations, even in the absence

of external stimulation. A fuller account of

the details of the APE model (see Gawronski

& Bodenhausen, 2006, 2011) is beyond the

scope of this chapter, but it should be noted

that the APE model offers many specific

hypotheses about the eliciting circumstances

and processes underlying patterns of atti-

tude change evident in implicit and explicit

measures.

One issue addressed by the APE model

that has interesting implications for affect

regulation concerns negation. The act of

negating a proposition may be insufficient

to change the relevant associative struc-

ture in memory. Indeed, though negation

may influence propositional processes in

a straightforward manner (i.e., processing

consistent with the negated proposition), the

act of negation may have ironic effects at

the associative level due to the coactivation

of elements (e.g., Deutsch, Gawronski, &

Strack, 2006). For example, telling oneself,

“I am not afraid of giving a speech,” may

have some immediate positive consequences

due to its consciously processed implica-

tion. However, this also risks increasing the

(automatic) association in memory between

fear and public speaking merely because of

their simultaneous activation. Gawronski

and Bodenhausen (2011) suggest that the

overall success of regulating future affec-

tive reactions depends on whether unwanted

propositions are negated (“I’m not afraid of

public speaking”) or preferable propositions

are affirmed (“Public speaking is fun”),

implying that affirmation works better than

negation for emotion regulation.

For exam-

ple, a study in which stereotypical associ-

ates were negated led to increased automatic

stereotype activation and, significantly for

the question of affect regulation, increased

bias on an evaluative priming task (Gaw-

ronski, Deutsch, Mbirkou, Seibt, & Strack,

2008). Gawronski and Bodenhausen (2011)

suggested that such ironic effects may bear

some responsibility for the general superi-

ority in emotion regulation (Gross, 1998)

of an affirmative strategy of reappraisal as

opposed to a negative strategy of suppres-

sion. However, other work suggests that

generating or encountering negations may

have positive influences on affect regulation.

For example, Herbert, Deutsch, Sütterlin,

Kübler, and Pauli (2011; see also Mauss,

Evers, Wilhelm, & Gross, 2006) examined

startle eyeblink responses to pleasant and

unpleasant nouns that had or had not been

negated. They found (with ample processing

time) online effects of negation consistent

with the logical meaning: reduced startle

response to negated unpleasant words and

increased response to negated pleasant

words. Thus, the role of negation in affect

regulation remains controversial.

The APE model suggests that the inter-

play of associative and propositional pro-

cesses underlies evaluation. It is sometimes

misunderstood to be a dual- system or

dual- representation model but it explicitly

is not (Gawronski & Bodenhausen, 2011,

pp. 104–105). The APE model argues that

all information is stored in the form of asso-

ciations, and that there is not a separate

store for propositions, thus rejecting the

possibility of dual representations. The APE

model does not explicitly endorse or reject

a dual- system approach, which emphasizes

separate mental systems (i.e., neurocognitive

substrates).

Some researchers believe that

the sometimes stark dissociations between

observed implicit and explicit evaluations

are best explained by their origination from

separate systems. We turn now to a recent

model of dual systems to explore this idea in

greater detail.

The Systems of Evaluation Model

The systems of evaluation model (SEM)

describes an associative system that pro-

duces implicit evaluations and a rule-based

system that produces explicit evaluations

(McConnell & Rydell, in press; Rydell &

McConnell, 2006). It builds on prior dual-

system models of cognition, particularly

Sloman’s (1996) model of fast and slow

learning systems of reasoning. These par-

tially independent systems operate in par-

allel and differ in the type of knowledge

they use and the operations conducted on

that knowledge. The associative system

reflects associations governed by principles

of similarity and contiguity, whereas the

258 SOCIAL ASPECTS

rule-based system operates on symbolic rep-

resentations (e.g., language) that are sub-

jected to operations of logic and deductive

reasoning. Because implicit measures tend

to reflect construct activation and explicit

measures tend to reflect symbolic reason-

ing, the measures differ in their sensitivity

to the output of the two systems. This sug-

gests that the primary distinction between

these systems is similar to the APE model.

However, a major difference is that the SEM

emphasizes distinctive characteristics of the

two systems that lead to differential rates of

change. The SEM suggests that the explicit

system is faster, while the implicit system

is slower, both to form and to change atti-

tudes. Explicit evaluations “can be formed

and modified relatively quickly because

logic and syllogism are responsive to one’s

deliberate goals and deductive reasoning

processes,” whereas implicit evaluations

“typically are slower to form and change

because they are based on accumulated atti-

tude object- evaluation pairings in memory”

(McConnell & Rydell, in press). In this way,

the SEM bears some resemblance to the

earlier dual- attitudes model of Wilson and

colleagues (2000), insofar as an implicit atti-

tude tends to be distinguished by stability.

However, the SEM does not posit separate

stores for “old” and “new” attitudes, nor

does it consider prior attitude change neces-

sarily responsible for divergence on implicit

and explicit measures. Though implicit mea-

sures are sometimes quite labile, this can be

reconciled with the SEM by noting that this

often appears to be due to activation of dif-

ferent subset of associations from memory

that influence an implicit measure, among

other reasons, rather than a rapid change in

particular associative representations.

The SEM is supported by research dem-

onstrating strong dissociations between

implicit and explicit measures, consistent

with a dual- systems view. For example,

Rydell and McConnell (2006, Experiment

2) presented participants with a series of

behaviors performed by a target individual.

Presenting a large number of positive or neg-

ative behaviors established positive or nega-

tive attitudes, respectively, that were evident

on both implicit and explicit measures. This

was followed by a series of counterattitudinal

behaviors. When 100 initial behaviors were

followed by 20 conflicting behaviors (i.e.,

positive followed by negative, or vice versa),

explicit attitude measures showed consider-

able sensitivity to new information, while

implicit measures were largely unaffected by

it. When 100 counterattitudinal behaviors

followed the initial 100, both types of mea-

sures reflected the new information. This is

interpreted as being consistent with the pres-

ence of a slow- learning associative system

and fast rule-based system. In other work

supportive of the SEM, a series of sublimi-

nal primes was paired with target individu-

als (Rydell, McConnell, Mackie, & Strain,

2006). Because repeated subliminal priming

might produce the gradual association of

affect with an attitude object, it would be

expected to influence the associative sys-

tem. Moreover, by virtue of being sublimi-

nal, such a manipulation would not provide

grist for the rule-based system. However,

the rule-based system should be especially

sensitive to the consciously accessible behav-

ioral information that was presented, as evi-

denced by influences on explicit measures.

Results in line with these hypotheses were

obtained: Across several studies, implicit

attitudes formed and changed in response

to subliminal primes, and explicit attitudes

formed and changed in response to con-

sciously accessible information.

An interesting aspect of the SEM with

wide implications for affect regulation is the

study of the consequences of discrepancy

between implicit and explicit evaluations.

One consequence of implicit– explicit dis-

crepancy involves the extent of information

processing. It has been suggested that these

discrepancies lead to increased information

processing (e.g., Petty, Tormala, Briñol, &

Jarvis, 2006). Moreover, recent work has

suggested that this may be due to the arousal

of cognitive dissonance caused by the con-

flicting outputs of the two systems (Rydell,

McConnell, & Mackie, 2008). Seeking out

information to resolve the discrepancy is a

major route to dissonance reduction. How-

ever, the source of these aversive feelings

can be mysterious to those experiencing

them, and consequently, the feelings might

be misattributed to inappropriate sources.

Specifically, negative arousal caused by atti-

tude formation with valence- inconsistent

information led participants to report lower

subjective well-being (Rydell & Durso,

2012). Thus, the SEM suggests that when

Attitudes and Emotion Regulation 259

the systems of evaluation produce discrep-

ant evaluations, negative affect and affective

regulation tend to follow. Another relevant

consequence of implicit– explicit discrepancy

involves affective forecasting. It has also been

suggested that thoughtful affective forecast-

ing relies on explicit evaluations of objects,

ignoring implicit evaluations (McConnell,

Dunn, Austin, & Rawn, 2011). Consistent

with this idea, implicit, but not explicit, atti-

tudes predicted error in affective forecasting

when considering future enjoyment of foods.

The Meta‑Cognitive Model

Petty and colleagues’ meta- cognitive model

(MCM; Petty, 2006; Petty et al., 2006; Petty,

Briñol, & DeMarree, 2007) has elements of

most of the other models we have discussed.

It focuses on how attitudes might be stored

in memory, with particular emphasis on

meta- cognitive perceptions of the validity of

responses. Moreover, the MCM draws on

research arguing that the neural substrates

of positive and negative valence are dis-

tinct (e.g., Cacioppo, Gardner, & Berntson,

1997), suggesting that separate positive and

negative evaluations of an object might be

represented in memory.

According to the MCM, though many

attitudes are predominantly univalent, it is

not uncommon for an object to be associ-

ated with both positive and negative sum-

mary evaluations. Whether the positive or

negative attitude associated with an object

is activated depends on associative strength,

recency of prior positive and negative expe-

riences, and whether the current context

is a better fit with the positive or negative

association. Reflecting on these attitudes

can lead them to become associated with a

tag, marking them as either valid or invalid.

The associated confidence indicator serves

as a signal to utilize or disregard the atti-

tude with minimal reflection required.

However, the MCM notes that validity tags

also vary in their associative strength to the

evaluation and in accessibility, meaning that

sometimes the tag may not be retrieved from

memory when the attitude object is. Often,

attitudes marked with an invalidity tag are

prior assessments that have been changed

but still may exert an influence (Petty et al.,

2006). The MCM concurs with the APE in

the assumption that the default response to

association activation is acceptance, the pre-

sumption of validity (see also Gilbert, 1991).

Therefore, it tends to matter more when an

invalidity tag is not retrieved, in which case a

rejected evaluation is likely to influence judg-

ment and behavior. The MCM distinguishes

between explicit ambivalence, in which both

positive and negative evaluations are associ-

ated with validity tags, and implicit ambiva-

lence, in which one association is validated

and the other is not. Explicit ambivalence is

perceived as subjectively conflicting when it

is experienced, but implicit ambivalence is

not, due to the conscious rejection of either

the positive or negative evaluation.

In summary, the MCM suggests that

the creation and retrieval of validity tags

serve a self- regulatory function by mark-

ing which associations are (in)appropriate

for guiding action. Unlike the other models

discussed, the MCM particularly may be

seen as clearly concerning the regulation of

attitudes per se. Validity tags concern the

associative network of an attitude and the

adaptive regulation of relatively general-

ized responses that can guide later action.

Though all models concern the regulation of

attitudes insofar as the process of evaluation

not only recruits but also changes attitudes

in memory, the MCM is particularly use-

ful for considering how attitude structure

changes over time.

The Iterative Reprocessing Model

and Dynamism

Our final contemporary perspective empha-

sizes dynamism in evaluation and regula-

tion. Dynamism refers to the notion that

mental representations are constantly evolv-

ing states in which partial representations

are cascading, competing, and interactive.

The dynamical approach to processing (e.g.,

Spivey, 2007) has been applied to multiple

social psychological concepts, including

categorization (Freeman, Ambady, Rule, &

Johnson, 2008), stereotyping (Freeman &

Ambady, 2009), and evaluation (Wojnowicz,

Ferguson, Dale, & Spivey, 2009). Wojnow-

icz and colleagues argue that explicit evalu-

ations are “merely the end result of a com-

plex, non- linear, time- dependent process of

multiple less- explicit attitudes competing

with one another over hundreds of millisec-

onds” (p. 1428). In early processing, mul-

260 SOCIAL ASPECTS

tiple patterns of evoked activity are partially

consistent with various evaluations. Over

time, “a continuous accrual of information

causes the distributed pattern to dynami-

cally ‘sharpen’ into a confident (selected)

interpretation, forcing other, partially acti-

vated, competing alternative[s] . . . to gradu-

ally die out” (p. 1429), an idea consistent

with the connectionist modeling notion of

an “attractor state” (e.g., Conrey & Smith,

2007). Selection is spurred by a cyclical pro-

cessing loop between higher- order integra-

tive brain regions and lower-level informa-

tional sources, in which the former enact

representation competition that promotes

or inhibits alternatives. Wojnowicz and col-

leagues (2009) drew on research on racial

attitudes (e.g., Fazio et al., 1995) suggesting

that negative partial evaluations of black tar-

gets would be common early in participants’

processing streams but would be subsumed

by more positive evaluations due to the moti-

vation to control prejudice. They anticipated

that the dynamic evolution of an evaluation

would be evident in subtle behavioral traces

as participants moved a cursor to associ-

ate “black” with “like” or “dislike.” Their

theory specifically predicted a curvature in

trajectory toward the eventually unchosen

alternative (“dislike”) when expressing lik-

ing for the target “black” that would not be

evident when the target was “white.” This is

what they observed.

The IR model (Cunningham & Zelazo,

2007) considers such dynamism central in

regulating evaluative responses. As noted,

the terms attitude and evaluation are often

used interchangeably, but we believe that

it is useful to refer to them as qualitatively

different. Whereas an attitude is a relatively

stable set of representations of a stimulus, an

evaluation reflects one’s current appraisal of

the stimulus. Evaluative processes transform

attitudes into evaluations. In other words, to

generate an evaluation, one uses preexisting

attitudes to retrieve useful affective informa-

tion about a stimulus, but the evaluation also

takes into consideration information about

the environment and context, as well as cur-

rent goals (see Figure 16.1). Furthermore,

because information is distributed, not all

aspects of the attitude are activated; as such,

only the currently active aspects of attitude

can shape an evaluation. Critically, because

active representations shape perception and

construal of a situation, and because cate-

gories and construals shape which attitude

aspects are foregrounded and made more

active, stimuli initiate an iterative sequence

of evaluative processes (the evaluative cycle)

through which the stimuli are interpreted

and reinterpreted in light of an increasingly

rich set of contextually meaningful repre-

sentations. Such a view blurs the traditional

distinctions found in dual- systems or dual-

process models of attitudes and attitude

regulation. Indeed, although evaluations

that are based on few iterations of the evalu-

ative cycle may be thought to be relatively

automatic or implicit, they can be shaped

by higher- order processes before they are

ever encountered (Cunningham, Van Bavel,

Arbuckle, Packer, & Waggoner, 2012; Todd

et al., 2012). Furthermore, although evalua-

tions that are based on additional iterations

may become more integrated, they do not

necessarily require or use new representa-

tions to generate ongoing evaluations.

Given the iterative nature of the model,

evaluations are proposed to be the dynamic

result of an integrated set of distributed pro-

cesses, each of which responds to and resolves

specific computational problems (see Cun-

ningham & Johnson, 2007). Evaluation is

an emergent property of multiple processes

that unfold over time. Critically, the model

proposes that a common set of processes is

consistently involved in generating current

evaluations that are shaped by both bottom-

up and top-down influences. Thus, evalua-

tive processes are part of an iterative cycle:

With every iteration, the current evaluation

of a stimulus is adjusted in light of addi-

tional contextual and motivational informa-

tion in order to create an updated evalua-

tion. Information is continually passed back

from relatively higher- order to relatively

lower-order processes, and the evaluation is

recalculated. This “reseeding” of informa-

tion allows for the foregrounding of relevant

(and backgrounding of irrelevant) attitude

representations and contextual information

in order to develop incorporate current goals

and standards, and allows for the regulation

of an evaluation response to come into line

with situational or motivational constraints.

At each iteration, the current evaluation

serves as input for ongoing evaluative pro-

cessing; as such, earlier evaluations are likely

to bias subsequent evaluative processing by

Attitudes and Emotion Regulation 261

influencing attention, information seeking,

stimulus construal, and so forth. Impor-

tantly, while conscious deliberation exerts

an influence on evaluative processing, infor-

mation about the valence and arousal value

of a stimulus continues to be represented in

subcortical structures.

To understand when people are more

likely to generate complex evaluations, the IR

model proposes that two competing motiva-

tional drives influence the extent of evalua-

tive processing. First, a drive to minimize the

discrepancy between one’s evaluation and

the hedonic environment (i.e., to minimize

error) increases reflective processing dur-

ing evaluation. Second, a drive to minimize

processing demands decreases in reflective

processing during evaluation. These oppos-

ing drives create a dynamic tension that can

help individuals to strike a delicate balance

between an initial “gut” response and evalu-

ations that are more nuanced but not com-

putationally overwhelming. The influence of

these competing motivations likely varies as

a function of situational demands, current

goals, and individual differences in process-

ing style.

Thus, unlike models that propose a stark

difference between automatic and controlled

processes, the IR model suggests a contin-

uum from relatively automatic to controlled

evaluative processes that can operate on a set

of representations. At the early stages of pro-

cessing, the strongest weights associated with

an attitude give rise to a specific pattern of

activation, and result in quick and automatic

evaluations. However, with more iterations

and the potential for reflective processing

in areas of the brain responsible for higher

processing (e.g., prefrontal cortex), evalua-

tions are shaped by a dynamic interaction of

several bottom- up and top-down processes.

This interaction allows for the foreground-

ing and backgrounding of particular pat-

terns of activation in accordance with cur-

rent contexts and goals. Evaluations based

on additional iterations are generally more

reflective. As individuals engage in reflec-

tive reprocessing, they are able to formulate

more complex, nuanced representations of

a stimulus (e.g., allowing a stimulus to be

understood in terms of multiple conflicting

dimensions of evaluation). This hierarchical

approach, which views reflection as a matter

FIGURE 16.1. The iterative reprocessing model. From Cunningham, Zelazo, Packer, and Van Bavel

Evaluative

Processes

Evaluative

Processes

Evaluative

Processes

Stimulus

Construal

Stimulus

Construal

Stimulus

Construal

Evaluation

Stimulus

Attitude Representations

Iteration

T+~200ms

Iteration

T+~400ms

Iteration

Time

262 SOCIAL ASPECTS

of degree, is consistent with contemporary

characterizations of prefrontal cortical func-

tion (Bunge & Zelazo, 2006).

But although it is possible to draw parallels

between standard dual- process models and

the IR model, the nature of the relationship

between what can be considered automatic

and controlled differs in important ways.

The IR model proposes that what is typically

considered more controlled or reflective pro-

cessing in dual- process models merely biases

which representations remain active and the

complexity of the evaluation that is possible

given this set of active representations. Thus,

the biasing of representations can come prior

to processing any given stimulus, allowing

for automatic regulation— the initial rep-

resentation, categorization, and evaluation

of an object can be modified at the earliest

levels of processing. Indeed, attention to one

category (race) or another (age) for stimuli

that can be multiply categorized leads to

greater affective priming to the focal cat-

egory (Gawronski, Cunningham, LeBel, &

Deutsch, 2010). That is, foregrounding one

category or the other changed the initial

evaluation as measured by affective priming.

Linking the Literatures on Attitudes,

Evaluation, and Emotion Regulation

In this chapter, we suggest that the pro-

cesses by which attitudes are transformed

into evaluations may be more dynamic that

previously considered. As such, the classical

distinctions between automatic/implicit and

controlled/explicit processes may need to

be modified to articulate the dynamic and

iterative nature of evaluative processes. In

doing so, many parallels with the literature

on affect and its regulation are noted. For

example, to the extent that evaluations are

constantly updated, and regulation (defined

as biasing representations) exists through-

out the process, this suggests that the ways

that we shape affect will be important for

the types of representations that are active,

and how we use them to generate appropri-

ate evaluations. For example, the processes

of appraisal and reappraisal will be essential

for determining the meaning of an object in

a situation, and determining its value. To

the extent that one is a successful dieter, by

reappraising a donut as an efficient calorie

delivery system rather than a tasty snack,

the nature of active representations will be

more negative, and a more negative evalu-

ation will be constructed. This process

is central to emotion regulation, because

changing the value of the goal state or the

experienced outcome is the most effective

means to feel better (e.g., “I didn’t actually

want that donut, because it is bad for me”).

Furthermore, attitudes and their transfor-

mation into information are essential for all

stages of emotion regulation, from situation

selection (one can use attitudes to determine

whether a situation is likely to be good or

bad) to attention deployment (attitudes

guide attention; Roskos- Ewoldsen & Fazio,

1992). Attitudes provide the expectations

for a stimulus, and this information is criti-

cal to guiding responses that lead to good

outcomes and more positive emotions.

Conclusion

We hope the reader will find conceptual

parallels within the models reviewed and

emotion regulation. Many of the automatic

influences of goals and standards on auto-

matic evaluation, and the means and eliciting

circumstances of effortful self- regulation of

attitudes and evaluation, are likely relevant

to the regulation of emotion. Unfortunately,

these literatures have as yet seen little inte-

gration despite their potential to inform one

another. For example, attitude theory has

often neglected the role of arousal, which

has been integral to the study of emotion.

We end with a final note on the applicability

of models of evaluation for emotion regula-

tion. Although typically studied in isolation

from one another, the processes involved in

attitudes greatly overlap with those involved

in emotion regulation. Indeed, as suggested

in this chapter, the critical question con-

cerning how one converts attitudes (stored

representations about the world) into cur-

rent evaluations (temporary affective experi-

ences that can be used to drive thoughts and

behavior) can be viewed fundamentally as a

regulatory process in which an evoked affec-

tive response is shaped to reflect the exigen-

cies of the moment.

This view goes beyond more traditional

notions of regulation, which typically involve

Attitudes and Emotion Regulation 263

the inhibition or alteration of an automatic

response, dependent upon conscious will

and ability. We argue that the translation of

representation (attitude) to experience (eval-

uation) involves regulation, as active repre-

sentations are shaped and reshaped across

multiple levels of organization. At lower lev-

els, the perceptual system helps to regulate

what stimuli to attend to and what stimuli to

ignore by biasing attention, while at higher

levels, the more reflective regulatory systems

make use of similar foregrounding and back-

grounding processes. As such, the ability to

regulate one’s emotions effectively has been

linked to the ways in which these lower- and

higher- order processes interact (Lee, Heller,

van Reekum, Nelson, & Davidson, 2012).

Critically, the ability to reinterpret or recon-

strue incoming information flexibly— or

cognitive flexibility (Scott, 1962)—is an

essential feature of these models and may

be vital for emotion regulation. Although

dynamic perspectives on attitudes are only

beginning to receive attention, it is our hope

that these perspectives will be influential in

guiding future research beyond the scope of

attitudes alone. After all, these models, at

their core, are models of cognitive process-

ing, and as such are relevant to and overlap

with many domains, emotion regulation

included.

Notes

1. This basic distinction between associative and

propositional processes is shared with Strack

and Deutsch’s (2004) reflexive– impulsive

model (RIM), which in turn drew from mul-

tiple earlier dual- process theories (see Smith

& DeCoster, 2000, for a review). However,

the APE model focuses on evaluation per

se, whereas the RIM is explicitly a model of

behavior.

2. It should be noted that some negations

are familiar (“no way”) and/or very easily

reversed (“not good”), such that their appro-

priate meaning may be encoded even when

cognitive resources are strained (e.g., Mayo,

Schul, & Burnstein, 2004), rendering ironic

effects unlikely in these cases.

3. However, its authors express skepticism that

a strong dual- systems approach is consistent

with emerging evidence from neuroscience.

References

Allport, G. W. (1935). Attitudes. In C. Murchi-

son (Ed.), Handbook of social psychology.

Worcester, MA: Clark University Press.

Barden, J., Maddux, W. W., Petty, R. E., &

Brewer, M. B. (2004). Contextual modera-

tion of racial bias: The impact of social roles

on controlled and automatically activated atti-

tudes. Journal of Personality and Social Psy-

chology, 87, 5–22.

Bargh, J. A. (1994). The four horsemen of auto-

maticity: Awareness, intention, efficiency, and

control in social cognition. In R. S. Wyer, Jr.

& T. K. Srull (Eds.), Handbook of social cog-

nition (Vol. 1, 2nd ed., pp. 1–40). Hillsdale,

NJ: Erlbaum.

Bargh, J. A. (1999). The cognitive monster: The

case against controllability of automatic ste-

reotyping effects. In S. Chaiken & Y. Trope

(Eds.), Dual process theories in social psy-

chology (pp. 361–382). New York: Guilford

Press.

Bunge, S. A., & Zelazo, P. D. (2006). A brain-

based account of the development of rule use

in childhood. Current Directions in Psycho-

logical Science, 15, 118–121.

Cacioppo, J. T., Gardner, W. L., & Berntson, G.

G. (1997). Beyond bipolar conceptualizations

and measures: The case of attitudes and evalu-

ative space. Personality and Social Psychology

Review, 1, 3–25.

Carver, C. S., & Scheier, M. F. (1982). Control

theory: A useful conceptual framework for

personality— Social, clinical, and health psy-

chology. Psychological Bulletin, 92, 111–135.

Conrey, F. R., & Smith, E. R. (2007). Attitude

representation: Attitudes as patterns in a dis-

tributed, connectionist representational sys-

tem. Social Cognition, 25, 718–735.

Crandall, C. S., Eshleman, A., & O’Brien, L.

(2002). Social norms and the expression and

suppression of prejudice: The struggle for

internalization. Journal of Personality and

Social Psychology, 82, 359–378.

Crone, E. A., & Van der Molen, M. W. (2004).

Developmental changes in real-life decision-

making: Performance on a gambling task pre-

viously shown to depend on the ventromedial

prefrontal cortex. Developmental Neuropsy-

chology, 25, 251–279.

Cunningham, W. A., & Johnson, M. K. (2007).

Attitudes and evaluation: Toward a component

process framework. In E. Harmon-Jones & P.

264 SOCIAL ASPECTS

Winkielman (Eds.), Social neuroscience: Inte-

grating biological and psychological explana-

tions of social behavior (pp. 227–245). New

York: Guilford Press.

Cunningham, W. A., Johnson, M. K., Raye, C.

L., Gatenby, J. C., Gore, J. C., & Banaji, M.

R. (2004). Separable neural components in the

processing of Black and White faces. Psycho-

logical Science, 15, 806–813.

Cunningham, W. A., Raye, C. L., & Johnson,

M. K. (2004). Implicit and explicit evalua-

tion: fMRI correlates of valence, emotional

intensity, and control in the processing of atti-

tudes. Journal of Cognitive Neuroscience, 16,

1717–1729.

Cunningham, W. A., Van Bavel, J. J., Arbuckle,

N. L., Packer, D. J., & Waggoner, A. S. (2012).

Rapid social perception is flexible: Approach

and avoidance motivational states shape P100

responses to other-race faces. Frontiers in

Human Neuroscience, 6, 140.

Cunningham, W. A., & Zelazo, P. D. (2007).

Attitudes and evaluations: A social cognitive

neuroscience perspective. Trends in Cognitive

Sciences, 11, 97–104.

Cunningham, W. A., Zelazo, P. D., Packer, D.

J., & Van Bavel, J. J. (2007). The Iterative

Reprocessing Model: A multilevel framework

for attitudes and evaluation. Social Cognition,

25, 736–760.

De Houwer, J., & Moors, A. (2007). How to

define and examine the implicitness of implicit

measures. In B. Wittenbrink & N. Schwarz

(Eds.), Implicit measures of attitudes: Proce-

dures and controversies (pp. 179–194). New

York: Guilford Press.

De Houwer, J., Thomas, S., & Baeyens, F. (2001).

Associative learning of likes and dislikes: A

review of 25 years of research on human eval-

uative conditioning. Psychological Bulletin,

127, 853–869.

Deutsch, R., Gawronski, B., & Strack, F. (2006).

At the boundaries of automaticity: Negation

as reflective operation. Journal of Personality

and Social Psychology, 91, 385–405.

Devine, P. G. (1989). Stereotypes and prejudice:

Their automatic and controlled components.

Journal of Personality and Social Psychology,

56, 5–18.

Dovidio, J. F., Kawakami, K., Johnson, C., John-

son, B., & Howard, A. (1997). On the nature

of prejudice: Automatic and controlled pro-

cesses. Journal of Experimental Social Psy-

chology, 33, 510–540.

Eagly, A. H., & Chaiken, S. (1993). The psychol-

ogy of attitudes. Fort Worth, TX: Harcourt

Brace Jovanovich.

Eiser, J. R., Fazio, R. H., Stafford, T., & Prescott,

T. J. (2003). Connectionist simulation of atti-

tude learning: Asymmetries in the acquisition

of positive and negative evaluations. Personal-

ity and Social Psychology Bulletin, 29, 1221–

1235.

Fazio, R. H. (1990). Multiple processes by which

attitudes guide behavior: The MODE model

as an integrative framework. In M. P. Zanna

(Ed.), Advances in experimental social psy-

chology (Vol. 23, pp. 75–109). New York:

Academic Press.

Fazio, R. H. (2001). On the automatic activation

of associated evaluations: An overview. Cog-

nition and Emotion, 15, 115–141.

Fazio, R. H. (2007). Attitudes as object-

evaluation associations of varying strength.

Social Cognition, 25, 603– 637.

Fazio, R. H., Jackson, J. R., Dunton, B. C., &

Williams, C. J. (1995). Variability in auto-

matic activation as an unobtrusive measure

of racial attitudes: A bona fide pipeline? Jour-

nal of Personality and Social Psychology, 69,

1013–1027.

Festinger, L. (1957). A theory of cognitive dis-

sonance. Evanston, IL: Row Peterson.

Freeman, J. B., & Ambady, N. (2009). Motions

of the hand expose the partial and parallel

activation of stereotypes. Psychological Sci-

ence, 20, 1183–1188.

Freeman, J. B., Ambady, N., Rule, N. O., &

Johnson, K. L. (2008). Will a category cue

attract you?: Motor output reveals dynamic

competition across person construal. Journal

of Experimental Psychology: General, 137,

673–690.

Fujita, K. (2011). On conceptualizing self-

control as more than the effortful inhibition of

impulses. Personality and Social Psychology

Review, 15, 352–366.

Gawronski, B., & Bodenhausen, G. V. (2006).

Associative and propositional processes in

evaluation: An integrative review of implicit

and explicit attitude change. Psychological

Bulletin, 132, 692–731.

Gawronski, B., & Bodenhausen, G. V. (2011).

The associative– propositional evaluation

model: Theory, evidence, and open ques-

tions. Advances in Experimental Social Psy-

chology, 44, 59–127.

Gawronski, B., Cunningham, W. A., Lebel, E.

P., & Deutsch, R. (2010). Attentional influ-

ences on affective priming: Does categoriza-

Attitudes and Emotion Regulation 265

tion influence spontaneous evaluations of

multiply categorizable objects? Cognition, 24,

1008–1026.

Gawronski, B., Deutsch, R., Mbirkou, S., Seibt,

B., & Strack, F. (2008). When “just say no”

is not enough: Affirmation versus negation

training and the reduction of automatic ste-

reotype activation. Journal of Experimental

Social Psychology, 44, 370–377.

Gawronski, B., & LeBel, E. P. (2008). Under-

standing patterns of attitude change: When

implicit measures show change, but explicit

measures do not. Journal of Experimental

Social Psychology, 44, 1355–1361.

Gawronski, B., & Strack, F. (2004). On the

propositional nature of cognitive consistency:

Dissonance changes explicit, but not implicit

attitudes. Journal of Experimental Social Psy-

chology, 40, 535–542.

Gilbert, D. T. (1991). How mental systems

believe. American Psychologist, 46, 107–119.

Greenwald, A. G., & Banaji, M. R. (1995).

Implicit social cognition: Attitudes, self-

esteem, and stereotypes. Psychological

Review, 102, 4 –27.

Greenwald, A. G., McGhee, D. E., & Schwartz,

J. L. (1998). Measuring individual differences

in implicit cognition: The Implicit Association

Test. Journal of Personality and Social Psy-

chology, 74, 1464–1480.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J., & Barrett, L. F. (2011). Emotion

generation and emotion regulation: One or

two depends on your point of view. Emotion

Review, 3, 8–16.

Herbert, C., Deutsch, R., Sütterlin, S., Kübler,

A., & Pauli, P. (2011). Negation as a means

for emotion regulation?: Startle reflex modu-

lation during processing of negated emotional

words. Cognitive, Affective, and Behavioral

Neuroscience, 11, 199–206.

Hofmann, W., Gawronski, B., Gschwendner, T.,

Le, H., & Schmitt, M. (2005). A meta- analysis

on the correlation between the Implicit Asso-

ciation Test and explicit self- report measures.

Personality and Social Psychology Bulletin,

31, 1369–1385.

Hovland, C. I., Janis, I. L., & Kelley, H. H.

(1953). Communication and persuasion: Psy-

chological studies of opinion change. New

Haven, CT: Yale University Press.

Jones, C. R., & Fazio, R. H. (2010). Person cat-

egorization and automatic racial stereotyping

effects on weapon identification. Personality

and Social Psychology Bulletin, 36, 1073–

1085.

Jones, C. R., Olson, M. A., & Fazio, R. H.

(2010). Evaluative conditioning: The “how”

question. In M. P. Zanna & J. M. Olson

(Eds.), Advances in experimental social psy-

chology (Vol. 43, pp. 205–255). New York:

Academic Press.

Karpinski, A., & Hilton, J. L. (2001). Attitudes

and the Implicit Association Test. Journal of

Personality and Social Psychology, 81, 774–

788.

Lee, H., Heller, A. S., van Reekum, C. M., Nel-

son, B., & Davidson, R. J. (2012). Amygdala–

prefrontal coupling underlies individual differ-

ences in emotion regulation. NeuroImage, 62,

1575–1581.

Lieberman, M. D. (2007). Social cognitive neu-

roscience: A review of core processes. Annual

Review of Psychology, 58, 259–289.

Lowery, B. S., Hardin, C. D., & Sinclair, S.

(2001). Social influence effects on automatic

racial prejudice. Journal of Personality and

Social Psychology, 81, 842–855.

Mauss, I. B., Evers, C., Wilhelm, F. H., & Gross,

J. J. (2006). How to bite your tongue without

blowing your top: Implicit evaluation of emo-

tion regulation predicts affective responding

to anger provocation. Personality and Social

Psychology Bulletin, 32, 589–602.

Mayo, R., Schul, Y., & Burnstein, E. (2004). “I

am not guilty” vs. “I am innocent”: Successful

negation may depend on the schema used for

its encoding. Journal of Experimental Social

Psychology, 40, 433–449.

McConnell, A. R., Dunn, E. W., Austin, S. N., &

Rawn, C. D. (2011). Blind spots in the search

for happiness: Implicit attitudes and nonverbal

leakage predict affective forecasting errors.

Journal of Experimental Social Psychology,

47, 628–634.

McConnell, A. R., & Rydell, R. J. (in press). The

systems of evaluation model: A dual- systems

approach to attitudes. In J. Sherman, B. Gaw-

ronski, & Y. Trope (Eds.), Dual process theories

of the social mind. New York: Guilford Press.

Moskowitz, G. B., Gollwitzer, P. M., Wasel, W.,

& Schaal, B. (1999). Preconscious control of

stereotype activation through chronic egali-

tarian goals. Journal of Personality and Social

Psychology, 77, 167–184.

Olson, M. A., & Fazio, R. H. (2009). Implicit

and explicit measures of attitudes: The per-

spective of the MODE model. In R. E. Petty,

266 SOCIAL ASPECTS

R. H. Fazio, & P. Briñol (Eds.), Insights from

the new implicit measures (pp. 19–63). New

York: Psychology Press.

Olson, M. A., Fazio, R. H., & Hermann, A. D.

(2007). Reporting tendencies underlie discrep-

ancies between implicit and explicit measures

of self- esteem. Psychological Science, 18, 287–

291.

Payne, B. K., Burkley, M. A., & Stokes, M. B.

(2008). Why do implicit and explicit attitude

tests diverge?: The role of structural fit. Jour-

nal of Personality and Social Psychology, 94,

16–31.

Petty, R. E. (2006). A metacognitive model of

attitudes. Journal of Consumer Research, 33,

22–24.

Petty, R. E., & Briñol, P. (2006). A metacognitive

approach to “implicit” and “explicit” evalua-

tions: Comment on Gawronski and Boden-

hausen (2006). Psychological Bulletin, 132,

740–744.

Petty, R. E., Briñol, P., & DeMarree, K. G.

(2007). The Meta- Cognitive Model (MCM) of

attitudes: Implications for attitude measure-

ment, change, and strength. Social Cognition,

25, 657–686.

Petty, R. E., Tormala, Z. L., Briñol, P., & Jarvis,

W. B. G. (2006). Implicit ambivalence from

attitude change: An exploration of the PAST

model. Journal of Personality and Social Psy-

chology, 90, 21– 41.

Roskos- Ewoldsen, D. R., & Fazio, R. H. (1992).

On the orienting value of attitudes: Attitude

accessibility as a determinant of an object’s

attraction of visual attention. Journal of Per-

sonality and Social Psychology, 63, 198–211.

Russell, J. A. (2003). Core affect and the psycho-

logical construction of emotion. Psychological

Review, 110, 145–172.

Rydell, R. J., & Durso, G. R. O. (2012). Can I

borrow a feeling?: Spillover of negative arousal

from inconsistent information during attitude

formation diminishes perceptions of well-

being. Journal of Experimental Social Psy-

chology, 48, 575–578.

Rydell, R. J., & McConnell, A. R. (2006). Under-

standing implicit and explicit attitude change:

A systems of reasoning analysis. Journal of

Personality and Social Psychology, 91, 995–

1008.

Rydell, R. J., McConnell, A. R., & Mackie, D.

(2008). Consequences of discrepant explicit

and implicit attitudes: Cognitive dissonance

and increased information processing. Jour-

nal of Experimental Social Psychology, 44,

1526–1532.

Rydell, R. J., McConnell, A. R., Mackie, D. M.,

& Strain, L. M. (2006). Of two minds: Form-

ing and changing valence- inconsistent implicit

and explicit attitudes. Psychological Science,

17, 954–959.

Sassenberg, K., & Moskowitz, G. B. (2005).

Don’t stereotype, think different!: Overcom-

ing automatic stereotype activation by mind-

set priming. Journal of Experimental Social

Psychology, 41, 506–514.

Scott, W. A. (1962). Cognitive complexity and

cognitive flexibility. Sociometry, 25, 405–414.

Schwarz, N., & Bohner, G. (2001). The construc-

tion of attitudes. In A. Tesser & N. Schwarz

(Eds.), Blackwell handbook of social psychol-

ogy: Intraindividual processes (pp. 436–457).

Oxford, UK: Blackwell.

Sloman, S. A. (1996). The empirical case for two

systems of reasoning. Psychological Bulletin,

119, 3–22.

Smith, E. R., & DeCoster, J. (2000). Dual pro-

cess models in social and cognitive psychol-

ogy: Conceptual integration and links to

underlying memory systems. Personality and

Social Psychology Review, 4, 108–131.

Spivey, M. J. (2007). The continuity of mind.

Oxford, UK: Oxford University Press.

Strack, F., & Deutsch, R. (2004). Reflective and

impulsive determinants of social behavior.

Personality and Social Psychology Review, 8,

220 –247.

Todd, R. M., Cunningham, W. A., Anderson,

A. K., & Thompson, E. (2012). Affect- biased

attention as emotion regulation. Trends in

Cognitive Sciences, 16, 365–372.

Watson, D., & Tellegen, A. (1985). Toward a

consensual structure of mood. Psychological

Bulletin, 98, 219–235.

Wilson, T. D., Lindsey, S., & Schooler, T. Y.

(2000). A model of dual attitudes. Psychologi-

cal Review, 107, 101–126.

Wojnowicz, M. T., Ferguson, M. J., Dale, R., &

Spivey, M. J. (2009). The self- organization of

explicit attitudes. Psychological Science, 20,

1428–1435.

Zanna, M. P., & Rempel, J. K. (1988). Attitudes:

A new look at an old concept. In D. Bar-Tal

& A. Kruglanski (Eds.), The social psychol-

ogy of knowledge (pp. 315–334). New York:

Cambridge University Press.

267

Whereas research on emotion regulation in

individuals has been extremely useful, there

are numerous advantages to studying emo-

tion regulation in couples. Couples afford

high ecological validity, provide opportuni-

ties to view the rich panoply of emotion reg-

ulatory strategies, and are ideal for study-

ing the dynamics of emotion regulation as

partners engage in a rich choreography of

emotional expression and regulation that

unfolds in complex ways over time.

In this chapter, we consider several

important aspects of emotion regulation in

couples, discussing its social nature, defin-

ing qualities, consequences, development,

and assessment. We end by considering

the future of this research area, including

unmet needs, unfilled gaps, and unanswered

research questions. Our aim in this review

of the relevant literatures is not intended to

be exhaustive but rather to highlight key

studies that illustrate important issues. We

also draw anecdotally from our experiences

with couples who seek therapy for troubled

relationships (Levenson, Cowan, & Cowan,

2010). These couples almost always have

problems with emotion regulation.

The Social Nature

of Emotion Regulation

Research on emotion regulation in couples

should be booming. After all, most human

emotions occur in decidedly social situations

(Campos, Walle, Dahl, & Main, 2011).

Other people are deeply entwined in the

fabric of our emotional lives. They are the

proximal stimulus for most of our emotions

and the recipients of most of the emotions

we express. When others respond to our

emotions with their own emotional reac-

tions, they provide the fuel needed to sustain

the chains of exchanged emotions that are so

emblematic of our social lives.

With so much of human emotion being

socially situated, it is reasonable to expect

that most emotion regulation would be simi-

larly social. In fact, it has been observed that

up to 98% of emotion regulation episodes

CHAPTER 17

Emotion Regulation in Couples

Robert W. Levenson

Claudia M. Haase

Lian Bloch

Sarah R. Holley

Benjamin H. Seider

268 SOCIAL ASPECTS

may take place in social contexts (Gross,

Richards, & John, 2006). Viewed from a

functionalist perspective, emotion regula-

tion is a critical element for promoting social

cohesion. If we were to discharge our emo-

tions upon others, full-bore, undiluted, and

absent the moderating influence of emotion

regulation, the resultant affective tsunami

would have dire consequences for us and for

our social groupings.

Given its profoundly social nature, we

might expect that studies of emotion regula-

tion would almost always be conducted in

social situations. However, this could not

be further from the truth. In a recent review

of studies since 2001 (Campos et al., 2011),

less than 12% of the studies assessed emo-

tion regulation in the presence of another

person (and this is an optimistic estimate

that includes studies using both imagined

and real others). Clearly, studies of emotion

regulation in individuals have advantages

over those conducted with couples. They are

easier to administer and more amenable to

tight experimental control. However, they

are not optimal for studying the dynamic,

interpersonal aspects of emotion regulation.

Although most theorists would agree that

emotion regulation is profoundly social in

nature and is a fundamental area of concern

in close relationships, the literature on emo-

tion regulation in couples is still surprisingly

immature, with many gaps and unanswered

questions.

Before moving forward with our consid-

eration of emotion regulation in couples in

intimate relationships we should note that

they are only one of many kinds of dyads

for whom emotion regulation is critical

(e.g., new acquaintances, friends, enemies).

Moreover, emotion regulation in social con-

texts scales up from dyads through families,

groups, communities, and nations. Emotion

regulation in these larger social groupings is

fascinating and instructive (e.g., communi-

ties and nations coping with fear, anger, and

grief following collective losses, seen quite

famously in the U.S. and world responses to

the September 11, 2001, terrorist attacks).

So, why focus on couples in intimate rela-

tionships? Dyads are the smallest social unit,

thus providing an excellent starting point

for building a science of socially embedded

emotion regulation. Intimate relationships

assume a central role in the lives of most

individuals. For example, according to the

2009 census, 96% of all Americans over age

65 have been married at least once.

Defining Qualities

There are many ways to define emotion reg-

ulation. Because most theory and research

in the field of emotion regulation have

focused on individuals, popular definitions

of emotion regulation reflect this bias. For

example, Gross (1998b, p. 275) defines emo-

tion regulation as “the processes by which

individuals [emphasis added] influence

which emotions they have, when they have

them, and how they experience and express

these emotions.” Of course, a definition of

this sort could be altered so that “individu-

als” becomes “individuals and couples.”

But does this cover all bases? The answer to

this question depends on whether we think

that emotion regulation in couples can be

fully captured by summing the regulatory

activities of the two individuals involved, or

whether there are emergent qualities of emo-

tion regulation that are found only in the

couples context. Clearly there are aspects

of emotion regulation that are common to

both individuals and couples. For example,

emotion regulation in both can be explicit

(i.e., effortful) or implicit (i.e., automatic)

(Gyurak, Gross, & Etkin, 2011), and suc-

cessful or unsuccessful (Gross & Levenson,

1993). And in both contexts it can be diffi-

cult to determine where emotional reactivity

ends and emotion regulation begins (Gross,

Sheppes, & Urry, 2011). Nonetheless, as we

hope the following sections illustrate, emo-

tion regulation in couples has a number of

characteristics that are quite different from

those found in individuals.

Dynamic and Iterative

Consider two emotion regulatory scenarios.

In the first, a recent PhD recipient is prepar-

ing to give an important job talk and is in

the throes of a bout of stage fright. Fear is

the dominant emotion welling up. He is con-

cerned that the intensity of his fear, should

it reach sufficiently high levels, will compro-

mise the quality of the talk. The standard-

issue emotion regulatory toolbox offers a

number of strategies, including altering the

Emotion Regulation in Couples 269

context, reappraising the situation, or will-

fully controlling aspects of the emotional

response. The speaker chooses one (or

more) of these strategies, applies them in the

moment, successfully down- regulates the

fear, gives an excellent talk, and averts the

crisis.

Now, consider a second scenario involv-

ing emotion regulation in couples. A mar-

ried couple is talking about the husband’s

pending surgery, and he is clearly experienc-

ing high levels of fear. In that moment he

wants calming support from his wife. But

she is reacting with a great deal of sadness,

talking about her concerns that he might die

and that their children would go through

life without a father. Getting from this start-

ing point to a place where both husband

and wife are feeling less distressed is not as

straightforward as the situation in the first

scenario, in large part because there are two

actors involved. Both individuals have to

react to their own and their partner’s emo-

tional state, the impact of each partner’s

regulatory attempts (some well- chosen, oth-

ers misguided), and the unfolding sequence

of action and reaction that will occur over

time as the couple works toward achieving

a state that is more emotionally optimal for

both partners.

The second scenario illustrates some of

the ways that emotion regulation in couples

differs from emotion regulation in indi-

viduals. In regulation in couples there are

always two actors and reactors, each with

his or her own emotional motivations, goals,

strengths, blind spots, and hot buttons. Cou-

ples often find themselves in a complex emo-

tional landscape that changes continuously

as partners express and regulate their own

emotions, respond to each other’s emotions

and regulatory attempts, and try to regulate

each other’s emotions. This extremely fluid

situation, replete with highly dynamic and

iterative sequences of emotion, creates an

extremely challenging, complex landscape

for emotion regulation, one that is quite dif-

ferent from that faced by individuals.

Bidirectional

Although most discussions of emotion reg-

ulation in individuals allow for both up-

regulation and down- regulation of emotion,

the emphasis most often seems to be on

reducing emotional responses. In the canon-

ical examples, individuals seek to reduce

their negative emotions to avoid harmful

consequences for self and others. Consis-

tent with this, our own early experimental

studies of emotion regulation focused exclu-

sively on the consequences of having sub-

jects reduce their behavioral responses to

emotion- inducing films (Gross & Levenson,

1993). It was only later that we began to con-

sider up- regulation of emotion in these kinds

of studies as well (Kunzmann, Kupperbusch,

& Levenson, 2005). In recent years, espe-

cially as researchers have explored the neu-

ral bases of emotion regulation using patient

and neuroimaging models, studies including

both up- regulation and down- regulation

have become more common (e.g., Gyurak,

Goodkind, Kramer, Miller, & Levenson,

2012; Ochsner et al., 2004). However, it is

still the case that when studying emotion

regulation in individuals, the primary focus

is on reducing emotion.

In the realm of emotion regulation in

couples, this emphasis on down- regulation

is less appropriate. There are many times

when couples need to amplify the magnitude

of emotion so that it emerges more clearly

against the backdrop of other aspects of

their interaction. This amplification takes

many forms, ranging from the exaggerated

tonality of emotional speech patterns used

by mothers when they communicate with

and soothe their infants (Fernald, 1991) to

the stylized and exaggerated expressions of

love and affection that are so important in

courtship rituals. Interestingly, among those

who seek couple therapy, it is extremely

common for one partner (usually the woman

in heterosexual couples) to desire the other

partner (usually the man in these couples) to

up- regulate emotion (i.e., expressing emo-

tion more often and more clearly).

Bivalent

The prototypical examples of emotion reg-

ulation in individuals all focus on negative

emotions. This is seen in common parlance

(e.g., “Don’t let them see you sweat” [fear],

“Don’t let it get to you” [anger], “Grown

men don’t cry” [sadness]); in many ado-

lescent rituals in which a calm demeanor

is maintained while viewing, touching, or

ingesting extremely gross things (disgust);

270 SOCIAL ASPECTS

and even in therapeutic contexts (where

cathartic release is often sought for pent up

anger, fear, and sadness). Consistent with

this emphasis, most laboratory research on

emotion regulation has focused on control-

ling negative emotions. Such work is facili-

tated by eliciting negative emotions such as

disgust readily and powerfully, using static

images (Lang, Greenwald, & Bradley, 1988)

and films (Gross & Levenson, 1995). In addi-

tion, although studies comparing the regula-

tion of negative and positive emotions have

been rare, these comparisons have often not

produced dramatic differences (e.g., Gross

& Levenson, 1997).

In couples, however, the regulation of

positive emotion is at least as important

as the regulation of negative emotion. Up-

regulating positive emotion is critical for

building and maintaining intimate relation-

ships throughout the lifespan. This is seen

in parent– infant and parent– child relation-

ships, and continues with childhood friend-

ships, early romantic relationships, mate

selection, and long-term committed rela-

tionships (Carstensen, Graff, Levenson, &

Gottman, 1996). Similarly, down- regulating

positive emotion also plays an important role

for couples. For example, failure to down-

regulate amusement in response to a part-

ner’s failures and insecurities can be critical.

In these contexts, laughing, aggressive teas-

ing, and unrelenting, unsupportive humor

can be experienced as cruel and demeaning,

thus serving to undermine relationship qual-

ity (see Martin, 2007).

Coregulatory

Most of us find managing our own emotions

sufficiently challenging to occupy signifi-

cant segments of our waking (and sleeping)

hours. This challenge increases dramatically

when we take on the additional responsibil-

ity of attempting to manage the emotions

of another person. Whether the interaction

partner is an infant, a friend, a romantic love

interest, or a partner in a long-term relation-

ship, moving the focus of emotion regula-

tion from “my emotions” to “your and our

emotions” takes us into new and complex

realms. A recurrent theme in studies of opti-

mal performance is that individuals function

optimally when they are somewhat, but not

overly, aroused (Yerkes & Dodson, 1908).

We expect that the same is true of couples.

Maintaining an optimal level of emotional

arousal for couples, however, requires moni-

toring and regulating the emotional state

of both partners. The dynamic and itera-

tive nature of emotion exchanges in couples

means that the level of emotional arousal is

constantly changing. Thus, the maintenance

of an optimal state requires continuous

monitoring of arousal levels and continuous

adjustment of regulatory efforts. This situ-

ation has caused us on multiple occasions

to observe that a good marriage requires a

good thermostat (a role most often assumed

by wives in heterosexual couples; Gottman

& Levenson, 1988).

Further complicating matters, in cou-

ples, one partner’s regulatory efforts often

become potent emotional stimuli for the

other partner. Consider this example: A

husband has been trying to soothe his wife’s

anger over a canceled vacation, hoping that

when she is calmed down they will be able

to discuss alternative plans. At this point in

the interaction, the wife is overly aroused

and the husband is relatively calm. The wife

says, “I hate it when you try to manage me.

It’s insulting and belittling. You’re just so

incredibly selfish; if you really loved me, you

wouldn’t do this to me.” Hearing this, the

husband feels unjustly judged and injured.

His anger starts welling up and he becomes

quite defensive. Suddenly, they are both

overly aroused and find themselves casting

hurtful aspersions about each other’s char-

acter defects. Any possibility of having a

constructive discussion about vacation plans

will soon be placed on indefinite hold.

Coregulation in couples would be chal-

lenging enough if both partners always had

the same regulatory goals (e.g., both want-

ing to feel less aroused and more calm, or

both wanting to intensify feelings of pas-

sionate love). However, the emotional

stars are not always so well- aligned. The

“demand– withdraw” pattern, commonly

found in both opposite sex (Christensen,

1987) and same-sex (Holley, Sturm, &

Levenson, 2010) couples, provides a good

example. A couple wants to talk effectively

about a significant relationship issue. How-

ever, one partner (typically the one who

wants change) becomes quite aroused and

engages energetically in complaining and

criticizing the other partner. The criticized

Emotion Regulation in Couples 271

partner (typically the one who wants to

maintain the status quo) increasingly tunes

out and withdraws emotionally from the

interaction, thus achieving some level of

calm. For this couple, the coregulatory chal-

lenge is to calm the overaroused, demanding

partner and at the same time increase the

emotional involvement of the underaroused,

withdrawing partner. However, this must

be done without causing either partner to

overshoot the desired emotional endpoint

(no easy feat). Coregulation of emotion in

couples regularly introduces these kinds of

complexities, which are simply not found in

individual emotion regulation.

Consequences

It is easy to make a case for the importance of

emotion regulation in the lives of individuals.

Greater use of specific emotion regulation

strategies, as measured by self- and other-

reports, has been found to predict higher

levels of well-being, mental health, physical

health, relationship quality, and social func-

tioning, and lower levels of problem behav-

ior (Aldao, Nolen- Hoeksema, & Schweizer,

2010; Caspi, Henry, McGee, Moffitt, &

Silva, 1995; Gross & John, 2003; John &

Gross, 2004; Lopes, Salovey, Côté, Beers,

& Petty, 2005; Nelis et al., 2011). Although

studies of these associations using labora-

tory assessments of emotion regulation (as

opposed to self- and other- reports) are still

rare, we recently found that greater ability

to down- regulate and up- regulate emotional

response (as assessed using well- established

laboratory procedures) was associated with

greater well-being and higher income (Côté,

Gyurak, & Levenson, 2010). If emotion

regulation is broadened to include delay of

gratification, another laboratory- based par-

adigm, research strongly indicates that high

levels of this ability early in preschool years

are associated with a host of positive out-

comes, including greater cognitive and aca-

demic competence and ability to cope with

frustration later in life (Mischel et al., 2011).

Because of a relative dearth of studies

that have directly measured emotion regu-

lation in couples and its consequences, the

case for the importance of emotion regula-

tion in couples must be based on collateral

literatures. One such literature, concerned

with marriage and other committed rela-

tionships, has produced a number of find-

ings that suggest greater ability to regulate

emotion in couples is associated with posi-

tive outcomes. For example, questionnaire

studies have found that couples who report

less frequent use of “control or contain-

ment” (which is similar to suppression) of

negative emotion have higher marital satis-

faction (Feeney, 1999). In the literature on

intimate partner violence, inability to regu-

late negative emotion has been associated

with increased likelihood of partner abuse

(McNulty & Hellmuth, 2008).

A paradigm for studying couples’ interac-

tion developed by Levenson and Gottman

(1983) has been endorsed as an exemplar

for how emotion regulation can be studied

in social contexts (Campos et al., 2011). In

this paradigm, couples (usually married het-

erosexual couples, but also same-sex and

dating couples) come to the laboratory and

engage in a series of unrehearsed 15-minute

conversations on relationship topics (e.g.,

events of the day, a problem area, a pleasant

topic). During these conversations, behavior

is videotaped for subsequent coding of emo-

tional behavior by trained observers, and

in both partners a number of physiological

measures relevant to emotional responding

are monitored continuously. Later, partners

view the videotapes of their conversations

and use a rating dial to provide continu-

ous ratings of the valence of their emotional

experience during the interactions (Gott-

man & Levenson, 1985). These streams of

continuous multimethod data (self- report,

behavior, physiology) can be used to derive

measures of emotion reactivity and emotion

regulation in the individual partners and in

the dyad.

A number of findings from these stud-

ies seem highly relevant when considering

the consequences of emotion regulation

for couples. In this regard, the discussions

about marital problems (which can occa-

sion intense negative emotions and heroic

efforts at emotion regulation) have been

particularly informative, with links found

between measures of emotion regulation (in

subjective experience, behavior, and physiol-

ogy) and important consequences in several

domains.

In terms of subjective emotional experi-

ence, low levels of both negative emotion

272 SOCIAL ASPECTS

and negative emotion reciprocity (i.e., nega-

tive emotional experience by one partner

followed by negative emotional experience

by the other partner) have been associated

with higher levels of marital satisfaction

both concurrently and over time (Leven-

son & Gottman, 1983, 1985). In terms of

emotional behavior, husbands’ inability to

deescalate negative emotion during marital

conflict predicted less marital stability over

time (Gottman, Coan, Carrere, & Swanson,

1998). In a similar vein, “regulated” cou-

ples, operationalized as those who produced

an increasingly high ratio of positive to neg-

ative emotional behaviors over the course

of a 15-minute conflictive interaction, had

higher levels of marital satisfaction, lower

risk for marital dissolution, and better health

measured over a 4-year period (Gottman &

Levenson, 1992). Finally, less escalation of

negative emotional behavior was associated

with higher marital satisfaction in couples in

long-term marriages (Carstensen, Gottman,

& Levenson, 1995).

The continuous measures of peripheral

physiological activity have been particularly

interesting, in part because autonomic ner-

vous system responses are very difficult to

control voluntarily (e.g., Levenson, 1976)

and because they can provide a ready metric

of changing levels of arousal in the couple.

Using these measures, low levels of both

physiological arousal and physiological

linkage (synchrony between partners’ physi-

ology) were associated with higher marital

satisfaction (Levenson & Gottman, 1983,

1985).

Couple Therapy

Not surprisingly, given its critical role in

couple relationships and profound down-

stream consequences, issues with emotion

regulation frequently assume center stage

when couples seek treatment for relationship

problems. Although the specifics differ from

couple to couple, distressed couples almost

always struggle with either down- regulating

negative emotion (e.g., issues involving jeal-

ousy and disagreements over things such

as household duties, relatives, child rear-

ing, and finances) or up- regulating positive

emotions (e.g., issues involving poor and

infrequent communication, not doing things

together, loss of sexual interest and intimacy,

coldness and lack of empathy, and absence

of joy) or both. Historically, couples thera-

pies have focused more on nonemotional

aspects of these problems (e.g., communi-

cation deficits, individual psychopathology,

attachment histories, poor family- of- origin

relationship models), but emotion and emo-

tion regulation are increasingly becoming

important foci in many forms of couple ther-

apy (Gottman & Gottman, 2008; Johnson,

1996; Wile, 2002).

Development

Viewed from a developmental perspective,

several key dyadic relationships assume

prominence at different stages of the lifes-

pan and serve as crucibles for the emergence

and refinement of regulatory skills. Here we

focus on three of these dyads: parents and

infants, early romantic relationships, and

late-life couples.

Parent–Infant Dyads

Parent– infant dyads, and mother– infant

dyads in particular, invest significant efforts

in emotion regulation. The initial focus is

on reducing negative emotion (managing

the infant’s distress), but this quickly engen-

ders efforts to increase positive emotion

(engaging in activities that amuse, distract,

and calm). In this stage of life, infants can

become overwhelmed by their negative emo-

tions and lack the skills to bring them under

control themselves. Thus, infants rely on

their caregivers to regulate their emotions

(Thompson, 1991). The ontological origins

of social emotion regulation clearly reside in

these dyads. If all goes well, coregulation of

emotion in the parent– infant dyad will lead

to infants beginning to develop the ability to

regulate their own emotions.

Attachment theory (Bowlby, 1988) pro-

vides the most influential account of the

transition from coregulation to individual

regulation in infancy, providing elegant

descriptions about the kinds of parent–

infant relationships that are likely to result

in good versus poor emotion regulation in

the infant. Attachment theory was given an

enormous empirical boost with the develop-

ment of observational methods for quantify-

ing mother– infant attachment. For example,

Emotion Regulation in Couples 273

the “Strange Situation” paradigm (Ain-

sworth, Blehar, Waters, & Wall, 1978) uses

close observation of episodes of mother–

infant separation and reunion to classify

attachment styles in ways that have profound

implications for emotion regulation initially

in the dyad and ultimately in the infant (e.g.,

securely attached infants develop greater

ability to regulate their own emotions than

do insecurely attached infants).

The Strange Situation focuses on the

down- regulation of negative emotions (pri-

marily fear and sadness), but the mother–

infant dyad also is involved in a great deal of

coregulation of positive emotion. The social

nature of positive emotion regulation in

infancy is seen vividly in studies of the syn-

chrony and reciprocity of positive emotion

(Cole, Teti, & Zahn- Waxler, 2003; Tron-

ick, 1989). In addition, parent– infant dyads

often engage in elaborate behavioral rituals

designed to increase positive emotions in the

infant (e.g., tickling and peekaboo rituals).

For parents, the infant’s smile is a highly

prized reinforcer; parents will go to great

lengths to evoke smiles in their infants.

We include discussion of these early

parent– infant dyads because we believe they

have important implications for emotion

regulation and other aspects of later inti-

mate relationships. However, one enduring

question about attachment styles (and asso-

ciated emotion regulatory abilities) is how

parent– infant interactions are related to

attachment styles that characterize intimate

relationships later in life (Mikulincer &

Shaver, 2007). In this regard, some theorists

have emphasized discontinuity (e.g., Kagan,

1984), while others have leaned more toward

continuity (e.g., Bowlby, 1988). Conducting

empirical research on these issues is quite

challenging. One approach has been to uti-

lize chain mediation models, in which expe-

riences during one life stage predict expe-

riences in the next, which in turn predict

experiences in the next (Sroufe, Coffino, &

Carlson, 2010). In one such study, which

bridged infancy, adolescence, and adult rela-

tionships, secure attachment in infancy was

found to predict more secure relationships

with close friends in adolescence, which in

turn predicted more positive daily emotional

experiences in adult romantic relationships

and less negative affect in conflict resolution

(Simpson, Collins, Tran, & Haydon, 2007).

Early Romantic Dyads

Selecting a partner and building a roman-

tic bond are critical developmental tasks.

Although often viewed through a lens that

emphasizes mate selection and family build-

ing (Havighurst, 1976), these relationships

are also important vehicles for develop-

ing emotion regulatory skills. In contrast

to parent– infant dyads, where the primary

focus is on mastering down- regulation of

negative emotions, in early romantic rela-

tionships the primary focus is clearly on

up- regulating positive emotions. The emo-

tions that are typically targets for this up-

regulation include passionate love, affection,

joy, excitement, and enthusiasm (Gable,

Gonzaga, & Strachman, 2006).

Several lines of research highlight the

importance of positive emotions in early

romantic relationships. Romantic love is a

phenomenon found across many cultures

(Jankowiak & Fischer, 1998) and has been

termed a “mammalian system for mate

choice” (Fisher, Aron, & Brown, 2006).

It is associated with a complex physiologi-

cal, psychological, and behavioral profile

that includes feelings of euphoria, focused

attention, and obsessive thinking about a

specific individual; craving for emotional

connection with the other person; expanded

sense of self; and greatly increased energy

(A. Aron et al., 2005; E. N. Aron & Aron,

1996). There is good evidence linking the

early stages of intense passionate love with

subcortical reward and goal centers in the

brain that are highly responsive to dopa-

mine (A. Aron et al., 2005; Fisher, Aron,

& Brown, 2006), which may help explain

the almost addictive quality of passionate

love, along with its attendant cravings (e.g.,

intensely missing the partner when absent)

and powerful withdrawal reactions (e.g., the

pain of lost love). From an emotion regula-

tory point of view, these high- intensity posi-

tive emotional states are highly desirable,

and, not surprisingly, lovers engage in quite

elaborate strategies to up- regulate their

positive feelings to extremely high levels

of intensity. There is little doubt that these

intense feelings contribute significantly to

mate selection and reproduction. In many

ways, they are the perfect fuel for launch-

ing romantic dyads along the path to family

formation.

274 SOCIAL ASPECTS

Clearly, down- regulating negative emo-

tion is an important item on the dyadic

agenda at all stages of development. This

often takes the form of managing jeal-

ousy (Shaver & Mikulincer, 2007) in early

romantic relationships, in which real and

imagined infidelities are a source of power-

ful negative emotions (fear, sadness, anger)

that must be controlled if the relationship

is to survive. Emotion regulation continues

to play a critical role as romantic relations

grow and develop. Looming large is the tran-

sition to parenthood, which is highly chal-

lenging for most couples (Cowan & Cowan,

1992; Doss, Rhoades, Stanley, & Markman,

2009). Successful navigation of this transi-

tion requires couples to deploy the full range

of individual, dyadic, and, ultimately, triadic

emotion regulatory skills.

Late‑Life Dyads

In late life, as couples move beyond the

prime reproductive period, life challenges

and life goals change, and emotion regula-

tory needs change accordingly. During this

developmental period, dealing with losses

and finding meaning in life become particu-

larly salient (Erikson, Erikson, & Kivnick,

1986). As individuals get older, they expe-

rience functional losses in domains such

as cognition (Salthouse, 2004), physical

abilities, and health (albeit with consider-

able individual differences, Rowe & Kahn,

1997). They also experience losses in their

social networks as retirement from the

workforce limits daily social contacts and

friends are lost due to relocation, illness,

and death (Charles & Carstensen, 2007;

Wrzus, Hänel, Wagner, & Neyer, 2013).

Lifespan developmental theory emphasizes

the importance of finding new sources of

meaning in late life, because earlier sources

of meaning (e.g., partner selection, family

building, career building) are no longer as

relevant. These can include developing qual-

ities of generativity (caring for future genera-

tions) and integrity (acceptance of one’s life)

(Erikson, 1950), and investing more deeply

in close social relationships (Carstensen,

Isaacowitz, & Charles, 1999).

In late-life couples, emotion regulation

becomes very important and may contrib-

ute to older adults’ relatively preserved lev-

els of well-being even in the face of decline

and loss (Mather, 2012). In survey studies,

older individuals report believing that they

improve in this ability (Gross et al., 1997).

Laboratory studies (e.g., Shiota & Leven-

son, 2009) paint a more complex picture,

with some regulatory strategies remaining

stable with age (i.e., suppressing visible signs

of emotional response), others declining

with age (i.e., using detached appraisals to

down- regulate emotion), and still others in

fact improving (i.e., using positive apprais-

als to down- regulate emotion). In late life,

up- regulating particular kinds of positive

emotion is very important. For example,

reminiscing with others about past accom-

plishments can be particularly rewarding

(Erikson, 1982), and companionate love,

which is characterized by low levels of pas-

sion but high levels of intimacy and com-

mitment (Sternberg, 1986), often assumes

the position of primary importance that

was occupied earlier by romantic love. Also

important is the ability to down- regulate

particular negative emotions such as sad-

ness (in response to interpersonal losses) and

embarrassment (in response to losses in cog-

nitive and physical abilities). Finally, com-

plex emotions such as poignancy, become

increasingly prevalent in late life (Ersner-

Hershfield, Mikels, Sullivan, & Carstensen,

2008), leading to time spent reliving and

savoring memories that have both positive

and negative emotional qualities (e.g., chil-

dren marrying and leaving home).

Importantly, the coregulation of emo-

tion also becomes increasingly important

as older adults spend more time with their

spouses as opposed to friends and acquain-

tances (Charles & Carstensen, 2007). For

those without close friends, down- regulating

negative emotions (e.g., sadness, fear) asso-

ciated with loneliness becomes critically

important. The stakes may be especially

high for failures of emotion regulation in

late life; the negative consequences of lone-

liness, for example, on health, have been

widely documented (Hawkley & Cacioppo,

2010).

Earlier we presented evidence that cou-

ples’ ability to lower levels of physiologi-

cal arousal is an important predictor of

relationship quality and stability over time

(Gottman & Levenson, 1992; Levenson &

Gottman, 1985). These kinds of calming

effects can be produced by touch (Coan,

Emotion Regulation in Couples 275

Schaefer, & Davidson, 2006) and also by

positive emotions, which can reduce levels

of autonomic nervous system arousal pro-

duced by negative emotions in individu-

als (Fredrickson & Levenson, 1998) and

in couples (Yuan, McCarthy, Holley, &

Levenson, 2010). These soothing effects of

positive emotions may contribute to positive

emotions becoming increasingly important,

desired, and salient in late life (Carstensen

et al., 1999).

Assessment

Emotion regulation in couples can be mea-

sured using self- report measures that assess

beliefs (one’s own or those of others who

know us) about emotion regulation. Alter-

natively, emotion regulation in couples can

be measured using performance measures

based on the observation of actual emotion

regulation. In both self- report and perfor-

mance measures, the focus can be on regula-

tory abilities (i.e., what the person or couple

is capable of doing) or regulatory practices

(i.e., what the person or couple typically

does). As noted earlier, there are aspects (e.g.,

coregulation) and qualities (e.g., dynamic) of

emotion regulation that are more prominent

in couples than in individuals. Thus, the

measures used for assessing emotion regula-

tion in couples should be designed to capture

these qualities, in addition to qualities that

are also prominent in emotion regulation in

individuals.

Unfortunately, the state of the art in mea-

suring emotion regulation in couples is not

as advanced as we would wish. As we discuss

below, most existing self- report measures of

emotion regulation clearly focus on indi-

vidual regulation. The self- report measures

that do have items relevant for assessing

emotion regulation in couples were almost

all designed for other purposes (e.g., mea-

suring relationship satisfaction). Progress

in developing methods for assessing actual

regulatory performance in couples is also

hindered by the lack of studies of emotion

regulation that include an actual (or even

an imagined) interaction partner (Campos

et al., 2011). Moreover, when such stud-

ies have been conducted, they have often

used unacquainted dyads (e.g., Butler et al.,

2003). These stranger pairings, although

clearly useful, are a far cry from the kinds of

intimate dyads in which emotion regulation

emerges and is refined during development

(see earlier discussion).

Observational studies of mother– infant,

mother– toddler, and mother– preschooler

dyads (Cole et al., 2003; Denham, 1993;

Dumas, LaFreniere, & Serketich, 1995;

Tronick, 1989) provide one bright spot in

this otherwise sparsely populated land-

scape. Although typically not designed to

study emotion regulation per se, they do

offer some valuable insights as to how emo-

tion regulatory processes function in these

early-life dyads.

Self‑Report Measures

In the emotion regulation domain, most

self- report measures focus on regulation in

the individual, not in the couple. For exam-

ple, the Emotion Regulation Questionnaire

(Gross & John, 2003) assesses two styles of

emotion regulation using a 10-item scale in

which six items assess the dispositional ten-

dency to use cognitive reappraisal strategies

and four items assess the dispositional ten-

dency to use suppression strategies. Another

individual- focused inventory, the Difficul-

ties in Emotion Regulation Scale (Gratz &

Roemer, 2004), comprises 36 items that

assess six dimensions of emotion regulation:

(1) lack of awareness of emotional responses,

(2) lack of clarity of emotional responses, (3)

nonacceptance of emotional responses, (4)

limited access to emotion regulation strat-

egies, (5) difficulties controlling impulses

when experiencing negative emotions, and

(6) difficulties engaging in goal- directed

behavior when experiencing negative emo-

tions.

It is certainly possible to alter an individ-

ual self- report measure of emotion regula-

tion so that items refer to a particular couple

relationship. However, this would essentially

constitute a new instrument, and its reliabil-

ity and validity would need to be established.

Moreover, questionnaires that were origi-

nally developed with a focus on the individ-

ual are unlikely to assess aspects of emotion

regulation that are particularly relevant to

couples (e.g., reciprocity of emotion, reac-

tions to each other’s regulatory styles).

The literature on close relationships has

produced a number of self- report inventories

276 SOCIAL ASPECTS

that were developed to assess relationship

functioning and satisfaction. A subset of

these inventories focuses on couples’ conflict

resolution and communication skills, and

includes items that are relevant to assessing

couples’ emotion regulation. For example, in

the 78-item Revised Conflict Tactics Scales

(Straus, Hamby, Boney-McCoy, & Sugar-

man, 1996), respondents are asked about

how they deal with disagreement, with ques-

tions asking how often they “shouted at or

yelled at my partner,” or how often conflict

escalated into several more violent acts. In

the 109-item Managing Affect and Differ-

ences Scale (Arellano & Markman, 1995),

subscales that are directly relevant to emo-

tion regulation include Negative Escalation

(e.g., “Unable to get out of heated argu-

ments”), Stop Actions (e.g., “When conflicts

get out of hand, agree to stop and talk at a

later time”), and Withdrawal (e.g., “When

discussing issues, my partner usually with-

draws for fear of conflict”). In a brief,

10-item screening inventory for relationship

discord (Whisman, Snyder, & Beach, 2009),

respondents are asked, “Whenever you are

feeling sad, does your partner make you feel

loved and happy again?” and “Do minor

disagreements with your partner often end

up in big arguments?”

There are a few self- report measures that

do focus on individuals’ emotion regulation

vis-à-vis a specific partner (e.g., a roman-

tic partner or a parent). Arguably, the best

known of these are primarily designed to

assess attachment styles, but they do have

items of relevance to emotion regulation.

The Experiences in Close Relationships

Scale (Brennan, Clark, & Shaver, 1998) is a

36-item measure that assesses avoidance and

anxiety in close relationships, with items

that focus on the dyadic context (e.g., “I pre-

fer not to show a partner how I feel deep

down”). The Adult Attachment Interview

(Main & Goldwyn, 1984) is based on 20

questions, some of which focus on impor-

tant aspects of emotion regulation (e.g.,

experiences with parents involving distress,

separation, rejection, or loss). It analyzes

responses to these questions, focusing on not

only what is said but also how it is said (e.g.,

the coherence of the narrative).

All of the measures reviewed thus far yield

scores that are considered to represent trait-

like qualities. Such approaches are ideal for

capturing enduring dispositional qualities of

couples’ regulatory styles but are not well-

suited for capturing the dynamics of emo-

tion regulation. Emotion self- reports can be

obtained in ways that yield more dynamic

information using affect rating dial (Ruef

& Levenson, 2007) and experience sam-

pling (Hektner, Schmidt, & Csikszentmih-

alyi, 2007) methodologies. There have also

been attempts to use self- report measures of

emotion regulation in new ways to capture

dynamic dyadic processes. For example,

in one study (Butner, Diamond, & Hicks,

2007), couples were asked to provide daily

ratings of positive and negative affect for

3 weeks, operationalizing coregulation as

covariation in partners’ daily levels of affect

and coupling of the rates of change of part-

ners’ affective cycles. In a similar vein, Fer-

rer and Nesselroade (2003) assessed emo-

tional experience of partners in one married

dyad, who recorded their experience of 20

emotions over 182 consecutive days.

None of these approaches provides an

off-the-shelf solution for measuring emo-

tion regulation in couples, but they do pro-

vide items and scales (mostly focused on

the management of negative emotion) that

could be useful starting points for build-

ing more comprehensive couple assessment

instruments. Nonetheless, our enthusiasm

for self- report measures of emotion regula-

tion is tempered by the problems that beset

all self- report measures (e.g., social desir-

ability and other self- presentation biases,

vulnerability to wording and context). In

the realm of emotional functioning, these

problems are compounded by individuals

often not being very accurate observers and

reporters of the nuances of their own emo-

tional functioning. Evidence of this comes

from findings of low correlations between

self- report and behavioral measures of emo-

tional functioning (e.g., low correlations

between well- established self- report mea-

sures of empathy and a performance- based

measure of empathic accuracy; Levenson

& Ruef, 1992) and variations among indi-

viduals in the coherence between self- report,

behavioral, and physiological measures of

emotion (Mauss, Levenson, McCarter, Wil-

helm, & Gross, 2005; Sze, Gyurak, Yuan,

& Levenson, 2010). Whether these kinds of

problems do in fact beset particular ques-

tionnaires designed to measure emotion reg-

Emotion Regulation in Couples 277

ulation in couples, and the ultimate utility of

such questionnaires for particular purposes,

are best settled on the basis of actual data.

Performance Measures

Whereas self- report measures of emo-

tion regulation assess the rater’s beliefs

about emotion regulation in self or others,

performance- based measures assess emo-

tion regulation in vivo, evaluating emotion

regulation as it actually occurs. These are

often multimethod performance measures

that include assessment of subjective experi-

ence, emotional behavior, and physiological

activation.

As noted earlier, performance measures

(and self- report measures) can focus on

either regulatory abilities or regulatory

practices. Measures of regulatory abilities

typically provide participants with spe-

cific instructions to alter some aspect of

emotional responding (e.g., “Try not to let

your emotions show”), then assess how well

they do (e.g., measuring the amount of vis-

ible emotional expression using a sensitive

behavioral coding system). Measures of reg-

ulatory practices, in contrast, typically place

participants in a situation in which emo-

tion regulation would be expected to occur

(e.g., discussing an area of conflict with a

relationship partner), then assess how well

participants regulate their emotions (e.g.,

measuring positive and negative emotional

behaviors and physiological arousal).

Each of these approaches has advantages

and disadvantages. For example, measures

of abilities tell us a lot about what people

are capable of doing in the emotion regula-

tory domain but not necessarily what they

actually do in their day-to-day lives (e.g.,

a person might be able to suppress all vis-

ible signs of emotion when watching a sad

movie but be very volatile in interactions

with her romantic partner, or vice versa).

With measures of practices, the lack of

instructions reduces experimental control,

and inferential leaps must be made between

what is measured and its relationship to

emotion regulation (e.g., slowed heart rate

might indicate emotional calming, but it

can also have many different psychological

and physiological causes). We should also

note that recent evidence from neurological

patients indicates that ability and perfor-

mance measures of emotion regulation are

likely subserved by different neural circuits

(Goodkind, Gyurak, McCarthy, Miller, &

Levenson, 2010). For all of these reasons,

measures of abilities and performance

should not be used interchangeably.

Measures of regulatory ability that have

been widely used in studies of emotion regu-

lation in individuals instruct participants to

suppress and amplify behavioral responses

(e.g., Gross & Levenson, 1993, 1997; Hage-

mann, Levenson, & Gross, 2006; Roberts,

Levenson, & Gross, 2008) and use vari-

ous appraisal strategies (e.g., Gross, 1998a;

Shiota & Levenson, 2009). However, these

measures have not been used as much with

couples. One exception is a study by Rich-

ards, Butler, and Gross (2003), in which dat-

ing couples were instructed to reappraise or

suppress their emotions as they discussed a

relationship conflict to determine the effects

on memory for conversation utterances

(which were increased by reappraisal and

decreased by suppression) and emotional

memories (which were increased by suppres-

sion).

Measures of regulatory practices have

been utilized in studies of emotion regula-

tion in adult dyads, with emotion regulation

operationalized in a number of different

ways, including (1) the amount of negative

or positive emotional experience (e.g., feel-

ing positive regard; Murray, 2005); (2) the

amount or ratio of negative and positive

emotional behavior (Gottman, 1993; Gott-

man & Levenson, 1992); (3) autonomic ner-

vous system activation (Levenson & Gott-

man, 1985); and (4) central nervous system

activation (Coan et al., 2006).

Measures of regulatory practices have also

been utilized in mother– infant dyads, most

famously in research using the Strange Situ-

ation (Ainsworth, Blehar, Waters, & Wall,

1978). In this test, children’s behavior is

measured after separation from the attach-

ment figure, a prototypical situation for elic-

iting distress and fear in infants. Another

measure of emotion regulation in infant–

caregiver dyads is the Still-Face Paradigm

(Tronick, Als, Adamson, Wise, & Brazelton,

1978). Here, the primary caregiver becomes

unresponsive and maintains a neutral facial

expression. In response, infants typically

show increased gaze aversion, less smiling,

and heightened negative affect.

278 SOCIAL ASPECTS

Many of the aforementioned approaches

to measuring emotion regulation in couples

result in scores that represent regulation

averaged over some period of time. However,

it is also possible for performance- based

measures to be dynamic, quantifying pat-

terns of emotional reactivity and regulation

that unfold over time. These more dynamic

approaches have been utilized in studies

that track changes in emotional experience

(e.g., Levenson & Gottman, 1983), emo-

tional behavior (see review in Gottman &

Levenson, 1988), autonomic nervous system

physiology (Yuan et al., 2010), hormonal

responses (Laurent & Powers, 2007), and

central nervous system activation (Coan et

al., 2006). Particularly promising are those

techniques that use the responses of both

members of the dyad to characterize quali-

ties of emotional coregulation over time

(Butler, 2011). These include measures of

(1) emotional reciprocity—the exchange of

emotions between partners in continuous

self- ratings of emotional experience (Lev-

enson & Gottman, 1983) or observational

coding of emotional behavior (Carstensen

et al., 1995; Gottman et al., 1998; Gottman

& Levenson, 1992; Julien, Brault, Char-

trand, & Bégin, 2000; Tronick et al., 1978);

(2) emotional linkage—the extent to which

physiological, hormonal, or mood responses

of partners become “synchronized” or can

be predicted from each other (Levenson &

Gottman, 1983; Saxbe & Repetti, 2010);

or (3) physiological soothing—the transi-

tion from high to low levels of autonomic

activation in a couple (Yuan et al., 2010).

Recently, Levenson (2013) described a new

statistical approach that characterizes cycles

of emotion (transitions between high and

low arousal, and between negative and posi-

tive emotion) that incorporates continuous

measurement of behavior, physiology, and

subjective experience.

Agenda for Future Research

Research on emotion regulation in couples

is poised for growth and discovery. Studies

of close social relationships are dramatically

increasing in many areas of psychology.

Clearly, we have only scratched the surface

in terms of both understanding the role that

emotion regulation plays in the functioning

of couples’ relationships and using couples’

relationships as a test bed for increasing our

understanding of what emotion regulation

is, how it operates, and its sources and con-

sequences. For this research area to move

forward and realize its potential, there are

several pressing needs:

1. Needed are sound self- report and per-

formance measures of couples’ emotion reg-

ulation that have been carefully constructed

and have well- established psychometric

qualities of reliability and validity. Mea-

sures are needed that (a) assess both emo-

tion regulatory abilities (what people can

do) and practices (what people do do); (b)

move beyond a primary focus on the down-

regulation of negative emotion to include the

up- regulation and down- regulation of both

positive and negative emotion; (c) assess

multiple aspects of emotion regulation (sub-

jective experience, behavior, physiology);

and (d) allow assessment of emotion regula-

tion in ways that capture its dynamic, itera-

tive, co- regulatory nature.

2. Needed are the development and

refinement of experimental paradigms that

are appropriate for studying emotion regu-

latory abilities and practices in couples. We

believe that observational studies of couple

and parent– child interactions provide good

bases for moving forward, but hope that

new paradigms will also be developed that

stimulate new research in this area.

3. Relationships between self- report and

performance measures of emotion regula-

tion in couples need to be studied and estab-

lished. The existing self- report measures

of emotion regulation in individuals have

generally not been studied in this way; thus,

there is not a firm basis for assuming equiva-

lencies across methods.

4. Issues concerning the distinctions

between emotion reactivity and emotion

regulation need to be addressed in emotion

regulation in couples, in much the same way

as they are being addressed in research on

individual emotion regulation (e.g., Ochsner

et al., 2009). These are challenging issues

with deep theoretical and practical impli-

cations. They should benefit greatly from

expanding knowledge about how emotional

functioning is organized in the central and

peripheral nervous systems.

Emotion Regulation in Couples 279

5. Research is needed on the anteced-

ents of emotion regulation in couples. We

expect that additional progress can be made

in exploring biological (e.g., genetic, temp-

eramental) and psychological (e.g., per-

sonality, attachment history) factors that

predispose couples to develop particular

regulatory styles. Of great interest are the

ways that couples’ emotion regulatory styles

develop over the course of the relationship,

when they are malleable, and when they

solidify.

6. More research is needed on the conse-

quences of emotion regulation, with special

attention given to mapping different kinds of

emotion regulation in relation to outcomes

in multiple domains (including physical and

mental heath, well-being, and relationship

quality). This kind of research would benefit

greatly from longitudinal designs; we expect

that many effects of particular regulatory

styles only emerge over fairly long periods

of time.

7. Research is needed on the similarities

and differences that emerge when socially

situated emotion regulation is scaled up

from dyads to larger groups (e.g., commu-

nity responses to traumatic events). We need

more comparisons of the nature of emotion

regulation in different kinds of dyads (e.g.,

romantic, friendship, coworker dyads). We

also need more research on how communi-

ties deal with tragic and triumphant events,

with a particular focus on the emotion regu-

latory challenges that must be faced in their

aftermath.

8. Research is needed on ways to improve

emotion regulation abilities in individuals,

dyads, and groups. In the realm of adult rela-

tionships, there are a number of therapeutic

approaches that afford particular attention

to emotional functioning (Gottman & Gott-

man, 2008; Johnson, 1996; Wile, 2002).

Unfortunately, research on the efficacy and

effectiveness of these treatments tends to

compare outcomes for one extremely com-

plex, multifaceted treatment package to a

non- treatment condition (or sometimes to

another highly complex treatment pack-

age). More research is needed using designs

that enable honing in on the “active ingredi-

ents” responsible for specific areas of change

and improvement. For parent– child rela-

tionships, despite a huge cottage industry

devoted to proffering parenting advice, the

research needs are similar.

Although the state of the science in emo-

tion regulation in couples is still relatively

immature, the potential is clearly enormous.

With the development of new measurement

tools and sound, ecologically valid experi-

mental paradigms that enable us to study

regulatory dynamics in interpersonal con-

texts, we expect great progress to be made

in many important areas related to emotion

regulation in couples.

References

Ainsworth, M. D. S., Blehar, M. C., Waters, E.,

& Wall, S. (1978). Patterns of attachment: A

psychological study of the Strange Situation.

Oxford, UK: Erlbaum.

Aldao, A., Nolen- Hoeksema, S., & Schweizer, S.

(2010). Emotion- regulation strategies across

psychopathology: A meta- analytic review.

Clinical Psychology Review, 30, 217–237.

Arellano, C. M., & Markman, H. J. (1995).

The Managing Affect and Differences Scale

(MADS): A self- report measure assessing con-

flict management in couples. Journal of Fam-

ily Psychology, 9, 319–334.

Aron, A., Fisher, H., Mashek, D. J., Strong, G.,

Li, H., & Brown, L. L. (2005). Reward, moti-

vation, and emotion systems associated with

early-stage intense romantic love. Journal of

Neurophysiology, 94, 327–337.

Aron, E. N., & Aron, A. (1996). Love and the

expansion of the self: The state of the model.

Personal Relationships, 3, 45–58.

Bowlby, J. (1988). A secure base: Parent–child

attachment and healthy human development.

New York: Basic Books.

Brennan, K. A., Clark, C. L., & Shaver, P. R.

(1998). Self- report measurement of adult

attachment: An integrative overview. In J. A.

Simpson & W. S. Rholes (Eds.), Attachment

theory and close relationships (pp. 46–76).

New York: Guilford Press.

Butler, E. A. (2011). Temporal interpersonal

emotion systems: The “TIES” that form rela-

tionships. Personality and Social Psychology

Review, 15, 367–393.

Butler, E. A., Egloff, B., Wilhelm, F. H., Smith,

N. C., Erickson, E. A., & Gross, J. J. (2003).

The social consequences of expressive suppres-

sion. Emotion, 3, 48 – 67.

280 SOCIAL ASPECTS

Butner, J., Diamond, L. M., & Hicks, A. M.

(2007). Attachment style and two forms of

affect coregulation between romantic part-

ners. Personal Relationships, 14, 431–455.

Campos, J. J., Walle, E. A., Dahl, A., & Main, A.

(2011). Reconceptualizing emotion regulation.

Emotion Review, 3, 26–35.

Carstensen, L. L., Gottman, J. M., & Levenson,

R. W. (1995). Emotional behavior in long-

term marriage. Psychology and Aging, 10,

140–149.

Carstensen, L. L., Graff, J., Levenson, R. W., &

Gottman, J. M. (1996). Affect in intimate rela-

tionships: The developmental course of mar-

riage. In C. Magai & S. H. McFadden (Eds.),

Handbook of emotion, adult development,

and aging (pp. 227–247). San Diego, CA: Aca-

demic Press.

Carstensen, L. L., Isaacowitz, D. M., & Charles,

S. T. (1999). Taking time seriously: A theory

of socioemotional selectivity. American Psy-

chologist, 54, 165–181.

Caspi, A., Henry, B., McGee, R. O., Moffitt,

T. E., & Silva, P. A. (1995). Temperamental

origins of child and adolescent behavior prob-

lems: From age three to fifteen. Child Devel-

opment, 66, 55–68.

Charles, S. T., & Carstensen, L. L. (2007). Emo-

tion regulation and aging. In J. J. Gross (Ed.),

Handbook of emotion regulation (pp. 307–

327). New York: Guilford Press.

Christensen, A. (1987). Detection of conflict pat-

terns in couples. In K. Hahlweg & M. J. Gold-

stein (Eds.), Understanding major mental dis-

order: The contribution of family interaction

research (pp. 250–265). New York: Family

Process Press.

Coan, J. A., Schaefer, H. S., & Davidson, R. J.

(2006). Lending a hand: Social regulation of

the neural response to threat. Psychological

Science, 17, 1032–1039.

Cole, P. M., Teti, L. O., & Zahn- Waxler, C.

(2003). Mutual emotion regulation and the

stability of conduct problems between pre-

school and early school age. Development and

Psychopathology, 15, 1–18.

Côté, S., Gyurak, A., & Levenson, R. W. (2010).

The ability to regulate emotion is associated

with greater well-being, income, and socioeco-

nomic status. Emotion, 10, 923–933.

Cowan, C. P., & Cowan, P. A. (1992). When

partners become parents. New York: Basic

Books.

Denham, S. A. (1993). Maternal emotional

responsiveness and toddlers’ social- emotional

competence. Journal of Child Psychology and

Psychiatry, 34, 715–728.

Doss, B. D., Rhoades, G. K., Stanley, S. M., &

Markman, H. J. (2009). The effect of the tran-

sition to parenthood on relationship quality:

An 8-year prospective study. Journal of Per-

sonality and Social Psychology, 96, 601–619.

Dumas, J. E., LaFreniere, P. J., & Serketich, W.

J. (1995). “Balance of power”: A transactional

analysis of control in mother– child dyads

involving socially competent, aggressive, and

anxious children. Journal of Abnormal Psy-

chology, 104, 104–113.

Erikson, E. H. (1950). Childhood and society.

New York: Norton.

Erikson, E. H. (1982). The life cycle completed:

A review. New York: Norton.

Erikson, E. H., Erikson, J., & Kivnick, H.

(1986). Vital involvement in old age. New

York: Norton.

Ersner- Hershfield, H., Mikels, J. A., Sullivan,

S. J., & Carstensen, L. L. (2008). Poignancy:

Mixed emotional experience in the face of

meaningful endings. Journal of Personality

and Social Psychology, 94, 158 –167.

Feeney, J. A. (1999). Adult attachment, emo-

tional control, and marital satisfaction. Per-

sonal Relationships, 6, 169–185.

Fernald, A. (1991). Prosody in speech to children:

Prelinguistic and linguistic functions. Annals

of Child Development, 8, 43–80.

Ferrer, E., & Nesselroade, J. R. (2003). Model-

ing affective processes in dyadic relations via

dynamic factor analysis. Emotion, 3, 344–

360.

Fisher, H. E., Aron, A., & Brown, L. L. (2006).

Romantic love: A mammalian brain system

for mate choice. Philosophical Transactions of

the Royal Society B: Biological Sciences, 361,

2173–2186.

Fredrickson, B. L., & Levenson, R. W. (1998).

Positive emotions speed recovery from the

cardiovascular sequelae of negative emotions.

Cognition and Emotion, 12, 191–220.

Gable, S. L., Gonzaga, G. C., & Strachman, A.

(2006). Will you be there for me when things

go right?: Supportive responses to positive

event disclosures. Journal of Personality and

Social Psychology, 91, 904 –917.

Goodkind, M. S., Gyurak, A., McCarthy, M.,

Miller, B. L., & Levenson, R. W. (2010).

Emotion regulation deficits in frontotemporal

lobar degeneration and Alzheimer’s disease.

Psychology and Aging, 25, 30 –37.

Gottman, J. M. (1993). A theory of marital dis-

Emotion Regulation in Couples 281

solution and stability. Journal of Family Psy-

chology, 7, 57–75.

Gottman, J. M., Coan, J., Carrere, S., & Swan-

son, C. (1998). Predicting marital happiness

and stability from newlywed interactions.

Journal of Marriage and the Family, 60, 5–22.

Gottman, J. M., & Gottman, J. S. (2008). Gott-

man method couple therapy. In A. S. Gurman

(Ed.), Clinical handbook of couple therapy

(pp. 138–164). New York: Guilford Press.

Gottman, J. M., & Levenson, R. W. (1985). A

valid procedure for obtaining self- report of

affect in marital interaction. Journal of Con-

sulting and Clinical Psychology, 53, 151–160.

Gottman, J. M., & Levenson, R. W. (1988). The

social psychophysiology of marriage. In P.

Noller & M. A. Fitzpatrick (Eds.), Perspectives

on marital interaction: Monographs in social

psychology of language, No. 1. (pp. 182–200).

Clevedon, UK: Multilingual Matters.

Gottman, J. M., & Levenson, R. W. (1992).

Marital processes predictive of later dissolu-

tion: Behavior, physiology, and health. Jour-

nal of Personality and Social Psychology, 63,

221–233.

Gratz, K. L., & Roemer, L. (2004). Multidi-

mensional assessment of emotion regulation

and dysregulation: Development, factor struc-

ture, and initial validation of the Difficulties

in Emotion Regulation Scale. Journal of Psy-

chopathology and Behavioral Assessment, 26,

41–54.

Gross, J. J. (1998a). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74, 224–237.

Gross, J. J. (1998b). The emerging field of emo-

tion regulation: An integrative review. Review

of General Psychology, 2, 271–299.

Gross, J. J., Carstensen, L. L., Pasupathi, M.,

Tsai, J., Skorpen, C. G., & Hsu, A. Y. C.

(1997). Emotion and aging: Experience,

expression, and control. Psychology and

Aging, 12, 590–599.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85, 348–362.

Gross, J. J., & Levenson, R.W. (1993). Emo-

tional suppression: Physiology, self- report,

and expressive behavior. Journal of Personal-

ity and Social Psychology, 64, 970–986.

Gross, J. J., & Levenson, R. W. (1995). Emotion

elicitation using films. Cognition and Emo-

tion, 9, 87–108.

Gross, J. J., & Levenson, R. W. (1997). Hiding

feelings: The acute effects of inhibiting nega-

tive and positive emotion. Journal of Abnor-

mal Psychology, 106, 95–103.

Gross, J. J., Richards, J. M., & John, O. P.

(2006). Emotion regulation in everyday life.

In D. K. Snyder, J. Simpson, & J. N. Hughes

(Eds.), Emotion regulation in couples and

families: Pathways to dysfunction and health

(pp. 13–35). Washington, DC: American Psy-

chological Association.

Gross, J. J., Sheppes, G., & Urry, H. L. (2011).

Taking one’s lumps while doing the splits: A

big tent perspective on emotion generation and

emotion regulation. Cognition and Emotion,

25, 789–793.

Gyurak, A., Goodkind, M. S., Kramer, J. H.,

Miller, B. L., & Levenson, R. W. (2012).

Executive functions and the down- regulation

and up- regulation of emotion. Cognition and

Emotion, 26(1), 103–118.

Gyurak, A., Gross, J. J., & Etkin, A. (2011).

Explicit and implicit emotion regulation: A

dual- process framework. Cognition and Emo-

tion, 25, 400– 412.

Hagemann, T., Levenson, R. W., & Gross, J.

J. (2006). Expressive suppression during an

acoustic startle. Psychophysiology, 43, 104–

112.

Havighurst, R. J. (1976). Developmental tasks

and education. New York: David McKay.

Hawkley, L. C., & Cacioppo, J. T. (2010). Lone-

liness matters: A theoretical and empirical

review of consequences and mechanisms.

Annals of Behavioral Medicine, 40, 218 –227.

Hektner, J. M., Schmidt, J. A., & Csikszentmih-

alyi, M. (2007). Experience sampling method:

Measuring the quality of everyday life. Thou-

sand Oaks, CA: Sage.

Holley, S. R., Sturm, V. E., & Levenson, R. W.

(2010). Exploring the basis for gender differ-

ences in the demand– withdraw pattern. Jour-

nal of Homosexuality, 57, 666–684.

Jankowiak, W. R., & Fischer, E. F. (1998). A

cross- cultural perspective on romantic love. In

J. M. Jenkins, K. Oatley, & N. L. Stein (Eds.),

Human emotions: A reader (pp. 55–62). Mal-

den, MA: Blackwell.

John, O. P., & Gross, J. J. (2004). Healthy and

unhealthy emotion regulation: Personal-

ity processes, individual differences, and life

span development. Journal of Personality, 72,

1301–1333.

282 SOCIAL ASPECTS

Johnson, S. M. (1996). The practice of emotion-

ally focused marital therapy: Creating connec-

tion. Philadelphia: Brunner/Mazel.

Julien, D., Brault, M., Chartrand, É., & Bégin, J.

(2000). Immediacy behaviours and synchrony

in satisfied and dissatisfied couples. Canadian

Journal of Behavioural Science, 32, 84–90.

Kagan, J. (1984). The nature of the child. New

York: Basic Books.

Kunzmann, U., Kupperbusch, C. S., & Leven-

son, R. W. (2005). Behavioral inhibition and

amplification during emotional arousal: A

comparison of two age groups. Psychology

and Aging, 20, 144–158.

Lang, P. J., Greenwald, M. K., & Bradley, M. M.

(1988). The International Affective Picture

System (IAPS) standardization procedure and

initial group results for affective judgments.

Gainesville: Center for the Study of Emotion

and Attention, University of Florida.

Laurent, H., & Powers, S. (2007). Emotion regu-

lation in emerging adult couples: Tempera-

ment, attachment, and HPA response to con-

flict. Biological Psychology, 76, 61–71.

Levenson, R. W. (1976). Feedback effects and

respiratory involvement in voluntary control

of heart rate. Psychophysiology, 13, 108–114.

Levenson, R. W. (2013). Emotion and emo-

tion regulation. In D. Hermans, B. Rimé,

& B. Mesquita (Eds.), Changing emotions

(pp. 105–112). New York: Psychology Press.

Levenson, R. W., Cowan, C. P., & Cowan, P. A.

(2010). A specialty clinic model for clinical

science training: Translating couples research

into practice in the Berkeley Couples Clinic.

In M. C. Schulz, M. K. Pruett, P. K. Kerig, &

D. Ross (Eds.), Strengthening couple relation-

ships for optimal child development: Lessons

from research and intervention (pp. 197–209).

Washington, DC: American Psychological

Association.

Levenson, R. W., & Gottman, J. M. (1983).

Marital interaction: Physiological linkage and

affective exchange. Journal of Personality and

Social Psychology, 45, 587–597.

Levenson, R. W., & Gottman, J. M. (1985). Phys-

iological and affective predictors of change in

relationship satisfaction. Journal of Personal-

ity and Social Psychology, 49, 85–94.

Levenson, R. W., & Ruef, A. M. (1992). Empa-

thy: A physiological substrate. Journal of Per-

sonality and Social Psychology, 63, 234–246.

Lopes, P. N., Salovey, P., Côté, S., Beers, M., &

Petty, R. E. (2005). Emotion regulation abili-

ties and the quality of social interaction. Emo-

tion, 5, 113–118.

Main, M., & Goldwyn, R. (1984). Adult attach-

ment scoring and classification system.

Unpublished manuscript, University of Cali-

fornia, Berkeley.

Martin, R. A. (2007). The psychology of humor:

An integrative approach. Amsterdam, The

Netherlands: Elsevier.

Mather, M. (2012). The emotion paradox in the

aging brain. Annals of the New York Acad-

emy of Sciences, 1251, 33– 49.

Mauss, I. B., Levenson, R. W., McCarter, L.,

Wilhelm, F. H., & Gross, J. J. (2005). The tie

that binds?: Coherence among emotion expe-

rience, behavior, and physiology. Emotion, 5,

175–190.

McNulty, J. K., & Hellmuth, J. C. (2008). Emo-

tion regulation and intimate partner violence

in newlyweds. Journal of Family Psychology,

22, 794–797.

Mikulincer, M., & Shaver, P. R. (2007). Attach-

ment in adulthood: Structure, dynamics, and

change. New York: Guilford Press.

Mischel, W., Ayduk, O., Berman, M. G., Casey,

B. J., Gotlib, I. H., Jonides, J., et al. (2011).

“Willpower” over the life span: Decomposing

self- regulation. Social Cognitive and Affective

Neuroscience, 6, 252–256.

Murray, S. L. (2005). Regulating the risks of

closeness: A relationship- specific sense of felt

security. Current Directions in Psychological

Science, 14, 74–78.

Nelis, D., Kotsou, I., Quoidbach, J., Hansenne,

M., Weytens, F., Dupuis, P., et al. (2011).

Increasing emotional competence improves

psychological and physical well-being, social

relationships, and employability. Emotion, 11,

354–366.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D., et al.

(2004). For better or for worse: Neural sys-

tems supporting the cognitive down- and up-

regulation of negative emotion. NeuroImage,

23, 483– 499.

Ochsner, K. N., Ray, R. R., Hughes, B., McRae,

K., Cooper, J. C., Weber, J., et al. (2009).

Bottom-up and top-down processes in emo-

tion generation: Common and distinct neu-

ral mechanisms. Psychological Science, 20,

1322–1331.

Richards, J. M., Butler, E. A., & Gross, J. J.

(2003). Emotion regulation in romantic rela-

tionships: The cognitive consequences of con-

Emotion Regulation in Couples 283

cealing feelings. Journal of Social and Per-

sonal Relationships, 20, 599–620.

Roberts, N. A., Levenson, R. W., & Gross, J. J.

(2008). Cardiovascular costs of emotion sup-

pression cross ethnic lines. International Jour-

nal of Psychophysiology, 70, 82–87.

Rowe, J. W., & Kahn, R. L. (1997). Successful

aging. The Gerontologist, 37, 433–440.

Ruef, A. M., & Levenson, R. W. (2007). Contin-

uous measurement of emotion. In J. A. Coan

& J. J. B. Allen (Eds.), The handbook of emo-

tion elicitation and assessment (pp. 286–297).

New York: Oxford University Press.

Salthouse, T. A. (2004). What and when of cog-

nitive aging. Current Directions in Psycholog-

ical Science, 13, 140–144.

Saxbe, D., & Repetti, R. L. (2010). For better

or worse?: Coregulation of couples’ cortisol

levels and mood states. Journal of Personality

and Social Psychology, 98, 92–103.

Shaver, P. R., & Mikulincer, M. (2007). Adult

attachment strategies and the regulation of

emotion. In J. J. Gross (Ed.), Handbook of

emotion regulation (pp. 446–465). New York:

Guilford Press.

Shiota, M. N., & Levenson, R. W. (2009).

Effects of aging on experimentally instructed

detached reappraisal, positive reappraisal, and

emotional behavior suppression. Psychology

and Aging, 24, 890–900.

Simpson, J. A., Collins, W. A., Tran, S., & Hay-

don, K. C. (2007). Attachment and the experi-

ence and expression of emotions in romantic

relationships: A developmental perspective.

Journal of Personality and Social Psychology,

92, 355 –367.

Sternberg, R. J. (1986). A triangular theory of

love. Psychological Review, 93, 119–135.

Straus, M. A., Hamby, S. H., Boney-McCoy, S.,

& Sugarman, D. B. (1996). The Revised Con-

flict Tactics Scales (CTS2). Journal of Family

Issues, 17, 283–316.

Sroufe, L. A., Coffino, B., & Carlson, E. A.

(2010). Conceptualizing the role of early

experience: Lessons from the Minnesota lon-

gitudinal study. Developmental Review, 30,

36–51.

Sze, J. A., Gyurak, A., Yuan, J. W., & Levenson,

R. W. (2010). Coherence between emotional

experience and physiology: Does body aware-

ness training have an impact? Emotion, 10,

803–814.

Thompson, R. A. (1991). Emotional regulation

and emotional development. Educational Psy-

chology Review, 3, 269 –307.

Tronick, E., Als, H., Adamson, L., Wise, S., &

Brazelton, T. B. (1978). The infant’s response

to entrapment between contradictory mes-

sages in face-to-face interaction. Journal of the

American Academy of Child and Adolescent

Psychiatry, 17, 1–13.

Tronick, E. Z. (1989). Emotions and emotional

communication in infants. American Psychol-

ogist, 44, 112–119.

Whisman, M. A., Snyder, D. K., & Beach, S. R.

H. (2009). Screening for marital and relation-

ship discord. Journal of Family Psychology,

23, 247–254.

Wile, D. B. (2002). Collaborative couple therapy.

In A. S. Gurman & N. S. Jacobson (Eds.),

Clinical handbook of couple therapy (3rd ed.,

pp. 281–307). New York: Guilford Press.

Wrzus, C., Hänel, M., Wagner, J., & Neyer, F. J.

(2013). Social network changes and life events

across the life span: A meta- analysis. Psycho-

logical Bulletin, 139, 53–80.

Yerkes, R. M., & Dodson, J. D. (1908). The rela-

tion of strength of stimulus to rapidity of habit

formation. Journal of Comparative Neurol-

ogy and Psychology, 18, 459–482.

Yuan, J. W., McCarthy, M., Holley, S. R., &

Levenson, R. W. (2010). Physiological down-

regulation and positive emotion in marital

interaction. Emotion, 10, 467–474.

284

Emotion regulation promotes an individu-

al’s social adjustment. Having an emotion

means to take a stance, to have a particu-

lar relationship with the world (Solomon,

2004), and to have a specific intention to act

(Frijda, 1986). To take anger as an example,

the experience of anger implies an attitude

of nonacceptance, an assessment that one

has a relatively high level of control over

(others in) the situation (Frijda, Kuipers, &

Terschure, 1989), and a readiness to act in

such a way that these other people accom-

modate to your wishes, goals, and values

(Stein, Trabasso, & Liwag, 1993). Emotions

are thus relationship engagements (Mes-

quita, Marinetti, & Delvaux, 2012). Emo-

tion regulation refers to all those processes

involved in fashioning emotions to be most

adaptive within the relationship.

Cultural differences in emotion regulation

are to be expected, because the common and

most valued relationships differ across socio-

cultural contexts (e.g., Markus & Kitayama,

1991). Therefore, the emotions that are most

adaptive within those relationships— the

endpoints of emotion regulation— are likely

to differ cross- culturally as well. For exam-

ple, feelings of cheerfulness and happiness

are conceived as “good” and “desirable” in

European American culture (D’Andrade,

1984; Wierzbicka, 1994), because they sig-

nal that a person has successfully managed

the central cultural tasks of standing out and

accomplishing personal and material goals

(e.g., Hochschild, 1995). Happiness com-

municates to other Americans a “good inner

self” and psychological well-being (Markus

& Kitayama, 1994). Yet, as natural as the

desire to be happy may seem to most Ameri-

can readers, this emotion norm is far from

universal. The anthropologist Catherine

Lutz (1987), herself a European American,

was reprimanded for smiling at a girl who

acted happy during her stay with the Ifaluk

(on a Pacific atoll). The Ifaluk condemn hap-

piness, because they believe it leads a person

to neglect his or her social duties. Whereas

European Americans seek to yield and to

maximize happiness, Ifaluk life is geared

toward minimizing this emotion. An emo-

tion’s fit with the cultural models of self and

relationships will thus determine whether it

is up- or down- regulated.

In this chapter we propose, first, that the

endpoints of emotion regulation in each cul-

ture are those that match the culture’s valued

ideas and norms of how to be a good person

and how to relate to other people— the so-

called cultural models of self and relating

(Bruner, 1990; D’Andrade, 1984; Markus

& Kitayama, 1991). Second, we propose

that cultural regulation of emotions may be

initiated by an individual, but often is an

effect of the way the social environment is

CHAPTER 18

The Cultural Regulation of Emotions

Batja Mesquita

Jozefien De Leersnyder

Dustin Albert

The Cultural Regulation of Emotions 285

organized. Third, we will show that culture

(defined both at the level of the individual

and at the level of the social environment)

plays an important role in all stages of emo-

tion regulation.

Cultural Models

To provide a foundation for the discus-

sion on emotion regulation, we first briefly

review the idea of the cultural model itself.

Dominant cultural models of self and

relating are manifest in two distinct ways

that may be described as “culture in the

world” and “culture in the head” (Adams

& Markus, 2004) On the one hand, “cul-

ture in the world” refers to a culture’s daily

routines and organizational structures, to

the reward structures that are in place, to

social expectancies, and to the common

types of social interaction. “Culture in the

world” thus stands for the affordances and

constraints that implicitly (but powerfully)

shape individual experience. On the other

hand, “culture in the head” refers to inter-

nalized goals, values, meanings, representa-

tions, and behavioral repertoires, and thus

translates into experiential and behavioral

tendencies. Both manifestations of cultural

models— in the world and in the head—

appear to be involved in emotion regulation.

This idea can be illustrated by contrasting

the most widely studied cultural models: the

European American and East Asian cultural

models. According to middle- class Euro-

pean American models of self and relating,

the individual should be independent and

free from others, as well as stand out among

them (e.g., Kim & Markus, 1999). On the

one hand, everyday social arrangements fos-

ter a self that is independent and free. Exam-

ples are sleeping arrangements: In contrast

to infants in many areas of the world, Euro-

pean American infants sleep by themselves

very early on (Morelli, Rogoff, Oppenheim,

& Goldsmith, 1992; Shweder, 1991). On

the other hand, culture is internalized as the

psychological tendency of self- enhancement

and the value attached to choice in Euro-

pean American contexts (Heine, Lehman,

Markus, & Kitayama, 1999; Hochschild,

1995).

In contrast, the dominant goal of the self

in most East Asian cultural contexts is to be

like others and to enhance the fit between

what one is doing and what is expected (e.g.,

Heine et al., 1999; Lebra, 1992). The culture

values a person’s self- improvement, with the

aim of meeting these relational expectations,

fulfilling role-based obligations, and dem-

onstrating one’s loyalty to significant social

ingroups (Heine et al., 1999; Rothbaum

Pott, Azuma, Miyake, & Weisz, 2000). Cul-

ture in the world is organized toward these

goals: Politeness rituals and strictly prescrip-

tive role behavior are cases in point. “Cul-

ture in the head” can be seen from the East

Asian tendency to take the perspective of the

generalized other and thus focus on meeting

expectations (Cohen, Hoshino- Brown, &

Leung, 2007; Masuda et al., 2008).

It should be noted that the theoretical

framework of cultural models does not

assume or argue that people who live in

the same cultural context engage in exactly

the same way. First, people engage in many

models at the same time, such as models

of gender, socioeconomic status, cohort,

ethnicity, religion, and professional status.

These models all structure individuals’ real-

ity, as do family dynamics, close relationship

characteristics, and parenthood. Second,

and perhaps relatedly, people do not inter-

nalize the dominant cultural models in the

same way and to the same extent. Yet even if

people have not completely internalized the

dominant models, they still have to contend

with cultural models in the world (Shweder,

1991).

The “Right” Emotions Match

the Cultural Models

What feels “right” differs substantially

across cultures, yet we propose that every-

where the endpoints of emotion regulation

match the cultural models of self and rela-

tionships (Eid & Diener 2001; Kitayama,

Mesquita, & Karasawa, 2006; Mesquita &

Leu, 2007; Tsai, Knutson, & Fung, 2006).

The “right” emotions may be those consis-

tent with injunctive norms (ought-emotions,

[dis]approved by most others in the culture),

ideal emotions (emotions wanted by most

others in the culture), or descriptive norms

(emotions actually experienced by most oth-

ers in the culture). Cultural differences in

the explicit feeling rules and ideal emotions

286 SOCIAL ASPECTS

illustrate the different endpoints of regula-

tion; cultural differences in the commonly

experienced emotions are taken as evidence

for culture- specific emotion norms, if they

match the respective models of self and relat-

ing.

Feeling Rules and Ideal Emotions

Match the Cultural Models

A culture’s feeling rules—the most desirable

and valued emotional states— are endpoints

of emotion regulation. Differences in feeling

rules can be understood from differences in

the dominant cultural models. For instance,

Eid and Diener (2001) conducted a large

cross- cultural study in which participants

from both independent (European American

and Australian) and interdependent (China

and Taiwan) cultural contexts rated the

desirability of several emotions, both posi-

tive and negative. The largest cultural differ-

ences in desirability were found for “pride”

and “guilt.” Feelings of pride were more

positively valued in independent than in

interdependent cultures, whereas the oppo-

site was true for feelings of guilt. This may

be the case, because pride signals a person’s

autonomy and uniqueness, which are val-

ued in independent cultures but considered

“dangerous” in interdependent cultures that

recognize the potential of pride to disrupt

social harmony. Conversely, guilt may be

desirable from the viewpoint of East Asian

cultural models, because it signals an indi-

vidual’s concern for relational harmony (and

the readiness to take full responsibility for a

violation of this harmony), but undesirable

in Western cultures because it suggests a less

than positive performance of the individual.

There are also systematic cultural dif-

ferences in the emotions people “ideally

would like to feel” (Tsai et al., 2006). Tsai

and her colleagues asked people from dif-

ferent cultures to rate their “ideal feelings”

on emotion scales that represented the

four quadrants of the affective circumplex;

The affective circumplex is defined by the

dimensions of pleasantness (unpleasant–

pleasant) and activation (low–high). They

found consistent differences between Euro-

pean Americans, who “ideally” wanted to

feel more high- activation positive states such

as excitement and elation, and East Asians,

who preferred low- activation positive states

such as peaceful and serene feelings. Further

research showed that ideal emotions prepare

individuals best for the tasks that are cul-

turally central (Tsai, Miao, Seppala, Fung,

& Yeung, 2007). High- activation positive

emotions, promoted in North American

contexts, prepare individuals for influencing

others. In contrast, low- activation positive

emotions, promoted in East Asian contexts,

facilitate social adjustment.

Patterns of Emotional Experience

Match the Cultural Models

That the endpoints of regulation differ may

also be inferred from cultural differences

in the prevalent emotional patterns (i.e.,

the patterns of frequencies and intensities),

which can be understood from the pertinent

cultural models of self and relating. Adopt-

ing a variety of methods, Kitayama and his

colleagues (2006; Kitayama & Markus,

2000) found that European American par-

ticipants reported more socially disengag-

ing emotions— such as feeling pride, anger,

or irritation— and Japanese participants

reported more socially engaging emotions—

such as feeling close, ashamed or indebted.

The dimension of social engagement was

empirically derived, and emotions on the

disengaging end of the dimension underline

an individual’s independence, whereas emo-

tions on the engaging end foreground the

connectedness between people. The studies

made use of the self- reported frequency of

emotions in the past month, the self- reported

emotional experience in response to a pre-

defined set of situation types, and daily dairy

studies. Cultural differences in emotions, as

they appear from these studies, correspond

with other reports of emotions for the same

cultures (see the high frequency and preva-

lence of shame in Japanese cultural contexts

as reported by Benedict, 1946; Heine et al.,

1999). Culturally prevalent patterns of emo-

tions thus appeared to match the cultural

models of self and relating.

That the endpoints of regulation are cul-

turally defined is also suggested by research

on emotional acculturation: changes in the

patterns of emotional experience after peo-

ple move to a different culture. In a series

of studies, we asked immigrant and majority

groups to rate the patterns of emotions expe-

rienced in different types of situations that

The Cultural Regulation of Emotions 287

were defined according to the valence (posi-

tive, negative) and the social engagement

(engaged, disengaged) of the emotion they

tended to elicit. For each type of situation,

we compared immigrants’ pattern of emo-

tion ratings with the average majority mem-

ber’s pattern. The more an immigrant had

been exposed to the new culture, the more

his or her pattern of emotions resembles that

of the average majority member. This finding

held true for two different minority groups

in two different majority cultures: Turkish

immigrants in Belgium, and Korean immi-

grants in the United States (De Leersnyder,

Mesquita, & Kim, 2011). In both immigrant

groups, the number of years spent in the new

culture, as well as the degree of contact with

members of the majority culture, predicted

emotional similarity to the majority culture.

A separate study compared, for the same

type of situations, emotional patterns of Bel-

gian Turks and Belgian natives to those of

Turks living in Turkey (De Leersnyder, Mes-

quita, & Kim, 2013). Emotional patterns of

Belgian Turks were more similar to the Bel-

gian norm than were emotional patterns of

Turks in Turkey, even though the Turks in

Turkey were on average better educated (and

in that respect more similar to the Belgians)

than Belgian Turks. The combined find-

ings suggest that exposure to a new culture

sparks changes in the prevalent emotional

patterns that supposedly match the new cul-

tural models more closely.

That cross- culturally different endpoints

of regulation are rewarding can be inferred

from the link with well-being. The combined

evidence suggests that having the “right”

emotions is associated with higher well-

being. In the diary study reviewed earlier

(Kitayama et al., 2006), emotions that were

consistent with the descriptive norm best pre-

dicted well-being: disengaging emotions in

the European American sample, and engag-

ing emotions in the Japanese sample. Simi-

larly, our own research with U.S., Korean,

and Belgian samples showed that emotional

similarity to the cultural average predicted

higher satisfaction with social relationships

(De Leersnyder, Mesquita, Kim, Eom, &

Choi, 2013).Thus, having the “right” emo-

tions appears to be rewarding, even if the

exact processes involved are as yet unknown.

Conversely, emotions that are discrep-

ant with the culturally ideal emotions have

negative consequences for well-being. Tsai

and her colleagues (2006) found that the

discrepancy between a person’s actual and

ideal emotions predicted that person’s level

of depressive symptoms, but only for the

domain of emotions that was culturally most

focal: The discrepancy between actual and

ideal high- activation positive emotions pre-

dicted depression in European Americans,

whereas the discrepancy between actual and

ideal low- activation positive emotions pre-

dicted depression in East Asians. Therefore,

not having the “right” emotions appears to

have negative personal consequences.

In summary, emotions appear to be regu-

lated in ways that improve their match with

the prevalent cultural models of self and

relating. This is suggested by findings that

(1) actual emotions fit the culture’s models

of self and relating, (2) immigrants’ actual

emotions become more consistent with the

new cultural models, and (3) emotions that

are consistent with either the descriptive

norms or the ideal emotions in a culture

positively predict well-being. The rest of this

chapter is devoted to the question of how the

match between emotions and cultural mod-

els is achieved: This is the domain of emo-

tion regulation proper.

Cultural Regulation of Emotions

Emotion regulation has been defined broadly

as “the processes that influence which emo-

tions we have, when we have them, and how

we experience or express these emotions”

(Gross, 1998; Gross, Sheppes, & Urry, 2011,

p. 767). In this chapter, we subscribe to this

definition, and we note that it is agnostic to

(1) the source of regulation, and (2) whether

the regulation is effortful or conscious. We

propose that culturally driven emotion regu-

lation may be initiated by either individuals

themselves or their social environments, and

they may be either conscious and effortful

or automatic and effortless. We speak of cul-

tural regulation when there is evidence that

emotional processes are fashioned to match

the cultural models of self and relationship.

Most of the literature on emotion regula-

tion has focused on individual emotion reg-

ulation—for example, a person who avoids

seeing a friend who makes her feel miser-

able, who seeks distraction after a fight with

288 SOCIAL ASPECTS

her boss, or who tries to see the situation

in a different light. However, a full under-

standing of the role of culture in emotion

regulation requires that we move beyond

individual emotion regulation to include

what we call social emotion regulation. We

speak of social emotion regulation when the

social environment is the agent of emotion

regulation. Culture “in the world” is clearly

important to this type of regulation. Exam-

ples abound: Sex segregation in some cul-

tures is a means to avoid situations of embar-

rassment (Abu- Lughod, 1986); head hunting

rituals in another culture serve to channel

individuals’ ingroup anger (Rosaldo, 1980).

Closer to home, social sharing with friends

can help to restore a person’s self- esteem

after a painful breakup, thereby alleviating

distress. Thus, culture plays an important

role in both individual and social emotion

regulation.

It should be noted that our approach dif-

fers from accounts that assimilate emotion

regulation to the effortful redirection of

“the spontaneous flow” of emotions (Koole,

2009, p. 6). First, in light of cultural differ-

ences in the most prevalent emotions, we

challenge the notion of spontaneous flow.

Second, we propose that emotion regula-

tion is often automatic (cf. Bargh & Wil-

liams, 2007; Gyurak, Gross, & Etkin, 2011;

see Mauss, Bunge, & Gross, 2008, for a

cultural perspective on automatic emotion

regulation).

It is not always possible (and perhaps not

meaningful either; see Mesquita & Frijda,

2011) to draw a distinction between cultural

emotion regulation and culturally influenced

emotion generation. Regulatory processes

are clearly distinct when individual and

social emotion regulation changes the course

of an ongoing emotion in culture- specific

ways, but in many cases, emotion regulation

is inferred from the fact that emotional out-

comes cross- culturally vary in nonrandom

ways. For example, the types of situations

that individuals encounter may be responsi-

ble for aligning emotions with the endpoints

of regulation (e.g., politeness reduces anger,

and may thus help to achieve relational har-

mony). In this case, the distinction between

emotion generation and emotion regulation

becomes futile (Mesquita & Frijda, 2011).

However, we speak of emotion regulation in

these cases because the social organization

indisputably plays a role in “what emotions

we have” and “when we have them” (Gross

et al., 2011, p. 767). To the extent that

either individual or social processes seem to

increase the match of emotions to norms, we

consider them forms of emotion regulation.

We assume that a culture’s individual and

social emotion regulation strategies go hand

in hand, and supplement each other, in an

attempt to realize the cultural norms (Kita-

yama, Karasawa, & Mesquita, 2004; Mauss

et al., 2008). Below we discuss evidence for

the role of culture in multiple strategies of

emotion regulation; for each strategy we

consider evidence for both individual and

social emotion regulation.

Situation Selection

One major path of emotion regulation has

been termed situation selection, described

as “approaching or avoiding certain people,

places, or objects in order to regulate emo-

tions” (Gross, 1998, p. 283). Cultural dif-

ferences in situation selection are suggested

with regard to individual and social emotion

regulation. Differences in individuals’ moti-

vational focus are taken as evidence for the

role of culture in individual emotion regula-

tion; differences in the social realities that

individuals encounter— the a priori selec-

tion of situations— are considered a form of

social emotion regulation.

Individual Regulation

of Situation Selection

There is some evidence that different cul-

tural models affect individuals’ situation

selection. A number of studies found that

the relative focus of individuals on either

avoiding negative or approaching posi-

tive situations differs across cultures (e.g.,

Elliott, Chirkov, Kim, & Sheldon, 2001;

Lee, Aaker, & Gardner, 2000). Whereas

the dominant focus in American contexts

appears to be on the accomplishment of

positive outcomes (i.e., a promotion focus),

East Asians and Russians have been found

to be more concerned with avoiding failures

to meet social expectations (i.e., a preven-

tion focus). These cultural differences in

motivational focus can be understood from

the respective models of self and relating: An

independent American model emphasizes

The Cultural Regulation of Emotions 289

self- enhancement and the achievement of

positive outcomes, whereas the more inter-

dependent East Asian and Russian models

underline the importance of avoiding social

violations, and may thus be more driven by

avoidance than approach.

That differences in situation selection

may affect emotional experience was sug-

gested by a cross- cultural vignette study by

Lee et al. (2000, Studies 3–5). The research-

ers examined differences in emotional reac-

tions to success and failure between Euro-

pean Americans (promotion focus) and

East Asian Hong Kong Chinese (prevention

focus). They hypothesized that a promo-

tion focus would foster happiness under

conditions of success, and sadness under

conditions of failure, whereas a prevention

focus would lead to reports of relaxation

or relief upon success, and anxiety upon

failure. Consistent with the differences in

motivational focus, the European Ameri-

can participants reported higher intensi-

ties of happiness– depressed emotions than

relief– anxiety emotions, whereas the Chi-

nese participants reported higher intensities

of relief– anxiety than happiness– depressed

emotions. This is some of the first evidence

that cultural differences in situation selec-

tion may be related to differences in the

prevalent types of emotions. In summary,

cultural models of self and relating moti-

vate individual- level selection of situations,

which itself can be understood as a form of

emotion regulation.

Social Regulation of Situation Selection

Social situation selection may render certain

emotions either more frequent or more rare.

For example, European American social

life is characterized by practices that serve

to make individuals feel special and unique,

and that promote happiness and feeling

good about themselves (D’Andrade, 1984).

Contemporary American schools promote

the happiness and pride of their students

with practices that make the children feel

important and special. As early as preschool,

children are the focus of attention during

“show-and-tell” meetings, and throughout

elementary school, children’s accomplish-

ments are marked by smiley faces, stickers,

and gift-box rewards for every achieve-

ment, however small. The importance of

self- esteem is nicely illustrated by anecdotal

evidence. In his book The Geography of

Thought, the American psychologist Rich-

ard Nisbett (2003) describes how the school

board in his hometown even “debated

whether the chief goal of the schools should

be to impart knowledge or inculcate self-

esteem” (p. 55).

In contrast, many of the practices in Japa-

nese cultural contexts promote anticipatory

fear or shame, consistent with a cultural

model emphasizing the continuing obliga-

tion to accommodate others, fulfill one’s

roles, and perfect one’s contributions in

order to approach others’ expectations or

cultural ideals in general (Heine et al., 1999).

For example, at the end of each day Japanese

schoolchildren are encouraged to engage in

self- reflection or self- criticism (i.e., hansei),

so that they can look for ways to improve

their shortcomings or weaknesses in order

to meet the group’s standards (e.g., Lewis,

1995). The constant awareness of one’s

shortcomings is conducive to the experience

of emotions such as anticipated fear and

shame.

Culturally comparative research provides

systematic support for the idea that situa-

tions eliciting culturally condoned emotions,

such as shame in Japan, are relatively more

frequent than culturally condemned emo-

tions, such as anger in Japan (e.g., Boiger,

Mesquita, Uchida, & Barrett, 2013). In a

recent study, we compared the frequency of

shame and anger situations in Japan and the

United States, utilizing carefully selected,

representative elicitors of shame and anger

that had been reported in extensive pilot

studies by either Japanese or U.S. college

students. Shame was chosen because it was

expected to be consistent with an inter-

dependent, but not with an independent,

model of self and relating; anger was selected

because it was thought to have the opposite

connotations. New samples of Japanese and

U.S. students read standardized vignettes

describing these eliciting situations, and

rated (1) their likelihood of occurrence

and (2) the degree to which the situations

would elicit the intended emotion (anger or

shame). In the United States, where shame

violates the cultural model of independence,

we expected people to avoid shame, but

in Japan, where shame is an expression of

the cultural model of interdependence, we

290 SOCIAL ASPECTS

expected them to promote it. In contrast,

we expected anger to be avoided in Japan

(because it interferes with social harmony),

and promoted in the United States (since it

underlines independence). The findings pro-

vided support for culturally different pat-

terns of situation selection. Situations that

elicited higher levels of shame were rated

as more likely to occur in Japan, and as less

likely to occur in the United States. In con-

trast, situations that were thought to elicit

more anger were rated as more frequent in

the United States, and less frequent in Japan.

Thus, the “social” selection of situations

may contribute to the previously reported

differences in the frequencies with which

people in American and Japanese cultural

contexts experience anger (disengaging) and

shame (engaging) emotions (see Kitayama et

al., 2006). One way of understanding these

findings is that Americans simply encoun-

ter more anger- provoking situations, and

Japanese more shame- provoking situations

in their everyday lives. Social conventions

may help to avoid situations of interper-

sonal frustration in Japan, and situations of

interpersonal criticism in the United States,

respectively. In other words, social interac-

tions may be structured in culture- specific

ways that affect emotional experience.

Child- rearing practices provide another

example of social situation selection affect-

ing emotional experience. Several studies

suggest that Japanese mothers structure

their children’s environment in ways that

encourage relative stability and modera-

tion of emotion, whereas American mothers

provide greater situational variability, thus

increasing the probability that their children

will experience a range of both positive and

negative emotions (Rothbaum et al., 2000).

Japanese mothers lull and comfort their

infants more by soothing and maintaining

close proximity to their children. In doing

so, they create a safe and stable environ-

ment, thus decreasing the likelihood that

their children experience strong negative

emotions. In contrast, American mothers

allow their children more exploratory activ-

ity and use more distal proximity strategies

(e.g., eye contact) than do Japanese mothers

(Rothbaum et al., 2000). They offer their

children the opportunity for exploration,

and in doing so create more excitement but

also greater potential for negative emotions.

In summary, cultural differences in the

common forms of social interaction account

for differences in emotion experience. We

speak of social situation selection if these

differences in emotional experience match

the respective cultural models of self and

relating. Several studies suggest the exis-

tence of cultural differences in social situa-

tion selection.

Focus of Attention

Culture may also be instrumental in regu-

lating the focus of attention, or what in the

emotion regulation literature has been called

attentional deployment (Gross, 1998): the

channeling of attention in ways that are con-

ducive to the desired emotional outcome.

There is some evidence that attention may be

channeled in ways that are consistent with

the cultural models.

Individual Regulation of the Focus

of Attention

Cultural models may affect individuals’

focus of attention on relatively different

aspects of emotional situations. In a com-

parative study on emotion perception, Japa-

nese and Americans rated the emotions of

a central person expressing anger, sadness,

or happiness, who was surrounded by four

other people (Masuda et al., 2008). The

facial expressions of the other people var-

ied, independent of the expression of the

central person. Consistent with an indepen-

dent model, Americans exclusively focused

attention on the central person’s emotions,

disregarding the emotions of the surround-

ing people. Consistent with an interdepen-

dent model, however, the Japanese focused

attention on the other people in the picture

as well. For example, Japanese rated the

sadness of the central person to be higher if

the other people in the situation were sad as

well, relative to situations in which the other

people were not sad. Eye tracking confirmed

that, compared to American participants,

Japanese participants spent more time scan-

ning the periphery of the picture for the

facial expressions of the other people. There-

fore, consistent with interdependent models

of self and relating, Japanese focused their

attention on everybody involved in the social

situation.

The Cultural Regulation of Emotions 291

Culture might focus individuals’ atten-

tion on not only different types of social

information but also differently valenced

information. A recent study by Grossmann,

Ellsworth, and Hong (2012) compared Rus-

sian and European American participants’

focus on positive and negative emotional

stimuli, respectively. This was based on eth-

nographic and empirical work that charac-

terized Russian people as “brooders” who

place greater value than European Ameri-

cans on immersing themselves in negative

feelings. The researchers hypothesized that

Russians’ attention would be drawn more to

negative stimuli. In support of this hypoth-

esis, Russians, but not European Americans,

spent significantly more time looking at neg-

ative than at positive stimuli. In a follow- up

study with biculturals, Russian culture was

compared to a European culture (Latvia).

Making use of a technique used to study

cultural frame switching in biculturals, the

authors primed bicultural Russian Latvians’

with either Russian or Latvian culture, by

presenting them with Russian or Latvian

cultural symbols. Priming biculturals with

their Russian heritage led to a faster recogni-

tion of negative words and a slower recogni-

tion of positive words as compared to their

baseline reaction time to these words; also

consistent with the authors’ expectations,

Russian Latvians primed with Latvian cul-

tural symbols failed to focus more attention

on negative information. Interestingly, the

effect of priming Russian culture was more

pronounced for biculturals who reported

more affinity with their Russian heritage; it

is possible that the priming activated a more

elaborate Russian emotional repertoire in

these individuals.

Social Regulation of the Focus

of Attention

Other people are often involved in funnel-

ing an individual’s attention. We refer to

this as social regulation when the changed

focus of attention aligns the individual’s

emotional experiences with the dominant

cultural model of self and relating. Research

on caregiver– child interactions in two Nep-

alese groups illustrates this idea nicely (Cole,

Tamang, & Shrestha, 2006). Tamang and

Chhetri- Brahmin mothers were asked what

they would do if their 4- or 5-year-old child

was angry at them. Both groups of moth-

ers channeled their children’s attention in

ways that were consistent with the cultural

models. The majority of Tamang mothers

reported that they would give the children

food and cajole them in order to calm them

down; this distraction (of attention) strategy

is consistent with Tamang Buddhist models

of social harmony that focus on egalitarian-

ism, compassion, and tolerance. In contrast,

the majority of Chhetri- Brahmin mothers

reported they would respond by telling their

children to behave, to study, and to go to

school. The Chhetri- Brahmin mothers thus

focused their children’s attention on the val-

ues of social order and disciplined action

central to their Hindu cultural models, sup-

posedly inducing more conflictual emotions.

In both cases, the refocusing of attention

had an effect on emotional experience that

was consistent with the cultural model.

Further evidence for the role of others in

focusing attention comes from an observa-

tional study with European American and

Taiwanese mothers of 3-year-olds. Euro-

pean American mothers drew the child’s

attention to his or her independent achieve-

ments, thereby fostering the child’s hap-

piness and pride. In contrast, Taiwanese

mothers shamed their children by focusing

their attention on their transgressions, and

the negative effects these transgressions had

had on the mothers (Miller, Fung, & Mintz,

1996). In both cases, parental regulation of

the child’s attention served to increase the

fit between the child’s emotional experience

and the cultural model.

Although more obvious in child research

(for a review, see Diamond & Aspinwall,

2003), emotion regulation by others does

not cease in childhood or adolescence; even

after children are mature enough to inter-

nalize effective emotion regulation strate-

gies of their own, significant social partners

continue to contribute regulatory influence

across the lifespan. This can be observed in

not only adult interpersonal practices such

as the provision of comfort and support,

the expression of empathy, the redirection

of attention, or suggestions for cognitive

reframing of emotionally salient informa-

tion (Diamond & Aspinwall, 2003), but also

other common practices of social sharing of

emotions in adults (e.g., support groups). In

summary, other people may focus a person’s

292 SOCIAL ASPECTS

attention in ways that render emotional

experience consistent with cultural mod-

els of self and relating. Individuals’ social

environments may be especially likely to

help and channel attention when individuals

focus on aspects of the situation that render

their emotional experience inconsistent with

the cultural model.

Regulation of Appraisal

Another major path of emotion regulation is

through fashioning the individual’s apprais-

als of the situation. Appraisal always occurs

against the backdrop of the cultural models

that constitute reality. These cultural models

may be internalized, in which case they play

a role in individual emotion regulation, or

they may be instantiated by the social con-

text, in which case they may activate in the

individual certain appraisals; the latter may

be seen as a form of social appraisal regula-

tion.

Individual Regulation of Appraisal

Cultural models form the background

against which situations are appraised, and

emotional experience is contingent on an

individual’s interpretation of the situation

(e.g, Ellsworth, 1994; Mesquita & Ells-

worth, 2001). One obvious way in which

cultural models of self and relating are

essential to emotion regulation is by fashion-

ing the appraisal processes to create certain

emotions.

Individual appraisal is fashioned, in the

first place, by the concerns and schemas

against which situations are appraised. Cul-

tures differ with respect to these concerns.

For instance, what it means to a woman

that a man—not her intimate— looks at her

may differ depending on whether her culture

construes such attention as an honor viola-

tion, a sign that she is attractive, or a marker

that she is being objectified in a sexist world.

Receiving male attention has different emo-

tional consequences in each of these cases:

A woman would feel an emotion of shame

or embarrassment if she lived in an honor

culture, an emotion of pride or excitement

if she experienced the male attention as a

sign of her attractiveness, and an emotion

of indignation if she considered it an act of

sexism. Depending on the “availability” or

”salience” of certain interpretations, the

woman would feel a different emotion. We

refer to these cultural differences in appraisal

as forms of cultural emotion regulation, even

if they may not involve attempts at effortful

regulation on the part of the individual. The

salience of concerns that fit the cultural mod-

els is “culture in the head.” It is this culture

in the head that renders the emotion norma-

tive (i.e., “regulates” the emotion).

Differences in daily emotional experi-

ences can often be understood from cultural

differences in individuals’ common world

views or daily preoccupations (also “culture

in the head”). For example, the emotion of

anger is characterized by appraisals of an

event as unpleasant, going against personal

goals, but relatively controllable. In trying to

understand the near absence of frustration

and anger among Tahitians, the American

anthropologist Robert Levy (1978, p. 226)

pointed to “a shared common sense that

individuals have very limited control over

nature and over the behavior of others.”

Thus, as Levy notes, a universe so defined is

“cognitively less frustrating than those cul-

tures which define realities in which almost

anything is possible to individuals” (p. 226).

The general expectation that the world is

minimally rewarding, and that there is no

way to force rewards, leads to a lower preva-

lence of anger. The Tahitian perspective on

life contrasts with middle- class American

models that emphasize and value control

and predictability (Mesquita & Ellsworth,

2001). In middle- class American contexts,

the prevailing view is that the world is mal-

leable. Changing or influencing the environ-

ment rather than adjusting to it tends to be

a dominant response, reflecting the assump-

tion that circumstances can be made to fit

one’s personal goals (Boiger, Mesquita,

Tsai, & Markus, 2012; Morling, Kitayama,

& Miyamoto, 2002; Weisz, Rothbaum, &

Blackburn, 1984). Hence, there is a relative

emphasis on control and agency in middle-

class American appraisals of emotional

situations. As such, people more readily

appraise events in terms of inconsistency

with their goals, the responsibility of other

people, and the possibility of forcing oth-

ers to accommodate to their wishes; hence,

the emotional experiences of frustration and

anger are more likely (Frijda, 1986). Cultural

models thus provide the backdrop against

The Cultural Regulation of Emotions 293

which events are meaningful. A sense that

the world is a place in which agents make

a difference also renders the experience of

a lack of agency more unpleasant. This is

illustrated by a study by Roseman, Dha-

wan, Rettek, Naidu, and Thapa (1995), in

which Indian and American college students

reported instances of anger, sadness, and

fear, and rated their experiences on several

appraisal dimensions. Cultural models for

Indian college students are less likely to make

salient the possibility of successful control of

one’s circumstances than are cultural mod-

els for American students (Savani, Markus,

Naidu, Kumar, & Berlia, 2010). Consistent

with this understanding, Roseman and col-

leagues (1995) found that Indian college stu-

dents rated self- reported emotional events

to be less “incongruent with their motives”

than did their American counterparts. As

expected, Indian students also reported

lower overall intensities of both sadness and

anger; moreover, these cultural differences in

emotion intensity were fully mediated by the

perception that the event was less discrepant

with goals. Although the link between the

cultural emphasis on controllability and the

perception of goal relevance was not mea-

sured, we suggest that cultural representa-

tions of agency affected the perception of a

discrepancy between emotional events and

personal goals, and in turn influenced the

intensity of felt sadness and anger.

A more direct test of the relationship

between concerns and emotional experiences

was provided by two recent studies of Bel-

gian students (De Leersnyder & Mesquita,

2013), who were asked to describe a recently

experienced emotional situation and to indi-

cate if and to what extent the situation had

been either consistent or inconsistent with a

number of different concerns, some of which

were other- focused (e.g., being loyal, helping

others), and others which were self- focused

(personal success, ambition). The frequency

with which these values were judged as rele-

vant to the emotional situations exactly mir-

rored young Belgians’ value hierarchy (i.e.,

most important values as “guiding prin-

ciples in people’s life”), as obtained from a

national representative sample by the Euro-

pean Social Survey (ESS, Round 5; Norwe-

gian Social Science Data Services, 2012).

Moreover, the types of emotions depended

on the types of values considered relevant.

The combined results thus suggest that (1)

culturally salient concerns are more readily

available as standards of evaluation for emo-

tional situations, and (2) the different types

of concerns translate into different patterns

of emotional experience. As such, emotional

experiences are culturally regulated to be

about the most important cultural themes

and concerns.

In summary, cultural models appear to

provide the backdrop of expectations and

point(s) of view with which individuals meet

the world. As such, culture regulates the

meaning and thus the emotional significance

of the world to the individual.

Social Regulation of Appraisal

Other people appear to influence an indi-

vidual’s appraisals in two ways. One is by

example: Other people’s emotions and

appraisals inform an individual’s appraisals

in a given situation. There is developmental

work showing that children look at their

caregivers’ facial expressions in trying to

appraise a situation as, for example, danger-

ous or safe (e.g., Campos & Stenberg, 1981).

Adults also use other people’s appraisals as

input for the meaning of the situation (Par-

kinson & Simons, 2009). We expect that

social appraisal regulation plays a large role

in cultural differences, because the prevalent

emotions in each culture differ. When other

people’s emotions are used as a compass, this

compass will point in different directions

for different cultural environments. There

are some illustrations of this phenomenon

in the parenting literature: Parents’ own

reactions to their children’s emotions may

sometimes model their children’s appraisal.

For instance, Japanese parents rarely express

direct disagreement with their angry chil-

dren; instead, they go through cycles of

mutual perspective taking (Trommsdorff &

Kornadt, 2003) or express negativity indi-

rectly (e.g., by silence). Parents thus model

the interpretation of the situation as one

that requires perspective taking. In contrast,

German parents in the same study (Trom-

msdorff & Kornadt, 2003) were much more

confrontational, and in that way, modeled

the appraisal as one of conflict.

A second social appraisal situation con-

sists of more explicit approval or disapproval

of certain emotions or interpretations. There

294 SOCIAL ASPECTS

is again some cross- cultural work on social

appraisal regulation in the caregiver– child

literature (Boiger & Mesquita, 2012; De

Leersnyder, Boiger, & Mesquita, 2013).

For example, parents may pay attention to

some of their children’s emotions, thus vali-

dating the appraisal of the situation, and

ignore other emotions of the child, thus fail-

ing to endorse the child’s interpretation of

the event. German mothers who witnessed

their children’s mishaps focused on the chil-

dren’s distress, thereby confirming that the

children had a good reason for their negative

emotions. By contrast, Japanese and Indian

mothers ignored their child’s negative emo-

tions, thus challenging their interpretation

of the situation as one of distress (Tromms-

dorff & Friedlmeier, 2010). Japanese care-

givers also helped their children adopt the

outside- in perspective that is also common

for Japanese adults: They drew their chil-

dren’s attention to how their anger makes

others feel (e.g., Conroy, Hess, Azuma, &

Kashiwagi, 1980). Reappraising anger-

ing situations in this way may explain the

lower levels of anger in Japan (Zahn- Waxler,

Radke- Yarrow, & King, 1979). European

American parents, on the other hand,

expected their children to self- assert and

to stand up for themselves (Conroy et al.,

1980). When dealing with an angry child,

they tended to encourage appraisals of frus-

tration in the child, leading to high levels of

anger.

To our knowledge, there is no systematic

empirical evidence that adults help each

other in reappraising situations in ways that

are consistent with their cultural values.

However, there is some anecdotal evidence

for social appraisal regulation beyond child-

hood. For instance, Kitayama and Masuda

(1995) describe how American friends help

each other when one is feeling shameful and

down “by reorienting the person’s atten-

tion . . . to external objects or events the

person can reasonably blame for the imped-

ing problem” (p. 220). This social regula-

tion may explain why shame is frequently

transformed into anger in the American cul-

tural context (Kitayama & Masuda, 1995).

By reappraising the shameful event as being

caused by others rather than by oneself, the

focus of appraisal shifts from one’s own

painful shortcomings to the more empower-

ing experience of self- integrity, and others’

blameworthiness. Maintaining high self-

esteem and avoiding self- critical informa-

tion constitute central goals for the Ameri-

can independent self; anger can thus be seen

as a more desirable endpoint of emotion

regulation than shame.

Behavior Regulation

Cross- cultural differences have tradition-

ally been explained as differences in delib-

erate and effortful suppression of emotional

expressions that did not match the cultural

ideals (e.g., Matsumoto, 1990). The idea has

been that people across different cultural

contexts adhere to the prevalent “display

rules” (i.e., the “cultural norms that dictate

the management and modification of emo-

tional displays depending on social circum-

stances; Ekman & Friesen, 1969),” and that

this type of post hoc regulation is the most

important route to cultural differences in

emotion (Matsumoto et al., 2008, p. 58).

While it is clear that cultural differences in

emotion regulation are not due to differ-

ences in response suppression only, there is

evidence that suggests cultural differences in

this strategy, too. We discuss this evidence

below, but we also suggest that cultural

differences in the regulation of emotional

behavior are not limited to differences in

individual emotion suppression.

Individual Regulation of Behavior

There is evidence of cultural differences in

display rules. Several studies have linked the

use of display rules to the culture’s level on

the individualism dimension; a dimension

that is an important aspect of cultural mod-

els of self and relationship. Cultures with

interdependent models are thought to be low

on individualism (and high on collectivism);

while independent cultures are high on indi-

vidualism. Pertinent studies have found that

there is a greater desire to express emotions,

especially positive, high- activation emotions

in cultures higher on individualism. For

instance, Matsumoto and colleagues (2008)

asked participants from 32 different coun-

tries what they should do if they felt each

of seven emotions (anger, contempt, disgust,

fear, happiness, sadness, and surprise) on a

scale ranging from emotion amplification

(i.e., express more), to deamplification (i.e.,

The Cultural Regulation of Emotions 295

express less) or masking (i.e., hide emo-

tion with smile). The authors found that

the country’s scores on individualism (as

indexed by Hofstede, 2001) predicted the

country’s mean level of emotional expressiv-

ity. However, several qualifications of these

results are in order.

First, much of the relationship between

individualism and expression was “carried

by the relationship between individualism

with happiness and surprise” (Matsumoto

et al., 2008, p. 66). Thus, whereas people

in the United States, Canada, and Australia

expressed a desire to up- regulate happiness

and surprise, people in East Asian countries

indicated that they would actively seek to

avoid these emotional states (see also Tsai et

al., 2006). Second, nearly all of the emotions

included in the current study except sadness

were high- activation (disengaging) emo-

tions. Since the expression of high- activation

disengaged emotions would be more incon-

sistent with the prevalent cultural models,

there may indeed be a higher need to regu-

late these types of emotions in East Asian

than in Western cultural contexts. Conse-

quently, the association between emotion

expressivity and individualism may not have

been found (or even be in the opposite direc-

tion) if only low-activation engaging emo-

tional experiences had been included— an

idea that is supported by the negative (par-

tial) correlation between individualism and

emotional expressivity of sadness (Matsu-

moto et al., 2008). Therefore, rather than

concluding that individuals in collectivist

cultures suppress their emotions more than

individuals in individualist cultures, a bet-

ter conclusion might be that people across

cultural contexts engage in the suppression

of those emotions that are inconsistent with

the pertinent cultural models.

There are also cultural differences in both

the effectiveness and costs of emotion sup-

pression (Cheung & Park, 2010; Mauss &

Butler, 2010; Soto, Perez, Kim, Lee, & Min-

nick, 2011) Convergent results from experi-

mental and questionnaire studies show that

suppression of emotional responses is effort-

ful in European American samples, and

although effective in modifying emotional

behavior, it does not change the emotional

experience. Furthermore, in European

American samples, suppression is associ-

ated with increases in physiological arousal

and with detrimental effects on memory,

felt affect (less positive and no less nega-

tive emotion), and social relationships (e.g.,

Gross, 1998; Richards & Gross, 2000).

Finally, habitual suppression in European

Americans was related to both high levels of

depressive symptoms and low levels of life

satisfaction (Cheung & Park, 2010; Soto et

al., 2011).

In Western cultures, emotional suppres-

sion has therefore been found to be maladap-

tive. However, there are many indications

that this is not the case in Asian American

or East Asian samples. First, emotion sup-

pression may be more effective in these sam-

ples. For example, in a study by Mauss and

Butler (2010), Asian Americans who valued

emotional control were not only coded as

expressing less anger but they also reported

feeling less angry than before. Moreover,

they showed a “challenge pattern” of car-

diovascular responding, suggesting that the

suppression was not that effortful, because

their resources met or exceeded the demands

of the situation. Second, habitually engag-

ing in emotionally suppressive behavior

was unrelated to psychological well-being

in Hong Kong Chinese participants (Soto

et al., 2011) and much less associated with

depression in Asian American compared to

European American respondents (Cheung &

Park, 2010).

The different meanings of suppression can

be understood from the respective cultural

models (see Mesquita & Delvaux, 2012).

Whereas the expression of one’s feeling in

independent cultural contexts defines iden-

tity, it does not do so in interdependent con-

texts. These latter contexts emphasize situ-

ational adjustment, and may thus encourage

suppression of emotions whenever the situa-

tion requires it.

Culturally comparative work has focused

on up- and down- regulation of emotions but

has not paid much attention to the quality

of emotional behavior: What do people usu-

ally do when they feel a certain emotion?

Descriptive, ethnographic work has sug-

gested that individuals in some cultures have

specific behavioral scripts associated with

certain emotions (Mesquita & Frijda, 1992).

These behavioral scripts may be considered

the outcome of regulation to the extent that

they serve the prevalent cultural models of

self and relationships. A good illustration

296 SOCIAL ASPECTS

is the Balinese reaction to socially threat-

ening events, falling asleep (Bateson &

Mead, 1942), which can be understood as

an expression of the emotion of fear that

avoids disrupting the cultural model. Falling

asleep satisfies, at least subjectively, the goal

of reducing one’s exposure to threat, while

avoiding the emotional disruption that other

fear responses are felt to cause. Therefore,

falling asleep can be considered a culturally

effective form of individual emotion regula-

tion.

In summary, cultural models implicate

display rules for emotion regulation: Indi-

viduals tend to suppress emotions that are

inconsistent with the cultural models. Emo-

tional suppression is an individual regula-

tion strategy that requires different efforts,

that differs in effectiveness and is associated

with different psychological costs across dif-

ferent cultural contexts, in ways that can

be understood from the cultural models of

self and relationship. Furthermore, cultures

may model specific behaviors that meet the

cultural models. When individuals engage in

behavior that is culturally modeled, we call

this regulation. We do not think that indi-

viduals necessarily suppress another (more

natural) response before engaging in culture-

specific behavior. Rather, the fact that they

choose a culturally valued, rather than a less

valued response, makes this a meaningful

case of cultural regulation.

Social Regulation of Behavior

Across cultures, the preferred contexts and

practices for behavioral expression differ as

well. Certain social contexts provide oppor-

tunity for emotional expression, whereas

other cultural contexts inhibit the display of

emotions, or of certain emotions. Rituals are

an example: “Rituals consist of prescribed

behavior modes that remove the need to

expose one’s individual feelings. Yet at the

same time, they form opportunities to vent

one’s emotions in a socially acceptable way”

(Mesquita & Frijda, 1992, p. 197). A good

example of a ritual that appears to provide

an institutionalized means for expressing

emotional behaviors that would otherwise

conflict with the prevailing cultural model

was described for the Philippine Ilongots by

the anthropologist Michelle Rosaldo. In this

small community, in-group harmony was

essential for survival of the group. Ilongots,

therefore, saw it as a communal responsibil-

ity to regulate emotions that could threaten

the harmony of the group. Liget—an emo-

tion denoting energy, passion, and anger

simultaneously— was one of those threaten-

ing emotions (Rosaldo, 1980). A ritual of

headhunting was in place, should feelings

of liget arise. When one or more Ilongot

men experienced the heavy feeling of liget,

a group of them would go out to kill an out-

sider. After the beheading, the Ilongot men

came home purged of violence, and the com-

munity celebrated the overcoming of liget

by singing together. The ritual thus directed

the behavioral intentions elicited by liget

toward an out-group target, channeling a

potentially intraculturally disruptive behav-

ior into one that reinforced the solidarity of

the group. Rituals may thus be understood

as prototypes for the mechanisms by which

sociocultural practices afford opportunities

to express (or act on) emotions in culturally

supported ways.

In summary, there are cultural differences

in both individual and social behavioral reg-

ulation. Some of these are differences in sup-

pression versus expressivity. However, the

connotations of suppression are not cultur-

ally the same. Other differences are better

seen as differences in the selection of behav-

ior, often in the function of the models and

practical opportunities for behavior that the

culture provides.

Cultural Differences in the Preference

for Different Strategies

of Emotion Regulation

In a number of studies that have compared

cultural preferences for particular types of

emotion regulation, the suppression of emo-

tional responses was not contrasted with

expression, but rather with reappraisal, a

different type of emotion regulation. In dif-

ferent studies, participants from indepen-

dent cultural contexts expressed a stronger

preference for reappraisal over suppression

than participants in interdependent cultural

contexts, for whom this preference was

sometimes even absent (e.g., Novin, Ban-

jeree, Dadhkah, & Rieffe, 2009; Soto et al.,

2011). These differential preferences may

correspond to different cultural models. In

independent cultural contexts, the expres-

The Cultural Regulation of Emotions 297

sion of one’s feeling is identity defining. A

change in emotional expression achieved by

reappraisal respects the link between feeling

and expression. On the other hand, suppres-

sion of emotions seems fine in interdepen-

dent cultural contexts, where the emphasis

is on situational adjustment; suppression

and reappraisal would be equivalent means

to reaching this goal. Among respondents

from independent cultural contexts, the use

of suppression is inversely related to the use

of reappraisal, suggesting that they more

readily use the one or the other strategy.

In contrast, there is a positive correlation

between the use of suppression and reap-

praisal among respondents from interdepen-

dent cultural contexts, suggesting that they

use both strategies when they attempt to

regulate their emotions (Matsumoto et al.,

2008).

Conclusion

There is substantial evidence of the cultural

regulation of emotions, conceived here as

the combined mechanisms that align an

individual’s emotional experience to the per-

tinent cultural model. Cultural regulation

takes place not only at the level of culture,

by way of the habitual social practices and

interpersonal interactions that constitute

an individual’s lived environment, but also

at the level of individual schemas, goals,

and modes of attention. Moreover, regula-

tion takes place at all the different stages of

the emotion: Both cultural and individual

processes are instrumental in creating and

modifying emotional events, channeling an

individual’s attention, and shaping an indi-

vidual’s appraisals of the situation in ways

that promote culturally desirable emotions;

moreover, both cultural and individual

processes shape emotion expression into

congruence with cultural norms. Cultural

practices and psychological tendencies thus

co- constitute emotional experiences and

expressions that are aligned with prevailing

cultural models of self and relating.

At the level of the individual, emotion

regulation is often implicit and automatic,

although it can also be conscious and effort-

ful. When it is automatic, it can be con-

ceived in terms of psychological tendencies:

the tendency to engage in certain types of

interactions, to focus attention on certain

aspects of the situation, and to appraise a

situation in a certain way. These psychologi-

cal tendencies may originate from culture-

level regulation. Thus, individuals’ tenden-

cies to experience certain emotions may be

a consequence of repeated exposure to a cul-

tural set of daily situations (see Kitayama &

Imada, 2010). For instance, a habitual focus

on controllability may chronically increase

the propensity to appraise a situation as one

of high control, and thus of experiencing

anger. In the same way, caregivers’ repeated

emphasis on the child’s inability to meet

social standards may bias the child’s focus

toward noticing failures, thus enhancing the

tendency to feel shame. The resulting regula-

tion is implicit and antecedent- focused.

The large cultural differences observed in

everyday emotional experience suggest that

emotion regulation is widespread. How-

ever, given the functional role of emotions

in guiding adaptive behavior, we contend

that effortful emotion regulation must be

very limited; it is “culture’s last resort” for

shaping emotions in a culturally normative

fashion, used only when all other means

have failed. Most regulatory processes must

be automatic, as in the culturally different

psychological tendencies that align an indi-

vidual’s experience and expression with the

cultural models.

The cultural perspective contributes sev-

eral insights to emotion regulation generally.

First, it suggests that while the goal of emo-

tion regulation may universally be proper

self- presentation and relationship mainte-

nance, specific cultural models define the

norms for self- presentation, as well as the

ways to maintain a relationship. Cultural

models thus set specific goals for emotion

regulation. In this way, emotion regulation

ties a person to the most important cultural

goals and values, just as it ties a person to his

or her personality (e.g., Tamir, 2005).

Second, the cultural perspective suggests

that emotion regulation is not merely an

intrapersonal process. Rather, emotions are

importantly regulated by the ways in which

our worlds are structured and our lives are

organized. We have illustrated how emotion

is regulated at the level of cultural practices

through the structuring of social situations

and the dynamics of social interactions;

close others’ attempts to modify the indi-

298 SOCIAL ASPECTS

vidual’s focus of attention within a situation;

and the opportunities afforded for emo-

tional behavior. The structure of everyday

life can be seen as the primary way in which

emotions are culturally regulated, although

at this level the distinction between emotion

generation and emotion regulation is mute

(see also Kappas, 2011; Mesquita & Frijda,

2011).

Taken together, the results suggest that

there is “redundancy” in the cultural regu-

lation of emotions (Levy, 1978), such that

regulatory processes at many different loci

of the emotion, and as initiated by many

different sources, converge into a pattern of

emotional experience and expression that

fits the cultural model (more than not).

References

Abu- Lughod, L. (1986). Veiled sentiments.

Berkeley: University of California Press.

Adams, G., & Markus, H. R. (2004). Toward

a conception of culture suitable for a social

psychology of culture. In M. Schaller & C. S.

Crandall (Eds.), Psychological foundations of

culture (pp. 335–360). Mahwah, NJ: Erlbaum.

Bargh, J. A., & Williams, L. E. (2007). The

nonconscious regulation of emotion. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp. 429–445). New York: Guilford Press.

Bateson, G., & Mead, M. (1942). Balinese char-

acter: A photographic analysis. New York:

New York Academy of Sciences.

Benedict, R. (1946). The chrysanthemum and

the sword. Patterns of Japanese culture. Bos-

ton: Houghton Mifflin.

Boiger, M., & Mesquita, B. (2012). The construc-

tion of emotion in interactions, relationships,

and cultures. Emotion Review, 4, 221–229.

Boiger, M., Mesquita, B., Tsai, A., & Markus,

H. (2012). Influencing and adjusting in daily

emotional situations: A comparison of Euro-

pean and Asian American action styles. Cog-

nition and Emotion, 26, 332–340.

Boiger, M., Mesquita, B., Uchida, Y., & Barrett,

L. F. (2013). Condoned or condemned: The

situational affordance of anger and shame in

Japan and the US. Personality and Social Psy-

chology Bulletin, 39(4), 540–553.

Bruner, J. (1990). Acts of meaning. Cambridge,

MA: Harvard University Press.

Campos, J. J., & Stenberg, C. (1981). Perception,

appraisal, and emotion: The onset of social

referencing. In M. E. Lamb & L. R. Sher-

rod (Eds.), Infant social cognition: Empirical

and theoretical considerations (pp. 273–314).

Hillsdale, NJ: Erlbaum.

Cheung, R. Y. M., & Park, I. J. K. (2010). Anger

suppression, interdependent self- construal,

and depression among Asian American and

European American college students. Cul-

tural Diversity and Ethnic Minority, 16(4),

517–525.

Cohen, D., Hoshino- Browne, E., & Leung, A.

K.-Y. (2007). Culture and the structure of

personal experience: Insider and outsider phe-

nomenologies of the self and social world. In

M. P. Zanna (Ed.), Advances in experimental

social psychology (Vol. 39, pp. 1–67). San

Diego, CA: Academic Press.

Cole, P. M., Tamang, B. L., & Shrestha, S.

(2006). Cultural variations in the socialization

of young children’s anger and shame. Child

Development, 77, 1237–1251.

Conroy, M., Hess, R. D., Azuma, H., & Kashi-

wagi, K. (1980). Maternal strategies for

regulating children’s behavior: Japanese and

American families. Journal of Cross- Cultural

Psychology, 11, 153–172.

D’Andrade, R. G. (1984). Culture meaning sys-

tems. In R. A. Shweder & R. A. Levine (Eds.),

Culture theory: Essays on mind, self, and

emotion (pp. 88–119). Cambridge, UK: Cam-

bridge University Press.

De Leersnyder, J., Boiger, M., & Mesquita, B.

(2013). Cultural regulation of emotion: Indi-

vidual, relational, and structural sources.

Frontiers in Psychology, 4(55). [E-publication

prior to print]

De Leersnyder, J., & Mesquita, B. (2013). What

are emotions about?: The role of cultural val-

ues in emotional experience. Manuscript in

preparation.

De Leersnyder, J., Mesquita, B., & Kim, H.

(2011). Where do my emotions belong?: A

study of immigrants’ emotional acculturation.

Personality and Social Psychology Bulletin,

37, 451–463.

De Leersnyder, J., Mesquita, B., & Kim, H.,

(2013). Emotional acculturation. In D. Her-

mans, B. Mesquita, & B. Rime (Eds.), Chang-

ing emotions (pp. 127–133). Hove, UK: Psy-

chology Press.

De Leersnyder, J., Mesquita, B., & Kim, H.

(2013). Emotional fit with culture: A predic-

tion of individual differences in relational

well-being. Manuscript under review.

Diamond, L. M., & Aspinwall, L. G. (2003).

The Cultural Regulation of Emotions 299

Emotion regulation across the life span: An

integrative perspective emphasizing self-

regulation, positive affect, and dyadic pro-

cesses. Motivation and Emotion, 27, 125–156.

Eid, M., & Diener, E. (2001). Norms for expe-

riencing emotions in different cultures: Inter-

and intranational differences. Journal of

Personality and Social Psychology, 81(5),

869–885.

Ekman, P., & Friesen, W. V. (1969). The reper-

toire of nonverbal behavior: Categories, ori-

gins, usage, and coding. Semiotica, 1, 49–98.

Elliott, A., Chirkov, V., Kim, Y., & Sheldon, K.

(2001). A cross- cultural analysis of avoidance

(relative to approach) personal goals. Psycho-

logical Science, 12, 505–510.

Ellsworth, P. C. (1994). Sense, culture, and sensi-

bility. In S. Kitayama & H. R. Markus (Eds.),

Emotion and culture: Empirical studies of

mutual influence (pp. 23–50). Washington,

DC: American Psychological Association.

ESS Round 5: European Social Survey Round 5

Data. (2012). Data file edition 3.0. Norway:

Norwegian Social Science Data Services, data

archive and distributor of ESS data.

Frijda, N. H. (1986). The emotions. Cambridge,

UK: Cambridge University Press.

Frijda, N. H., Kuipers, P., & Terschure, E. (1989).

Relations between emotion, appraisal and

emotional action readiness. Journal of Person-

ality and Social Psychology, 57, 212–228.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J., Sheppes, G., & Urry, H. L. (2011).

Emotion generation and emotion regulation: A

distinction we should make (carefully). Cogni-

tion and Emotion, 25, 765–781.

Grossmann, I., Ellsworth, P. C., & Hong, Y.

(2012). Culture, attention, and emotion. Jour-

nal of Experimental Psychology: General,

14(1), 31–36.

Gyurak, A., Gross, J. J., & Etkin, A. (2011).

Explicit and implicit emotion regulation: A

dual- process framework. Cognition and Emo-

tion, 25(3), 400–412.

Heine, S. J., Lehman, D. R., Markus, H. R., &

Kitayama, S. (1999). Is there a universal need

for positive self- regard? Psychological Review,

106(4), 766–794.

Hochschild, J. L. (1995). What is the American

dream? In J. L. Hochschild (Ed.), Facing up

to the American dream: Race, class and the

soul of the nation (pp. 15–38). Princeton, NJ:

Princeton University Press.

Hofstede, G. H. (2001). Culture’s consequences:

Comparing values, behaviors, institutions

and organizations across nations (2nd ed.).

Thousand Oaks, CA: Sage.

Kappas, A. (2011). Emotion and regulation are

one! Emotion Review, 3, 17–25.

Kim, H., & Markus, H. R. (1999). Deviance

or uniqueness, harmony or conformity?: A

cultural analysis. Journal of Personality and

Social Psychology, 77(4), 785–800.

Kitayama, S., & Imada, T. (2010). Implicit inde-

pendence and interdependence: A cultural task

analysis. In B. Mesquita, L. F. Barrett, & E. R.

Smith (Eds.), The mind in context (pp. 174–

200). New York: Guilford Press.

Kitayama, S., Karasawa, M., & Mesquita, B.

(2004). Collective and personal processes

in regulating emotions: Emotion and self

in Japan and the US. In P. Philippot & R. S.

Feldman (Eds.), The regulation of emotion

(pp. 251–273). Hillsdale, NJ: Erlbaum.

Kitayama, S., & Markus, H. R. (2000). The pur-

suit of happiness and the realization of sym-

pathy: Cultural patterns of self, social rela-

tions, and well-being. In E. Diener & E. Suh

(Eds.), Subjective well-being across cultures

(pp. 113–161). Cambridge, MA: MIT Press.

Kitayama, S., & Masuda, T. (1995). Reapprais-

ing cognitive appraisal from a cultural per-

spective. Psychological Inquiry, 6, 217–223.

Kitayama, S., Mesquita, B., & Karasawa, M.

(2006). The emotional basis of independent

and interdependent selves: Socially disengag-

ing and engaging emotions in the US and

Japan. Journal of Personality and Social Psy-

chology, 91(5), 890–903.

Koole, S. L. (2009). The psychology of emotion

regulation: An integrative review. Cognition

and Emotion, 23(1), 4 – 41.

Lebra, T. S. (1992). Self in Japanese culture. In

N. E. Rosenberger (Ed.), Japanese sense of

self. New York: Oxford University Press.

Lee, A. Y., Aaker, J. L., & Gardner, W. L.

(2000). The pleasures and pains of distinct

self- construals: The role of interdependence in

regulatory focus. Journal of Personality and

Social Psychology, 78(6), 1122–1134.

Levy, R. I. (1978). Tahitian gentleness and redun-

dant controls. In A. Montagu (Ed.), Learn-

ing non- aggression: The experience of non-

literate societies (pp. 222–235). New York:

Oxford University Press.

Lewis, C. C. (1995). Educating hearts and minds.

New York: Cambridge University Press.

Lutz, C. (1987). Goals, events, and understand-

300 SOCIAL ASPECTS

ing in Ifaluk emotion theory. In N. Quinn &

D. Holland (Eds.), Cultural models in lan-

guage and thought (pp. 290–312). New York:

Cambridge University Press.

Markus, H. R., & Kitayama, S. (1991). Culture

and self: Implications for cognition, emotion,

and motivation. Psychological Review, 98(2),

224–253.

Markus, H. R., & Kitayama, S. (1994). The

cultural construction of self and emotion:

Implications for social behavior. In S. Kita-

yama & H. R. Markus (Eds.), Emotion and

culture: Empirical studies of mutual influence

(pp. 89–130). Washington, DC: American Psy-

chological Association.

Masuda, T., Ellsworth, P. C., Mesquita, B., Leu,

J., Tanida, S., & Veerdonk, E. (2008). Plac-

ing the face in context: Cultural differences

in the perception of facial emotion. Journal

of Personality and Social Psychology, 94(3),

365–381.

Matsumoto, D. (1990). Cultural similarities and

differences in display rules. Motivation and

Emotion, 14(3), 195–214.

Matsumoto, D., Yoo, S. H., Fontaine, J., Anguas-

Wong, A. M., Arriola, M., & Ataca, B. (2008).

Mapping expressive differences around the

world: The relationship between emotional

display rules and individualism versus collec-

tivism. Journal of Cross- Cultural Psychology,

39(1), 55–74.

Mauss, I. B., Bunge, S. A., & Gross, J. J. (2008).

Culture and automatic emotion regulation.

In S. Ismer, S. Jung, S. Kronast, C. van Sch-

eve, & M. Vanderkerckhove (Eds.), Regulat-

ing emotions: Culture, social necessity and

biological inheritance (pp. 39–60). London:

Blackwell.

Mauss, I. B., & Butler, E. A. (2010). Cultural

context moderates the relationship between

emotion control values and cardiovascular

challenge versus threat responses. Biological

Psychology, 84, 521–530.

Mesquita, B., & Delvaux, E. (2012). A cultural

perspective on emotion labor. In A. Grandey,

J. Diefendorff, & D. Rupp (Eds.), Emotional

labor in the 21st century: Diverse perspectives

on emotion regulation at work (pp. 251–272).

New York: Psychology Press/Routledge.

Mesquita, B., & Ellsworth, P. C. (2001). The role

of culture in appraisal. In K. R. Scherer & A.

Schorr (Eds.), Appraisal processes in emotion:

Theory, methods, research (pp. 233–248).

New York: Oxford University Press.

Mesquita, B., & Frijda, N. H. (1992). Cultural

variations in emotions: A review. Psychologi-

cal Bulletin, 112(2), 179–204.

Mesquita, B., & Frijda, N. H. (2011). An emo-

tion perspective on emotion regulation. Cog-

nition and Emotion, 25, 782–784.

Mesquita, B., & Leu, J. (2007) The cultural

psychology of emotions. In S. Kitayama & D.

Cohen (Eds.), Handbook for cultural psychol-

ogy (pp. 734–759). New York: Guilford Press.

Mesquita, B., Marinetti, C., & Delvaux, E.

(2012). The social psychology of emotions. In

S. Fiske & N. Macrae (Eds.), Sage handbook

of social cognition (pp. 290–310). Thousand

Oaks, CA: Sage.

Miller, P. J., Fung, H., & Mintz, J. (1996). Self-

construction through narrative practices: A

Chinese and American comparison of early

socialization. Ethos, 24(2), 237–280.

Morelli, G. A., Rogoff, B., Oppenheim, D., &

Goldsmith, D. (1992). Cultural variation in

infants’ sleeping arrangements: Questions of

independence. Developmental Psychology,

28(4), 604–613.

Morling, B., Kitayama, S., & Miyamoto, Y.

(2002). Cultural practices emphasize influence

in the United States and adjustment in Japan.

Personality and Social Psychology Bulletin,

28(3), 311–323.

Nisbett, R. E. (2003). The geography of thought.

How Asians and Westerners think differ-

ently . . . and why. New York: Free Press.

Novin, S., Banjeree, R., Dadhkah, A., & Rieffe,

C. (2009). Self- reported use of display use in

the Netherlands and Iran: Evidence for socio-

cultural influence. Social Development, 18(2),

397– 411.

Parkinson, B., & Simons, G. (2009). Affecting

others: Social appraisal and emotion contagion

in everyday decision making. Personality and

Social Psychology Bulletin, 35, 1071–1084.

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79, 410–424.

Rosaldo, M. Z. (1980). Knowledge and passion:

Ilongot notions of self and social life. New

York: Cambridge University Press.

Roseman, I., Dhawan, N., Rettek, S., Naidu, R.

K., & Thapa, K. (1995). Cultural differences

and cross- cultural similarities in appraisals

and emotional responses. Journal of Cross-

Cultural Psychology, 26(1), 23– 48.

Rothbaum, F., Pott, M., Azuma, H., Miyake,

K., & Weisz, J. (2000). The development of

close relationships in Japan and the United

The Cultural Regulation of Emotions 301

States: Paths of symbiotic harmony and gen-

erative tension. Child Development, 71(5),

1121–1142.

Savani, K., Markus, H. R., Naidu, N. V. R.,

Kumar, S., & Berlia, N. (2010). What counts

as a choice?: U.S. Americans are more likely

than Indians to construe actions as choices.

Psychological Science, 21, 391–398.

Shweder, R. A. (1991). Thinking through cultures.

Cambridge, MA: Harvard University Press.

Solomon, R. C. (2004). Thinking about feeling:

Contemporary philosophers on emotions.

New York: Oxford University Press.

Soto, J. A., Perez, C. R., Kim, Y.-H., Lee, E.

A., & Minnick, M. R. (2011). Is expressive

suppression always associated with poorer

psychological functioning?: A cross- cultural

comparison between European Americans

and Hong Kong Chinese. Emotion, 11(6),

1450–1455.

Stein, N. L., Trabasso, T., & Liwag, M. (1993).

The representation and organization of emo-

tional experience: Unfolding the emotion epi-

sode. In M. Lewis & J. M. Haviland (Eds.),

Handbook of emotions (pp. 279–300). New

York: Guilford Press.

Tamir, M. (2005). Don’t worry, be happy?: Neu-

roticism, trait- consistent affect regulation,

and performance. Journal of Personality and

Social Psychology, 89, 449– 461.

Trommsdorff, G., & Friedlmeier, W. (2010). Pre-

school girls’ distress and mothers’ sensitivity

in Japan and Germany. European Journal of

Developmental Psychology, 7, 350–370.

Trommsdorff, G., & Kornadt, H. (2003). Parent–

child relations in cross- cultural perspective. In

L. Kuczynski (Ed.), Handbook of dynamics in

parent– child relations (pp. 271–305). Thou-

sand Oaks, CA: Sage.

Tsai, J. L., Knutson, B., & Fung, H. H. (2006).

Cultural variation in affect valuation. Jour-

nal of Personality and Social Psychology, 90,

288–307.

Tsai, J. L., Miao, F., Seppala, E., Fung, H. H.,

& Yeung, D. (2007). Influence and adjustment

goals: Mediators of cultural differences in

ideal affect. Journal of Personality and Social

Psychology, 92(6), 1102–1117.

Weisz, J. R., Rothbaum, F. M., & Blackburn, T.

C. (1984). Standing out and standing in: The

psychology of control in America and Japan.

American Psychologist, 39(9), 955–969.

Wierzbicka, A. (1994). Emotion, language,

and cultural scripts. In S. Kitayama & H. R.

Markus (Eds.), Emotion and culture: Empiri-

cal studies of mutual influence (pp. 133–196).

Washington, DC: American Psychological

Association.

Zahn- Waxler, C., Radke- Yarrow, M., & King,

R. A. (1979). Child rearing and children’s pro-

social initiations toward victims of distress.

Child Development, 50, 319–330.

PART VI

PERSONALITY PROCESSES

AND INDIVIDUAL DIFFERENCES

305

In recent years, advances in research on tem-

perament have contributed to many other

areas of psychology, including socioemo-

tional and personality development, psycho-

pathology, emotion, and emotion regulation

(Zentner & Shiner, 2012). Temperament

refers to constitutionally based individual

differences in reactivity and self- regulation,

and historically, has been linked to the biol-

ogy of the person (Rothbart, 2011). Recent

temperament research has employed increas-

ingly sophisticated psychometric methods,

developing a basic taxonomy of tempera-

ment that extends from infancy to adult-

hood and links temperament to neural anat-

omy and function.

In our research, broad factors of Fear,

Frustration, Negative Affectivity, Extraver-

sion/Surgency, Affiliativeness, Orienting/

Perceptual Sensitivity, and Effortful Control

have been extracted from questionnaire data

(Putnam, Ellis, & Rothbart, 2001; Roth-

bart, 2011). These dimensions show strong

similarities to those found in other laborato-

ries, and reactive and self- regulative aspects

of temperament have been observed in both

the laboratory and in parent and self- report

data (Zentner & Shiner, 2012).

In this chapter we describe concepts of

emotion and emotion regulation within a

temperament framework. We first put for-

ward definitions of temperament, personal-

ity, emotion, and emotion regulation. We

then consider how defense and approach

emotion systems regulate each other, fol-

lowed by a review of links between emotion

regulation and individual differences in ori-

enting. We then examine in detail the rela-

tion of emotion regulation to temperamen-

tal effortful control (EC) and describe the

underpinnings of EC in the brain’s executive

attention network. Because temperament

develops, and because EC provides a general

mechanism for the control of emotion that

is not well- developed until early childhood

(Rueda, 2012), we describe emotion regu-

lation in a developmental context. Finally,

we raise empirical issues about the study

of emotional reactivity and regulation, and

describe future directions for research.

Definitions of Key Terms

Rothbart and Bates (2006) define tempera-

ment as “constitutionally based individual

differences in reactivity and self- regulation,

in the domains of affect, activity, and atten-

tion.” This chapter focuses on the tempera-

ment domains of affect and attention, and

the term affect is used synonymously with

emotion. The term constitutional indicates

that temperament is biologically based and

influenced over time by heredity, matura-

CHAPTER 19

Temperament and Emotion Regulation

Mary K. Rothbart

Brad E. Sheese

Michael I. Posner

306 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

tion, and experience. Reactivity and self-

regulation are terms originally used broadly

by Rothbart and Derryberry (1981) to orga-

nize the temperament domain. Reactivity

refers to responses to change in the external

and internal environment, including reac-

tions that can be conceptualized broadly

or narrowly (e.g., fear, motor activity, ori-

enting, negative affectivity, cardiac reactiv-

ity). Reactivity is measured in terms of the

latency, duration, and intensity of affective,

motor, and orienting reactions (Rothbart &

Derryberry, 1981). Self- regulation involves

effortful attention that serves to modulate

reactivity and organize change.

Individual differences in temperament

fall within the more general rubric of per-

sonality. We define personality as individual

differences in dispositional traits, coping

strategies, and cognitions of self and oth-

ers that influence the person’s adjustments

to the environment. Dispositional traits are

patterns of thoughts, emotions, and behav-

ior that show consistency across situations

and stability over time (Allport, 1937), and

temperament traits constitute a subset of

personality traits (Rothbart, 2011). Tem-

perament traits include consistent patterns

of reactivity of the emotions and the self-

regulation of thoughts, emotions, and action

through attention. We note that this defini-

tion relates temperament to personality and

at the same time differentiates temperament

from other personality domains.

Personality goes beyond temperament to

include attitudes, cognitive coping strate-

gies, concepts of self and other, values, mor-

als, and beliefs, but there is also evidence

that the broad personality traits of Extra-

version, Agreeableness, Conscientiousness,

Neuroticism, and Openness may be orga-

nized around the basic temperament traits

that can be observed early in life (McCrae et

al., 2000; Rothbart, 2011; Shiner & Caspi,

2012).

Emotions can be seen as broadly integra-

tive systems that order feelings, thoughts,

and actions (LeDoux, 1989, 2000). They

represent the output of neural information-

processing networks that assess the mean-

ing or affective significance of events for the

individual. Whereas object recognition sys-

tems and spatial processing systems address

the questions “What is it?” and “Where is

it?,” emotion- processing networks address

the questions “Is it good for me?”; “Is it bad

for me?”; and “What shall I do about it?”

(action tendencies). These networks have

been evolutionarily conserved to allow the

organism to deal with environmental and

internally generated threat and opportu-

nity. When we discuss temperamental reac-

tivity, we include individual differences in

emotion- processing networks. Because the

emotions include both action tendencies and

physiological support for these tendencies,

they have regulatory aspects, and one emo-

tion can regulate another. Thus, fear poten-

tiates withdrawal, attack, or inhibition, and

positive affectivity potentiates the speed and

energy of approach.

By emotion regulation, we mean the

modulation of a given emotional reaction,

including its inhibition, activation, or graded

modulation. Down- and up- regulation refer

to general reductions or increases in the acti-

vation of emotion- related neural networks.

Emotion regulation includes attentional

strategies employed through effortful con-

trol (EC), as well as the modulating effects

of other emotions and orienting. Orienting

early in life is chiefly reactive, and when

distractors are presented to infants, orient-

ing modulates the expression of the infants’

emotions (Harman, Rothbart, & Posner,

1997). Later, orienting comes more under

the control of executive attention. A purer

form of self- regulation is seen in the execu-

tive attentional processes underlying EC

that regulate reactivity (Posner & Rothbart,

2007a, 2007b).

Thus when we consider individual differ-

ences in temperament, we are dealing with

a dynamic balance between emotional ten-

dencies, and between emotions and atten-

tion. Again, it is important to recognize

that emotion regulation strategies go far

beyond temperament to reflect cognitive and

experience- dependent behavioral strategies,

although temperamental characteristics are

likely to be involved in their development

(Rueda, 2012).

Temperament and

Emotion–Motivation

Emotion, cognition, and behavior are orga-

nized around the goals of the organism

(Campos, Caplovitz, Lamb, Goldsmith, &

Temperament and Emotion Regulation 307

Stenberg, 1983; Derryberry & Rothbart,

1997). These goals have been evolutionarily

conserved in the nervous system but are fur-

ther programmed by the person’s specific

experiences, plans, and effortful actions.

Affective– motivational systems of emotion

evaluate goal- relevant situations and orga-

nize goal- appropriate behavior. Based on

a review of the literature, Derryberry and

Rothbart (1997) described temperament

systems that include emotional components.

These include systems that support defense

and fear, approach and appetitive behaviors,

and nurturance/affiliation. Here, we con-

centrate on the first two of these, the defense

and approach systems.

Defense and Approach Systems

The term defense describes a system of brain

networks that serve to avoid harm by pro-

moting organized responses to immediate

and long-term threats (Derryberry & Roth-

bart, 1997). Portions of the lateral and cen-

tral amygdala appear to be key neural struc-

tures in the functioning of this network.

Fear, anxiety, and defensive anger are emo-

tions that reflect activation of the defense

system. These emotions are related to

behavioral tendencies to inhibition or with-

drawal from active threats and avoidance of

potentially threatening situations in a flight

response. When withdrawal from severe

threats is blocked, however, the defense sys-

tem also serves to promote defensive aggres-

sion and a fight response. Systems analogous

to the defense system are common to many

psychobiological approaches to emotion,

including LeDoux’s (1989) fear system and

Gray’s behavioral inhibition system (Gray &

McNaughton, 1996; see review by Zucker-

man, 2012).

Fear and anxiety are aversive states com-

monly associated with various forms of

dysfunction and pathology in the clinical

literature (Rothbart & Posner, 2006). Con-

sequently, it might be expected that indi-

viduals exhibiting high levels of fear would

be more prone to pathology than those

exhibiting lower levels, and there is some

evidence that this is the case (Rothbart &

Bates, 2006). A psychobiological approach,

however, notes that fear and anxiety are

evolutionarily conserved to promote poten-

tially adaptive behavior when signals of dan-

ger are detected, so very low levels of fear

and anxiety can also be problematic. There

is a need for some level of fear and anxiety

to promote adaptive patterns of respond-

ing, while under- or overactivation of the

system may promote maladaptive respond-

ing. Although all negative emotions contrib-

ute to general negative affectivity or stress

proneness, we have also found it useful to

differentiate anger from fear (Rothbart,

2011; Rothbart & Bates, 2006). Anger is

positively related to the approach (Extraver-

sion/Surgency) system described next, and

it is particularly linked to the development

of externalizing problems (Rothbart, 2011;

Rothbart & Bates, 2006).

An approach system serves the goal of

resource acquisition by promoting organized

responses to potential rewards (Derryberry

& Rothbart, 1997). Dopaminergic neurons

appear to form the core of this network,

which also extends to the basolateral amgy-

dala, ventral tegmental area, and the nucleus

accumbens. Positive emotional states, such

as joy and elation, as well as feelings of eager

anticipation, are thought to reflect the broad

alterations in neurological and physiologi-

cal responding that occur in the activation

of approach. These serve to bias responding

toward positive emotion and reward acquisi-

tion, and can be seen in behavioral tendencies

to seek out and approach rewards and atten-

tional sensitivity to rewards (Derryberry

& Reed, 1994). When goals are blocked,

anger and possibly aggression may result (see

review by Deater- Deckard & Wang, 2012).

Co‑Occuring Approach

and Defense Reactions

When situations present potential reward

along with risk, both approach and defense

systems can become active and may either

cooperate or compete to influence process-

ing. In some networks, there appears to be

localized competition affecting specific cor-

tical and subcortical processes in a winner-

take-all process, in which the “stronger” sys-

tem dominates (Norman & Shallice, 1986).

However, over time, activation strength may

wax and wane, leading to an alternation of

opposing behaviors or to the appearance of

disorganized or inconsistent responding. In

our laboratory, we have seen such oppos-

ing behaviors in infants, who show abrupt

308 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

alternation between approach- related and

withdrawal- related behaviors, such as smil-

ing directly followed by distress in response

to potentially threatening stimuli.

Inhibitory influences of defense and

approach systems may not be symmetrical.

Instead, defense systems appear to have

preferential status. Observation of a norma-

tive “negativity bias” in humans and other

animal species (e.g., Ito & Cacioppo, 2005)

suggests that defense tends to dominate

approach in situations that present both

risk and reward. While the balance may be

usually skewed toward defense, this bal-

ance may not characterize every individual.

Instead, individuals will differ in the degree

to which they exhibit a negativity bias based

on temperament and life experience (Ito &

Cacioppo, 2005).

Aspects of the approach system, includ-

ing sociability, smiling and laughter, and

approaching novel objects, can be observed

by 3 months of age, and show normative

increases over the first year of life (Rothbart,

Derryberry, & Hershey, 2000). Late in the

first year, some infants also begin to demon-

strate fear and related behavioral inhibition

of approach and positive emotion in response

to unfamiliar and intense stimuli (Rothbart,

1988), and fearful inhibition shows consid-

erable longitudinal stability across child-

hood and into adolescence (Kagan & Fox,

2006). In our longitudinal research, infant

fear was assessed by inhibited approach and

negative emotion in the laboratory, and it

predicted childhood fear, sadness, and shy-

ness at 7 years of age (Rothbart et al., 2000).

Fear also predicted lower approach, impul-

sivity, and aggression. These findings sug-

gest that fear is involved in the regulation of

both approach and aggressive tendencies (as

argued by Gray & McNaughton, 1996).

More fearful infants also showed greater

empathy, guilt, and shame in childhood

(Rothbart, Ahadi, & Hershey, 1994).

These findings suggested that fear might be

involved in the early development of moral

motivation, and Kochanska (1997) has

found that temperamental fearfulness pre-

dicts conscience development in preschool-

age children. Extreme fear, on the other

hand, may lead to problems through chil-

dren’s rigid control of their own behavior,

as in Block’s (2002) description of overcon-

trolled responses that can limit children’s

positive experiences. Thus, although fear

and its component inhibition allows the first

major control system over approach, it is a

reactive one that can lack flexibility.

Other temperament emotion systems also

regulate each other. For example, affiliative-

ness is related to lower anger/aggression,

and affiliativeness is also related to higher

internalizing negative affect, including sad-

ness (Rothbart, 2011). In this chapter, how-

ever, we focus on individual differences in

developing networks of attention and emo-

tion regulation. We begin with individual

differences in orienting.

Attention and Emotion Regulation

Orienting

Much of the early life of the infant is con-

cerned with the regulation of state, includ-

ing regulation of distress (Rothbart, 2011).

Orienting, that is, the selection of informa-

tion from sensory input (Posner, 2012), is a

major mechanism for this regulation (Pos-

ner, Rothbart, Sheese, & Voelker, 2012).

Caregivers report how they use attention

to regulate the state of the infant, distract-

ing their infants by bringing their attention

to other stimuli. As infants orient, they are

often quieted, and their distress appears to

diminish.

We have studied orienting and sooth-

ing in 3- to 6-month-old infants (Harman,

Rothbart, & Posner, 1997). Infants were

first shown a sound and light display that

led to distress in about 50% of the infants.

These infants strongly oriented to interest-

ing visual and auditory soothing events

when they were presented, and during their

orienting, facial and vocal signs of dis-

tress disappeared. As soon as the orienting

stopped (e.g., when the object was removed),

however, infant distress returned to almost

exactly the level shown prior to presentation

of the distractor. An internal system, which

we termed the “distress keeper,” appeared

to hold a computation of the initial level of

distress, so that it returned if the infant’s ori-

entation to the novel event was lost. In later

studies, we found that infants could be qui-

eted by distraction for as long as 1 minute,

without changing the eventual level of dis-

tress reached once the orienting had ended

(Harman et al., 1997).

Temperament and Emotion Regulation 309

For young infants, the control of orienting

is at first largely in the hands of caregiver

presentations. By 4 months, however, infants

have gained considerable control over disen-

gaging their gaze from one visual location

and moving it to another, and greater ori-

enting skill in the laboratory has been asso-

ciated with lower parent- reported negative

emotion and greater soothability (Johnson,

Posner, & Rothbart, 1991). Sustained atten-

tion, as indexed by engagement with low-

intensity toys (blocks) at 9 months, is also

predictive of observed effortful control at

22 months (Kochanska, Murray, & Harlan,

2000). Difficulty with sustaining attention

at 9 months predicts behavioral inhibition in

toddlers and social difficulties in adolescents

(Pérez-Edgar et al., 2010), and Crockenberg,

Leerkes, & Barrig (2008) found that infants

who focused more on frustrating stimuli at 6

months of age were more aggressive as tod-

dlers.

We observed a number of changes in emo-

tion regulation in longitudinal observations

of infants between 3 and 13 months (Roth-

bart, Ziaie, & O’Boyle, 1992). Older infants

increasingly looked to their mothers dur-

ing presentation of arousing stimuli such as

masks and unpredictable mechanical toys.

Infants’ disengagement of attention from

arousing stimuli was also related to lower

levels of negative affect in the laboratory at

13 months. Stability from 10 to 13 months

was found in infants’ use of attentional dis-

engagement, mouthing, hand to mouth (e.g.,

thumb sucking), approach, and withdraw-

ing the hand, suggesting that some of the

infants’ regulatory strategies were becom-

ing habitual. Over the period from 3 to 13

months, passive self- soothing decreased

and more active approach, attack on the

object, and body self- stimulation increased.

Infants who showed the greatest distress at

3 months, however, tended to persist in an

early form of regulation, self- soothing. Once

a mechanism for emotion regulation devel-

ops, it may persist because it has brought

relief, even though more sophisticated emo-

tion regulation mechanisms are now avail-

able, an important consideration in devel-

opmental approaches to social relationships

and clinical problems (Rothbart, 2011).

Other studies have found direct links

between infants’ disengagement of atten-

tion and decreases in their concurrent nega-

tive emotion. In one study of 7-month-olds,

parent reports of infants’ orienting in daily

life were related to higher levels of positive

emotionality and lower levels of negative

emotionality (Sheese, Voelker, Posner, &

Rothbart, 2009). Early mechanisms for cop-

ing with negative emotion may also later be

transferred to the control of cognition and

behavior (Posner & Rothbart, 1998). Cor-

relations have been found, for example,

between infants’ use of regulatory strategies

in anger- inducing situations and their pre-

school ability to delay responses (Calkins &

Williford, 2003). In research by Mischel and

his colleagues (Sethi, Mischel, Aber, Shoda,

& Rodriguez, 2000), toddlers’ use of dis-

traction strategies in an arousing situation

was positively related to their later delay of

gratification at age 5.

Activation of defense or approach may

also alter orienting and the processing of

sensory information (LeDoux, 2000). Selec-

tion and attention to emotion- related stim-

uli may be critically important in situations

related to the health and well-being of the

individual. This selection process can be

viewed as involving multiple potential tar-

gets in competition for attention. Orienting

of attention can produce a bias toward one or

more of these targets, and emotion is related

to attentional bias (see review by Kanske &

Kotz, 2012). For example, more threatening

stimuli are associated with greater vigilance

in a probe detection task (Beaver, Mogg, &

Bradley, 2005), and presentation of aversive

stimuli is associated with increased interfer-

ence during mathematical problem- solving

and line detection tasks (Schimmack, 2005).

The effect of emotions on perceptual

processes varies as temperament systems

develop and differs across individuals,

reflecting each person’s pattern of tempera-

mental reactivity. In adults, negative emo-

tionality, neuroticism, and trait anxiety have

been related to biases in patterns of look-

ing to various kinds of threatening stimuli

(see review by Derryberry & Reed, 2002),

as well as to patterns of attention toward

detecting errors (Paulus, Feinsten, Simmons,

& Stein, 2004). Neuroticism has also been

linked to difficulty in disengaging attention

from sources of threat, and extraversion is

related to similar difficulties in disengag-

ing from rewarding stimuli (Derryberry &

Reed, 2002).

310 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Initial orienting to threatening or reward-

ing stimuli is often accompanied by behav-

ioral quieting and muted physiological

responding, including cardiac deceleration,

but orienting may be quickly followed by

an action phase involving behaviors such as

approach, fight, or flight that require dra-

matic changes in metabolic functioning. The

modulation of autonomic arousal in prepa-

ration for behavioral responding is another

mechanism through which defense and

approach systems can influence respond-

ing. Relevant here are changes in skin con-

ductance, heart and respiration rate, blood

pressure and patterns of blood circulation,

potentiation of the startle response, and

secretion of cortisol and catecholamines

(Bradley, Codispoti, Cuthbert, & Lang,

2001).

We now turn to attention processes under-

lying the development of EC, a flexible and

attention- based form of self- regulation of

thought, action, and emotion. We focus par-

ticularly on this topic because of its impor-

tance to behavior and emotion regulation,

its susceptibility to training, and the many

recent research advances in this area.

EC and Executive Attention

EC is defined as the ability to inhibit a domi-

nant response so as to activate a subdomi-

nant response (Rothbart & Bates, 2006). EC

initially emerged from psychometric temper-

ament research as a higher- order factor that

included lower-order scales of attentional

focusing, inhibitory control, perceptual sen-

sitivity, and low- intensity pleasure in child-

hood (Rothbart, 2011; Rothbart, Ahadi,

Hershey, & Fisher, 2001), and attentional

control, inhibitory control, and activational

control in adulthood (Evans & Rothbart,

2007). We have proposed that EC describes

individual differences in self- regulatory

capacities linked to the functioning of the

executive attention network (Posner &

Rothbart, 1998, 2007a, 2007b).

EC predicts a broad array of outcomes,

including the development of higher proso-

cial and lower antisocial behavior (Lengua

& Wachs, 2012; Rueda, 2012). The direct

regulation of negative emotional reactions,

such as anger, anxiety, or fear, represents

one avenue through which EC can influence

behavior. It has been argued that individuals

with higher EC are better able to regulate the

affective responses that promote antisocial

behavior (e.g., Kochanska et al., 2000). EC

has also been positively linked to empathy

and prosocial behavior (Rothbart & Bates,

2006), and it interacts with contextual vari-

ables to predict behaviors linked to emotion

regulation. For example, early temperament

interacts with parenting practices to predict

conscience development (Kochanska, 1997)

and psychopathology (see review in Roth-

bart, 2011).

Kochanska et al. (2000) have character-

ized the construct of EC as “situated at the

intersection of the temperament and behav-

ioral regulation literatures” (p. 220). What

does EC mean for theories of temperament

and personality? It means that contrary

to earlier theories that emphasized how

behavior is driven by positive and nega-

tive emotions or one’s level of arousal, we

are not always at the mercy of emotion and

the affective– motivational systems (Roth-

bart, 2011). Using EC, we can more flexibly

approach the situations we fear and inhibit

the actions we desire. The efficiency of EC,

however, may depend on the strength of the

emotional processes against which effort is

exerted. For example, when a child must

delay an approach to an appealing toy, the

child with a stronger disposition to approach

is likely to require greater EC to succeed.

EC is also involved in the inhibition

of immediate approach, with the goal of

attaining a larger reward later, as in delay

of gratification research (Shoda, Mischel, &

Peak, 1990), and in Block’s (2002) hedonism

of the future. EC also allows activation of

behavior that would otherwise not be per-

formed, letting one act “on principle” when

the principle opposes one’s otherwise domi-

nant response. EC is not itself a basic moti-

vation; rather, it provides the means to effec-

tively satisfy desired ends. It resembles the

attentional capacities that underlie Block’s

(2002) construct of ego resiliency, that is,

the ability to shift one’s level of control flex-

ibly depending on requirements of the situ-

ation.

There is substantial evidence that during

childhood EC, as measured bytemperament

questionnaires, is correlated with the ability

to resolve conflict in many cognitive tasks

Temperament and Emotion Regulation 311

(Rothbart, 2011; Rueda, 2012). This pro-

vides an opportunity to examine the brain

systems that are related to both conflict res-

olution and EC.

The Executive Attention Network

Posner and colleagues have identified three

brain networks that serve different functions

of attention and have different neural anato-

mies and neuromodulators (Posner, 2012).

The first two networks involve alerting and

orienting, respectively. The third, the execu-

tive attention network, which functions to

monitor and resolve conflict, involves the

anterior cingulate cortex (ACC), anterior

insula, and basal ganglia. Dorsal areas of the

cingulate have been implicated in the regula-

tion of cognitive processing, while more ven-

tral areas have been implicated in emotional

processing (Bush, Luu, & Posner, 2000). In

more recent research, individual differences

in the functioning of the executive attention

network have been theoretically and empiri-

cally linked to the temperament construct of

EC (Chang & Burns, 2005; Posner, 2012;

Rothbart, 2011).

According to one theory, executive atten-

tion, and the ACC in particular, is involved

primarily in the monitoring of conflict

between potentially competing systems

(Botvinick, Braver, Barch, Carter, & Cohen,

2001) whereas the prefrontal cortex, partic-

ularly on the right side, is involved in inhibi-

tion of competing systems (see review by Pos-

ner, 2012). This division of labor between

the ACC and the prefrontal cortex may not

be the full story, but these ideas suggest com-

plementary associations between the ACC

and prefrontal cortex in self- regulation.

The ACC, one of the main nodes of the

executive attention network, has been linked

to specific functions related to self- regulation

(see reviews by Posner, 2012; Rueda, 2012).

These include the monitoring of conflict,

control of working memory, regulation of

emotion, and response to error. In emotion

studies, the cingulate is often seen as part of

a network involving the orbitofrontal cortex

and amygdala that regulates our emotional

response to input. Activation of the ACC is

observed when people are asked to control

their reactions to strong positive (Beaure-

gard, Levesque, & Bourgouin, 2001) and

negative emotions (Ochsner, Bunge, Gross,

& Gabrieli, 2002).

As noted previously, dorsal areas of the

cingulate have been implicated in regulating

cognitive processing and more ventral areas

in emotional processing (Bush et al., 2000).

The portion of the ACC related to emotion

regulation has a very high level of tonic

activity, even at rest. This activity, together

with the widespread connectivity of the cin-

gulate to other brain areas, may be related

to the need to maintain emotional control

even when one is not performing any spe-

cific task. There is also some evidence of an

inhibitory interaction between the more ven-

tral emotion regulation part of the ACC and

the more dorsal areas related to cognitive

control (Drevets & Raichle, 1998).

ACC activation in response to perceived

errors has been reported in infants as young

as 7 months of age (Berger, Tzur, & Pos-

ner, 2006). Adults show ACC activation

and usually slow down following an error.

However, in a study using a Simple Simon

task, we found that slowing down follow-

ing an error did not arise until children were

between 39 and 41 months of age (Jones,

Rothbart, & Posner, 2003). We believe that

the difference between infants who detect

the error and children who modify action

based on the error involves the change in

connectivity of the ACC to other brain

structures that takes place during child-

hood (Fair et al., 2009; Gao et al., 2009).

The connectivity hypothesis may also have

implications for other issues in develop-

ment, for example, the observation that

fear is shown in distress reactions before it

is linked to behavioral inhibition (Rothbart

et al., 2000). Further research is needed to

relate connectivity to behavioral changes

such as slowing.

One assessment of executive attention in

early childhood is the spatial conflict task,

in which object identity and spatial loca-

tion of a stimulus are placed in conflict

(Gerardi- Caulton, 2000). Here the child

has two response keys, labeled with pictures

of stimuli. Stimuli are presented on a com-

puter screen, and the child is instructed to

press the key corresponding to the picture

presented. Conflict trials are those in which

the stimulus appears on the side opposite the

correct key.

312 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Between 30 and 36 months of age, chil-

dren learn to perform this task, which

requires inhibiting the dominant response

toward a spatial location in order to make

a response based on matching identity

(Gerardi- Caulton, 2000; Rothbart, Ellis,

Rueda, & Posner, 2003). At 24 months,

children are only able to carry out this task

when the stimulus is on the same side of the

computer screen as the matching response

key (the congruent condition), but by 30

months, most children can handle incongru-

ent trials in which the matching target is on

the opposite side of the stimulus, although

they are greatly slowed in conflict trials

(adults are also slowed in this condition).

Children with higher levels of perfor-

mance on spatial conflict have also been

reported by their parents as having higher

levels of EC and lower levels of negative

emotionality on the Children’s Behavior

Questionnaire (CBQ; Rothbart et al., 2001,

2003). Two-year-old children who could not

complete the spatial conflict task were also

described by their parents as having lower

EC and higher negative emotionality. These

findings are consistent with the idea that the

capacity to engage in rule-based action in

conflict situations can support responding

to social rules and regulation of emotion in

daily life.

Another important conflict task is the

Attention Networks Task (ANT), which

measures efficiency of the alerting, orient-

ing, and executive attention networks. In the

ANT flanker task, the response to a target is

in conflict with surrounding flanker stimuli

(Rueda et al., 2004). Both spatial conflict

and flanker tasks have been linked in imag-

ing studies to the functioning of the brain’s

executive attention network (Fan, Flom-

baum, McCandliss, Thomas, & Posner,

2003) and have been used as model tasks

for assessing the functioning of this net-

work (Posner, 2012). Using the Child ANT

(Rueda et al., 2004), significant improve-

ment in conflict resolution has been found

up until age 7, but a remarkable similarity in

both reaction time and accuracy was found

from the age of 7 to adulthood.

Throughout childhood, ANT perfor-

mance is related to EC performance (Roth-

bart, 2011; Rueda, 2012), and adults high

in EC show lower conflict scores and lower

negative emotion (Rothbart, 2011). In ado-

lescents and adults, performance on the

ANT has also been linked to a number of

psychopathologies (see review by Posner,

2012). These studies illustrate the close rela-

tion between attention, EC, and emotion

regulation throughout life.

EC in Childhood

Evidence for stability of EC has been found

in research by Mischel and his colleagues

(Shoda et al., 1990). Preschoolers were tested

on their ability to wait for a delayed treat

that was larger than a readily accessible one.

Children better able to delay gratification

were found to have better self- control and

greater ability to regulate reactions to stress

and frustration. Their delay of gratification

in seconds also predicted parent- reported

attentiveness, concentration, emotion regu-

lation, and intelligence during adolescence.

In follow- up studies when the participants

were in their 30s, preschool delay predicted

goal- setting and self- regulatory abilities

(Ayduk et al., 2000), suggesting remarkable

continuity in self- regulatory skills.

Some of the complexity of this continuity

in self- regulation is reflected in longitudi-

nal studies of genetic contributions to early

development. There is substantial evidence

in adult studies that genetic alleles in the

dopamine system are related to executive

attention (Posner, 2012). One of these genes,

the dopamine 4 receptor gene, was found to

influence sensation seeking behavior as early

as 18–20 months in interaction with the qual-

ity of parenting (Sheese, Voelker, Rothbart,

& Posner, 2007). When the 7-repeat allele

was present, relatively low- quality parenting

produced higher sensation- seeking ratings,

but when the 7-repeat was absent, sensa-

tion seeking was moderate or low, regard-

less of parenting quality. The remarkable

susceptibility of children with the 7-repeat

allele to parental and other environmental

influences has been replicated multiple times

(e.g., Belsky & Pluess, 2009). We did not

see any relation of this gene to EC at 18–20

months (Sheese et al., 2007), but by 4 years

there was a gene × parenting quality inter-

action in which EC ratings of children with

the 7-repeat were more positively influenced

by parenting quality than children without

Temperament and Emotion Regulation 313

the 7-repeat (Sheese, Voelker, Rothbart &

Posner, 2012). Adult studies have also indi-

cated that people with the 7-repeat allele are

more influenced by their environment than

those without it (Larsen et al., 2010). Thus,

there appears to be an underlying continu-

ity of genetic influence even though neural

networks may be changing in their connec-

tivity.

EC plays an important role in the develop-

ment of conscience, with greater internalized

conscience in children high in EC (Kochan-

ska et al., 2000). Both the reactive tempera-

mental control system of fearful inhibition

and the attention- based system of EC appear

to regulate the development of socialized

thought and behavior, with the influence of

fear found earlier in development. We have

found that 6- to 7-year-old children who

were high in EC were also high in empathy

and guilt/shame, and low in aggressiveness

(Rothbart et al., 1994). EC may support

empathy by allowing children to attend to

another child’s condition instead of focus-

ing only on their own sympathetic distress.

Eisenberg, Fabes, Nyman, Bernzweig, and

Pinulas (1994) found that 4- to 6-year-old

boys with good attentional control tended to

deal with anger by using nonhostile verbal

methods rather than overt aggression.

During the toddler and preschool years,

development of the executive attention net-

work underlying EC allows children greater

control of stimulation and response, includ-

ing the ability to select responses in a con-

flict situation. Aksan and Kochanska (2004)

found that children who were more fearful

and inhibited at 33 months showed more

volitional inhibitory control at 45 months.

They suggest that more fearful and inhibited

children have a greater opportunity to foster

their own self- control during their periods

of slow approach to novel situations.

Attention and Emotion Regulation

We now consider contributions of execu-

tive attention to emotion regulation via dis-

traction, suppression, and reappraisal. In

the section on orienting we described how

defense and approach systems monitor for

goal- relevant stimuli and, once activated,

bias orienting toward some targets. Levels

of emotional activation are thus maintained

or increased until something occurs to inter-

rupt the cycle. One way to interrupt the

cycle is to perform actions that remove the

stimulus or make it less relevant. For exam-

ple, if a person is afraid of heights, visual

cues indicating precipitous drops may initi-

ate a cycle of anxiety and fear. One way to

interrupt this cycle is to back away from the

ledge. If such an action is not available or

is undesirable, a second approach is to “not

look down.” Information reception can thus

be controlled to reduce the activation of the

system. This kind of regulation can also be

applied to the approach system. Just as one

can look away from things that are feared,

one can also look away from things that are

desired. Consistent with this hypothesis,

children who are most able to resist temp-

tation are those most likely to orient away

from desired stimuli while waiting for them

(e.g., Sethi et al., 2000).

Regulation of orienting may not always

be sufficient to manage emotional reactions.

Not looking at a cookie may reduce the

probability we will eat it, but even when we

are not looking at it, we still know it is there.

Conceptual processing and memory allow us

to maintain an internal representation of the

stimulus over time. Internal representations

may be just as effective, or even more so, in

triggering and maintaining the activation of

affective systems. Consequently, regulating

internal representations becomes an impor-

tant avenue for the regulation of emotional

responding. Executive attention has been

related to regulation of inappropriate cogni-

tions, as in the Stroop effect (Posner, 2012),

and similar mechanisms are likely involved

in emotional regulation.

The same general network involved in

control of emotions is active during the

manipulation of internal representations,

such as generating word associations (Pos-

ner & Raichle, 1994). Because working

memory is finite, focusing attention on other

representations may lead to the exclusion of

“unwanted” representations. The execu-

tive attention system serves to monitor and

resolve conflict among brain networks and

may facilitate the manipulation of internal

representations by allowing for the selection

of one representation over another. We can

thus attempt to control emotional respond-

ing by literally thinking about other things,

314 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

a process that has been referred to as dis-

traction. However, as an emotion regulation

strategy, distraction may have limited util-

ity and ultimately adverse long-term conse-

quences (Gross, this volume).

Research on sensory systems has shown

that attention can work by increasing acti-

vation in an attended sensory system, as well

as by reducing or suppressing activation of

other systems (Posner & Raichle, 1994). To

date, the upregulation of emotions has not

been commonly addressed in either theoreti-

cal treatments or empirical studies of emo-

tion regulation, although Kieras, Tobin,

Graziano, and Rothbart (2005) have found

that children higher in EC skills are more

likely to be able to smile at the presenta-

tion of a disappointing gift, and laboratory

research has linked high executive attention

on the Child ANT to smiling in this para-

digm (Rothbart et al., 2003). It seems likely

that, as in orienting to sensory systems, the

ability to smile in the face of disappointment

involves both activation of smiling and the

suppression of the emotion related to the

disappointing gift.

Links have also been found between the

executive attention network and another

strategy for altering representations to pro-

mote emotion regulation, reappraisal, which

involves reinterpreting the meaning or value

of a representation (Gross, 2002). Ochsner

et al. (2002) found that reappraisal led to

reduced activity in the amgydala, suggest-

ing that reappraisal changes emotion- related

processing. Subsequent research has indi-

cated that prefrontal and anterior cingu-

late regions are involved in the modulation

of emotion processing through reappraisal

(Ochsner et al., 2004). In some studies the

orbitofrontal area that lies adjacent to the

ACC seems to account for the major differ-

ence in brain activity found between dis-

traction and reappraisal (Kanske, Heissler,

Schönfelder, Bongers, & Wessa, 2011).

Reappraisal may thus be another mecha-

nism through which the executive attention

system regulates affective systems, in that

it involves a competition among alterna-

tive internal representations. The executive

attention system facilitates the selection of

a secondary representation over the prepo-

tent representation (Posner, 2012). Recent

studies of depressed patients have found

that emotion regulation through reappraisal

does not result in the same reduction in

amygdala activity in patients as in normal

participants. However, distraction worked

similarly in both groups (Kanske, Heissler,

Schönfelder, & Wessa, 2012).

Controlling attentional orienting, exclud-

ing prepotent representations, and reinter-

pretation are strategies for reducing activa-

tion of reactive systems by altering overt or

internal input into those systems. A differ-

ent avenue for regulation concerns altering

output of the reactive systems. Bidirectional

links between the affective– motivational

systems and areas of output, such as the

autonomic system, allow for feedback loops

that can maintain emotional states (Tang &

Posner, 2009). The executive attention sys-

tem may enable efforts to modulate different

aspects of physiological arousal, including

both up- regulation and down- regulation.

Direct manipulation of aspects of physio-

logical arousal that may be under conscious

control, such as changes in rates of respira-

tion and body muscle tension, is one pos-

sibility. Evidence from imaging studies and

animal models indicates that the ACC plays

a substantial role in the modulation of auto-

nomic reactivity in response to situational

demands (e.g., Critchley et al., 2003).

So far, we have primarily considered

emotion regulation in terms of reduction of

activation. The defense and approach sys-

tems motivate adaptive behavior by induc-

ing emotional states, while the executive

attention system allows for the suppres-

sion of these reactive systems. However, it

is important to note that the same mecha-

nisms through which the executive attention

system produces reductions in activation of

reactive systems can also be used to produce

increases in activation. If we want to induce

an affective state, we can consciously shift

attention to the appropriate affect- inducing

stimuli, recall affect- inducing representa-

tions, or reinterpret neutral representa-

tions to promote affective responses. The

executive attention system may also allow

us to elicit emotional responses by increas-

ing physiological arousal or by produc-

ing behaviors that are consistent with the

desired emotional state.

Since the executive attention network is

important in emotional control, an obvious

question is whether intervention during pre-

school or later can improve the functioning

Temperament and Emotion Regulation 315

of this network and thus alter the ability to

regulate emotion. We now describe efforts

to improve executive attention through

training.

Training Executive Attention

There may be two quite different ways to

train attention (Tang & Posner, 2009). One

involves training by exercising a particular

attention network, and the other, a change

in brain state through meditation or related

procedures. We have examined training of

the executive attention system in children

ages 4–6 years (Rueda, Rothbart, McCan-

dliss, Saccomanno, & Posner, 2005). The

programs we have used were adapted from

those used to train monkeys for space flight

(Rumbaugh & Washburn, 1995). They

involve first training the child to use a joy-

stick to place a cat on grass rather than on

mud. As training proceeds, the grass shrinks

and control becomes more difficult; these

skills are further built on to train anticipa-

tion, improve memory, and exercise the abil-

ity to resolve conflict (Rueda et al., 2005).

Both 4- and 6-year-olds showed greater

improvements in the brain networks related

to executive attention after 5 days of com-

puter training than a control group that

interacted with videos (Rueda et al., 2005).

The group taking attention training also

showed improved IQ scores. A replication

and extension of this study to 10 days of

training was carried out in a Spanish pre-

school (see review in Rueda, 2012). In addi-

tion to replicating previous work, attention

training in this study improved children’s

emotion regulation and self- control, includ-

ing their performance on delay of reward

and children’s gambling tasks. A number

of other methods used in classroom stud-

ies have also been effective in enhancing the

development of executive attention; they are

helpful to children with and without prob-

lems in attention (see Diamond & Lee, 2011,

for a summary).

Studies of mindfulness meditation have

also reported improvements of adults on

the conflict measure of the ANT and more

positive mood after only 5 days of training

in comparison with a control group given

relaxation training (Tang et al., 2007). After

5 days of training, stress levels, as measured

by cortisol secretion, were reduced follow-

ing a cognitive challenge of mental arithme-

tic. After 30 days of training, cortisol levels

were lower even at baseline, suggesting that

the meditation group members experienced

reduced stress in their daily life to a greater

degree than those without this training

(Tang et al., 2007). The mechanism of these

changes appears to be in alterations of the

activation and connectivity of the ACC to

other brain areas (Tang, Lu, Fan, Yang, &

Posner, 2012).

Issues in Temperament Assessment

In temperament studies involving emotion

regulation it has been common to consider

only individual differences in components of

reactive temperament, without considering

either regulatory aspects of temperament,

such as EC, or the interactions between

these components. Studies focusing on only

single traits or looking only at main effects

may be missing important opportunities for

understanding the dynamic contribution of

temperament to outcomes. Research sup-

ports the importance of considering inter-

actions among dimensions of temperament

in predicting external criteria. For example,

Gunnar, Sebanc, Tout, Donzella, and van

Dulmen (2003) found that high levels of sur-

gency (approach) combined with low levels

of EC were associated with higher cortisol

levels and higher peer rejection in childhood

(see reviews by Rothbart, 2011; Rothbart &

Bates, 2006).

It is also important to note that depend-

ing on context, the systems may either act

relatively independently, in direct competi-

tion, or complement one another. Without

considering the person’s goals, it is difficult

to predict his or her particular reactions a

priori. For example, considering fearfulness

in terms of the defense system emphasizes

that the network serves not only to inhibit

behavior in some circumstances but also to

motivate avoidance or attack. In contrast,

EC, considered as an index of individual

differences in the functioning of the execu-

tive attention system, serves to inhibit and

facilitate processing in diverse cognitive and

affective networks, with the goal of modu-

lating prepotent responses. Sometimes, the

goals of the defense and executive atten-

tion systems may agree. In these instances

316 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

we would expect both temperamental fear-

fulness and EC to contribute to predicting

an outcome (e.g., following directions dur-

ing a fire drill). In other circumstances the

goals of the systems may be at odds, and we

would expect behavioral outcomes to reflect

an interaction between the two systems (e.g.,

jumping out of an airplane).

The approach adopted here also suggests

that it is important to consider how each

system contributes to a given temperament

assessment. When we bring a child into the

laboratory and attempt to assess EC using a

variety of game-like tasks, task performance

reflects dynamic interactions among several

systems, not just EC. The approach sys-

tem may respond to engaging activities and

rewards; the defense system may respond to

the novelty of the laboratory, the procedures,

and the experimenters. Finally, the executive

attention system contributes to task per-

formance, and also to keeping emotional

responses in line with the parent’s, experi-

menter’s, and personal expectations. We can

try to get direct assessments of one aspect of

temperament, but outcomes almost always

reflect a mix of reactive and regulatory pro-

cesses. For example, Laptook, Klein, Olino,

Dyson, and Carlson (2010) showed that

children displaying the same low approach/

engagement could be differentiated into chil-

dren with low positive affect and children

with high behavioral inhibition.

Inhibitory control tasks, commonly

employed in behavioral assessments of EC,

present an interesting example of how even

basic assessments may potentially tap into

multiple temperament systems. Assessments

such as the day–night Stroop task focus

on assessing the inhibition of prepotent

responses. However, to perform this task

successfully, children must also sit still, fol-

low instructions, attend to the stimuli, and

activate nonprepotent responses; motivation

to perform the task is also important (Hui-

zenga, van der Molen, Bexkens, Bos, & van

den Wildenbeg, 2012).

Even in the absence of overt feedback or

reward from the experimenter, we might

expect participants’ reactive responses to

vary in the performance of these tasks. Con-

sistent with this idea, Wolfe and Bell (2004)

found that while parent- reported inhibitory

control was a significant predictor of perfor-

mance on inhibitory control laboratory tasks

(r = .36), parent- reported approach/anticipa-

tion was a better predictor (r = –.56). Thus,

while inhibitory control may be properly

considered a facet of EC, inhibitory control

measures may reflect an interaction between

the approach and the executive attention

systems.

Dynamic interaction between brain

areas is also found in imaging studies when

increases in activation of the ACC are accom-

panied by reduced activity in the amygdala

during control of negative emotion (Etkin,

Egner, Peraza, Kandel, & Hirsch, 2006). In

patient populations such as those suffering

from borderline personality disorder (Gold-

stein et al., 2007) or depression (Kanske &

Kotz, 2012), this interaction is disrupted.

This dynamic view of interacting systems

suggests that single- method assessments of

temperament may be problematic. When

possible, researchers should employ batter-

ies of differentiated assessments in which the

common feature is the temperament charac-

teristic of interest. Multimethod assessment

procedures are further complemented when

multiple temperament traits are assessed

(e.g., in questionnaires), particularly when

reactive and regulatory components of tem-

perament are being examined. A multitrait

approach allows us to better assess individ-

ual differences in regulation by controlling

for individual differences in reactivity, and

vice versa.

Future Directions

We suggest that our understanding of emo-

tion regulation will be advanced if we con-

ceptualize temperament constructs in terms

of affective– motivational and attentional

systems, study these systems at multiple lev-

els, including the level of neural networks,

and consider dynamic interactions among

these systems. Considering emotional reac-

tivity and emotion regulation as core compo-

nents of temperament represents a first step

toward a more dynamic, process- oriented

view. The second step leads to considering

reactive and regulative components of tem-

perament together rather than in isolation.

Linking temperament to the study of emo-

tion and emotion regulation also provides

temperament researchers with a rich empiri-

cal base for generating models of tempera-

Temperament and Emotion Regulation 317

ment development, such as models of the

development of social interaction and the

development of coping strategies (Rothbart,

2011). Advances in understanding the basic

processes in emotional reactivity and emo-

tion regulation should inform and enrich

research on temperament. At the same time,

research on temperament offers a unique

perspective for examining emotion and emo-

tion regulation.

References

Aksan, N., & Kochanska, G. (2004). Links

between systems of inhibition from infancy

to preschool years. Child Development, 75,

1477–1490.

Allport, G. W. (1937). Personality: A psychologi-

cal interpretation. Oxford, UK: Holt.

Ayduk, O., Mendoza- Denton, R., Mischel, W.,

Downey, G., Peake, P., & Rodriguez, M.

(2000). Regulating the interpersonal self: Stra-

tegic self- regulation for coping with rejection

sensitivity. Journal of Personality and Social

Psychology, 79, 776–792.

Beauregard, M., Levesque, J., & Bourgouin, P.

(2001). Neural correlates of conscious self-

regulation of emotion. Journal of Neurosci-

ence, 21(RC165), 1–6.

Beaver, J. D., Mogg, K., & Bradley, B. P. (2005).

Emotional conditioning to masked stimuli and

modulation of visuospatial attention. Emo-

tion, 5, 67–79.

Belsky, J., & Pluess, M. (2009). Beyond diathesis

stress: Differential susceptibility to environ-

mental stress. Psychological Bulletin, 135,

895–908.

Berger, A., Tzur, G., & Posner, M. I. (2006).

Infant brains detect arithmetic error. Proceed-

ing of the National Academy of Sciences USA,

103, 12649–12653.

Block, J. (2002). Personality as an affect-

processing system: Toward an integrative the-

ory. Mahwah, NJ: Erlbaum.

Botvinick, M. M., Braver, T. S., Barch, D. M.,

Carter, C. S., & Cohen, J. D. (2001). Conflict

monitoring and cognitive control. Psychologi-

cal Review, 108, 624–652.

Bradley, M. M., Codispoti, M., Cuthbert, B. N.,

& Lang, P. J. (2001). Emotion and motivation

I: Defense and appetitive reactions in picture

processing. Emotion, 1, 276–299.

Bush, G., Luu, P., & Posner, M. I. (2000). Cogni-

tive and emotional influences in anterior cin-

gulate cortex. Trends in Cognitive Sciences, 4,

215–222.

Calkins, S. D., & Williford, A. P. (2003, April).

Anger regulation in infancy: Consequences

and correlates. Paper presented at the meeting

of the Society for Research in Child Develop-

ment, Tampa, FL.

Campos, J. J., Caplovitz, B. K., Lamb, M. E.,

Goldsmith, H. H., & Stenberg, C. (1983).

Socioemotional development. In P. H. Mussen,

M. M. Haith, & J. J. Campos (Eds.), Hand-

book of child psychology (Vol. 2, pp. 783–

915). New York: Wiley.

Chang, F., & Burns, B. M. (2005). Attention in

preschoolers: Associations with effortful con-

trol and motivation. Child Development, 76,

247–263.

Critchley, H. D., Mathias, C. J., Josephs, O.,

O’Doherty, J., Zanini, S., Dewar, B. K., et

al. (2003). Human cingulate cortex and auto-

nomic control: Converging neuroimaging and

clinical evidence. Brain, 126, 2139–2152.

Crockenberg, S. C., Leerkes, E. M. J., & Barrig,

P. S. (2008). Predicting aggressive behavior

in the third year from infant reactivity and

regulation as moderated by maternal behav-

ior. Development and Psychopathology, 20,

37–54.

Deater- Deckard, K., & Wang, Z. (2012). Anger

and irritability. In M. Zentner & R. L. Shiner

(Eds.), Handbook of temperament (pp. 124–

144). New York: Guilford Press.

Derryberry, D., & Reed, M. A. (1994). Tem-

perament and attention: Orienting toward and

away from positive and negative signals. Jour-

nal of Personality and Social Psychology, 66,

1128–1139.

Derryberry, D., & Reed, M. A. (2002). Anxiety-

related attentional biases and their regulation

by attentional control. Journal of Abnormal

Psychology, 111, 225–236.

Derryberry, D., & Rothbart, M. K. (1997). Reac-

tive and effortful processes in the organization

of temperament. Developmental Psychopa-

thology, 9, 633–652.

Diamond, A., & Lee, K. (2011). Interventions

shown to aid Executive Function develop-

ment in children 4–12 years old. Science, 333,

959–964.

Drevets, W. C., & Raichle, M. E. (1998). Recip-

rocal suppression of regional cerebral blood

flow during emotional versus higher cogni-

tive processes: Implications for interactions

between emotion and cognition. Cognition

and Emotion, 12, 353–285.

318 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Eisenberg, N., Fabes, R. A., Nyman, M., Bern-

zweig, J., & Pinulas, A. (1994). The relations

of emotionality and regulation to children’s

anger-

related reactions. Child Development,

65, 109–128.

Etkin, A., Egner, T., Peraza, D. M., Kandel, E.

R., & Hirsch, J. (2006). Resolving emotional

conflict: A role for the rostral anterior cingu-

late cortex in modulating activity in the amyg-

dala. Neuron, 51, 871–882.

Evans, D., & Rothbart, M. K. (2007). Develop-

ing a model for adult temperament. Journal of

Research in Personality, 41, 868–888.

Fair, D. A., Cohen, A. L., Power, J. D., Dosen-

bach, N. U. F., Church, J. A., Miezin, F. M., et

al. (2009). Functional brain networks develop

from a local to distributed organization. PLoS

Computational Biology, 5, e1000381.

Fan, J., Flombaum, J. I., McCandliss, B. D.,

Thomas, K. M., & Posner, M. I. (2003). Cog-

nitive and brain consequences of conflict.

NeuroImage, 18, 42–57.

Gao, W., Zhu, H., Giovanello, K. S., Smith, J.

K., Shen, D., Gilmore, J. H., et al. (2009).

Evidence on the emergence of the brain’s

default network from 2-week-old to 2-year-

old healthy pediatric subjects. Proceedings of

the National Academy of Sciences USA, 106,

6790–6795.

Gerardi-

aulton, G. (2000). Sensitivity to spatial

conflict and the development of self-

egulation

in children 24–36 months of age. Develop-

mental Science, 3, 397–404.

Goldstein, M., Brendel, G., Tuescheer, O., Pan,

H., Epstein, J., Beutel, M., et al. (2007). Neu-

ral substrates of the interaction of emotional

stimulus process and motor inhibitory control:

An emotional linguistic go/no-go fMRI study.

NeuroImage, 36, 1026–1040.

Gray, J. A., & McNaughton, N. (1996). The

neuropsychology of anxiety: Reprise.

Nebraska Symposium on Motivation, Per-

spectives on anxiety, panic and fear. Vol. 38,

pp.

61–134.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39, 281–291.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp.

3–20). New York:

Guilford Press.

Gunnar, M. R., Sebanc, A. M., Tout, K., Don-

zella, B., & van Dulmen, M. M. (2003). Peer

rejection, temperament, and cortisol activity

in preschoolers. Developmental Psychobiol-

ogy, 43, 346–358.

Harman, C., Rothbart, M. K., & Posner, M. I.

(1997). Distress and attention interactions in

early infancy. Motivation and Emotion, 21,

27–43.

Huizenga, H. M., van der Molen, M. W.,

Bexkens, A., Bos, M. G., & van den Wilden-

berg, W. P. (2012). Muscle or motivation?: A

stop-

ignal study on the effects of sequential

cognitive control. Frontiers in Cognition, 3.

[E-publication prior to print]

Ito, T. A., & Cacioppo, J. T. (2005). Variations

on a human universal: Individual differences

in positivity offset and negativity bias. Cogni-

tion and Emotion, 19, 1–26.

Johnson, M. H., Posner, M. I., & Rothbart, M.

K. (1991). Components of visual orienting in

early infancy: Contingency learning, antici-

patory looking, and disengaging. Journal of

Cognitive Neuroscience, 3, 335–344.

Jones, L. B., Rothbart, M. K., & Posner, M. I.

(2003). Development of executive attention in

preschool children. Developmental Science, 6,

498–504.

Kagan, J., & Fox, N. A. (2006). Biology, culture,

and temperamental biases. In W. Damon & N.

Eisenberg (Eds.), Handbook of child psychol-

ogy: Vol. 3. Social, emotional and personal-

ity development (6th ed., pp. 167–225). New

York: Wiley.

Kanske, P., Heissler, J., Schönfelder, S., Bongers,

A., & Wessa, M. (2011). How to regulate emo-

tion?: Neural networks for reappraisal and

distraction. Cerebral Cortex, 21, 1379–1388.

Kanske, P., Heissler, J., Schönfelder, S., & Wessa,

M. (2012). Neural correlates of emotion reg-

ulation deficits in remitted depression: The

influence of regulation strategy, habitual regu-

lation use, and emotional valence. NeuroIm-

age, 61, 686–693.

Kanske, P., & Kotz, S. A. (2012). Effortful con-

trol, depression, and anxiety correlate with the

influence of emotion on executive attentional

control. Biological Psychology, 91, 88–95.

Kieras, J. E., Tobin, R. M., Graziano, W. G.,

& Rothbart, M. K. (2005). You can’t always

get what you want: Effortful control and chil-

dren’s responses to undesirable gifts. Psycho-

logical Science, 16, 391–396.

Kochanska, G. (1997). Multiple pathways to

conscience for children with different temper-

aments: From toddlerhood to age 5. Develop-

mental Psychology, 33, 228–240.

Kochanska, G., Murray, K. T., & Harlan, E. T.

Temperament and Emotion Regulation 319

(2000). Effortful control in early childhood:

Continuity and change, antecedents, and

implications for social development. Develop-

mental Psychology, 36, 220–232.

Laptook, R. S., Klein, D. N., Olino, T. M.,

Dyson, M. W., & Carlson, G. (2010). Low

positive affectivity and behavioral inhibition

in preschool- age children: A replication and

extension of previous findings. Personality

and Individual Differences, 48, 547–551.

Larsen, H., van der Zwaluw, C. S., Overbeek, G.,

Granic, I., Franke, B., & Engels, R. C. (2010).

A variable- number- of- tandem- repeats poly-

morphism in the dopamine D4 receptor gene

affects social adaptation of alcohol use: Inves-

tigation of a gene– environment interaction.

Psychological Science, 21, 1064–1068.

LeDoux, J. E. (1989). Cognitive– emotional inter-

actions in the brain. Cognition and Emotion,

3, 267–289.

LeDoux, J. E. (2000). Emotion circuits in the

brain. Annual Review of Neuroscience, 23,

155–184.

Lengua, L. J., & Wachs, T. D. (2012). Tem-

perament and risk: Resilient and vulnerable

responses to adversity. In M. Zentner & R.

L. Shiner (Eds.), Handbook of temperament

(pp. 519–540). New York: Guilford Press.

McCrae, R. R., Costa, P. T., Jr., Ostendorf, F.,

Angleitner, A., Hrebícková, M., Avia, M. D.,

et al. (2000). Nature over nurture: Tempera-

ment, personality, and life span development.

Journal of Personality and Social Psychology,

78, 173–186.

Norman, D. A., & Shallice, T. (1986). Atten-

tion to action: Willed and automatic control

of behavior. In G. E. Schwartz & D. Shap-

iro (Eds.), Consciousness and self- regulation

(Vol. 4, pp. 1–18). New York: Plenum.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. E. (2002). Rethinking feelings:

An FMRI study of the cognitive regulation of

emotion. Journal of Cognitive Neuroscience,

14, 1215–1229.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D., et al.

(2004). For better or for worse: Neural sys-

tems supporting the cognitive down- and up-

regulation of negative emotion. NeuroImage,

23, 483– 499.

Paulus, M. P., Feinstein, J. S., Simmons, A., &

Stein, M. B. (2004). Anterior cingulate activa-

tion in high trait anxious subjects is related to

altered error processing during decision mak-

ing. Biological Psychiatry, 55, 1179–1187.

Pérez-Edgar, K., McDermott, J. N. M., Korelitz,

K., Degnan, K. A., Curby, T. W., Pine, D. S.,

et al. (2010). Patterns of sustained attention

in infancy shape the developmental trajectory

of social behavior from toddlerhood through

adolescence. Developmental Psychology, 46,

1723–1730.

Posner, M. I. (2012). Attention in a social world.

New York: Oxford University Press.

Posner, M. I., & Raichle, M. E. (1994). Images

of mind. New York: Scientific American

Library.

Posner, M. I., & Rothbart, M. K. (1998). Atten-

tion, self- regulation and consciousness. Philo-

sophical Transactions of the Royal Society of

London B, 353, 1915–1927.

Posner, M. I., & Rothbart, M. K. (2007a). Edu-

cating the human brain. Washington, DC:

American Psychological Association Books.

Posner, M. I., & Rothbart, M. K. (2007b).

Research on attentional networks as a model

for the integration of psychological science.

Annual Review of Psychology, 58, 1–23.

Posner, M. I., Rothbart, M. K. Sheese, B. E., &

Voelker, P. (2012). Control networks and neu-

romodulators in early development. Develop-

mental Psychology, 48, 827–835.

Putnam, S. P., Ellis, L. K., & Rothbart, M. K.

(2001). The structure of temperament from

infancy through adolescence. In A. Eliasz &

A. Angleitner (Eds.), Advances in research on

temperament (pp. 165–182). Lengerich, Ger-

many: Pabst Science.

Rothbart, M. K. (2011). Becoming who we are:

Temperament and personality in develop-

ment. New York: Guilford Press.

Rothbart, M. K. (1988). Temperament and the

development of inhibited approach. Child

Development, 59, 1241–1250.

Rothbart, M. K., Ahadi, S. A., & Hershey, K.

L. (1994). Temperament and social behavior

in childhood. Merrill–Palmer Quarterly, 40,

21–39.

Rothbart, M. K., Ahadi, S. A., Hershey, K. L.,

& Fisher, P. (2001). Investigations of tempera-

ment at three to seven years: The children’s

behavior questionnaire. Child Development,

72, 1394–1408.

Rothbart, M. K., & Bates, J. E. (2006). Tem-

perament in children’s development. In W.

Damon, R. Lerner, & N. Eisenberg (Eds.),

Handbook of child psychology: Vol 3. Social,

emotional, and personality development (6th

ed., pp. 99–166). New York: Wiley.

Rothbart, M. K., & Derryberry, D. (1981). Devel-

320 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

opment of individual differences in tempera-

ment. In M. E. Lamb & A. L. Brown (Eds.),

Advances in developmental psychology (Vol.

1, pp. 37–86). Hillsdale, NJ: Erlbaum.

Rothbart, M. K., Derryberry, D., & Hershey,

K. (2000). Stability of temperament in child-

hood: Laboratory infant assessment to parent

report at seven years. In V. J. Molfese & D. L.

Molfese (Eds.), Temperament and personality

development across the life span (pp. 85–119).

Hillsdale, NJ: Erlbaum.

Rothbart, M. K., Ellis, L. K., Rueda, M. R., &

Posner, M. I. (2003). Developing mechanisms

of temperamental effortful control. Journal of

Personality, 71, 1113–1143.

Rothbart, M. K., & Posner, M. I. (2006). Tem-

perament, attention, and developmental psy-

chopathology. In D. Cicchetti & D. J. Cohen

(Eds.), Developmental psychopathology: Vol.

2. Developmental neuroscience (2nd ed.,

pp. 465–501). New York: Wiley.

Rothbart, M. K., Ziaie, H., & O’Boyle, C. G.

(1992). Self- regulation and emotion in infancy.

In N. Eisenberg & R. A. Fabes (Eds.), Emo-

tion and its regulation in early development

(pp. 7–23). San Francisco: Jossey-Bass.

Rueda, M. R. (2012). Effortful control. In M.

Zentner & R. L.Shiner (Eds.), Handbook of

temperament (pp. 145–167). New York: Guil-

ford Press.

Rueda, M. R., Fan, J., McCandliss, B. D., Hal-

parin, J. D., Gruber, D. B., Lercari, L. P., et

al. (2004). Development of attentional net-

works in childhood. Neuropsychologia, 42,

1029–1040.

Rueda, M. R., Rothbart, M. K., McCandliss, B.

D., Saccomanno, L., & Posner, M. I. (2005).

Training, maturation, and genetic influences

on the development of executive attention.

Proceedings of the National Academy of Sci-

ences USA, 102, 14931–14936.

Rumbaugh, D. M., & Washburn, D. A. (1995).

Attention and memory in relation to learning:

A comparative adaptation perspective. In G.

R. Lyon & N. A. Krasengor (Eds.), Attention,

memory and executive function (pp. 199–

219). Baltimore: Brookes.

Schimmack, U. (2005). Attentional interference

effects of emotional pictures: Threat, negativ-

ity, or arousal? Emotion, 5, 55–66.

Sethi, A., Mischel, W., Aber, J. L., Shoda, Y., &

Rodriguez, M. L. (2000). The role of strate-

gic attention deployment in development of

self- regulation: Predicting preschoolers’ delay

of gratification from mother– toddler interac-

tions. Developmental Psychology, 36, 767–

777.

Sheese, B. E., Voelker, P., Posner, M. I., & Roth-

bart, M. K. (2009). Genetic variation influ-

ences on the early development of reactive

emotions and their regulation by attention.

Cognitive Neuropsychiatry, 14, 332–355.

Sheese, B. E., Voelker, P. M., Rothbart, M. K., &

Posner, M. I. (2007). Parenting quality inter-

acts with genetic variation in dopamine recep-

tor DRD4 to influence temperament in early

childhood. Development and Psychopathol-

ogy, 19, 1039–1046.

Sheese, B. E., Voelker, P. M., Rothbart, M. K.,

& Posner, M. I. (2012). The dopamine recep-

tor D4 gene 7-repeat allele interacts with par-

enting quality to predict effortful control in

four-year-old children. Child Development

Research, 86, 32–42.

Shiner, R. L., & Caspi, A. (2012). Temperament

and the development of personality traits,

adaptations, and narratives. In M. Zentner &

R. L. Shiner (Eds.), Handbook of temperament

(pp. 497–518). New York: Guilford Press.

Shoda, Y., Mischel, W., & Peake, P. K. (1990). Pre-

dicting adolescent cognitive and self- regulatory

competencies from preschool delay of gratifica-

tion: Identifying diagnostic conditions. Devel-

opmental Psychology, 26, 978–986.

Tang, Y.-Y., Lu, Q., Fan, M., Yang, Y., & Pos-

ner, M. I. (2012). Mechanisms of white matter

changes induced by meditation. Proceedings

of the National Academy of Sciences USA,

109, 10570–10574.

Tang, Y.-Y., Ma, Y., Wang, J., Fan, Y., Feng, S.,

Lu, Q., et al. (2007). Short term meditation

training improves attention and self regula-

tion. Proceedings of the National Academy of

Sciences USA, 104, 17152–17156.

Tang, Y., & Posner, M. I. (2009). Attention

training and attention state training. Trends

in Cognitive Science, 13, 222–227.

Wolfe, C. D., & Bell, M. A. (2004). Working

memory and inhibitory control in early child-

hood: Contributions from electrophysiology,

temperament, and language. Developmental

Psychobiology, 44, 68–83.

Zentner, M., & Shiner, R. L. (2012). Handbook

of temperament. New York: Guilford Press.

Zuckerman, M. (2012). Models of adult temper-

ament. In M. Zentner & R. L. Shiner (Eds.),

Handbook of temperament (pp. 41–68). New

York: Guilford Press.

321

Over the past two decades, interest in the

way people can and do regulate their affec-

tive states has increased rapidly. Much of

the research has been experimental (e.g.,

Webb, Miles, & Sheeran, 2012). However,

to understand the antecedents and conse-

quences of affect regulation in everyday life,

outside the laboratory, one must study natu-

rally occurring individual differences (John

& Gross, 2007). Although it is now widely

agreed that individuals differ systematically

and consistently in affect regulation, these

individual differences have been conceptual-

ized and measured in many different ways.

Different conceptualization and measures

arose, in part, because individual differences

in affect regulation are not uniquely associ-

ated with just one field within psychology.

Instead, researchers in several distinct sub-

disciplines in psychology are keenly inter-

ested in this topic.

Personality and social psychologists are

interested in positive and negative mood

states, and how stable individual differ-

ences in self- control influence longer- term

adaptation (e.g., Block & Block, 1980;

Baumeister, Zell, & Tice, 2007). Stress and

coping researchers study the myriad ways

individuals differ when they encounter an

intensely stressful life situation and try to

maintain well-being (e.g., Carver & Scheier,

1994; Folkman & Lazarus, 1980). Clinical

psychologists tend to focus on the dysregu-

lation of affect (i.e., failures and problems

with regulation) and its contribution to

various forms of pathology (e.g., Kring &

Sloan, 2009). Emotion researchers exam-

ine the specific experiential, expressive, and

physiological components of the emotional

response process and the role of regulation

within this process (e.g., Gross & Leven-

son, 1993). Developmental psychologists are

interested in how children learn to regulate

emotional states in family and peer contexts

and to do so in ways that are adaptive and

socially appropriate, thus becoming emo-

tionally competent adults (e.g., Morris, Silk,

Steinberg, Myers, & Robinson, 2007).

With such a wide range of stakehold-

ers and their particular interests, concep-

tual preferences, and measurement tradi-

tions, it is not surprising that research on

individual differences in the regulation of

affective states (e.g., stress, mood, specific

emotions) has not proceeded as a unified

science. Many researchers agree that this is

not a desirable state of affairs. For example,

Weinberg and Klonsky (2009, p. 616) noted,

CHAPTER 20

Three Approaches

to Individual Differences in Affect Regulation:

Conceptualizations, Measures, and Findings

Oliver P. John

Joshua Eng

322 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

“Despite growing consensus regarding the

importance of emotion dysregulation in psy-

chopathology, the field has not yet reached

an agreement on the construct’s definition.

Multiple components of emotion regulation

have been proposed. . . . ” Similarly, Mor-

ris et al. (2007, p. 363) concluded, “Existing

empirical studies of ER [emotion regulation]

differ widely in the measures, methods, and

levels of analyses employed.”

More generally, research on individual

differences

in the emotion regulation domain is still in

its infancy. A consequence is the lack of a

definitive conceptualization and assessment

methods of ER, with significant inconsisten-

cies across studies. . . . In order to contrib-

ute to greater scientific and methodological

rigor, there is a need to empirically examine

these relationships within a valid theoretical

framework that conceptualizes ER in a multi-

faceted way. . . . Utilization of a model, such

as Gross’ (1998), would do good service to this

weakness in the existing literature. (Bariola,

Gullone, & Hughes, 2011, p. 208)

Indeed, the process model proposed by

Gross (1998, this volume; see also Gross &

Thompson, 2007) has attracted much atten-

tion and has proven influential in research on

individual differences as well (e.g., Gross &

John, 2003; John & Gross, 2004), because it

defines core constructs and provides a gen-

eral terminology.

In the first major part of this chapter,

we describe this model and the individual-

differences research it has inspired, focus-

ing on a small set of carefully specified pro-

cesses used to regulate emotions. We begin

with this approach to individual differences

for two reasons, one personal and the other

conceptual. First, having contributed to this

research, we are obviously more familiar

with this work than with other approaches.

Second, Gross’s process model is sufficiently

general to serve as a framework that can help

organize, interpret, and compare the various

ways individual differences in affect regula-

tion have been conceptualized and studied.

Our review of the existing research on

individual differences suggests that, in

addition to work based on the emotion

regulation process model, two other major

approaches address the regulation of affec-

tive states broadly defined, namely, indi-

vidual differences in coping with stress and

individual differences in emotional compe-

tence. We begin with a brief overview of

these three approaches. Then we consider

each approach in turn, focusing on concep-

tualization and major measures. In the final

section we outline limitations, continuing

issues, and future directions for research.

Overview: Three Approaches

to Individual Differences

in Affect Regulation

Humans have multiple kinds of affective

(i.e., valenced) states that they may control

or regulate, such as stress, negative affect,

or distinct emotions (e.g., pride or sadness)

(Gross & Thompson, 2007). Therefore, we

designate individual differences in affect reg-

ulation as the superordinate domain; here

we include all kinds of regulatory attempts

to influence any valenced responses. Figure

20.1 shows that below that broad rubric, we

may consider three somewhat overlapping

subdomains, namely, individual differences

(1) in specific processes used to regulate

emotions, (2) in coping with stress, and (3)

in emotional competence.

Most goal- directed actions and cognitions

can serve to maximize pleasure or minimize

pain and may therefore be said to regu-

late affective states. Nonetheless, the three

approaches to the study of individual dif-

ferences in Figure 20.1 do differ from each

other, in terms of the particular affective

responses subject to regulation, the relevant

situational contexts, and the nature of the

cognitive and behavioral processes included.

Broadly speaking, the coping approach

can be distinguished from the specific emo-

tion regulation process approach by the fact

that coping focuses primarily on reducing

negative affect rather than distinct emo-

tions, and typically extends across longer

periods of time (e.g., coping with loss).

Stress responses also are less clearly defined

than specific emotions in terms of behav-

ioral response tendencies; thus, coping is

more likely to involve changing experiential,

rather than behavioral– expressive, compo-

nents of the affective response.

Whereas the coping approach is narrowly

focused on those situations that are stress-

ful, individual differences in the emotional

Individual Differences in Affect Regulation 323

competence approach apply to a broader

set of contexts. Furthermore, the emotional

competence approach includes a host of

processes, skills, and competencies (e.g.,

attention to feelings; clarity about feeling

states) that do not directly regulate emo-

tions but make it easier for the individual

to behave in socioemotionally appropriate

ways. Additionally, in the emotional compe-

tence approach, the specific processes used

to regulate feelings or moods are not of core

importance and thus tend to remain undif-

ferentiated; individual differences in strat-

egy use are often summarized in terms of a

single concept, such as whether the individ-

ual makes greater or lesser efforts at “mood

repair” (e.g., Salovey et al., 1995) or has

great or only limited “access to effective reg-

ulation strategies” (e.g., Gratz & Roemer,

2004). Thus, the emotional competence

approach is much broader than the specific

emotion regulation process approach.

Each of these three broad conceptual

approaches has generated a number of

measures. Examples of the major measures

associated with each approach are listed in

Figure 20.1. We now describe each approach

and the associated measures in some detail.

Individual Differences

in Specific Processes Used

to Regulate Emotions

The Process Model

We begin with an approach to individual

differences that is based on the model of

specific emotion regulation processes devel-

oped by Gross (1998). He derived this model

from a generally accepted conception of the

emotion- generative process, which holds

that an emotion begins with an evalua-

tion (or appraisal) of emotion cues. When

attended to and evaluated in certain ways,

emotion cues trigger a coordinated set of

experiential, behavioral, and physiological

response tendencies. Once these response

tendencies arise, they may be modulated

in various ways. Because emotion unfolds

over time, emotion regulation strategies

can be differentiated in terms of when they

have their primary impact on the emotion-

FIGURE 20.1. Three major approaches to studying individual differences in affect regulation via self-

report and some of the major measures.

AFFECT REGULATION

•

Emotion Regulation

Questionnaire

(ERQ; Gross & John,

2003)

•

Emotion Regulation

Questionnaire for

Children and

Adolescents (ERQ-CA;

Gullone & Taffe,

2012)

•

Negative Mood Regulation

Scale (NMR; Catanzaro &

Mearns, 1990)

•

Trait Meta-Mood Scale

(TMMS; Salovey et al.,

1995)

•

Difficulties in Emotion

Regulation Scales (DERS;

Gratz & Roemer, 2004)

•

Mayer–Salovey–Caruso

Emotional Intelligence

Test (MSCEIT

; Mayer,

Salovey, & Caruso, 2002)

•

Ways of Coping (WOC;

Folkman & Lazarus,

1980)

•

COPE Inventory (Carver,

Scheier, & Weintraub,

1989)

•

Cognitive Emotion

Regulation

Questionnaire

(CERQ; Garnefski &

Kraaij, 2007)

Specific Processes to

Regulate Emotion

Coping with Stress

Emotional

Competence

324 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

generative process. As shown in Figure 20.2,

five families of more specific strategies can

be located along the timeline of the emotion

process (Gross, 1998).

Here we illustrate the use of these strat-

egies for the most frequent goal of emo-

tion regulation in everyday life, namely,

down- regulating (decreasing) emotions

that typically have a negative valence, such

as anxiety/fear, sadness, and anger (Gross,

Richards, & John, 2006). Specific forms of

emotion down- regulation are indicated in

Figure 20.2 in parentheses under each fam-

ily name. In particular, situation selection

refers to avoiding certain people, places, or

activities so as to limit one’s exposure to sit-

uations likely to generate negative emotion.

Once a situation has been selected, situation

modification operates to tailor or change a

situation so as to decrease its negative emo-

tional impact. Third, situations have many

different aspects, so attentional deploy-

ment can be used to focus on less negatively

valenced aspects of the situation. Once one

has focused on a particular aspect of the sit-

uation, cognitive change refers to construct-

ing a more positive meaning out of the many

possible meanings that may be attached to

that situation. Finally, response modulation

refers to various kinds of attempts to influ-

ence emotion response tendencies once they

already have been elicited.

Individual Differences

Measured with the Emotion

Regulation Questionnaire

Empirical research on individual differences

has focused on two specific regulatory pro-

cesses (for reviews, see John & Gross, 2004,

2007). Cognitive reappraisal is a form of

cognitive change that involves construing a

potentially emotion- eliciting situation in a

way that changes its emotional impact. For

example, during an admissions interview,

one might view the give and take as an oppor-

tunity to find out how much one likes the

school, rather than as a test of one’s worth.

Expressive suppression is a form of response

modulation that involves inhibiting ongoing

emotion- expressive behavior. For example,

one might keep a poker face while holding

a great hand during an exciting card game.

Antecedent- focused strategies such as reap-

praisal influence whether or not particular

emotion response tendencies are triggered,

and are therefore expected to have generally

positive implications for affective and social

functioning. In contrast, response- focused

strategies such as suppression influence how

emotion response tendencies are modulated

once they have been triggered, and are

therefore expected to have generally more

negative implications for affective and social

functioning (cf. Gross, 1998).

Situation ResponseAttention Appraisal

Situation

Selection

(Avoidance)

Situation

Modification

(Self-Assertion)

Attention

Deployment

(Distraction)

Response

Modulation

(Suppression)

Cognitive

Change

(Reappraisal)

FIGURE 20.2. A process model of emotion regulation. Individual differences in emotion regulation

may arise at five points in the emotion- generative process: (1) selection of the situation; (2) modification

of the situation; (3) deployment of attention; (4) change of cognitions; and (5) modulation of experien-

tial, behavioral, or physiological responses. Specific instantiations of these five families of regulatory

strategies (given in parentheses) may be used for the down- regulation of negative emotion, as described

sion.

Individual Differences in Affect Regulation 325

To test whether there are reliable and sys-

tematic individual differences in these two

emotion regulation processes, Gross and

John (2003) developed the Emotion Regu-

lation Questionnaire (ERQ), a brief 10-item

measure of the habitual use of reappraisal

and suppression. Items were derived ratio-

nally, starting with the experimental manip-

ulations used in previous experimental

research, and indicating clearly in each item

the intended emotion regulatory process,

such as “I control my emotions by changing

the way I think about the situation I’m in”

(reappraisal) and “I control my emotions by

not expressing them” (suppression). These

example items refer to emotion in general. In

addition, the Reappraisal and Suppression

scales each include at least one item asking

about regulating negative emotion (illus-

trated for the participants by giving sad-

ness and anger as examples) and one item

about regulating positive emotion (exempli-

fied by joy and amusement). Gross and John

also were careful to limit the item content

to the intended emotion regulatory strategy

in order to avoid potential confounding by

mentioning any positive or negative conse-

quences on affect, social functioning, or

well-being.

The structure of the ERQ is consistent

across samples, ages, and cultures, indicat-

ing a clear two- factor structure. Factor anal-

yses have shown two independent factors in

multiple samples of young and older adults

in the United States (John & Gross, 2004),

Germany (Abler & Kessler, 2009), Italy

(Balzarotti, John, & Gross, 2010), China

(English & John, 2013), Japan (Eng, Akutsu,

Gross, & John, 2013), and more than 15

other language communities in which the

ERQ has been adapted (Matsumoto et al.,

2008). Consistent with factor- analytic

findings, the correlation between the ERQ

Reappraisal and Suppression scales tends

to be close to zero. That is, individuals who

frequently use reappraisal are no more (or

less) likely to use suppression than individu-

als who use reappraisal infrequently. These

findings are important because they provide

clear evidence against a single, general- factor

model, in which some individuals regulate

their emotions a lot using both reappraisal

and suppression, whereas other individuals

regulate their emotions rarely, using neither

strategy frequently. Instead, reappraisal and

suppression are two independent regulatory

strategies that different individuals use to

varying degrees.

In terms of mean differences, gender and

culture differences emerged for suppres-

sion, which is expected to reflect culturally

defined display rules for emotion (Ekman,

1972). The pattern of gender differences was

highly consistent across cultures. Masculin-

ity is generally associated with acting tough

and unemotional, thus avoiding any indica-

tion of weakness or dependency (Knobloch

& Metts, 2013). Indeed, emotion expression

may be costly for men; for example, expres-

sion of negative emotion has been linked

to lower social status for men but not for

women (Anderson, John, Keltner, & Kring,

2001). In general, then, men should use sup-

pression more often than women. As shown

in Figure 20.3, men indeed reported lower

levels of suppression use than women; in

contrast, there were no gender differences in

reappraisal use in any of the cultures stud-

ied.

Figure 20.3 also shows that among both

men and women, the Japanese samples scored

highest in suppression use. This is consistent

with mean suppression scores in 23 nations

(Matsumoto et al., 2008); individuals in

Western countries that value independence

were less likely to suppress their emotions

than individuals in East Asian countries

that value interdependence. However, cross-

national comparisons cannot conclusively

pinpoint the origin of the national– group

differences, so Eng et al. (2013) tested for

acculturation effects (1) between groups

of European Americans and East Asian

Americans and (2) within a group of Asian

American immigrants who differed in their

acculturation to Western culture (indexed

by the length of their residence in the United

States). Figure 20.4A shows that European

Americans scored lower in suppression than

did East Asian Americans. Figure 20.4B

shows parallel suppression differences in

the within- group analysis: The longer East

Asian immigrants had lived in the United

States and been exposed to Western cultural

values and practices, the less suppression

they reported, in effect becoming more like

European Americans. How can these cul-

tural group differences and acculturation

effects be explained? As we will argue in

the final section of this chapter, models of

326 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

individual differences in emotion regulation

need to consider values, goals, and other

motivational factors, such as the culturally

transmitted values associated with indepen-

dent and interdependent self- construal.

Finally, it is important to comment on

discriminant validity. The ERQ Reappraisal

and Suppression scales were not related to

various measures of cognitive ability (Gross

& John, 2003; McRae, Jacobs, Ray, John,

& Gross, 2012). Similarly, correlations with

social desirability were small, probably

because the ERQ items are worded fairly

neutrally and do not mention adjustment or

psychological health outcomes. Finally, cor-

relations with the broad personality dimen-

sions defined by the Big Five traits (e.g.,

John, Naumann, & Soto, 2008) showed

only modest relations; highly neurotic indi-

viduals were slightly less likely to use reap-

praisal, and highly extraverted individuals

were somewhat less likely to use suppres-

sion. Overall, these findings are consistent

with a conceptualization of reappraisal

and suppression as rather specific and nar-

rowly defined individual differences in emo-

tion regulation processes. The discriminant

validity findings are particularly important

here, because theory predicts habitual use of

reappraisal should have generally favorable

implications for adjustment and psychologi-

cal health, whereas greater habitual use of

suppression should have less favorable impli-

cations. Thus, it is important that any such

adjustment effects cannot be attributed to

other factors, such as intelligence, socially

desirable responding, or general tempera-

ment and personality traits.

In terms of adjustment outcomes, the

general process model (Gross, 1998) holds

that reappraisal occurs early in the emotion-

generative process, before emotion response

tendencies have been fully generated, and

thus permits the modification of the entire

emotional sequence, including the expe-

rience of more positive and less negative

emotion, without notable physiological,

cognitive, or interpersonal costs. Suppres-

sion, by contrast, comes relatively late in the

emotion- generative process and primarily

modifies behavioral emotion response ten-

dencies, without reducing the experience

of negative emotion. Because suppression

comes late in the emotion- generative pro-

cess, it requires the individual to effortfully

manage emotion response tendencies that

arise continually, thus consuming cognitive

resources that could otherwise be used for

optimal performance in the social contexts

in which the emotions occur. Moreover, in

everyday life, the habitual suppression of

one’s true feelings is expected to create in the

Women Men

Mean Suppression

U.S. Germany Italy Japan

4.5

3.5

2.5

1.5

FIGURE 20.3. Men suppress more than women across four cultures. Mean ERQ suppression scores

are shown for men and women in samples from the United States (Gross & John, 2003), Germany

(Abler & Kessler, 2009), Italy (Balzarotti, John, & Gross, 2010), and Japan (Eng et al., 2013).

Individual Differences in Affect Regulation 327

individual a sense of discrepancy between

inner experience and outer expression, lead-

ing to negative feelings about the self and

to interpersonal behavior that is distracted,

strained, and avoidant, thus impeding the

development of emotionally close relation-

ships (see also English & John, 2013; Eng-

lish, John, & Gross, 2013; John & Gross,

2004).

In general, empirical evidence has sup-

ported the prediction that more regulation

is not necessarily better but, instead, the

effects of regulation should depend on the

particular regulatory process used: Indi-

vidual differences in the habitual use of

reappraisal and suppression have differen-

tial implications for effective functioning

(e.g., Abler & Kessler, 2009; Balzarotti et

al., 2010; English & John, 2013; English,

John, & Gross, 2013; Gross & John, 2003;

Richards & Gross, 2000; Srivastava, Tamir,

McGonigal, John, & Gross, 2009). Figure

20.5 illustrates typical findings. In terms of

affective implications, habitual use of reap-

praisal was related to more positive emo-

tion and less negative emotion. Cognitively,

reappraisal does not appear to have reliable

effects on social memory. In the domains of

interpersonal functioning and well-being,

reappraisal was generally associated with

better psychological health. However, these

relationships may turn out to be more com-

plex; for example, the positive interpersonal

effects of reappraisal may be more apparent

in peer ratings of relationship quality than

in self- ratings, and the well-being effects

of reappraisal may vary somewhat depend-

ing on measures and samples (e.g., Aldao,

Nolen- Hoeksema, & Schweizer, 2010; Eng-

lish & John, 2013; English, John, Srivastava,

& Gross, 2012).

A rather different picture emerges for

habitual use of suppression. As shown in

Figure 20.5, suppression is related to less

positive and more negative emotion experi-

ence. Cognitively, suppression is associated

with degraded memory for socially relevant

information. Socially, suppression is con-

sistently related to relationships that are

less close, satisfying, and supportive, even

in highly interdependent cultures such as

China (English & John, 2013). In terms of

well-being, suppression again has unfavor-

able effects, although that may be limited

to Western cultures that highly value inde-

pendence and authenticity (English & John,

2013).

Whereas there is now considerable evi-

dence for effects on adjustment and psycho-

logical health, much less is known about

the development of individual differences

in reappraisal and suppression (see John

& Gross, 2004). For example, research on

adults suggests that gender and cultural

socialization processes are likely playing a

role. As discussed earlier (see Figures 20.3

and 20.4), on average men report higher lev-

Independence

Interdependence

SuppressionAsian vs. White

Ethnicity

n.s.

–

(A)

Independence

Interdependence

Suppression

Length of

Residence

in U.S.

n.s.

–

(B)

FIGURE 20.4. Explaining the effects of culture

on emotion regulation: Ethnicity and accul-

turation effects on suppression were mediated

by independent (but not interdependent) self-

construal. Panel (A) shows that in a sample of

Asian and White students, the between- group

effect of ethnicity (coded Asian = 0, White = 1)

on suppression was mediated through indepen-

dence (but not through interdependence). Panel

(B) shows parallel mediation effects within the

group of Asian immigrants: length of accultura-

tion (residence) in the United States was associ-

ated with less suppression use, and this effect was

mediated through greater independence (but not

interdependence) in self- construal. Signs indicate

the relationship between variables: “+” indicates

a positive effect, “-“ a negative effect, and “n.s.”

a null effect.

328 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

els of suppression use than women, and East

Asians report higher levels of suppression

use than Westerners. However, at this point

we know little about when and how these

differences in emotion regulation develop.

There is reason to expect this state of

affairs to change for the better in the near

future. A version of the ERQ adapted for

children and adolescents (ERQ-CA) has

recently been published (Gullone & Taffe,

2012). Using this instrument, promising

findings on the development of reappraisal

and suppression are beginning to appear

(e.g., Bariola et al., 2011).

The Coping-with-Stress Approach

and Its Major Measures

The literature on stress and coping origi-

nated from psychodynamic concepts and

ideas on anxiety and defense mechanisms

that have provided an important start-

ing point for much thinking about affec-

tive states (e.g., Shaver & Mikulincer,

2007; Westen & Blagov, 2007). For several

decades, stress researchers have studied

individual differences in coping styles— the

ways individuals attempt to deal with adver-

sity (e.g., Lazarus & Folkman, 1984; see

also Carver & Scheier, 1994). In their pio-

neering work, Folkman and Lazarus (1985)

emphasized that coping has two major func-

tions, namely, “the regulation of distressing

emotions and doing something to change

for the better the problem causing the dis-

tress” (p. 152). That is, coping includes

regulatory efforts directed at internal emo-

tional responses (e.g., anxiety) or at external

problems facing the individual (e.g., a final

exam). What are the major ways, or dimen-

sions, of coping in which individuals differ

from each other?

Ways of Coping Questionnaire

Folkman and Lazarus (1980, 1985, 1988)

reasoned that multiple ways of coping could

REAPPRAISAL

Well-Being

(e.g., life

satisfaction)

Social

(e.g., closeness)

Cognitive

(e.g., memory)

Negative

Emotion

Positive

Emotion

SUPPRESSION

–.47*

.35*

.17

.26*

.30*

.36*

–.58*

–.27*

–.25*

–.34*

FIGURE 20.5. Individual differences in the habitual use of reappraisal and suppression are differen-

tially associated with healthy adaptation in emotion experience, cognition, relationships, and well-

being (adapted from John & Gross, 2004, 2007). Specific correlational findings in the figure are given

only for illustrative purposes, and effect sizes vary across samples and measures used.

Individual Differences in Affect Regulation 329

be distinguished but, lacking an established

theoretical framework, tried to discover

the major dimensions of coping empiri-

cally. They initially assembled in the Ways

of Coping Questionnaire 68 items intended

to capture a wide variety of behavioral and

cognitive coping responses, representing

the things people commonly do when deal-

ing with stress. Some of these items were

inspired by previous theory and literature,

including defense mechanisms (e.g., wish-

ful thinking, denial), whereas others were

added later at the suggestion of subjects in

their studies (e.g., prayer). Exploratory fac-

tor analyses and rational item selection led

eventually to eight scales assumed to mea-

sure distinct ways of coping: Confrontive,

Distancing, Self- Controlling, Seeking Social

Support, Accepting Responsibility, Escape-

Avoidance, Planful Problem Solving, and

Positive Reappraisal (Folkman & Lazarus,

1988). These eight coping styles constituted

the first and “most commonly used measure

of basic coping responses” (Parker, Endler,

& Bagby, 1993, p. 361).

The inclusion of cognitive coping styles

such as Planful Problem Solving and Accept-

ing Responsibility shows that the concep-

tual domain of coping (see Figure 20.1) also

includes processes that are not aimed at the

regulation of affective states per se, such as

“analyzing the problem in order to under-

stand it better.”

Some scales, however, do fit with the

broader notion of affect regulation set out

in Figure 20.1. Consider, for example, the

scale initially labeled Emphasizing the Posi-

tive (Folkman & Lazarus, 1985). Its revised

label, Positive Reappraisal, implies a concep-

tual link to the family of emotion regulation

strategies that Gross (1998) called Cognitive

Change, especially the Cognitive Reappraisal

strategy. Do the seven items on Folkman and

Lazarus’s (1988) Positive Reappraisal coping

scale measure cognitive reappraisal? They

include “I was inspired to do something cre-

ative”; “I changed or grew as a person in a

good way”; “I came out of the experience

better than I went in”; “I found new faith”;

“I rediscovered what is important in life”; “I

changed something about myself”; and “I

prayed.” These items indeed describe a per-

son who emphasizes positive experiences or

behaviors in a stressful situation. However,

they do not directly assess the particular

process of changing the personal meaning

or appraisal of an emotion- eliciting event.

Instead, these items describe diverse, though

generally positive, consequences arising

from or after the stressful experience (e.g.,

“I came out of the experience better than I

went in”), including personal growth, self-

transformation, greater creativity, and even

spiritual renewal.

This complex item content poses serious

issues for research on the correlates and

adaptive consequences of using a particu-

lar coping style. As Lazarus (2000, p. 666)

explained, “The danger of confounding is

that measures of coping could contain some

of the same variables— for example, distress

or psychopathology— as the outcome mea-

sure of mental health. Thus, if the anteced-

ent and consequent measures are essentially

the same, any correlation between them

would represent some degree of tautology.”

This problem— confounding the predictor

or causal variable (i.e., regulation) with sub-

sequent outcomes to be predicted (i.e., better

adjustment) within the same item—is a com-

mon issue in research on individual differ-

ences in affect regulation. It highlights that

in writing items researchers should focus

item content specifically on the regulatory

process of interest. Indeed, among the items

listed earlier, only one (“I prayed”) describes

a potential emotion regulatory activity with-

out mentioning some other, positive out-

comes as well.

In addition to confounding, lack of speci-

ficity is another potential issue in these

items. For example, the item “I prayed” is

vague vis-à-vis the particular regulatory pro-

cess at work: Individuals may pray in order

to gain a new perspective or understanding

of an emotion- eliciting event, but they may

also pray to distract themselves, or to share

their feelings with a greater power, or even

to muster the inner strength to modify the

situation. These uses of prayer and religion

for affect regulation may well be distinct

and show differential correlates and adjust-

ment outcomes.

These issues also apply to items on other

scales (see Folkman & Lazarus, 1985). For

example, “I jog or exercise,” scored on the

Tension Reduction scale, may represent

multiple specific regulation strategies, such

as situation selection (e.g., avoiding the

stressor), attentional deployment (e.g., dis-

330 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

tracting oneself), and even response mod-

ulation (e.g., going off to jog in order to

avoid expressing one’s emotion to another

person). These items could be more specific

regarding the specific regulatory processes

intended.

In summary, most items on the Ways of

Coping Questionnaire are worded broadly

and lack specificity regarding the regulatory

process involved. Many items suffer from

a confounding problem where regulation

and extraneous outcomes (e.g., psychoso-

cial consequences) are combined in the same

item. At the scale level, the lack of a process

model led to a reliance on exploratory factor

analyses of these broad and complex items

to define the conceptual building blocks (i.e.,

the particular coping styles). The resulting

concepts (as represented by the scales) are

heterogeneous and often combine conceptu-

ally distinct regulatory processes. With such

complex and global concepts, the scales are

hard to interpret and have been criticized

for lacking construct validity; discriminant

validity has been a particular problem,

because intercorrelations between some of

the scales tend to be very high, with some

exceeding .70 (e.g., Parker et al., 1993).

COPE Inventory

In an important contribution, Carver,

Scheier, and Weintraub (1989) substan-

tially reworked the original Folkman and

Lazarus scales, using modern psychometric

methods. They subdivided some of the most

heterogeneous scales, added new scales, and

improved the overall conceptual coherence

and internal consistency. The resulting Cop-

ing Orientations to Problems Experienced

Scale (COPE) is a self- report questionnaire

that measures 14 coping styles with four

items each. Even though the COPE scales

are shorter, they are more reliable than the

earlier Ways of Coping scales. The COPE

covers a broad array of diverse coping styles,

such as Planning, Active Coping, Mental

Disengagement, Seeking Social Support—

Instrumental, Seeking Social Support—

Emotional, Positive Reinterpretation and

Growth, Turning to Religion, Focus on and

Venting of Emotion, and Denial.

However, some of the problems of the

Ways of Coping Questionnaire remain. The

lack of a process, structural, or concep-

tual model continues to be a problem. The

scales thus continue to define coping styles

at rather different levels of abstraction, with

some scales (e.g., Turning to Religion) mea-

suring very broad and complex constructs

and others (e.g., Denial) measuring much

more specific processes. It is not clear how

the various coping styles being measured

should be conceptually or causally related.

And many of the scales remain conceptu-

ally heterogeneous; for example, the scale

labeled Focus on and Venting of Emotions

involves both being aware of one’s distress

and “letting it out.”

Before using these scales, it is important

to examine the item content of the COPE

scales to understand what they are mea-

suring (e.g., John & Gross, 2007). Some

of them can be linked to the specific emo-

tion regulation strategies defined in Gross’s

(1998) process model. For example, the

COPE Active Coping and Planning scales

include items that refer to regulatory pro-

cesses involving situation selection and situ-

ation modification. Another example is the

scale that Folkman and Lazarus (1988) had

initially called Emphasizing the Positive and

that Carver et al. (1989) relabeled Positive

Reinterpretation and Growth (e.g., looking

for the silver lining in stressful situations;

trying to learn from difficult experiences).

One would expect this coping style to be

related to the specific emotion regulation

strategy of Cognitive Reappraisal. How-

ever, this COPE scale also includes general

optimism and longer- term positive changes

and adaptations individuals might make

later on, following the stressful experience.

Indeed, the correlation of this COPE scale

with Gross and John’s (2003) Cognitive

Reappraisal scale tends to be moderate (e.g.,

Gross & John, 2003; Balzarotti, John, &

Gross, 2010), consistent with the broader

definition of the COPE scale. That is, the

inclusion of positive processes and long-

term outcomes that have little to do with

the immediate regulatory task at hand make

the scale complex and conceptually hetero-

geneous.

This conceptual heterogeneity makes it

difficult to establish whether and when a

particular coping style is effective or dys-

functional. For example, Carver et al.

(1989) had assumed that the Focus on and

Venting of Emotions scale would be dys-

Individual Differences in Affect Regulation 331

functional but instead found its adjustment

correlates to be complex; the positive cor-

relation with Social Support suggests some

positive adjustment implications. Concep-

tually, we suggest, this scale combines two

distinct processes with potentially different

adjustment implications. On the one hand,

items like “I get upset, and am really aware

of it” are conceptually related to rumina-

tion (Nolen- Hoeksema, Parker, & Larson,

1994); focusing on a negative emotion will

likely intensify the experience of that emo-

tion further and thus make down- regulation

more difficult, leading to lower adjustment

and well-being. On the other hand, items

like “I feel a lot of emotional distress and I

find myself expressing those feelings a lot”

describe an individual whose emotion expe-

rience and expression are congruent (Mauss

et al., 2011); congruence between experience

and expression, and sharing of emotions

with others, can increase authenticity and

generate greater closeness with others, lead-

ing to higher well-being (English & John,

2013). If the research goal is to understand

individual differences relevant to affect reg-

ulation and how these individual differences

are related to important life outcomes, such

as well-being and relationship functioning,

then less complex measures may be needed

to provide conceptual clarity and coherence

in findings.

A similar analysis applies to the two Seek-

ing Social Support scales on the COPE—

after all, talking to another person about

one’s problems requires some sharing and

expression of feelings (i.e., low suppres-

sion) and will serve to focus the individual

on these emotions rather than distract him

or her from them (i.e., low distraction). In

contrast, the Mental Disengagement scale

(e.g., coping by turning to work; going to the

movies) should relate most to distraction;

however, as Carver et al. (1989) noted, these

items represent a rather loose set of diverse

activities. The inclusion of items about sleep

and daydreaming suggest a potential link

to situation selection as well, because these

activities can be performed for reasons other

than distraction (e.g., avoiding the stressful

situation).

Drug and alcohol use “in order to think

about it less” may also be related to distrac-

tion. As noted earlier in our discussion of

prayer use, the Turning to Religion scale

on the COPE could serve several regulatory

strategies; it would be interesting to clarify

empirically the processes that account for

positive effects of religiosity on well-being,

which may include antecedent processes,

such as reappraisal or distraction, or even

response modulation via lowering suppres-

sion, because prayer may offer a safe place

for emotional expression by sharing feelings

with a trusted higher entity.

Consistent with our earlier observation

that coping styles are defined rather broadly,

several COPE scales fall clearly outside

the scope of the affect regulation domain.

For example, the Suppression of Compet-

ing Activities scale and the Restraint Cop-

ing scale involve behavioral responses that

reflect problem- focused coping, showing

that coping efforts are often directed at

problems or events in the external world

that interfere with the individual’s goals,

even though they do not cause a specific

emotional response. Several other COPE

scales refer to long-term adjustments some

individuals make as a consequence of the

stressful experience, a timescale outside the

more limited time frame of the immediate

emotion regulatory episode. This temporal

issue applies to Behavioral Disengagement

(“I just give up trying to reach my goal”),

Acceptance (“I learn to live with it”; “I get

used to the idea that it happened”), Denial

(“I act as though it hasn’t even happened”),

and the Growth component of Positive Rein-

terpretation and Growth (“I try to grow as a

person as a result of the experience”).

Cognitive Emotion

Regulation Questionnaire

Although its name does not refer to stress

and coping, Garnefski and Kraaij’s (2007)

Cognitive Emotion Regulation Question-

naire (CERQ) also originated in the coping

approach. Like the COPE, the goal was to

assess a set of regulatory strategies that help

people “to keep control over their emotions

during or after the experience of threaten-

ing or stressful events” (Garnefski & Kraaij,

2007, p. 141). However, the CERQ focuses

more narrowly than the COPE on cognitive

coping strategies, which are said to represent

“the conscious, cognitive way of handling

the intake of emotionally arousing informa-

tion” (p. 141).

332 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

The CERQ has a format very similar to

the COPE and also consists of relatively brief

4-item scales, “each referring to what some-

one thinks after the experience of threaten-

ing or stressful events” (Garnefski & Kraaij,

2007, p. 141). In other words, just like the

coping styles on the COPE, these cognitive

regulation dimensions focus on stressful

situations and have the longer time horizons

(e.g., after the actual emotional experience)

that differentiate coping styles from the spe-

cific emotion- regulation processes defined in

Gross’s model.

Some of the nine CERQ scales were

adapted from the COPE and other cop-

ing instruments: “These dimensions were

defined either by taking out or reformulat-

ing the cognitive dimensions of existing cop-

ing measures (Carver et al., 1989; de Ridder,

1997), ‘transforming’ non- cognitive coping

strategies into cognitive dimensions or add-

ing new strategies on theoretical grounds”

(Garnefski & Kraaij, 2007, p. 142). Cop-

ing styles that were clearly cognitive, such

as Acceptance, Planning, and Positive Rein-

terpretation and Growth (renamed Positive

Reappraisal) were retained from the COPE.

Behavioral and overly complex coping styles

from the COPE, such as Use of Social Sup-

port, Substance Abuse, Humor, Religious

Coping, and even Focus on and Venting of

Emotions were left out of the CERQ.

In addition, some regulatory processes

from other literatures were added, such as

Focus on Thought/Rumination (e.g., “I

often think about how I feel about what I

have experienced”), Catastrophizing (e.g.,

“I continually think how horrible the situa-

tion has been”), and Self-Blame (e.g., “I feel

that I am the one to blame for it”). Again,

as in the earlier coping measures, many of

the scales do not focus on the regulation

of internal experiences; rather, they focus

on the external, stressful situation, as illus-

trated by the items on the Acceptance scale

(e.g., “I think that I have to accept the situa-

tion”; “I think that I have to accept that this

has happened”).

In our view, the singular focus on “think-

ing” aspects in an instrument with nine dis-

tinct scales has two potential disadvantages.

One is discriminant validity, in the sense that

subsets of the scales become relatively simi-

lar and thus highly correlated. This problem

has been criticized in the two earlier cop-

ing style measures as well. For example, the

three CERQ scales— Positive Reappraisal (“I

think that I can become a stronger person as

a result of what has happened”), Refocus on

Planning (“I think of what I can do best”),

and Putting into Perspective (“I think that

it hasn’t been too bad compared to other

things”)—all share elements of cognitive

change or reappraisal. Indeed, Garnefski

and Kraaij (2007) reported that Positive

Reappraisal and Refocus on Planning corre-

lated close to .70 in their adult participants.

Unfortunately, the ERQ (or COPE) was not

included, thus providing no information

about the convergent validity of these three

new CERQ scales with earlier measures of

cognitive reappraisal.

The second disadvantage of the purely

cognitive focus is that emotion researchers

agree that emotions have not only experi-

ential but also behavioral– expressive com-

ponents (e.g., Mauss et al., 2011), and the

coherence of these emotion response systems

is likely a function of regulatory processes.

Therefore, the omission of any scales related

to individual differences in response modu-

lation, such as expressive suppression, would

seem to make an instrument less useful for

research on individual differences in affect

regulation.

In conclusion, this comparison of three

measures of coping styles and specific emo-

tion regulation processes suggests that there

is some overlap between the two approaches.

Overall, however, the two approaches are

surprisingly distinct. One core difference is

that the constructs measured by all the cop-

ing questionnaires are defined in broader

and more complex terms than the specific

emotion regulatory strategies. Several cop-

ing styles, especially the problem- focused

ones, fall outside the domain of emotion reg-

ulation processes. A great methodological

strength of the coping approach is its clear

focus on stressful situations. Much coping

research has studied individual differences

within the concrete context of a particular

stressful encounter (e.g., preparing for an

upcoming test), focusing on the individu-

al’s behavioral and cognitive responses in

this situation. This contextually grounded

approach emphasizes what individuals actu-

ally do, or try to do, in a specific context

(even when reported on questionnaires or

in interviews) and contrasts with global

Individual Differences in Affect Regulation 333

approaches such as the Big Five trait model

(e.g., John et al., 2008) that pay scant atten-

tion to the context and instead assess broad

trends in usual or typical behavior.

Future coping research may take a more

theoretically guided approach to resolve the

conceptual complexity and heterogeneity

of the coping scales in terms of their affect

regulatory implications. Renewed scale con-

struction efforts may address the confound-

ing of regulatory processes and downstream

adjustment outcomes within the same ques-

tionnaire item. Finally, because the coping

approach and the specific emotion regula-

tion processes approach differ in terms of

their time horizons and relevant situational

contexts, each has unique advantages and

applications. The various measures of cop-

ing styles provide a useful focus on stressful

situations and regulating negative affective

states.

The Emotional Competence

Approach and Its Major Measures

The emotional competence approach origi-

nated in developmental and clinical analyses

of what a child needs to learn to become an

emotionally and socially competent adult.

Saarni (e.g., 1999, 2011) analyzed emotional

functioning from the perspective of how

well it serves the adaptive and instrumental

goals of the individual, then defined emo-

tional competence as a set of affect- oriented

behavioral, cognitive, and regulatory skills.

Simply put, the child needs to learn what it

means to feel something and to do some-

thing about those feelings.

Saarni (1999, 2011) postulated eight broad

skills that she considers to be prerequisites

for emotional competence: (1) awareness of

one’s own emotional state; (2) the skills to

discern and understand the emotions of oth-

ers; (3) skill in using the common vocabu-

lary of emotion and expression; (4) capacity

for empathic and sympathetic involvement

in others’ emotional experiences; (5) ability

to realize that one’s inner emotional state

need not correspond to outer expression; (6)

capacity for adaptive coping with aversive or

distressing emotions by using self- regulatory

strategies that ameliorate the intensity or

temporal duration of such emotional states;

(7) awareness that relationships are defined

by emotional genuineness of expressive dis-

play and reciprocity; and (8) capacity for

emotional self- efficacy (i.e., individuals can

accept their own emotional experiences and

view themselves as generally feeling the way

they want to feel). Although not necessarily

accepted by all, these eight emotional com-

petencies provide a formidable set of com-

plex socioemotional skills that researchers

in this tradition consider to be part of affect

regulation. Note that from the perspective

of the specific emotion regulation process

approach, the capacity for adaptive cop-

ing would relate most directly to individual

differences in affect regulation. The other

competencies seem to specify processes that

make emotion regulation possible or may

help (rather than hinder) the enactment of

effective regulatory strategies. For example,

if an individual has no awareness of his or

her current emotional state, then that person

would hardly proceed with attempts to regu-

late that emotion.

Generalized Expectancies

for Negative Mood Regulation Scale

The Generalized Expectancies for Negative

Mood Regulation Scale (NMR) was devel-

oped by Catanzaro and Mearns (1990) and

is one of the earliest measures to take the

emotional competence approach. It now has

fallen out of use. This 30-item self- report

questionnaire focuses on individuals’ beliefs

that some “behavior or cognition will allevi-

ate a negative state or induce a positive one”

(p. 547), and asks them to indicate the extent

to which they believe their attempts to alter

their negative moods will work.

Many of the items focus on ways to

eliminate or at least avoid negative emo-

tions. Thus, the measure has been criti-

cized for equating mood regulation with

the avoidance of negative affect (e.g., Gratz

& Roemer, 2004); simply avoiding nega-

tive states is assumed to be an indication

of effective regulation, as shown by items

such as “When I’m upset, I believe that I can

forget about what’s upsetting me pretty eas-

ily” versus “When I’m upset, I believe that

I won’t be able to put it out of my mind”

(reverse scored). Moreover, the NMR does

not assess aspects of mood regulation, such

as awareness, clarity, or acceptance of emo-

tions, that later emotional competence

334 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

researchers, such as Saarni (1999), Salovey

et al. (1995), and others, deemed important.

Finally, regulatory processes are not differ-

entiated but are instead measured only in

terms of whether the individual thinks he or

she has access to mood regulation strategies

perceived to be effective.

Trait Meta‑Mood Scales

Consistent with their emotional competence

perspective, Salovey et al. (1995) aimed to

understand the reflective (or meta) processes

that accompany many mood states. These

“meta-mood” processes capture how indi-

viduals reflect on their feelings, including

how they monitor, evaluate, and regulate

them (Mayer & Gaschke, 1988). Salovey et

al. (1995) assumed that emotions serve as an

important source of information, and that

individuals differ in how skilled they are at

processing this kind of information, particu-

larly in “their understanding of and ability

to articulate their affective states” and their

ability to “regulate such feelings and use them

adaptively to motivate behavior” (p. 147).

The Trait Meta-Mood Scales (TMMS) were

designed to measure stable and general atti-

tudes about moods and the degree to which

individuals attempt to manage (or repair)

mood experiences. The TMMS measures

three constructs— people’s tendency to

attend to their moods and emotions (atten-

tion), to discriminate clearly among them

(clarity), and to regulate them (repair)—each

capturing individual differences considered

“fundamental to the self- regulatory domain

of emotional intelligence” (p. 147).

Given that the TMMS focuses on indi-

vidual differences in meta-moods—that

is, thoughts and attitudes that accompany

mood experiences— we would not expect

any links to regulatory strategies that

occur earlier in the emotion process, prior

to the onset of an emotional episode itself,

such as situation selection or modification.

However, attentional processes, cognitive

change, and response modification should

be of considerable relevance.

The TMMS Attention scale refers to pay-

ing close attention to feelings, accepting

feelings, valuing them positively, and letting

oneself experience them fully and inten-

sively, using items such as “I often think

about my feelings” versus “I don’t think it’s

worth paying attention to your emotions or

moods” (reverse scored). As expected, the

Attention scale correlates with the Private

Self- Consciousness scale, which measures

awareness and attention to private aspects

of the self (e.g., thoughts and feelings). One

would expect the Attention scale to relate

negatively to chronic use of the emotion

regulation strategies distraction and sup-

pression. The link to distraction is theoreti-

cally interesting, because paying close atten-

tion to negative mood states has been shown

to magnify and intensify the experience of

negative affect and the risk for depression

(Scheier & Carver, 1977), whereas in our

model, distraction is expected to decrease

negative emotion experience. Indeed, in one

of the studies by Salovey et al. (1995), the

Attention scale was related to higher depres-

sion scores. Regarding the negative link to

suppression, being intensely aware of and

paying close attention to one’s emotions

should interfere with the considerable and

ongoing cognitive effort required to sup-

press one’s emotions effectively (Richards &

Gross, 2000), and that should be especially

true for individuals who experience their

emotions intensely. Moreover, individuals

scoring high on the Attention scale value

their feelings and believe in letting them

guide their behavior. That is the opposite of

individuals who habitually use suppression

and thus show expressive behavior that is

inconsistent with their inner feelings (Gross

& John, 2003). Indeed, the TMMS Atten-

tion scale correlated negatively with the

ERQ Suppression scale.

The TMMS Clarity scale assesses clarity

about one’s feelings, and contrasts aware-

ness and acceptance of feelings with confu-

sion about feelings and their meaning and

implications. True- scored item examples

include “I feel at ease about my emotions”

versus false- scored items such as “I can’t

make sense out of my feelings.” Low clarity

was related not only to ambivalence about

emotional expression but also to vulner-

ability to negative affect, such as neuroti-

cism, distress, and depression. Salovey et al.

(1995) conceptually linked lack of clarity to

ruminative thought processes (e.g., individu-

als who do not know how they feel about a

negative event have to keep thinking about it)

and showed empirically that, after watching

a stressful video, individuals scoring high on

Individual Differences in Affect Regulation 335

the Clarity scale exhibited a decline in rumi-

native thought and recovered their positive

mood to a greater extent than low- scoring

individuals. These findings suggest a positive

relation between clarity and distraction (the

ability to use attentional resources to move

away from a negative emotion stimulus,

rather than ruminating about it), and a nega-

tive relation with suppression. Individuals

who are clear about and comfortable with

their emotions should feel little need to sup-

press their behavioral expression of emotion,

and the evidence supported this predicted

negative relation (Gross & John, 2003).

The TMMS Repair scale assesses attempts

to improve negative mood by thinking posi-

tively and taking an optimistic (rather than

pessimistic) attitude more generally. Item

examples include “Although I am sometimes

sad, I have a mostly optimistic outlook” and

“I try to think good thoughts no matter how

badly I feel,” contrasted with “Although I

am sometimes happy, I have a mostly pes-

simistic outlook” (reverse scored). This scale

seems conceptually similar to coping styles

reviewed earlier, such as Emphasizing the

Positive on the original Ways of Coping

Questionnaire and Positive Reinterpretation

and Growth on the COPE.

As expected, the Repair scale correlated

substantially with general optimism and low

vulnerability to distress and depression; it

also predicted lower levels of distress after

participants watched a stressful video. In

terms of specific emotion regulation pro-

cesses, one would expect the Repair scale to

relate positively to the use of distraction, as

well as reappraisal: The explicit mood repair

efforts included in the scale involve (1) using

thought to focus on something other (e.g.,

pleasant things; good thoughts) than the dis-

tressing stimulus, thus implicating distrac-

tion, and (2) also trying to think differently

(e.g., more positively) about the situation,

thus implicating reappraisal. In contrast,

expressive suppression is hardly an optimis-

tic process (Gross & John, 2003); its habit-

ual use is related not only to negative emo-

tion, as shown in Figure 20.5, but also to

feelings of inauthenticity (English & John,

2013) and the pessimistic expectation that

others will disapprove if shown one’s “real

self,” as shown as in Table 20.1. Consistent

with these considerations, Gross and John

(2003) found that the TMMS Repair scale

was differentially related to the ERQ Reap-

praisal (r = .36) and Suppression (r = –.26)

scales.

TABLE 20.1. Examples of Beliefs and Motivations Predicting Individual Differences

in the Habitual Use of Reappraisal and Suppression as Measured by the ERQ

Construct studied

Emotion regulation strategy

Reappraisal Suppression

Incremental (vs. entity) theory of emotion

.35 .04

(If they want to, people can change the emotions they have)

Global emotion regulation self-efficacy

.21 .00

(I certainly can control my emotions when running into a former

boyfriend/girlfriend)

Subjective authenticity

–.02 –.30

(It’s important to me to be true to myself)

Fear of negative consequences

–.05 .31

(I worry that if I express negative emotions, such as fear and anger,

other people will not approve of me)

Low self-efficacy for self-expression

–.12 .45

(At times I am just not able to express what I am really feeling)

Note. ERQ, Emotion Regulation Questionnaire (Gross & John, 2003).

Tamir, John, Srivastava, and Gross (2007, Study 1).

English and John (2013; mean across Studies 1–3).

John (2010).

336 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

However, the correlations of the ERQ

scales and the TMMS scales were not large in

size. Suppression was related negatively to all

three TMMS scales, most strongly to Atten-

tion (r = –.41) and least strongly to Repair

(r = –.26). This is interesting and worth fur-

ther study for two reasons. First, we need

to understand better how individual differ-

ences in cognitive variables such as attention

to emotion are linked to behavioral vari-

ables, such as emotion- expressive behavior.

Second, we need to address questions about

causal order: How are cognitive variables

such as attention best conceptualized? In our

view, some may be antecedents (see Figure

20.6 below): Individuals may use suppres-

sion frequently because they have learned to

devalue and ignore their emotions as impor-

tant sources of information, and because

they have the pessimistic belief that others

will respond negatively if they truly express

their feelings. Other meta-mood processes

may represent consequences: Frequent use of

suppression leads to expressive behavior that

is incongruent with internal feeling states,

and may in turn lead to confusion and lack of

clarity about one’s emotions (and eventually

an unclear self- concept and low self- esteem).

These considerations imply that research

on individual differences in beliefs and moti-

vational factors will be critical in helping

us conceptualize how meta-mood processes

and specific emotion regulatory processes

are related. Table 20.1 summarizes the find-

ings from several initial studies. Incremental

beliefs that emotions can be changed, and

self- efficacy beliefs about one’s own ability

to change one’s emotions, predicted greater

use of cognitive reappraisal, whereas sub-

jective inauthenticity, fear of negative con-

sequences, and low self- efficacy predicted

greater use of suppression.



Demographic and

Experiential Factors

Gender socialization

Aging

Acculturation

Personality Factors

Big Five traits

Attachment

Cognitive Factors

Cognitive control

DISTAL

ANTECEDENTS

Use

Habitual

Situational

Ability

Actual

Perceived

INDIVIDUAL

DIFFERENCES IN

EMOTION REGULATION

Implicit theories

(incremental vs. entity)

Self-efficacy and

control beliefs

BELIEFS

Attention

Awareness

Clarity

EMOTION PERCEPTION

AND UNDERSTANDING

Ideal affect

Hedonic/instrumental

goals

Self-construal goals

VALUES AND GOALS

Feeling rules

Display rules

NORMS AND

EXPECTATIONS

FIGURE 20.6. Examples of several types of individual differences in emotion regulation and their

potential antecedents.

Individual Differences in Affect Regulation 337

Difficulties in Emotion

Regulation Scale

Gratz and Roemer (2004) defined emotion

regulation competencies almost as broadly

as did Saarni (1999), whose influence they

acknowledge: “(a) awareness and under-

standing of emotions, (b) acceptance of emo-

tions, (c) ability to control impulsive behav-

iors and behave in accordance with desired

goals even when experiencing negative emo-

tions, and (d) ability to use situationally

appropriate regulation strategies flexibly to

modulate emotional responses as desired

in order to meet individual goals and situ-

ational demands” (p. 42).

In devising measures of these four compe-

tency constructs, Gratz and Roemer (2004,

see p. 44) were influenced by the content of

Salovey et al.’s (1995) TMMS scales, as well

as by the older NMR, which they used as a

template to structure the format of some of

the items. Specifically, they wrote their items

assessing difficulties with regulating emo-

tions during times of distress using the same

general format as the NMR. Thus, many

of their items begin with the sentence stem

“When I’m upset, I . . . ” This focus on a

global negative affect (upset) is a feature that

both the NMR and the Difficulties in Emo-

tion Regulation Scale (DERS) share with the

coping scales discussed earlier.

The 36-item DERS has six subscales.

Note that because the authors are interested

in dysregulation and its link to psychopa-

thology, they score all the subscales in terms

of difficulties with various competencies

considered important for emotion regula-

tion. Possibly as a result of this naming con-

vention, several of the DERS subscales have

vague or confusing names. It is thus impera-

tive to review the items that make up each

scale to ascertain what is being measured.

Two subscales seem rather similar to

existing TMMS scales but label the opposite

pole: (1) Lack of Emotional Awareness (e.g.,

“I pay attention to how I feel”—reverse

scored; emphasis added) captures the low

pole of the TMMS Attention scale; (2) Lack

of Emotional Clarity (e.g., “I am clear about

my feelings”—reverse scored; emphasis

added) is very similar to the low pole of the

TMMS Clarity scale.

Two other subscales seem to assess cop-

ing styles: (3) Nonacceptance of Emotional

Responses (e.g., “When I’m upset, I feel

ashamed with myself for feeling that way”;

emphasis added) seems similar to ineffective

coping scales such as Self- Blaming, which

might be a simpler yet clearer label for this

subscale; (4) Difficulties Engaging in Goal-

Directed Behavior (e.g., “When I’m upset,

I have difficulty thinking about anything

else”; emphasis added) seems to involve not

goal- directed behavior per se but ineffec-

tive attentional deployment (Gross, 1998)

and resembles what Nolen- Hoeksema et al.

(1994) conceptualized as ruminative coping

(i.e., difficulty shifting attention and disen-

gaging from a preoccupying affective state).

Finally, (5) the Impulse Control Diffi-

culties subscale (e.g., “When I’m upset, I

become out of control”) is similar to Impulse

Strength or Intensity scales (e.g., Gross &

John, 1997, 1998) that describe individu-

als who have very strong feelings that are

hard to control; and (6) the subscale Lim-

ited Access to Effective Emotion Regulation

Strategies (e.g., “When I’m upset, I believe

that there is nothing I can do to make myself

feel better” and “When I’m upset, I believe

that wallowing in it is all I can do”; empha-

ses added) is similar to the earlier NMR

Belief scale and seems to capture the low

pole of Tamir, John, Srivastava, and Gross’s

(2007) measure of Emotion Regulation Self-

Efficacy Beliefs (see Table 20.1).

As with the NMR and the TMMS, these

six subscales do not differentiate between

kinds of regulatory strategies. As with the

coping measures in the previous section,

discriminant validity has been noted as a

potential problem with the DERS, because

some of the scale intercorrelations exceed

.60 and the subscales tend to correlate simi-

larly with indicators of distress or dysfunc-

tion (e.g., Weinberg & Klonsky, 2009). All

six subscales are often simply summed to

obtain an overall dysregulation score.

The DERS (and its Adolescent version)

is increasingly being used in studies of

adult pathology and child disorders; find-

ings show that scores on the DERS are

correlated with rather diverse psychologi-

cal problems, such as depression, anxiety,

suicidal ideation, eating disorders, alcohol

use, and drug use (e.g., Weinberg & Klon-

sky, 2009). Such a sweeping pattern of

maladjustment correlates may indicate that

the DERS assesses a rather undifferenti-

338 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

ated self- presentation as a troubled person:

Such individuals are overwhelmed by strong

affective impulses they do not understand,

and they feel no confidence (self- efficacy)

that they can control these impulses. With-

out some evidence of discriminant validity,

it is difficult to interpret correlations of the

DERS with indicators of psychopathology.

Overall, it is not clear which of these six

subscales was intended to capture the core

regulatory concept defined as the “ability

to use situationally appropriate regulation

strategies flexibly to modulate emotional

responses” (Gratz & Roemer, 2004, p. 42).

Certainly, use of the DERS for individual

cases in clinical and applied contexts seems

premature.

Emotional Intelligence Test

We have seen repeatedly that the emotional

competence approach conceptualizes emo-

tion regulation in terms of a number of spe-

cific abilities. Yet all the measures we have

discussed so far have used self- report ques-

tionnaire methodology: that is, research-

ers assess self- perceptions (including self-

efficacy beliefs) and typical experiences and

behaviors. In fact, we have seen that some

of these “competence” scales can be diffi-

cult to differentiate from coping styles. This

is hardly a foolproof way to assess ability

constructs, which are usually measured in

terms of carefully controlled maximum per-

formance tests of the behavior or process in

question.

Considerable credit is due to Mayer,

Salovey, and Caruso (2002), who acknowl-

edged this methodological inconsistency

and tackled the difficult task of construct-

ing a test of emotional intelligence that

is scored in terms of correct and incorrect

answers, namely, the Mayer– Salovey–

Caruso Emotional Intelligence Test (abbre-

viated MSCEIT). They define emotional

intelligence as a set of skills involved in the

processing of emotion- relevant informa-

tion. Due to space limitations, of the four

MSCEIT components, we briefly address

only the component that is most relevant

here, namely, emotion management ability,

which they define as the capacity to reduce,

increase, or maintain particular emotions

in both oneself and other people. The tasks

they use to measure these abilities require

respondents to react to hypothetical scenar-

ios and evaluate the effectiveness of various

behaviors and subjective construals for emo-

tion management purposes. For example,

participants are asked to judge the effective-

ness of strategies to help a friend enhance a

joyful mood or reduce feelings of sadness.

Unfortunately, scientific evaluation and

research use of the MSCEIT are hindered,

because the test is owned by a commer-

cial “test publisher (who) does not autho-

rize reproduction of actual test items”

(e.g., Lopes, Salovey, Côté, & Beers, 2005,

p. 114); thus, we are allowed to provide here

only two abridged examples that were pub-

lished in this form by Lopes et al. (2005,

pp. 114–115), each consisting of a vignette

paired with separate response options:

Debbie just came back from vacation. She was

feeling peaceful and content. How well would

each action preserve her mood? (1) She started

to make a list of things at home that she needed

to do. (2) She began thinking about where and

when to go on her next vacation. (3) She called

a friend to tell her about the vacation . . .

Ken and Andy have been good friends for over

10 years. Recently, however, Andy was pro-

moted and became Ken’s manager. Ken felt

that the new promotion had changed Andy

in that Andy had become very bossy to him.

How effective would Ken be in maintaining

a good relationship, if he chose to respond in

each of the following ways? (1) Ken tried to

understand Andy’s new role and tried to adjust

to the changes in their interactions. (2) Ken

approached Andy and confronted him regard-

ing the change in his behavior . . .

These examples are from the fourth (Man-

aging Emotions) “branch” of the MSCEIT,

which comprises two distinct tasks. Five

vignettes measure ability in emotion man-

agement, and each describes a person (like

Debbie) who is experiencing a mood or

emotion. For each of the five vignettes, the

respondent rates (on a 5-point scale) how

effective four different actions would be for

obtaining a specified effect on the person’s

experience (here, to preserve Debbie’s good

mood), yielding a total of 20 separate rat-

ings. The second task measures emotional

relationship abilities and comprises three

vignettes describing relationships between

persons (like Ken and Andy). In each

Individual Differences in Affect Regulation 339

vignette, the respondent rates how effective

three different actions would be to maintain

a good relationship between the persons, for

a total of nine separate ratings. Each of the

29 individual ratings is scored according to

normative effectiveness ratings provided by

a panel of emotion experts or the group con-

sensus.

Although abbreviated, these two exam-

ples are very instructive. First, they illustrate

that the total emotion management ability

score includes more than 30% of ratings that

assess not emotional but relational skills,

raising questions about content validity. Sec-

ond, each vignette and action includes a lot

of detailed contextual information specific

to that rating, which adds error and keeps

interitem correlations, and thus reliability,

low; with 29 ratings aggregated into the

total score, reliability in this study was a

measly .63, and that is higher than in other

studies (see Føllesdal & Hagtvet, 2009, for

a thoughtful psychometric analysis and cri-

tique). Third, as the MSCEIT authors read-

ily acknowledge, these vignette ratings do

not actually measure individual differences

in skillful or effective regulation scored or

observed objectively in an emotional situa-

tion; instead they tap the individual’s knowl-

edge, and capacity to reason, about emo-

tions and emotional situations (e.g., Lopes

et al., 2005, p. 114). Fourth, the emphasis

on knowledge and complex reasoning pro-

cesses is likely to introduce correlations with

measures of other abilities, creating dis-

criminant validity problems. Fifth, because

there are interpersonal themes even in the

emotion management vignettes (e.g., calling

a friend to share one’s mood, thus capital-

izing on the experience), performance on

these items may yield surprising correlations

with personality variables, again introduc-

ing potential problems with discriminant

validity. In response to these discriminant

validity concerns, the test authors and their

collaborators have tried to demonstrate that

the MSCEIT predicts social, emotional, and

leadership outcomes even when intelligence

and broad personality traits are controlled.

So far, however, many researchers have

remained unconvinced; the MSCEIT, and

emotional intelligence research more gener-

ally, is viewed with some skepticism among

researchers (e.g., Landy, 2005; Joseph &

Newman, 2010).

For example, Lopes et al. (2005) obtained

eight criterion measures (e.g., interpersonal

sensitivity; socioemotional competence;

friendship nominations) with self- ratings

or peer nominations. When the personal-

ity traits measured by the Big Five Inven-

tory (John et al., 2008) were controlled, the

MSCEIT emotion management ability scale

still significantly predicted two of these cri-

teria. However, with two out of eight signifi-

cant correlations, it is hard to say whether

the predictive validity goblet is a quarter full

or three quarters empty. Of greater interest

to personality researchers is a finding not

highlighted by the authors: By far the high-

est correlation (r = .40) was not found with

any of the eight predicted socioemotional

outcome measures but, somewhat unexpect-

edly, with the Big Five trait of Agreeableness.

In conclusion, the MSCEIT, though an

admirable and conceptually interesting

undertaking, has not proven to be the deci-

sive fix for the less compelling self- report

measures of emotional “competencies” that

have come before it. Even though, as outsid-

ers, we do not know much about the inner

workings of the MSCEIT, it seems unlikely

that a measure consisting of only five emo-

tion management vignettes and three rela-

tionship vignettes can provide the conceptual

building blocks needed to construct a com-

prehensive conception of emotion regulation

in terms of specific competencies. More gen-

erally, the emotional competence approach

(e.g., Saarni, 1999) includes all manner of

cognitive, behavioral, self- perception, and

emotion perception processes under one

broad rubric. This conceptual richness and

reach, and the resulting complexity, is theo-

retically appealing but may be keeping this

approach from achieving its full empirical

potential. Fewer constructs, more narrowly

delineated distinctions, and tighter links

between construct definitions and actual

measures (and items) may prove a fruitful

avenue for future research on the vast dif-

ferences in people’s emotional competence.

Continuing Issues, Limitations,

and Future Directions

In this brief and necessarily limited review,

we have covered almost 50 scales purporting

to measure individual differences in affec-

340 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

tive regulation. Our review suggests that

the most recent arrivals show a great deal

of redundancies with their forebears, such

as the newer CERQ with the older COPE,

and the newer DERS with the older NMR

and TMMS. In our view, the time has come

to stop the proliferation of self- report scales

and to begin a moratorium that refocuses on

solid theory development.

The Need for an Integrative

Framework and for

Mediation Research

In addition to a great number of affect regu-

lation concepts and scales, we have touched

upon a number of factors that predict or

influence individual differences in emotion

regulation. As a first, modest step toward a

broader framework, we have organized these

variables in the first two columns of Figure

20.6. In the first column we have included

broad person factors that we expect to shape

the acquisition and use of particular emo-

tion regulation strategies, such as gender

socialization, acculturation, and aging, all of

which have been shown to predict individual

differences in emotion regulation in adult-

hood. Broad personality factors, attachment,

and cognitive ability factors also need to be

considered, even if only as control variables,

as we have seen in the debate over the valid-

ity and utility of the MSCEIT.

The effects of gender, acculturation,

and aging on regulation are unlikely to be

direct and thus will need to be explained. In

research on naturally occurring individual

differences, explanatory research usually

takes the form of mediation designs, such

as the one depicted in Figure 20.4. In this

example, the increasing adoption of cul-

turally transmitted values associated with

independent (but not interdependent) self-

construal is the mechanism through which

greater acculturation to Western practices

and values leads Asian immigrants to use

suppression less and less frequently the lon-

ger they live in the United States. Another

example is a recent series of studies show-

ing that the link between habitual suppres-

sion and negative social consequences (see

Figure 20.5; consequences of regulation are

not shown in Figure 20.6) can be explained

by individual differences in authenticity in

young and older adults, as well as in samples

from the United States and China (English

& John, 2013).

More generally, we recommend that the

field increase recent efforts (see Table 20.1)

to link values, goals, and other motivational

factors, as well as beliefs, norms, and expec-

tations, to emotion regulation, both concep-

tually and empirically. We have organized

these social- cognitive processing character-

istics into four boxes in the middle column

of Figure 20.6, with arrows indicating that

these concepts have the greatest promise for

explanatory accounts.

Finally, Figure 20.6 also illustrates our

hypotheses about where cognitive meta-

mood processes may belong in such an inte-

grative framework. In particular, attention

to emotional experience, awareness of emo-

tional experience, and clarity of emotional

experience do not seem to us to be isomor-

phic with regulatory processes. Rather, these

cognitive meta-mood processes seem to be

important antecedents that can trigger, help,

or hinder the use of various, more or less

effective regulatory processes. For exam-

ple, Scheier and Carver (1977) showed that

focusing attention on an emotional state can

result in both intensification of that state

and clarification; intensification may make

subsequent regulation efforts less effective,

whereas greater clarity may have the oppo-

site effect. In other words, the nature and

causal direction of the relationships among

the concepts in Figure 20.6 needs to be

tested empirically.

The Need to Expand Beyond Habitual

Measures of Individual Differences

It is time to acknowledge some limitations

in our coverage and in the work presented

here. We have focused almost exclusively on

habitual differences in affective regulation,

which implies that the individual differences

under study show at least some consistency

over time and may in fact be chronic in

nature. It is true that in all three approaches

reviewed here, habitual concepts represent

the lion’s share of the work, but other kinds

of individual differences in emotion regula-

tion have been studied (see the third column

of Figure 20.6). For example, a number of

recent studies have examined situationally

Individual Differences in Affect Regulation 341

flexible and spontaneous use of emotion reg-

ulation as well as abilities. Using a longitudi-

nal design, Srivastava et al. (2009) explicitly

differentiated habitual or stable use from

dynamic use of suppression during the tran-

sition from high school and home town to

college; they found considerable change dur-

ing this transition, with suppression use tem-

porarily increasing as students constructed

new friendship networks. Feinberg, Willer,

Antonenko, and John (2012) studied spon-

taneous, rather than habitual, emotion regu-

lation. In one study, they had subjects make

moral judgments about a variety of dis-

gusting (but not unethical) behaviors; cod-

ing thought protocols, they tested whether

some individuals had spontaneously used

reappraisal to down- regulate their disgust

response and, in turn, made less affectively

driven and therefore less moralistic judg-

ments about the behaviors.

We have also not been able to cover recent

efforts to extend ERQ work to the domain

of individual differences in emotion regula-

tion ability, such as actual differences in the

effectiveness of reappraisal as assessed with

laboratory procedures (e.g., McRae et al.,

2012; Troy, Willhelm, Shallcross, & Mauss,

2010) and self- perceived differences in effec-

tiveness in implementing an instructional

set in the laboratory (e.g., Gruber, Har-

vey, & Gross, 2012). This is exciting work,

and we are looking forward to seeing more

diverse individual- difference measures that

go beyond the existing measures of habitual

emotion regulation.

Limitations and Future Directions

in Research on Specific Emotion

Regulation Processes

Finally, lest we forget, we must acknowledge

some fundamental limitations of previous

research using the ERQ. Whereas much of

the work in the coping approach has focused

specifically on negative affect and stress-

ful situations, work using the ERQ (e.g.,

English et al., 2012) has studied individual

differences more generally, measuring reap-

praisal and suppression at the global regula-

tory process level, shown as Level 2 in the

hierarchical model in Figure 20.7. Certainly,

the level of specific regulatory processes is

preferable to the even more abstract level of

general emotional control (Level 1). How-

ever, the choice of Level 2 (e.g., Gross &

John, 2003) should not be taken as an indi-

cation that theorists believe regulatory pro-

cesses operate exactly in the same way for

positive and negative emotions (Level 3), or

that there are no important regulatory differ-

ences (at Level 4) between discrete negative

emotions, such as anger and fear, or positive

emotion, such as pride and joy (e.g., Shiota,

Keltner, & John, 2006). Indeed, theoreti-

cal accounts of Asian–White differences in

emotion suggest that Asians’ greater use of

suppression is particularly pronounced for

emotions that are positive and highly acti-

vated, such as pride and love. Along similar

lines, Larsen (2000) suggested that suppres-

sion might be “more effective for controlling

affects with clear expressive components,

such as angry moods, compared to affects

that are not clearly expressive, such as lone-

liness” (p. 138). Webb et al. (2012) note that

even in the experimental literature few stud-

ies compared the effectiveness of a particu-

lar strategy in regulating different emotions.

This is certainly an important new direction

in research on individual differences as well.

Indeed, as shown in Figure 20.7, our con-

ceptual framework needs to be extended even

further downward to include contextual fac-

tors (at Level 5) that change the meaning of

the emotion for the individual; for example,

an Asian American feeling pride in a col-

lective context (e.g., feeling proud of the

achievements of a younger sibling) should

suppress much less than he or she would in

an individualistic context (e.g., having won

a prize for personal achievement). Finally,

research on individual differences with the

ERQ has focused on two important regula-

tory processes, reappraisal and suppression.

Future research needs to extend this focus

along the horizontal dimension of Level 2

shown in Figure 20.7 and add exemplars of

the other three families of regulatory pro-

cesses in Gross’s process model (see Figure

20.2), namely, situation selection, situation

modification, and attention deployment. We

have discussed these processes conceptually

throughout this chapter, but we have not yet

measured them in terms of individual differ-

ences. In brief, there is plenty left to do. It is

an exciting time to be working on individual

differences in affect regulation.

342

Emotional Control

Reappraisal Suppression

Negative

Fear Anger

Positive

Pride Joy

Negative

Fear Anger

Positive

Pride Joy

Individual

(e.g., of self)

Collective

(e.g., of family member)

Low Status

(e.g., with boss)

High Status

(e.g., with employee)

Level 1

Global

Regulation

Level 2

Regulatory

Process

Level 3

Emotion

Valence

Level 4

Specific

Emotion

Level 5

Context

FIGURE 20.7. Hierarchical framework for the study of individual differences in emotion regulation. Emotion regulation is conceptualized at five levels of

abstraction: (1) global emotional control, (2) particular regulatory processes, (3) regulation of positive and negative emotion, (4) regulation of specific emotions,

and (5) regulation of specific emotions in particular contexts.

Individual Differences in Affect Regulation 343

Acknowledgments

This work was supported in part by a Retire-

ment Research Foundation grant and a Faculty

Research Grant (University of California, Berke-

ley) to Oliver P. John, and by a National Science

Foundation Graduate Research Fellowship and a

Dissertation Year Fellowship (University of Cali-

fornia, Berkeley) to Joshua S. Eng.

References

Abler, B., & Kessler, H. (2009). Emotion Regu-

lation Questionnaire: A German version of

the ERQ by Gross & John. Diagnostica, 55,

144–152.

Aldao, A., Nolen- Hoeksema, S., & Schweizer, S.

(2010). Emotion- regulation strategies across

psychopathology: A meta- analytic review.

Clinical Psychology Review, 30, 217–237.

Anderson, C., John, O. P., Keltner, D., & Kring,

A. M. (2001). Who attains social status?

Effects of personality and physical attractive-

ness in social groups. Journal of Personality

and Social Psychology, 81, 116–132.

Balzarotti, S., John, O. P., & Gross, J. J. (2010).

An Italian adaptation of the Emotion Regula-

tion Questionnaire. European Journal of Psy-

chological Assessment, 26, 61– 67.

Bariola, E., Gullone, E., & Hughes, E. K. (2011).

Child and adolescent emotion regulation:

The role of parental emotion regulation and

expression. Clinical Child and Family Psycho-

logical Review, 14, 198–212.

Baumeister, R. F., Zell, A. L., & Tice, D. M.

(2007). How emotions facilitate and impair

self- regulation. In J. J. Gross (Ed.), Handbook

of emotion regulation (pp. 408–426). New

York: Guilford Press.

Block, J. H., & Block, J. (1980). The role of ego-

control and ego resiliency in the organization

of behavior. In W. A. Collins (Ed.), Minne-

sota Symposia on Child Psychology (Vol. 13,

pp. 39–101). Hillsdale, NJ: Erlbaum.

Carver, C. S., & Scheier, M. F. (1994). Situ-

ational coping and coping dispositions in a

stressful transaction. Journal of Personality

and Social Psychology, 66, 184–195.

Carver, C. S., Scheier, M. F., & Weintraub, J. K.

(1989). Assessing coping strategies: A theoreti-

cally based approach. Journal of Personality

and Social Psychology, 56, 267–283.

Catanzaro, S. J., & Mearns, J. (1990). Mea-

suring generalized expectancies for negative

mood regulation: Initial scale development

and implications. Journal of Personality

Assessment, 54, 546–563.

de Ridder, D. (1997). What is wrong with coping

assessment?: A review of conceptual and meth-

odological issues. Psychology and Health, 12,

417– 431.

Ekman, P. (1972). Universals and cultural dif-

ferences in facial expression of emotion. In

J. Cole (Ed.), Nebraska Symposium on Moti-

vation (pp. 207–283). Lincoln: University of

Nebraska Press.

Eng, J., Akutsu, S., Gross, J. J., & John, O. P.

(2013). Emotion regulation in East Asian and

European Americans: Effects of regulatory

strategy, emotion, and independent construal.

Unpublished manuscript, Department of Psy-

chology, University of California, Berkeley.

English, T., & John, O. P. (2013). Understanding

the social effects of emotion regulation: The

mediating role of authenticity for individual

differences in suppression. Emotion, 13, 314–

329.

English, T. E., John, O. P., & Gross, J. J. (2013).

Emotion regulation in close relationships. In J.

A. Simpson & L. Campbell (Eds.), The Oxford

handbook of close relationships (pp. 500–

513). Oxford, UK: Oxford University Press.

English, T. E., John, O. P., Srivastava, S., &

Gross, J. J. (2012). Emotion regulation and

peer-rated social functioning: A 4-year longi-

tudinal study. Journal of Research in Person-

ality, 46, 780–784.

Feinberg, M., Willer, R., Antonenko, O., &

John, O. P. (2012). Liberating reasons from

passion: Overriding intuitionist moral judg-

ments through emotion reappraisal. Psycho-

logical Science, 23, 788–795.

Folkman, S., & Lazarus, R. S. (1980). An analy-

sis of coping in a middle- aged community

sample. Journal of Health and Social Behav-

ior, 21, 219–239.

Folkman, S., & Lazarus, R. S. (1985). If it

changes it must be a process: Study of emo-

tion and coping during three stages of a col-

lege examination. Journal of Personality and

Social Psychology, 48, 150–170.

Folkman, S., & Lazarus, R. S. (1988). Manual

for the Ways of Coping Questionnaire. Palo

Alto, CA: Consulting Psychology Press.

Føllesdal, H., & Hagtvet, K. A. (2009). Emo-

tional intelligence: The MSCEIT from the

perspective of generalizability theory. Intelli-

gence, 37, 94–105.

Garnefski, N., & Kraaij, V. (2007). The Cogni-

344 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

tive Emotion Regulation Questionnaire: Psy-

chometric features and prospective relation-

ships with depression and anxiety in adults.

European Journal of Psychological Assess-

ment, 23, 141–149.

Gratz, K. L., & Roemer, L. (2004). Multidi-

mensional assessment of emotion regulation

and dysregulation: Development, factor struc-

ture, and initial validation of the Difficulties

in Emotion Regulation Scale. Journal of Psy-

chopathology and Behavioral Assessment, 26,

41–54.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp.

3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (1997). Revealing

feelings: Facets of emotional expressivity in

self-

eports, peer ratings, and behavior. Jour-

nal of Personality and Social Psychology, 72,

435–448.

Gross, J. J., & John, O. P. (1998). Mapping the

domain of emotional expressivity: Multi-

ethod evidence for a hierarchical model.

Journal of Personality and Social Psychology,

74, 170–191.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85, 348–362.

Gross, J. J., & Levenson, R. W. (1993). Emo-

tional suppression: Physiology, self-

port,

and expressive behavior. Journal of Personal-

ity and Social Psychology, 64, 970–986.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp.

3–24). New York: Guilford Press.

Gross, J. J., Richards, J. M., & John, O. P. (2006).

Emotion regulation in everyday life. In D. K.

Snyder, J. A. Simpson, & J. N. Hughes (Eds.),

Emotion regulation in families and close rela-

tionships: Pathways to dysfunction and health

(pp.

13–35). Washington, DC: American Psy-

chological Association.

Gruber, J., Harvey, A. G., & Gross, J. J. (2012).

When trying is not enough: Emotion regula-

tion and the effort-

uccess gap in bipolar dis-

order.

Emotion, 12, 997–1003.

Gullone, E., & Taffe, J. (2012). The Emotion

Regulation Questionnaire for Children and

Adolescents (ERQ–CA): A psychometric

evaluation. Psychological Assessment, 24,

409– 417.

John, O. P., & Gross, J. J. (2004). Healthy and

unhealthy emotion regulation: Personality

processes, individual differences, and lifes-

pan development. Journal of Personality, 72,

1301–1334.

John, O. P., & Gross, J. J. (2007). Individual

differences in emotion regulation strategies:

Links to global trait, dynamic, and social cog-

nitive constructs. In J. J. Gross (Ed.), Hand-

book of emotion regulation (pp.

351–372).

New York: Guilford Press.

John, O. P., Naumann, L. P., & Soto, C. J. (2008).

Paradigm shift to the integrative Big Five trait

taxonomy: History, measurement, and con-

ceptual issues. In O. P. John, R. W. Robins,

& L. A. Pervin (Eds.), Handbook of personal-

ity: Theory and research (pp.

114–158). New

York: Guilford Press.

Joseph, D. L., & Newman, D. A. (2010). Emo-

tional intelligence: An integrative meta-

nalysis and cascading model. Journal of

Applied Psychology, 95, 54–78.

Knobloch, L. K., & Metts, S. (2013). Emotion in

relationships. In J. A. Simpson & L. Campbell

(Eds.), The Oxford handbook of close rela-

tionships (pp. 514–534). Oxford, UK: Oxford

University Press.

Kring, A. M., & Sloan, D. S. (Eds.). (2009).

Emotion regulation and psychopathology:

A transdiagnostic approach to etiology and

treatment. New York: Guilford Press.

Landy, F. (2005). Some historical and scientific

issues related to research on emotional intel-

ligence. Journal of Organizational Behavior,

26, 411–424.

Larsen, R. J. (2000). Toward a science of mood

regulation. Psychological Inquiry, 11, 129–

141.

Lazarus, R. S. (2000). Toward better research on

stress and coping. American Psychologist, 55,

665–673.

Lazarus, R. S., & Folkman, S. (1984). Stress,

appraisal and coping. New York: Springer.

Lopes, P. N., Salovey, P., Côté, S., & Beers, M.

(2005). Emotion regulation ability and the

quality of social interaction. Emotion, 5, 113–

118.

Matsumoto, D., Yoo, S. H., Nakagawa, S., Alex-

andre, J., Altarriba, J., Anguas-Wong, A. M.,

Individual Differences in Affect Regulation 345

et al. (2008). Culture, emotion regulation, and

adjustment. Journal of Personality and Social

Psychology, 94, 925–937.

Mauss, I. B., Shallcross, A. J., Troy, A. S., John,

O. P., Ferrer, E., Wilhelm, F. H., et al. (2011).

Don’t hide your happiness! Positive emotion

dissociation, social connectedness, and psy-

chological functioning. Journal of Personality

and Social Psychology, 100, 738–748.

Mayer, J. D., & Gaschke, Y. N. (1988). The

experience and meta-

xperience of mood.

Journal of Personality and Social Psychology,

55, 102–111.

Mayer, J. D., Salovey, P., & Caruso, D. R. (2002).

MSCEIT user’s manual. Toronto: Author.

McRae, K., Jacobs, S. E., Ray, R. D., John, O.

P., &

Gross, J. J. (2012). Individual differ-

ences in reappraisal ability: Links to reap-

praisal frequency, well-being, and cognitive

control. Journal of Research in Personality, 7,

253–262.

Morris, A. S., Silk, J. S., Steinberg, L., Myers,

S. S., & Robinson, L. R. (2007). The role

of the family context in the development of

emotionregulation. Social Development, 16,

362–388.

Nolen-

oeksema, S., Parker, L. E., & Larson,

J. (1994). Ruminative coping with depressed

mood following loss. Journal of Personality

and Social Psychology, 67, 92–104.

Parker, J. D. A., Endler, N. S., & Bagby, R. M.

(1993). If it changes, it might be unstable:

Examining the factor structure of the ways of

coping questionnaire. Psychological Assess-

ment, 5, 361–368.

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79, 410–424.

Saarni, C. (1999). The development of emo-

tional competence. New York: Guilford Press.

Saarni, C. (2011). Emotional development in

childhood. In R. E. Tremblay, R. G. Barr, R.

DeV. Peters, & M. Boivin (Eds.), Encyclopedia

on early childhood development: Emotions

(pp.

1–7). Montréal: Centre of Excellence for

Early Childhood Development and Strategic

Knowledge Cluster on Early Child Develop-

ment.

Salovey, P., Mayer, J. D., Golman, S. L., Turvey,

C., & Palfai, T. P. (1995). Emotional attention,

clarity, and repair: Exploring emotional intel-

ligence using the Trait Meta-Mood Scale. In

J. W. Pennebaker (Ed.), Emotion, disclosure,

and health (pp.

125–154). Washington, DC:

American Psychological Association.

Scheier, M. F., & Carver, C. S. (1977). Self-

ocused attention and the experience of

emotion: Attraction, repulsion, elation, and

depression. Journal of Personality and Social

Psychology, 35, 625–636.

Shaver, P. R., & Mikulincer, M. (2007). Adult

attachment strategies and the regulation of

emotion. In J. J. Gross (Ed.), Handbook of

emotion regulation (pp.

446–465). New York:

Guilford Press.

Shiota, L., Keltner, D., & John, O. P. (2006).

Positive emotion dispositions differentially

associated with Big Five personality and

attachment style. Journal of Positive Psychol-

ogy, 1, 61–71.

Srivastava, S.,

Tamir, M., McGonigal, K. M.,

John, O. P., & Gross, J. J. (2009). The social

costs of emotional suppression: A prospective

study of the transition to college. Journal of Per-

sonality and Social Psychology, 96, 883 –897.

Tamir, M., John, O. P., Srivastava, S., & Gross, J.

J. (2007). Implicit theories of emotion: Affec-

tive and social outcomes across a major life

transition. Journal of Personality and Social

Psychology, 92, 731–744.

Troy, A. S., Willhelm, F. H., Shallcross, A. J.,

& Mauss, I. B. (2010). Seeing the silver lin-

ing: Cognitive reappraisal ability moderates

the relationship between stress and depressive

symptoms. Emotion, 10, 783–795.

Weinberg, A., & Klonsky, E. (2009). Measure-

ment of emotion dysregulation in adolescents.

Psychological Assessment, 21, 616– 621.

Webb, T. L., Miles, E., & Sheeran, P. (2012).

Dealing with feeling: A meta-

nalysis of the

effectiveness of strategies derived from the

process model of emotion regulation. Psycho-

logical Bulletin, 138, 775–808.

Westen, D., & Blagov, P. S. (2007). A clinical–

mpirical model of emotion regulation: From

defense and motivated reasoning to emotional

constraint satisfaction. In J. J. Gross (Ed.),

Handbook of emotion regulation (pp.

373–

392). New York: Guilford Press.

346

Desires pervade everyday life. Accordingly,

our language is filled with metaphors of how

we experience and deal with desire:

We burn and are aflame with desire; we are

pierced by or riddled with desire; we are sick or

ache with desire; we are tortured, tormented,

and racked by desire; we are possessed, seized,

ravished, and overcome by desire; . . . our

desire is fierce, hot, intense, passionate, incan-

descent, and irresistible; . . . We battle, resist,

and struggle with, or succumb, surrender to,

and indulge our desires. (Belk, Ger, & Askeg-

aard, 2000, p. 99)

Even though the described struggle with

desire is primarily mental, the downstream

implications of poor desire regulation can

be enormous, such as when political leaders

lose their jobs over a scandalous love affair.

Additionally, public health statistics show

that 40% of deaths in the United States

each year are associated with unhealthy

behaviors— behaviors that are at least par-

tially attributable to the way people deal

with certain appetitive desires, such as

those for unhealthy foods, tobacco, alcohol,

unprotected sex, and illicit drugs (Schro-

eder, 2007). From this perspective, gaining

a better understanding of how and when

desires impact behavior and how unwanted

desires may be successfully regulated is

clearly needed.

With this chapter, we hope to show that

some new insights may be gleaned by treat-

ing desires as emotions and, consequently,

desire regulation as an instance of emo-

tion regulation. In our reading, the issues

of desire and desire regulation have been

studied primarily from the vantage point

of addiction research, clinical research,

and cognitive neuroscience. Applying some

of the insights gained from the burgeoning

emotion regulation literature to the desire

case may broaden our understanding of the

problem at hand and open up new avenues

of inquiry.

We believe that an emotion regulation per-

spective on desire may also benefit the field

of self- control. That is, a focus on desire

and its regulation, may be helpful, wherever

the motivational conflicts under study can

be framed as a struggle between immediate

desires (e.g., for tasty food, alcoholic drinks,

sexual interaction) and self- regulatory goals

and values (e.g., maintaining one’s weight,

not driving drunk, staying faithful). Such

conflicts arguably make up a great deal of

self- control situations in everyday life. Yet

until recently, they have been mainly stud-

ied under the rubric of goal conflicts (e.g.,

a short-term goal to eat tasty chocolate vs.

a long-term goal to lose weight). While such

a terminology is parsimonious and helpful

in many respects, it may not get at a deeper

CHAPTER 21

Desire and Desire Regulation:

Basic Processes and Individual Differences

Wilhelm Hofmann

Hiroki P. Kotabe

Desire and Desire Regulation 347

understanding of the specific characteris-

tics of the two opponents involved in such

motivational struggles (two opponents,

which we argue, are quite different). That

is, by framing the short-term goal as “just”

another goal, we might miss a closer analysis

of the driving force (i.e., of desire) behind

that short-term motivation, the specific laws

that trigger this driving force, and the most

effective strategies to tame it. By treating

desire as an essentially emotional phenom-

enon (involving motivational and cognitive

components), we can begin to ask more spe-

cific questions about how desire waxes and

wanes in close interaction with environmen-

tal characteristics and how it can be strategi-

cally up- or down- regulated.

Accordingly, self- control researchers have

begun to scrutinize the driving forces under-

lying many self- control struggles (Hofmann,

Friese, & Strack, 2009; Hofmann & Van

Dillen, 2012) and to look at how factors

commonly thought to impact people’s con-

trol capacity might also affect the strength

of desires and cravings (Schmeichel, Har-

mon-Jones, & Harmon-Jones, 2010; Vohs

et al., 2012). By and large, the science of

self- control appears to be shifting toward

the more balanced view that for many self-

control situations, the role of desire is just as

important and vital to our understanding as

the role of restraint (Hofmann & Van Dil-

len, 2012).

To advance an emotion regulation per-

spective on desire, we address the following

three major questions in this chapter:

1. What are the main characteristics of

desire?

2. How can desire be successfully regu-

lated?

3. How does personality shape desire expe-

riences and desire regulation?

Desire Characteristics

Colloquially, there are many usages of the

word desire, especially as a verb to express

all kinds of wishes and wants (e.g., “I desire

that there be more rainbows next year”).

Here, we focus exclusively on so- called

appetitive desires, which are those motiva-

tions that propel us to approach and con-

sume objects or otherwise engage in activi-

ties that provide a relative gain in immediate

pleasure (including relief from discomfort).

Appetitive desires, in the narrow sense, are

typically rooted in primary or acquired

physiological need states, such as the desires

for food and drink, alcohol, sex, a cigarette,

and sleep (no story line intended here); how-

ever, we would also include more second-

ary, socially learned desires (e.g., the urge

to check one’s smartphone for new messages

or the desire to watch a favorite TV show)

in a broader definition of appetitive desires.

We therefore use the term desire to refer to

appetitive desires of all sorts. Moreover, we

use the term craving to refer to desires across

domains that are particularly high- intensity

(e.g., drug craving, food craving).

Desire as Emotion

In this chapter, we want to make a strong

case for treating desires as emotions. Why?

Because desires, in our view, share many

of the major hallmark characteristics of an

emotion (see Franken, 2003). Most impor-

tant, like emotions, desires are multifaceted

phenomena combining affective, motiva-

tional, and cognitive components (see Table

21.1).

First, desires have a clearly affective com-

ponent, consisting of a phenomenological

feeling of “wanting” of varying intensity.

On the stimulus side, we perceive objects of

desire as appealing; desires signal to us that

a given thing, person, or activity has high

momentary relevance against the backdrop

of our current goals, bodily need states,

and learning history. Although enacting or

thwarting desires may have various emo-

TABLE 21.1. Components of Desire

Component Description

Affective A feeling of “wanting” toward

certain appealing objects of desire

(things, activities, people).

Motivational A prepotent behavioral driving

force to acquire, consume, or be

close to the object of desire.

Cognitive Accompanying thoughts (e.g.,

expectations, images, and

fantasies) regarding the enactment

of desire.

348 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

tional consequences (more on this later),

desires, intrinsically, have a distinct emo-

tional experience to them, which is that phe-

nomenological feeling of wanting.

Second, like other emotions, desires pre-

pare and motivate behavior. Desiring some-

thing means wanting to have, consume, or

do something that we expect will yield plea-

sure (or reduce discomfort). When we desire

a cupcake, we expect its consumption to

provide us with a highly pleasurable experi-

ence. When a tobacco addict craves a ciga-

rette, he or she expects that smoking it will

alleviate distress (including, somewhat iron-

ically, the discomfort of deprivation created

by the addiction). Desires therefore motivate

us through their more or less explicit prom-

ise of pleasure or relief. Even though hedonic

motives may not be the only reasons we pur-

sue desires, we consider the striving for a

relative gain in immediate pleasure the pri-

mary motivational underpinning of desire.

Because desires are directed toward certain

objects (i.e., things, persons, activities), they

share a sense of “aboutness” (Higgins, 1998)

with all other emotions (e.g., being happy,

sad, angry, disgusted about something).

Their target- oriented nature distinguishes

them, among other things, from more dif-

fuse affective states such as mood.

Third, desires also have an important

cognitive component that is strongly inter-

twined with the aforementioned affective–

motivational components: According to

Kavanagh, Andrade, and May’s (2005)

elaboration– intrusion theory of desire,

desire is typically accompanied by intrusive

thoughts about the object of desire. Such

cognitions comprise expectations about the

consequences of desire enactment and the

feasibility of attaining the desired object,

as well as imagination and fantasies. These

cognitions may vary on a continuum, from

very realistic to very unrealistic (i.e., overly

optimistic), with stronger desires typically

leading to more biased and distorted cog-

nitions (Kavanagh et al., 2005). Moreover,

the interplay between cognition and affect

is recursive and dynamical; as a person

mentally elaborates a desire, its strength

increases, and more and more mental

resources are allocated to the desire, thus

lending desire its well-known potential to

escalate. As we elaborate below, this state of

affairs can reach a point where desire can

fully crowd out opposing mental represen-

tations such as those of self- control goals

(Hofmann, Friese, Schmeichel, & Baddeley,

2011; Hofmann & Van Dillen, 2012; Kava-

nagh et al., 2005).

Not All Desires Are Temptations

It is important to clarify that desires and

temptations are not synonyms. In our view,

temptations are a special subset of desires.

To say that somebody is “tempted” by some-

thing means that the person has a desire to do

A on one hand, and simultaneously has rea-

son not to do A (Mele, 2001). (In this chap-

ter we use the term temptation to refer to

the ambivalent psychological state of being

tempted, whereas we use tempting stimuli to

refer specifically refer to the external objects

that give rise to temptation.) Whether a

person has reason not to do A depends on

whether the behavior implied by the desire

conflicts with a person’s background set of

endorsed values and self- regulatory goals

(Hofmann, Baumeister, Förster, & Vohs,

2012). For instance, the desire for mousse

au chocolat seems harmless unless one sub-

scribes to a low-fat diet. Similarly, the desire

for physical closeness with an attractive

acquaintance may be completely unproblem-

atic unless one is subscribed to traditional

Western marriage, and—to add some fur-

ther intricacies—that acquaintance is also

one’s best friend’s spouse. The problem that

our appetitive desires are so strongly con-

nected to whatever provides us with imme-

diate pleasure or relief from discomfort on

a physiological basis, and that their impli-

cations may deviate from what is rationally

regarded as optimal, proper, or virtuous,

renders occasional self- control conflict an

inevitable feature of the human condition.

A recent experience- sampling project

called the “Everyday Temptations Study”

set out to collect base rate information on

the prevalence of desires and temptations

in everyday life (Hofmann, Baumeister,

et al., 2012; Hofmann, Vohs, & Baumeis-

ter, 2012). Participants were equipped with

smartphones for a week. On multiple random

occasions each day, they received a question-

naire via these smartphones and were asked

whether they were currently experiencing

a desire from a list of 15 desire domains,

including food, nonalcoholic drinks, sleep,

Desire and Desire Regulation 349

sex, social contact, leisure, sports, spending,

media, alcohol, tobacco, and other drugs.

Participants reported a current desire about

50% of the time they were signaled. The

lion’s share of desires were reported to be

unproblematic, that is, not in conflict with

other important goals (Hofmann, Baumeis-

ter, et al., 2012). However, more than one-

third of desires were experienced as conflict-

ing with important self- regulatory goals,

such as health goals (e.g., healthy eating,

bodily fitness), abstinence/restraint goals

(e.g., remaining abstinent, saving money,

being faithful), achievement- related goals

(e.g., educational achievements), social goals

(e.g., social recognition, moral integrity),

and time use goals (e.g., not delaying things)

(Hofmann, Vohs, et al., 2012). Although

there were some prominent connections

between specific desires and specific oppos-

ing goals (e.g., desire for tobacco ↔ reduc-

ing health damage; spending ↔ saving

expenses), desire– goal conflicts on average

were very multifaceted. Thus, one and the

same desire can be experienced as a tempta-

tion for many different reasons.

Linked Emotions

As noted earlier, the inherent affective core

of desire (the feeling of “wanting”) needs to

be distinguished from the emotional conse-

quences of desire enactment– nonenactment,

which we call linked emotions. The enact-

ment of desire is typically linked to a relative

short-term gain in pleasure resulting from

need satisfaction or relief from discomfort.

Conversely, the prolonged nonenactment of

desire typically leads to a period of frustra-

tion, until the motivational system man-

ages to disengage from the desire altogether

(Carver & Scheier, 1998). Note, however,

that the primary emotions of pleasure and

frustration need not be the only linked emo-

tions. In the case of temptation, things may

become more complicated: Because enact-

ing a temptation implies that one may have

violated important values relevant for one’s

identity, giving in to temptation may lead

to feelings of guilt or shame (Hofmann &

Fisher, 2012; Shiffman et al., 1997), on top

of pleasure. Conversely, not enacting a temp-

tation may trigger feelings of pride on top

of frustration. Thus, in contrast to unprob-

lematic desires, enacting temptations may at

times yield a combination of (positive and

negative) primary and secondary emotions

(pleasure and guilt; frustration and pride).

As we argue elsewhere (Hofmann, Kotabe,

& Luhmann, in press), the net affective out-

come of such mixed emotional states may be

a function of the relative intensities of the

linked emotions involved. Enacting a certain

temptation (e.g., desire to eat cake when on

a diet) may therefore result in a “spoiled

pleasure” effect, a reduction in the overall

gain in affect as compared with the enact-

ment of the equivalent desire in an unprob-

lematic context (e.g., desire to eat cake when

not on a diet).

Although not a focus of the present chap-

ter, the linked emotions of desire enact-

ment and nonenactment can themselves, of

course, be subject to emotion regulation.

For instance, to increase their affective well-

being, people may try to down- regulate the

frustration ensuing from unproblematic

desires that cannot be enacted because of

external obstacles, or to cherish the pleasure

ensuing from their enactment for as long as

possible. In the case of temptation, a person

may try to down- regulate guilt after a lapse

has occurred. Likewise, people may try to

maintain or up- regulate pride ensuing from

successful resistance—a self- conscious emo-

tion that some have argued is often not “har-

vested” enough for bolstering self- control

(Hofmann & Fisher, 2012).

How Does Desire Emerge

and Impact Behavior?

Desire emerges in a relatively automatic

manner as reward processing centers in

midbrain regions (e.g., the ventral striatum)

evaluate external stimuli (or mental images

thereof

) against the backdrop of internal

need states and an individual’s learning his-

tory (Hofmann et al., 2009; Hofmann &

Van Dillen, 2012). This early reward pro-

cessing may have the potential to trigger fast

impulsive, habitual responses (e.g., Mogen-

son, Jones, & Yim, 1980; Winkielman, Ber-

ridge, & Wilbarger, 2005). However, most

typically, reward signals from midbrain

regions are forwarded to prefrontal regions

in the brain involved in reward representa-

tion and integration, with the orbitofrontal

cortex (OFC) being among the regions most

consistently implicated (Van der Laan, de

350 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Ridder, Viergevera, & Smeetsa, 2011). Even

though somewhat speculative, we believe

that the involvement of prefrontal regions

such as the OFC is an important element in

the conscious representation of desires and

cravings.

As desire gains access to consciousness

and, therefore, the global workspace of the

mind, it gains the potential to “broadcast”

its message to a wide range of participat-

ing systems, including those that generate

thoughts and behavioral intentions (Baars

& Franklin, 2003; Baumeister, Masicampo,

& Vohs, 2011; Hofmann & Wilson, 2010).

Like market criers who try to gather atten-

tion of those around them, contents of the

global workspace of consciousness com-

pete for mental processing resources. Once

a desire becomes conscious, it can function

very much like an attractor state (Carver &

Scheier, 2002) that exerts increasing influ-

ence on conscious processing the more sup-

porting working memory resources it is able

to acquire, along the lines of “whoever has

will be given more.” In other words, desire-

related processing can be subject to a vicious

circle of reprocessing and rumination as

people harbor increasingly elaborated, con-

scious mental representations of desire that

bias attentional, affective, and cognitive

processing.

As desire grows in consciousness, so does

its potential to instigate concrete action

plans and behavioral intentions to consume

the object of desire. In the case of tempta-

tion, desires may lead to the inhibition of

self- regulatory values and goals (Hofmann,

Koningsbruggen, Stroebe, Ramanathan,

& Aarts, 2010; Stroebe, Mensink, Aarts,

Schut, & Kruglanski, 2008). Moreover, as

people become increasingly occupied by a

certain desire (Kavanagh et al., 2005), they

may engage in processes of motivated reason-

ing that license and justify indulgence (e.g.,

“I deserve a special treat today because . . .”;

“This is going to be my last cigarette, and

then I’ll quit!”; Kunda, 1990; Sayette &

Griffin, 2011). Unless people manage to

down- regulate desire effectively and/or allo-

cate attention away from desire- related (hot)

cognitions toward competing (cooler) attrac-

tor states such as those of self- control goals,

desires can hijack the very mechanisms that

may otherwise support “reasoned” action.

In extreme cases of desire escalation, a

desire may have gathered so much clout in

working memory that it may be able to fully

crowd out all other opposing, goal- related

representations—a state we describe as “all-

consuming passion” in everyday language.

How Can Desire Be

Successfully Regulated?

Given that desires and cravings may some-

times be experienced as conflicting with

one’s set of self- regulatory goals and values,

the question that emerges is how can tempt-

ing desires be effectively controlled? In the

remainder of this chapter, we therefore focus

on the down- regulation of tempting desires.

Note, however, that the taming of tempta-

tions is only one special case of desire regu-

lation, because desires may be up- or down-

regulated for a variety of other reasons. For

instance, in order to enjoy a special dinner

even more, one may deliberately up- regulate

one’s appetitive desire for food by refrain-

ing from the regular afternoon snack. Or

in order to stay awake on a train ride from

Tokyo to Osaka to view Mt. Fuji from the

window, one may deliberately down- regulate

one’s desire to sleep on the train by getting a

good night’s rest the night before.

As laid out by Gross (this volume), emo-

tion regulation refers to shaping which emo-

tions one has, when one has them, and how

one experiences them. Applied to tempting

desires, we focus on regulatory processes

and strategies affecting (1) whether a given

tempting desire is consciously experienced to

begin with, and, if so, (2) how such a tempt-

ing desire can be effectively down- regulated.

The underlying assumption is that the like-

lihood of a given tempting desire to impact

behavior, all else being equal, is a function of

the desire’s intensity (more intense desire is

more capable of hijacking working memory

resources in its favor). Therefore, all mecha-

nisms that help keep the intensity of tempting

desire below a critical enactment level, either

by preventing tempting desire from emerg-

ing in consciousness in the first place, or by

helping the person down- regulate tempting

desire, can be considered effective desire reg-

ulation strategies. Conversely, mechanisms

that increase desire intensity, contrary to the

desire down- regulation goal, can be consid-

ered ineffective.

Desire and Desire Regulation 351

In close accordance with the process

model of emotion regulation (Gross, 1998),

we review emotion regulation mechanisms

and strategies pertaining to situation and

stimulus control, attention allocation, cog-

nitive reappraisal, and suppression. The

emotion regulation strategies reviewed vary

in the extent to which they may prevent

the emergence of conscious desire (i.e., by

preventing exposure to triggering cues or

interfering with the conscious processing of

tempting stimuli) or aid the down- regulation

of conscious desire experiences.

Situation and Stimulus Control

Availability begets desire (Carter & Tiffany,

2001). Without any doubt, the most effec-

tive strategy to prevent desire is to avoid

exposure to tempting situations or stimuli

altogether through techniques of situation

and stimulus control (Mahoney & Thore-

sen, 1972). Based on the notion that external

stimuli, in their interaction with a person’s

learning history and current need states,

play a seminal role in the generation of

desire as “impellers” (Finkel & Eckhardt, in

press; Hofmann & Van Dillen, 2012), these

techniques can greatly alter the odds that

people will experience temptation. Situation

and stimulus control techniques can either

be learned and applied by a person directly

(e.g., keeping one’s home free of unhealthy

but tempting foods) or be applied through

paternalistic “nudges” (Thaler & Sunstein,

2010) that reduce the availability of temp-

tations in people’s environments (e.g., “no

smoking” bans in restaurants and bars; caf-

eterias that primarily offer healthy choice

options). Because situation and stimulus

control are not always feasible (e.g., when

one is “stuck” in a temptation- rich environ-

ment), however, situation and stimulus con-

trol cannot be the sole answer to effective

desire regulation.

Attention Allocation

Our previous analysis of how desire emerges

suggests a fundamental role of attention in

desire regulation. Attention can be parsed

into both automatic, bottom- up attention

(i.e., attention driven by salient stimulus

properties) and controlled, top-down atten-

tion (i.e., the goal- driven allocation of atten-

tion toward goal- relevant information in

working memory) (Knudsen, 2007). Both

types of attention shape desire experiences;

therefore, both mechanisms may be har-

nessed to regulate desire effectively, though

we argue that top-down attention is ulti-

mately more important.

Regarding bottom- up attention, a grow-

ing number of studies in the addiction

domain have tried to reduce conscious crav-

ings and associated behaviors by modifying

automatic attentional biases toward tempt-

ing stimuli (see also MacLeod & Grafton,

this volume). However, the results of these

attentional retraining studies have been

mixed. Sometimes the effects generalized to

other contexts, but at other times the effects

did not extend much beyond the retrain-

ing task (Attwood, O’Sullivan, Leonards,

Mackintosh, & Munafo, 2008; Fadardi &

Cox, 2009; Field, Duka, Tyler, & Schoen-

makers, 2009; Schoenmakers, Wiers, Jones,

Bruce, & Jansen, 2007). The most encour-

aging results were obtained when several

attentional retraining sessions were used

and participants were explicitly told about

the purpose and theoretical rationale of the

retraining task.

Increasing evidence suggests, however,

that top-down attention may be more deci-

sive in desire regulation. Top-down atten-

tion has been shown to modulate bottom-

up attention (Rauss, Schwartz, & Pourtois,

2011; Van Dillen & Koole, 2009). Top-down

attention enables the selective processing of

information relevant for one’s current goal,

preventing distracting information from

entering awareness (Knudsen, 2007). Hence,

when a current goal directs attention in such

a way that tempting information becomes

irrelevant, the attentional capture of tempt-

ing stimuli should be substantially reduced

or not occur at all. Conversely, people should

process tempting cues more strongly in the

absence of a specific goal (i.e., when their

top-down attention is free to be captured by

salient cues), or when their current goal focus

prompts attentional processing of such cues.

Indeed, recent research has shown that cog-

nitively demanding tasks (unrelated to the

temptation at hand), can actually prevent the

emergence of desire in response to tempting

stimuli (Kemps, Tiggemann, & Christian-

son, 2008; Van Dillen, Papies, & Hofmann,

2013). For instance, in the Van Dillen et al.

352 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

(Study 1), participants categorized pictures

of tempting (e.g., brownies) versus neutral

(e.g., radishes) food stimuli according to their

spatial location on the screen while rehears-

ing either a one-digit number (low load) or

an eight-digit number (high load) during

each task trial. Participants under low cogni-

tive load allocated more attention to tempt-

ing than to neutral stimuli, as evidenced by

slower spatial categorizations of attractive

food pictures compared to neutral food pic-

tures. Participants under high cognitive load

were equally fast to respond to tasty and

neutral food items, suggesting that they may

not have processed the hedonic relevance of

the attractive food (as much). Consequently,

participants in the high load condition

reported lower snack cravings following the

categorization task. Hence, the desire to con-

sume attractive food temptations may only

surface in consciousness to the extent that

people have sufficient attentional resources

to assess their hedonic value.

Early power-

ful distraction may therefore facilitate desire

regulation by preventing the emergence of

desire and—by implication—the conscious

pursuit of desire satisfaction.

The powerful role of top-down attention

in desire regulation suggests that teach-

ing people how to distract themselves from

cravings through mentally engaging activi-

ties may be an effective element in craving

management and relapse prevention (Flor-

sheim, Heavin, Tiffany, Colvin, & Hiraoka,

2008). The power of attention is also exem-

plified in recent applied interventions show-

ing how mindfulness- and acceptance- based

interventions can reduce cravings in prob-

lem populations (Alberts, Mulkens, Smeets,

& Thewissen, 2010; Forman et al., 2007).

The concept of mindfulness (see also Farb,

Anderson, Irving, Segal, this volume) has

been tightly linked with effective top-down

attention (Chambers, Lo, & Allen, 2008).

One mechanism through which mindfulness

interventions may work is by increasing peo-

ple’s ability to maintain their self- regulatory

goals in working memory and shield them

from interference through desire- related

processing (Hofmann, Gschwendner, Fri-

ese, Wiers, & Schmitt, 2008; Hofmann,

Schmeichel, & Baddeley, 2012). In addition,

the down- regulation of ongoing desires and

cravings may be facilitated by the acceptance

component contained in these interventions:

Accepting desires and cravings as transient

(i.e., fleeting) states instead of trying to sup-

press them may make it easier for people to

disengage from the maladaptive vicious cir-

cle of reprocessing and rumination.

Reappraisal

Rather than avoid tempting situations and

stimuli or allocate attention in strategic

ways, people can also employ strategies that

modify how they appraise tempting stimuli.

For instance, in On Desire: Why We Want

What We Want, William Irvine (2006)

relates advice provided by a Buddhist monk

on how to deal with tantalizing sexual desire

by thinking about the human body in less

favorable terms: “Don’t think about her full

breasts and flaxen hair; think instead about

her lungs, . . . phlegm, pus, spittle.” Accord-

ing to the monk, the aim of the mediation

“is not to produce aversion and disgust but

detachment, to extinguish the fire of lust by

removing its fuel” (p. 187).

Early pioneering research on delay of grat-

ification by Walter Mischel has shown that

cognitive reappraisal of tempting stimuli can

have a large impact on how well schoolchil-

dren are able to resist immediate rewards,

such as marshmallows, by cognitively trans-

forming the rewards in nonconsummatory

ways (e.g., imagining the marshmallows

as white puffy clouds) (Mischel & Baker,

1975). Recent work applying this idea has

demonstrated that reappraisal can have a

profound impact on affective responses to

tempting stimuli (Fujita & Han, 2009; Hof-

mann, Deutsch, Lancaster, & Banaji, 2010).

Engaging people in an abstract rather than

concrete mindset (Fujita & Han, 2009) or

imagining tempting stimuli in nonconsum-

matory ways (Hofmann, Deutsch, et al.,

2010) appear to interfere with the early

reward processing of these stimuli, thus tak-

ing the edge of temptation.

Findings that cognitive reappraisal can

have far- reaching effects on how people ini-

tially appraise tempting stimuli align well

with recent accounts arguing that emotion

regulation can often operate via powerful

automatic or implicit processes (see Gyurak

& Etkin, this volume). For instance, several

lines of work have suggested that, at least

Desire and Desire Regulation 353

under certain circumstances, mental repre-

sentations of self- control goals may exert an

automatic inhibiting effect on mental rep-

resentations of desire, implying that tempt-

ing stimuli may lose their desire- activating

potential. For instance, Fishbach, Friedman,

and Kruglanski (2003) argued that tempting

stimuli can trigger the automatic activation

of an overriding self- control goal in success-

ful self- regulators (e.g., the sight of a cake

activating a dieting goal).

Thus, strong and

easily accessible self- control goals may help

to reduce desire- related processing because

of the automatic inhibition of goal- irrelevant

information (Shah, Friedman, & Kruglan-

ski, 2002), which typically implies a relative

devaluation of the tempting stimulus (Veling,

Holland, & van Knippenberg, 2007, 2008).

Automatic self- regulatory processes may

thus contribute to desire down- regulation

and—depending on their potency—may

even make the need for more effortful self-

control obsolete.

The discovery of automatic self- regulatory

processes has raised the intriguing question

of whether the initial appraisal of tempt-

ing stimuli (i.e., the reward signal triggered

upon exposure) may be altered through

training and intervention techniques. The

underlying rationale is that people should

have an easier time keeping desires at bay

if the tempting stimuli that typically elicit

strong desires and cravings are appraised in

less positive terms. One method to shape the

initial appraisal of tempting stimuli is evalu-

ative conditioning (Hofmann, De Houwer,

Perugini, Baeyens, & Crombez, 2010). Spe-

cifically, pairing a tempting stimulus (e.g.,

alcohol) repeatedly with an affectively nega-

tive unconditioned stimulus can decrease

desire for alcohol among problematic

drinkers (Houben, Havermans, & Wiers,

2010; Van Gucht, Baeyens, Vansteenwe-

gen, Hermans, & Beckers, 2010). A second

promising method is avoidance training, in

which people are trained to respond rou-

tinely to tempting stimuli with avoidance

responses (Wiers, Eberl, Rinck, Becker, &

Lindenmeyer, 2011; Wiers, Rinck, Kordts,

Houben, & Strack, 2010). In one intrigu-

ing study, alcoholic inpatients who under-

went cognitive- behavioral therapy (CBT)

and four 15-minute training sessions to

avoid alcohol stimuli showed reduced crav-

ings after the avoidance treatment, as well

as reduced relapse 1 year after treatment

when compared with control patients who

only did CBT (Wiers et al., 2011). Relatedly,

laboratory work has shown that implemen-

tation intentions to avoid tempting stimuli

can reduce automatic affective reponses

to these stimuli, presumably because such

implementation intentions reprogram the

mind to appraise the tempting stimulus more

negatively (Hofmann, Deutsch, et al., 2010).

Suppression

If accepting a desire may facilitate desire

regulation as noted earlier, how does the

opposite strategy fare? Is the willful sup-

pression or negation of cravings an effective

desire regulation strategy? The bulk of the

literature on appetitive thought suppres-

sion across domains suggests not (Barnes

& Tantleff- Dunn, 2010; Erskine, 2008;

Johnston, Bulik, & Anstiss, 1999; Mann &

Ward, 2001). The problem with the forced

suppression of desire is that even though

suppression may provide some short-term

relief, suppression may often backfire, lead-

ing to ironic rebound effects (Wegner, 1994).

According to Wegner’s theory, when one

tries actively to suppress something, atten-

tion may be repeatedly redirected toward the

very mental content one is trying to avoid.

This feature of suppression may contribute to

keeping the desire– processing loop alive, or

even lead to the hyperaccessibility of desire-

related thoughts. As we argue below, these

(main) effects do not imply that everybody

suffers from ironic rebound effects to the

same extent. Suppression may well be effec-

tive for those individuals who are particu-

larly skilled at directing their attention in a

top-down manner (Brewin & Smart, 2005).

Individual Differences in Desire

and Its Regulation

Our main focus, up to this point, has been

on general mechanisms that facilitate or hin-

der successful desire regulation. In this last

part of this chapter, we address the research

on how individual differences may shape the

way people experience and deal with appeti-

tive desires.

354 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Regarding the intensity of desire experi-

ences, there is strong evidence that indi-

viduals high in behavioral approach system

(BAS) sensitivity experience stronger desires

and cravings than do those low in BAS. This

effect was found both in cue- reactivity para-

digms in the laboratory (Franken, 2002)

and when aggregating average self- reported

desire strength across many desire domains

(Hofmann, Baumeister, et al., 2012). These

findings clearly support Gray’s (1982) rein-

forcement sensitivity theory, arguing that

the BAS is responsible for the reward pro-

cessing in appetitive motivation, and suggest

an important role for related constructs such

as sensation seeking.

The Everyday Temptations Study also

showed that individuals high in trait self-

control (TSC) reported lower average desire

strength (as well as lower average conflict

and less use of active resistance to control

desire) (Hofmann, Baumeister, et al., 2012).

Even though somewhat speculative, we

believe this surprising pattern of findings

may reflect the joint impact of two mech-

anisms. First, individuals with high TSC

may make more use of preventive situation

and stimulus control strategies, thus avoid-

ing tempting desires more often than their

low-TSC counterparts (and hence reduc-

ing the need for effortful control). In sup-

port, independent raters rated the desires

reported by high-TSC participants as less

problematic for the “average person” than

the desires reported by low-TSC partici-

pants (Hofmann, Baumeister, et al., 2012).

In other words, high-TSC individuals seem

to be navigating an objectively less tempt-

ing desire landscape. Second, it is conceiv-

able that those with high TSC have more

powerful automatic desire regulation pro-

cesses at their disposal. Some support for

this assumption comes from studies reveal-

ing that people who report to be success-

ful self- regulators in a given domain, such

as dieting, tend to show more effective

automatic self- regulation than do unsuc-

cessful self- regulators (Papies, Stroebe, &

Aarts, 2008a). These findings are intriguing

because they suggest that, in everyday life,

TSC may not so much be about how well

temptations are resisted (the type of “late-

stage” self- control typically studied in the

laboratory situations) as about how well

temptations are being avoided or appraised

at early stages in the self- control process.

Furthermore, we believe that TSC is dis-

tinct from individual differences in what has

been called the restraint bias (Nordgren, van

Harreveld, & van der Pligt, 2009), which

taps into people’s overoptimistic—and thus

unrealistic—beliefs about their capacity

at self- control. As a consequence of their

inflated beliefs, people high in the restraint

bias tend to overexpose themselves to tempt-

ing situations, leading to more frequent self-

control failures in the heat of the moment

(Nordgren et al., 2009). Thus, we predict

that individuals high in TSC harbor more

realistic impulse control beliefs than do indi-

viduals low in TSC. This more realistic will-

power self- assessment (and a more realistic

appreciation of the power of the situation)

may lead them to prudently avoid high-risk

situations and remove tempting stimuli from

their environment when they can.

Individuals also differ considerably in

their command of top-down attention.

In the cognitive literature on executive

functioning, top-down attention has been

strongly linked with the concept of working

memory capacity (WMC; Kane, Bleckley,

Conway, & Engle, 2001), which represents

the ability to maintain and update relevant

information in working memory, and to

shield it from interfering processing or dis-

traction (Engle, 2002; Kane et al., 2001).

This ability may be highly instrumental to

a variety of strategies important for effective

desire regulation (Hofmann et al., 2011).

First, WMC may help people disengage

faster and be less influenced by attention-

grabbing desire- related cues. Eye- tracking

studies, for instance, have shown that people

low in WMC are prone to bias eye direction

toward tempting cues, with the degree of

bias correlating with their automatic affec-

tive reactions toward those cues (Friese, Bar-

gas-Avila, Hofmann, & Wiers, 2010; Friese

& Hofmann, 2012). Those high in WMC,

in contrast, were much less influenced by

their automatic affective reactions, which

suggests that they were faster at disengaging

attention from salient cues.

Second, WMC may aid a host of emotion

regulation strategies, such as the efficient

use of distraction, reappraisal, and emo-

tion suppression (Hofmann et al., 2008,

Study 3; Hofmann, Schmeichel, et al., 2012;

McRae, Jacobs, Ray, John, & Gross, 2012;

Desire and Desire Regulation 355

Schmeichel, Volokhov, & Demaree, 2008).

Third, individuals high in WMC seem to

be better at controlling their own thoughts,

with fewer thought intrusions (Brewin

& Smart, 2005; Kane et al., 2007). Even

though more direct evidence for the mod-

erating role of WMC in the regulation of

desires and cravings is missing, it does not

appear to be great leap to suggest that indi-

viduals with high WMC are more effective

than those with low WMC at breaking the

desire- processing cycle.

Because executive functions such as work-

ing memory can be trained, at least to some

extent (for a discussion, see Shipstead,

Redick, & Engle, 2012), there is a large

potential for intervention research aimed at

finding ways to improve the management

of unwanted desires and cravings. Further-

more, fascinating new research suggests that

repeated high- frequency (i.e., excitatory)

stimulation of the dorsolateral prefrontal

cortex via transcranial magnetic stimulation

(TMS) or transcranial direct current stimu-

lation (tDCS) may reduce cravings (e.g.,

Amiaz, Levy, Vainiger, Grunhaus, & Zan-

gen, 2009; Boggio et al., 2008; Camprodon,

Martinez- Raga, Alonso- Alonso, Shih, &

Pascual- Leone, 2007). One highly plausible

explanation is that the high- frequency stim-

ulation leads to an additional mobilization

of executive control processes implied in the

down- regulation of cravings.

Regarding further personality traits, the

Everyday Temptations Study showed that a

measure of perfectionism (tapping primarily

into negative, dysfunctional perfectionism)

was associated with stronger desire inten-

sity in daily life (Hofmann, Baumeister, et

al., 2012), more intense feelings of conflict,

and more frequent desire resistance. Even

though somewhat speculative, this find-

ing suggests that people high in this sort of

perfectionism may become overly preoccu-

pied with regulating their desires, perhaps

making too much use of counterproductive

strategies such as suppression, consistent

with research on the trait’s connection with

emotion suppression (Bergman, Nyland, &

Burns, 2007).

Finally, when discussing the positive

effects of mindfulness on desire regulation,

we highlighted the possible mediating role

of desire acceptance as an effective regula-

tion strategy. The case of acceptance raises

the intriguing issue of whether there are reli-

able individual differences in the way people

relate to their desires. A number of personal-

ity characteristics, such as faith in intuition,

trait hedonism, tolerance for ambiguity, as

well as demographic variables, such as reli-

giosity, may moderate the extent to which

people see their appetitive desires as integral

parts of themselves (leading to high accep-

tance) as opposed to “dark and sinister”

forces that lack integration with the self and

thus need to be kept at bay. In the absence

of empirical work that has explored such

possible links between acceptance of appeti-

tive desires and personality traits, we predict

that such personality characteristics should

(1) relate to how often people go about regu-

lating their appetitive desires and (2) facili-

tate regulation of appetitive desires to the

extent that they promote acceptance- based

rather than suppression- based emotion regu-

lation strategies.

Conclusion

As humans we experience all sorts of appeti-

tive desires. Sometimes, these stand in strong

opposition to our self- regulatory goals or

values, forcing us to face the challenge of

how best to “get a grip” on such “unwanted

wants.” In this chapter, we have argued

that desires can be conceptually treated as

emotions, because, like emotions, desires

have affective, motivational, and cognitive

components. Hence, it may be beneficial to

address the issue of desire regulation from

an emotion regulatory perspective.

Our review of the available literature

suggests that, as with emotion regulation,

effective desire regulation can take place at

various phases of desire processing. Desire

regulation strategies can be roughly divided

into those that prevent exposure to desire-

eliciting stimuli (situation and stimulus con-

trol), those that may prevent a desire from

reaching conscious awareness (e.g., atten-

tion allocation), and those that prevent a

desire from becoming overly dominant (e.g.,

reappraisal). Mapping a given strategy to

just one of these different phases may be

overly simplistic, however. For example,

take attention allocation: Sometimes, pow-

erful distractors (resulting in mental preoc-

cupation) may prevent a desire from reach-

356 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

ing conscious awareness; at other times,

attention allocation may be used strategi-

cally to down- regulate a desire only after it

has reached conscious awareness. In a simi-

lar vein, it is possible that automatic down-

regulation may sometimes be so powerful

that it may even prevent the onset of a real

desire, whereas at other times, it may make

a desire less potent, so that it does not take

up as many mental resources as it otherwise

would. Moreover, it is possible that multiple

strategies may complement each other in

important ways that are worthy of future

study. For instance, powerful automatic reg-

ulation should reduce the demand for more

effortful emotion regulation processes.

Finally, people appear to differ as to how

intensely they experience desire and how

they go about regulating it. Individuals high

in TSC seem to make more use of early pre-

ventive strategies such as situation and stim-

ulus control. (Dysfunctional) perfectionists

may focus too much on suppression, thus

becoming overly obsessed with their desires.

Being dispositionally high in executive func-

tions such as WMC may make it a lot easier

to resist the attentional pull of tempting

stimuli. Taking a closer look at what strate-

gies work for what types of people should

help practitioners to devise more effective

customized treatments for those who suffer

from tempting desires and cravings. As tech-

nological possibilities mature, we expect

to see fascinating new developments in the

years to come with regard to one of the cen-

tral challenges of what it means to be human:

how to shape one’s internal landscape of

appetitive desires in a way that strikes a

healthy balance between desire enactment

and the occasional need to curb one’s pas-

sion for what might be a pretty good reason.

Notes

1. Even though the two are often correlated,

desires are also conceptually distinct from

attitudes, because liking does not necessar-

ily imply wanting and vice versa (Berridge,

1996). For instance, one may like lobster in

general but have no desire to eat one right

now. A long-term smoker may dislike ciga-

rettes (“They’re unhealthy and expensive”)

yet have a craving for one.

2. Whereas external stimuli are typically

involved and sometimes strategically

employed by those wanting to instigate cer-

tain desires in others (e.g., companies using

scents to better sell their products; a person

wearing sexy clothing on a date), it is also

possible that desires can be activated in a top-

down fashion in the absence of any external

stimuli by willfully activating certain memo-

ries or simulating certain experiences (Kava-

nagh et al., 2005).

3. Note that the effects of cognitive load are

quite the opposite of the effects of resource

depletion. Recent work by Vohs et al. (2012)

shows that people in a depleted state experi-

ence stronger emotional reactions to valenced

stimuli, intensified pain in a cold pressor task,

and an intensified desire to eat cookies pre-

sented during a taste and rate test.

4. The reverse process (i.e., inhibition of the

self- control goal) may take place among less

successful self- regulators (see Papies, Stroebe,

& Aarts, 2008b; Stroebe, Mensink, Aarts,

Schut, & Kruglanski, 2008), suggesting

important individual differences with regard

to automatic desire- regulation processes.

References

Alberts, H. J. E. M., Mulkens, S., Smeets, M.,

& Thewissen, R. (2010). Coping with food

cravings. Investigating the potential of a

mindfulness- based intervention. Appetite, 55,

160–163.

Amiaz, R., Levy, D., Vainiger, D., Grunhaus,

L., & Zangen, A. (2009). Repeated high-

frequency transcranial magnetic stimulation

over the dorsolateral prefrontal cortex reduces

cigarette craving and consumption. Addic-

tion, 104, 653–660.

Attwood, A. S., O’Sullivan, H., Leonards, U.,

Mackintosh, B., & Munafo, M. R. (2008).

Attentional bias training and cue reactivity

in cigarette smokers. Addiction, 103, 1875–

1882.

Baars, B. J., & Franklin, S. (2003). How con-

scious experience and working memory inter-

act. Trends in Cognitive Sciences, 7, 166–172.

Barnes, R. D., & Tantleff- Dunn, S. (2010).

Food for thought: Examining the relation-

ship between food thought suppression and

weight- related outcomes. Eating Behaviors,

11, 175–179.

Baumeister, R. F., Masicampo, E. J., & Vohs,

K. D. (2011). Do conscious thoughts cause

Desire and Desire Regulation 357

behavior? Annual Review of Psychology, 62,

331–361.

Belk, R. W., Ger, G., & Askegaard, S. (2000).

The missing streetcar named desire. In S. Rat-

neshwar, D. G. Mick, & C. Huffman (Eds.),

The why of consumption: Contemporary

perspectives on consumer motives, goals and

desires (pp. 98–119). London: Routledge.

Bergman, A. J., Nyland, J. E., & Burns, L. R.

(2007). Correlates with perfectionism and the

utility of a dual process model. Personality

and Individual Differences, 43, 389–399.

Berking, M., & Schwarz, J. (this volume, 2014).

Affect regulation training. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 529–547). New York: Guilford Press.

Berridge, K. C. (1996). Food reward: Brain sub-

strates of wanting and liking. Neuroscience

and Biobehavioral Reviews, 20, 1–25.

Boggio, P. S., Sultani, N., Fecteau, S., Merabet,

L., Mecca, T., Pascual- Leone, A., et al. (2008).

Prefrontal cortex modulation using transcra-

nial DC stimulation reduces alcohol craving:

A double- blind, sham- controlled study. Drug

and Alcohol Dependence, 92, 55–60.

Brewin, C. R., & Smart, L. (2005). Working

memory capacity and suppression of intrusive

thoughts. Journal of Behavior Therapy and

Experimental Psychiatry, 36, 61–68.

Camprodon, J. A., Martinez- Raga, J., Alonso-

Alonso, M., Shih, M. C., & Pascual- Leone, A.

(2007). One session of high frequency repeti-

tive transcranial magnetic stimulation (rTMS)

to the right prefrontal cortex transiently

reduces cocaine craving. Drug and Alcohol

Dependence, 86, 91–94.

Carter, B. L., & Tiffany, S. T. (2001). The cue-

availability paradigm: The effects of ciga-

rette availability on cue reactivity in smokers.

Experimental and Clinical Psychopharmacol-

ogy, 9, 183–190.

Carver, C. S., & Scheier, M. F. (1998). On the

self- regulation of behavior. Cambridge, UK:

Cambridge University Press.

Carver, C. S., & Scheier, M. F. (2002). Control

processes and self- organization as comple-

mentary principles underlying behavior. Per-

sonality and Social Psychology Review, 6,

304–315.

Chambers, R., Lo, B. C. Y., & Allen, N. B.

(2008). The impact of intensive mindfulness

training on attentional control, cognitive style,

and affect. Cognitive Therapy and Research,

32, 303–322.

Engle, R. W. (2002). Working memory capacity

as executive attention. Current Directions in

Psychological Science, 11, 19–23.

Erskine, J. A. K. (2008). Resistance can be futile:

Investigating behavioural rebound. Appetite,

50, 415–421.

Fadardi, J. S., & Cox, W. M. (2009). Reversing

the sequence: Reducing alcohol consumption

by overcoming alcohol attentional bias. Drug

and Alcohol Dependence, 101, 137–145.

Farb, N. A. S., Anderson, A. K., Irving, J. A., &

Segal, Z. V. (this volume, 2014). Mindfulness

interventions and emotion regulation. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 548–568). New York: Guilford

Press.

Field, M., Duka, T., Tyler, E., & Schoenmak-

ers, T. (2009). Attentional bias modification

in tobacco smokers. Nicotine and Tobacco

Research, 11, 812–822.

Finkel, E. J., & Eckhardt, C. I. (in press). Inti-

mate partner violence. In J. A. Simpson & L.

Campbell (Eds.), The Oxford handbook of

close relationships. New York: Oxford Uni-

versity Press.

Fishbach, A., Friedman, R. S., & Kruglanski, A.

W. (2003). Leading us not unto temptation:

Momentary allurements elicit overriding goal

activation. Journal of Personality and Social

Psychology, 84, 296–309.

Florsheim, P., Heavin, S., Tiffany, S., Colvin, P.,

& Hiraoka, R. (2008). An experimental test

of a craving management technique for adoles-

cents in substance- abuse treatment. Journal of

Youth and Adolescence, 37, 1205–1215.

Forman, E. M., Hoffman, K. L., McGrath, K.

B., Herbert, J. D., Brandsma, L. L., & Lowe,

M. R. (2007). A comparison of acceptance-

and control- based strategies for coping with

food cravings: An analog study. Behaviour

Research and Therapy, 45, 2372–2386.

Franken, I. H. (2003). Drug craving and addic-

tion: Integrating psychological and neuropsy-

chopharmacological approaches. Progress in

Neuropsychopharmacological Biological Psy-

chiatry, 27, 563–579.

Franken, I. H. A. (2002). Behavioral approach

system (BAS) sensitivity predicts alcohol crav-

ing. Personality and Individual Differences,

32, 349–355.

Friese, M., Bargas-Avila, J., Hofmann, W., &

Wiers, R. W. (2010). Here’s looking at you,

Bud: Alcohol- related memory structures pre-

dict eye movements for social drinkers with

low executive control. Social Psychological

and Personality Science, 1, 143–151.

358 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Friese, M., & Hofmann, W. (2012). Just a little

bit longer: Viewing time of erotic material

from a self- control perspective. Applied Cog-

nitive Psychology, 26, 489–496.

Fujita, K., & Han, H. A. (2009). Moving beyond

deliberative control of impulses: The effect of

construal levels on evaluative associations in

self- control conflicts. Psychological Science,

20, 799–804.

Gray, J. A. (Ed.). (1982). The neuropsychology

of anxiety: An enquiry into the functions of

the septo- hippocampal system. New York:

Oxford University Press.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gyurak, A., & Etkin, A. (this volume, 2014). A

neurobiological model of implicit and explicit

emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 76–90). New York: Guilford Press.

Higgins, E. T. (1998). The aboutness principle:

A pervasive influence on human inference.

Social Cognition, 16, 173–198.

Hofmann, W., Baumeister, R. F., Förster, G., &

Vohs, K. D. (2012). Everyday temptations: An

experience sampling study of desire, conflict,

and self- control. Journal of Personality and

Social Psychology, 102, 1318–1335.

Hofmann, W., De Houwer, J., Perugini, M.,

Baeyens, F., & Crombez, G. (2010). Evalua-

tive conditioning in humans: A meta- analysis.

Psychological Bulletin, 136, 390–421.

Hofmann, W., Deutsch, R., Lancaster, K., &

Banaji, M. R. (2010). Cooling the heat of

temptation: Mental self- control and the auto-

matic evaluation of tempting stimuli. Euro-

pean Journal of Social Psychology, 40, 17–25.

Hofmann, W., & Fisher, R. R. (2012). How

guilt and pride shape subsequent self- control.

Social Psychological and Personality Science,

3, 682–690.

Hofmann, W., Friese, M., Schmeichel, B. J., &

Baddeley, A. D. (2011). Working memory and

self- regulation. In K. D. Vohs & R. F. Baumeis-

ter (Eds.), The handbook of self- regulation:

Research, theory, and applications (Vol. 2,

pp. 204–226). New York: Guilford Press.

Hofmann, W., Friese, M., & Strack, F. (2009).

Impulse and self- control from a dual- systems

perspective. Perspectives on Psychological Sci-

ence, 4, 162–176.

Hofmann, W., Gschwendner, T., Friese, M.,

Wiers, R. W., & Schmitt, M. (2008). Working

memory capacity and self- regulatory behavior:

Toward an individual differences perspective

on behavior determination by automatic ver-

sus controlled processes. Journal of Personal-

ity and Social Psychology, 95, 962–977.

Hofmann, W., Koningsbruggen, G. M., Stroebe,

W., Ramanathan, S., & Aarts, H. (2010). As

pleasure unfolds: Hedonic responses to tempt-

ing food. Psychological Science, 21, 1863–

1870.

Hofmann, W., Kotabe, H., & Luhmann, M. (in

press). The spoiled pleasure of giving in to

temptation. Motivation and Emotion.

Hofmann, W., Schmeichel, B. J., & Baddeley,

A. D. (2012). Executive functions and self-

regulation. Trends in Cognitive Sciences, 3,

174–180.

Hofmann, W., & Van Dillen, L. F. (2012). Desire:

The new hotspot in self- control research. Cur-

rent Directions in Psychological Science, 21,

317–322.

Hofmann, W., Vohs, K. D., & Baumeister, R.

F. (2012). What people desire, feel conflicted

about, and try to resist in everyday life. Psy-

chological Science, 23, 582–588.

Hofmann, W., & Wilson, T. D. (2010). Con-

sciousness, introspection, and the adaptive

unconscious. In B. Gawronski & B. K. Payne

(Eds.), Handbook of implicit social cogni-

tion: Measurement, theory, and applications

(pp. 197–215). New York: Guilford Press.

Houben, K., Havermans, R. C., & Wiers, R.

W. (2010). Learning to dislike alcohol: Con-

ditioning negative implicit attitudes toward

alcohol and its effect on drinking behavior.

Psychopharmacology, 211, 79–86.

Irvine, W. B. (2006). On desire. Why we want

what we want. New York: Oxford University

Press.

Johnston, L., Bulik, C. M., & Anstiss, V. (1999).

Suppressing thoughts about chocolate. Inter-

national Journal of Eating Disorders, 26,

21–27.

Kane, M. J., Bleckley, M. K., Conway, A. R. A.,

& Engle, R. W. (2001). A controlled- attention

view of working- memory capacity. Journal

of Experimental Psychology: General, 130,

169–183.

Kane, M. J., Brown, L. H., McVay, J. C., Sil-

via, P. J., Myin- Germeys, I., & Kwapil, T.

R. (2007). For whom the mind wanders, and

Desire and Desire Regulation 359

when: An experience- sampling study of work-

ing memory and executive control in daily life.

Psychological Science, 18, 614–621.

Kavanagh, D. J., Andrade, J., & May, J. (2005).

Imaginary relish and exquisite torture: The

elaborated intrusion theory of desire. Psycho-

logical Review, 112, 446–467.

Kemps, E., Tiggemann, M., & Christianson, R.

(2008). Concurrent visuo-

patial processing

reduces food cravings in prescribed weight-

oss dieters. Journal of Behavior Therapy and

Experimental Psychiatry, 39, 177–186.

Knudsen, E. I. (2007). Fundamental components

of attention. Annual Review of Neuroscience,

30, 57–78.

Kunda, Z. (1990). The case for motivated rea-

soning. Psychological Bulletin, 108, 480–498.

MacLeod, C., & Grafton, B. (this volume, 2014).

Regulation of emotion through modification

of attention. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 508–528).

New York: Guilford Press.

Mahoney, M. J., & Thoresen, C. E. (1972).

Behavioral self-

ontrol: Power to the person.

Educational Researcher, 1, 5–7.

Mann, T., & Ward, A. (2001). Forbidden fruit:

Does thinking about a prohibited food lead

to its consumption? International Journal of

Eating Disorders, 29, 319–327.

McRae, K., Jacobs, S. E., Ray, R. D., John, O.

P., & Gross, J. J. (2012). Individual differences

in reappraisal ability: Links to reappraisal

frequency, well-being, and cognitive control.

Journal of Research in Personality, 46, 2–7.

Mele, A. (2001). Autonomous agents. From self-

ontrol to autonomy. Oxford, UK: Oxford

University Press.

Mischel, W., & Baker, N. (1975). Cognitive

appraisals and transformations in delay behav-

ior. Journal of Personality and Social Psychol-

ogy, 31, 254–261.

Mogenson, G. J., Jones, D. L., & Yim, C. Y.

(1980). From motivation to action: Functional

interface between the limbic system and the

motor system. Progress in Neurobiology, 14,

69–97.

Nordgren, L. F., van Harreveld, F., & van der

Pligt, J. (2009). The restraint bias: How the

illusion of self-

estraint promotes impulsive

behavior. Psychological Science, 20, 1523–

1528.

Papies, E. K., Stroebe, W., & Aarts, H. (2008a).

The allure of forbidden food: On the role of

attention in self-

egulation. Journal of Experi-

mental Social Psychology, 44, 1283–1292.

Papies, E. K., Stroebe, W., & Aarts, H. (2008b).

Healthy cognition: Processes of self-

egulatory

success in restrained eating. Personality and

Social Psychology Bulletin, 34, 1290–1300.

Rauss, K., Schwartz, S., & Pourtois, G. (2011).

Top-down effects on early visual processing

in humans: A predictive coding framework.

Neuroscience and Biobehavioral Reviews, 35,

1237–1253.

Sayette, M. A., & Griffin, K. M. (2011). Self-

egulatory failure and addiction. In R. F. Bau-

meister & K. D. Vohs (Eds.), Handbook of

self-

egulation: Research, theory, and applica-

tions (Vol. 2, pp.

505–521). New York: Guil-

ford Press.

Schmeichel, B. J., Harmon-Jones, C., & Har-

mon-Jones, E. (2010). Exercising self-

ontrol

increases approach motivation. Journal of

Personality and Social Psychology, 99, 162–

173.

Schmeichel, B. J., Volokhov, R. N., & Demaree,

H. A. (2008). Working memory capacity and

the self-

gulation of emotional expression

and experience. Journal of Personality and

Social Psychology, 95, 1526–1540.

Schoenmakers, T., Wiers, R. W., Jones, B. T.,

Bruce, G., & Jansen, A. T. M. (2007). Atten-

tional retraining decreases attentional bias in

heavy drinkers without generalization. Addic-

tion, 102, 399–405.

Schroeder, S. A. (2007). We can do better—

Improving the health of the american peo-

ple. New England Journal of Medicine, 357,

1221–1228.

Shah, J. Y., Friedman, R. S., & Kruglanski, A.

W. (2002). Forgetting all else: On the anteced-

ents and consequences of goal shielding. Jour-

nal of Personality and Social Psychology, 83,

1261–1280.

Shiffman, S., Hickcox, M., Paty, J. A., Gnys, M.,

Kassel, J. D., & Richards, T. J. (1997). The

abstinence violation effect following smoking

lapses and temptations. Cognitive Therapy

and Research, 21(5), 497–523.

Shipstead, Z., Redick, T. S., & Engle, R. W.

(2012). Is working memory training effective?

Psychological Bulletin, 138, 628–654.

Stroebe, W., Mensink, W., Aarts, H., Schut,

H., & Kruglanski, A. (2008). Why dieters

fail: Testing the goal conflict model of eating.

Journal of Experimental Social Psychology,

44, 26–36.

Thaler, R. H., & Sunstein, C. R. (2010). Nudge:

Improving decisions about health, wealth,

and happiness. New York: Penguin Books.

360 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Van der Laan, L. N., de Ridder, D. T. D.,

Viergevera, M. A., & Smeetsa, P. A. M.

(2011). The first taste is always with the eyes:

A meta- analysis on the neural correlates of

processing visual food cues. NeuroImage, 55,

296–303.

Van Dillen, L. F., & Koole, S. L. (2009). How

automatic is oautomatic vigilance?: The role

of working memory in attentional interference

of negative information. Cognition and Emo-

tion, 23, 1106–1117.

Van Dillen, L. F., Papies, E., & Hofmann, W.

(2013). Turning a blind eye to temptation.

How task load can facilitate self- regulation.

Journal of Personality and Social Psychology,

3, 427–443.

Van Gucht, D., Baeyens, F., Vansteenwegen, D.,

Hermans, D., & Beckers, T. (2010). Counter-

conditioning reduces cue- induced craving and

actual cue- elicited consumption. Emotion, 10,

688–695.

Veling, H., Holland, R. W., & van Knippenberg,

A. (2007). Devaluation of distracting stimuli.

Cognition and Emotion, 21, 442–448.

Veling, H., Holland, R. W., & van Knippenberg,

A. (2008). When approach motivation and

behavioral inhibition collide: Behavior regula-

tion through stimulus devaluation. Journal of

Experimental Social Psychology, 44, 1013–

1019.

Vohs, K. D., Baumeister, R. F., Mead, N. L., Hof-

mann, W., Ramanathan, S., & Schmeichel, B.

J. (2012). Engaging in self- control heightens

urges and feelings. Unpublished manuscript.

Wegner, D. M. (1994). Ironic processes of mental

control. Psychological Review, 101, 34–52.

Wiers, R. W., Eberl, C., Rinck, M., Becker, E.

S., & Lindenmeyer, J. (2011). Retraining

automatic action tendencies changes alco-

holic patients’ approach bias for alcohol and

improves treatment outcome. Psychological

Science, 22, 490–497.

Wiers, R. W., Rinck, M., Kordts, R., Houben,

K., & Strack, F. (2010). Retraining automatic

action- tendencies to approach alcohol in haz-

ardous drinkers. Addiction, 105, 279–287.

Winkielman, P., Berridge, K. C., & Wilbarger,

J. L. (2005). Unconscious affective reactions

to masked happy versus angry faces influ-

ence consumption behavior and judgments of

value. Personality and Social Psychology Bul-

letin, 31, 121–135.

361

Much of human behavior is purposeful, or

goal directed (Bandura, 1986; Carver &

Scheier, 2000; Deci & Ryan, 1985; Fish-

bach & Ferguson, 2007; Gollwitzer, 1990;

Mischel, Cantor, & Feldman, 1996). Goals

can target our appearance (e.g., to be thin),

our mind (e.g., to be smart), and our behav-

ior (e.g., to spend more time with family or

to work harder). As we argue in this chap-

ter, some of our most important goals target

emotions (e.g., to be happy). A goal is a “cog-

nitive representation of a desired endpoint”

(Fishbach & Ferguson, 2007, p. 491). There-

fore, we define an emotion goal as the cogni-

tive representation of a particular emotional

state that is the desired endpoint. Although

any goal may indirectly involve desired

emotional endpoints (e.g., “I want to buy a

car in order to feel happy as a result”), we

focus on goals that directly target emotions

as the desired endpoint (e.g., “I want to feel

happy”). Emotion goals are a specific type of

affect goal. Whereas affect goals target states

of pleasure or pain, more generally (e.g., “I

want to feel pleasant”), emotion goals target

specific emotional states (e.g., “I want to feel

joyful, proud, or amused”). Therefore, in

this chapter, we distinguish nonaffect goals

(i.e., goals that do not involve affective states

as the direct desired endpoint), affect goals

(i.e., goals that involve pleasure or pain as

the direct desired endpoint), and emotion

goals (i.e., goals that involve specific emo-

tional states as the direct desired endpoint),

and focus mainly on the latter.

It follows from this definition that peo-

ple’s emotion goals are foundational to emo-

tion regulation. In fact, the activation of an

emotion goal is necessary for emotion regu-

lation (Gross, this volume; Mauss, Bunge,

& Gross, 2007). Emotion goals determine

whether people engage in emotion regula-

tion, which emotions they attempt to regu-

late, when they cease their emotion regula-

tory efforts, and people’s satisfaction with

their emotion regulation attempts. Thus,

understanding emotion goals has crucial

implications for understanding emotion reg-

ulation and its effects on well-being.

To date, research on emotion regulation

has focused on understanding different emo-

tion regulation strategies and their outcomes

(Gross & Thompson, 2007; Webb, Miles, &

Sheeran, 2012). As a function of this focus,

research to date has examined the “how”

(e.g., What strategies do people use to regu-

late their emotions?) more than the “why”

and “what” of emotion regulation (e.g.,

When do people decide to regulate an emo-

tion? What emotional states do people want

to attain?). The goal framework we outline

here emphasizes the importance of under-

standing not only the “how” but also the

“why” and “what” of emotion regulation.

CHAPTER 22

Emotion Goals: How Their Content,

Structure, and Operation Shape

Emotion

Regulation

Iris B. Mauss

Maya Tamir

362 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

A Goal Framework

for Emotion Regulation

Although relatively little research has directly

examined emotions as goals, there is ample

research on goals and self- regulation in gen-

eral (e.g., Baumeister & Heatherton, 1996;

Carver & Scheier, 2000; Custers & Aarts,

2010). Applying this body of knowledge to

the emotion domain could greatly advance

the understanding of emotion regulation (cf.

Harmon-Jones, Harmon-Jones, Amodio, &

Gable, 2011; Koole, van Dillen, & Sheppes,

2011; Webb, Schweiger Gallo, Miles, Goll-

witzer, & Sheeran, 2012). People’s goals

determine their actions as they attempt to

decrease perceived discrepancies between

current and desired states. As Figure 22.1

illustrates, when applied to emotions, this

idea can help us understand what determines

the initiation and course of emotion regula-

tion. More specifically, perceived discrepan-

cies between current emotional states (e.g.,

“I feel sad”) and emotion goals (“I want to

feel less sad”) initiate emotion regulation,

which is set in motion to bring current emo-

tional states closer to desired emotion states.

Thus, the emotion goals people hold deter-

mine whether or not they engage in emotion

regulation, which emotions they attempt to

regulate, and in which direction (i.e., increase

or decrease). In this chapter we discuss emo-

tion goals, building on available knowledge

about goal pursuit. We organize this chap-

ter around three features of goals that have

been highlighted in research on goal pursuit

(Fishbach & Ferguson, 2007): their content,

their hierarchical structure, and their opera-

tion. First, we consider the content of emo-

tion goals. We examine what emotion goals

people adopt and highlight two factors that

determine these goals: hedonic benefits (i.e.,

greater pleasure and less pain) and nonhe-

donic benefits (e.g., to prepare an organism

for fight) of particular emotions. Second, we

consider the structure of emotion goals. Mul-

tiple goals, including emotion and nonemo-

tion ones, coexist at any given point in time

and are hierarchically organized. We con-

sider possible features of this organization

and their implications. Third, we consider

the operation of emotion goals that unfolds

as people regulate their emotions, distin-

guishing relatively automatic from deliber-

ate types of emotion regulation. Finally, we

highlight the goal framework’s implications

for understanding the links between emotion

regulation and well-being.

FIGURE 22.1. Hypothesized operation of emotion goals. Perceived discrepancy between current

emotional states and emotion goals initiates and directs emotion regulation, which influences cur-

rent emotional states. The evaluation of the difference between current emotional states and emotion

goals is emotional in nature (e.g., contentment when discrepancy decreases, distress when discrepancy

increases). We therefore refer to the output of this evaluation as meta- emotion.

Goal Pursuit

Goal Content

Comparator

Emotion

Regulation

Meta-

Emotion

Current

Emotional State

Emotion Goal

Emotion Goals 363

The Content of Emotion Goals:

Emotions as Desired States

What emotion goals do people have and

what determines these goals? Because all

creatures strive to attain pleasure and avoid

pain, and because emotions are pleasant

or painful subjective states, emotion goals

are often determined by the immediate

hedonic benefits of emotions. For example,

people may be motivated to increase hap-

piness because it is pleasant, and they may

be motivated to decrease fear because it is

unpleasant. Pleasant emotions generally are

preferred to unpleasant emotions by people

from different cultures (Diener, 2000; Tsai,

Knutson, & Fung, 2006) and with different

personality dispositions (Rusting & Larsen,

1995).

The immediate hedonic benefits of emo-

tions are a powerful determinant of emo-

tion goals. However, they are not the sole

determinant. Functional theories of emo-

tions hold that emotions serve to promote a

broad array of nonhedonic benefits (Frijda,

1986; Nesse & Ellsworth, 2009). Accord-

ing to the instrumental approach to emotion

regulation (Bonanno, 2001; Parrott, 1993;

Tamir, 2009), people may be motivated to

experience emotions to attain either hedonic

or nonhedonic benefits. When hedonic ben-

efits are prioritized, people are motivated

to experience pleasant emotions and avoid

unpleasant ones. However, when nonhe-

donic benefits are prioritized, people may

be motivated to experience either pleasant

or unpleasant emotions, depending on their

instrumental implications (Tamir, 2009).

Emotions can offer at least three types

of nonhedonic benefits. First, emotions can

offer performance benefits. By engaging

various physiological, cognitive, and moti-

vational processes, emotions can change

how effectively we deal with situational

demands (Frijda, 1986). Second, emotions

can have epistemic benefits. They provide us

with important information regarding our

state in the world (Clore, Gasper, & Garvin,

2001). Third, emotions can carry cultural

benefits. In group contexts, emotions signal

group membership and support of cultural

values (Keltner & Haidt, 1999).

We believe that people may be motivated

to experience emotions to attain any one

of these benefits. First, emotions can orient

behavior to deal with situational demands

as effectively as possible (Frijda, 1986). For

instance, joy may promote creativity (Fred-

rickson, 2001). Therefore, when perfor-

mance is likely to benefit from increased cre-

ativity, joy might be useful for performance.

People may be motivated to experience an

emotion to attain its performance- related

benefits. In support of this hypothesis, we

have recently shown that people want to

experience emotions they believe would

promote their performance (Tamir, Salerno,

Rhodes, & Schreier, 2012). In a series of stud-

ies, we led participants to expect anger to be

either useful, irrelevant, or harmful for per-

formance on an upcoming task. Participants

were motivated to increase the experience

of anger when they expected it be useful for

performance, even though it was unpleasant

to experience. This effect was obtained even

when beliefs about usefulness were manipu-

lated outside of conscious awareness. These

findings demonstrate that emotion goals can

be determined by the expected benefits of

emotions for performance.

Second, emotions provide people with

important information about themselves

and their state in the world (Clore et al.,

2001). Such information can support or

conflict with core assumptions about who

we are and what the world is like. People are

generally motivated to preserve these core

assumptions (Swann & Schroeder, 1995).

Just as people seek feedback that maintains

their self-image (Swann & Schroeder, 1995),

people may be motivated to experience emo-

tions that maintain their self-image (i.e.,

that have epistemic benefits). In support of

this proposition, Wood and her colleagues

showed that people with low self esteem

are motivated to maintain sad feelings,

because such feelings are familiar to them

and because they reinforce their low sense of

personal value (Wood, Heimpel, Manwell,

& Whittington, 2009).

Third, emotions can reinforce one’s com-

mitment to and investment in particular

cultural values. For instance, pride is tied to

the value of personal achievement, whereas

shame is tied to the value of social harmony

(Kitayama, Mesquita, & Karasawa, 2006).

Because cultures generally seek to preserve

specific values, they prescribe certain emo-

tions as more normative than others (Eid

& Diener, 2001). In support of this notion,

364 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Tsai and her colleagues (2006) have shown

that cultures vary in the extent to which they

value different emotional states. Whereas

pleasant high- arousal states are more highly

valued in individualistic cultures, pleasant

low- arousal states are more highly valued

in collectivistic cultures. Thus, beyond emo-

tions’ hedonic benefits, emotion goals may

be determined by values that are prevalent

in people’s cultural context.

As the research reviewed here demon-

strates, people are often motivated to expe-

rience emotions for their immediate hedonic

benefits, but they can also be motivated to

experience emotions for their performance-

related benefits, epistemic benefits, or cul-

tural benefits. This list of determinants of

emotion goals is not exhaustive (for a more

complete list, see Tamir & Bigman, in press).

But it demonstrates that people can be moti-

vated to experience almost any emotion.

Thus, and perhaps surprisingly, emotion

goals are not limited to pleasant emotions.

The Structure of Emotion Goals

Up to this point, we have treated emotion

goals as though they are singular, isolated

entities. However, people pursue many dif-

ferent goals at any given moment. As Figure

22.2 illustrates, goals can be ordered hier-

archically according to their importance,

centrality, and abstraction, with some goals

assuming superordinate and others assum-

ing subordinate positions (Carver & Scheier,

2000; Fishbach & Ferguson, 2007). To fully

understand emotion goals, it is important to

FIGURE 22.2. Hypothesized organization of emotion goals. Multiple goals are hierarchically orga-

nized, with some goals assuming superordinate and others assuming subordinate positions. Goals can

be emotional or nonaffective in nature, and they can be compatible or in conflict with one another.

As the examples illustrates, goal structure can be characterized by multifinality and equifinality. The

goal of “joy” may serve the superordinate goal to be happy or to feel competent (multifinality). The

superordinate goal to feel competent can be subserved by either joy or anger (equifinality). Conflict can

arise when one goal (e.g., feel anger) subserves one superordinate goal (feel competent) but not another

(be happy).

Superordinate

goals

Subordinate

goals

Joy Worry Love

Spend time

with family

Do well

at work

Feel

pleasant

BE HAPPY

Superordinate

goals

Subordinate

goals

Joy Joy Anger

Win in

confrontations

Feel

pleasant

Make

friends

FEEL COMPETENT

Emotion Goals 365

examine them within the hierarchical struc-

ture of a broader goal system.

Goal systems can be characterized by mul-

tifinality and equifinality (Kruglanski et al.,

2002). Multifinality refers to the idea that

a given subordinate goal may serve multiple

superordinate goals (see Figure 22.2). In the

context of emotion goals, this implies that a

subordinate emotion goal (e.g., to feel joy)

may serve superordinate affect goals (e.g., to

feel pleasant) as well as superordinate non-

affect goals (e.g., to make friends). Equifi-

nality refers to the idea that a given super-

ordinate goal may be subserved by multiple

subordinate goals (see Figure 22.2). In the

context of emotion goals, this implies that a

superordinate goal (e.g., to be happy) may be

served by various affect (e.g., to feel good, to

feel less bad) and nonaffect (e.g., to do well

at work, to spend time with family) goals.

The pursuit of superordinate goals can

automatically activate related subordinate

goals (e.g., Fishbach & Ferguson, 2007).

Adapting this principle to the study of emo-

tion goals, we have recently shown that emo-

tion goals can be activated by priming related

superordinate goals (Tamir, Ford, & Ryan,

2013). Building on the idea that anger can

impair collaboration, we showed that par-

ticipants who were nonconsciously primed

with the goal of collaboration became less

motivated to experience anger before a

social interaction. These findings could not

be explained by concurrent emotional expe-

riences and demonstrate that emotion goals

can operate in the service of superordinate

nonaffect goals.

Multifinality and equifinality of goals can

thus facilitate goal pursuit because they offer

multiple ways to achieve goals. However, as

Figure 22.2 illustrates, the multifinality of

goals can also give rise to goal conflict when

subordinate goals simultaneously promote

the pursuit of some superordinate goals and

impair the pursuit of others. This may be

particularly salient in the context of emotion

goals, because emotions have both hedonic

and nonhedonic implications. Pleasant

emotions can either promote or impair the

attainment of superordinate nonaffect goals

(e.g., joy might help people make friends but

also lead them to spend less time studying

for an exam). However, pleasant emotions

generally promote the attainment of super-

ordinate affect goals (i.e., they feel good).

Thus, goal conflict may be less likely when a

pleasant emotion promotes both affect and

nonaffect superordinate goals, and more

likely when a pleasant emotion promotes an

affect goal but impairs a nonaffect goal.

Goal conflict may be particularly likely

when pursuing unpleasant emotions. Like

pleasant emotions, unpleasant emotions can

either promote or impair the attainment of

superordinate nonaffect goals (e.g., anger

might help people win a fight but it might

also impair friendships). However, unlike

pleasant emotions, unpleasant emotions

often impair the attainment of superordinate

affect goals (i.e., they feel bad). Therefore,

the pursuit of unpleasant emotions depends

on the relative strength of competing super-

ordinate nonaffect and affect goals. People

may be more likely to pursue subordinate

unpleasant emotion goals when superor-

dinate nonaffect goals become salient, and

such pursuits likely involve some degree of

goal conflict.

These ideas lie at the heart of the instru-

mental approach to emotion regulation

(Tamir, 2009). According to this approach,

people can pursue either pleasant or unpleas-

ant emotion goals, to the extent that such

goals serve salient superordinate goals. For

instance, to the extent that anger promotes

successful confrontation (e.g., Frijda, 1986),

people may be motivated to feel angry when

it is important for them to win a fight. In

such cases, people would be motivated to

experience unpleasant emotions, despite the

immediate hedonic cost of doing so.

There is now a body of empirical evidence

in support of these ideas. For instance, Tamir,

Mitchell, and Gross (2008) tested whether

people wanted to increase their anger when

preparing for confrontation. Participants

were given salient confrontational or non-

confrontational goals (e.g., kill enemies or

build an empire in a virtual computer game).

To assess emotion goals, participants indi-

cated the extent to which they preferred to

engage in various emotion- inducing activi-

ties, including those that were neutral, excit-

ing, and anger- inducing. Although partici-

pants acknowledged that the anger- inducing

activities would be unpleasant, they nonethe-

less preferred to engage in them when pursu-

ing the confrontational, but not the noncon-

frontational, goals. A similar pattern was

found in an examination of people’s prefer-

366 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

ences for anger before a face-to-face nego-

tiation task (Tamir & Ford, 2012b). Partici-

pants who thought they were preparing for a

confrontational negotiation showed stronger

preferences for anger before the negotiation.

In contrast, participants who thought they

were preparing for a collaborative negotia-

tion showed weaker preferences for anger

and stronger preferences for happiness. Such

preferences, in turn, were fully mediated

by the belief that anger would promote or

impair successful performance. These stud-

ies suggest that emotion goals can subserve

nonaffect goals, and that people pursue

unpleasant emotions when they expect them

to subserve salient superordinate goals.

Interestingly, the relative importance of

affect and nonaffect goals may shift system-

atically across the lifespan. Specifically, the

importance of affect goals seems to change

with age, with affect goals gaining in relative

importance over nonaffect goals (Charles

& Carstensen, this volume; Carstensen,

Isaacowitz, & Charles, 1999). If people are

likely to pursue unpleasant emotions when

they subserve superordinate nonaffect goals,

unpleasant emotion goals should be more

prevalent in younger than in older adults.

Indeed, wanting to maintain or increase

unpleasant emotions and decrease pleasant

emotions is more prevalent in younger than

in older adults (Riediger, Schmiedek, Wag-

ner, & Lindenberger, 2009).

In this section, we have discussed the

structure of emotion goals, highlighting

the fact that emotion goals operate within

a broader goal system, which includes both

affect and nonaffect goals that are hierarchi-

cally organized. The features of this orga-

nization have important implications for

understanding how emotion goals interact

with one another and with other types of

goals. In the next section, we focus on the

operation of emotion goals.

The Operation of Emotion Goals:

Automatic and Deliberate

Emotion Regulation

As illustrated in Figure 22.1, according

to feedback, or cybernetic, models of self

regulation, people initiate self- regulatory

attempts when they perceive discrepancies

between their current state and their goal

(Baumeister & Heatherton, 1996; Carver

& Scheier, 2000). When applied to emotion

goals, these models direct our attention to

an important element of emotion regula-

tion. Goals can be represented outside of

conscious awareness, as well as consciously

(Custers & Aarts, 2010; Fishbach & Fergu-

son, 2007). People pursue conscious goals

deliberately, whereas they pursue noncon-

scious goals relatively effortlessly and with

little or no conscious awareness (automati-

cally). It follows that emotion goals can

set in motion relatively automatic as well

as deliberate emotion regulation attempts.

Research shows that nonemotion goals, such

as achievement and cooperation, can be pur-

sued automatically (e.g., Bargh, Gollwitzer,

Lee-Chai, Barndollar, & Trötschel, 2001).

Might emotion goals also be pursued in an

automatic manner, with little effort and out-

side of conscious awareness?

While it has long been hypothesized that

people can engage in emotion regulation

unconsciously (Freud, 1936), only recently

has empirical research begun to explore this

possibility (see Gyurak & Etkin, this vol-

ume; Fitzsimons & Bargh, 2004; Gyurak,

Gross, & Etkin, 2011; Mauss, Bunge, et al.,

2007). To examine individual differences in

automatic emotion regulation, we developed

a variant of the Implicit Association Test

(IAT; Greenwald, McGhee, & Schwartz,

1998) that estimates implicit evaluation of

emotion control versus expression, the Emo-

tion Regulation IAT (ER-IAT; Mauss, Evers,

Wilhelm, & Gross, 2006, Study 1). We

reasoned that people who implicitly evalu-

ate emotion control positively would tend

to engage in automatic emotion regulation

(Aarts & Dijksterhuis, 2000; Custers &

Aarts, 2005).

To examine how automatic emotion reg-

ulation predicts emotional responding we

assessed whether ER-IAT scores were asso-

ciated with responses to a laboratory anger

provocation (Mauss et al., 2006, Study 2).

While most participants became angry

during the provocation, those with greater

ER-IAT scores (i.e., those who implicitly

evaluated emotion control more positively)

reported relatively less anger experience. In

addition, and in line with the notion that

regulation attempts had taken place, they

exhibited a challenge cardiovascular acti-

vation pattern, characterized by greater

Emotion Goals 367

cardiac output and lower total peripheral

resistance (cf. Tomaka, Blascovich, Kelsey,

& Leitten, 1993). The relative reduction of

anger experience appeared to have happened

without conscious effort, because asso-

ciations between ER-IAT scores and anger

responding held when researchers controlled

for self- reported effortful emotion control.

In summary, these findings are consistent

with the idea that people who implicitly val-

ued emotion control tended to regulate their

emotion automatically and experienced less

anger.

To examine the possible causal role of

automatic emotion regulation, we (Mauss,

Cook, & Gross, 2007) manipulated noncon-

scious emotion regulation goals by priming

emotion control versus emotion expression

with a sentence- unscrambling task (Srull &

Wyer, 1979). Participants primed with emo-

tion control in the laboratory responded

with less anger to a subsequent anger provo-

cation than did participants primed with

emotion expression. The fact that partici-

pants were not aware of the purpose of the

priming task suggests that these effects were

not conscious. These conclusions were con-

firmed in a study in which participants were

either explicitly instructed or primed outside

of awareness to engage in emotion regula-

tion. Participants in the priming condition

achieved the same decrease in physiological

reactivity to an anxiety induction as those

explicitly instructed to regulate their emo-

tion (Williams, Bargh, Nocera, & Gray,

2009).

Work on implementation intentions also

suggests that emotion regulation can unfold

automatically. An implementation inten-

tion is a plan that links situations to specific

goal- directed behaviors (Gollwitzer, 1999),

such as “After I get up in the morning, I

will run 2 miles.” By putting goal- directed

behavior under the control of the situation

in this way, the execution of the goal is

removed from effortful and conscious con-

trol and rendered relatively automatic (Webb

& Sheeran, 2007). Recent research suggests

that implementation intentions can be used

in the service of emotion regulation (for a

review, see Webb, Schweiger Gallo, et al.,

2012). For example, Schweiger- Gallo, Keil,

McCulloch, Rockstroh, and Gollwitzer

(2009) showed spider phobics images that

included spiders. Participants were given

no instructions, were asked to form a goal

intention (“I will not get frightened!”), or

were asked to form an implementation inten-

tion (“If I see a spider, then I will remain

calm and relaxed!”). Afterward, when view-

ing spider pictures, participants who formed

implementation intentions reported less

negative affect and exhibited less physiologi-

cal arousal compared to both other groups.

This research further supports the idea that

emotion regulation can take place without

conscious awareness.

It appears, then, that the nonconscious

pursuit of emotion goals may be just as

effective as the conscious pursuit of emotion

goals. Unlike conscious goal pursuit, how-

ever, nonconscious goal pursuit “eats up”

less cognitive resources and is less effortful

(Custers & Aarts, 2010; Fishbach, Fried-

man, & Kruglanski, 2003). Automatic emo-

tion regulation, therefore, could help people

cope with powerful negative situations with-

out conscious effort. Given how impor-

tant emotion regulation is to psychological

health (Rottenberg & Johnson, 2007), the

intriguing possibility arises that the auto-

matic pursuit of emotion goals might play

a beneficial role in psychological health. A

recent study tested whether this might be

the case (DeWall et al., 2011). It showed that

after social exclusion, participants low in

depressive symptoms or high in self- esteem

automatically (without conscious intent)

initiated the up- regulation of positive emo-

tion. Similar findings have been obtained

for individuals with healthy traits such as

high action orientation or secure attach-

ment (for review, see Koole & Rothermund,

2011). These findings suggest that automatic

emotion regulation may be part of the psy-

chological immune system: in healthy indi-

viduals a threat sets in motion an automatic

emotion regulation process that leads to

increased positive and decreased negative

emotions.

This does not imply that automatic emo-

tion regulation is always associated with

beneficial outcomes. After all, defensiveness

and repression are based on implicitly rep-

resented goals, yet they are associated with

negative outcomes (Freud, 1936; Vaillant,

1977; Weinberger, 1995). The goal frame-

work may help explain when automatic emo-

tion regulation is beneficial versus harmful.

As we discuss in the next section, automatic

368 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

emotion regulation may be beneficial to the

extent that people (1) use effective regulation

strategies and (2) pursue adaptive emotion

goals (Hopp, Troy, & Mauss, 2011).

Implications for Well-Being

The goal framework leads to several novel

predictions regarding when and why emo-

tion regulation is associated with healthy

versus unhealthy outcomes. Next, we exam-

ine two particularly important sets of pre-

dictions and empirical evidence to support

them.

Emotion Goals and Emotion

Regulation Strategies

People can use a multitude of emotion regu-

lation strategies to attain emotion goals. For

example, to feel less angry, Person A might

think of something else whereas Person B

may vent. The study of emotion regulation

strategies and their relative adaptiveness

(i.e., to what extent different types of emo-

tion regulation strategies are associated with

greater well-being) has paid relatively little

attention to the emotion goals people pur-

sue. We argue that it is fruitful to examine

emotion regulation strategies in the context

of emotion goals. The goal framework offers

three specific hypotheses. First, the adaptive-

ness of emotion regulation strategies should

depend on the extent to which they help a

person achieve their emotion goals (i.e., to

the extent that they are effective). Second,

the adaptiveness of emotion regulation strat-

egies should depend on not only their inher-

ent features but also the extent to which they

are used in a goal- sensitive, flexible manner.

Third, the adaptiveness of emotion regula-

tion strategies should depend on the extent

to which they are used in the service of adap-

tive emotion goals.

Much research has focused on classify-

ing the various emotion regulation strategies

that exist (Gross & Thompson, 2007; Koole,

2009; Totterdell & Parkinson, 1999). One

of the most prominent models distinguishes

different emotion regulation strategies based

on the stage in the emotion process in which

they intervene (Gross & Thompson, 2007).

According to this model, emotion regulation

strategies can be characterized depending

on whether they target the emotional situ-

ation, a person’s attention to it, or appraisal

of it (antecedent- focused) versus a later

component of the emotional response, such

as emotion- expressive behaviors (response-

focused).

Which emotion regulation strategies are

most effective for attaining emotion goals

(e.g., decrease anger)? Antecedent- focused

emotion regulation strategies should be rela-

tively more effective at altering emotional

responses because they have the advantage

of a preventive strategy: they take place

before the emotional response fully unfolds

and thus should be more effective than

response- focused emotion regulation strate-

gies. A recent meta- analysis of 190 studies

is broadly consistent with this hypothesis

(Webb, Miles, et al., 2012). Are the most

effective emotion regulation strategies also

the most adaptive? Research comparing

antecedent- focused emotion regulation (i.e.,

cognitive appraisal) to response- focused

emotion regulation (i.e., expressive suppres-

sion) suggests that, indeed, on average reap-

praisal is associated with better psychologi-

cal health (Garnefski & Kraaij, 2006; Gross

& John, 2003; Troy, Wilhelm, Shallcross, &

Mauss, 2010). Thus, there is some evidence

that some of the most effective emotion reg-

ulation strategies are also relatively adaptive.

Importantly, from a goal perspective, the

adaptiveness of an emotion regulation strat-

egy should be determined by its inherent

properties, but also by how flexibly it is used

to support an individual’s changing emotion

goals (Bonanno & Burton, in press; Brandt-

staedter & Rothermund, 2002; Cheng,

2001; Kashdan & Rottenberg, 2010). Find-

ings in support of this notion have been

obtained from daily diary studies in which

participants reported on stressful life events

and how many different coping strategies

they used (Cheng, 2001). Flexibility was

operationalized as participants’ ability to

vary coping strategies with the demand of

the stressful event. Participants demonstrat-

ing greater flexibility exhibited greater well-

being compared to participants who adhered

more rigidly to particular coping strategies,

regardless of the particular type of coping

strategy.

Bonanno, Papa, Lalande, Westphal, and

Coifman (2004) tested a related idea by

deriving a laboratory measure of how well

Emotion Goals 369

participants were able to match their emo-

tion regulation efforts to changing goals

(either increase or decrease emotional

expression). Participants who were better

able to regulate their emotions in pursuit

of their concurrent goals reported greater

psychological health after the September

11, 2001 attacks (Bonanno et al., 2004)

and greater well-being after high life stress

(Westphal, Seivert, & Bonanno, 2010).

From a goal framework, emotion regula-

tion strategies are therefore adaptive to the

extent that they help people attain their

concurrent emotion goals. However, the

adaptiveness of emotion regulation more

generally depends on which emotion goals

people are trying to achieve. If people hold

maladaptive emotion goals, even the most

effective and flexible emotion regulation

strategies should not be adaptive. Which

emotion goals are adaptive? Perhaps those

that are sensitive to situational demands

and are consistent with superordinate goals

and basic needs (Deci & Ryan, 1985; Troy,

Shallcross, & Mauss, in press) (e.g., increase

joy in the service of successfully collaborat-

ing with others, and increase anger in the

service of successfully confronting others).

Consistent with these ideas, we found that

the more people wanted to feel angry and

the less they wanted to feel happy in con-

frontational situations, the higher their

psychological well-being. The converse pat-

tern was found the more angry and the less

happy people wanted to feel in collaborative

situations (Tamir & Ford, 2012a).

In summary, the goal framework can help

us understand when and why emotion regu-

lation strategies are adaptive or maladaptive.

Emotion regulation strategies are adaptive to

the extent that they help individuals attain

their emotion goals, are used in a goal-

sensitive and flexible manner, and are used

in the context of adaptive emotion goals.

Feedback Processing: Emotion Goals,

Evaluation, and Meta‑Emotion

Emotion regulation does not operate in a

linear, one- directional fashion. Rather, as

Figure 22.1 illustrates, it involves recursive

feedback loops. Feedback models of self-

regulation (Carver & Scheier, 2000) propose

that people monitor the discrepancy between

their current state and the desired end state,

as well as the progress of their efforts to

decrease discrepancies between the two.

Importantly, the output of this monitoring

process is emotional in nature. When people

progress faster than expected toward their

goal, they feel positively (e.g., contentment);

when people progress more slowly than

expected they feel negatively (e.g., distress).

Because these emotional states are about an

emotional state, they can be referred to as

meta- emotion. Considering emotion regu-

lation in the context of this feedback loop

leads to two interesting predictions. First,

decreasing the discrepancy between current

and desired state should yield better well-

being, whether the discrepancy reduction

occurs by changing one’s current emotional

state or by changing one’s desired emotional

state. Conversely, an increased discrepancy

between current and desired state should

yield negative outcomes, whether it is due to

one’s current or desired emotional state. Sec-

ond, meta- emotion may play an important

role in the effects of emotion regulation on

well-being.

The hypothesis that adjusting one’s goals

(in addition to or instead of one’s current

state) plays an important role in well-being

has been supported in the context of cop-

ing with stressors (e.g., Brandtstaedter &

Rothermund, 2002; Wrosch, Scheier, Miller,

Schulz, & Carver, 2003). This research sug-

gests that goal adjustment (e.g., failing to

disengage from impossible goals) is at least

as important to well-being as the effective

pursuit of goals. This principle also appears

to apply to emotion goals. In one experi-

mental study, researchers manipulated par-

ticipants’ emotion goals by instructing them

to make themselves feel as happy as possible

while they listened to emotionally ambigu-

ous music (i.e., their desired emotional end

state was set to a highly positive state). In line

with the idea that unrealistic emotion goals

can lead to negative emotional outcomes,

participants in this condition were less

happy compared to participants who were

not given an emotion goal (Schooler, Ariely,

& Loewenstein, 2003). In another study,

researchers manipulated emotion goals more

subtly by presenting to participants a sham

newspaper article discussing the advantages

of happiness. Participants induced in this

way to assume a happiness goal were less

happy than control participants after subse-

370 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

quently watching a happy film clip (Mauss,

Tamir, Anderson, & Savino, 2011, Study

2). This research converges to support the

hypothesis that holding unrealistic emotion

goals (e.g., high levels of happiness) can lead

to decreased positive emotion.

Do people who chronically hold unreal-

istic emotion goals experience more nega-

tive well-being outcomes? We examined this

question by measuring the extent to which

participants held the goal to be happy, with

items such as “Feeling happy is extremely

important to me.” On average, the more par-

ticipants valued happiness, the lower their

emotional well-being (Mauss et al., 2011,

Study 1), and the higher their likelihood of

being diagnosed with major depressive dis-

order (Ford, Shallcross, Mauss, Floerke, &

Gruber, under review). These studies make

the point that one’s emotion goals play an

important role in well-being and psychologi-

cal health.

The perspective that adjusting one’s emo-

tion goals is one important avenue to well-

being brings insight to a puzzling area of

research: that of emotional acceptance.

Acceptance is defined as the process of non-

judgmentally engaging with negative emo-

tions (Teasdale et al., 2000). Correlational

and experimental research on acceptance

has consistently found it to be negatively

correlated with negative emotion and mood

disorder (Campbell- Sills, Barlow, Brown, &

Hofmann, 2006; Kashdan, Barrios, Forsyth,

& Steger, 2006; Roemer, Salters, Raffa,

& Orsillo, 2005; Shallcross, Troy, Boland,

& Mauss, 2010). The inverse relationship

between acceptance and negative affect may

appear paradoxical at first: How can engag-

ing with negative emotions be associated

with less negative emotion? The goal per-

spective suggests one solution to this appar-

ent paradox: Acceptance may involve more

realistic emotion goals, which in turn lead

to greater well-being. Well-being, therefore,

is a function of not only effective emotion

regulation but also having attainable emo-

tion goals. Or, in the words of the adage,

“Happiness is not having what you want,

but wanting what you have.”

As there are with nonemotion goals, there

are likely costs for inflexibly pursuing emo-

tion goals that are difficult to attain. How-

ever, unlike nonemotion goals, because it

leads to meta- emotion, the pursuit of unat-

tainable emotion goals can be self- defeating.

For instance, in the study discussed earlier

(Mauss et al., 2011, Study 2), compared to

participants in the control condition, par-

ticipants who were led to pursue happiness

goals ended up feeling more disappointed in

their emotional state, which resulted in less

happiness. Interestingly, these effects were

only observed for participants who watched

a happy film clip, not for those who watched

a sad film clip. This may be because in rela-

tively negative situations (e.g., when watch-

ing a sad film clip), people have a good rea-

son not to feel happy, and are less likely to

feel disappointed if they fail to meet their

happiness goal. Conversely, in relatively

positive situations (e.g., when watching a

happy film clip), people have every reason

to feel happy and ironically end up feeling

disappointed when they do not. Whereas

the pursuit of nonemotion goals influences

behavior and results in emotions, the pur-

suit of emotion goals influences emotions

and results in emotions. Thus, when pursu-

ing emotion goals, meta- emotional experi-

ences can interfere with successful goal pur-

suit.

In summary, the goal framework high-

lights the fact that people’s well-being is

determined by not only how they pursue

emotion goals but the goals themselves. Set-

ting exceedingly positive emotion goals or

failing to adjust emotion goals can, ironi-

cally, lead to less positive emotion and to

lower well-being. These effects are due in

part to people’s meta- emotion (how they feel

about their feelings).

Conclusions and Future Directions

In this chapter, we argue that it is crucial

to consider emotion regulation in the con-

text of the emotions people want to feel.

Understanding the content of emotion goals

helps us better understand the initiation and

course of emotion regulation; understand-

ing the structure of emotion goals helps us

better understand how emotion and other

goals interact with one another in goal hier-

archies; and understanding the operation of

emotion goals helps us better understand the

emotion regulation process.

Taking a goal perspective can offer

answers to questions such as the following:

Emotion Goals 371

When do people regulate their emotions?

How do multiple, potentially conflicting

goals interact with one another? What role

do automatic processes play in the pursuit

of emotion goals? How do emotion goals

and pursuit of them affect well-being? In

addition to guiding us to approach these

novel questions, the proposed goal frame-

work helps us critically examine some core

assumptions in research on emotion regula-

tion. For example, one core assumption is

that people want to feel pleasant emotions

and avoid unpleasant emotions. However,

the goal framework challenges this assump-

tion (Tamir, 2009; Tamir & Ford, 2009).

Positioning emotion goals in a broader goal

hierarchy leads us to predict that individuals

will seek more unpleasant emotions in pur-

suit of superordinate nonaffect goals.

Another core assumption in research on

emotion regulation is that there is something

inherently beneficial or harmful about par-

ticular emotion regulation strategies. The

goal framework suggests that emotion regu-

lation and its implications for well-being can

be fully understood only in the context of

a person’s broader goal hierarchy (Bonanno

& Burton, in press; Thompson, 2011; Troy

et al., in press).

While some research has already adopted

a goal framework in emotion regulation,

more work needs to be done on each of the

three domains of emotion goals on which

we have focused (i.e., their content, struc-

ture, and operation). In terms of the content

of emotion goals, it will be important to

develop a systematic approach to measur-

ing these goals, whether they are transient

or more chronically held. More work is

necessary especially to measure implicitly

represented emotion goals (those not read-

ily accessible to introspection). In addition,

important open questions remain about

what biological, psychological, and cultural

factors shape people’s emotion goals.

In terms of the structure of emotion goals,

it will be important to obtain a systematic

and comprehensive understanding of how

emotion and nonaffect goals interact with

one another, and to identify the implica-

tions of different types of goal conflict. For

example, how malleable are the associations

between subordinate and superordinate

emotion and nonaffect goals? What are the

short- and long-term implications of conflict

among goals? Of particular interest here

might be conflict among explicit (relatively

conscious) and implicit (relatively uncon-

scious) emotion goals. Understanding con-

flict among explicit and implicit goals has

been fruitful in domains such as achieve-

ment motives (Brunstein, Schultheiss, &

Grässman, 1998); it would be promising in

the domain of emotion goals as well.

In terms of the operation of emotion

goals, there is still much to learn about their

nonconscious representation and automatic

pursuit. For instance, what gives rise to indi-

vidual differences in automatic emotion reg-

ulation? What are its costs and benefits? In

addition, the goal framework makes several

predictions about emotion goals’ implica-

tions for well-being. For example, it implies

that healthy functioning hinges on the selec-

tion of appropriate emotion goals, interac-

tions among emotion regulation strategies

and emotion goals, and the meta- emotions

that arise as a function of emotion goal pur-

suit. These features and implications of emo-

tion goals have yet to be fully explored.

Note

1. Our review is selective. We do not cover con-

cepts such as emotional effects of goals and

goal pursuit (e.g., feelings of disappoint-

ment when not attaining a nonemotion goal,

positive evaluation of goals) or goals that are

infused with a lot of emotion (e.g., a goal

about which one feels passionate). While these

phenomena are important, they are distinct

from the focus of this chapter.

References

Aarts, H., & Dijksterhuis, A. (2000). Habits as

knowledge structures: Automaticity in goal-

directed behavior. Journal of Personality and

Social Psychology, 78, 53–63.

Bandura, A. (1986). Social foundations of

thought and action: A social cognitive theory.

Upper Saddle River, NJ: Prentice Hall.

Bargh, J. A., Gollwitzer, P. M., Lee-Chai, A.,

Barndollar, K., & Trötschel, R. (2001). The

automated will: Nonconscious activation and

pursuit of behavioral goals. Journal of Person-

ality and Social Psychology, 81, 1014–1027.

Baumeister, R. F., & Heatherton, T. F. (1996).

372 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Self- regulation failure: An overview. Psycho-

logical Inquiry, 7, 1–15.

Bonanno, G. A. (2001). Emotion self- regulation.

In T. J. Mayne & G. A. Bonanno (Eds.), Emo-

tions: Current issues and future directions

(pp. 251–285). New York: Guilford Press.

Bonanno, G. A., & Burton, C. (in press). Regu-

latory flexibility: An individual differences

perspective on coping and emotion regulation.

Perspectives on Psychological Science.

Bonanno, G. A., Papa, A., Lalande, K., West-

phal, M., & Coifman, K. (2004). The impor-

tance of being flexible: The ability to both

enhance and suppress emotional expression

predicts long term adjustment. Psychological

Science, 15, 482–487.

Brandtstaedter, J., & Rothermund, K. (2002).

The life- course dynamics of goal pursuit and

goal adjustment: A two- process framework.

Developmental Review, 22, 117–150.

Brunstein, J. C., Schultheiss, O. C., & Gräss-

man, R. (1998). Personal goals and emotional

well-being: The moderating role of motive dis-

positions. Journal of Personality and Social

Psychology, 75, 494–508.

Campbell- Sills, L., Barlow, D. H., Brown, T. A.,

& Hofmann, S. G. (2006). Effects of suppres-

sion and acceptance on emotional responses

of individuals with anxiety and mood disor-

ders. Behaviour Research and Therapy, 44,

1251–1263.

Carstensen, L. L., Isaacowitz, D. M., & Charles,

S. T. (1999). Taking time seriously: A theory

of socioemotional selectivity. American Psy-

chologist, 54, 165–181.

Carver, C. S., & Scheier, M. F. (2000). On the

structure of behavioral self- regulation. In M.

Boekaerts, P. R. Pintrich, & M. Zeidner (Eds.),

Handbook of self-regulation (pp. 41–84). San

Diego, CA: Academic Press.

Charles, S. T., & Carstensen, L. L. (this volume,

2014). Emotion regulation and aging. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 203–218). New York: Guilford

Press.

Cheng, C. (2001). Assessing coping flexibility

in real-life and laboratory settings: A multi-

method approach. Journal of Personality and

Social Psychology, 80, 814–833.

Clore, G. L., Gasper, K., & Garvin, E. (2001).

Affect as information. In J. P. Forgas (Ed.),

Handbook of affect and social cognition

(pp. 121–144). Mahwah, NJ: Erlbaum.

Custers, R., & Aarts, H. (2005). Positive affect

as implicit motivator: On the nonconscious

operation of behavioral goals. Journal of

Personality and Social Psychology, 89, 129–

142.

Custers, R., & Aarts, H. (2010). The uncon-

scious will: How the pursuit of goals operates

outside of conscious awareness. Science, 329,

47–50.

Deci, E. L., & Ryan, R. M. (1985). Intrinsic

motivation and self- determination in human

behavior. New York: Plenum.

DeWall, C. N., Twenge, J. M., Koole, S. L., Bau-

meister, R. F., Marquez, A., & Reid, M. W.

(2011). Automatic emotion regulation after

social exclusion: Tuning to positivity. Emo-

tion, 11, 623–636.

Diener, E. (2000). Subjective well-being: The sci-

ence of happiness and a proposal for a national

index. American Psychologist, 55, 34–43.

Eid, M., & Diener, E. (2001). Norms for expe-

riencing emotions in different cultures: Inter-

and intranational differences. Journal of Per-

sonality and Social Psychology, 81, 869–885.

Fishbach, A., & Ferguson, M. F. (2007). The

goal construct in social psychology. In A. W.

Kruglanski & E. T. Higgins (Eds.), Social

psychology: Handbook of basic principles

(pp. 490–515). New York: Guilford Press.

Fishbach, A., Friedman, R. S., & Kruglanski, A.

W. (2003). Leading us not unto temptation:

Momentary allurements elicit overriding goal

activation. Journal of Personality and Social

Psychology, 84, 296–309.

Fitzsimons, G. M., & Bargh, J. A. (2004). Auto-

matic self- regulation. In R. F. Baumeister & K.

D. Vohs (Eds.), Handbook of self- regulation:

Research, theory, and applications (pp. 151–

170). New York: Guilford Press.

Ford, B. Q., Shallcross, A. J., Mauss, I. B.,

Floerke, V. A., & Gruber, J. (under review).

Desperately seeking happiness: Valuing hap-

piness is associated with symptoms and diag-

nosis of depression.

Fredrickson, B. L. (2001). The role of positive

emotions in positive psychology: The broaden-

and-build theory of positive emotions. Ameri-

can Psychologist, 56, 218–226.

Freud, A. (1936). The ego and the mechanisms of

defense. New York: International Universities

Press.

Frijda, N. H. (1986). The emotions. New York:

Cambridge University Press.

Garnefski, N., & Kraaij, V. (2006). Relationships

between cognitive emotion regulation strate-

Emotion Goals 373

gies and depressive symptoms: A comparative

study of five specific samples. Personality and

Individual Differences, 40, 1659–1669.

Gollwitzer, P. M. (1990). Action phases and

mind-sets. In E. T. Higgins & R. M. Sorren-

tino (Eds.), Handbook of motivation and cog-

nition: Foundations of social behavior (Vol. 2,

pp. 53–92). New York: Guilford Press.

Gollwitzer, P. M. (1999). Implementation inten-

tions: Strong effects of simple plans. American

Psychologist, 54, 493–503.

Greenwald, A. G., McGhee, D. E., & Schwartz,

J. L. K. (1998). Measuring individual differ-

ences in implicit cognition: The Implicit Asso-

ciation Test. Journal of Personality and Social

Psychology, 74, 1464–1480.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85, 348–362.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp. 3–24). New York: Guilford Press.

Gyurak, A., & Etkin, A. (this volume, 2014). A

neurobiological model of implicit and explicit

emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 76–90). New York: Guilford Press.

Gyurak, A., Gross, J. J., & Etkin, A. (2011).

Explicit and implicit emotion regulation: A

dual- process framework. Cognition and Emo-

tion, 25, 400– 412.

Harmon-Jones, E., Harmon-Jones, C., Amo-

dio, D. M., & Gable, P. A. (2011). Attitudes

toward emotions. Journal of Personality and

Social Psychology, 101, 1332–1350.

Hopp, H., Troy, A. S., & Mauss, I. B. (2011). The

unconscious pursuit of emotion regulation:

Implications for psychological health. Cogni-

tion and Emotion, 25, 532–545.

Kashdan, T. B., Barrios, V., Forsyth, J. P., & Ste-

ger, M. F. (2006). Experiential avoidance as a

generalized psychological vulnerability: Com-

parisons with coping and emotion regulation

strategies. Behaviour Research and Therapy,

44, 1301–1320.

Kashdan, T. B., & Rottenberg, J. (2010). Psy-

chological flexibility as a fundamental aspect

of health. Clinical Psychology Review, 30,

865–878.

Keltner, D., & Haidt, J. (1999). Social functions

of emotions at four levels of analysis. Cogni-

tion and Emotion, 13, 505–521.

Kitayama, S., Mesquita, B., & Karasawa, M.

(2006). Cultural affordances and emotional

experience: Socially engaging and disengag-

ing emotions in Japan and the United States.

Journal of Personality and Social Psychology,

91, 890–903.

Koole, S. L. (2009). The psychology of emotion

regulation: An integrative review. Cognition

and Emotion, 23, 4– 41.

Koole, S. L., & Rothermund, K. (2011). “I feel

better but I don’t know why”: The psychology

of implicit emotion regulation. Cognition and

Emotion, 25, 389–399.

Koole, S. L., van Dillen, L. F., & Sheppes, G.

(2011). The self- regulation of emotion. In K.

D. Vohs & R. F. Baumeister (Eds.), Hand-

book of self- regulation: Research, theory, and

applications (2nd ed., pp. 22–40). New York:

Guilford Press.

Kruglanski, A. W., Shah, J. Y., Fishbach, A.,

Friedman, R., Chun, W. Y., & Sleeth- Keppler,

D. (2002). A theory of goal- systems. In M. P.

Zanna (Ed.), Advances in experimental psy-

chology (pp. 331–378). New York: Academic

Press.

Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007).

Automatic emotion regulation. Social and Per-

sonality Psychology Compass, 1, 146 –167.

Mauss, I. B., Cook, C. L., & Gross, J. J. (2007).

Automatic emotion regulation during anger

provocation. Journal of Experimental Social

Psychology, 43, 698–711.

Mauss, I. B., Evers, C., Wilhelm, F. H., & Gross,

J. J. (2006). How to bite your tongue without

blowing your top: Implicit evaluation of emo-

tion regulation predicts affective responding

to anger provocation. Personality and Social

Psychology Bulletin, 32, 589–602.

Mauss, I. B., Tamir, M., Anderson, C. L., & Sav-

ino, N. S. (2011). Can seeking happiness make

people unhappy?: Paradoxical effects of valu-

ing happiness. Emotion, 11, 807–815.

Mischel, W., Cantor, N., & Feldman, S. (1996).

Principles of self- regulation: The nature of

willpower and self- control. In E. T. Higgins

& A. W. Kruglanski (Eds.), Social psychology:

Handbook of basic principles (pp. 329–360).

New York: Guilford Press.

374 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

Nesse, R. M., & Ellsworth, P. C. (2009). Evo-

lution, emotions, and emotional disorders.

American Psychologist, 129–139.

Parrott, W. G. (1993). Beyond hedonism: Motives

for inhibiting good moods and for maintain-

ing bad moods. In D. M. Wegner & J. W. Pen-

nebaker (Eds.), Handbook of mental control

(pp. 278–305). Upper Saddle River, NJ: Pren-

tice Hall.

Riediger, M., Schmiedek, F., Wagner, G. G., &

Lindenberger, U. (2009). Seeking pleasure and

seeking pain: Differences in prohedonic and

contra- hedonic motivation from adolescence

to old age. Psychological Science, 20, 1529–

1535.

Roemer, L., Salters, K., Raffa, S. D., & Orsillo,

S. M. (2005). Fear and avoidance of internal

experiences in GAD: Preliminary tests of a

conceptual model. Cognitive Therapy and

Research, 29, 71–88.

Rottenberg, J., & Johnson, S. L. (2007). Emo-

tion and psychopathology: Bridging affective

and clinical science. Washington, DC: Ameri-

can Psychological Association.

Rusting, C. L., & Larsen, R. J. (1995). Moods as

sources of stimulation: Relationships between

personality and desired mood states. Personal-

ity and Individual Differences, 18, 321–329.

Schooler, J. W., Ariely, D., & Loewenstein, G.

(2003). The pursuit and monitoring of hap-

piness can be self- defeating. In J. Carrillo &

I. Brocas (Eds.), Psychology and economics

(pp. 41–70). Oxford, UK: Oxford University

Press.

Schweiger- Gallo, I. S., Keil, A., McCulloch, K.

C., Rockstroh, B., & Gollwitzer, P. M. (2009).

Strategic automation of emotion regulation.

Journal of Personality and Social Psychology,

96, 11–31.

Shallcross, A. J., Troy, A. S., Boland, M., &

Mauss, I. B. (2010). Let it be: Accepting nega-

tive emotional experiences predicts decreased

negative affect and depressive symptoms.

Behaviour Research and Therapy, 48, 921–

929.

Srull, T. K., & Wyer, R. S. (1979). Role of cat-

egory accessibility in the interpretation of

information about persons— Some determi-

nants and implications. Journal of Personality

and Social Psychology, 37, 1660–1672.

Swann, W. B., & Schroeder, D. G. (1995). The

search for beauty and truth—A framework for

understanding reactions to evaluations. Per-

sonality and Social Psychology Bulletin, 21,

1307–1318.

Tamir, M. (2009). What do people want to feel

and why?: Pleasure and utility in emotion reg-

ulation. Current Directions in Psychological

Science, 18, 101–105.

Tamir, M., & Bigman, Y. (in press). When do peo-

ple want to feel bad?: A taxonomy of motives.

In W. G. Parrott (Ed.), The positive side of

negative emotions. New York: Guilford Press.

Tamir, M., Bigman, Y., Rhodes, E., Salerno, J.,

& Schreier, J. (2013). Utilitarian emotions:

Expected usefulness of emotions shapes emo-

tion regulation, experience, and decision

making. Manuscript under review.

Tamir, M., & Ford, B. Q. (2009). Choosing to

be afraid: Preferences for fear as a function of

goal pursuit. Emotion, 9, 488 – 497.

Tamir, M., & Ford, B. Q. (2012a). Should people

pursue feelings that feel good or feelings that

do good?: Emotional preferences and well-

being. Emotion, 12, 1061–1070.

Tamir, M., & Ford, B. Q. (2012b). When feeling

bad is expected to be good: Emotion regula-

tion and outcome expectancies in social con-

flicts. Emotion, 12, 807–816.

Tamir, M., Ford, B. Q., & Ryan, E. (2013). Non-

conscious goals can shape what people want to

feel. Journal of Experimental Social Psychol-

ogy, 49, 292–297.

Tamir, M., Mitchell, C., & Gross, J. J. (2008).

Hedonic and instrumental motives in anger

regulation. Psychological Science, 19, 324–328.

Teasdale, J. D., Segal, Z. V., Williams, J. M. G.,

Ridgeway, V. A., Soulsby, J. M., & Lau, M.

A. (2000). Prevention of relapse/recurrence in

major depression by mindfulness- based cogni-

tive therapy. Journal of Consulting and Clini-

cal Psychology, 68, 615–623.

Thompson, R. A. (2011). Emotion and emotion

regulation: Two sides of the developing coin.

Emotion Review, 3, 53–61.

Tomaka, J., Blascovich, J., Kelsey, R. M., & Leit-

ten, C. L. (1993). Subjective, physiological,

and behavioral effects of threat and challenge

appraisal. Journal of Personality and Social

Psychology, 65, 248–260.

Totterdell, P., & Parkinson, B. (1999). Use and

effectiveness of self- regulation strategies for

improving mood in a group of trainee teach-

ers. Journal of Occupational Health Psychol-

ogy, 4, 219–232.

Troy, A. S., Shallcross, A. J., & Mauss, I. B.

(in press). A person-by-situation approach to

emotion regulation: Cognitive reappraisal can

either hurt or help depending on the context.

Psychological Science.

Emotion Goals 375

Troy, A. S., Wilhelm, F. H., Shallcross, A. J., &

Mauss, I. B. (2010). Seeing the silver lining:

Cognitive reappraisal ability moderates the

relationship between stress and depression.

Emotion, 10, 783–795.

Tsai, J. L., Knutson, B., & Fung, H. H. (2006).

Cultural variation in affect valuation. Jour-

nal of Personality and Social Psychology, 90,

288–307.

Vaillant, G. (1977). Adaptation to life. Boston:

Little, Brown.

Webb, T. L., Miles, E., & Sheeran, P. (2012).

Dealing with feeling: A meta- analysis of the

effectiveness of strategies derived from the

process model of emotion regulation. Psycho-

logical Bulletin, 138, 775–808.

Webb, T. L., Schweiger Gallo, I., Miles, E., Goll-

witzer, P. M., & Sheeran, P. (2012). Effective

regulation of affect: An action control perspec-

tive on emotion regulation. European Review

of Social Psychology, 23, 143–186.

Webb, T. L., & Sheeran, P. (2007). How do

implementation intentions promote goal

attainment?: A test of component processes.

Journal of Experimental Social Psychology,

43, 295–302.

Weinberger, D. A. (1995). The construct validity

of the repressive coping style. In J. L. Singer

(Ed.), Repression and dissociation: Implica-

tions for personality theory, psychopathology,

and health (pp. 337–386). Chicago: University

of Chicago Press.

Westphal, M., Seivert, N. H., & Bonanno, G.

A. (2010). Expressive flexibility. Emotion, 10,

92–100.

Williams, L. E., Bargh, J. A., Nocera, C. C., &

Gray, J. R. (2009). The unconscious regulation

of emotion: Nonconscious reappraisal goals

modulate emotional reactivity. Emotion, 9,

847–854.

Wood, J. V., Heimpel, S. A., Manwell, L. A., &

Whittington, E. J. (2009). This mood is familiar

and I don’t deserve to feel better anyway: Mech-

anisms underlying self- esteem differences in

motivation to repair sad moods. Journal of Per-

sonality and Social Psychology, 96, 363–380.

Wrosch, C., Scheier, M. F., Miller, G. E., Schulz,

R., & Carver, C. S. (2003). Adaptive self-

regulation of unattainable goals: Goal disen-

gagement, goal reengagement, and subjective

well-being. Personality and Social Psychology

Bulletin, 29, 1494–1508.

376

The evolution of human self- awareness con-

stituted a seismic shift in mammalian psy-

chology. Although some of our prehuman

ancestors may have possessed rudimentary

forms of self- awareness, much like modern

chimpanzees and orangutans, evidence sug-

gests that prehistoric people did not begin

to think consciously about themselves until

around 2 million years ago. Moreover, the

archeological record indicates that people

did not have the capacity to think about

themselves in the abstract and symbolic ways

that characterize modern human beings until

culture began to appear between 40,000

and 60,000 years ago (Leary & Buttermore,

2003). The evolution of self- awareness had

important implications for human beings’

emotional lives, because human emotions

often arise from the ways in which people

think about themselves and the events that

happen to them. Self- awareness and self-

relevant thought have implications for the

stimuli that trigger emotional states, the

specific emotions that people experience,

and people’s efforts to manage and regulate

their emotions.

Evidence suggests that most animals

lack the ability to think consciously about

themselves. Yet animals nonetheless experi-

ence a variety of emotions (Veissier, Boissy,

Désiré, & Greiveldinger, 2009), and people

sometimes experience emotions even when

they are not self-aware. Thus, conscious self-

awareness is not necessary for emotional

experience. The emotional reactions of ani-

mals that lack self- awareness and those of

human beings when they are not self-aware

are controlled by two primary processes that

occur without conscious awareness. First,

many stimuli naturally and automatically

evoke emotions. For example, most spe-

cies instinctively react to certain threat cues

without conscious thought, such as when

the silhouette of a hawk in flight elicits fear

in many birds, or when human beings react

with fear to an object that approaches them

suddenly. Other emotions, such as anger,

sadness, and joy, appear to be similarly

hard-wired.

Second, animals may learn to experience

emotions in response to previously neutral

stimuli through classical conditioning. For

example, human and nonhuman animals

may come to respond with negative emotions

to otherwise neutral stimuli that have been

repeatedly paired with aversive stimuli, or to

respond positively to a neutral stimulus that

has been associated with rewarding events.

Indeed, clinical psychologists have used

conditioning techniques such as systematic

desensitization and counterconditioning to

change people’s emotional responses and

CHAPTER 23

Self‑Awareness and Self‑Relevant Thought

in the Experience and Regulation of Emotion

Mark R. Leary

Dina Gohar

Self‑ Awareness and Self‑ Relevant Thought in Emotion 377

improve their emotion regulation in the

treatment of anxiety problems such as pho-

bias, panic attacks, and posttraumatic stress

disorder (Foa, Huppert, & Cahill, 2006).

Although emotions can occur without

self- awareness, people’s capacity for self-

awareness and self- relevant thought renders

their emotional lives far more complex than

those of animals that lack self- awareness. In

this chapter, we discuss four basic ways in

which self- awareness affects emotional expe-

rience and examine how people intentionally

capitalize on these processes to manage their

emotions. Specifically, due to their ability to

think consciously about themselves, people’s

emotions are affected when they (1) com-

pare themselves to their personal standards,

(2) think about themselves in the past and

future, (3) evaluate their personal charac-

teristics, and (4) think about how they are

perceived by other people. Each of these pro-

cesses requires the ability to self- reflect.

Comparisons to Personal Standards

Emotions often result when people assess the

implications of a particular situation, event,

or experience for their personal concerns

(Frijda, 1986). Generally, these assessments

involve a comparison of real or imagined

outcomes to some goal or standard. Decades

of research have shown that people’s goals

and standards influence their reactions to

events, particularly when they are thinking

consciously about them at the time, which

requires self- awareness.

Self‑Awareness

and Personal Standards

According to various theories of self-

awareness (Carver & Scheier, 1981; Duval

& Wicklund, 1972), being self-aware

induces an evaluative process in which peo-

ple compare themselves to whatever stan-

dards are salient at that particular moment.

For example, becoming self-aware while

taking a test may lead people to evaluate

themselves with regard to standards involv-

ing intellectual ability, whereas being self-

aware while trying on new clothes may lead

people to compare themselves to standards

of physical attractiveness. Self- awareness is

not necessary for goal pursuit (Bargh, Goll-

witzer, & Lee-Chai, 2001); nevertheless,

becoming self-aware seems to cause people

to compare themselves and their behaviors

to salient goals.

Becoming self-aware induces an evalua-

tive process that evokes positive emotions

when conditions meet or exceed one’s stan-

dards and negative emotions when they do

not. Because discrepancies between people’s

standards and their behavior are unpleasant,

people who are self-aware try to avoid vio-

lating their personal standards and reduce

such discrepancies when they occur (Duval

& Wicklund, 1972; Macrae, Bodenhausen,

& Milne, 1998; Scheier, Fenigstein, & Buss,

1974). In brief, many emotional experiences

involve a comparison of situations, events,

or experiences to goals and standards, and

self- awareness is intimately involved in peo-

ple’s emotional reactions to events that have

implications for their self- relevant goals.

According to self- discrepancy theory

(Higgins, 1987), the specific emotions that

people experience when they fail to achieve

their goals depend on the nature of the dis-

crepancy involved. When people perceive a

discrepancy between how they think they are

and how they would like to be (i.e., between

their actual and ideal selves), dejection-

related emotions such as disappointment,

sadness, and depression predominate. In

contrast, a discrepancy between how peo-

ple think they are and how they think they

ought to be (i.e., between actual and ought

selves) leads to agitation- related emotions

such as guilt, fear, and anxiety. Research

has generally supported the notion that self-

discrepancies influence emotion, but specific

discrepancies do not always predict distinct

emotions precisely as self- discrepancy theory

predicts (Phillips & Silvia, 2010; Tangney,

Niedenthal, Covert, & Barlow, 1998). For

example, Phillips and Silvia (2010) found

that although actual– ought discrepancies

uniquely predicted anxiety, both actual–

ideal and actual– ought discrepancies pre-

dicted depressed affect. When people think

that they are close to becoming their feared

selves, these actual– feared discrepancies pre-

dict agitation- related emotions better than

do actual– ought discrepancies (i.e., how

people think they ought to be), which more

strongly predict emotions when people think

they are far from assuming a feared identity

(Carver, Lawrence, & Scheier, 1999).

378 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

In any case, discrepancies between how

people think they are and how they want

(and do not want) to be evoke negative

emotions and lower subjective well-being

(Brown & McConnell, 2011; Philips, Silvia,

& Paradise, 2007; Tangney et al., 1998).

When people make internal attributions

for these discrepancies, they are especially

likely to experience strong negative emo-

tions (Petrocelli & Smith, 2005). For exam-

ple, attributing a negative outcome to one’s

own bad decisions or incompetent behav-

ior would likely result in different emo-

tions than attributing the same outcome

to another person’s malevolent actions.

Only when people believe that they played

some role in undesired outcomes do self-

discrepancies come into play. In addition,

increased self- awareness (e.g., induced by

seeing one’s reflection in a mirror; Phillips

& Silvia, 2005) and dispositional private

self- consciousness (Fromson, 2006) both

strengthen the relationship between self-

discrepancies and negative emotions. These

findings suggest that people can reduce the

emotional impact of self- relevant discrepan-

cies both by making external attributions

for them and by reducing self- awareness.

Minimizing Self‑Awareness

One implication of the link between self-

awareness and emotion is that people can

sometimes regulate their emotions by man-

aging their self- awareness. Self- awareness

prolongs and intensifies people’s emotional

states (Bryant & Veroff, 2007; Silvia, 2002).

People who have experienced undesired

events often find it difficult to stop thinking

about them and their self- relevant implica-

tions, even though doing so usually makes

them feel worse (Kross & Ayduk, 2008).

In fact, trying not to think about disturb-

ing events can increase the frequency of

such thoughts and lead to a mood that is the

opposite of the one intended (Wegner, Erber,

& Zanakos, 1993). Therefore, rather than

trying to stop thinking about themselves by

force of will, people sometimes try to reduce

their self- awareness more generally, thereby

diminishing any unpleasant feelings that are

sustained by self- thought. Evidence suggests

that people sometimes try to attenuate their

negative emotions by engaging in activities

that lower their self- awareness (Baumeister,

1991). Although some of these tactics can be

problematic (e.g., frequent substance abuse),

others (e.g., mindfulness and meditation

practices) can help people respond to nega-

tive events with greater equanimity.

One common way that people attenu-

ate self- awareness is through distraction.

People report that they watch television,

socialize, read, engage in hobbies, exercise,

shop, and distract themselves in other ways

to take their mind off of unpleasant events.

Research suggests that such distraction can,

in fact, reduce negative feelings (Joormann,

Siemer, & Gotlib, 2007; Kross & Ayduk,

2008). The effects of distraction on emo-

tion may be mediated by a number of pro-

cesses (e.g., many distracting activities are

inherently pleasurable), but the reduction of

self- thought is likely involved. Not only does

thinking about one’s experiences help to

maintain one’s emotional reactions to them,

but self- awareness also intensifies affective

states (Field, Joudy, & Hart, 2010; Scheier

& Carver, 1977). Therefore, anything that

lowers self- awareness should reduce emo-

tion.

People also try to escape self- awareness

and the aversive emotions that it can elicit in

ways that may be maladaptive, for example,

using alcohol and drugs, binge eating, and

even masochism (Baumeister, 1991). Not all

of the ways that people try to escape self-

awareness are maladaptive, however. For

example, people have used meditation to

reduce their internal self-talk since ancient

times. Although meditative practices are

often promoted within spiritual traditions,

their primary function is to reduce the

amount of time that the practitioner engages

in self- reflection (Leary, 2004). By taming

what Hindus call the “chattering monkey

mind,” people are less likely to respond emo-

tionally to self- related thoughts and more

likely to be relaxed and present- focused.

Indeed, clinical and counseling psycholo-

gists have successfully reduced problematic

emotions in their clients by helping them to

quiet their negative thoughts and to focus

on the present moment, with practices that

include features of mindfulness or medi-

tation (e.g., acceptance and commitment

therapy: Hayes, Strosahl, & Wilson, 1999;

dialectical behavior therapy: Linehan, 1993;

mindfulness- based stress reduction: Kabat-

Zinn, 2003).

Self- Awareness and Self- Relevant Thought in Emotion 379

Reflecting on the Past

and the Future

Unlike most other animals, people can reflect

consciously on themselves over time—that

is, to remember themselves in the past and

imagine themselves in the future. Through

the “eyes” of their cognitive analogue- I

(Jaynes, 1976; Leary, Estrada, & Allen,

2009), people are able not only to remember

or imagine themselves in other situations but

also to plan intentionally for the future, to

consider behavioral options, to imagine ret-

rospectively how events might have turned

out differently, and to learn from their mis-

takes. This ability to think consciously about

the past and future also leads people to react

emotionally to events that exist only in their

minds. Because remembered, anticipated,

and fantasized experiences of the analogue-

I often have the emotional potency of real

events, they can similarly impact people’s

emotions.

Reliving the Past and Imagining

the

Future

Reflecting about oneself in the past and

future has a strong influence on people’s

emotions. Indeed, we suspect that a far

greater proportion of people’s emotional

experiences arise from thinking about them-

selves in the past or future than from events

that are occurring at the present time, and

that people often compromise the positivity

of their current emotional states by unneces-

sarily reflecting on the past and future.

First, people often experience strong emo-

tions by reliving past experiences in their

minds. For example, ruminating about past

mistakes or misfortunes can elicit sadness,

regret, or guilt. Autobiographical memories

involving unfulfilled desires for competence,

autonomy, and relatedness seem to affect

negative emotions particularly strongly

(Philippe, Koestner, Lecours, Beaulieu-

Pelletier, & Bois, 2011). Conversely, recall-

ing positive memories from the past plays

an important role in maintaining positive

moods (Joormann et al., 2007).

Similarly, many emotions, both pleasant

and unpleasant, can be triggered by self-

relevant thoughts about the future. Of these,

anxiety is perhaps the most common. Of

course, anticipating future threats is often

adaptive, because it motivates people to take

steps to avoid problems or plan how to cope

effectively with future threats. However,

people typically imagine far more frequent

and more serious threats than actually occur.

And even when dreaded events do arise,

anticipatory anxiety typically does little

more than to cause suffering in advance. In

fact, many people experience chronic anxi-

ety because they consistently overestimate

the probability of negative events occurring

or the adverse consequences of those events

(Marshall et al., 2007; Miranda & Mennin,

2007). Moreover, believing that negative

events are likely to occur (and that positive

events are not likely to occur) can produce

hopelessness and depression (Joiner, 2001).

Thus, the human capacity to worry about

things that have not yet happened— and that

might, in fact, never even happen— takes a

heavy emotional toll (Roemer & Borkovec,

1993).

If anxiety about the future is so often

unnecessary, if not maladaptive, then why

are people so prone to experiencing anxiety?

Martin (1999) speculated that self- generated

anxiety about the future became prevalent

only with the emergence of agriculture

around 10,000 years ago. Although our

prehistoric ancestors were self-aware before

this time (Leary & Buttermore, 2003), their

hunting– gathering– scavenging lifestyle did

not evoke much rumination about the dis-

tant future. With the emergence of agricul-

ture, however, people moved to a delayed-

return lifestyle in which many important

outcomes— both good and bad—lay weeks

or months in the future. The agricultural

revolution led people to settle in commu-

nities, accumulate possessions, and plan

for planting and harvesting of crops, and,

thus, to fret about future outcomes that lay

months or years ahead. Modern industrial-

ized societies are profoundly delayed- return

environments in which people devote con-

siderable effort now for uncertain outcomes

in the future. As a result, we are plagued by

far more self- generated anxiety than were

our hunter– gatherer ancestors.

When people imagine future events, they

often think about how they are likely to feel

when those events occur, which requires

reflection about oneself in the future.

Although people’s affective forecasts are

often inaccurate (Wilson & Gilbert, 2003),

380 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

imagining how they will feel in the future

often helps people behave in ways that lead

to desired emotional outcomes (e.g., “I will

regret it later if I don’t do something now”).

Moreover, people’s expectations about how

they will feel when an event occurs can

influence their emotional reactions to the

event when it actually transpires (Wilson &

Gilbert, 2003).

How people feel when an event occurs also

depends on how they think about the alter-

natives. Concocting imaginary scenarios

about how events might have turned out dif-

ferently can make people feel better or worse

about their lot depending on whether the

alternatives they imagine are worse or bet-

ter than what actually happened. Medvec,

Madey, and Gilovich’s (1995) finding that

Olympic bronze medal winners (i.e., third-

place finishers) appeared happier than silver

medal winners (i.e., second- place finishers)

is a good example of this effect. Presumably,

bronze medalists compare finishing third

to not getting a medal at all, whereas silver

medalists compare their second- place finish

to the imagined alternative of winning the

gold. Similarly, people may become discon-

tent even when current circumstances are

good if they think that being somewhere else

would be even better. Therefore, people can

regulate their emotional responses to events

by managing the ways in which they con-

strue alternative outcomes.

In addition, cognitive representations of

desired future states can motivate and guide

people’s behaviors (Emmons, 1986; Markus

& Nurius, 1986). The capacity for self-

thought again enters the picture, because

thinking about progress toward one’s goals

evokes positive emotions, while lack of prog-

ress (and particularly movement away from

those goals) evokes negative emotions (Hig-

gins, 1987; Markus & Nurius, 1986). Thus,

emotions are experienced not only because

the current state of affairs is favorable or

unfavorable to one’s well-being but also

because events reflect movement toward or

away from one’s goals.

Predictive Control

As noted, some tactics for improving peo-

ple’s emotion regulation involve teaching

them to remain focused on the present situa-

tion as much as possible, turning to thoughts

about the past and future only as needed to

deal with practical issues. People can also

regulate their emotional reactions to future

events by managing their expectations. Peo-

ple’s emotional reactions to events depend

in part on what they expect to happen. For

instance, expected negative outcomes tend

to evoke less distress than unexpected ones,

and events that fail to occur as anticipated

may evoke stronger reactions than if they

had not been expected. Self- awareness is

not necessary for animals to develop expec-

tations or to react emotionally to fulfilled

and unfulfilled expectancies (e.g., the fam-

ily pet may become distressed when daily

routines are disrupted). However, the ability

to self- reflect allows people to manage their

feelings about upcoming events by exerting

deliberate “predictive control” (Rothbaum,

Weisz, & Snyder, 1982) in which they tell

themselves what to expect.

For example, people can use positive

self-talk to allay their anxiety about future

outcomes. By telling themselves that things

will turn out OK, people can sometimes

positively influence how they feel. Such opti-

mism is sometimes costly, though. Sweeny

and Shepperd (2010) found that after con-

trolling for actual exam performance, stu-

dents who expected higher exam scores did

not feel any better before receiving feedback

and actually felt worse after learning their

scores.

At other times, people manage their

expectations to avoid being disappointed.

For example, people try to soften the blow

of failures, bad news, disappointments,

and other aversive events by lowering their

expectations and telling themselves that bad

outcomes are likely to occur. This may not

be an optimal tactic for maximizing positive

affect, however, because the costs of nega-

tive expectations can outweigh the benefits

for many people (Golub, Gilbert, & Wilson,

2009). On average, participants felt worse

when they expected a negative rather than

a positive outcome; moreover, their pessi-

mistic expectations did not serve as a buf-

fer against negative emotions once the event

occurred. However, anticipating negative

outcomes appears to lower anxiety among

dispositionally anxious people who use this

strategy regularly (i.e., defensive pessimists;

Norem & Illingworth, 1993). In fact, pre-

venting defensive pessimists from thinking

Self‑ Awareness and Self‑ Relevant Thought in Emotion 381

about anticipated negative events typically

increases their negative emotions. Thus,

defensive pessimism may be a useful means

of emotional self- regulation for some people

but not for others.

Evaluation of One’s

Personal Characteristics

People’s self- relevant beliefs and evalua-

tions often evoke emotional responses and

are also involved in emotion regulation.

Human infants develop a conception of

themselves slowly over the first 2 years of

life (Kagan, 1998) and characterize them-

selves in increasingly complex and abstract

ways in a developmental progression that

continues into late adolescence (Harter,

2012). As their self- concepts develop, chil-

dren begin to experience myriad emotions

by thinking about their own characteris-

tics and behavior. Once people develop the

capacity to label, characterize, and evaluate

themselves, they react emotionally to these

self- representations, as well as to events and

information that validate or threaten them.

Self‑Evaluations and Emotion

People react negatively to events that threaten

their self-views and positively to events that

affirm them, even when such events have no

real consequences for their well-being. Thus,

by virtue of being self-aware, people become

emotionally invested in whether reality

conforms to their desired self-views. Two

kinds of symbolic satisfactions and threats

to people’s self- construals have received

the most attention from researchers— self-

enhancement and self- verification.

People prefer to evaluate themselves posi-

tively rather than negatively, and a great deal

of research has examined the ways in which

people try to maintain views of being good

and effective individuals. Thus, events that

support a favorable view of oneself tend to

evoke positive emotions, such as pride, hap-

piness, and satisfaction; events that contra-

dict one’s favorable self-view, on the other

hand, are associated with negative emotions,

such as anxiety, despondency, frustration,

shame, and rage (Baumeister, 1998). Because

people’s identities include significant others

in their lives, people also feel good or bad

because of the successes or failures of people

with whom they are associated.

Although many theorists have assumed

that people desire positive feedback about

themselves because they have a need to

maintain or enhance their self- esteem, self-

enhancement may be more parsimoniously

viewed as a way to regulate emotion. People

seek positive information about themselves,

because being capable, attractive, socially

skilled, or likable elicits positive emotions

by increasing the perceived likelihood of

desired outcomes. Conversely, receiving neg-

ative self- relevant feedback typically indi-

cates a lower likelihood of desired outcomes

and a greater likelihood of undesired ones.

Sociometer theory carries this notion

a step further by suggesting that people’s

affective reactions to self- enhancing and

self- depreciating events serve an important

interpersonal function by providing feed-

back about the degree to which they are

valued and accepted by others (for a review,

see Leary, 2006). Events that threaten a

person’s positive self-image evoke negative

emotions, because they cast that person in

an undesirable light in other people’s eyes,

thereby undermining his or her relation-

ships with them (Leary, Tambor, Terdal, &

Downs, 1995). From this perspective, the

feelings that arise from positive and negative

self- relevant events are part of a monitoring

system that keeps people apprised of their

relational value and motivates behaviors to

help them avoid social rejection.

Several perspectives suggest that people

want to maintain not only a positive view

of themselves but also a stable and consis-

tent self-view (Swann & Buhrmester, 2012).

As a result, information suggesting that

people are not who or what they think they

are evokes negative feelings. Cognitive dis-

sonance theory was among the first per-

spectives to describe the emotional effects

of having inconsistent beliefs. Any pair of

contradictory beliefs can potentially induce

the unpleasant affective state of dissonance,

but inconsistent beliefs involving aspects of

oneself seem to be particularly unpleasant

(Aronson, 1968).

Swann and his colleagues have specifi-

cally examined people’s responses to events

that verify or disconfirm their self-views (for

a review, see Swann & Buhrmester, 2012).

People tend to be troubled by information

382 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

that discredits their self- perceptions, pre-

sumably because such information under-

mines their certainty in their beliefs about

themselves and lowers their sense of predict-

ability and control (Swann, Stein- Seroussi,

& Giesler, 1992). As a result, receiving

information that is inconsistent with one’s

self- concept is often troubling, even if it is

favorable (Kwang & Swann, 2010).

Although self- verification and self-

enhancement have often been pitted against

one another as theoretical perspectives on

motivated self- cognition, evidence shows

that both processes occur, and research

has begun to uncover the conditions under

which each effect is obtained (Kwang, &

Swann, 2010). Importantly, the possibility

exists that both processes serve the goal of

promoting one’s social acceptance. That is,

people often increase their chances of social

acceptance by either portraying themselves

in positive ways or seeking to interact with

people who see them as they see themselves.

Regulating Emotion

by Managing Self‑Evaluations

Because self- evaluations influence emotions,

people can regulate their emotions by man-

aging how they perceive and evaluate them-

selves. Two of the most widely researched

tactics for doing so involve social compari-

son and attribution.

Social Comparison

People’s self- evaluations— and their

emotions— are affected by how they com-

pare to others, particularly in domains where

no objective standard for self- evaluation

exists (e.g., judgments of physical attractive-

ness or popularity). Therefore, people some-

times regulate their emotions through their

choices of social comparison targets (Suls &

Wheeler, 2012). Although people sometimes

use comparison targets that provide an

accurate indication of their own attributes,

their selections more often appear designed

to promote positive feelings (Buunk, Col-

lins, Taylor, VanYperen, & Dakof, 1990;

Morrell et al., 2012). At times, people seek

downward comparisons to feel better about

themselves by contrast; at other times, they

seek upward comparisons for inspiration or

hope.

Theorists once assumed that comparing

ourselves to those who are worse off than

we are (i.e., downward social comparison)

generally leads to more positive emotions

than comparing ourselves to people who

are better off (upward social comparison).

However, whether downward or upward

comparisons lead to positive or negative

affect depends on how people interpret the

comparative information. When downward

comparisons make people feel better or

more fortunate than others, they induce pos-

itive emotions. In contrast, when downward

social comparisons raise the specter that one

might also fare poorly (e.g., when a newly

diagnosed cancer patient compares him- or

herself to a patient in later stages of the ill-

ness), they lead to negative emotions (Buunk

et al., 1990; Morrell et al., 2012). Similarly,

comparing oneself to outstanding role mod-

els evokes positive affect if the superstar’s

accomplishments seem personally attain-

able but negative affect when they do not

(Lockwood & Kunda, 1997). The effects

of upward and downward social compari-

son are quite complex and are also moder-

ated by variables such as self- esteem, mood,

neuroticism, and optimism (Lyubomirsky

& Ross, 1997). Nevertheless, people often

choose and interpret social comparisons in

ways that help them regulate their emotions.

Attributions

In the same vein, people can regulate their

emotions through their attributions for

events that occur. People’s beliefs about

why particular emotion- inducing events

occurred in the first place (e.g., “Why was

I passed over for the promotion?”) and why

they reacted as they did to those events (e.g.,

“Why did I lose my temper?”) influence both

their self- evaluations and their emotions.

Since Schachter and Singer’s (1962) initial

demonstration that people’s interpretations

of arousing events affect their emotional

experiences, research has shown that attri-

butions have a strong effect on emotion. The

same event can evoke drastically different

emotions depending on the person’s attribu-

tions for it (Siemer, Mauss, & Gross, 2007),

and such attributions necessarily involve

self- focused thought.

Weiner’s (1985) attribution theory of

emotion most fully describes the relation-

Self‑ Awareness and Self‑ Relevant Thought in Emotion 383

ship between patterns of attributions and

specific emotions. From this perspective,

people’s emotional responses to positive and

negative events depend on three aspects of

the attributions that they make—causal

locus (whether the cause of the event was

internal or external to the individual), sta-

bility (whether the cause is short-lived or

long- lasting), and controllability (whether

the cause is under the person’s control). For

example, if people attribute success to their

own efforts (an internal, stable, and control-

lable cause), they experience positive self-

agency emotions such as pride, satisfaction,

and confidence, whereas attributing that

same success to other people (an external,

stable, uncontrollable cause) results in posi-

tive other- agency emotions such as gratitude,

obligation, and appreciation toward those

who helped. And, if the success is attributed

to impersonal circumstances (an external,

unstable, and uncontrollable causes), people

feel lucky and happily surprised (positive

situation- agency emotions).

The attribution of agency has proven to

be particularly important in distinguishing

among negative emotions, such as anger

(other- agency), guilt (self- agency), and sor-

row (circumstance- agency; Ellsworth &

Smith, 1988). Additionally, agency attribu-

tions, regardless of their accuracy, influence

people’s appraisals of their ability to deal

with negative events and their consequences

(Ellsworth & Scherer, 2003). The emotional

effects of attributions are also mediated

by people’s appraisals of the implications

of those attributions for their well-being

(David, Schnur, & Belloiu, 2002).

Research on both student and clinical

samples demonstrates that people who char-

acteristically explain negative events in terms

of internal, stable, and global causes (i.e.,

a pessimistic explanatory style) are more

likely to develop symptoms of depression

(in particular, the subtype “hopeless depres-

sion”) than those who tend to make exter-

nal, unstable, and specific attributions for

negative outcomes (Abramson, Metalsky, &

Alloy, 1989; Alloy et al., 2000). In addition,

attributing positive events to unstable and

specific sources is associated with depres-

sion, albeit less strongly than attributions

for negative events (Ahrens & Haaga, 1993).

In fact, negative attributional styles contrib-

ute to a variety of common emotional dif-

ficulties, including depression, anxiety, and

frequent anger and guilt (Hilt, 2004).

In light of the link between people’s

attributions and their emotions, interven-

tions and psychotherapy techniques have

been developed that focus on attributional

reframing to ameliorate emotional distress.

Such approaches involve teaching people

to identify and challenge their inaccurate

causal attributions and to develop more

accurate, positive ones. For example, when

people engage in excessive self-blame about

negative events (i.e., unrealistically attribut-

ing negative events to a stable internal fac-

tor), an approach known as attributional

retraining has been used with beneficial

effects on depression, anxiety, and guilt.

Attributional retraining involves reviewing

the negative event that led to the attribution,

searching for alternative explanations that

are at least equally plausible, and alleviating

some or all of the person’s responsibility for

the negative outcome. Conversely, attribu-

tional retraining can also involve fostering

internal attributions for positive outcomes

when appropriate, such as learning to attri-

bute one’s successes to effort and skill rather

than luck, in order to increase positive emo-

tions and self- efficacy (Hilt, 2004).

Techniques to help clients reframe their

attributions are often used within the con-

text of cognitive- behavioral therapy, which

makes it difficult to assess their effectiveness

as a unique mechanism for change. Even so,

research generally supports the efficacy of

attributional reframing for reducing emo-

tional distress (Hilt, 2004). For example,

decreased negative attributions in couples

mediated increases in relationship satis-

faction (Hrapczynski, Epstein, Werlinich,

& LaTaillade, 2012), and a reduction in

patients’ negative inferences lowered their

depression and anxiety (DeFronzo Dobkin

et al., 2007). In addition, an integral compo-

nent of treatment for panic disorder involves

modifying patients’ attributions for their

physiological symptoms of anxiety (e.g.,

learning that they are not harmful) in order

to reduce anxiety and the frequency of panic

attacks.

Attributional retraining has also been

used successfully in nonclinical settings,

such as schools and the workplace, as both

a method for preventing emotional distress

and an intervention for emotional problems.

384 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

For instance, a study that focused on chang-

ing employees’ negative attributional styles

resulted in significant increases in job sat-

isfaction and subjective well-being (Proud-

foot, Corr, Guest, & Dunn, 2009). Overall,

research suggests that attributional refram-

ing can be an effective technique for improv-

ing emotional outcomes in both clinical and

nonclinical populations. And, again, all of

these effects are mediated by people’s self-

relevant thoughts.

Awareness of Other People’s

Perceptions and Evaluations

A great deal of human emotion arises from

people’s beliefs about how they are perceived

and evaluated by other people. Other peo-

ple’s judgments of us have important impli-

cations for our social, occupational, roman-

tic, financial, and other outcomes, so we

understandably react differently when we

are viewed favorably rather than unfavorably

by other people. Self- awareness is needed to

infer other people’s thoughts, and some the-

orists have even proposed that the ability to

reflect on one’s private experiences evolved

to help people infer what others might be

thinking about them (Gallup, 1997). In fact,

in young children the ability to imagine

other people’s perspectives emerges at about

the same time as self- awareness (Focquaert,

Braeckman, & Platek, 2008).

Self‑Awareness and Social Emotions

Around this time, children also begin to

experience self- conscious emotions— such as

embarrassment, pride, shame, and guilt—in

response to the real or imagined evaluations

of other people (Miller, 1996). This particu-

lar subset of emotions is often labeled “self-

conscious” because these emotions typically

involve acute feelings of self- consciousness,

as people think a great deal about them-

selves and what other people might be think-

ing about them (Tangney & Tracy, 2012).

Yet the central feature of these emotions is

that they occur when people believe that

others have formed, or might form, particu-

lar positive or negative impressions of them.

These emotions inherently involve reactions

to social- evaluative events or perceived vio-

lations of social standards (see Dickerson,

Grunewald, & Kemeny, 2004), even if those

standards have been internalized and people

are no longer consciously aware of their ori-

gin (Baldwin & Baccus, 2004).

People’s perceptions of how others view

and evaluate them (often called reflected

appraisals) can elicit a variety of emotions.

For example, people experience social anxi-

ety when they think that others will not

form desired impressions of them, even if

they know that they possess positive attri-

butes. Research has shown that people who

score high in social anxiety tend to be highly

self- focused and think about themselves

negatively during social interactions. In fact,

negative self- relevant imagery is causally

involved in both trait social anxiety and the

experience of state social anxiety in people

who are not typically anxious (Makkar &

Grisham, 2011). Similarly, people become

embarrassed when they believe that other

people have formed undesired impressions

of them (Miller, 1996) and experience hurt

feelings when they think that others do not

sufficiently value them (Leary, Springer,

Negel, Ansell, & Evans, 1998). In each of

these cases, self- reflection is needed to infer

what others might be thinking and to elicit

the emotional response.

Guilt and shame also involve concerns

about other people’s evaluations. Guilt

involves a negative evaluation of a specific

behavior, whereas shame involves a nega-

tive evaluation of oneself (Tangney & Tracy,

2012). People often feel guilty or ashamed

simply from knowing that others regard

their behavior or character unfavorably,

even if they personally believe that they did

nothing wrong. Of course, people also expe-

rience positive emotions from imagining

other people’s reactions to them. People may

experience pride when they think that others

admire them, and joy when they think that

others love them deeply, even in the absence

of explicit indications of admiration or love.

Furthermore, people’s beliefs about how

others expect them to feel also affect their

emotions. For example, when people feel

sad but believe that others think they should

be happy, they experience stronger negative

emotions and lower subjective well-being. In

fact, perceived social expectancies predict

people’s subsequent emotions and well-being

more consistently than—and independently

of—their personal expectancies. Research

Self‑ Awareness and Self‑ Relevant Thought in Emotion 385

has shown this is the case because perceived

social expectancies (e.g., to be happy) pro-

mote negative self- evaluations in people

when their emotions (e.g., sadness) violate

these expectations (Bastian et al., 2012).

Regulating Social Emotions

Given the role of self- relevant thought in

social emotions, another way that people

can regulate their emotions is by managing

their thoughts about what others might be

thinking about them. Such strategies fall

into two broad categories.

First, people sometimes reduce undesired

social emotions by reevaluating the impor-

tance of other people’s impressions and eval-

uations of them. Although people tend to

react rather automatically to indications that

others are judging them unfavorably, they

may later decide that others’ judgments are

not actually important or consequential in

a particular instance (Leary, 2006). Reduc-

ing the motivation to make a desired impres-

sion or the importance of being evaluated in

a particular way can attenuate or minimize

emotions such as social anxiety, embarrass-

ment, guilt, and hurt feelings.

Second, to the extent that unpleasant

social emotions arise from believing that

one is being viewed unfavorably, people can

reevaluate others’ likely evaluations of them.

For example, people who frequently experi-

ence social anxiety can be taught that other

people’s evaluations of them are usually not

as negative as they imagine. Similarly, peo-

ple whose feelings are easily hurt can learn

that others’ seemingly hurtful actions—

such as minor slights, snubs, and signs of

disinterest— are usually more benign than

they might first appear.

Conclusion

Our focus in this chapter has been on the

ways in which the human ability to self-

reflect affects emotional experience and

regulation. As we have seen, self- awareness

allows people to experience emotions by

comparing themselves to their personal stan-

dards, thinking about themselves in the past

and future, assessing their personal charac-

teristics, and thinking about how they are

perceived by other people. By virtue of being

self-aware, human beings live in an emo-

tional world that differs greatly from that of

other animals. Indeed, it is difficult to imag-

ine what human subjective experience would

be like without self- awareness and the inter-

nal self-talk that underlies so much human

emotion.

Self- awareness was perhaps the pivotal

psychological adaptation that put human

beings on such a distinctly different path

than that of other animals. From the stand-

point of emotion, however, the capacity

to think consciously about oneself is both

a blessing and a curse (Leary, 2004). Self-

awareness and self- relevant thought are ben-

eficial in planning for the future in ways that

maximize gains and minimize losses, and

the emotions that arise when people look

forward and backward are often useful in

informing judicious decisions and effective

behavior. Yet, as we have seen, people suf-

fer far more from temporal emotions such

as anxiety and regret than is necessary for

successful self- regulation. Similarly, people’s

ability to compare themselves to standards

and evaluate themselves accordingly pro-

vides important input into their behavioral

choices. But people are often distressed by

unfavorable self- evaluations even when they

do not matter in a practical sense. Likewise,

people could not interact successfully with

others without an ability to infer what oth-

ers are thinking about them, and the self-

conscious emotions that sometimes arise are

often beneficial in steering their behavior in

ways that are socially advantageous. How-

ever, people are frequently more concerned

about others’ evaluations than they need to

be, resulting in unnecessary social anxiety,

embarrassment, guilt, and shame that can

sometimes interfere with effective behavior

and self- regulation.

People obviously prefer to feel positive

emotions more than negative emotions, and

they can change how they feel by changing

how they think about themselves. As we have

seen, people regulate their emotions in many

ways, including attenuating self- awareness,

predictive control, social comparison, and

attributional reframing, among others.

But even this hedonically desirable ability

has both good and bad effects. Minimiz-

ing unwanted emotions certainly promotes

subjective well-being, and managing one’s

emotions often facilitates effective behavior

386 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

and better self- regulation. However, when

unpleasant emotions serve an important

purpose in keeping people attuned to threats

to their well-being or motivating them to

engage in needed behavioral change, the use

of self-talk to dampen such emotions might

be counterproductive. We hope that future

research will result in a better understand-

ing of the conditions under which regulating

emotions via self- relevant thought is benefi-

cial rather than detrimental to people’s well-

being.

Note

1. Although our focus is on the implications of

self- awareness for emotion, we should note

that affective experiences can also influence

the operation of self- related processes. For

example, emotions can affect people’s self-

perceptions, self- efficacy, and ability to self-

regulate (DeSteno & Salovey, 1997; Leith &

Baumeister, 1996). Emotional experiences

also influence where people focus their atten-

tion (Fredrickson & Branigan, 2005) and

how they make decisions (Kugler, Connolly,

& Ordóñez, 2012). Thus, not only is self-

awareness intimately involved in the experi-

ence and regulation of emotion, but emotions

also reciprocally affect self- related attention

and thought.

References

Alloy, L. B., Abramson, L. Y., Hogan, M. E.,

Whitehouse, W. G., Rose, D. T., Robinson,

M. S., et al. (2000). The Temple– Wisconsin

Cognitive Vulnerability to Depression (CVD)

Project: Lifetime history of Axis I psychopa-

thology in individuals at high and low cogni-

tive risk for depression. Journal of Abnormal

Psychology, 109, 403– 418.

Abramson, L. Y., Metalsky, F. I., & Alloy, L.

B. (1989). Hopelessness depression: A theory

based subtype of depression. Psychological

Review, 96, 358–372.

Ahrens, A. H., & Haaga, D. A. F. (1993). The

specificity of attributional style and expec-

tations to positive and negative affectivity,

depression, and anxiety. Cognitive Therapy

and Research, 17, 83–98.

Aronson, E. (1968). Dissonance theory: Prog-

ress and problems. In R. P. Abelson, E. Aron-

son, W. J. McGuire, T. M. Newcomb, M. J.

Rosenberg, & P. H. Tannenbaum (Eds.), The-

ories of cognitive consistency: A sourcebook

(pp. 5–27). Chicago: Rand McNally.

Baldwin, M. W., & Baccus, J. R. (2004). Main-

taining a focus on the social goals underly-

ing self- conscious emotions. Psychological

Inquiry, 15, 139–144.

Bargh, J. A., Gollwitzer, P. M., & Lee-Chai, A.

(2001). The automated will: Nonconscious

activation and pursuit of behavioral goals.

Journal of Personality and Social Psychology,

81, 1014–1027.

Bastian, B., Kuppens, P., Hornsey, M. J., Park,

J., Koval, P., & Uchida, Y. (2012). Feeling bad

about being sad: The role of social expectan-

cies in amplifying negative mood. Emotion,

12, 69–80.

Baumeister, R. F. (1991). Escaping the self. New

York: Basic Books.

Baumeister, R. F. (1998). The self. In D. T. Gil-

bert, S. T. Fiske, & G. Lindzey (Eds.), Hand-

book of social psychology (4th ed., Vol. 2,

pp. 680–740). Boston: McGraw-Hill.

Brown, C. M., & McConnell, A. R. (2011).

Discrepancy- based and anticipated emotions

in behavioral self- regulation. Emotion, 11,

1091–1095.

Buunk, B. P., Collins, R. L., Taylor, S. E., VanY-

peren, N. W., & Dakof, G. A. (1990). The

affective consequences of social comparison:

Either direction has its ups and downs. Jour-

nal of Personality and Social Psychology, 59,

1238–1249.

Bryant, F. B., & Veroff, J. (2007). Savoring: A

new model of positive experience. Mahwah,

NJ: Erlbaum.

Carver, C. S., Lawrence, J. W., & Scheier, M. F.

(1999). Self- discrepancies and affect: Incorpo-

rating the role of fear selves. Personality and

Social Psychology Bulletin, 25, 783–792.

Carver, C. S., & Scheier, M. F. (1981). Atten-

tion and self- regulation: A control theory

approach to human behavior. New York:

Springer- Verlag.

David, D., Schnur, J., & Belloiu, A. (2002).

Another search for the “hot” cognitions:

Appraisal, irrational beliefs, attributions, and

their relation to emotion. Journal of Rational-

Emotive and Cognitive- Behavior Therapy,

20, 93–132.

DeFronzo Dobkin, R., Allen, L. A., Alloy, L. B.,

Menza, M., Gara, M. A., & Panzarella, C.

Self‑ Awareness and Self‑ Relevant Thought in Emotion 387

(2007). Adaptive inferential feedback partner

training for depression: A pilot study. Cogni-

tive and Behavioral Practice, 14(4), 350–363.

DeSteno, D. A., & Salovey, P. (1997). The effects

of mood on the structure of the self- concept.

Cognition and Emotion, 11, 351–372.

Dickerson, S. S., Grunewald, T. L., & Kemeny,

M. E. (2004). When the social self is threat-

ened: Shame, physiology, and health. Journal

of Personality, 72, 1189–1216.

Duval, S., & Wicklund, R. A. (1972). A theory of

objective self awareness. New York: Academic

Press.

Ellsworth, P. C., & Scherer, K. R. (2003).

Appraisal processes in emotion. In R. J. David-

son, K. R. Scherer, & H. H. Goldsmith (Eds.),

Handbook of affective sciences (pp. 575–595).

New York: Oxford University Press.

Ellsworth, P. C., & Smith, C. A. (1988a). From

appraisal to emotion: Differentiating among

unpleasant feelings. Motivation and Emotion,

12, 271–302.

Emmons, R. A. (1986). Personal strivings: An

approach to personality and subjective well-

being. Journal of Personality and Social Psy-

chology, 51, 1058–1068.

Field, N. P., Joudy, R., & Hart, D. (2010). The

moderating effect of self- concept valence on

the relationship between self- focused atten-

tion and mood: An experience sampling

study. Journal of Research in Personality, 44,

70 –77.

Foa, E. B., Huppert, J. D., & Cahill, S. P.

(2006). Emotional processing theory: An

update. In B. O. Rothbaum (Ed.), Pathologi-

cal anxiety: Emotional processing in etiology

and treatment (pp. 3–24). New York: Guil-

ford Press.

Focquaert, F., Braeckman, J., & Platek, S. M.

(2008). An evolutionary cognitive neurosci-

ence perspective on human self- awareness and

theory of mind. Philosophical Psychology, 21,

47–68.

Fredrickson, B. L., & Branigan, C. (2005). Posi-

tive emotions broaden the scope of attention

and thought– action repertoires. Cognition

and Emotion, 19, 313–332.

Fromson, P. M. (2006). Self- discrepancies and

negative affect: The moderating roles of pri-

vate and public self- consciousness. Social

Behavior and Personality, 34, 333–350.

Frijda, N. H. (1986). The emotions. London:

Cambridge University Press.

Gallup, G. G., Jr. (1997). On the rise and fall of

self- conception in primates. In J. G. Snodgrass

& R. L. Thompson (Eds.), The self across psy-

chology (pp. 78–82). New York: New York

Academy of Sciences.

Golub, S. A., Gilbert, D. T., & Wilson, T. D.

(2009). Anticipating one’s troubles: The costs

and benefits of negative expectations. Emo-

tion, 9, 277–281.

Harter, S. (2012). The construction of the self:

A developmental perspective (2nd ed.). New

York: Guilford Press.

Hayes, S. C., Strosahl, K., & Wilson, K. G.

(1999). Acceptance and commitment therapy:

An experiential approach to behavior change.

New York: Guilford Press.

Higgins, E. T. (1987). Self- discrepancy: A theory

relating self and affect. Psychological Review,

94, 319–340.

Hilt, L. M. (2004). Attribution retraining for

therapeutic change: Theory, practice, and

future directions. Imagination, Cognition and

Personality, 23(4), 289–307.

Hrapczynski, K. M., Epstein, N. B., Werlinich,

C. A., & LaTaillade, J. J. (2012). Changes in

negative attributions during couple therapy for

abusive behavior: Relations to changes in sat-

isfaction and behavior. Journal of Marital and

Family Therapy, 38(1), 117–132.

Jaynes, J. (1976). The origin of consciousness in

the breakdown of the bicameral mind. Boston:

Houghton- Mifflin.

Joiner, T. E. (2001). Negative attributional style,

hopelessness depression and endogenous

depression. Behaviour Therapy and Research,

39, 139–149.

Joormann, J., Siemer, M., & Gotlib, I. H. (2007).

Mood regulation in depression: Differential

effects of distraction and recall of happy mem-

ories on sad mood. Journal of Abnormal Psy-

chology, 116, 484–490.

Kabat-Zinn, J. (2003). Mindfulness- based stress

reduction (MBSR). Constructivism in the

Human Sciences, 8, 73 –107.

Kagan, J. (1998). Is there a self in infancy? In

M. Ferrari & R. J. Sternberg (Eds.), Self-

awareness: Its nature and development

(pp. 137–147). New York: Guilford Press.

Kross, E., & Ayduk, O. (2008). Facilitating

adaptive emotional analysis: Distinguishing

distanced- analysis of depressive experiences

from immersed- analysis and distraction. Per-

sonality and Social Psychology Bulletin, 34,

924–938.

Kugler, T., Connolly, T., & Ordóñez, L. D.

388 PERSONALITY PROCESSES AND INDIVIDUAL DIFFERENCES

(2012). Emotion, decision, and risk: Betting

on gambles versus betting on people. Journal

of Behavioral Decision Making, 25, 123–134.

Kwang, T., & Swann, W. B. (2010). Do people

embrace praise even when they feel unworthy?:

A review of critical tests of self- enhancement

versus self- verification. Personality and Social

Psychology Review, 14, 263–280.

Leary, M. R. (2004). The curse of the self: Self-

awareness, egotism, and the quality of human

life. New York: Oxford University Press.

Leary, M. R. (2006). Sociometer theory and the

pursuit of relational value: Getting to the root

of self- esteem. European Review of Social

Psychology, 16, 75–111.

Leary, M. R., & Buttermore, N. E. (2003). Evo-

lution of the human self: Tracing the natural

history of self- awareness. Journal for the The-

ory of Social Behaviour, 33, 365–404.

Leary, M. R., Estrada, M. J., & Allen, A. B.

(2009). The analogue- I and the analogue- me:

The avatars of the self. Self and Identity, 8,

147–161.

Leary, M. R., Springer, C., Negel, L., Ansell, E.,

& Evans, K. (1998). The causes, phenomenol-

ogy, and consequences of hurt feelings. Jour-

nal of Personality and Social Psychology, 74,

1225–1237.

Leary, M. R., Tambor, E. S., Terdal, S. K., &

Downs, D. L. (1995). Self- esteem as an inter-

personal monitor: The sociometer hypothesis.

Journal of Personality and Social Psychology,

68, 518–530.

Leith, K. P., & Baumeister, R. F. (1996). Why do

bad moods increase self- defeating behavior?:

Emotion, risk- taking, and self- regulation.

Journal of Personality and Social Psychology,

71, 1250–1267.

Linehan, M. M. (1993). Cognitive behavioral

treatment of borderline personality disorder.

New York: Guilford Press.

Lockwood, P., & Kunda, Z. (1997). Superstars

and me: Predicting the impact of role models

on the self. Journal of Personality and Social

Psychology, 73, 91–103.

Lyubomirsky, S., & Ross, L. (1997). Hedonic

consequences of social comparison: A con-

trast of happy and unhappy people. Journal

of Personality and Social Psychology, 73,

1141–1157.

Macrae, C. N., Bodenhausen, G. V., & Milne,

A. B. (1998). Saying no to unwanted thoughts:

Self-focus and the regulation of mental life.

Journal of Personality and Social Psychology,

75, 578–589.

Makkar, S. R., & Grisham, J. R. (2011). Social

anxiety and the effects of negative self- imagery

on emotion, cognition, and post-event pro-

cessing. Behaviour Research and Therapy, 49,

654–664.

Markus, H., & Nurius, P. (1986). Possible selves.

American Psychologist, 41, 954–969.

Marshall, R. D., Bryant, R. A., Amsel, L., Suh,

E., Cook, J. M., & Neria, Y. (2007). The

psychology of ongoing threat: Relative risk

appraisal, the September 11 attacks, and

terrorism- related fears. American Psycholo-

gist, 62, 304–316.

Martin, L. (1999). I-D compensation the-

ory: Some implications of trying to satisfy

immediate- return needs in a delayed- return

culture. Psychological Inquiry, 10, 195–208.

Medvec, V. H., Madey, S. E., & Gilovich, T.

(1995). When less is more: Counterfactual

thinking and satisfaction among Olympic

medalists. Journal of Personality and Social

Psychology, 69, 603–610.

Miller, R. S. (1996). Embarrassment: Poise and

peril in everyday life. New York: Guilford Press.

Miranda, R., & Mennin, D. S. (2007). Cognitive

Therapy and Research, 31, 71–82.

Morrell, B., Jordens, C. C., Kerridge, I. H., Har-

nett, P., Hobbs, K., & Mason, C. (2012). The

perils of a vanishing cohort: A study of social

comparisons by women with advanced ovar-

ian cancer. Psycho- Oncology, 21, 382–391.

Norem, J. K., & Illingworth, K. S. S. (1993).

Strategy- dependent effects of reflecting on self

and tasks: Some implications of optimism and

defensive pessimism. Journal of Personality

and Social Psychology, 65, 822–835.

Petrocelli, J. V., & Smith, E. R. (2005). Who I

am, who we are, and why: Links between

emotions and causal attributions for self- and

group discrepancies. Personality and Social

Psychology Bulletin, 31, 1628–1642.

Phillips, A. G., & Silvia, P. J. (2005). Self-

awareness and the emotional consequences of

self- discrepancies. Personality and Social Psy-

chology Bulletin, 31, 703–713.

Phillips, A. G., & Silvia, P. J. (2010). Individual

differences in self- discrepancies and emotional

experience: Do distinct discrepancies predict

distinct emotions? Personality and Individual

Differences, 49, 148–151.

Phillips, A. G., Silvia, P. J., & Paradise, M. J.

(2007). The undesired self and emotional

experience: A latent variable analysis. Journal

of Social and Clinical Psychology, 26, 1035–

1047.

Self- Awareness and Self- Relevant Thought in Emotion 389

Philippe, F. L., Koestner, R., Lecours, S.,

Beaulieu-

elletier, G., & Bois, K. (2011). The

role of autobiographical memory networks in

the experience of negative emotions: How our

remembered past elicits our current feelings.

Emotion, 11, 1279–1290.

Proudfoot, J. G., Corr, P. J., Guest, D. E., &

Dunn, G. (2009). Cognitive-

ehavioural

training to change attributional style improves

employee well-being, job satisfaction, produc-

tivity, and turnover. Personality and Individ-

ual Differences, 46(2), 147–153.

Roemer, L., & Borkovec, T. D. (1993). Worry:

Unwanted cognitive activity that controls

unwanted somatic experience. In D. M. Weg-

ner & J. W. Pennebaker (Eds.), Handbook of

mental control (pp.

220–238). Englewood

Cliffs, NJ: Prentice Hall.

Rothbaum, F., Weisz, J. R., & Snyder, S. S.

(1982). Changing the world and changing the

self: A two-

rocess model of perceived control.

Journal of Personality and Social Psychology,

42, 5–37.

Schachter, S., & Singer, J. E. (1962). Cognitive,

social, and physiological determinants of emo-

tional state. Psychological Review, 69, 379–

399.

Scheier, M. F., & Carver, C. S. (1977). Self-

ocused attention and the experience of

emotion: Attraction, repulsion, elation, and

depression. Journal of Personality and Social

Psychology, 35, 625–636.

Siemer, M., Mauss, I., & Gross, J. J. (2007). Same

situation—

ifferent emotions: How appraisals

shape our emotions. Emotion, 7, 592–600.

Silvia, P. J. (2002). Self-

wareness and emotional

intensity. Cognition and Emotion, 16, 195–

216.

Scheier, M. F., Fenigstein, A., & Buss, A. H.

(1974). Self-

wareness and physical aggres-

sion. Journal of Experimental Social Psychol-

ogy, 10, 264–273.

Suls, J., & Wheeler, L. (2012). Social comparison

theory. In P. M. Van Lange, A. W. Kruglanski,

& E. Higgins (Eds.), Handbook of theories

of social psychology (Vol. 1, pp.

460–482).

Thousand Oaks, CA: Sage.

Swann, W. B., Jr., & Buhrmester, M. D. (2012).

Self-

erification: The search for coherence. In

M. R. Leary & J. P. Tangney (Eds.), Hand-

book of self and identity (2nd ed., pp. 405–

424). New York: Guilford Press.

Swann, W. B., Jr., Stein-

eroussi, A., & Giesler,

R. B. (1992). Why people self-

erify. Journal

of Personality and Social Psychology, 62,

392–401.

Sweeny, K., & Shepperd, J. A. (2010). The costs

of optimism and the benefits of pessimism.

Emotion, 10, 750–753.

Tangney, J. P., Niedenthal, P. M., Covert, M.

V., & Barlow, D. H. (1998). Are shame and

guilt related to distinct self-

iscrepancies?:

A test of Higgins’s (1987) hypotheses. Jour-

nal of

ersonality and Social Psychology, 75,

256–268.

Tangney, J. P., & Tracy, J. L. (2012). Self-

onscious emotions. In M. Leary & J. P. Tang-

ney (Eds.), Handbook of self and identity (2nd

ed., pp.

446–478). New York: Guilford Press.

Veissier, I. I., Boissy, A. A., Désiré, L. L., &

Greiveldinger, L. L. (2009). Animals’ emo-

tions: Studies in sheep using appraisal theo-

ries. Animal Welfare, 18, 347–354.

Wegner, D. M., Erber, R., & Zanakos, S. (1993).

Ironic processes in the mental control of mood

and mood-

elated thought. Journal of Person-

ality and Social Psychology, 65, 1093–1104.

Weiner, B. (1985). An attributional theory of

achievement motivation and emotion. Psycho-

logical Review, 92, 548–573.

Wilson, T. D., & Gilbert, D. T. (2003). Affec-

tive forecasting. In M. Zanna (Ed.), Advances

in experimental social psychology (Vol. 35,

pp.

345–411). New York: Elsevier.

PART VII

PSYCHOPATHOLOGY

393

The relationship between emotion regula-

tion (ER) and anxiety disorders has received

considerable attention since the publication

of the first edition of this handbook. ER

features more prominently in conceptual

accounts of anxiety disorders, and empiri-

cal investigations that focus on the intersec-

tion of ER and anxiety have increased dra-

matically. It is no longer justified to assert

that the role of emotion and ER is under-

recognized in conceptualizations and treat-

ments for anxiety disorders. Nor is it nec-

essary to rely on extrapolation of findings

from healthy samples to posit relationships

between ER and anxiety disorders: In an

exciting development, we are now able to

review behavioral and neurobiological lit-

eratures that elucidate the role of ER in the

development, phenomenology, and treat-

ment of anxiety disorders.

This recent acceleration of research has

generated an array of potentially important

observations regarding the relationship of

ER to anxiety disorders, which we aim to

integrate in this chapter. One area of partic-

ular interest is the use of specific ER strate-

gies (e.g., suppression, cognitive reappraisal)

by individuals with anxiety disorders: how

frequently they use certain strategies, how

successful they are at implementing them,

and—most importantly— how this may

relate to the development and maintenance

of anxiety disorder symptoms. We contend

that the use of specific ER strategies by anx-

ious individuals is best understood within

the broader context of the basic emotional

processing that characterizes anxiety disor-

ders. The first section of the chapter there-

fore reviews evidence supporting the view

that ER in anxiety disorders derives in large

part from biological and psychological vul-

nerabilities that confer increased emotional

reactivity, attentional biases toward threat

and other negative information, and global

tendencies to experience emotions as aver-

sive and to engage in avoidant processing

and behavior. These features of anxiety dis-

orders influence anxious individuals’ use of

the specific ER strategies that constitute the

focus of the latter portion of the chapter. In

discussing these strategies, we consider sev-

eral potential pathways to the ER difficulties

reported by individuals with anxiety disor-

ders, including overreliance on maladaptive

ER, less frequent use or compromised effec-

tiveness of adaptive ER, and dysfunction of

neural systems supporting ER.

Defining Our Terms

Before we turn to our main topics, it will be

useful to clarify the definitions of terms used

throughout this chapter. Our definitions of

CHAPTER 24

Emotion Regulation in Anxiety Disorders

Laura Campbell-Sills

Kristen K. Ellard

David H. Barlow

394 PSYCHOPATHOLOGY

emotion and emotion regulation closely par-

allel those articulated by Gross (this volume).

We consider emotions to be multimodal phe-

nomena that involve changes in subjective

experience, physiology, and action tenden-

cies. Emotions occur in response to internal

or external stimuli that are meaningful to

the organism’s survival, well-being, or other

goals. In many situations, the subjective

experience, physiological changes, or behav-

ioral tendencies associated with an emo-

tion increase the chances of attaining a goal

(e.g., sympathetic arousal and the impulse

to flee help achieve the goal of survival in

a life- threatening situation). However, by

definition, the emotions that characterize

anxiety disorders are excessive, often caus-

ing the individual both subjective distress (in

the form of intense emotions, catastrophic

thoughts, and/or uncomfortable physical

sensations) and interference with adaptive

functioning (e.g., when patterns of extreme

avoidance develop).

When using the term emotion regula-

tion, we refer to processes that influence

the occurrence, intensity, duration, and

expression of emotion. These processes may

support up- regulation or down- regulation

of positive or negative emotions, and can

be placed on a continuum of automatic to

effortful (Gross, this volume). While all

forms of ER are likely relevant to anxiety

disorders, much of this chapter focuses on

effortful down- regulation of negative emo-

tion. This choice is partly based on typical

anxiety disorder presentations, which are

largely characterized by excessive negative

emotions such as fear and anxiety. It also

reflects the predominant focus of empiri-

cal work to date, because most research has

focused on a limited number of effortful ER

strategies.

Throughout the chapter we also refer to

maladaptive and adaptive ER. By maladap-

tive we mean that an ER strategy is either

unsuccessful in reducing the unwanted emo-

tional response (as reflected by subjective

report, physiological arousal, behavioral

data, or brain imaging data) or associated

with costs that likely outweigh any benefits

of short-term reduction of acute emotion.

In contrast, “adaptive” strategies promote

(1) decreased subjective distress, physiologi-

cal arousal, maladaptive behavior, and/

or activation of emotion- generating brain

regions; and (2) maintenance of abilities to

pursue short- and long-term goals that are

important to the individual. Effective ER

likely involves a combination of selecting

“good” strategies and being able to apply

these methods flexibly depending on contex-

tual demands (e.g., Kashdan & Rottenberg,

2010).

A Conceptual Framework

for Examining ER

in Anxiety Disorders

Consideration of the biological and psycho-

logical factors that underlie anxiety disor-

ders provides an important framework for

understanding ER in these disorders. Barlow

(1988, 2002) proposed that anxiety disor-

ders emerge out of a “triple vulnerability,”

wherein generalized biological vulnerabili-

ties toward greater emotional reactivity, and

a generalized psychological vulnerability

arising from early developmental events that

engender a sense of the world as uncontrol-

lable or unpredictable (hence, threatening),

represent an etiological diathesis toward

psychopathology. When combined with

life stress and learned experiences (specific

vulnerabilities), symptoms associated with

anxiety and related emotional disorders are

likely to result. Specific diagnostic presenta-

tions (e.g., social anxiety disorder [SAD],

panic disorder [PD]) are determined by learn-

ing experiences that focus the diathesis on

particular contexts (e.g., social evaluation,

bodily sensations; Barlow, 2002; Suárez,

Bennett, Goldstein, & Barlow, 2009). In this

way, the DSM anxiety diagnoses represent

the endpoint of the convergence of the triple

vulnerabilities. However, at the core of each

specific disorder lies a common tendency to

experience intense emotions that are viewed

as threatening or unwanted, often prompt-

ing efforts to diminish or avoid the aversive

emotional experience (Barlow, 1988, 2002).

Various lines of research lend support

to the different components of this model.

Neurobiological findings are broadly con-

sistent with the notion of a generalized bio-

logical vulnerability to increased emotional

reactivity in anxiety and related emotional

disorders. Specific genetic polymorphisms

have been associated with anxiety- related

traits (e.g., Montag, Fiebach, Kirsch, &

Emotion Regulation in Anxiety Disorders 395

Reuter, 2011) and shown to interact with

stressors to predict anxiety sensitivity (an

established risk factor for PD; Stein, Schork,

& Gelernter, 2008) and onset of symptoms

of emotional disorders (e.g., Caspi et al.,

2003). Genetic findings have been linked to

neural models of anxiety disorders, in that

associations have been observed between

these polymorphisms and both activation

of neural substrates of emotion generation

(e.g., Drabant et al., 2012; Munafo, Brown,

& Hariri, 2008) and functional connectiv-

ity between emotion- generating regions and

structures implicated in their inhibitory

control (Pezawas et al., 2005). Importantly,

hyperactivation of limbic structures impli-

cated in emotion generation (e.g., amygdala,

insula) coupled with reduced inhibitory cor-

tical control of these structures has been

found across anxiety disorders (e.g., Etkin

& Wager, 2007; Shin & Liberzon, 2010).

Empirical support for a generalized psy-

chological vulnerability to anxiety disorders

is also evident. Anxious individuals con-

sistently display attentional biases toward

negative or threatening cues, as well as dif-

ficulty disengaging from negative stimuli

(Beck & Clark, 1997; MacLeod, Mathews,

& Tata, 1986; Olantunji & Wolitzky- Taylor,

2009; Pineles & Mineka, 2005). These cog-

nitive biases toward negative information

have been shown to predict elevated anxi-

ety symptoms in response to stress (e.g.,

MacLeod & Hagan, 1992; van den Hout,

Tenney, Huygens, Merckelbach, & Kindt,

1995). Additionally, traits reflecting dimin-

ished tolerance for distress, physical sensa-

tions, and other types of discomfort (e.g.,

uncertainty) are associated with a range

of anxiety and mood disorders (Boswell,

Thompson- Holland, Farchione, & Barlow,

2013; Keough, Riccardi, Timpano, Mitch-

ell, & Schmidt, 2010; McEvoy & Mahoney,

2012; Olatunji & Wolitzky- Taylor, 2009)

and in some cases have been shown to pre-

dict onset of anxiety disorders following

stress (Schmidt, Lerew, & Jackson, 1999) or

to mediate change in anxiety symptoms over

time (Dugas, Laugesen, & Bukowski, 2012).

Implications for Emotion Regulation

in Anxiety Disorders

The underlying features of anxiety disorders

described earlier (i.e., heightened emotional

reactivity, hypersensitivity to threat, and

tendencies to experience emotions as aver-

sive) likely have a considerable impact on

the ER of anxious individuals. These influ-

ences may occur at multiple points along

the temporal continuum of ER (see Gross,

this volume), beginning at the earliest stages

when automatic processes related to atten-

tion and awareness are engaged. Attention

and automatic responses to threat occur

within milliseconds and influence further

information processing almost immediately

(e.g., Garner, Mogg, & Bradley, 2006). As

noted earlier, an extensive literature sug-

gests that attentional biases toward threat

and other negative information are key fea-

tures of anxiety disorders (Beck & Clark,

1997; MacLeod et al., 1986; Olantunji &

Wolitzky- Taylor, 2009; Pineles & Mineka,

2005). Such biases in the early processing of

emotional stimuli may provoke a range of

subsequent responses, including behavioral

efforts to dampen responding (e.g., gaze

aversion; Garner et al., 2006) and attempts

to escape threatening information via cog-

nitive control (e.g., Leutgeb, Schäfer, &

Schienle, 2009; Paquette et al., 2003).

According to the “hypervigilance–

avoidance” model, the early attentional

biases toward threat that characterize anxi-

ety disorders are paradoxically followed

by reduced processing of threat (e.g., via

cognitive avoidance) and increased avoid-

ant responding. This model converges with

behavioral and neuroimaging findings (e.g.,

Bishop, Duncan, Brett, & Lawrence, 2004;

Koster, Crombez, Verschuere, Van Damme,

& Wiersema, 2006; see Hofmann, Ellard,

& Siegle, 2012, for a review), and with the

clinical consensus that cognitive and behav-

ioral avoidance are integral to the psycho-

pathology of anxiety disorders. Examples

from clinical observation include avoid-

ance of situational and interoceptive (i.e.,

bodily sensation) cues in PD; avoidance of

eye contact and social interactions in SAD;

avoidance of contamination through wash-

ing, doubting thoughts through checking, or

intrusive images through repetitive phrases

in obsessive– compulsive disorder (OCD);

avoidance of trauma reminders in posttrau-

matic stress disorder (PTSD); and avoidance

of anxious arousal and uncertainty through

worry and reassurance seeking in general-

ized anxiety disorder (GAD).

396 PSYCHOPATHOLOGY

Tendencies toward cognitive and behav-

ioral avoidance likely have broad impacts on

anxious individuals’ ER. Available evidence

suggests that engagement with emotion-

ally salient stimuli generally promotes more

effective ER than avoidance or disengage-

ment. For instance, a study that employed

eye- tracking demonstrated that regardless of

the specific ER strategy used (cognitive reap-

praisal or suppression), subjects who focused

visual attention more on the emotionally

salient aspects of a stimulus were more likely

to regulate emotions successfully (Bebko,

Franconeri, Ochsner, & Chiao, 2011). In

addition, simply labeling emotions (which

involves awareness and acknowledgment

of emotions) has been shown to reduce dis-

tress as effectively as “active” ER strategies

such as cognitive reappraisal and distraction

(Lieberman, Inagaki, Tabibnia, & Crockett,

2011). Anxious subjects’ tendencies to avoid

deeper processing of emotional stimuli may

preclude them from experiencing the ben-

efits of engagement- oriented responses to

emotional stimuli.

Relationship of Anxiety Disorders

to ER: General or Specific?

Thus far we have discussed anxiety as a

global trait, without distinguishing among

the anxiety disorders (cf. Barlow, Sauer-

Zavala, Carl, Bullis, & Ellard, 2013). As

we move toward discussion of specific ER

strategies, we will for the most part continue

to refer to anxiety disorders collectively. We

should, however, note that there has been

particular interest in the relationship of

ER to GAD (e.g., McLaughlin, Mennin, &

Farach, 2007; Mennin, Heimberg, Turk, &

Fresco, 2005; Mennin, McLaughlin, & Fla-

nagan, 2009; Salters- Pedneault, Roemer,

Tull, Rucker, & Mennin, 2006; Turk, Heim-

berg, Luterek, Mennin, & Fresco, 2005). The

emotion dysregulation model of GAD posits

that this disorder results from a convergence

of high levels of emotional reactivity and

intensity, dysfunctional meta- emotion (e.g.,

decreased clarity and understanding of emo-

tions), and maladaptive efforts to regulate

emotions (Mennin et al., 2005; Mennin &

Fresco, this volume). GAD has been con-

ceptualized as the “basic” anxiety disorder

given that its defining features (e.g., anxious

apprehension) reflect processes that contrib-

ute to the manifestation of symptoms in all

anxiety disorders (Barlow, 1988; Brown,

Barlow, & Liebowitz, 1994). Thus, findings

related to emotion dysregulation in GAD

may reflect processes found in anxiety dis-

orders more generally.

In support of this view, several analogous

findings emerge when considering emotional

experience and ER across specific anxiety

disorders. For instance, decreased emotional

clarity has been associated with symptoms

of GAD, PD, PTSD, and SAD (Baker, Hol-

loway, Thomas, Thomas, & Owens, 2004;

McLaughlin et al., 2007; Tull & Roemer,

2007; Weiss et al., 2012). Decreased accep-

tance of emotions has been found in GAD,

PD, and PTSD (McLaughlin et al., 2007;

Tull & Roemer, 2007; Weiss et al., 2012),

and in one study individuals with SAD were

not clearly differentiated from individuals

with GAD on this variable (Mennin et al.,

2009). Individuals with symptoms of PTSD

(e.g., Ehring & Quack, 2010; Weiss et al.,

2012), GAD (Mennin et al., 2005, 2009;

Salters- Pedneault et al., 2006), and SAD

(Mennin et al., 2009; Turk et al., 2005) also

endorse difficulties with repairing negative

mood and accessing effective ER strategies

when distressed (these dimensions of ER

were not assessed in available studies of PD).

Recent meta- analytic work also supports

the view that maladaptive ER represents

a transdiagnostic feature of anxiety and

related emotional disorders. An analysis of

114 studies suggested comparable relation-

ships of ER strategies to anxiety and mood

disorder symptoms, which tended to display

stronger relationships to ER than did eat-

ing and substance use disorder symptoms

(Aldao, Nolen- Hoeksema, & Schweizer,

2010). Avoidance, rumination, and suppres-

sion were positively related to anxiety and

depression, whereas problem solving and

cognitive reappraisal were negatively associ-

ated with both types of symptoms (though

the reappraisal– anxiety relationship was

only marginally significant, it was similar

in magnitude to the reappraisal– depression

relationship). Another investigation found

that a latent “cognitive ER” factor (defined

by cognitive reappraisal, problem solving,

suppression, and rumination) was signifi-

cantly associated with symptoms of three

classes of disorder: anxiety, mood, and eat-

ing disorders (Aldao & Nolen- Hoeksema,

2010). The strongest association of the cog-

nitive ER factor was with depressive symp-

Emotion Regulation in Anxiety Disorders 397

toms, followed by anxiety symptoms, then

eating symptoms.

Sum mary

Anxiety disorders are understood to emerge

from a combination of biological vulner-

abilities, psychological vulnerabilities, and

stress. The vulnerabilities that underlie

anxiety disorders have numerous potential

impacts on the ER process. At the earliest

stages, hypersensitivity to threat constrains

attention, thereby limiting perceptual infor-

mation and increasing threat salience. This

appears to set the stage for attempts to reg-

ulate away from the threat either through

cognitive control strategies or behavioral

strategies that limit ongoing contact with

the threatening stimuli. These types of

avoidant responses may preclude effective

ER that derives from engagement with emo-

tional stimuli and recognition of emotions.

Available evidence suggests that these basic

emotion- processing and ER tendencies are a

common factor across anxiety disorders.

Investigating Use of Specific ER

Strategies in Anxiety Disorders

Having provided an overview of our concep-

tual framework for considering ER in rela-

tion to anxiety disorders, we now turn to

discussion of specific ER strategies that have

been the focus of most empirical work on

this topic. We have chosen to highlight three

ER strategies: cognitive reappraisal, suppres-

sion, and acceptance. These strategies have

been strongly represented in recent empirical

work and in development of treatments for

anxiety disorders. For our purposes in this

chapter, we examine acceptance alongside

the “straightforward” ER strategies (cog-

nitive reappraisal and suppression), while

recognizing that acceptance is perhaps more

precisely characterized as an “orientation”

or “attitude” toward emotions rather than

a regulation strategy per se (i.e., by defini-

tion, acceptance involves a relinquishing of

efforts to modify emotional experience). We

also should note that many other ER strate-

gies are potentially relevant to anxiety; some

of these (e.g., rumination, distraction) have

been more extensively studied in relation to

mood disorders and are covered by Joor-

mann and Siemer (this volume).

Suppression

Suppression is a response- focused ER strat-

egy that occurs late in the temporal unfold-

ing of the emotional response (Gross, this

volume). Suppression can be directed spe-

cifically toward inhibition of the behav-

ioral expression of emotion (expressive sup-

pression) and/or toward the dampening of

subjective feelings (emotion suppression).

Studies of healthy subjects indicate that

expressive suppression (relative to passive

viewing of emotional stimuli) effectively

reduces expressive behavior; however, it also

increases sympathetic arousal and fails to

reduce the intensity of the subjective experi-

ence of emotion (Gross & Levenson, 1993,

1997). Neuroimaging work further suggests

that expressive suppression increases acti-

vation of emotion- generating brain regions

(e.g., amygdala and insula; Goldin, McRae,

Ramel, & Gross, 2008).

Investigations of suppression with anxiety-

prone subjects report similar results. Several

studies have employed biological challenges

involving inhalation of carbon dioxide–

enriched air, which can provoke panic

symptoms. In these studies, instructions to

suppress emotions did not lead to reduced

subjective distress in subjects with high anx-

iety sensitivity (Eifert & Heffner, 2003) or in

patients diagnosed with PD (Levitt, Brown,

Orsillo, & Barlow, 2004). A study using a

mixed anxiety and mood disorder sample

also found that instructions to suppress

emotions during an emotion- provoking film

did not reduce the subjective experience of

emotion, and were associated with increased

heart rate when compared to instructions to

accept emotions during the film (Campbell-

Sills, Barlow, Brown, & Hofmann, 2006a).

This study also measured recovery of emo-

tional responses, and showed that subjects

instructed to suppress emotions during the

film reported higher levels of distress during

the postfilm recovery period than did sub-

jects who had accepted emotions. This lat-

ter finding raises the possibility that another

detrimental effect of suppression could be

interference with recovery of emotions fol-

lowing termination of an emotion- provoking

stimulus.

While these results suggest that suppres-

sion is generally an ineffective ER strategy

for both healthy and anxious individuals,

it should be noted that suppression is likely

398 PSYCHOPATHOLOGY

beneficial under certain circumstances. For

example, suppression after exposure to

traumatic scenes was shown to reduce both

subjective distress during exposure and later

intrusions (Dunn, Billotti, Murphy, & Dal-

gleish, 2009). It may not be the engagement

of suppression per se, but the rigid or habit-

ual use of this ER strategy, that is maladap-

tive (cf. Bonanno, Papa, Lalande, Westphal,

& Coifman, 2004).

Cognitive Reappraisal

Cognitive reappraisal entails thinking about

stimuli in a way that diminishes the inten-

sity of emotions. For example, while view-

ing mourners at a funeral, a person using

cognitive reappraisal might think that the

deceased person is at peace and that the

mourners will recover with time. This strat-

egy is conceptualized as an antecedent-

focused strategy (i.e., one that is deployed

before the full-scale emotional response has

occurred; Gross, this volume). Use of cogni-

tive reappraisal to manage negative emotions

is associated with a range of beneficial effects

in healthy subjects. These include reduced

intensity of the subjective experience of emo-

tion (Bebko et al., 2011; Gross, 1998; Hof-

mann, Heering, Sawyer, & Asnaani, 2009),

reduced expressive behavior (Gross, 1998),

attenuation of startle (Jackson, Malmstadt,

Larson, & Davidson, 2000), enhanced para-

sympathetic tone (Aldao & Mennin, 2012),

reduced behavioral avoidance (Wolgast,

Lundh, & Viborg, 2011), and reduced amyg-

dala activation (e.g., Goldin et al., 2008;

Ochsner, Bunge, Gross, & Gabrieli, 2002;

Ochsner, Ray, et al., 2004).

Several of these outcomes have not been

measured in studies of cognitive reappraisal

that included anxious subjects. However, the

most frequently reported benefit of cognitive

reappraisal— reduced intensity of the subjec-

tive experience of emotion— has been dem-

onstrated in individuals high in trait anxiety

(Campbell- Sills et al., 2011) and in subjects

diagnosed with anxiety disorders (Aldao &

Mennin, 2012; Ball, Ramsawh, Campbell-

Sills, Paulus, & Stein, 2012). Available evi-

dence suggests divergent effects of cognitive

reappraisal on the physiological responses

and brain function of anxious and nonanx-

ious individuals; these findings are discussed

in detail below (“Pathways to Ineffective ER

in Anxiety Disorders”).

Acceptance

Acceptance entails allowing oneself to

experience emotions without attempting to

alter or suppress them. Acceptance- based

interventions promote accepting attitudes

toward emotions (e.g., emotions have a nat-

ural trajectory and will dissipate if allowed

to run their course) and explicitly discour-

age suppression. The concept of acceptance

shares features with the concept of mind-

fulness, which promotes nonjudgmental,

present- moment awareness of emotions and

other internal experiences. Acceptance and

mindfulness are intended to increase sub-

jects’ awareness of their emotions (including

habitual impulses to suppress or avoid dis-

comfort), which may provide them greater

opportunity to respond to emotions adap-

tively (Roemer, Orsillo, & Salters- Pedneault,

2008; Hill & Updegraff, 2012).

Experimental studies of healthy and anx-

ious samples have shown that instructions to

accept emotions are associated with reduc-

tions in subjective distress and behavioral

avoidance (Eifert & Heffner, 2003; Levitt et

al., 2004; Wolgast et al., 2011). For exam-

ple, studies employing carbon dioxide chal-

lenges have shown that anxious subjects who

accepted emotions reported less intense fear,

fewer catastrophic thoughts, and greater

willingness to complete another biological

challenge when compared to subjects who

either suppressed emotions or received no

instructions (Eifert & Heffner, 2003; Levitt

et al., 2004). Another study of a mixed anxi-

ety and mood disorder sample showed that,

compared to suppression, engaging in accep-

tance resulted in reduced heart rate during

emotion- provoking films and faster recovery

of subjective distress (Campbell- Sills et al.,

2006a).

Summary

Results of experiments instructing subjects

to use specific ER strategies support the view

that reappraisal and acceptance are generally

adaptive strategies, whereas suppression is

adaptive under a more restricted range of cir-

cumstances (and can often be maladaptive).

The available literature (though still limited)

suggests that, like healthy subjects, individ-

uals with anxiety disorders derive benefits

from cognitive reappraisal and acceptance

(e.g., reduced subjective distress) and experi-

Emotion Regulation in Anxiety Disorders 399

ence detrimental effects of suppression (e.g.,

increased physiological arousal).

Pathways to Ineffective ER

in Anxiety Disorders

Individuals with anxiety disorders report

wide- ranging difficulties related to emo-

tional experience and ER (Baker et al., 2004;

Ehring & Quack, 2010; McLaughlin et al.,

2007; Mennin et al., 2005, 2009; Salters-

Pedneault et al., 2006; Tull & Roemer,

2007; Turk et al., 2005; Weiss et al., 2012).

Consideration of the literature focused on

specific ER strategies such as suppression,

cognitive reappraisal, and acceptance raises

a number of possible explanations for these

ER difficulties. In this section, we consider

the following potential pathways to ineffec-

tive ER in anxiety disorders:

1. Strategy selection. Anxious individuals

might select maladaptive strategies more

often, or adaptive strategies less often,

than nonanxious individuals.

2. ER ability. Anxious individuals may be

less competent in applying ER strategies.

3. Divergent effects of ER strategies. The

same ER strategy, applied with a similar

level of competence, may have different

effects for individuals with and without

anxiety disorders.

4. Neurobiological differences. Function-

ing of neural substrates supporting spe-

cific ER strategies may be compromised

in anxious individuals.

Strategy Selection

Neurobiology, temperament, learning his-

tory, and other factors likely interact to

determine individual differences in propensi-

ties to use specific ER strategies (e.g., see, in

this volume, John & Eng; Rothbart, Sheese,

& Posner; and Thompson). Consistent with

experimental results, questionnaire studies

suggest that habitual use of reappraisal to

manage emotions is associated with a range

of positive outcomes, including higher lev-

els of overall positive affect and well-being,

lower levels of overall negative affect, better

interpersonal functioning, and fewer symp-

toms of anxiety and mood disorders (Aldao

& Nolen- Hoeksema, 2010; Aldao et al.,

2010; Eftekhari, Zoellner, & Vigil, 2009;

Gross & John, 2003). In contrast, habitual

use of suppression is related to lower levels

of overall positive affect and well-being;

higher levels of overall negative affect;

poorer interpersonal functioning; and more

symptoms of anxiety, mood, and eating dis-

orders (Aldao & Nolen- Hoeksema, 2010;

Aldao et al., 2010; Gross & John, 2003).

Though effects of habitual use of acceptance

have not been investigated, habitual mind-

fulness has been associated with lower lev-

els of daily anxiety and depression, reduced

emotional reactivity to laboratory stressors,

improved abilities to differentiate emotions,

decreased emotional lability, and fewer self-

reported ER difficulties (Arch & Craske,

2010; Hill & Updegraff, 2012).

When selecting strategies to regulate emo-

tional experiences, there is evidence that

individuals with anxiety disorders rely more

on maladaptive strategies, such as suppres-

sion, and less on adaptive strategies, such

as reappraisal and acceptance. For instance,

studies using both survey- based and experi-

mental methods have found that individuals

with anxiety disorders utilize suppression

more than do nonanxious individuals (Baker

et al., 2004; Campbell- Sills et al., 2006a;

Levitt et al., 2004; Ball et al., 2012). With

regard to adaptive strategy use, subjects

with GAD have been found to endorse less

frequent use of cognitive reappraisal (Ball et

al., 2012) and acceptance (Salters- Pedneault

et al., 2006). Children and adolescents diag-

nosed with anxiety disorders also report

less frequent use of reappraisal in everyday

life than do nonanxious subjects (Carthy,

Horesh, Apter, Edge, & Gross, 2010).

A critical issue related to ER strategy

selection in anxiety disorders is the role of

emotional intensity. Empirical work has now

shown that for healthy controls, ER strategy

preference depends on situation intensity.

Engagement of reappraisal is preferred in

lower intensity situations, whereas disen-

gagement/distraction is preferred in higher

intensity situations (Sheppes, Scheibe, Suri,

& Gross, 2011). Due to differences in base-

line emotional state, emotional reactivity,

and attentional biases, the same situation

may be significantly more intense for anx-

ious than for nonanxious individuals. The

more intense emotions elicited by the situa-

tion may in turn create different conditions

for selection of ER strategies; for instance,

facilitating a disengagement- oriented strat-

400 PSYCHOPATHOLOGY

egy (e.g., suppression) in a situation where

the lower intensity emotions of healthy

individuals would prompt an engagement-

oriented strategy (e.g., cognitive reappraisal).

A variety of other factors may contribute

to the observed differences between anxious

and nonanxious subjects in the selection of

ER strategies. With respect to reappraisal,

an expanded awareness is necessary to allow

for the processing of alternative interpreta-

tions. The narrowed attention fostered by

attentional biases associated with anxiety

disorders may preclude processing of alter-

nate stimulus meanings, a necessary compo-

nent of successful reappraisal. Similarly, the

propensity toward hypervigilance followed

by avoidant processing may preclude engage-

ment of mindfulness and acceptance, both

of which require openness toward all experi-

ence, including that which is uncomfortable.

By contrast, suppression and behavioral

avoidance naturally emanate from avoid-

ant processing, and may therefore be more

readily recruited by individuals with anxiety

disorders.

ER strategy selection also may relate to

individual differences in abilities to use

executive control to mitigate the impact of

emotional stimuli. Recent work suggests

that individuals who habitually use cogni-

tive reappraisal may have an enhanced abil-

ity to use executive control in the service

of regulating emotions (Cohen, Henik, &

Moyal, 2012; Gyurak, Goodkind, Kramer,

Miller, & Levenson, 2012). By contrast,

individuals with anxiety disorders may have

compromised abilities in this regard. This

view is consistent with findings of neuro-

imaging studies (discussed in more detail

below) that show reduced prefrontal cortex

(PFC) activation in individuals with anxi-

ety disorders using reappraisal to regulate

emotions (Goldin, Manber-Ball, Werner,

Heimberg, & Gross, 2009; Goldin, Manber,

Hakimi, Canli, & Gross, 2009; Ball et al.,

2012; New et al., 2009), and the observa-

tion that nonclinical, anxiety- prone subjects

require greater PFC resources than healthy

controls to down- regulate negative emo-

tions with reappraisal (Campbell- Sills et al.,

2011). Diminished abilities to recruit execu-

tive control networks early in the processing

of emotional stimuli could also lead to over-

reliance on suppression (a strategy deployed

later in the temporal continuum of ER) to

manage negative emotions.

Another factor relevant to ER strategy

selection is subjects’ “meta- experience” of

emotion, which includes dimensions such

as attitudes toward emotions, understand-

ing of emotions, emotional clarity, and

acceptability of emotions. As noted earlier,

individuals with anxiety disorders exhibit

higher levels of traits reflecting diminished

tolerance for emotional distress and other

types of discomfort, as well as decreased

clarity and acceptability of emotions. While

studies directly examining the relationships

between meta- experiences of emotion and

selection of ER strategies have been sparse,

one study using a mixed anxiety and mood

disorder sample showed that less accepting

attitudes toward current emotions mediated

the relationship between negative emotion

intensity and spontaneous use of suppression

(Campbell- Sills et al., 2006a). Thus, more

intense negative emotion prompted subjects

to engage in suppression only when the emo-

tions were experienced as less acceptable.

This finding suggests that meta- experience

of emotion may influence strategy selection

in individuals with anxiety disorders.

ER Ability

Individual differences in abilities to imple-

ment ER strategies undoubtedly exist

and may be relevant to the ER difficulties

reported by anxious subjects. However,

very few studies have evaluated the levels

of competence that subjects have in apply-

ing specific ER strategies. This research aim

requires methods for assessing the quality

of the process by which individuals engage

in ER strategies. One exception is Carthy et

al.’s (2010) analysis of cognitive reappraisal

abilities demonstrated by children with and

without anxiety disorders during a labora-

tory ER task. In this study, subjects recited

their reappraisals out loud during the task

(which utilized negative images) and their

responses were coded as reappraisal suc-

cesses or failures. While children with anxi-

ety disorders were able to reappraise the

majority of stimuli successfully (87%), they

demonstrated slightly but significantly lower

reappraisal abilities than healthy controls

(93%). One other study reported on the pro-

cess of training subjects to use reappraisal to

down- regulate emotions elicited by negative

images (Campbell- Sills et al., 2011). Anxious

and healthy control groups did not differ in

Emotion Regulation in Anxiety Disorders 401

their need for extra training in reappraisal

prior to performing the experimental task.

More work is needed to elucidate whether

there are important differences in abilities

of anxious and nonanxious individuals to

apply cognitive reappraisal and other ER

strategies.

Divergent Effects of ER Strategies

Even when the same ER strategy is selected

and applied with a similar level of compe-

tence, its effects may vary for anxious and

nonanxious individuals. In particular, the

beneficial effects of adaptive strategies could

be attenuated, or the negative effects of mal-

adaptive strategies could be amplified, lead-

ing to greater ER difficulties in individuals

with anxiety disorders.

Two studies suggest that the costs of sup-

pression may be higher for anxious individu-

als. In one study, the effects of suppression

and no instructions were compared in sub-

jects high and low in trait negative affect

(a trait strongly associated with anxiety

and mood disorders; Barlow, 2002; Brown

& Barlow, 2009). Individuals with high

negative affect who engaged in suppression

showed a paradoxical increase in negative

emotions when writing about a negative

personal memory, whereas those with low

negative affect did not (Dalgleish, Yiend,

Schweizer, & Dunn, 2009). Another study

found that instructions to suppress emo-

tions were associated with increased subjec-

tive distress in subjects with elevated scores

on a measure of experiential avoidance (a

trait also associated with anxiety disorders;

Feldner, Zvolensky, Eifert, & Spira, 2003).

The increased sympathetic arousal found

to accompany suppression may render this

strategy particularly ineffective for anxiety-

prone individuals, who are sensitive to and

often fear physical symptoms.

Research suggests that under controlled

experimental conditions (i.e., when sub-

jects are trained to reappraise standard-

ized emotional stimuli), anxious subjects

can achieve reductions in subjective distress

that are comparable to those observed in

healthy subjects (Campbell- Sills et al., 2011;

Ball et al., 2012). However, another recent

study suggests that even when the subjec-

tive outcomes of cognitive reappraisal are

equivalent, the physiological benefits of this

strategy may be compromised for anxious

individuals. In this study, subjects with

GAD and healthy controls were assigned

to cognitive reappraisal, acceptance, or

passive viewing conditions (Aldao & Men-

nin, 2012). Their subjective experience and

heart rate variability (HRV) were measured

while they viewed films that elicited anxi-

ety, sadness, and disgust. HRV, an index

of parasympathetic influence on the heart,

reflects the capacity of the autonomic ner-

vous system to respond adaptively to chang-

ing environmental conditions. HRV tends

to decrease under conditions of threat and

to increase under conditions of flexible and

adaptive regulation (Friedman, 2007).

Results revealed that subjects who used

cognitive reappraisal reported lower subjec-

tive negative affect in response to the films

compared to subjects who used acceptance

or who engaged in passive viewing (which

did not differ). This pattern was consistent

across the GAD and healthy control groups.

With respect to physiological effects, sub-

jects with GAD displayed significantly

lower HRV than healthy controls across

all film types and regulation conditions.

These findings were consistent with previ-

ous reports of low parasympathetic tone

in GAD (Thayer, Friedman, & Borkovec,

1996). Moreover, during recovery from anx-

iety- and disgust- provoking films, subjects

with GAD showed an HRV pattern that was

opposite to that displayed by healthy con-

trols. Healthy subjects who used reappraisal

and acceptance showed higher HRV than

those who had received no instructions,

suggesting enhanced parasympathetic tone

with adaptive ER. In contrast, subjects with

GAD who used reappraisal and acceptance

showed lower HRV than those who received

no instructions. This pattern of parasym-

pathetic response may indicate diminished

efficacy of reappraisal and acceptance in

GAD that is only observed at the physiologi-

cal level.

Aldao and Mennin’s (2012) HRV find-

ings converge with those of another study of

reappraisal in healthy individuals classified

as high or low on neuroticism, a personality

trait strongly related to anxiety and mood

disorders (e.g., Brown, Chorpita, & Barlow,

1998; Barlow et al., 2013; Wilamowska et

al., 2010). In this study (Di Simplicio et al.,

2012), “low neuroticism” subjects showed

the expected pattern of higher HRV when

regulating emotions (vs. maintaining emo-

402 PSYCHOPATHOLOGY

tions), while “high neuroticism” subjects

showed no significant difference in HRV

across the two conditions. These results sig-

nify low parasympathetic tone in the high

neuroticism group, as well as reduced physi-

ological benefits of cognitive reappraisal for

anxiety- prone individuals.

Finally, a recent ecological study of anx-

ious and healthy children found differences

in the efficacy of ER strategies that were

related to anxiety disorder status (Tan et al.,

2012). This study assessed emotional reac-

tions to negative events in the past hour, use

of ER strategies (distraction, reappraisal,

problem solving, acceptance, avoidance, and

rumination), and current emotional experi-

ence. Interestingly, children with anxiety

disorders endorsed using the various ER

strategies with the same frequency as non-

anxious youth. Examination of strategy use

in relation to peak and current emotional

intensity ratings revealed that some adaptive

strategies (e.g., reappraisal) were equally

effective in down- regulating subjective dis-

tress in children with and without anxiety

disorders. However, the data suggested that

acceptance was only effective for decreasing

subjective distress in nonanxious children.

Neurobiological Differences

Another factor that may contribute to inef-

fective ER in anxiety disorders is dysfunc-

tion of neural systems supporting ER. The

majority of research on this topic has focused

on cognitive reappraisal, and these studies

have revealed several potentially important

neural correlates of anxious subjects’ use of

this strategy.

One pattern that has now been observed

in participants diagnosed with several dis-

tinct anxiety disorders (GAD, SAD, PD,

and PTSD) is hypoactivation of PFC regions

implicated in “top-down” control of emo-

tions during reappraisal of emotional stim-

uli (Ball et al., 2012; Goldin, Manber, et al.,

2009; Goldin, Manber-Ball, et al., 2009;

New et al., 2009). This suggests that less

robust engagement of PFC may contribute

to ER difficulties across anxiety disorders.

One recent study (Ball et al., 2012) showed

that subjects with GAD and PD who were

trained to use cognitive reappraisal achieved

similar reductions in subjective distress com-

pared to healthy controls who received the

same training. However, the subjects with

GAD and PD displayed decreased dorsome-

dial and dorsolateral PFC activation while

implementing this strategy. Moreover, PFC

activation during reappraisal was inversely

related to anxiety severity (e.g., subjects with

the highest levels of anxiety severity dis-

played the lowest levels of left dorsolateral

PFC activation), providing additional evi-

dence of a significant relationship between

anxiety and PFC function during ER.

Functional abnormalities also were

observed when subjects with SAD were

instructed to use cognitive reappraisal to

reduce emotions elicited by personally rel-

evant statements (Goldin, Manber-Ball,

et al., 2009). In this study, potentiated

responses in regions such as the medial PFC

and amygdala delayed normal cognitive pro-

cessing in the dorsolateral PFC, which only

occurred after a temporal lag relative to that

in healthy controls. One possible interpreta-

tion of this pattern is that anxious individu-

als must overcome an initial increased aver-

sive response (reflected in medial PFC and

amygdala hyperactivity) before implement-

ing reappraisal (reflected in delayed dorso-

lateral PFC processing).

Dysfunction of neural circuitry support-

ing cognitive reappraisal (and other forms of

ER) may be context dependent. In particu-

lar, dysfunction may be exacerbated in the

presence of emotional cues that represent the

focus of the individual’s anxiety disorder. A

study of individuals with SAD found differ-

ences in neural activation that were related

to stimulus type (Goldin, Manber, et al.,

2009). When regulating responses to images

depicting physical threat, no differences

emerged between subjects with SAD and

healthy controls. However, when regulating

reactions to social threat, subjects with SAD

displayed reduced activation in brain regions

implicated in cognitive control (dorsolat-

eral PFC, dorsal anterior cingulate cortex),

visual attention (medial cuneus, posterior

cingulate), attention (bilateral dorsal pari-

etal), and visual feature detection (bilateral

fusiform, superior temporal gyrus). These

findings suggest that in SAD the coordina-

tion of cognitive control circuitry may be

selectively compromised during the regula-

tion of social threat.

Few neuroimaging studies have exam-

ined anxious subjects’ use of ER strategies

Emotion Regulation in Anxiety Disorders 403

other than reappraisal. An exception, a

recent investigation of subjects with GAD,

compared the effects of acceptance, sup-

pression, and worry on subjective and neu-

ral responses to personally relevant worry

statements (Ellard, 2012). Both acceptance

and suppression were associated with less

subjective distress and amygdala activation

than worry. However, engagement of PFC

structures to meet these regulatory goals

differed for the two conditions. Suppression

was associated with increased activation

of insula and of right lateral PFC regions

implicated in working memory and the gen-

eration of inner speech, which suggested

paradoxically greater engagement of brain

regions implicated in somatic and linguistic

representations of emotional stimuli. On the

other hand, acceptance was associated with

reduced insula activation and greater left

dorsomedial PFC activation. The dorsome-

dial PFC has been implicated in representa-

tions of meta- states of self- awareness, such

as making inferences about moment- to-

moment feelings (Ochsner, Knierim, et al.,

2004), intentions for action (Lau, Rogers,

Haggard, & Passingham, 2004), and tacti-

cal response selection (Matsuzaka, Akiya-

maa, Tanjib, & Mushiake, 2012). Addition-

ally, left lateralization of PFC activation has

been associated with approach motivation,

whereas right lateralized activation has been

associated with avoidance (Speilberg et al.,

2011). Importantly, acceptance also engaged

ventromedial PFC regions implicated in

extinction learning, which may relate to

behavioral data suggesting greater willing-

ness to reengage with aversive stimuli fol-

lowing acceptance (Eifert & Heffner, 2003;

Levitt et al., 2004).

Studies of functional connectivity mea-

sured during resting states also contribute

to our understanding of ER in anxiety dis-

orders. Deviations in functional connectiv-

ity between subregions of the amygdala and

a broad network of somatosensory asso-

ciation cortices, motor regions, memory

regions, and regions associated with self-

referential processing have been observed

in individuals with GAD (Etkin, Prater,

Schatzberg, Menon, & Greicius, 2009).

Increased amygdala– dorsolateral PFC con-

nectivity was also found in patients with

GAD, whereas no such functional connec-

tivity was found in healthy controls. This

finding is intriguing given the consistent

implication of dorsolateral PFC in down-

regulation of negative emotions via cogni-

tive reappraisal (e.g., Goldin et al., 2008;

Ochsner et al., 2002; Ochsner, Ray, et al.,

2004). The greater amygdala– dorsolateral

PFC coupling in GAD may represent a com-

pensatory mechanism that functions as an

attempt to dampen emotional responding

through cognitive control (cf. Borkovec,

Alcaine, & Behar, 2004). Such a compen-

satory mechanism may in fact be counter-

productive for anxious individuals given the

observation that worry is associated with

increased amygdala activation in subjects

with GAD (Ellard, 2012).

Finally, it should be noted that more

complex and fine- grained analyses are

needed to further elucidate the neural bases

of ER difficulties in anxiety disorders. A

recent pathway mapping analysis identified

subcortical regions that mediated the rela-

tionship between PFC activation and reap-

praisal success in healthy subjects (Wager,

Davidson, Hughes, Lindquist, & Ochsner,

2008). Two distinct pathways— one through

the amygdala (associated with reduced

reappraisal success) and one through the

nucleus accumbens and ventral striatum

(associated with greater reappraisal suc-

cess)—were identified. This implies that

successful reappraisal may involve both the

dampening of amygdala responses by the

PFC and an increase in nucleus accumbens/

ventral striatum activation, which may

facilitate approach toward the emotion-

provoking stimulus. Extrapolating to the

case of ER in anxiety disorders, these

results raise the possibility that dysfunction

may extend beyond regions implicated in

cognition and emotion to include regions

implicated in processing sensory informa-

tion and choosing an adaptive behavioral

response. Specifically, ER difficulties across

anxiety disorders may be characterized by

not only deficits in cortical control of affec-

tive responses but also a failure to bring

appropriate approach- and reward- related

behaviors online (e.g., Etkin, Prater, Hoeft,

Menon, & Schatzberg, 2010). These find-

ings also suggest that cortical control of

limbic responses represents only one aspect

of widespread processing necessary in order

to achieve regulatory goals through reap-

praisal.

404 PSYCHOPATHOLOGY

Summary

The available evidence suggests that the

problems with ER reported by individuals

with anxiety disorders may be partly due to

strategy selection, because anxious individu-

als appear to select the maladaptive strategy

of suppression more frequently and adap-

tive strategies such as cognitive reappraisal

and acceptance less frequently. This may be

attributable to the more intense emotions

experienced by anxiety- prone individuals or

to their more negative meta- experiences of

emotions, both of which may favor avoid-

ant and less cognitively demanding methods

for regulating emotions (e.g., suppression).

Biases against use of reappraisal may relate

to diminished abilities of anxious individu-

als to use executive control to modulate emo-

tions, or to narrowed (i.e., threat- focused)

attention that does not allow for process-

ing of alternative appraisals. Overreliance

on suppression may be particularly costly

for anxious individuals given evidence that

they are more susceptible to paradoxical

increases in distress when using suppression

to manage emotions.

More research is needed to determine

whether individuals with anxiety disorders

are less competent in applying adaptive

strategies (e.g., cognitive reappraisal) once

they have been prompted to use them. Avail-

able evidence suggests that when trained to

use reappraisal, anxious and nonanxious

subjects achieve similar reductions in subjec-

tive distress. However, reappraisal may be

less effective in promoting enhanced para-

sympathetic tone in anxious individuals.

The growing neuroimaging literature on ER

and anxiety disorders further suggests a fail-

ure to recruit PFC effectively and efficiently

during cognitive reappraisal. Dysfunction

of neural substrates of ER likely constitutes

another basis of the regulatory difficulties

reported by individuals with anxiety disor-

ders.

Maladaptive ER:

Risk Factor or Epiphenomenon

of Anxiety Disorders?

An important issue we have yet to address

is the directionality of relationships

between anxiety- and ER-related constructs.

Although the reviewed associations between

ER strategies and anxiety disorders are com-

pelling, it is not possible to ascertain causal

relationships due to the cross- sectional

nature of virtually all available studies. For

instance, the findings that anxious subjects

use suppression more than healthy controls

could be explained by habitual suppression

being a risk factor for anxiety disorders.

However, it is also plausible that the intense

emotions that characterize anxiety disorders

could overwhelm the subject to the extent

that more cognitively demanding ER strate-

gies (e.g., reappraisal) are less available and

suppression becomes the chosen strategy by

default.

Fortunately, two recent longitudinal stud-

ies provide data that permit discrimination

between the “risk” and “epiphenomenon”

hypotheses. The data so far suggest that use

of maladaptive ER conveys risk for psycho-

pathology. In a prospective study of ado-

lescents, structural equation modeling was

used to evaluate the relationship between

ER (a latent factor defined by indicators

of emotional understanding, dysregulated

expression of sadness and anger, and rumi-

native responses to distress) and symptoms

of anxiety, depression, aggression, and eat-

ing pathology (McLaughlin, Hatzenbuehler,

Mennin, & Nolen- Hoeksema, 2011). Ado-

lescents were assessed at baseline and again

seven months later. Analyses showed that

after researchers controlled for baseline

symptoms, poor ER at baseline predicted

increased symptoms of anxiety, aggression,

and eating pathology (but not depression)

measured 7 months later. Importantly, psy-

chopathology symptoms measured at base-

line did not predict worse ER at the follow-

up.

A large (N > 1,000), prospective,

community- based study also investigated

the relationship between use of adaptive and

maladaptive ER strategies and psychopa-

thology (Aldao & Nolen- Hoeksema, 2012).

Composite ER scores were used, such that

maladaptive ER reflected use of behavioral

disengagement, denial, suppression, and the

“brooding” facet of rumination, and adap-

tive ER reflected use of positive reframing

(similar to reappraisal) and acceptance. The

overall index of psychopathology that was

used included anxiety symptoms, depres-

sive symptoms, and alcohol use. Regression

Emotion Regulation in Anxiety Disorders 405

analyses controlling for baseline symptoms

showed that self- reported use of maladap-

tive strategies at baseline predicted global

psychopathology 1 year later. The authors

noted that the same results emerged when

only internalizing symptoms (depression

and anxiety) were considered, though results

pertaining to anxiety symptoms alone were

not reported. Although measurement of anx-

iety was not optimal in this study (composite

of a single clinician rating and questionnaire

that mainly assesses autonomic arousal), the

results contribute to the evidence that use of

maladaptive strategies is not simply an epi-

phenomenon or consequence of anxiety dis-

orders or other psychopathology.

If overreliance on maladaptive ER strate-

gies constitutes a risk factor for anxiety and

related emotional disorders, it is plausible

that habitual use of adaptive strategies could

impart resilience to psychopathology. How-

ever, the only available longitudinal data

do not support this hypothesis. In Aldao

and Nolen- Hoeksema’s (2012) longitudinal

study, self- reported use of adaptive strategies

(cognitive reappraisal and acceptance) at

baseline did not significantly predict psycho-

pathology symptoms 1 year later. Nor did

the interaction of adaptive and maladaptive

strategies at baseline predict psychopathol-

ogy at follow- up. The lack of a significant

longitudinal relationship between adaptive

ER and psychopathology converges with

cross- sectional research showing that mal-

adaptive strategies have stronger associations

with symptoms of anxiety and mood disor-

ders than adaptive strategies (e.g., Aldao &

Nolen- Hoeksema, 2010; Aldao et al., 2010;

Moore, Zoellner, & Mollenholt, 2008). For

example, a cross- sectional investigation of

ER in trauma- exposed women found that

expressive suppression was strongly posi-

tively associated with stress- related symp-

toms, whereas cognitive reappraisal was

only weakly negatively associated with these

symptoms (Moore et al., 2008).

Despite these negative findings, it is still

possible that adaptive ER relates in impor-

tant ways to anxiety disorders and other

psychopathology. For example, one longi-

tudinal study of an undergraduate sample

reported divergent outcomes for individuals

high in neuroticism who endorsed low and

high levels of “emotional repair,” a construct

related to use of adaptive ER (Auerbach,

Abela, & Ringo Ho, 2007). Highly neurotic

individuals with low levels of emotional

repair endorsed increased engagement in

risky behaviors following increases in anxi-

ety and depression symptoms. In contrast,

highly neurotic individuals who endorsed

high levels of emotional repair displayed

decreased engagement in risky behaviors fol-

lowing increases in anxiety and depression.

These results suggest that adaptive ER may

curtail emotional responses that could lead

to clinical worsening or complications.

Cross- sectional evidence also suggests

that adaptive ER strategies may have a pal-

liative effect on anxiety disorder symptoms.

For example, a study of male veterans with

PTSD found that the combination of higher

levels of emotional clarity and more fre-

quent use of cognitive reappraisal was asso-

ciated with lower overall PTSD severity and

greater positive affect (Boden, Bonn- Miller,

Kashdan, Alvarez, & Gross, 2012). Another

study showed that trauma- exposed under-

graduates with “probable PTSD” endorsed

greater difficulties related to ER such as

decreased emotional acceptance and diffi-

culties engaging in goal- directed behavior,

controlling impulsive behavior, and access-

ing adaptive ER strategies when distressed.

In contrast, trauma- exposed subjects with-

out PTSD had fewer difficulties controlling

impulsive behaviors and greater access to

adaptive ER strategies when distressed (rela-

tive to both trauma- exposed subjects with

probable PTSD and those without trauma

exposure; Weiss et al., 2012). Aldao and

Nolen- Hoeksema (2012) also reported a

significant interaction effect of adaptive and

maladaptive ER strategies on psychopathol-

ogy symptoms at the baseline assessment of

their study. Level of adaptive strategy use

was negatively correlated with psychopa-

thology for subjects endorsing high usage of

maladaptive strategies, suggesting that adap-

tive ER mitigated the detrimental effects of

maladaptive ER.

It is also possible that aspects of adap-

tive ER that have not yet been examined in

longitudinal investigations are important to

resilience to psychopathology. Although fre-

quent use of adaptive ER strategies was not

shown to predict psychopathology symp-

toms (Aldao & Nolen- Hoeksema, 2012),

frequent and competent use may do so.

Though cross- sectional, one community-

406 PSYCHOPATHOLOGY

based study showed that cognitive reap-

praisal ability (measured as success in reduc-

ing subjective and physiological indicators

of emotion on a standardized task) was

associated with lower levels of depressive

symptoms in women experiencing high lev-

els of stress (Troy, Wilhelm, Shallcross, &

Mauss, 2010).

Finally, it is noteworthy that treatment-

related changes in ER are associated with

reductions in anxiety disorder symptoms.

For example, a recent study showed that

changes in reappraisal self- efficacy mediated

the effects of cognitive- behavioral therapy

for SAD (Goldin et al., 2012). Initial efficacy

data from several treatments for anxiety dis-

orders that directly target ER further sug-

gest that facilitating adaptive ER can lead to

resolution of anxiety disorder symptoms. In

addition to ER-focused treatments for spe-

cific anxiety disorders (e.g., emotion regu-

lation therapy for GAD: Mennin & Fresco,

this volume; acceptance- based behavior

therapy for GAD: Roemer et al., 2008),

our group has developed and tested a uni-

fied protocol for transdiagnostic treatment

of emotional disorders, designed to reduce

maladaptive emotional processing, promote

increased engagement of adaptive ER, and

facilitate extinction of distressing reactions

to intense negative emotions (Barlow et al.,

2011). Results of the initial randomized con-

trolled trial demonstrated that this interven-

tion led to significant reductions in anxiety

focused on emotional experience, anxiety

sensitivity, and emotional avoidance strate-

gies (Ellard et al., 2011), while another study

showed large treatment effect sizes across

disorders (Farchione et al., 2012). Empirical

support for the efficacy of the unified pro-

tocol and other ER-focused treatments for

anxiety disorders reinforces the notion that

ER is an important factor that may contrib-

ute to the onset and/or maintenance of anxi-

ety disorders.

Summary

The results of two recent longitudinal inves-

tigations suggest that maladaptive ER may

temporally precede and increase risk for

psychopathology, including anxiety disor-

ders, consistent with the etiological model to

which we have referred in this chapter. While

adaptive ER does not appear to confer pro-

tection against later anxiety or related symp-

toms, preliminary research suggests that

adaptive ER is associated with decreased

severity of anxiety disorder symptoms and

may reduce clinical complications (which

often result from maladaptive/avoidant ER).

Interventions designed to facilitate adaptive

ER also have shown promising results. More

longitudinal research is needed to determine

whether competent use of adaptive strategies

protects individuals from developing anxi-

ety and related emotional disorders when

exposed to stressors or in the presence of

other risk factors for disorder.

Conclusions and Future Directions

A dramatic increase in research over the last

decade has led to important observations

regarding the relationship of ER to the etiol-

ogy, phenomenology, and treatment of anxi-

ety disorders. We have attempted to synthe-

size these important data and to consider

them within the broader context of basic

features of anxiety disorders that influence

ER.

Individuals with anxiety disorders report

wide- ranging difficulties related to emo-

tional experience and ER. We have posited

that these difficulties emanate from underly-

ing features of anxiety disorders that include

heightened emotional reactivity, hypersen-

sitivity to threat, and increased tendencies

toward avoidant processing and behavior.

These basic characteristics of anxiety dis-

orders may contribute to problematic ER

strategy selection, because the emotional

processing of anxious individuals appears

to facilitate maladaptive strategies, such as

suppression, and impede adaptive strategies,

such as cognitive reappraisal and accep-

tance. ER-related difficulties also may be

exacerbated by differences in consequences

of ER strategies for anxious individuals

(e.g., negative effects of suppression may be

potentiated; physiological benefits of adap-

tive strategies may be attenuated). Further-

more, mounting evidence of dysfunction of

neural systems supporting adaptive ER sug-

gests that this may be a key factor underly-

ing the difficulties reported by individuals

with anxiety disorders.

Despite the substantial expansion of inter-

est and research related to ER and anxiety

Emotion Regulation in Anxiety Disorders 407

disorders, it is clear that much more empiri-

cal work is needed to refine our understand-

ing of the topics addressed in this chapter.

Basic questions related to measurement of

ER and construct validity remain impor-

tant areas for further study and, in general,

replication of many of the findings summa-

rized in this chapter is needed. Although we

believe the evidence points to maladaptive

ER being a transdiagnostic feature of anxi-

ety and related emotional disorders, more

empirical work is needed to confirm this

view or, alternatively, to establish the speci-

ficity of relationships among ER-related

constructs and distinct anxiety symptoms

and disorders. Additionally, because longi-

tudinal studies have been sparse, more of

this type of research is needed to clarify the

directionality of relationships between ER-

and anxiety- related variables, and to iden-

tify the most optimal ER-related targets for

treatment and prevention of anxiety disor-

ders. The recent longitudinal work suggest-

ing that maladaptive ER contributes to risk

for anxiety disorders offers further support

for the view that ER is an important factor

to consider in etiological models of anxi-

ety disorders, as well as in future treatment

development and prevention efforts.

References

Aldao, A., & Mennin, D. S. (2012). Paradoxical

cardiovascular effects of implementing adap-

tive emotion regulation strategies in general-

ized anxiety disorder. Behaviour Research

and Therapy, 50, 122–130.

Aldao, A., & Nolen-

oeksema, S. (2010). Speci-

ficity of cognitive emotion regulation strate-

gies: A transdiagnostic examination. Behav-

iour Research and Therapy, 48, 974–983.

Aldao, A., & Nolen-

Hoeksema, S. (2012). When

are adaptive strategies most predictive of psy-

chopathology? Journal of Abnormal Psychol-

ogy, 121, 276–281.

Aldao, A., Nolen-

oeksema, S., & Schweizer, S.

(2010). Emotion-

egulation strategies across

psychopathology: A meta-

nalytic review.

Clinical Psychology Review, 30, 217–237.

Arch, J. J., & Craske, M. G. (2010). Labora-

tory stressors in clinically anxious and non-

nxious individuals: The moderating role of

mindfulness. Behaviour Research and Ther-

apy, 48, 495–505.

Auerbach, R. P., Abela, J. R., & Ringo Ho,

M. H. (2007). Responding to symptoms of

depression and anxiety: Emotion regulation,

neuroticism, and engagement in risky behav-

iors. Behaviour Research and Therapy, 45,

2182–2191.

Baker, R., Holloway, J., Thomas, P. W., Thomas,

S., & Owens, M. (2004). Emotional process-

ing and panic. Behaviour Research and Ther-

apy, 42, 1271–1287.

Ball, T. M., Ramsawh, H. J., Campbell-

ills, L.,

Paulus, M. P., & Stein, M. B. (2013). Prefron-

tal dysfunction during emotion regulation in

generalized anxiety and panic disorder. Psy-

chological Medicine, 43(7), 1475–1486.

Barlow, D. H. (1988). Anxiety and its disorders:

The nature and treatment of anxiety and

panic (1st ed.). New York: Guilford Press.

Barlow, D. H. (2002). Anxiety and its disorders:

The nature and treatment of anxiety and

panic (2nd ed.). New York: Guilford Press.

Barlow, D. H., Ellard, K. K., Fairholme, C. P.,

Farchione, T. J., Boisseau, C. L., Allen, L. B.,

et al. (2011). Unified protocol for the trans-

diagnostic treatment of emotional disorders:

Therapist guide. New York: Oxford Univer-

sity Press.

Barlow, D. H., Sauer-

avala, S. E., Carl, J. R.,

Bullis, J. R., & Ellard, K. K. (in press). The

nature, diagnosis, and treatment of neuroti-

cism: Back to the future. Clinical Psychologi-

cal Science.

Bebko, G. M., Franconeri, S. L., Ochsner, K. N.,

& Chiao, J. Y. (2011). Look before you regu-

late: Differential perceptual strategies underly-

ing expressive suppression and cognitive reap-

praisal. Emotion, 11, 732–742.

Beck, A. T., & Clark, D. A. (1997). An informa-

tion processing model of anxiety: Automatic

and strategic processes. Behaviour Research

and Therapy, 35, 49–58.

Bishop, S., Duncan, J., Brett, M., & Lawrence,

A. D. (2004). Prefrontal cortical function and

anxiety: Controlling attention to threat-

elated

stimuli. Nature Neuroscience, 7, 184–188.

Boden, M. T., Bonn-

iller, M. O., Kashdan,

T. B., Alvarez, J., & Gross, J. J. (2012). The

interactive effects of emotional clarity and

cognitive reappraisal in posttraumatic stress

disorder. Journal of Anxiety Disorders, 26,

233–238.

Bonanno, G. A., Papa, A., Lalande, K., West-

phal, M., & Coifman, K. (2004). The impor-

tance of being flexible: The ability to both

enhance and suppress emotional expression

408 PSYCHOPATHOLOGY

predicts long-term adjustment. Psychological

Science, 15, 482–487.

Borkovec, T. D., Alcaine, O., & Behar, E. (2004).

Avoidance theory of worry and generalized

anxiety disorder. In R. G. Heimberg, C. L.

Turk, & D. S. Mennin (Eds.), Generalized anx-

iety disorder: Advances in research and prac-

tice (pp. 77–108). New York: Guilford Press.

Boswell, J. F., Thompson- Holland, J., Farchione,

T. J., & Barlow, D. H. (2013). Intolerance of

uncertainty: A common change factor in the

treatment of emotional disorders. Journal of

Clinical Psychology, 69, 630–645.

Brown, T. A., & Barlow, D. H. (2009). A pro-

posal for a dimensional classification system

based on the shared features of the DSM-IV

anxiety and mood disorders: Implications

for assessment and treatment. Psychological

Assessment, 21, 256–271.

Brown, T. A., Barlow, D. H., & Liebowitz, M.

(1994). The empirical basis of GAD. Ameri-

can Journal of Psychiatry, 151, 1272–1280.

Brown, T. A., Chorpita, B. F., & Barlow, D. H.

(1998). Structural relationships among dimen-

sions of the DSM-IV anxiety and mood disor-

ders and dimensions of negative affect, posi-

tive affect, and autonomic arousal. Journal of

Abnormal Psychology, 107, 179–192.

Campbell- Sills, L., Barlow, D. H., Brown, T. A.,

& Hofmann, S. G. (2006a). Effects of suppres-

sion and acceptance on emotional responses of

individuals with anxiety and mood disorders.

Behaviour Research and Therapy, 44, 1251–

1263.

Campbell- Sills, L., Barlow, D. H., Brown, T. A.,

& Hofmann, S. G. (2006b). Acceptability and

suppression of negative emotion in anxiety

and mood disorders. Emotion, 6, 587–595.

Campbell- Sills, L., Simmons, A. N., Lovero, K.

L., Rochlin, A. A., Paulus, M. P., & Stein, M.

B. (2011). Functioning of neural systems sup-

porting emotion regulation in anxiety- prone

individuals. NeuroImage, 54, 689–696.

Carthy, T., Horesh, N., Apter, A., Edge, M. D.,

& Gross, J. J. (2010). Emotional reactivity

and cognitive regulation in anxious children.

Behaviour Research and Therapy, 48, 384–

393.

Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A.,

Craig, I. W., Harrington, H., et al. (2003).

Influence of life stress on depression: Modera-

tion by a polymorphism in the 5-HTT gene.

Science, 301, 386–389.

Cohen, N., Henik, A., & Moyal, N. (2012).

Executive control attenuates emotional

effects— for high reappraisers only? Emotion,

12, 970–979.

Dalgleish, T., Yiend, J., Schweizer, S., & Dunn,

B. D. (2009). Ironic effects of emotion sup-

pression when recounting distressing memo-

ries. Emotion, 9, 744–749.

Di Simplicio, M., Costoloni, G., Western, D.,

Hanson, B., Taggart, P., & Harmer, C. J.

(2012). Decreased heart rate variability dur-

ing emotion regulation in subjects at risk for

psychopathology. Psychological Medicine, 42,

1775–1783.

Drabant, E. M., Ramel, W., Edge, M. D., Hyde,

L. W., Kuo, J. R., Goldin, P. R., et al. (2012).

Neural mechanisms underlying 5-HTTLPR-

related sensitivity to acute stress. American

Journal of Psychiatry, 169, 397–405.

Dugas, M. J., Laugesen, N., & Bukowski, W. M.

(2012). Intolerance of uncertainty, fear of anx-

iety, and adolescent worry. Journal of Abnor-

mal Child Psychology, 40, 863–870.

Dunn, B. D., Billotti, D., Murphy, V., & Dal-

gleish, T. (2009). The consequences of effortful

emotion regulation when processing distress-

ing material: A comparison of suppression and

acceptance. Behaviour Research and Therapy,

47, 761–773.

Eftekhari, A., Zoellner, L. A., & Vigil, S. A.

(2009). Patterns of emotion regulation and

psychopathology. Anxiety, Stress and Coping,

22, 571–586.

Ehring, T., & Quack, D. (2010). Emotion regula-

tion difficulties in trauma survivors: The role

of trauma type and PTSD symptom severity.

Behavior Therapy, 41, 587–598.

Eifert, G. H., & Heffner, M. (2003). The effects

of acceptance versus control contexts on

avoidance of panic- related symptoms. Journal

of Behavior Therapy and Experimental Psy-

chiatry, 34, 293–312.

Ellard, K. K. (2012). An examination of the neu-

ral correlates of emotion acceptance versus

worry in generalized anxiety disorder. Unpub-

lished doctoral dissertation, Boston Univer-

sity, Boston, MA.

Ellard, K. K., Fairholme, C. P., Thompson-

Hollands, J., Carl, J. R., Farchione, T. J., &

Barlow, D. H. (2011, November). Early reduc-

tions in distress and anxiety related to emo-

tional experiences in the Unified Protocol:

Effect on treatment response. Paper presented

at the 45th annual meeting of the Associa-

tion for Behavioral and Cognitive Therapies,

Toronto, Canada.

Etkin, A., Prater, K. E., Hoeft, F., Menon, V.,

Emotion Regulation in Anxiety Disorders 409

& Schatzberg, A. F. (2010). Failure of anterior

cingulate activation and connectivity with the

amygdala during implicit regulation of emo-

tional processing in generalized anxiety dis-

order. American Journal of Psychiatry, 167,

545–554.

Etkin, A., Prater, K. E., Schatzberg, A. F., Menon,

V., & Greicius, M. D. (2009). Disrupted amyg-

dalar subregion functional connectivity and

evidence of a compensatory network in gen-

eralized anxiety disorder. Archives of General

Psychiatry, 66, 1361–1372.

Etkin, A., & Wager, T. D. (2007). Functional

neuroimaging of anxiety: A meta- analysis of

emotional processing in PTSD, social anxiety

disorder, and specific phobia. American Jour-

nal of Psychiatry, 164, 1476–1488.

Farchione, T. J., Fairholme, C. P., Ellard, K. K.,

Boisseau, C. L., Thompson- Hollands, J., Carl,

J. R., et al. (2012). Unified protocol for trans-

diagnostic treatment of emotional disorders:

A randomized controlled trial. Behavior Ther-

apy, 43, 666–678.

Feldner, M. T., Zvolensky, M. J., Eifert, G. H., &

Spira, A. P. (2003). Emotional avoidance: An

experimental test of individual differences and

response suppression using biological chal-

lenge. Behaviour Research and Therapy, 41,

403–411.

Friedman, B. H. (2007). An autonomic

flexibility– neurovisceral integration model

of anxiety and cardiac vagal tone. Biological

Psychology, 74, 185–199.

Garner, M., Mogg, K., & Bradley, B. P. (2006).

Orienting and maintenance of gaze to facial

expressions in social anxiety. Journal of

Abnormal Psychology, 115, 760–770.

Goldin, P. R., Manber, T., Hakimi, S., Canli, T.,

& Gross, J. J. (2009). Neural bases of social

anxiety disorder: Emotional reactivity and

cognitive regulation during social and physi-

cal threat. Archives of General Psychiatry, 66,

170–180.

Goldin, P. R., Manber-Ball, T., Werner, K.,

Heimberg, R., & Gross, J. J. (2009). Neural

mechanisms of cognitive reappraisal of nega-

tive self- beliefs in social anxiety disorder. Bio-

logical Psychiatry, 66, 1091–1099.

Goldin, P. R., McRae, K., Ramel, W., & Gross, J.

J. (2008). The neural bases of emotion regula-

tion: Reappraisal and suppression of negative

emotion. Biological Psychiatry, 63, 577–586.

Goldin, P. R., Ziv, M., Jazaieri, H., Werner, K.,

Kraemer, H., Heimberg, R. G., et al. (2012).

Cognitive reappraisal self- efficacy mediates

the effects of individual cognitive- behavioral

therapy for social anxiety disorder. Journal of

Consulting and Clinical Psychology, 80(6),

1034–1040.

Gross, J. J. (1998). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74, 224–237.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85, 348–362.

Gross, J. J., & Levenson, R. W. (1993). Emo-

tional suppression: Physiology, self- report,

and expressive behavior. Journal of Personal-

ity and Social Psychology, 64, 970–986.

Gross, J. J., & Levenson, R. W. (1997). Hiding

feelings: The acute effects of inhibiting nega-

tive and positive emotion. Journal of Abnor-

mal Psychology, 106, 95–103.

Gyurak, A., Goodkind, M. S., Kramer, J. H.,

Miller, B. L., & Levenson, R. W. (2012).

Executive functions and the down- regulation

and up- regulation of emotion. Cognition and

Emotion, 26, 103–118.

Hill, C. L., & Updegraff, J. A. (2012). Mindful-

ness and its relationship to emotional regula-

tion. Emotion, 12, 81–90.

Hofmann, S. G., Ellard, K. K., & Siegle, G. J.

(2012). Neurobiological correlates of cog-

nitions in fear and anxiety: A cognitive–

neurobiological information- processing model.

Cognition and Emotion, 26, 282–299.

Hofmann, S. G., Heering, S., Sawyer, A. T., &

Asnaani, A. (2009). How to handle anxiety:

The effects of reappraisal, acceptance, and

suppression strategies on anxious arousal.

Behaviour Research and Therapy, 47, 389–

394.

Jackson, D. C., Malmstadt, J. R., Larson, C.

L., & Davidson, R. J. (2000). Suppression

and enhancement of emotional responses to

unpleasant pictures. Psychophysiology, 37,

515–522.

John, O. P., & Eng, J. (this volume, 2014). Three

approaches to individual differences in affect

regulation: Conceptualization, measures, and

findings. In J. J. Gross (Ed.), Handbook of

410 PSYCHOPATHOLOGY

emotion regulation (2nd ed., pp. 321–345).

New York: Guilford Press.

Joormann, J., & Siemer, M. (this volume, 2014).

Emotion regulation in mood disorders. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 413–427). New York: Guilford

Press.

Kashdan, T. B., & Rottenberg, J. (2010). Psy-

chological flexibility as a fundamental aspect

of health. Clinical Psychology Review, 30,

865–878.

Keough, M. E., Riccardi, C. J., Timpano, K. R.,

Mitchell, M. A., & Schmidt, N. B. (2010).

Anxiety symptomatology: The association

with distress tolerance and anxiety sensitivity.

Behavior Therapy, 41, 567–574.

Koster, E. H., Crombez, G., Verschuere, B.,

Van Damme, S., & Wiersema, J. R. (2006).

Components of attentional bias to threat in

high trait anxiety: Facilitated engagement,

impaired disengagement, and attentional

avoidance. Behaviour Research and Therapy,

44, 1757–1771.

Lau, H. C., Rogers, R. D., Haggard, P., & Pass-

ingham, R. E. (2004). Attention to intention.

Science, 303, 1208–1210.

Leutgeb, V., Schäfer, A., & Schienle, A. (2009).

An event- related potential study on exposure

therapy for patients suffering from spider pho-

bia. Biological Psychology, 82, 293–300.

Levitt, J. T., Brown, T. A., Orsillo, S. M., & Bar-

low, D. H. (2004). The effects of acceptance

versus suppression of emotion on subjective

and psychophysiological response to carbon

dioxide challenge in patients with panic disor-

der. Behavior Therapy, 35, 747–766.

Lieberman, M. D., Inagaki, T. K., Tabibnia, G., &

Crockett, M. J. (2011). Subjective responses to

emotional stimuli during labeling, reappraisal,

and distraction. Emotion, 11, 468–480.

MacLeod, C., & Hagan, R. (1992). Individual

differences in the selective processing of threat-

ening information, and emotional responses to

a stressful life event. Behaviour Research and

Therapy, 30, 151–161.

MacLeod, C., Mathews, A., & Tata, P. (1986).

Attentional bias in emotional disorders. Jour-

nal of Abnormal Psychology, 95, 15–20.

Matsuzaka, Y., Akiyama, T., Tanji, J., & Mush-

iake, H. (2012). Neuronal activity in the pri-

mate dorsomedial prefrontal cortex contrib-

utes to strategic selection of response tactics.

Proceedings of the National Academy of Sci-

ences, 109, 4633–4638.

McEvoy, P. M., & Mahoney, A. E. (2012). To

be sure, to be sure: Intolerance of uncertainty

mediates symptoms of various anxiety disor-

ders and depression. Behavior Therapy, 43,

533–545.

McLaughlin, K. A., Hatzenbuehler, M. L., Men-

nin, D. S., & Nolen- Hoeksema, S. (2011).

Emotion dysregulation and adolescent psy-

chopathology: A prospective study. Behaviour

Research and Therapy, 49, 544–554.

McLaughlin, K. A., Mennin, D. S., & Farach, F.

J. (2007). The contributory role of worry in

emotion generation and dysregulation in gen-

eralized anxiety disorder. Behaviour Research

and Therapy, 45, 1735–1752.

Mennin, D. S., & Fresco, D. M. (this volume,

2014). Emotion regulation therapy. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 469–490). New York: Guilford

Press.

Mennin, D. S., Heimberg, R. G., Turk, C. L., &

Fresco, D. M. (2005). Preliminary evidence

for an emotion dysregulation model of gener-

alized anxiety disorder. Behaviour Research

and Therapy, 43, 1281–1310.

Mennin, D. S., McLaughlin, K. A., & Flanagan,

T. J. (2009). Emotion regulation deficits in

generalized anxiety disorder, social anxiety

disorder, and their co- occurrence. Journal of

Anxiety Disorders, 23, 866–871.

Montag, C., Fiebach, C. J., Kirsch, P., & Reuter,

M. (2011). Interaction of 5-HTTLPR and a

variation on the oxytocin receptor gene influ-

ences negative emotionality. Biological Psy-

chiatry, 69, 601–603.

Moore, S. A., Zoellner, L. A., & Mollenholt, N.

(2008). Are expressive suppression and cogni-

tive reappraisal associated with stress- related

symptoms? Behaviour Research and Therapy,

46, 993–1000.

Munafo, M. R., Brown, S. M., & Hariri, A. R.

(2008). Serotonin transporter (5-HTTLPR)

genotype and amygdala activation: A meta-

analysis. Biological Psychiatry, 63, 852–857.

New, A. S., Fan, J., Murrough, J. W., Liu, X.,

Liebman, R. E., Guise, K. G., et al. (2009). A

functional magnetic resonance imaging study

of deliberate emotion regulation in resilience

and posttraumatic stress disorder. Biological

Psychiatry, 66, 656–664.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. (2002). Rethinking feelings:

An FMRI study of the cognitive regulation of

emotion. Journal of Cognitive Neuroscience,

14, 1215–1229.

Ochsner, K. N., Knierim, K., Ludlow, D. H.,

Emotion Regulation in Anxiety Disorders 411

Hanelin, J., Ramachandran, T., Glover, G.,

& Mackey, S. C. (2004). Reflecting upon feel-

ings: An fMRI study of neural systems sup-

porting the attribution of emotion to self or

other. Journal of Cognitive Neuroscience, 16,

1746–1772.

Ochsner, K. N., Ray, R. D., Cooper, J. C., Rob-

ertson, E. R., Chopra, S., Gabrieli, J. D., et al.

(2004). For better or for worse: Neural sys-

tems supporting the cognitive down- and up-

regulation of negative emotion. NeuroImage,

23, 483– 499.

Olatunji, B. O., & Wolitzky- Taylor, K. B. (2009).

Anxiety sensitivity and the anxiety disorders:

A meta- analytic review and synthesis. Psycho-

logical Bulletin, 135, 974–999.

Paquette, V., Lévesque, J., Mensour, B., Ler-

oux, J. M., Beaudoin, G., Bourgouin, P., et al.

(2003). “Change the mind and you change the

brain”: Effects of cognitive- behavioral therapy

on the neural corrleates of spider phobia. Neu-

roImage, 18, 401–409.

Pezawas, L., Meyer- Lindenberg, A., Drab-

ant, E. M., Verchinski, B. A., Munoz, K. E.,

Kolachana, B. S., et al. (2005). 5-HTTLPR

polymorphism impacts human cingulate–

amygdala interactions: A genetic susceptibility

mechanism for depression. Nature Neurosci-

ence, 8, 828–834.

Pineles, S. L., & Mineka, S. (2005). Attentional

biases to internal and external sources of

potential threat in social anxiety. Journal of

Abnormal Psychology, 114, 314–318.

Roemer, L., Orsillo, S. M., & Salters- Pedneault,

K. (2008). Efficacy of an acceptance- based

behavior therapy for generalized anxiety dis-

order: Evaluation in a randomized controlled

trial. Journal of Consulting and Clinical Psy-

chology, 76, 1083–1089.

Rothbart, M. K., Sheese, B. E., & Posner, M. I.

(this volume, 2014). Temperament and emo-

tion regulation. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 305–320).

New York: Guilford Press.

Salters- Pedneault, K., Roemer, L., Tull, M. T.,

Rucker, L., & Mennin, D. S. (2006). Evidence

of broad deficits in emotion regulation associ-

ated with chronic worry and generalized anxi-

ety disorder. Cognitive Therapy and Research,

30, 469–480.

Schmidt, N. B., Lerew, D. R., & Jackson, R. J.

(1999). Prospective evaluation of anxiety sen-

sitivity in the pathogenesis of panic: Replica-

tion and extension. Journal of Abnormal Psy-

chology, 108, 532–537.

Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J.

(2011). Emotion regulation choice. Psycholog-

ical Science, 22, 1391–1396.

Shin, L. M., & Liberzon, I. (2010). The neuro-

circuitry of fear, stress, and anxiety disorders.

Neuropsychopharmacology, 35, 169–191.

Speilberg, J. M., Miller, G. A., Engels, A. S., Her-

rington, J. D., Sutton, B. P., Banich, M. T., et

al. (2011). Trait approach and avoidance moti-

vation: Lateralized neural activity associated

with executive function. NeuroImage, 54,

661–670.

Stein, M. B., Shorck, N. J., & Gelernter, J. (2008).

Gene-by- environment (serotonin transporter

and childhood maltreatment) interaction for

anxiety sensitivity, an intermediate phenotype

for anxiety disorders. Neuropsychopharma-

cology, 33, 312–319.

Straube, T., Glauer, M., Dilger, S., Mentzel, H. J.,

& Miltner, W. H. (2006). Effects of cognitive-

behavioral therapy on brain activation in spe-

cific phobia. NeuroImage, 29, 125–135.

Suárez, L. M., Bennett, S. M., Goldstein, C.

R., & Barlow, D. H. (2009). Understanding

anxiety disorders from a “triple vulnerabil-

ity” framework. In M. M. Antony & M. B.

Stein (Eds.), Oxford handbook of anxiety and

related disorders (pp. 153–172). New York:

Oxford University Press.

Tan, P. Z., Forbes, E. E., Dahl, R. E., Ryan,

N. D., Siegle, G. J., Ladouceur, C. D., et al.

(2012). Emotional reactivity and regulation in

anxious and nonanxious youth: A cell-phone

ecological momentary assessment study. Jour-

nal of Child Psychology and Psychiatry, 53,

197–206.

Thayer, J. F., Friedman, B. H., & Borkovec, T.

D. (1996). Autonomic characteristics of gener-

alized anxiety disorder and worry. Biological

Psychiatry, 39, 255–266.

Thompson, R. A. (this volume, 2014). Socializa-

tion of emotion and emotion regulation in the

family. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp. 173–186). New

York: Guilford Press.

Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., &

Foa, E. B. (2003). Intolerance of uncertainty

in obsessive– compulsive disorder. Journal of

Anxiety Disorders, 17, 233–242.

Troy, A. S., Wilhelm, F. H., Shallcross, A. J., &

Mauss, I. B. (2010). Seeing the silver lining:

Cognitive reappraisal ability moderates the

relationship between stress and depressive

symptoms. Emotion, 10, 783–795.

Tull, M. T., & Roemer, L. (2007). Emotion regu-

412 PSYCHOPATHOLOGY

lation difficulties associated with the experi-

ence of uncued panic attacks: Evidence of

experiential avoidance, emotional nonaccep-

tance, and decreased emotional clarity. Behav-

ior Therapy, 38, 378–391.

Turk, C. L., Heimberg, R. G., Luterek, J. A.,

Mennin, D. S., & Fresco, D. M. (2005). Emo-

tion dysregulation in generalized anxiety dis-

order: A comparison with social anxiety dis-

order. Cognitive Therapy and Research, 29,

89–106.

van den Hout, M., Tenney, N., Huygens, K.,

Merckelbach, H., & Kindt, M. (1995).

Responding to subliminal threat cues is related

to trait anxiety and emotional vulnerability: A

successful replication of Macleod and Hagan

(1992). Behaviour Research and Therapy, 33,

451–454.

Wager, T. D., Davidson, M. L., Hughes, B. L.,

Lindquist, M. A., & Ochsner, K. N. (2008).

Prefrontal- subcortical pathways mediating

successful emotion regulation. Neuron, 59,

1037–1050.

Weiss, N. H., Tull, M. T., Davis, L. T., Dehon,

E. E., Fulton, J. J., & Gratz, K. L. (2012).

Examining the association between emotion

regulation difficulties and probable posttrau-

matic stress disorder within a sample of Afri-

can Americans. Cognitive Behavior Therapy,

41, 5–14.

Wilamowska, Z. A., Thompson- Hollands, J.,

Fairholme, C. P., Ellard, K. K., Farchione, T.

J., & Barlow, D. H. (2010). Conceptual back-

ground, development, and preliminary data

from the unified protocol for transdiagnostic

treatment of emotional disorders. Depression

and Anxiety, 27, 882–890.

Wolgast, M., Lundh, L. G., & Viborg, G. (2011).

Cognitive reappraisal and acceptance: An

experimental comparison of two emotion

regulation strategies. Behaviour Research and

Therapy, 49, 858–866.

413

Imagine receiving a negative evaluation at

work, having an argument with your part-

ner, discovering you have forgotten to pay a

bill and have incurred a late fee; and imagine

experiencing all of this on a gray, rainy, win-

ter day. Situations like these, which have the

potential to induce lasting negative affect,

are part of everyday life. Perhaps not sur-

prisingly, researchers have found that peo-

ple generally do not endure negative affect

passively; rather, they actively use strategies

to try to regulate their negative moods and

emotions. It is important to note, however,

that there is a wide range of individual dif-

ferences in the ability to regulate affect:

Whereas some individuals can successfully

regulate their negative affect, others cannot,

and still others may respond to their emo-

tions in ways that further exacerbate their

negative affect. Importantly, it is becoming

increasingly clear that these individual dif-

ferences in the regulation of negative moods

and emotions play a significant role in the

onset and maintenance of mood disorders.

Less frequently discussed is the regulation

of positive moods and emotions and of dif-

ficulties that may stem from an inability to

respond effectively to positive affect. Exces-

sive bathing in the glory of initial posi-

tive feedback, for example, may lead to an

overestimation of the ability to complete

the project in a timely manner, whereas an

inability to savor a success and the use of

strategies that down- regulate the ensuing

positive mood may interfere with the moti-

vation to start the next project. Therefore,

both difficulties in the regulation of positive

and negative affect have been implicated in

mood disorders.

Mood disorders are among the most

prevalent of all psychiatric disorders, with

major depressive disorder (MDD) affecting

almost 20% of Americans at some point in

their lives (Kessler & Wang, 2009). Given

the high prevalence and the substantial per-

sonal and societal costs of mood disorders,

efforts to identify risk factors and underly-

ing mechanisms, as well as effective inter-

vention strategies, are particularly pressing.

As implied by the label, the hallmark fea-

ture of mood disorders is disordered affect.

MDD is defined by sustained negative affect

and difficulties experiencing positive affect.

Bipolar disorder (BD) is characterized by

episodes of depressed but also elevated and/

or irritable mood. Despite the fact that dis-

ordered affect is the central feature of mood

disorders, theories of the onset, mainte-

nance, and recurrence of these disorders

have traditionally focused on cognition and

CHAPTER 25

Emotion Regulation in Mood Disorders

Jutta Joormann

Matthias Siemer

414 PSYCHOPATHOLOGY

behavior but not as much on affect. Indeed,

cognitive- behavioral interventions have

proven successful in treating these disorders

by focusing on the modification of maladap-

tive cognitions and behaviors (Beck, Rush,

Shaw, & Emery, 1979). Despite these suc-

cesses, many researchers have pointed out

that there is room for improvement in our

theoretical models and in our treatment

approaches. Specifically, a closer look at

the concept of emotion regulation and at

mechanisms that allow us to understand

individual differences in the important abil-

ity to regulate affective states may help us

better understand vulnerability to affective

disorders and thereby improve our treatment

approaches.

Indeed, models of both depression and BD

have emphasized the role of emotion regu-

lation. It has been proposed, for example,

that individuals who experience episodes of

depression do not differ from their nonde-

pressed counterparts in the degree to which

they become sad but instead are character-

ized by an inability to repair or regulate their

emotions, resulting in longer episodes of

sadness and depressed mood for depression-

prone individuals (Teasdale, 1988; Nolen-

Hoeksema, Wisco, & Lyubomirsky, 2008).

In depression, preferential use of maladap-

tive strategies, such as rumination, as well

as difficulties using adaptive strategies, such

as reappraisal, may explain why negative

emotions in response to life events quickly

spiral into sustained negative mood (e.g.,

Nolen- Hoeksema et al., 2008). In BD, we

find similar difficulties regulating negative

affect. In addition, maladaptive responding

to positive affect and events may explain

how elevated mood leads into a manic

episode (Gruber, 2011; Johnson, 2005).

Indeed, Gruber (2011) points out that “BD

involves a tendency to increase or amplify

positive emotions” (p. 219). Likewise, John-

son (2005) has described how increases in

positive affect after an initial success and

individual differences in responding to posi-

tive mood are related to the development of

mania. Even though these predictions seem

plausible, however, empirical evidence is still

largely missing, particularly when it comes

to BD. A first goal of this chapter is there-

fore to summarize empirical findings that

support the proposition that people who are

diagnosed with affective disorders do indeed

differ from their nondisordered counterparts

in emotion regulation.

At least two different but related aspects

of emotion regulation are crucial in this con-

text. First, it is possible that people who are

prone to experience affective disorders and

their nondisordered counterparts differ in

the selection of specific emotion regulation

strategies because of wrong expectations

about the usefulness of a strategy in a given

situation, or because of acquired preferences

for the selection of ineffective or maladap-

tive strategies. Indeed, numerous studies

show that depression is associated with a

tendency to ruminate when experiencing

negative affect, and that the use of this strat-

egy is perceived as helpful in coping with

negative events even though it in fact inter-

feres with recovery (Papageorgiou & Wells,

2001). In addition, it is possible that affec-

tive disorders are characterized by a more

limited repertoire of strategies that may

interfere with the flexible use of multiple

strategies that fit the situation at hand. This

flexibility has been proposed as particularly

adaptive (Kashdan & Rottenberg, 2010). It

is also possible, however, that depression-

related difficulties in emotion regulation are

due not to strategy selection but to prob-

lems implementing adaptive strategies such

as reappraisal. Of course, these two aspects

of emotion regulation in affective disorders

may be related. Difficulties implementing an

adaptive strategy, for example, may result in

preferential selection of maladaptive strate-

gies.

In this chapter, we review studies examin-

ing the first aspect of emotion regulation in

affective disorders by summarizing research

on the use of different emotion regulation

strategies, then examine evidence for the sec-

ond, that people with affective disorders have

difficulties implementing adaptive strategies.

We also examine underlying mechanisms of

emotion dysregulation in affective disorders

by focusing on basic cognitive processes that

may help or hinder emotion regulation and

discuss how these may be affected by mood

disorders. Our discussion focuses on studies

that have used clinically diagnosed samples,

but we also review studies with analogue

samples if they are particularly informative

or if clinical studies are missing.

Emotion regulation is defined here as

strategic and automatic processes that influ-

Emotion Regulation in Mood Disorders 415

ence the occurrence, magnitude, duration,

and expression of an emotional response

(see Gross, this volume). The focus of most

studies on emotion regulation is the down-

regulation of negative affect. This aspect of

emotion regulation is also the primary focus

of this chapter when it comes to MDD. How-

ever, we also discuss how depression may be

associated with problems savoring positive

affect and that a risk factor for BD is rumi-

nation on positive events (e.g., in response

to successful goal achievement), which may

result in a failure to down- regulate positive

affect that may then spiral into a full-blown

manic episode (Johnson, 2005).

Strategy Selection

in Mood Disorders

Recent research suggests that it is overly

simplistic to differentiate adaptive from mal-

adaptive strategies. Indeed, the adaptiveness

of a particular strategy will likely depend on

the context in which it is used, as well as

the flexibility of its use (Bonnano, Papa, Lal-

ande, Westphal, & Coifman, 2004). Still,

previous research has identified specific

strategies that are more likely to incur addi-

tional costs (e.g., increase in cognitive load

or physiological arousal) and that seem less

likely to regulate affect effectively (Gross &

John, 2003). Emotion regulation is a broad

concept that comprises a number of different

processes, and it is beyond the scope of this

chapter to provide an exhaustive review of

the literature. We therefore focus on strat-

egies that have consistently been linked to

mood disorders and have been the focus of

empirical studies on depression and/or BD.

Rumination

A particularly detrimental response to nega-

tive affect that has been associated with

various emotional disorders is rumination,

which is bringing an idea back to mind

over and over again. Originally the word

referred to the way cows and certain other

animals eat, storing partially digested food

in a stomach called a rumen, bringing that

food up later to chew over more thoroughly.

Even in the original Latin, however, it took

on a vivid figurative meaning, describing the

practice of bringing an idea back to mind

to work over further. Many of us mull over

important matters in this way, digesting

them a little at a time. But in depression,

rumination frequently features negative,

self- deprecating statements and pessimistic

ideas about the world and the future.

Depressive rumination has been shown

in numerous studies to exacerbate and pro-

long depressed mood (see review by Nolen-

Hoeksema et al., 2008). It may seem coun-

terintuitive to think that someone would

use rumination as an emotion regulation

strategy given that numerous studies show

that it increases negative affect. However,

it is a frequently used response when peo-

ple experience negative affect or encoun-

ter a negative event, and studies show that

depressed individuals perceive many benefits

of rumination, such as feelings of increased

self- awareness and understanding (Papa-

georgiou & Wells, 2001). Lyubomirksy

and Nolen- Hoeksema (1993), for example,

reported that rumination in dysphoric par-

ticipants (i.e., participants with subclini-

cal levels of depressive symptoms usually

assessed via self- report) was associated with

an enhanced sense of insightfulness. Empiri-

cal evidence has shown that people who tend

to engage in rumination when distressed are

more likely to develop depressive disorders

and tend to experience more prolonged peri-

ods of depression (e.g., Nolen- Hoeksema,

2000). Indeed, considerable evidence has

linked higher trait rumination with the

onset and maintenance of depression (see

Nolen- Hoeksema et al., 2008, for a review).

Nolen- Hoeksema (2000), for example,

examined a sample of approximately 1,300

adults randomly selected from the com-

munity. Among nondepressed individuals,

rumination scores at first assessment pre-

dicted the onset of new major depressive epi-

sodes over the following year. Researchers

have also examined the effects of an experi-

mental induction of rumination on people’s

mood and behaviors. Rumination in these

studies is usually contrasted with distrac-

tion, another emotion regulation strategy

that we discuss later. In general, compared

with distraction, rumination leads to sus-

tained negative mood, increases in negative

cognitions and overgeneral autobiographical

memory, and decreases in effective problem

solving in depressed participants (e.g., Wat-

kins & Moulds, 2005).

416 PSYCHOPATHOLOGY

Although much less studied, individuals

with BD have also been shown to ruminate

about negative emotion. In fact, some studies

indicate that people with BD ruminate even

more than people with unipolar depression

(Kim, Yu, Lee, & Kim, 2012). However, BD

is associated with not only increased depres-

sive rumination but also rumination about

positive emotion. Indeed, positive rumina-

tion, defined as dwelling on the content,

consequences, and causes of positive feelings

(Feldman, Joormann, & Johnson, 2008),

has been identified as an important risk

factor for BD. Gruber (2011), for example,

proposes that positive rumination may inter-

fere with the processing of relevant external

information that could help terminate the

emotional state. Compared to control par-

ticipants, college students diagnosed with

BD or MDD endorsed heightened rumina-

tion in response to negative affect, but only

those with BD endorsed elevated rumina-

tion in response to positive affect (Johnson,

McKenzie, & McMurrich, 2008). Moreover,

within BD, ruminative responses to negative

affect were explained by depressive symp-

toms. Gruber, Eidelman, Johnson, Smith,

and Harvey (2011) also examined rumina-

tion about positive and negative emotions:

Compared to the control group, the BD

group endorsed greater trait rumination for

positive as well as negative emotions. Inter-

estingly, participants with BD in this sample

were not at the time experiencing episodes

of depression or mania, which suggests that

elevated rumination is not just a correlate of

the depressive or manic state. Importantly,

trait rumination about negative and posi-

tive emotion was associated with greater

lifetime depression frequency, whereas trait

rumination about positive emotion was

associated with greater lifetime mania fre-

quency. Similarly, Alloy et al. (2009) found

that trait rumination about positive emotion

was associated with greater lifetime mania

frequency in their BD group. Although few

rumination inductions have been used in the

BD literature, researchers found heightened

positive emotion in a ruminative compared

with reflective (i.e., third- person perspec-

tive) induction in participants with BD com-

pared with healthy controls (Gruber, Har-

vey, & Johnson, 2009). In contrast, Gruber

et al. (2011) exposed their participants with

interepisode BD and control participants to

a rumination induction in response to the

recall of a positive autobiographical memory

and reported no group differences in self-

reported affect or physiological responding.

It seems interesting that whereas positive

rumination is associated with negative out-

comes in BD, depressed participants may

have difficulties savoring positive events.

Thus, although rumination on negative

content clearly seems present and maladap-

tive in both MDD and BD, the maladap-

tive response may be rumination on posi-

tive content in BD, whereas lack of savoring

may be the maladaptive response in MDD.

Raes, Smets, Nelis, and Schoofs (2012), for

example, found in two nonclinical student

samples that a self- reported dampening

response to positive affect predicted depres-

sive symptoms in 3- and 5-month follow- up

assessments.

Reappraisal

In his fascinating book on depression,

Andrew Solomon (2001) writes about one

of his depressive episodes, “I started to fear,

every time my dog left the room, that it was

because he was not interested in me” (p. 86).

The tendency to interpret emotion- eliciting

situations in a negative way is a defining

feature of depressive disorders. Altering

these interpretations is obviously a power-

ful way to regulate affect and a main com-

ponent of cognitive therapy for depression.

Reappraisal involves changing a situation’s

meaning to alter one’s emotional response to

the situation (Gross, 1998; Gross & John,

2003). Reappraisal has been studied exten-

sively in nonclinical populations and has

been shown to reduce negative affect (John

& Gross, 2004; Urry, 2009). In addition,

reappraisal does not entail the social and

cognitive costs associated with rumination

and other less adaptive strategies (Richards

& Gross, 2000). Furthermore, it is associ-

ated with reduced physiological activation in

response to negative emotion (Ray, McRae,

Ochsner, & Gross, 2010; Urry, 2009).

Not surprisingly, studies in clinical and

nonclinical samples have tied less frequent

habitual use of reappraisal to greater depres-

sion severity (Garnefski & Kraaij, 2006;

Joormann & Gotlib, 2010). It should be

noted, however, that most of these studies

have used a cross- sectional design, which

Emotion Regulation in Mood Disorders 417

makes it difficult to examine whether

decreased reappraisal use is a symptom of

depression or indeed a risk factor. Garnef-

ski, Legerstee, Kraaij, van den Kommer, and

Teerds (2002), for example, found reduced

use of reappraisal in a clinical sample diag-

nosed with depression and anxiety. Few

researchers have examined the habitual use

of reappraisal in BD. One exception is Gru-

ber, Harvey, and Gross (2012), who exam-

ined the spontaneous use of reappraisal

in BD in response to emotional film clips.

They found that individuals with BD were

more likely than control individuals to use

reappraisal in response to not only positive

and negative but also neutral film clips. The

authors interpreted this result as showing

that BD is associated with more regulation

effort.

It is important to note that habitual reap-

praisal is not beneficial in all contexts. Some

studies have found habitual use of reappraisal

to be unrelated to symptoms or correlated

with poorer outcomes. Nezlek and Kuppens

(2008), for example, who examined daily

measures of affect and emotion regulation,

found that daily use of reappraisal to upreg-

ulate positive emotions was associated with

increases in positive affect and self- esteem,

whereas no relation was found between the

use of reappraisal to down- regulate nega-

tive affect and the experience of negative

affect. In addition, in a recent meta- analysis,

Aldao, Nolen- Hoeksema, and Schweizer

(2010) reported that whereas greater reap-

praisal use is related to lower depression

and anxiety symptoms, reappraisal is more

inconsistently related to symptoms than

other strategies (rumination, suppression).

In a follow- up study, Aldao and Nolen-

Hoeksema (2012) found that the degree to

which reappraisal is adaptive depends on

the frequency of maladaptive strategy use;

reappraisal was related to lower depression

symptoms but only for individuals who fre-

quently use maladaptive strategies (rumina-

tion, suppression, etc.). The authors argued

that reappraisal serves as a compensatory

strategy to counteract the problems that

come with greater maladaptive strategy use.

Suppression

Suppression has long been regarded as a

particularly maladaptive regulation strat-

egy. Suppression is conceptualized as an

emotion regulation strategy by which an

individual attempts to inhibit the effects of

external cues on internal (e.g., physiological)

and external (e.g., emotional expression)

states. The inhibition of emotion expression

is frequently referred to as expressive sup-

pression. Research on emotion suppression

indicates that habitual use of this strategy

is largely ineffective in reducing negative

emotions. Findings indicate that expressive

suppression, for example, is associated with

increased depression symptoms (Joormann

& Gotlib, 2010). Moreover, emotion sup-

pression is associated with increased use of

rumination (Liverant, Kamholz, Sloan, &

Brown, 2011) and decreased inhibitory con-

trol (Joormann & Gotlib, 2010). However,

one study indicates that providing instruc-

tions on the use of expressive suppression in

response to negative stimuli may be effica-

cious in reducing acute emotional respond-

ing among depressed participants (Liverant,

Brown, Barlow, & Roemer, 2008). Though

virtually no studies have examined the use

of emotion suppression in individuals with

BD, one recent study found that, compared

to healthy controls, interepisode partici-

pants with BD demonstrate increased use

of spontaneous expressive suppression in

response to both positive and negative mood

inductions (Gruber et al., 2012). In a clini-

cal sample that included depressed and anx-

ious participants, Campbell- Sills, Barlow,

Brown, and Hofmann (2006) examined

emotion suppression, using a mood induc-

tion film and the assessment of spontane-

ous use of emotion regulation strategies.

They reported that clinical participants used

more suppression, and that suppression was

related to higher levels of negative affect.

Use of Multiple Strategies

Few studies have examined the use of more

than one strategy in psychopathology. A

noteworthy exception is the aforementioned

meta- analysis by Aldao et al. (2010), which

examined the relation between the habit-

ual use of six emotion regulation strate-

gies (rumination, reappraisal, suppression,

acceptance, problem solving, avoidance) and

four groups of symptoms of psychopathol-

ogy (depression, anxiety, substance- related

disorders, and eating disorders) in studies

418 PSYCHOPATHOLOGY

that used clinical or normative samples.

They obtained a large effect size for the

association of depression with rumination

and avoidance, a medium to large effect size

for problem solving and suppression, and

small effect sizes for acceptance and reap-

praisal. The authors summarized their find-

ings by pointing out that, overall, adaptive

emotion regulation strategies (reappraisal,

acceptance) showed a weaker association

with psychopathology than maladaptive

strategies. In a follow- up study using a com-

munity sample, Aldao et al. (2010) further

found an interaction between the use of

adaptive and maladaptive strategies cross-

sectionally. High use of adaptive strategies

was associated with lower psychopathol-

ogy only in participants who also reported

high levels of use of maladaptive strategies.

The authors further reported that the use of

adaptive strategies did not predict psychopa-

thology in a follow- up assessment, whereas

the use of maladaptive strategies signifi-

cantly predicted psychopathology 6 months

later.

Studies that use clinical samples and

examine the use of a range of different

emotion regulation strategies are particu-

larly informative. D’Avanzato, Joormann,

Siemer, and Gotlib (2013), for example,

compared habitual use of emotion regula-

tion strategies in control participants and

in samples of participants diagnosed with

depression or social anxiety disorder. These

authors reported that depressed participants

were more likely to ruminate and less likely

to use reappraisal than control participants,

whereas participants with social anxiety dis-

order reported more expressive suppression

compared to the two other groups. In addi-

tion, whereas elevated rumination was also

found in previously depressed participants

who were not currently depressed, healthy

controls and the previously depressed group

did not differ on use of reappraisal or expres-

sive suppression. Interestingly, only use of

reappraisal and rumination were related to

symptom severity across all samples; expres-

sive suppression use was unrelated to depres-

sive or anxiety symptoms.

These results are in line with a recent

study by Ehring, Tuschen- Caffier, Schnülle,

Fischer, and Gross (2010) that compared

formerly depressed to never- depressed par-

ticipants. Like D’Avanzato et al. (2013),

they reported that formerly depressed par-

ticipants used more rumination but did not

differ from never- depressed participants in

reported use of reappraisal or suppression.

In addition, the formerly depressed group

reported more emotion nonacceptance.

Interestingly, even though the groups did

not differ on habitual use of suppression,

the formerly depressed group reported more

spontaneous use of suppression in response

to a negative film clip. No group differences

were found in reappraisal use in response

to the film clip. The authors interpret this

finding to suggest that depression may not

be associated with suppression of all emo-

tional experiences but rather with the spe-

cific suppression of sadness. Further studies

are needed to examine this possibility more

closely.

Few studies have examined the use of

multiple strategies in BD. Green et al. (2011)

showed that the BD group reported more

frequent use of rumination and less frequent

use of reappraisal in response to negative life

events compared to unaffected relatives, but

this study did not examine responses to posi-

tive events. Abnormal response styles to neg-

ative mood have previously been observed

in students with hypomanic traits (Thomas

& Bentall, 2002) and in patients with BD

(Thomas, Knowles, Tsai, & Bentall, 2007).

Thomas and Bentall (2002) found that hypo-

manic traits were associated with not only

rumination but also increased distraction

and risk taking. Thomas et al. (2007) found

that patients with mania reported high levels

of risk taking and active coping (distraction

and problem solving), whereas patients with

remitted BD reported high levels of rumina-

tion. Clearly more research is needed on the

interplay of emotion regulation strategies in

this disorder.

Summary of Strategy Selection

In summary, the results clearly show that

depression is characterized by increased use

of rumination and less use of reappraisal.

There is some indication that rumination

use may be a stable feature of depression

risk even outside of acute episodes of the

disorder, whereas reduced use of reappraisal

is observed only in people who are currently

depressed (see D’Avanzato et al., 2013;

Ehring et al., 2010). This finding suggests

Emotion Regulation in Mood Disorders 419

that rumination may be a risk factor for

not only the recurrence but also the onset of

depression, whereas changes in reappraisal

use may be an epiphenomenon of experienc-

ing a depressive episode. Results for expres-

sive suppression and other forms of suppres-

sion are less clear-cut, as are findings for the

use of acceptance in depression.

It is interesting to note that, in contrast

to MDD, BD seems to be characterized by

problems regulating negative and positive

affect, and many studies now suggest an

important role for positive rumination in the

onset of manic episodes. Indeed, it is possi-

ble that acute mood state plays an important

role here, with patients with BD in a depres-

sive episode resembling patients with MDD

in their use of rumination and reduced use

of reappraisal. At the same time, positive

rumination when experiencing hypomania

may play a critical role in the onset of manic

episodes (Johnson, 2005). Other studies

have shown that participants with BD delib-

erately choose self- calming strategies during

early phases of hypomania to try to prevent

the emergence of manic symptoms (Lam

& Wong, 1997). The use of other emotion

regulation strategies in BD, however, has

either not been studied or studies have led to

inconclusive results. It should be noted that

BD is also characterized by irritable affect,

yet no studies have examined the relation of

this aspect of the disorder to emotion regula-

tion.

It is further important to note that most

studies reviewed here examine individuals

who are currently in episode. It is not clear,

therefore, whether the use of maladaptive

strategies precedes the onset of the disor-

der or is merely another symptom of being

depressed or manic. Gaining more insight

into whether the use of emotion regulation

strategies is a vulnerability factor will be

important for intervention and prevention

programs. In addition, we should note that

the majority of studies of habitual strategy

use are cross- sectional and have relied on

self- report only. This is problematic, because

it is not clear to what extent people can accu-

rately report on their use of strategies, and

the self- report of emotion regulation may be

affected by current mood state. More stud-

ies that examine strategy use in response

to a mood manipulation (e.g., Ehring et al.

2010) are clearly needed. Importantly, it is

not clear what underlies the preference and

dispositional use of specific emotion regu-

lation strategies in affective disorders. It is

likely that difficulties implementing certain

strategies also shape the selection of emo-

tion regulation strategies. In the second part

of this chapter, we therefore examine the

implementation of emotion regulation strat-

egies in mood disorders and try to identify

cognitive processes that may underlie diffi-

culties in emotion regulation.

Implementation

of Adaptive Strategies

Whereas the majority of studies discussed in

the previous section used self- report to exam-

ine the frequency of use of different emotion

regulation strategies, other studies have

focused on whether affective disorders are

characterized by less effective implementa-

tion of adaptive strategies. These researchers

typically instruct participants to use a strat-

egy such as reappraisal during an emotion-

eliciting event, then assess affect, as well as

psychophysiological indicators of arousal,

before and after the use of the strategy.

Distraction

Perhaps the best studied adaptive strategy

in depression is distraction. Distraction is

frequently used as a control condition in

rumination studies, and many studies have

shown that distraction seems to regulate

affect effectively in depressed participants

(see Nolen- Hoeksema et al., 2008, for a

review). Whereas depressed participants

instructed to ruminate show increased nega-

tive affect and recall of negative memories,

those instructed to distract do not differ

from the control group on these measures.

For example, in a study that examined the

recall of positive memories in depression,

currently and formerly depressed partici-

pants did not differ from control partici-

pants in their affect recovery after a nega-

tive mood induction that was followed by

a distraction induction (Joormann, Siemer

& Gotlib, 2007). Thus, studies suggest

that depressed participants are able to use

distraction to regulate negative affect effec-

tively. Research on the use of distraction in

BD is currently nonexistent.

420 PSYCHOPATHOLOGY

Reappraisal

Only a handful of studies has examined the

effectiveness of reappraisal in affective dis-

orders, and results are much more mixed.

Indeed, to our knowledge, no study thus

far has examined whether current MDD is

associated with less effective reappraisal use.

Troy, Wilhelm, Shallcross and Mauss (2010)

recruited a nonclinical sample of individu-

als who had recently experienced a stressful

life event and found that elevated depression

symptoms were related to less effective reap-

praisal in response to an emotion- eliciting

film clip. Similarly, McRae, Jacobs, Ray,

John, and Gross (2012) reported that indi-

viduals with lower well-being (composite of

lower positive affect, higher negative affect,

and lower life satisfaction) exhibited reduced

effectiveness of reappraisal in response to

negative emotional pictures, and that per-

formance on this task was related to reduced

habitual use of reappraisal. Thus, this study

suggests a relation between the effectiveness

of strategies and habitual strategies use as

proposed earlier. In contrast, Ehring et al.

(2010) reported that even though formerly

depressed participants were less likely to

endorse the use of reappraisal on self- report,

they did not differ from the control group

in their ability to use reappraisal effectively

when explicitly instructed to do so. Indeed,

these authors summarized their results

by saying that formerly depressed partici-

pants choose ineffective strategies but can

use more functional ones if so instructed.

Given that no studies have examined reap-

praisal effectiveness in current depression,

however, it is unclear whether this result is

specific to a previously depressed sample or

would generalize to current depression. Very

few studies have looked at the effectiveness

of different emotion regulation strategies

in BD. A noteworthy exception is the pre-

viously mentioned study by Gruber et al.

(2012), who found that participants with

BD reported more effort when using reap-

praisal and suppression but also less success.

It should be noted, however, that effort and

success were assessed using two self- report

items; these results therefore clearly require

replication using alternative operationaliza-

tions of these constructs.

Flexibility of use and the timing over the

course of an emotional response are key

variables that may influence the effective-

ness of reappraisal. Reappraisal, initiated

once an emotional response is underway

(often referred to as online reappraisal),

appears to be more difficult to implement

and more cognitively taxing than anticipa-

tory reappraisal or other strategies, such as

distraction, implemented at early processing

stages of an emotional episode (Sheppes &

Meiran, 2007; Sheppes, Catran, & Meiran,

2009; Urry, 2009). Online reappraisal may

be particularly important to examine in

MDD. Given the persistent negative affect

characterizing this disorder, individuals with

depression are likely to need to implement

emotion regulation strategies in response to

an existing emotional state of relatively high

intensity. If implemented online, reappraisal

probably requires levels of cognitive control

that may not be available to people with

affective disorders. This may explain the

mixed findings on the effectiveness of reap-

praisal in mood disorders. We discuss this

point in more detail later, when we examine

cognitive processes that underlie effective

emotion regulation.

Mood‑Incongruent Recall

Other studies have examined the recall of

mood- incongruent material in depression

(Joormann et al., 2007). In these studies,

participants did not receive explicit instruc-

tions to regulate affect. Instead, they were

informed that the project examined memory

processes and were asked to recall mood-

incongruent memories (i.e., recall of a posi-

tive autobiographical memory) immediately

following a negative mood induction. Recall

of mood- incongruent memories was com-

pared to a distraction condition. The results

showed that not only dysphoric but also

currently depressed and formerly depressed

participants compared to controls did not

experience a recovery of their negative affect

when recalling mood- incongruent memories

(see also Werner- Seidler & Moulds, 2012).

Distraction, however, repaired negative

affect in all groups. These results suggest

that depression is associated with an inabil-

ity to focus on positive material to offset

negative affect, which may be an important

automatic mood repair mechanism. The

results are well aligned with the aforemen-

tioned finding that depression is associated

with reduced savoring after experiencing

positive events.

Emotion Regulation in Mood Disorders 421

Summary of Strategy Implementation

In summary, the studies presented so far

suggest that affective disorders are associ-

ated with more frequent use of maladap-

tive strategies, as well as difficulties imple-

menting adaptive strategies. Specifically,

even though distraction seemed to work

for depressed participants, recall of positive

material worked well in nondisordered par-

ticipants but did not repair negative affect in

the clinical sample. Results of studies focus-

ing on reappraisal are more mixed and it

may be important to take the timing of reap-

praisal into account.

Why do depressed people show a prefer-

ence for the use maladaptive strategies, and

why do they find it difficult to use adaptive

strategies? Cognitive theories of emotional

disorders have identified mood- congruent

biases in the processing of emotional infor-

mation, and recent research has examined

deficits in cognitive control that may inter-

fere with emotion regulation (Joormann,

2010). These studies may improve our

insight into mechanisms that underlie emo-

tion and mood regulation difficulties and

thereby provide critical information for

interventions. However, given the scarcity of

research on this topic in BD, in the following

section we focus primarily on MDD.

Cognitive Processes and Difficulties

in Emotion Regulation

Cognitive Biases

Individual differences in cognitive processes

such as attention, memory, and interpre-

tation may affect the attention toward

emotion- eliciting aspects of a situation,

the initial appraisal of a situation, and the

ability to use regulation strategies such as

reappraisal or distraction effectively (see

Figure 25.1). Cognitive models of depres-

sion posit that depressed individuals exhibit

mood- congruent biases in all aspects of

information processing, including atten-

tion, memory, and interpretation (Mathews

& MacLeod, 2005). Biased memory for

negative, relative to positive, information

represents perhaps the most robust cogni-

tive finding associated with MDD and may

be related to the difficulties using mood-

incongruent recall to repair negative affect,

as we discussed earlier. Other studies have

reported interpretation biases in depression

(Lawson, MacLeod, & Hammond, 2002).

Indeed, a recent meta- analysis by Hal-

lion and Ruscio (2012) showed that biased

interpretation is one of the most consis-

tently reported findings in the depression

literature. Interpretation biases may lead

FIGURE 25.1. Cognitive processes and emotion dysregulation in depression. Cognitive biases such as

difficulties disengaging from negative material and biases in interpretation and memory, affect both

attention to emotion-

liciting aspects of events and appraisals of the event, which in turn affect the emo-

tion response. Through their effect on attention and appraisal processes, cognitive biases also interfere

with emotion regulation. In addition, cognitive control deficits further impair the effective implemen-

tation of emotion regulation strategies such as reappraisal, distraction, and mood- incongruent recall,

increasing the likelihood of maladaptive responding, for example, in the form of rumination.

Negative Event

Attention

Appraisal

Emotional

Response

Attention Bias

Interpretation and

Memory Bias

Cognitive Control

Deficits

Reappraisal/

Mood-

Incongruent

Recall

Distraction/

Rumination

422 PSYCHOPATHOLOGY

to inflexible, automatic, and unconscious

appraisals that make it difficult to regulate

emotions by using deliberate reappraisal of

the situation (Siemer & Reisenzein, 2007).

Whereas some studies have failed to find

attentional biases in depression, others

suggest that stimulus exposure duration is

critical (e.g., Mogg, Bradley, Williams, &

Mathews, 1993). Specifically, biases have

been found when stimuli are presented for

longer durations (see Mathews & MacLeod,

2005, for a review). Recent studies therefore

suggest that depressed individuals do not

direct their attention to negative informa-

tion more frequently than do control partic-

ipants, but once it captures their attention,

they exhibit difficulties disengaging from it

(e.g., Joormann & Gotlib, 2007). Difficul-

ties disengaging from negative material may

result in maintenance of attention on mood-

congruent information, which may eventu-

ally lead to recurrent ruminative thoughts.

Cognitive Control

In addition to cognitive biases, depression-

related deficits in cognitive control may

affect emotion regulation (see Figure 25.1).

Negative mood is generally associated with

the activation of mood- congruent represen-

tations in working memory (Siemer, 2005).

The ability to control the contents of work-

ing memory (WM) might therefore play an

important role in recovery from negative

affect. WM is a limited- capacity system

that reflects the focus of attention and the

temporary activation of representations

that are the content of awareness. Cognitive

inhibition is part of executive control pro-

cesses that select and update WM content

(Hasher, Zacks, & May, 1999). Deficits in

cognitive inhibition may make it difficult to

discard mood- congruent content from WM,

keeping attention focused on the emotion-

eliciting aspects and the initial appraisals of

the event. The effectiveness of distraction

and reappraisal may directly depend on the

ability to inhibit mood- congruent content in

WM, and difficulties with inhibition may

result in rumination.

In a series of studies using a negative

priming task, dysphoric participants, clini-

cally depressed participants, and partici-

pants with a history of depressive episodes

exhibited reduced inhibition of negative but

not positive material (Joormann & Gotlib,

2010; Goeleven, De Raedt, Baert, & Koster,

2006). These findings suggest that depres-

sion involves difficulties keeping irrelevant

emotional information from entering WM.

Other studies suggest that depression is also

associated with difficulties removing previ-

ously relevant negative material from WM

(Joormann & Gotlib, 2008). Difficulties

inhibiting the processing of negative mate-

rial that was, but is no longer, relevant might

explain why people respond to negative

mood states and negative life events with

recurring, uncontrollable, and unintentional

negative thoughts.

It is likely that deficits in cognitive con-

trol not only affect people’s ability to disen-

gage attention from irrelevant material but

also make it difficult for them intentionally

to forget unwanted material. Investigators

have consistently documented such memory

biases in depression. Deficits in inhibition

have been tested in directed forgetting tasks,

in which participants are instructed to for-

get previously studied material at some point

during the experiment. Later, however,

recall is tested, of both material that was to

be remembered and material that was to be

forgotten. Using emotional material, Power,

Dalgleish, Claudio, Tata, and Kentish (2000)

reported that depressed participants showed

less forgetting of negative material. Using

a similar task with depressed participants,

Joormann, Hertel, LeMoult, and Gotlib

(2009) replicated these difficulties in the

intentional forgetting of negative material.

A subset of participants, however, was pro-

vided a strategy to improve suppression by

using thought substitutes. In this condition

depressed participants were able to inhibit

and forget negative words. This finding has

intriguing implications for interventions.

Deficits in disengaging attention from

negative material and difficulties controlling

the content of WM may affect emotion regu-

lation in various ways. An inability to appro-

priately expel mood- congruent items from

WM as they become irrelevant may result

in rumination. Deficits in cognitive control

may also lead to difficulties attending to and

processing new information, thereby hin-

dering the use of more adaptive strategies.

Effective reappraisal, for example, depends

on a person’s ability to override (automatic)

interpretation biases that lead to unwanted

appraisals of the emotion- eliciting cues.

Replacing automatic appraisals with alter-

Emotion Regulation in Mood Disorders 423

native evaluations of the situation requires

cognitive control. Finally, deficits in cogni-

tive control can make it difficult to access

mood- incongruent material. People fre-

quently recruit pleasant memories to repair

sad mood. Difficulties inhibiting salient but

irrelevant thoughts could therefore reduce

the use of more effective emotion regulation

strategies and/or render these strategies less

effective. Few studies so far have investigated

the association between inhibition and the

use and effectiveness of emotion regulation

strategies such as reappraisal and distrac-

tion. Numerous findings, however, support

the proposition that inhibition deficits are

related to the use of increased rumination.

For example, Joormann (2006) reported a

correlation between rumination and defi-

cits in cognitive inhibition, as assessed by

negative priming, and Joormann and Gotlib

(2008) found a correlation between rumi-

nation and the ability to remove irrelevant

negative material from WM. Finally, Joor-

mann and Gotlib (2010) reported that an

inability to inhibit the processing of negative

material was related to an increased likeli-

hood of rumination and a decreased likeli-

hood of using reappraisal, in both healthy

and depressed participants.

Summary and Future Directions

Given that sustained affective states are the

hallmark feature of mood disorders, basic

research on the regulation of mood states

and emotions provides important informa-

tion for an improved understanding of risk

factors for the development and mainte-

nance of MDD and BD. Research on emo-

tion regulation may thereby contribute to

the development of improved prevention and

intervention efforts. Our review of the litera-

ture provides evidence of the importance of

both aspects of emotion regulation presented

at the beginning of this chapter: individual

differences in the habitual use of specific

emotion regulation strategies and disorder-

related difficulties in the implementation

of adaptive strategies. Specifically, MDD is

associated with frequent use of rumination

and less use of reappraisal. BD is also related

to increased rumination use, although, inter-

estingly, in response to positive and negative

events. Results for other emotion regulation

strategies were either missing or inconsistent,

so more work is needed to clarify further the

role of suppression– avoidance and accep-

tance in both disorders, as well as the role

of reappraisal in BD. Given methodological

issues associated with the use of self- report

in research on emotion regulation, future

studies should include additional measures

such as experience sampling or experimental

manipulations of mood to understand strat-

egy selection better in affective disorders.

Fewer studies have examined difficulties

in the implementation of adaptive strate-

gies. Initial findings suggest that whereas

depressed participants can use distraction

effectively, reappraisal is more challenging.

Importantly, studies suggest that depression

is associated with difficulties using positive

material to offset negative affect. Whereas

some studies suggest that these difficulties

in strategy implementation do not just char-

acterize currently depressed participants,

more research is needed on the question of

whether we find similar deficits prior to the

first episode of the disorder, and whether

these difficulties predict future episodes of

depression or mania. Specifically, longitudi-

nal studies in high-risk samples are needed

to answer the important question of whether

these difficulties in emotion regulation are

indeed a risk factor for the onset of the dis-

order or simply an epiphenomenon of mood

disorders.

We further examined cognitive processes

that may underlie difficulties in emotion

regulation. Biased processing in depres-

sion may affect the initial appraisal of an

emotion- eliciting event, as well as the abil-

ity to reappraise. Cognitive control defi-

cits may affect response- focused strategies

such as distraction and online reappraisal

(see Figure 25.1). Whereas both strategies

require cognitive control, online reappraisal

is frequently seen as the more effortful strat-

egy, which may explain why distraction

works but reappraisal may fail in depressed

participants. Importantly, recent work by

Sheppes, Scheibe, Suri, and Gross (2011) has

shown that reappraisal becomes more dif-

ficult when affect is intense, and that non-

disordered participants prefer distraction

over reappraisal when dealing with intense

emotions. As discussed, mood disorders are

associated with deficits in cognitive con-

trol, and emotion regulation in these disor-

ders frequently requires modifying intense

affective states. Indeed, Sheppes and Gross

424 PSYCHOPATHOLOGY

(2011) have pointed out that engaging emo-

tion regulation strategies at a later point in

the emotion episode typically results in the

regulation of more intense affect. Mood dis-

orders probably involve many attempts at

regulation of high- intensity affect at later

points in time, because they frequently

require the regulation of global moods with

unclear or unknown antecedents. It is there-

fore not surprising that reappraisal is diffi-

cult to implement in mood disorders. Future

research should focus more on identifying

differences between emotion and mood reg-

ulation, and on implications of these differ-

ences for affective disorders.

Most studies on emotion regulation have

focused on the down- regulation of negative

affect, but our review of the literature shows

that the processing of mood- congruent

material and the regulation of positive affect

may also play an important role in mood

disorders, specifically in BD. Difficulties

savoring positive events and recalling posi-

tive material when feeling sad, however,

may also play a role in MDD. Therefore, the

down- regulation of negative affect seems a

very narrow focus, and studies in BD and

depression should pay more attention to the

regulation of positive affect. In addition, at

numerous points during the chapter, we have

recommended flexibility in the use of emo-

tion regulation strategies as an important

topic for future studies. Very few studies

examining affective disorders have assessed

more than one strategy, and it is currently

not known whether the primary problem

in emotion regulation in these disorders is

inflexibility or of habitual use of a specific

strategy, or difficulties implementing a strat-

egy.

Finally, there are some important treat-

ment implications of research on emotion

regulation in mood disorders. Cognitive-

behavioral therapy has focused on the iden-

tification and modification of maladaptive

cognitions, and recent additions to this

intervention have started to focus more sys-

tematically on training reappraisal skills and

preventing emotional avoidance (Campbell-

Sills & Barlow, 2007). If inflexibility is

a problem, it may be helpful to develop a

broader repertoire of strategies and to iden-

tify habitual emotion regulation strategies.

Given the earlier discussion of cognitive

processes that underlie emotion regulation,

recent studies on cognitive bias modification

and cognitive control training seem particu-

larly promising. Most of these studies have

involved anxiety disorders, but at least two

recent articles provide encouraging data to

indicate that training to modify attention

biases may also apply to depression (Wells &

Beevers, 2010; Baert, Koster, & De Raedt,

2011). Other studies have focused on modi-

fying memory and interpretation biases, but

these trainings have not yet been tested with

depressed participants (Raes, Williams, &

Hermans, 2009). Of special importance is

a recent study that showed improvement in

cognitive control after training in executive

control. Specifically, cognitive control train-

ing yielded transferable gains to improve

control over affective stimuli (Schweizer,

Hampshire, & Dalgleish, 2011). A similar

training showed effects on thought control

over intrusive memories (Bomyea & Amir,

2011). These findings are exciting and repre-

sent first steps toward a more comprehensive

model of how cognitive factors facilitate or

hinder emotion regulation, thereby affect-

ing individuals’ vulnerability to experience

depressive episodes.

At this point, however, a lot of questions

remain unanswered. Why do people diag-

nosed with affective disorders prefer certain

emotion regulation strategies, and are they

aware of these preferences? How do people

learn to use these strategies, and how can we

help them unlearn them? Are individual dif-

ferences in attention, interpretation, mem-

ory, and cognitive control indeed related to

the selection and effectiveness of regulation

strategies? Does modifying cognitive biases

and cognitive control affect emotional

responding, stress reactivity, and emotion

regulation? Are the outlined associations

among depression, cognitive processes, and

emotion regulation specific to depressive

disorders or a feature of psychopathology in

general? These and other questions should

be the main focus of future studies in this

exciting area of research. A deeper under-

standing of the ways that cognitive pro-

cesses help and hinder emotion regulation

may allow us to better address some of the

difficulties depressed individuals encounter

in developing new and more flexible ways

of thinking, a central goal of cognitive ther-

apy. Understanding the relation of cognitive

processes and emotion regulation may also

help us understand how we can get these

new ways of thinking to “stick” and lead to

Emotion Regulation in Mood Disorders 425

permanent changes in emotional response,

facilitating the use of these new skills in the

face of stress.

References

Aldao, A., & Nolen- Hoeksema, S. (2012). When

are adaptive strategies most predictive of psy-

chopathology? Journal of Abnormal Psychol-

ogy, 121(1), 276–281.

Aldao, A., Nolen- Hoeksema, S., & Schweizer, S.

(2010). Emotion- regulation strategies across

psychopathology: A meta- analytic review.

Clinical Psychology Review, 30(2), 217–237.

Alloy, L. B., Abramson, L. Y., Flynn, M., Liu,

R. T., Grant, D. A., Jager-Hyman, S., et al.

(2009). Self- focused cognitive styles and bipo-

lar spectrum disorders: Concurrent and pro-

spective associations. International Journal of

Cognitive Therapy, 2(4), 354–372.

Baert, S., Koster, E. H. W., & De Raedt, R.

(2011). Modification of information process-

ing biases in emotional disorders: Clinically

relevant developments in experimental psy-

chopathology. International Journal of Cog-

nitive Therapy, 4(2), 208–222.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery,

G. (1979). Cognitive therapy of depression: A

treatment manual. New York: Guilford Press.

Bomyea, J., & Amir, N. (2011). The effect of

an executive functioning training program

on working memory capacity and intrusive

thoughts. Cognitive Therapy and Research,

35(6), 529–535.

Bonanno, G. A., Papa, A., Lalande, K., West-

phal, M., & Coifman, K. (2004). The impor-

tance of being flexible. Psychological Science,

15, 482–487.

Campbell- Sills, L., & Barlow, D. H. (2007).

Incorporating emotion regulation into con-

ceptualizations and treatments of anxiety and

mood disorders. In J. J. Gross (Ed.), Hand-

book of emotion regulation (pp. 542–559).

New York: Guilford Press.

Campbell- Sills, L., Barlow, D. H., Brown, T. A.,

& Hofmann, S. G. (2006). Acceptability and

suppression of negative emotion in anxiety

and mood disorders. Emotion, 6(4), 587–595.

D’Avanzato, C., Joormann, J., Siemer, M., &

Gotlib, I. H. (2013). Emotion regulation in

depression and anxiety: Examining diagnos-

tic specificity and stability. Cognitive Therapy

and Research. [E-publication prior to print]

Ehring, T., Tuschen- Caffier, B., Schnülle, J.,

Fischer, S., & Gross, J. J. (2010). Emotion

regulation and vulnerability to depression:

Spontaneous versus instructed use of emotion

suppression and reappraisal. Emotion, 10(4),

563–572.

Feldman, G. C., Joormann, J., & Johnson, S. L.

(2008). Responses to positive affect: A self-

report measure of rumination and dampen-

ing. Cognitive Therapy and Research, 32(4),

507–525.

Garnefski, N., & Kraaij, V. (2006). Cogni-

tive Emotion Regulation Questionnaire—

development of a short 18-item version

(CERQ-short). Personality and Individual

Differences, 41(6), 1045–1053.

Garnefski, N., Legerstee, J., Kraaij, V., van den

Kommer, T., & Teerds, J. (2002). Cognitive

coping strategies and symptoms of depres-

sion and anxiety: A comparison between ado-

lescents and adults. Journal of Adolescence,

25(6), 603–611.

Goeleven, E., De Raedt, R., Baert, S., & Koster,

E. H. W. (2006). Deficient inhibition of emo-

tional information in depression. Journal of

Affective Disorders, 93(1–3), 149 –157.

Green, M. J., Lino, B. J., Hwang, E. J., Sparks,

A., James, C., & Mitchell, P. B. (2011). Cogni-

tive regulation of emotion in bipolar I disorder

and unaffected biological relatives. Acta Psy-

chiatrica Scandinavica, 124(4), 307–316.

Gross, J. J. (1998). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74, 224–237.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85(2), 348–362.

Gruber, J. (2011). Can feeling too good be bad?:

Positive emotion persistence (PEP) in bipolar

disorder. Current Directions in Psychological

Science, 20(4), 217–221.

Gruber, J., Eidelman, P., Johnson, S. L., Smith,

B., & Harvey, A. G. (2011). Hooked on a feel-

ing: Rumination about positive and negative

emotion in inter- episode bipolar disorder.

Journal of Abnormal Psychology, 120(4),

956–961.

Gruber, J., Harvey, A. G., & Gross, J. J. (2012).

When trying is not enough: Emotion regula-

426 PSYCHOPATHOLOGY

tion and the effort– success gap in bipolar dis-

order. Emotion, 12(5), 997–1003.

Gruber, J., Harvey, A. G., & Johnson, S. L.

(2009). Reflective and ruminative process-

ing of positive emotional memories in bipo-

lar disorder and healthy controls. Behaviour

Research and Therapy, 47(8), 697–704.

Hallion, L. S., & Ruscio, A. M. (2011). A meta-

analysis of the effect of cognitive bias modifi-

cation on anxiety and depression. Psychologi-

cal Bulletin, 137(6), 940–958.

Hasher, L., Zacks, R. T., & May, C. P. (1999).

Inhibitory control, circadian arousal, and age.

In D. Gopher & A. Koriat (Eds.), Attention

and performance XVII: Cognitive regulation

of performance: Interaction of theory and

application (pp. 653–675). Cambridge, MA:

MIT Press.

John, O. P., & Gross, J. J. (2004). Healthy and

unhealthy emotion regulation: Personality

processes, individual differences, and life span

development. Journal of Personality, 72(6),

1301–1333.

Johnson, S. L. (2005). Mania and dysregulation

in goal pursuit: A review. Clinical Psychology

Review, 25(2), 241–262.

Johnson, S. L., McKenzie, G., & McMurrich, S.

(2008). Ruminative responses to negative and

positive affect among students diagnosed with

bipolar disorder and major depressive disor-

der. Cognitive Therapy and Research, 32(5),

702–713.

Joormann, J. (2006). Differential effects of rumi-

nation and dysphoria on the inhibition of

irrelevant emotional material: Evidence from a

negative priming task. Cognitive Therapy and

Research, 30(2), 149–160.

Joormann, J. (2010). Cognitive inhibition and

emotion regulation in depression. Current

Directions in Psychological Science, 19(3),

161–166.

Joormann, J., & Gotlib, I. H. (2007). Selective

attention to emotional faces following recov-

ery from depression. Journal of Abnormal

Psychology, 116(1), 80 –85.

Joormann, J., & Gotlib, I. H. (2008). Updating

the contents of working memory in depres-

sion: Interference from irrelevant negative

material. Journal of Abnormal Psychology,

117(1), 182–192.

Joormann, J., & Gotlib, I. H. (2010). Emotion

regulation in depression: Relation to cognitive

inhibition. Cognition and Emotion, 24(2),

281–298.

Joormann, J., Hertel, P. T., LeMoult, J., & Got-

lib, I. H. (2009). Training forgetting of nega-

tive material in depression. Journal of Abnor-

mal Psychology, 118(1), 34 – 43.

Joormann, J., Siemer, M., & Gotlib, I. H. (2007).

Mood regulation in depression: Differential

effects of distraction and recall of happy mem-

ories on sad mood. Journal of Abnormal Psy-

chology, 116(3), 484–490.

Kashdan, T. B., & Rottenberg, J. (2010). Psy-

chological flexibility as a fundamental aspect

of health. Clinical Psychology Review, 30(4),

467–480.

Kessler, R. C., & Wang, P. S. (2009). Epidemi-

ology of depression. In I. H. Gotlib & C. L.

Hammen (Eds.), Handbook of depression

(2nd ed., pp. 5–22). New York: Guilford Press.

Kim, S., Yu, B. H., Lee, D. S., & Kim, J.-H.

(2012). Ruminative response in clinical

patients with major depressive disorder, bipo-

lar disorder, and anxiety disorders. Journal of

Affective Disorders, 136(1–2), e77–e81.

Lam, D., & Wong, G. (1997). Prodromes, cop-

ing strategies, insight and social functioning

in bipolar affective disorders. Psychological

Medicine, 27(5), 1091–1100.

Lawson, C., MacLeod, C., & Hammond, G.

(2002). Interpretation revealed in the blink

of an eye: Depressive bias in the resolution of

ambiguity. Journal of Abnormal Psychology,

111(2), 321–328.

Liverant, G. I., Brown, T. A., Barlow, D. H.,

& Roemer, L. (2008). Emotion regulation in

unipolar depression: The effects of acceptance

and suppression of subjective emotional expe-

rience on the intensity and duration of sadness

and negative affect. Behaviour Research and

Therapy, 46(11), 1201–1209.

Liverant, G. I., Kamholz, B. W., Sloan, D. M.,

& Brown, T. A. (2011). Rumination in clini-

cal depression: A type of emotional suppres-

sion? Cognitive Therapy and Research, 35(3),

253–265.

Lyubomirsky, S., & Nolen- Hoeksema, S. (1993).

Self- perpetuating properties of dysphoric

rumination. Journal of Personality and Social

Psychology, 65(2), 339–349.

Mathews, A., & MacLeod, C. (2005). Cognitive

vulnerability to emotional disorders. Annual

Review of Clinical Psychology, 1(1), 167–195.

McRae, K., Jacobs, S. E., Ray, R. D., John, O.

P., & Gross, J. J. (2012). Individual differences

in reappraisal ability: Links to reappraisal

frequency, well-being, and cognitive control.

Journal of Research in Personality, 46(1), 2–7.

Mogg, K., Bradley, B. P., Williams, R., &

Emotion Regulation in Mood Disorders 427

Mathews, A. (1993). Subliminal process-

ing of emotional information in anxiety and

depression. Journal of Abnormal Psychology,

102(2), 304–311.

Nezlek, J. B., & Kuppens, P. (2008). Regulating

positive and negative emotions in daily life.

Journal of Personality, 76(3), 561–579.

Nolen- Hoeksema, S. (2000). Further evidence

for the role of psychosocial factors in depres-

sion chronicity. Clinical Psychology: Science

and Practice, 7(2), 224–227.

Nolen- Hoeksema, S., Wisco, B. E., & Lyu-

bomirsky, S. (2008). Rethinking rumination.

Perspectives on Psychological Science, 3(5),

400–424.

Papageorgiou, C., & Wells, A. (2001). Positive

beliefs about depressive rumination: Devel-

opment and preliminary validation of a self-

report scale. Behavior Therapy, 32(1), 13–26.

Power, M. J., Dalgleish, T., Claudio, V., Tata, P.,

& Kentish, J. (2000). The directed forgetting

task: Application to emotionally valent mate-

rial. Journal of Affective Disorders, 57(1–3),

147–157.

Raes, F., Smets, J., Nelis, S., & Schoofs, H.

(2012). Dampening of positive affect prospec-

tively predicts depressive symptoms in non-

clinical samples. Cognition and Emotion,

26(1), 75–82.

Raes, F., Williams, J. M. G., & Hermans, D.

(2009). Reducing cognitive vulnerability to

depression: A preliminary investigation of

MEmory Specificity Training (MEST) in inpa-

tients with depressive symptomatology. Jour-

nal of Behavior Therapy and Experimental

Psychiatry, 40(1), 24–38.

Ray, R. D., McRae, K., Ochsner, K. N., & Gross,

J. J. (2010). Cognitive reappraisal of negative

affect: Converging evidence from EMG and

self- report. Emotion, 10(4), 587–592.

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79(3), 410–424.

Schweizer, S., Hampshire, A., & Dalgleish,

T. (2011). Extending brain- training to the

affective domain: Increasing cognitive and

affective executive control through emotional

working memory training. PLoS ONE, 6(9),

e24372.

Sheppes, G., Catran, E., & Meiran, N. (2009).

Reappraisal (but not distraction) is going to

make you sweat: Physiological evidence for

self- control effort. International Journal of

Psychophysiology, 71(2), 91–96.

Sheppes, G., & Gross, J. J. (2011). Is timing

everything? Temporal considerations in emo-

tion regulation. Personality and Social Psy-

chology Review, 15(4), 319–331.

Sheppes, G., & Meiran, N. (2007). Better late

than never?: On the dynamics of online regu-

lation of sadness using distraction and cogni-

tive reappraisal. Personality and Social Psy-

chology Bulletin, 33(11), 1518–1532.

Sheppes, G., Scheibe, S., Suri, G., & Gross, J. J.

(2011). Emotion- regulation choice. Psycholog-

ical Science, 22(11), 1391–1396.

Siemer, M. (2005). Mood- congruent cognitions

constitute mood experience. Emotion, 5(3),

296–308.

Siemer, M., & Reisenzein, R. (2007). The pro-

cess of emotion inference. Emotion, 7, 1–20.

Solomon, A. (2001). The noonday demon. New

York: Scribner.

Teasdale, J. D. (1988). Cognitive vulnerability

to persistent depression. Cognition and Emo-

tion, 2(3), 247–274.

Thomas, J., & Bentall, R. P. (2002). Hypomanic

traits and response styles to depression. Brit-

ish Journal of Clinical Psychology, 41(3),

309–313.

Thomas, J., Knowles, R., Tai, S., & Bentall, R. P.

(2007). Response styles to depressed mood in

bipolar affective disorder. Journal of Affective

Disorders, 100(1–3), 249–252.

Troy, A. S., Wilhelm, F. H., Shallcross, A. J., &

Mauss, I. B. (2010). Seeing the silver lining:

Cognitive reappraisal ability moderates the

relationship between stress and depressive

symptoms. Emotion, 10(6), 783–795.

Urry, H. L. (2009). Using reappraisal to regu-

late unpleasant emotional episodes: Goals and

timing matter. Emotion, 9(6), 782–797.

Watkins, E., & Moulds, M. (2005). Distinct

modes of ruminative self-focus: Impact of

abstract versus concrete rumination on prob-

lem solving in depression. Emotion, 5(3),

319–328.

Wells, T. T., & Beevers, C. G. (2010). Biased

attention and dysphoria: Manipulating selec-

tive attention reduces subsequent depressive

symptoms. Cognition and Emotion, 24(4),

719–728.

Werner- Seidler, A., & Moulds, M. L. (2012).

Mood repair and processing mode in depres-

sion. Emotion, 12(3), 470–478.

428

Have you ever had coffee or tea? A glass of

wine? Smoked even a single cigarette? Virtu-

ally all adults report consuming psychoac-

tive drugs

at some point in their lives, sug-

gesting that casual drug use is quite common

(Substance Abuse and Mental Health Ser-

vices Administration [SAMHSA], 2011). On

the other end of the drug use spectrum, sub-

stance use disorders (SUDs; or addictions)

are complex illnesses, encompassing a host

of severe negative physical, economic, and

social consequences, and contributing to

worldwide disability. With a lifetime preva-

lence of 35.3% in the general population,

individuals with SUDs constitute a relatively

small proportion of casual drug users, yet

they also represent the most prevalent and

costly of psychiatric disorders (National

Institute of Mental Health [NIMH], 2007;

SAMHSA, 2011).

Defined as “a problematic pattern of drug

use, leading to clinically significant impair-

ment or distress” (American Psychiatric

Association, 2013, p. 481), SUDs are both

personally and socially devastating in that

they are often chronic and can severely impair

even basic life functioning. In the fifth edi-

tion of the Diagnostic and Statistical Man-

ual of Mental Disorders (DSM-5), SUDs are

characterized by the presence of symptoms

including tolerance, withdrawal, continued

use despite wishes to stop, continued use

despite known negative consequences, and

importantly, a loss of regulatory control over

drug cravings, as well as further drug use.

As such, loss of regulatory control is a key

feature of SUDs. The addition of drug crav-

ing (strong desire for drugs) as a diagnostic

criterion for SUDs in DSM-5 emerged from

a wealth of accumulated research over the

last decade directly linking craving to drug

use and relapse (return to drug use follow-

ing abstinence; e.g., Shiffman et al., 2013;

see later sections for additional discussion).

This suggests that craving is also a key fea-

ture in SUDs, and that regulation of craving

is a specific form of emotion regulation that

can directly reduce drug use.

This chapter focuses on the crucial and

complex role of emotion regulation in SUDs

(see Figure 26.1 for a schematic summary).

In the first section, I discuss the role of acute

drug intoxication as a means of emotion

regulation, arguing specifically that people

use drugs in part to regulate their current

emotional state. This may include increasing

positive affect, ameliorating a preexisting

negative state, or decreasing craving. In the

next section, I explore the role of emotion

dysregulation in SUDs, both as a possible

cause for and a possible consequence of drug

use. In this section, I make several specific

arguments. First, I argue that emotion dys-

regulation in childhood and adolescence may

be an early risk factor and/or distal causal

factor in the later development of SUDs. Sec-

ond, I argue that an inability to effectively

regulate emotions in specific moments may

CHAPTER 26

Emotion Regulation

in Substance Use Disorders

Hedy Kober

Emotion Regulation in Substance Use Disorders 429

be a proximal causal factor for instances of

drug use in individuals who are already suf-

fering from SUDs. Third, I posit that SUDs

are marked by deficits in regulation of a spe-

cific appetitive state, namely, drug craving,

which is at the core of these disorders. I then

review evidence that suggests differences in

the structure and function of the prefrontal

cortex (PFC) may be the neural mechanisms

underlying emotion dysregulation in SUDs.

This section further highlights that although

some PFC abnormalities may precede drug

use, the long-term effect of chronic drug use

on PFC may further impair emotion regula-

tion in SUDs. In this way, drug use may lead

to further emotion dysregulation. The chap-

ter concludes with a section on treatments

for SUDs, many of which focus on increas-

ing emotion regulation skills geared specifi-

cally toward regulation of craving as means

of reducing substance use.

Drug Use as Emotion Regulation

Drugs can regulate emotion by pharmaco-

logically altering one’s current state. For

example, although the exact pharmacologi-

cal profiles of individual drugs differ, and

these differences have both theoretical and

neurobiological implications (e.g., Badiani,

Belin, Epstein, Calu, & Shaham, 2011),

many drugs are ultimately described as

euphoric, increasing positive emotion (Jaffe

& Jaffe, 1989). In human laboratory experi-

ments, self- administration of drugs, includ-

ing alcohol, methamphetamine, cocaine,

and marijuana, significantly increase feel-

ings of “high” and “good drug effects” (e.g.,

Hart, Ward, Haney, Foltin, & Fischman,

2001; see Figure 26.1A). Consistently, it is

has been proposed that these positive effects

of drugs lead to positive reinforcement and

increase the likelihood of future drug use

(Kober, Turza, & Hart, 2009). Further-

more, drug users often develop positive

expectancies regarding drug use (e.g., “If I

drink, I will feel good”) that are associated

with increased drug use and increased risk

of developing SUDs (e.g., Jones, Corbin, &

Fromme, 2001).

In addition to increasing positive emo-

tion, various drugs are known to alleviate

negative emotional states, including anxi-

ety (e.g., alcohol, and anxiolytic medication

such as Valium and Xanax), sadness and

A. Before SUD B. With SUD

PFC

Drugs

PFC

Drugs

Negative Appetitive

(high, craving)

Negative Appetitive

(craving)

Regulation

Emotion

FIGURE 26.1. A simplified model of emotion regulation in SUDs. Panel A: Before SUDs. Prefrontal

cortex (PFC) and drugs can both serve to regulate emotion. It is thought that PFC implements regula-

tion over negative emotion and craving (indicated by downward blunted arrows). In turn, unregulated

negative emotion and craving are associated with increased drug use (upward arrows). Here I propose

that drugs can be seen as a form of emotion regulation as well (indicated by downward blunted arrows),

increasing feelings of high, and decreasing negative emotion and craving. In this context, deficient emo-

tion regulation or PFC control may serve as risk factors for SUDs. Panel B: After development of SUDs.

Chronic drug use affects PFC (indicated by blunted arrow), diminishing its ability to regulate negative

emotion, as well as drug craving (dashed downward blunted arrows). In turn, unregulated negative

emotion and craving further lead to increased drug use (upward arrows). Drug use itself continues to

regulate both negative emotion and drug craving (though perhaps less effectively). This results in a

vicious cycle of reduced PFC-based emotion regulation, negative affect, craving, and increased drug

use. Therefore, treatments for SUDs often focus on enhancing emotion regulation skills, especially

regulation of craving, which has been linked to reduced drug use.

430 PSYCHOPATHOLOGY

depression (e.g., stimulants such as cocaine

and amphetamines), and pain (e.g., heroin,

morphine, and other synthetic prescrip-

tion opiates such as Vicodin). Consistently,

it has been proposed that these negativity-

reducing effects of drugs lead to negative

reinforcement, thus increasing the likeli-

hood of future drug use (Koob & Le Moal,

2008). This idea was initially popularized

by the “self- medication hypothesis” pro-

posed by Khantzian (1985), which has two

main components: (1) Unpleasant affective

states predispose individuals to drug use,

and (2) the choice of drug is not random;

rather, it is the nature of the drug’s effects

in ameliorating the preexisting negative

state that renders a particular drug more

or less reinforcing. In other words, those

with a particular predisposition to negative

affect states are more likely to develop an

SUD for a drug that reverses those particu-

lar affective states. To illustrate, Khantzian

suggested that individuals with strong rage

and aggression use opiate drugs to regu-

late these emotions. In contrast, individu-

als with preexisting depression and melan-

choly develop cocaine use disorders due to

cocaine’s ability to relieve these symptoms.

The self- medication hypothesis is consistent

with patients’ reports that “they got hooked

not because they had taken the drug, but

because they were not normal before in such

a way that the drugs were . . . not the prob-

lem but a solution” (Le Moal, 2009, p. 542).

It is further consistent with the observation

that the expectancy that drugs will allevi-

ate negative affect (e.g., “Drinking will calm

me down”) is associated with increased drug

use and increased risk for SUDs (Jones et al.,

2001).

Although the self- medication hypothesis

has been challenged, several lines of evidence

support the hypothesis that drug use serves

to regulate negative emotion. First, SUDs

frequently co-occur with a number of other

psychiatric disorders, especially mood and

anxiety disorders. Moreover, preexisting

psychiatric diagnoses increase the likelihood

of an individual to subsequently develop an

SUD (e.g., Kessler et al., 2005). This suggests

that individuals who already experience dif-

ficult emotions are more likely to seek and

use drugs, and to develop problematic habits

of drug use that presumably ameliorate their

affective symptoms. A related point is that

treatment for such comorbid disorders fre-

quently reduces drug use (Nunes & Levin,

2004). Second, and similarly, those with

chronic pain are far more likely to develop

SUDs relative to the general, pain-free pop-

ulation, especially to pain- reducing drugs

such as opiates (Morasco et al., 2011).

Third, even normal- range trait levels of

negative affect are related to drug use. For

example, trait depression and neuroticism

correlate negatively with time to relapse

in cigarette smokers (Gilbert, Crauthers,

Mooney, McClernon, & Jensen, 1999),

while trait levels of anger and anxiety corre-

late with craving to drink in alcoholics (Litt,

Cooney, & Morse, 2000). Fourth, negative

affective states are known triggers for crav-

ing in the context of both casual and prob-

lematic substance use (e.g., Shiffman, Paty,

Gnys, Kassel, & Hickcox, 1996). This phe-

nomenon ranges from the common epithet

“I had such a hard day, I need a beer or a

stiff drink” to instances of relapse to drug

use after experiencing a strong life stressor

(e.g., death in family). Indeed, it has been

well documented that both naturally occur-

ring and experimentally induced negative

affect and stress increase drug craving, drug

use, and relapse (e.g., Sinha & Li, 2007).

Finally, drug use also serves to regulate

the experience of craving, which is one of

the most common motivators for drug use

(Childress et al., 1993; Shiffman et al.,

2013). That is, individuals with SUDs use

drugs to temporarily alleviate their experi-

ence of craving, thus generating a vicious

cycle of increasing craving and use. Taken

together, the evidence reviewed in this sec-

tion suggests that drug taking can be a form

of emotion regulation. Specifically, the acute

effects of drugs may regulate preexisting

emotions in both casual and problem drug

users, including increasing positive emotion,

decreasing negative emotion, and decreas-

ing craving for drugs themselves (see Figure

26.1A).

Emotion (dys)Regulation Is a Causal

Factor in SUDs

Although many people casually use drugs

and alcohol, only a small percentage develop

SUDs, highlighting the need to identify risk

and causal factors for the initiation, develop-

Emotion Regulation in Substance Use Disorders 431

ment, and maintenance of these severe dis-

orders. Of course, because SUDs are com-

plex disorders, they are likely caused and

maintained by an intricate combination of

factors, including genetic, cognitive, behav-

ioral, individual- difference, and environ-

mental variables, that likely interact across

multiple levels of analysis. At this time, emo-

tion regulation abilities are already emerging

as one important contributor in the etiology

and maintenance of SUDs, although in the

next decade it is likely that larger longitu-

dinal studies will allow us to identify addi-

tional factors.

Emotion (dys)Regulation as an Early

Risk Factor

As reviewed below, SUDs are frequently

associated with emotion regulation deficits.

The specific question here is: Do these defi-

cits precede the development of the disorder

so that they may be considered a risk fac-

tor? The answer appears to be yes. Begin-

ning with the classic “marshmallow test”

experiments in the 1960s by Mischel and

colleagues, it has been proposed that the

ability to delay gratification, and regulate

emotions like desire, is crucial to children’s

developmental trajectories (for review, see

Mischel, Ayduk, Berman, Casey, Gotlib, et

al., 2011 and Luerssen & Ayduk, this vol-

ume). In these studies, preschool children

were typically presented with a tasty treat

and told that they could have it now, or

alternatively, wait to receive two treats at a

later time—if they could delay gratification.

In his seminal work, Mischel reported that

children vary in their ability to delay gratifi-

cation, ranging from not being able to wait

at all to waiting as long as the experimenter

allowed (and using a variety of spontaneous

strategies to facilitate delay). In his follow-

up work, Mischel (2011) reported that those

preschool children who were able to delay

gratification the longest (by waiting for a

larger treat rather than indulging immedi-

ately in a smaller treat) later achieved higher

Standard Achievement Test (SAT) scores,

had better social- cognitive and emotional

coping in adolescence, and importantly,

were least likely to use crack cocaine in

adulthood. This body of work highlights

how individual differences in emotion regu-

lation (which manifest as early as preschool)

may predate the development of SUDs and

could therefore be conceptualized as a risk

factor predicting illness onset.

In the years since this work was published,

additional data has accumulated to further

suggest that poor self- control

in childhood

is indeed a risk factor for drug use and the

development of SUDs. For example, Mof-

fitt and colleagues (2011) followed 1,000

children from birth to age 32. In childhood,

participants were assessed on various self-

control measures related to emotion regula-

tion, including emotional lability, frustra-

tion tolerance, and persistence. The authors

report that individual differences in self-

control were significantly predictive of adult

health outcomes, including substance use

and dependence, as much as 30 years later.

Importantly, the contribution of self- control

factors was distinct from the contribution of

intelligence, social class, and other family-

life variables. Strikingly, the highest and

lowest one-fifth of the sample on measured

self- control were associated with a preva-

lence of 3 and 10%, respectively, of polysub-

stance dependence in adulthood.

In addition, in childhood, the related

construct of trait impulsivity—the ten-

dency to act without thought or regard for

consequences— has been repeatedly asso-

ciated with the development of SUDs in

later adolescence and adulthood (see Iva-

nov, Newcorn, Morton, & Tricamo, 2011;

Verdejo- García, Lawrence, & Clark, 2008,

for reviews). Furthermore, longitudinal

studies suggest that children who suffer

from childhood disorders such as attention-

deficit/hyperactivity disorder and conduct

disorder, which are associated with poor

emotional/behavioral regulation and impul-

sivity, are far more likely to use drugs and

to receive an SUD diagnosis by late adoles-

cence or young adulthood (e.g., August et

al., 2006). It has also been suggested that

the association between childhood disrup-

tive behavior and adolescent- onset sub-

stance use may be mediated by early defi-

cits in emotion regulation and inhibitory

control (Ivanov et al., 2011). A similar con-

struct used by Tarter and colleagues (2003),

termed neurobehavioral disinhibition, is

indexed by measures of emotion regulation,

executive cognitive functioning, and behav-

ior control. This construct distinguishes

between 10- to 12-year-old boys who are at

432 PSYCHOPATHOLOGY

low vs. high risk for development of SUDs

(determined by parental SUD diagnosis). In

addition, this construct was found to predict

substance use at age 16, as well as SUDs in

early adulthood.

The mechanisms by which early emotion

dysregulation leads to later SUDs are a tar-

get of current investigation. One prevailing

hypothesis is that emotion regulation abili-

ties (and cognitive control more generally)

depend on the function of PFC regions (see

Ochsner & Gross, this volume; Johnstone

& Walter, this volume) that are not yet fully

developed in children and adolescents (see

Riediger & Klipker, this volume). Indeed,

adolescence represents a period of both

reduced emotion regulation abilities (Silvers

et al., 2012) as well as substantial neural

development (Giedd et al., 1999). Specifi-

cally, regions of lateral PFC have been found

to be relatively hypoactive during emotion-

related tasks in adolescents as compared to

adults (e.g., Pfeifer, Lieberman, & Dapretto,

2007), with regulation- related activation in

this area increasing with age (McRae et al.,

2012).

Given this developmental trajectory, emo-

tion dysregulation in adolescence may con-

tribute to SUD risk via two parallel routes.

First, immature emotion regulation capaci-

ties in adolescence may result in higher lev-

els of stress and negative emotion, which has

been shown to lead to the initiation of drug

use in animal models (e.g., Haney, Maccari,

Le Moal, Simon, & Vincenzo Piazza, 1995)

and in human adults (see Sinha & Li, 2007,

for review). Second, self- regulation fail-

ures in adolescence may underlie increased

impulsivity and risk- taking behaviors that

may also lead to initiation of drug use (e.g.,

Ivanov et al., 2011). Ultimately, the develop-

mental trajectory of self- regulatory function

suggests that at least some adolescents may

be less able to recruit the neural circuitry

needed to regulate their emotions optimally

and to ultimately avoid substance use.

The idea that adolescents as a group may

in fact be less able to recruit the necessary

neurocircuitry to regulate emotions and

avoid substance use—along with the obser-

vation that individual differences in the

ability to do so are predictive of future sub-

stance use—is especially important, because

adolescence is a period of heightened risk

taking (SAMHSA, 2011) and peer influence

(Steinberg, 2005), both of which expose ado-

lescents to drugs. Thus, increased exposure

to drugs, coupled with increased emotional

reactivity and decreased regulatory capaci-

ties (rooted in ongoing brain development),

make adolescence a particularly vulnerable

period for substance use.

Indeed, drug use is most often initiated

in adolescence. For example, 82.4% of first

uses of alcohol occur in individuals under

the age of 21 (the legal drinking age), and

58.8% of smokers had their first cigarette

under the age of 18 (SAMHSA, 2011). These

early use statistics are especially important,

because earlier age of onset is associated with

higher rates of SUDs and worse outcomes.

For example, those who initiated alcohol

use prior to age 14 are more than four times

more likely to receive an SUD diagnosis in

adulthood (16.2 vs. 3.8%; similar rates are

reported for illicit drugs). Similarly, earlier

age of smoking onset predicts a higher num-

ber of cigarettes smoked in adulthood (Tai-

oli & Wynder, 1991). Taken together, these

data support the notion that emotion (dys)

regulation is an early risk factor for SUDs.

Next I discuss how emotion regulation may

operate as an ongoing causal factor that may

contribute to and exacerbate existing SUDs.

Emotion (dys)Regulation

Current

SUDs

Several models of SUDs directly implicate

deficient regulation as a key and primary

motive for ongoing drug use and relapse,

including the relapse prevention model

(Marlatt & Witkiewitz, 2005), the affective

processing model (Baker, Piper, McCarthy,

Majeskie, & Fiore, 2004), and the aforemen-

tioned self- medication hypothesis (Khant-

zian, 1985), among others. Indeed, whether

or not emotion regulation deficits are a pre-

existing risk factor for SUDs (as proposed

in the previous section), those who currently

suffer from SUDs frequently display such

deficits, which may contribute to the clinical

course of the disorder. Several lines of evi-

dence support this association (Figure 26.1B

for schematic illustration).

First, self- reported emotion regulation

skills are lower in individuals with SUDs

than in healthy controls (e.g., Fox, Hong,

& Sinha, 2008). In addition, greater diffi-

culties in regulating emotion is associated

Emotion Regulation in Substance Use Disorders 433

with more drug use (e.g., Berking et al.,

2011) possibly as a means of emotion regu-

lation (Bonn- Miller, Vujanovic, & Zvolen-

sky, 2008). Second, less effective styles of

emotion regulation (e.g., suppression vs.

reappraisal) are related to increased drug

use (Fucito, Juliano, & Toll, 2010). Third,

individual differences in negative affect have

been repeatedly associated with drug use

and relapse in clinical (e.g., Gamble et al.,

2010), as well as laboratory studies (e.g.,

Sinha & Li, 2007). Fourth, as reviewed ear-

lier, SUDs are highly comorbid with affective

disorders, such as depression, which feature

impaired regulation of negative affect as a

key diagnostic feature (American Psychiatric

Association, 2013). Furthermore, those with

co- occurring symptoms of SUDs and affec-

tive disorders show significantly higher rates

of relapse to drug use after treatment (e.g.,

Bradizza, Stasiewicz, & Paas, 2006) offer-

ing additional support for the link between

emotion regulation deficits and SUDs.

Additional evidence links constructs

related to emotion regulation and SUDs. For

example, emotional intelligence—defined as

the ability to be aware of emotions, identify

emotions correctly, interpret them appro-

priately, and regulate them effectively— is

inversely associated with alcohol and drug-

related problems (Riley & Schutte, 2003).

Moreover, emotional intelligence moderated

the association between negative emotion

and alcohol craving in alcohol- dependent

individuals (Cordovil de Sousa Uva et al.,

2010). Furthermore, a recent meta- analysis

of this construct suggests that not only is it

inversely related to smoking, alcohol, and

drug use, but also that individual differences

in particular components, namely, “iden-

tification of emotion” and “regulation of

emotion,” are particularly related to SUDs

(Kun & Demetrovics, 2010). Similarly,

distress tolerance—the ability to persist in

goal- directed activity when experiencing

psychological distress— is related to emo-

tion regulation and is inversely associated

with substance use frequency and SUDs

(Marshall- Berenz, Vujanovic, & MacPher-

son, 2011), as well as SUD treatment drop-

out and eventual relapse (e.g., Daughters et

al., 2005). In addition, impulsivity is report-

edly higher in those with SUDs (see Verdejo-

García et al., 2008, for review). Finally, it

has been suggested that those with SUDs

exhibit relative deficits in nonaffective forms

of self- regulation and executive function,

including working memory and response

inhibition, which may also relate to PFC

function (Goldstein & Volkow, 2011).

Emotion (dys)Regulation in Current

SUDs: Regulation of Craving

In the previous section, I reviewed evidence

suggesting that those with SUDs have dif-

ficulties regulating emotions. Notably, the

evidence overwhelmingly centers on regula-

tion of negative emotions. However, in the

context of SUDs, it is critical to consider

not only regulation of negative emotion but

also an additional and very specific form of

emotion regulation, namely, the regulation

of craving.

Craving, defined here as “intense desire

for drugs,” has long been considered a key

contributor to drug use (e.g., O’Brien, Chil-

dress, Ehrman, & Robbins, 1998). Although

this view has been challenged (Perkins, 2009)

substantial evidence links drug craving to

drug- taking behavior, and it has been sug-

gested that loss of control over cue- induced

craving is at the root of compulsive drug tak-

ing (e.g., Goldstein & Volkow, 2011). For

example, levels of reported craving predict

drug use as well as relapse to drug taking

following abstinence (e.g., Crits- Christoph

et al., 2007; Epstein, Marrone, Heishman,

Schmittner, & Preston, 2010; Galloway, Sin-

gleton, & the Methamphetamine Treatment

Project Corporate Authors, 2008). Con-

versely, the ability to use various strategies

to regulate craving is associated with lower

craving (Kober, Kross, Mischel, Hart, &

Ochsner, 2010; Kober, Mende- Siedlecki, et

al., 2010; Westbrook et al., 2013) and lower

drug use (O’Connell, Hosein, Schwartz, &

Leibowitz, 2007). Further, the acquisition

of strategies during cognitive- behavioral

therapy (as discussed below) is associated

with better long-term outcomes (Carroll,

Nich, Frankforter, & Bisighini, 1999). Fur-

thermore, the use of cognitive strategies to

regulate craving both during and after treat-

ment is associated with reduced craving and

reduced relapse over time (O’Connell et al.,

2007; Shiffman et al., 1996). These findings

suggest that craving is a key motivator of

substance use, and that effective regulation

of craving is associated with lower drug use

434 PSYCHOPATHOLOGY

and better outcomes for those with SUDs.

This in turn suggests that regulation of crav-

ing is a specific form of regulation that is

particularly important in the maintenance

of drug use behavior in SUDs.

The neural mechanism by which regula-

tion of craving operates to reduce drug use

is a topic of current research. It has been

shown previously that exposure to drug

cues (e.g., drug- related images, movies, or

paraphernalia) increases craving, as well as

drug use (e.g., Shiffman et al., 2013). Fur-

thermore, several meta- analyses have shown

that such cue- induced craving is consistently

associated with neural activity in a network

of regions including the ventral striatum,

the subgenual anterior cingulate, and the

amygdala (e.g., Chase, Eickhoff, Laird, &

Hogarth, 2011). These regions, which are

thought to relate to learning, salience, and

value encoding, previously have been associ-

ated with the acute effects of drugs. We have

recently shown that when cigarette smokers

use cognitive strategies in instances of crav-

ing (e.g., when they think about the long-

term negative consequences of smoking),

they report lower craving (Kober, Kross,

et al., 2010), and exhibit lowered activity

in the neural systems that underlie craving,

such as the ventral striatum (Kober, Mende-

Siedlecki, et al., 2010). Importantly, the reg-

ulation of craving with cognitive strategies

is associated with concurrently increased

activity in PFC regions including the dor-

solateral (dlPFC) and ventral PFC—regions

previously associated with regulation of

negative emotion (see Ochsner & Gross, this

volume). These findings have since been rep-

licated with positron emission tomography

in cocaine users (Volkow et al., 2010) and

electrophysiological measurements in ciga-

rette smokers (Littel & Franken, 2011).

Interestingly, we’ve recently shown that

use of mindfulness- based strategies to regu-

late cue- induced craving is also associated

with reductions in reported craving, and

with reduced neural activity in “craving

regions,” including the subgenual cingulate.

However, the use of such mindfulness- based

strategies was not associated with concur-

rent increase in PFC activity (Westbrook et

al., 2013). Taken together, these findings are

consistent with the hypothesis that, across

strategies, regulation of craving operates by

reducing neural activity in regions that are

thought to instantiate the experience of crav-

ing. Preliminarily, it further appears that the

use of cognitive strategies to regulate crav-

ing may depend on increased activity in PFC

but that mindfulness- based strategies may

not, although additional data are required

to confirm this pattern of results.

To summarize, this section has reviewed

evidence suggesting that emotion regula-

tion is implicated in SUDs, both as an early

risk factor and as an ongoing motivator of

drug use. For example, individual differ-

ences in emotion regulation and impulsivity

during development are predictive of drug

use initiation and SUDs. Furthermore, indi-

viduals with ongoing SUDs exhibit deficits

in emotion regulation compared to healthy

controls, and negative affect in such indi-

viduals is associated with instances of drug

use. Importantly, most of the available evi-

dence centers around regulation of negative

emotion. However, regulation of craving is

emerging as another form of regulation that

is important in the etiology and mainte-

nance of these disorders, and may constitute

one key route by which targeted treatments

can ameliorate SUDs, as discussed further

below.

PFC in SUDs: Mechanism

for Emotion (dys)Regulation?

In the prior sections I have reviewed evi-

dence suggesting that PFC development may

underlie the role of emotion dysregulation

as a distal causal factor for development of

SUDs in adolescence. But is this the neural

mechanism that underlies general deficits in

emotion regulation present in SUDs? Indeed,

many current models of SUDs propose that

the loss of control over craving and drug

taking (as evident in the diagnostic criteria

for the disorder) is a result of reduced or

compromised PFC function (e.g., Everitt &

Robbins, 2005; Goldstein & Volkow, 2011;

Potenza, Sofuoglu, Carroll, & Rounsaville,

2011; Volkow, Wang, Fowler, & Tomasi,

2011). And this “PFC hypothesis” is con-

sistent with the already- established link

between cognitive control generally— and

emotion regulation specifically— and the

function of PFC in healthy adults (see Och-

sner & Gross, this volume). However, neu-

Emotion Regulation in Substance Use Disorders 435

roimaging studies directly testing emotion

regulation abilities in SUDs are scarce. Nev-

ertheless, in the following sections, I review

findings that individuals with SUDs exhibit

structural abnormalities in various PFC

regions, as well as functional differences

in studies of nonaffective forms of cogni-

tive control (for a brief review of neuroim-

aging methodologies used in such studies,

see Kober & DeLeone, 2011). Importantly,

although some of these PFC abnormalities

may precede the development of SUDs, I

review evidence suggesting that chronic

drug use is associated with both structural

and functional changes in PFC. Such drug-

induced changes, in turn, suggest that SUDs

may also lead to decrements in PFC that may

underlie further emotion dysregulation (Fig-

ure 26.1B).

In reviewing this evidence, it is important

to note that the PFC is a very large struc-

tural division in the brain, and that different

subregions within the PFC perform very dif-

ferent computations and subserve different

functions— even within the general “cogni-

tive control” framework (Miller & Cohen,

2001). However, at this stage, there are not

yet sufficient data to make finer distinctions

about the functional role of PFC subdivisions

in SUDs, or to begin to speculate about the

role each subregion might have in the neu-

ropathology of these disorders. I hope that

data collected in the next decade will allow

us to answer such questions with far greater

specificity than we can today.

Structural Differences in the PFC

Differences in brain structure have been

reported between those with SUDs and

healthy controls, using several different

methodologies, especially in various subre-

gions of PFC. For example, using voxel-based

morphometry, cigarette smokers exhibited

reduced PFC gray matter density compared

to healthy controls, and PFC thickness was

negatively correlated to reported smoking

(measured in packs-per-year; Brody et al.,

2004). In cocaine- dependent individuals,

relatively reduced gray matter density in

orbitofrontal cortex (OFC) and anterior cin-

gulate cortex (ACC) was reported (Franklin

et al., 2002). Similarly, lower thickness and

volume were reported for other stimulant

users in various prefrontal regions (e.g.,

Daumann et al., 2011) and in right ven-

trolateral PFC (vlPFC) specifically, where

thickness was inversely correlated with drug

craving (Tabibnia et al., 2011). In alcohol-

dependent subjects compared to controls,

lower gray matter volume was reported

across the PFC (Fein, Di Sclafani, & Mey-

erhoff, 2002) and more specifically in the

lateral and superior PFC and OFC (Durazzo

et al., 2011) and medial and lateral PFC

(Rando et al., 2011). In these latter studies,

lower medial PFC volume was associated

with more drinking posttreatment or shorter

time to relapse. In addition, in some studies

(but not all) PFC volume was inversely asso-

ciated with cognitive control measures. For

example, PFC gray matter volume correlated

inversely with executive function measures

in cocaine- dependent individuals (Fein et

al., 2002).

Consistent with these gray matter find-

ings in PFC, diffusion tensor imaging (DTI)

measures of PFC white matter integrity dis-

tinguish between individuals with alcohol

use disorders and controls (e.g., Pfeffer-

baum, Rosenbloom, Rohlfing, & Sullivan,

2009) and further differ between individu-

als who relapsed and those who sustained

abstinence following treatment (Sorg et al.,

2012). In cocaine- dependent participants,

lower measurements of white matter integ-

rity are consistently found in various PFC

regions (e.g., Romero, Asensio, Palau, San-

chez, & Romero, 2010). Similar findings

were reported in methamphetamine (Ali-

cata, Chang, Cloak, Abe, & Ernst, 2009)

and in opiate users (Bora et al., 2012; Liu et

al., 2008).

Taken together, this body of structural neu-

roimaging work suggests that there are con-

sistent anatomical differences between those

with SUDs and healthy controls. A caution-

ary note here is that it is not yet clear what

these differences mean. While it is tempting

to interpret these differences as indicating

impairment in individuals with SUDs, this

link has not yet been consistently demon-

strated. For instance, although reportedly

lower than that in controls, cortical thick-

ness and cognitive function are often within

normal range in SUDs (see Hart, Marvin,

Silver, & Smith, 2011, for extended discus-

sion). Nevertheless, these differences are

consistently reported across PFC and across

types of SUDs. Furthermore, although indi-

436 PSYCHOPATHOLOGY

vidual studies differ with respect to the local-

ization of these differences (possibly due to

sample characteristics, drug pharmacology,

drug use patterns, and methodological and

statistical differences), and only some stud-

ies find association with clinical outcomes,

the PFC is repeatedly implicated, especially

lateral portions. Reported differences are

especially salient given the known role for

PFC in emotion regulation and cognitive

control in healthy adults. Taken together,

these structural findings are consistent with

the hypothesized mechanism by which PFC

abnormalities may contribute to or underlie

deficient emotion regulation in SUDs. How-

ever, future work could more directly link

structural findings in PFC with emotion

regulation in SUDs.

Functional Differences in PFC

Differences in measures of PFC function

between individuals with SUDs and healthy

controls have been consistently reported

since the early days of functional neuroim-

aging. For example, using various forms of

positron emission tomography (PET), it has

been established that those with SUDs often

exhibit relative reductions in “D2” type

receptors of the neurotransmitter dopamine

in striatum and PFC, with some evidence that

these reductions persist even after months

of abstinence (see Volkow et al., 2011, for

review). PET measures of glucose metabo-

lism have repeatedly shown decreased activ-

ity in OFC, ACC, and dlPFC. In stimulant

users decreased activity is further related to

relatively decreased D2 receptor availability

in striatum (Volkow et al., 2011). Notably,

in alcohol- dependent individuals, striatal

D2 availability is linked to not only to PFC

activity but also to self- reported alcohol

craving, suggesting that all three processes

may be functionally related (i.e., OFC func-

tion, D2 receptor availability, and craving;

Heinz et al., 2005).

More recently, several studies have spe-

cifically investigated brain function dur-

ing performance of non- affective cognitive

control tasks comparing individuals with

SUDs and healthy controls, typically with

functional magnetic resonance imaging

(fMRI). One frequently used task is the go/

no-go response inhibition task, in which

participants are asked to respond to all

letters except X with a button press, and

to withhold responding to X. Using this

task, a series of studies reported relatively

worse performance in cocaine- and heroin-

dependent individuals compared to healthy

controls, along with reduced activity in

several PFC regions, including the dorsal

ACC (dACC), dlPFC, and vlPFC (e.g., Fu et

al., 2008; Hester & Garavan, 2004). Such

findings suggest at least some functional

alterations in PFC circuits in SUDs, even in

the absence of emotion regulation demand.

Similarly, Li, Luo, Yan, Bergquist, and

Sinha (2009) used the stop- signal response

inhibition task, and reported lower activ-

ity in dlPFC in alcohol dependence, which

further related to higher alcohol craving

self- reports. In cocaine- dependent individu-

als, dACC activity was lower than that in

controls and negatively correlated with self-

reported difficulties in emotion regulation

(Li et al., 2008).

The Stroop color–word task has also been

used to probe inhibitory control in SUDs by

comparing neural activity during incongru-

ent (BLUE written in red ink) and congruent

(BLUE written in blue ink) trials. Using PET,

both marijuana- and cocaine- dependent

participants showed reduced “Stroop effect”

activity in dACC and dlPFC (Bolla et al.,

2004; Eldreth, Matochik, Cadet, & Bolla,

2004). In the cocaine- dependent sample

only, dlPFC activity negatively correlated

with cocaine use (least “Stroop effect” activ-

ity for the heaviest users; Bolla et al., 2004).

Similarly, DeVito, Kober, Carroll, and

Potenza (in preparation) recently used the

Stroop task and fMRI in cocaine- dependent

participants, and found reduced Stroop-

related PFC activity compared to controls.

Similar findings have been reported with

methamphetamine users (Nestor, Ghahre-

mani, Monterosso, & London, 2011). In

marijuana- dependent individuals who were

about to begin treatment, Kober, DeVito,

DeLeone, Carroll, and Potenza (under

review) found reduced “Stroop effect” activ-

ity in dlPFC compared to healthy controls,

and positive correlations between PFC activ-

ity and treatment success. Similarly, Berk-

man, Falk, and Lieberman (2011) related

neural activity during go/no-go task perfor-

mance to treatment outcome and reported

that increased PFC activity during the task

was related to a weaker association between

Emotion Regulation in Substance Use Disorders 437

craving and cigarette smoking during subse-

quent abstinence.

Taken together, these studies suggest that

those with SUDs exhibit poorer performance

in cognitive control tasks, as well as lower

activity in PFC regions typically associated

with emotion regulation and executive func-

tion more generally, including dlPFC and

dACC. Some studies reported direct asso-

ciation between lower PFC function and

less cognitive control or emotion regulation,

while others link greater PFC activity to bet-

ter treatment outcomes (e.g., Berkman et

al., 2011; Kober et al., under review). These

findings are therefore consistent with the

hypothesis that PFC abnormalities in struc-

ture or function underlie emotion dysregula-

tion in SUDs.

Effects of Drug Use on PFC

Data reviewed thus far suggests that those

with SUDs exhibit deficits in emotion regu-

lation, and both structural and functional

differences in PFC compared to healthy con-

trols. Notably, most of the reviewed data

were generated in the context of case– control

studies— measured at a single point in time,

in individuals with active SUDs. Therefore,

it is not clear whether some of these reported

abnormalities precede the development of

SUDs (and may serve as a risk factor, as

discussed previously), whether they are the

result of chronic drug use (and reflect the

effects of drug exposure) or an interaction

of both. Evidence for PFC abnormalities as

a preexisting risk factor includes a recent

study of individuals with SUDs (cocaine or

amphetamine dependence) and their unaf-

fected siblings compared to healthy adults.

Both individuals with SUDs and their unaf-

fected siblings shared a neurological pheno-

type of reduced structural connectivity in

the right vlPFC, which was further related

to performance on the stop- signal response

inhibition task (Ersche et al., 2012). These

findings suggest that potential abnormalities

in lateral PFC may underlie regulatory defi-

cits that in fact predate the onset of SUDs.

On the other hand, there is ample evi-

dence, mostly from animal studies, that

chronic/regular drug use alters both func-

tion and structure of PFC and other brain

circuits (for an excellent recent review, see

Lüscher & Malenka, 2011). Although it is

outside of the scope of this chapter to discuss

the unique mechanism of action or pharma-

cological effects of individual drugs, one

now- classic finding is that all drugs that are

abused by humans share one common effect.

That is, all drugs of abuse— either directly

or indirectly— increase concentrations of the

neurotransmitter dopamine in the “meso-

corticolimbic” pathway, which includes the

ventral tegmental area, the ventral striatum,

and the PFC (e.g., Dichiara & Imperato,

1988; Volkow et al., 2011).

In turn, this

drug- induced increase in dopamine is asso-

ciated with long-term changes or adapta-

tions to neurons in this pathway, including

in PFC (Lüscher & Malenka, 2011). These

changes are thought to facilitate associa-

tions between drugs and drug- related cues

(e.g., alcohol and the bar where one drinks;

cigarettes and the lighter one uses for smok-

ing), lead to future cue- induced drug crav-

ing, and reduce cognitive control (Volkow et

al., 2011).

Furthermore, it is thought that some of

the effects of acute as well as chronic drug

use are neurotoxic—damaging to neural

tissue (Weiss & Koob, 2001). Such claims

emerge primarily from an animal literature

experimentally documenting various forms

of neuronal damage following heavy drug

administration (e.g., Gouzoulis- Mayfrank

& Daumann, 2009). Although it is not

clear that such findings translate to human

drug users (Hart et al., 2011), some studies

in humans have linked length of drug use

with measures of structural or functional

integrity, which is consistent with animal

findings. For example, in opiate users, PFC

white matter integrity correlated negatively

with length of opiate use (Bora et al., 2012;

Liu et al., 2008). Similarly, some human

studies have shown that various functional

and structural abnormalities normalize fol-

lowing drug abstinence, implicating drug

use itself in the originally observed differ-

ences in PFC (e.g., Gouzoulis- Mayfrank &

Daumann, 2009). Taken together, the evi-

dence suggests that even if some PFC abnor-

malities precede the development of SUDs,

drug use itself is associated with long-term

changes to many brain circuits, including

PFC. Furthermore, these changes may cre-

ate or exacerbate deficits in emotion regula-

tion in SUDs. In essence, this suggests that

chronic drug use may lead to a vicious cycle,

438 PSYCHOPATHOLOGY

in which impaired emotion regulation leads

to drug use, and drug use may further lead

to impaired emotion regulation.

Treatment for SUDs:

The Role of Emotion Regulation

Treatments for SUDs are varied and com-

plex, as is appropriate given the hetero-

geneous and complex nature of the disor-

ders that they treat. At this time, despite

repeated scientific efforts, there are few

FDA-approved pharmacological treatments

for SUDs. Therefore, nonpharmacological

(e.g., psychological) treatments are most

common. While the goal of treatment may

be conceptualized as reductions in drug use

and in drug- related harm, and increases in

psychosocial functioning, treatment suc-

cess is most often measured in abstinence,

or complete cessation of drug use. As such,

the available treatments are only moderately

effective; indeed, across all treatments for

SUDs, the most common outcome is relapse

(Dutra et al., 2008). This suggests that while

some individuals successfully remain absti-

nent, the majority of patients either do not

achieve abstinence or return to drug use

within a year, even with the best of treat-

ments. These grim findings underscore the

need to better understand the mechanisms

of action behind the treatments that do

work, in order to improve them further.

From a clinical perspective, treatment

for SUDs can be divided into three phases:

detoxification, recovery, and relapse preven-

tion (e.g., Potenza et al., 2011). The goal of

the detoxification stage is to achieve absti-

nence and undergo withdrawal symptoms

safely, until they abate. The onset, charac-

ter, and length of this stage depend on the

pharmacological properties of the individual

drug, as well as treatment type (some treat-

ments begin with recovery elements, then set

a “quit date” to begin detoxification). The

main stage of treatment is recovery, which

can last from 1 week to many weeks. The

goal of the recovery stage is to develop moti-

vation to avoid drug use and relapse, as well

as learn the skills to do so successfully. In

that sense, what does recovery entail? The

data reviewed in this chapter suggest that

difficulties regulating emotions are a core

feature of SUDs. Specifically, I have argued

that difficulties regulating both negative

(stress, anxiety, or depression) and appeti-

tive (drug craving) states are associated with

drug use and with relapse to drug use fol-

lowing abstinence. Therefore, it is no sur-

prise that at this recovery phase, many of the

leading treatments include training of emo-

tion regulation skills in general, and regula-

tion of craving in particular (e.g., Potenza et

al., 2011; see Figure 26.1B). Indeed, learning

to tolerate or regulate cravings and not to

act on them is the cornerstone of many of

the available treatments, as discussed below.

Finally, the last phase of treatment, relapse

prevention, focuses on implementing long-

term strategies for maintaining abstinence,

which includes replacing old behaviors with

a new and healthy, drug-free lifestyle. Over-

all, there are many types of treatments for

SUDs, and each type has many unique fea-

tures. The following sections focus on two

types of treatment that are related to the role

of emotion regulation in SUDs: cognitive-

behavioral and mindfulness- based treat-

ments.

Cognitive‑Behavioral Therapies

Cognitive- behavioral therapies (CBTs) are

considered the most effective treatment for

many psychiatric disorders (e.g., depres-

sion and anxiety). A version developed spe-

cifically for SUDs (Carroll, 1998) has been

empirically validated in multiple randomized

controlled trials and is considered by many

to be the “gold standard” (e.g., Dutra et al.,

2008; Potenza et al., 2011). CBT for SUDs

has two critical components: functional

analysis and skills training. Functional

analysis is used to identify and assess the

individualized circumstances that are likely

to lead to drug use, and provides insights

into some of the reasons the individual

may be using drugs. These “high-risk situa-

tions” are those in which new skills may be

applied to avoid drug use during and after

treatment. Therefore, in a complementary

fashion, skills training (including emotion

regulation) is individualized to help those

with SUDs “unlearn old habits associated

with [drug] . . . abuse and learn or relearn

healthier skills and habits” (Carroll, 1998,

p. 2). More specifically, these skills initially

include regulating thoughts about drugs,

learning strategies to regulate cravings for

Emotion Regulation in Substance Use Disorders 439

drugs, and managing situations related to

drug-use opportunities (e.g., refusing offers

of drugs).

Subsequent treatment sessions (modules)

focus on problem solving, tolerating and

regulating negative affect, and improv-

ing social skills more generally. Ultimately,

individuals who undergo CBT (compared to

other treatments) are more likely to decrease

drug use and/or achieve abstinence during

and even after treatment has ended (i.e.,

“the sleeper effect”; Potenza et al., 2011).

Although the treatment includes many mod-

ules and stages, one important mechanism

of action is thought to be via enhancing cog-

nitive control over negative affect that may

lead to drug craving, and over drug crav-

ing and drug taking behavior (e.g., Kiluk,

Nich, Babuscio, & Carroll, 2010; Potenza et

al., 2011). This hypothesis is supported by

the finding that the number and quality of

strategies for regulation of craving increase

from pre- to post-CBT treatment, and pre-

dict relapse (e.g., Carroll et al., 1999), and

formally mediate the relationship between

treatment and duration of abstinence (Kiluk

et al., 2010). In turn, this increase in regula-

tion skills is hypothesized to be mediated by

improved PFC function from pre- to post-

treatment (Potenza et al., 2011; see Figure

26.1B for a schematic illustration). Consis-

tent with this hypothesis, Kober, Kross, et al.

(2010) have shown that use of CBT-like cog-

nitive strategies during cue- induced craving

is associated with decreases in self- reported

craving, as well as increased activity in

dlPFC and vlPFC (Kober, Mende- Siedlecki,

et al., 2010). In addition, DeVito et al. (2011)

recently reported that those who underwent

CBT exhibited increased efficiency in vlPFC

and dlPFC during the Stroop task from pre-

to post-CBT treatment, which is consistent

with improvements in cognitive control and

emotion regulation. However, future studies

should test that hypothesis more directly.

Mindfulness‑Based Treatments

Mindfulness- based treatments (MBTs) for

a variety of psychiatric conditions have

emerged in recent years, beginning with

mindfulness- based stress reduction (MBSR).

Mindfulness has been defined as a two-

component construct: (1) self- regulation of

attention to the present moment, coupled

with (2) an attitude of acceptance toward

the present moment (Bishop et al., 2004). As

such, mindfulness is often practiced through

mindfulness meditation, which consists of

focusing attention on one’s immediate expe-

rience (e.g., sensations, breathing, thoughts,

emotion), and regarding it nonjudgmen-

tally. This is thought to cultivate the abil-

ity to observe— rather than be caught up

in—one’s own experience, and to further

facilitate more skillful or mindful respond-

ing (as opposed to automatic reaction;

Zgierska et al., 2009). Importantly, medita-

tion and MBTs have been associated with

beneficial effects on stress, anxiety, pain,

cardiac health, immune functions, psycho-

logical well-being, cognitive functioning,

and several psychiatric disorders (including

mood and anxiety disorders; see Hölzel et

al., 2011, for review). Therefore, it is not

difficult to extrapolate how MBTs could be

beneficial for fostering better emotion regu-

lation in SUDs.

Indeed, several mindfulness- based treat-

ments have recently been adapted for SUDs.

Unlike the well- established CBTs, these

treatments have just shown preliminary effi-

cacy and are now the focus of rigorous ran-

domized controlled trials. MBTs for SUDs

typically include training in mindfulness

meditation, and a focus on attention to and

acceptance of present- moment experience

(including negative emotion and drug crav-

ing). The modal instruction is to regard inter-

nal experiences (e.g., drug craving) as tran-

sient, and to observe and accept them as-is,

without reacting (e.g., without engaging in

drug use). For example, both mindfulness-

based relapse prevention (MBRP; Bowen,

Chawla, & Marlatt, 2010) and mindfulness

training for smoking (MTS; Brewer et al.,

2011) make use of the concept of “urge surf-

ing,” the practice of regarding craving like a

wave that rises, reaches a peak, and subsides

naturally. Patients are instructed to attend to

and accept the sensations as they rise, fall,

and finally disappear— and this technique

is likened to tolerating cravings rather than

actively regulating them, as in CBT (Brewer

et al., 2011). Consistently, Westbrook et al.

(2013) have shown that mindful attention to

smoking cues is associated with lower self-

reported craving and lower neural activity in

regions previously associated with craving,

without concomitant increases in PFC activ-

440 PSYCHOPATHOLOGY

ity. As such, mindful attention and accep-

tance may be regulatory, by preventing the

amplification of craving rather than damp-

ening them down.

Clinically, MBRP, typically administered

as a follow- up to inpatient treatment, is

reportedly efficacious in reducing drug use

and relapse across several different popu-

lations with SUDs, including alcohol and

polysubstance users (e.g., Witkiewitz &

Bowen, 2010). In addition, Brewer et al.

(2011) have recently shown in a pilot ran-

domized controlled trial that MTS admin-

istered as a stand-alone treatment was effec-

tive in achieving smoking cessation. Finally,

similar elements of mindful attention and

acceptance are parts of dialectical behav-

ior therapy and acceptance and commit-

ment therapy, both of which have shown

preliminary efficacy for SUDs (Hernández-

López, Luciano, Bricker, Roales-Nieto, &

Montesinos, 2009; Linehan et al., 2002).

Taken together, these data show substantial

promise for MBTs in the treatment of SUDs,

although the research is still in its infancy.

Nevertheless, one prominent hypothesis sug-

gests that these treatments work by enhanc-

ing emotion regulation, as patients learn to

practice mindfulness in the face of craving

as well as negative emotion. This is sup-

ported by several findings, including consis-

tent reductions in craving post-MBRP (e.g.,

Witkiewitz & Bowen, 2010), and a negative

correlation after MTS between amount of

meditation practice and smoking (Brewer et

al., 2011).

Concluding Remarks

Casual drug use is quite prevalent, and a

percentage of drug users develop SUDs,

which are severe psychiatric conditions with

staggering social, economic, and personal

costs. This underscores the need to identify

risk factors that render specific individu-

als more vulnerable to the development of

SUDs. Furthermore, once established, SUDs

are chronic, relapsing, and very difficult to

treat psychiatric conditions; this underscores

the need to better characterize the proximal

causal factors that lead to continued drug

use, and to better understand the mecha-

nisms that underlie effective treatments for

these disorders. In this chapter, I reviewed

data suggesting that emotion regulation is

one such crucial factor. Indeed, difficulties

in emotion regulation in childhood and ado-

lescence serve as predictive factors for future

drug use and the development of SUDs. Sub-

sequently, those with SUDs report greater

difficulty regulating negative emotions than

do healthy controls, which contributes to

ongoing drug use. Furthermore, I reviewed

evidence suggesting that craving for drugs is

one of the key predictors of drug use, and

that the ability to regulate craving effec-

tively is directly related to reduced drug use

in SUDs.

Consistent with these observations, psy-

chosocial treatments for SUDs often focus

on emotion regulation and on the regula-

tion of craving as means for reducing drug

use. Indeed, improvement in those skills fol-

lowing treatments such as CBT and MBTs

is associated with improved abstinence.

Finally, I reviewed data suggesting that dif-

ferences in PFC structure, as well as function,

may underlie impaired emotion regulation in

those with SUDs, and that ongoing drug use

leads to adaptations in PFC that may further

impair emotion regulation. However, it will

be critical to focus future research on more

precisely characterizing the neural mecha-

nisms behind observed PFC deficits in SUDs

and behind treatment- related improvements.

Indeed, it is my sincere hope that in the com-

ing years, additional data will allow us to

establish these links more firmly. This could

lead to the development of better treatments

that improve emotion regulation in individ-

uals suffering from these devastating disor-

ders.

Acknowledgments

I would like to thank Danielle Bolling, Cameron

DeLeone, and Maggie Mae Mell for their invalu-

able help preparing this chapter. Thanks also go

to Alan Anticevic, Rebecca Boswell, Kathleen

Carroll, Ralph DiLeone, James Gross, and one

anonymous reviewer, for very helpful comments.

And finally, thanks to all those who investigate

emotion regulation in substance use disorders.

Your work inspired this chapter and will con-

tinue to inspire research in this area for years to

come.

Emotion Regulation in Substance Use Disorders 441

Notes

1. Psychoactive drugs are those that primarily

act on the brain and change thinking, mood,

and behavior. These include legal drugs (e.g.,

alcohol, nicotine, caffeine, and opioid pain

medications), as well as illicit drugs (e.g., her-

oin, cocaine, amphetamines, and marijuana).

2. Self- control is often defined as the process of

inhibition of an otherwise imminent thought,

emotion, or action— and as such, it includes

emotion regulation. Related to this is the

construct of cognitive control, which more

broadly includes goal maintenance, selective

attention, conflict monitoring and resolution,

response inhibition, and emotion regulation.

See Gross (this volume) for discussion.

3. It is now known that many other neurotrans-

mitter systems are involved in drug taking

and in the development of SUDs, and the next

decade will likely bring additional investiga-

tions into other neurotransmitter systems and

their relation to SUDs.

References

American Psychiatric Association. (2013). Diag-

nostic and statistical manual of mental disor-

ders (5th ed.). Arlington, VA: Author.

Alicata, D., Chang, L., Cloak, C., Abe, K., &

Ernst, T. (2009). Higher diffusion in striatum

and lower fractional anisotropy in white mat-

ter of methamphetamine users. Psychiatry

Research: Neuroimaging, 174(1), 1–8.

August, G. J., Winters, K. C., Realmuto, G. M.,

Fahnhorst, T., Botzet, A., & Lee, S. (2006).

Prospective study of adolescent drug use

among community samples of ADHD and

non-ADHD participants. Journal of Ameri-

can Academy of Child and Adolescent Psy-

chiatry, 45(7), 824–832.

Badiani, A., Belin, D., Epstein, D., Calu, D.,

& Shaham, Y. (2011). Opiate versus psycho-

stimulant addiction: The differences do mat-

ter. Nature Reviews Neuroscience, 12(11),

685–700.

Baker, T. B., Piper, M. E., McCarthy, D. E.,

Majeskie, M. R., & Fiore, M. C. (2004).

Addiction motivation reformulated: An affec-

tive processing model of negative reinforce-

ment. Psychological Review, 111(1), 33–51.

Berking, M., Margraf, M., Ebert, D., Wupper-

man, P., Hofmann, S. G., & Junghanns, K.

(2011). Deficits in emotion- regulation skills

predict alcohol use during and after cognitive-

behavioral therapy for alcohol dependence.

Journal of Consulting and Clinical Psychol-

ogy, 79(3), 307–318.

Berkman, E. T., Falk, E. B., & Lieberman, M.

D. (2011). In the trenches of real-world self-

control: Neural correlates of breaking the link

between craving and smoking. Psychological

Science, 22(4), 498–506.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L.,

Anderson, N. D., Carmody, J., et al. (2004).

Mindfulness: A proposed operational defini-

tion. Clinical Psychology: Science and Prac-

tice, 11(3), 230–241.

Bolla, K., Ernst, M., Kiehl, K., Mouratidis, M.,

Eldreth, D., Contoreggi, C., et al. (2004).

Prefrontal cortical dysfunction in abstinent

cocaine abusers. Journal of Neuropsychiatry

and Clinical Neurosciences, 16(4), 456–464.

Bonn- Miller, M. O., Vujanovic, A. A., & Zvo-

lensky, M. J. (2008). Emotional dysregulation:

Association with coping- oriented marijuana

use motives among current marijuana users.

Substance Use and Misuse, 43(11), 1656–1668.

Bora, E., Yücel, M., Fornito, A., Pantelis, C.,

Harrison, B. J., Cocchi, L., et al. (2012).

White matter microstructure in opiate addic-

tion. Addiction Biology, 17(1), 141–148.

Bowen, S., Chawla, N., & Marlatt, G. A. (2010).

Mindfulness- based relapse prevention for

addictive behaviors: A clinician’s guide. New

York: Guilford Press.

Bradizza, C. M., Stasiewicz, P. R., & Paas, N. D.

(2006). Relapse to alcohol and drug use among

individuals diagnosed with co- occurring men-

tal health and substance use disorders: A

review. Clinical Psychology Review, 26(2),

162–178.

Brewer, J. A., Mallik, S., Babuscio, T. A., Nich,

C., Johnson, H. E., Deleone, C. M., et al.

(2011). Mindfulness training for smoking ces-

sation: Results from a randomized controlled

trial. Drug and Alcohol Dependence, 119(1–

2), 72–80.

Brody, A. L., Olmstead, R. E., London, E. D.,

Farahi, J., Meyer, J. H., Grossman, P., et al.

(2004). Smoking- induced ventral striatum

dopamine release. American Journal of Psy-

chiatry, 161(7), 1211–1218.

Carroll, K. M. (1998). Therapy manuals for drug

addiction: A cognitive- behavioral approach:

Treating cocaine addiction. Bethesda, MD:

National Institute of Drug Abuse.

442 PSYCHOPATHOLOGY

Carroll, K. M., Nich, C., Frankforter, T. L., &

Bisighini, R. M. (1999). Do patients change

in the way we intend?: Treatment- specific

skill acquisition in cocaine- dependent patients

using the Cocaine Risk Response Test. Psy-

chological Assessment, 11, 77–85.

Chase, H. W., Eickhoff, S. B., Laird, A. R., &

Hogarth, L. (2011). The neural basis of drug

stimulus processing and craving: An activation

likelihood estimation meta- analysis. Biologi-

cal Psychiatry, 70(8), 785–793.

Childress, A. R., Hole, A. V., Ehrman, R. N.,

Robbins, S. J., McLellan, A. T., & O’Brien,

C. P. (1993). Cue reactivity and cue reactiv-

ity interventions in drug dependence. NIDA

Research Monograph, 137, 73–73.

Cordovil de Sousa Uva, M., Timary, P., Cortesi,

M., Mikolajczak, M., Blicquy, P. R., & Lumi-

net, O. (2010). Moderating effect of emotional

intelligence on the role of negative affect in

the motivation to drink in alcohol- dependent

subjects undergoing protracted withdrawal.

Personality and Individual Differences, 48(1),

16–21.

Crits- Christoph, P., Gibbons, M. B. C., Barber, J.

P., Hu, B., Hearon, B., Worley, M., & Gallop,

R. (2007). Predictors of sustained abstinence

during psychosocial treatments for cocaine

dependence. Psychotherapy Research, 17(2),

240–252.

Daughters, S. B., Lejuez, C., Bornovalova, M.

A., Kahler, C. W., Strong, D. R., & Brown,

R. A. (2005). Distress tolerance as a predic-

tor of early treatment dropout in a residential

substance abuse treatment facility. Journal of

Abnormal Psychology, 114(4), 729–734.

Daumann, J., Koester, P., Becker, B., Wagner,

D., Imperati, D., Gouzoulis- Mayfrank, E.,

& Tittgemeyer, M. (2011). Medial prefron-

tal gray matter volume reductions in users

of amphetamine- type stimulants revealed by

combined tract-based spatial statistics and

voxel-based morphometry. NeuroImage,

54(2), 794–801.

DeVito, E. E., Kober, H., Carroll, K. M., &

Potenza, M. N. (in preparation). Sex differ-

ences in the neural correlates of cognitive con-

trol in cocaine dependence.

DeVito, E. E., Worhunsky, P. D., Carroll, K. M.,

Rounsaville, B. J., Kober, H., & Potenza, M.

N. (2011). A preliminary study of the neural

effects of behavioral therapy for substance use

disorders. Drug and Alcohol Dependence,

122(3), 228–235.

Dichiara, G., & Imperato, A. (1988). Drugs

abused by humans preferentially increase syn-

aptic dopamine concentrations in the meso-

limbic system of freely moving rats. Proceed-

ings of the National Academy of Sciences

USA, 85(14), 5274–5278.

Durazzo, T. C., Tosun, D., Buckley, S., Gazdz-

inski, S., Mon, A., Fryer, S. L., & Meyerhoff,

D. J. (2011). Cortical thickness, surface area,

and volume of the brain reward system in alco-

hol dependence: Relationships to relapse and

extended abstinence. Alcoholism: Clinical and

Experimental Research, 35, 1187–1200.

Dutra, L., Stathopoulou, G., Basden, S. L.,

Leyro, T. M., Powers, M. B., & Otto, M. W.

(2008). A meta- analytic review of psychoso-

cial interventions for substance use disorders.

American Journal of Psychiatry, 165(2), 179–

187.

Eldreth, D. A., Matochik, J. A., Cadet, J. L., &

Bolla, K. I. (2004). Abnormal brain activity

in prefrontal brain regions in abstinent mari-

juana users. NeuroImage, 23(3), 914–920.

Epstein, D. H., Marrone, G. F., Heishman, S.

J., Schmittner, J., & Preston, K. L. (2010).

Tobacco, cocaine, and heroin: Craving and use

during daily life. Addictive Behaviors, 35(4),

318–324.

Ersche, K. D., Jones, P. S., Williams, G. B., Tur-

ton, A. J., Robbins, T. W., & Bullmore, E.

T. (2012). Abnormal brain structure impli-

cated in stimulant drug addiction. Science,

335(6068), 601–604.

Everitt, B. J., & Robbins, T. W. (2005). Neural

systems of reinforcement for drug addiction:

From actions to habits to compulsion. Nature

Neuroscience, 8(11), 1481–1489.

Fein, G., Di Sclafani, V., Cardenas, V., Gold-

mann, H., Tolou-Shams, M., & Meyerhoff,

D. J. (2002). Cortical gray matter loss in

treatment- naive alcohol dependent individu-

als. Alcoholism: Clinical and Experimental

Research, 26(4), 558–564.

Fein, G., Di Sclafani, V., & Meyerhoff, D. J.

(2002). Prefrontal cortical volume reduction

associated with frontal cortex function deficit

in 6-week abstinent crack- cocaine dependent

men. Drug and Alcohol Dependence, 68(1),

87–93.

Fox, H. C., Hong, K. A., & Sinha, R. (2008).

Difficulties in emotion regulation and impulse

control in recently abstinent alcoholics com-

pared with social drinkers. Addictive Behav-

iors, 33(2), 388–394.

Franklin, T. R., Acton, P. D., Maldjian, J. A.,

Gray, J. D., Croft, J. R., Dackis, C. A., et al.

Emotion Regulation in Substance Use Disorders 443

(2002). Decreased gray matter concentration

in the insular, orbitofrontal, cingulate, and

temporal cortices of cocaine patients. Biologi-

cal Psychiatry, 51(2), 134–142.

Fu, L., Bi, G., Zou, Z., Wang, Y., Ye, E., Ma,

L., et al. (2008). Impaired response inhibition

function in abstinent heroin dependents: An

fMRI study. Neuroscience Letters, 438(3),

322–326.

Fucito, L. M., Juliano, L. M., & Toll, B. A.

(2010). Cognitive reappraisal and expressive

suppression emotion regulation strategies

in cigarette smokers. Nicotine and Tobacco

Research, 12(11), 1156–1161.

Galloway, G. P., Singleton, E. G., & the Meth-

amphetamine Treatment Project Corporate

Authors. (2008). How long does craving pre-

dict use of methamphetamine?: Assessment of

use one to seven weeks after the assessment

of craving. Substance Abuse: Research and

Treatment, 1, 63–79.

Gamble, S. A., Conner, K. R., Talbot, N. L., Yu,

Q., Tu, X. M., & Connors, G. J. (2010). Effects

of pretreatment and posttreatment depressive

symptoms on alcohol consumption following

treatment in project MATCH. Journal of Stud-

ies on Alcohol and Drugs, 71(1), 71–77.

Giedd, J. N., Blumenthal, J., Jeffries, N. O., Cas-

tellanos, F. X., Liu, H., Zijdenbos, A., et al.

(1999). Brain development during childhood

and adolescence: A longitudinal MRI study.

Nature Neuroscience, 2, 861–862.

Gilbert, D. G., Crauthers, D. M., Mooney, D.

K., McClernon, F. J., & Jensen, R. A. (1999).

Effects of monetary contingencies on smoking

relapse: Influences of trait depression, person-

ality, and habitual nicotine intake. Experi-

mental and Clinical Psychopharmacology,

7(2), 174–181.

Goldstein, R. Z., & Volkow, N. D. (2011). Dys-

function of the prefrontal cortex in addiction:

Neuroimaging findings and clinical implica-

tions. Nature Reviews Neuroscience, 12(11),

652– 669.

Gouzoulis- Mayfrank, E., & Daumann, J. (2009).

Neurotoxicity of drugs of abuse—the case of

methylenedioxy amphetamines (MDMA,

ecstasy), and amphetamines. Dialogues in

Clinical Neuroscience, 11(3), 305–317.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Haney, M., Maccari, S., Le Moal, M., Simon,

H., & Vincenzo Piazza, P. (1995). Social

stress increases the acquisition of cocaine self-

administration in male and female rats. Brain

Research, 698(1–2), 46–52.

Hart, C. L., Marvin, C. B., Silver, R., & Smith,

E. E. (2011). Is cognitive functioning impaired

in methamphetamine users?: A critical review.

Neuropsychopharmacology, 37(3), 586–608.

Hart, C. L., Ward, A. S., Haney, M., Foltin, R.

W., & Fischman, M. W. (2001). Methamphet-

amine self- administration by humans. Psycho-

pharmacology, 157(1), 75–81.

Heinz, A., Siessmeier, T., Wrase, J., Buchholz, H.

G., Gründer, G., Kumakura, Y., et al. (2005).

Correlation of alcohol craving with striatal

dopamine synthesis capacity and D2/3 recep-

tor availability: A combined [18F]DOPA and

[18F]DMFP PET study in detoxified alcoholic

patients. American Journal of Psychiatry,

162(8), 1515–1520.

Hernández-López, M., Luciano, M. C., Bricker,

J. B., Roales-Nieto, J. G., & Montesinos, F.

(2009). Acceptance and commitment therapy

for smoking cessation: A preliminary study of

its effectiveness in comparison with cognitive

behavioral therapy. Psychology of Addictive

Behaviors, 23(4), 723–730.

Hester, R., & Garavan, H. (2004). Executive

dysfunction in cocaine addiction: Evidence

for discordant frontal, cingulate, and cerebel-

lar activity. Journal of Neuroscience, 24(49),

11017–11022.

Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-

Olivier, Z., Vago, D. R., & Ott, U. (2011).

How does mindfulness meditation work?:

Proposing mechanisms of action from a con-

ceptual and neural perspective. Perspectives

on Psychological Science, 6(6), 537–559.

Ivanov, I., Newcorn, J., Morton, K., & Tri-

camo, M. (2011). Inhibitory control deficits

in childhood: Definition, measurement, and

clinical risk for substance use disorders. In M.

T. Bardo (Ed.), Inhibitory control and drug

abuse prevention: From research to trans-

lation (pp. 125–144). New York: Springer

Science+Business Media.

Jaffe, J. H., & Jaffe, F. K. (1989). Historical per-

spectives on the use of subjective effects mea-

sures in assessing the abuse potential of drugs.

NIDA Research Monographs, 92, 43–72.

Johnstone, T., & Walter, H. (this volume, 2014).

The neural basis of emotion dysregulation. In

J. J. Gross (Ed.), Handbook of emotion regu-

lation (2nd ed., pp. 58–75). New York: Guil-

ford Press.

444 PSYCHOPATHOLOGY

Jones, B. T., Corbin, W., & Fromme, K. (2001).

A review of expectancy theory and alcohol

consumption. Addiction, 96, 57–72.

Kessler, R. C., Berglund, P., Demler, O., Jin, R.,

Merikangas, K. R., & Walters, E. E. (2005).

Lifetime prevalence and age-of-onset distri-

butions of DSM-IV disorders in the National

Comorbidity Survey Replication. Archives of

General Psychiatry, 62(6), 593–602.

Khantzian, E. J. (1985). The self- medication

hypothesis of addictive disorders: focus on

heroin and cocaine dependence. American

Journal of Psychiatry, 142(11), 1259–1264.

Kiluk, B. D., Nich, C., Babuscio, T., & Carroll,

K. M. (2010). Quality versus quantity: Acqui-

sition of coping skills following computerized

cognitive behavioral therapy for substance use

disorders. Addiction, 105(12), 2120–2127.

Kober, H., & DeLeone, C. M. (2011). Smoking

and neuroimaging: A review. Current Cardio-

vascular Risk Reports, 5(6), 484–491.

Kober, H., DeVito, E. E., DeLeone, C. M., Car-

roll, K. M., & Potenza, M. N. (under review).

Pre- treatment neural activity in cannabis

users differs from controls and relates to long

term treatment outcome.

Kober, H., Kross, E. F., Mischel, W., Hart, C. L.,

& Ochsner, K. N. (2010). Regulation of crav-

ing by cognitive strategies in cigarette smok-

ers. Drug and Alcohol Dependence, 106(1),

52–55.

Kober, H., Mende- Siedlecki, P., Kross, E. F.,

Weber, J., Mischel, W., Hart, C. L., et al.

(2010). Prefrontal– striatal pathway underlies

cognitive regulation of craving. Proceedings of

the National Academy of Sciences, 107(33),

14811–14816.

Kober, H., Turza, A. C., & Hart, C. L. (2009).

Risk factors for substance use, abuse, and

dependence: Learning. In H. Kranzler & P.

Korsmeyer (Eds.), Encyclopedia of drugs,

alcohol, and addictive behavior (3rd ed.).

Macmillan Reference USA.

Koob, G. F., & Le Moal, M. (2008). Neurobio-

logical mechanisms for opponent motivational

processes in addiction. Philosophical Transac-

tions of the Royal Society B: Biological Sci-

ences, 363(1507), 3113–3123.

Kun, B., & Demetrovics, Z. (2010). Emotional

intelligence and addictions: A systematic

review. Substance Use and Misuse, 45(7–8),

1131–1160.

Le Moal, M. (2009). Drug abuse: Vulnerability

and transition to addiction. Pharmacopsychi-

atry, 42(S1), 542–555.

Li, C. S. R., Huang, C., Yan, P., Bhagwagar, Z.,

Milivojevic, V., & Sinha, R. (2008). Neural

correlates of impulse control during stop sig-

nal inhibition in cocaine- dependent men. Neu-

ropsychopharmacology, 33(8), 1798–1806.

Li, C. S. R., Luo, X., Yan, P., Bergquist, K., &

Sinha, R. (2009). Altered impulse control in

alcohol dependence: Neural measures of stop

signal performance. Alcoholism: Clinical and

Experimental Research, 33(4), 740–750.

Linehan, M. M., Dimeff, L. A., Reynolds, S. K.,

Comtois, K. A., Welch, S. S., Heagerty, P., et

al. (2002). Dialectical behavior therapy versus

comprehensive validation therapy plus 12-step

for the treatment of opioid dependent women

meeting criteria for borderline personality dis-

order. Drug and Alcohol Dependence, 67(1),

13–26.

Litt, M. D., Cooney, N. L., & Morse, P. (2000).

Reactivity to alcohol- related stimuli in the

laboratory and in the field: Predictors of crav-

ing in treated alcoholics. Addiction, 95(6),

889–900.

Littel, M., & Franken, I. H. A. (2011). Inten-

tional modulation of the late positive potential

in response to smoking cues by cognitive strat-

egies in smokers. PloS ONE, 6(11), e27519.

Liu, H., Li, L., Hao, Y., Cao, D., Xu, L.,

Rohrbaugh, R., et al. (2008). Disrupted white

matter integrity in heroin dependence: A con-

trolled study utilizing diffusion tensor imag-

ing. American Journal of Drug and Alcohol

Abuse, 34(5), 562–575.

Luerssen, A., & Ayduk, O. (this volume, 2014).

The role of emotion and emotion regulation in

the ability to delay gratification. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., 111–125). New York: Guilford Press.

Lüscher, C., & Malenka, R. C. (2011). Drug-

evoked synaptic plasticity in addiction: From

molecular changes to circuit remodeling. Neu-

ron, 69(4), 650–663.

Marlatt, G. A., & Witkiewitz, K. (2005). Relapse

prevention for alcohol and drug problems. In

G. Marlatt & D. Donovan (Eds.), Relapse

prevention: Maintenance strategies in the

treatment of addictive behaviors (2nd ed.,

pp. 1–44). New York: Guilford Press.

Marshall- Berenz, E. C., Vujanovic, A. A., &

MacPherson, L. (2011). Impulsivity and alco-

hol use coping motives in a trauma- exposed

sample: The mediating role of distress toler-

ance. Personality and Individual Differences,

50(5), 588–592.

McRae, K., Gross, J. J., Weber, J., Robertson, E.

Emotion Regulation in Substance Use Disorders 445

R., Sokol- Hessner, P., Ray, R. D., et al. (2012).

The development of emotion regulation: An

fMRI study of cognitive reappraisal in chil-

dren, adolescents and young adults. Social

Cognitive and Affective Neuroscience, 7(1),

11–22.

Miller, E. K., & Cohen, J. D. (2001). An inte-

grative theory of prefrontal cortex function.

Annual Review of Neuroscience, 24(1), 167–

202.

Mischel, W., Ayduk, O., Berman, M. G., Casey,

B., Gotlib, I. H., Jonides, J., et al. (2011).

‘Willpower’ over the life span: Decomposing

self- regulation. Social Cognitive and Affective

Neuroscience, 6(2), 252–256.

Moffitt, T. E., Arseneault, L., Belsky, D., Dick-

son, N., Hancox, R. J., Harrington, H. L., et

al. (2011). A gradient of childhood self- control

predicts health, wealth, and public safety.

Proceedings of the National Academy of Sci-

ences, 108(7), 2693–2698.

Morasco, B. J., Gritzner, S., Lewis, L., Oldham,

R., Turk, D. C., & Dobscha, S. K. (2011). Sys-

tematic review of prevalence, correlates, and

treatment outcomes for chronic non- cancer

pain in patients with comorbid substance use

disorder. Pain, 152(3), 488– 497.

National Institute of Mental Health (NIMH).

(2007). National Comorbidity Survey: Life-

time prevalence estimates. Available from

www.hcp.med.harvard.edu/ncs.

Nestor, L. J., Ghahremani, D. G., Monterosso,

J., & London, E. D. (2011). Prefrontal hypoac-

tivation during cognitive control in early absti-

nent methamphetamine- dependent subjects.

Psychiatry Research: Neuroimaging, 194(3),

287–295.

Nunes, E. V., & Levin, F. R. (2004). Treatment

of depression in patients with alcohol or other

drug dependence. Journal of the American

Medical Association, 291(15), 1887–1896.

O’Brien, C. P., Childress, A. R., Ehrman, R.,

& Robbins, S. J. (1998). Conditioning fac-

tors in drug abuse: Can they explain compul-

sion? Journal of Psychopharmacology, 12(1),

15–22.

Ochsner, K. N., & Gross, J. J. (this volume, 2014).

The neural bases of emotion and emotion regu-

lation: A valuation perspective. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp. 23–42). New York: Guilford Press.

O’Connell, K. A., Hosein, V. L., Schwartz, J. E.,

& Leibowitz, R. Q. (2007). How does coping

help people resist lapses during smoking cessa-

tion? Health Psychology, 26(1), 77–84.

Perkins, K. A. (2009). Does smoking cue- induced

craving tell us anything important about nico-

tine dependence? Addiction, 104(10), 1610–

1616.

Pfefferbaum, A., Rosenbloom, M., Rohlfing,

T., & Sullivan, E. V. (2009). Degradation of

association and projection white matter sys-

tems in alcoholism detected with quantitative

fiber tracking. Biological Psychiatry, 65(8),

680–690.

Pfeifer, J. H., Lieberman, M. D., & Dapretto, M.

(2007). “I know you are but what am I?”: Neu-

ral bases of self-and social knowledge retrieval

in children and adults. Journal of Cognitive

Neuroscience, 19(8), 1323–1337.

Potenza, M. N., Sofuoglu, M., Carroll, K. M.,

& Rounsaville, B. J. (2011). Neuroscience of

behavioral and pharmacological treatments

for addictions. Neuron, 69(4), 695–712.

Rando, K., Hong, K. I., Bhagwagar, Z., Li, C. S.

R., Bergquist, K., Guarnaccia, J., et al. (2011).

Association of frontal and posterior corti-

cal gray matter volume with time to alcohol

relapse: A prospective study. American Jour-

nal of Psychiatry, 168(2), 183–192.

Riediger, M., & Klipker, K. (this volume, 2014).

Emotion regulation in adolescence. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., 187–202). New York: Guilford Press.

Riley, H., & Schutte, N. S. (2003). Low emo-

tional intelligence as a predictor of substance-

use problems. Journal of Drug Education,

33(4), 391–398.

Romero, M. J., Asensio, S., Palau, C., Sanchez,

A., & Romero, F. J. (2010). Cocaine addiction:

Diffusion tensor imaging study of the inferior

frontal and anterior cingulate white matter.

Psychiatry Research: Neuroimaging, 181(1),

57–63.

Shiffman, S., Dunbar, M., Kirchner, T., Li, X.,

Tindle, H., Anderson, S., et al. (2013). Smoker

reactivity to cues: Effects on craving and on

smoking behavior. Journal of Abnormal Psy-

chology, 122(1), 264–280.

Shiffman, S., Paty, J. A., Gnys, M., Kassel, J. A.,

& Hickcox, M. (1996). First lapses to smok-

ing: Within- subjects analysis of real-time

reports. Journal of Consulting and Clinical

Psychology, 64(2), 366–379.

Silvers, J. A., McRae, K., Gabrieli, J. D. E.,

Gross, J. J., Remy, K. A., & Ochsner, K. N.

(2012). Age- related differences in emotional

reactivity, regulation, and rejection sensitiv-

ity in adolescence. Emotion, 12(6), 1235–

1247.

446 PSYCHOPATHOLOGY

Sinha, R., & Li, C. S. R. (2007). Imaging stress-

and cue- induced drug and alcohol craving:

Association with relapse and clinical impli-

cations. Drug and Alcohol Review, 26(1),

25–31.

Sorg, S. F., Taylor, M. J., Alhassoon, O. M.,

Gongvatana, A., Theilmann, R. J., et al.

(2012). Frontal white matter integrity predic-

tors of adult alcohol treatment outcome. Bio-

logical Psychiatry, 71, 262–268.

Steinberg, L. (2005). Cognitive and affective

development in adolescence. Trends in Cogni-

tive Sciences, 9(2), 69–74.

Substance Abuse and Mental Health Services

Administration (SAMHSA). (2011). Results

from the 2010 National Survey on Drug Use

and Health (NSDUH): Summary of national

findings (NSDUH Series H-41). Rockville,

MD: Author.

Tabibnia, G., Monterosso, J. R., Baicy, K., Aron,

A. R., Poldrack, R. A., Chakrapani, S., et al.

(2011). Different forms of self- control share a

neurocognitive substrate. Journal of Neurosci-

ence, 31(13), 4805–4810.

Taioli, E., & Wynder, E. L. (1991). Effect of the

age at which smoking begins on frequency of

smoking in adulthood. New England Journal

of Medicine, 325(13), 968–969.

Tarter, R. E., Kirisci, L., Mezzich, A., Cornelius,

J. R., Pajer, K., Vanyukov, M., et al. (2003).

Neurobehavioral disinhibition in childhood

predicts early age at onset of substance use

disorder. American Journal of Psychiatry,

160(6), 1078–1085.

Verdejo- García, A., Lawrence, A. J., & Clark, L.

(2008). Impulsivity as a vulnerability marker

for substance- use disorders: Review of find-

ings from high-risk research, problem gam-

blers and genetic association studies. Neuro-

science and Biobehavioral Reviews, 32(4),

777–810.

Volkow, N. D., Fowler, J., Wang, G., Telang, F.,

Logan, J., Jayne, M., et al. (2010). Cognitive

control of drug craving inhibits brain reward

regions in cocaine abusers. NeuroImage, 49,

2536–2543.

Volkow, N. D., Wang, G. J., Fowler, J. S., &

Tomasi, D. (2011). Addiction Circuitry in the

Human Brain. Annual review of pharmacol-

ogy and toxicology, 52(1), 321–336.

Weiss, F., & Koob, G. F. (2001). Drug addiction:

Functional neurotoxicity of the brain reward

systems. Neurotoxicity Research, 3(1), 145–

156.

Westbrook, C., Creswell, J. D., Tabibnia, G., Jul-

son, E., Kober, H., & Tindle, H. A. (2013).

Mindful attention reduces neural and self-

reported cue- induced craving in smokers.

Social Cognitive and Affective Neuroscience,

8(1), 73–84.

Witkiewitz, K., & Bowen, S. (2010). Depres-

sion, craving, and substance use following a

randomized trial of mindfulness- based relapse

prevention. Journal of Consulting and Clini-

cal Psychology, 78(3), 362–374.

Zgierska, A., Rabago, D., Chawla, N., Kushner,

K., Koehler, R., & Marlatt, A. (2009). Mind-

fulness meditation for substance use disorders:

A systematic review. Substance Abuse, 30(4),

266–294.

447

For the last several centuries, philosophers,

and later, psychologists have assumed that

the mind works like a machine— a printing

press, a switchboard, a computer. According

to the machine metaphor, the mind consists

of a number of functionally distinct pro-

cesses (mental “modules” or “faculties”) that

interact with one another; if separated, these

processes would still retain their identity and

function. The machine metaphor dictates a

particular view of mental causation: “Psy-

chological process A” localized in one swath

of brain tissue (a region or a network) causes

a change in a separate and distinct “psycho-

logical process B” localized in another swath

of tissue (see Figure 27.1). A good example

of the machine metaphor at work can be

found in the science of emotion regulation.

It is largely assumed, for example, that an

emotion, like fear, is created by one process

computed in one part of the brain (usually

in subcortical limbic or paralimbic cortex)

that is regulated by executive or other cogni-

tive processes located elsewhere in the brain

(typically somewhere in prefrontal cortex).

In the process model of emotion regulation

(Gross, this volume), an emotion can be trig-

gered first, then subsequently is regulated

(e.g., you are walking in the woods, and a

fuzzy bee buzzing around your head triggers

a state of fear, which you then regulate by

suppressing the urge to run and by distract-

ing yourself with a close examination of the

local scenery, such as an interestingly shaped

rock or tree). Regulation might also occur

before the response occurs, preempting the

CHAPTER 27

A Psychological Construction Account

of Emotion Regulation and Dysregulation:

The Role of Situated Conceptualizations

Lisa Feldman Barrett

Christine D. Wilson-Mendenhall

Lawrence W. Barsalou

FIGURE 27.1. A depiction of the machine meta-

phor of brain function.

448 PSYCHOPATHOLOGY

emotion from ever taking place (e.g., before

you start your walk, you might remind your-

self that bees are a part of nature; they pol-

linate beautiful flowers and make delicious

honey). Regardless of which comes first, the

emotion is separate from its regulation.

In the last several years, scientists have

come to question whether the mind and

brain work like a machine with separate,

interacting bits and pieces (e.g., Barrett,

2009), and assumptions about modularity,

even in sensory cortices, are strongly in ques-

tion. As a consequence, other working meta-

phors for the mind and the brain are more

apt—say, molecules that are constructed of

atoms, chamber music emerging from the

interplay of instruments, or recipes from

a well- stocked pantry full of ingredients.

These metaphors begin with a deceptively

simple observation: During every moment

of waking life, the brain takes in sensory

input captured from the world outside the

skin (light, vibrations, odors, etc.) and sen-

sations captured from within the body that

holds the brain (the internal “milieu”), and

uses knowledge from prior experience (also

variously called concepts, memories, associ-

ations, beliefs, predictions, etc.)—stored in

association cortex, and in sensory neurons

and subcortical regions— and makes those

sensory inputs meaningful. This occurs by

creating situated conceptualizations (Bar-

rett, 2006, 2012; Barsalou, 2003, 2009;

Barsalou, Niedenthal, Barbey, & Ruppert,

2003; Wilson- Mendenhall, Barrett, Sim-

mons, & Barsalou, 2011). A situated con-

ceptualization initially is like a prediction

of what sensory input stands for in the

world (i.e., object or event identification),

which properties are salient (i.e., deserving

of attention), what to do about that sensory

input (i.e., a predicted action), and what the

homeostatic and metabolic consequences

will be (i.e., affective changes). From our

perspective, the brain’s architecture can be

thought of as a situated conceptualization

generator producing the individual brain

states that correspond to each individual

mental state, such as an individual instance

of fear or an instance of regulation.

Building on the kitchen metaphor (in Bar-

rett, 2009), we have proposed that each

brain state, each situated conceptualization,

can be understood in terms of more core sys-

tems (i.e., the ingredients), which can them-

selves be characterized at both the psycho-

logical level (e.g., Barrett, 2006, 2012) and

the level of brain networks (e.g., Barrett &

Satpute, 2013; Lindquist & Barrett, 2012).

These core systems are like the “mental state

variables” (see Salzman & Fusi, 2010), fac-

ets or core systems that describe the brain

state. As basic “ingredients” of the mind,

they are necessary for but not specific to

emotion generation, or to emotion regula-

tion per se, just as flour and salt are nec-

essary for but not specific to bread. As the

brain transitions from one state to another,

mental states ebb and flow, and people give

special names to these different states. We

refer to this as a psychological construction-

ist, or merely a constructionist, approach to

the mind and brain. From this construction-

ist point of view, emotions are not unique

mental states that are caused by dedicated

mechanisms, to be modified by another set of

dedicated regulatory mechanisms. Instead,

emotions emerge, and regulation occurs, as

the consequence of an ongoing, continually

modified constructive process that makes

sensory inputs meaningful. Every mental

state, including an emotion both before and

after regulation is said to have occurred, is

a situated conceptualization, constructed

from assemblies of neurons that perform

sensory, conceptual, attentional, and action

functions.

In this chapter, we examine in more detail

the concept of emotion regulation as result-

ing from the never ending sequence of situ-

ated conceptualizations that occur as the

brain transitions from one state to another.

First, we introduce the general idea that

knowledge (as reactivation and recombina-

tion of prior experience) gives meaning to

incoming sensory input and is itself enac-

tive (i.e., adds novel features via perceptual

inference). Next, we link these notions to the

idea of situated conceptualizations from the

literature on concepts and categories, and

discuss how we have broadened it into a gen-

eral proposal of constructed mental states

that involve making meaning of sensory

input and even modifying sensations during

the process. We then discuss how emotions

might be understood as situated conceptual-

izations, and how emotion regulation might

be reconceptualized as shifting from one sit-

uated conceptualization to another. Finally,

we use this framework to consider how emo-

Emotion Regulation as Situated Conceptualizations 449

tional dysregulation might be understood in

terms of the situated conceptualizations that

are constructed.

Making Meaning of Sensory Input

Take a look at the image in Figure 27.2. As

you look at this image, your brain is try-

ing to make sense of the visual input it is

receiving. If you are having difficulty mak-

ing sense of the visual input from the image

(e.g., you cannot recognize an object in it),

then you are in a state of experiential blind-

ness (e.g., Fine, Wade, Brewer, May, Good-

man, et al., 2003). This is because, usually,

in the blink of an eye, quite automatically

and with no effort whatsoever, your brain

is able to integrate impinging sensory stim-

ulation seamlessly with its vast amount of

stored knowledge (from prior experience),

allowing you to construct a visual represen-

tation of the object. Such knowledge is not

merely helpful— it is necessary to normal

perception. Without prior experience, the

sensations are meaningless, and if this were

an object before you, in three- dimensional

space, you would not know how to act on

it. The definition of adaptive behavior is the

use of past experience to guide future action.

Now look at the image at the end of the

chapter (on page 465). Then return to look

again at Figure 27.2.

We hope you can now see the object,

because you have had an experience to help

you make sense of the visual input. The first

lesson here is that it very difficult to “unsee”

the object in the original “blobby” black-

and-white image. A second lesson is that no

matter how hard you try, you cannot gain

introspective access to the processes in your

brain that underlie using stored knowledge

to make incoming sensations meaningful.

Experimental methods are necessary to

unmask its workings. The third lesson from

this example is that your brain infers ele-

ments of the experience that are not imme-

diately present (e.g., the lines that link the

black and gray blobs together into the shape

of a bee). Although you cannot gain intro-

spective access to these inferred features, you

can get a sense that this inference process

works by conjuring some additional percep-

tual detail— the soft drone of buzzing, or the

delicate flutter of wings. In your mind’s eye,

you might see the object nose around as it

searches for pollen. You might even be able

to smell the sweet fragrance of the flower.

Inference is considered one of the primary

purposes of memory and is how experiences

of the past help to inform situated action

in the present. You could not survive in the

world without this capacity. Some scientists

refer to this inference process as simulation

(e.g., Barsalou, 1999, 2009), where you can

connect immediate sensory input with a vast

body of sensory, motor, affective, and other,

related information stored in memory; we

also refer to it as categorization (Barrett,

2006).

The fourth lesson is that these inferences

prepare you for situated action. For some

people, perhaps, who have experienced

bees as part of a beautiful garden and/or

as producing a sweet, tasty delight (honey),

the image of a bee is calming and bucolic.

FIGURE 27.2. An illustration of experiential blindness.

450 PSYCHOPATHOLOGY

For them, seeing a bee might mean moving

in to get a closer look, with an associated

reduction in heart rate, blood pressure, and

skin conductance. For other people, perhaps

who have been stung, resulting in pain and

swelling, the image of a bee is terrifying. For

these people, seeing a bee might mean freez-

ing, with an associated increase in heart

rate, blood pressure, and skin conductance.

Or, it might mean waving their arms or run-

ning away, with an increase in heart rate and

skin conductance but a decrease in blood

pressure. These are the sorts of physiologi-

cal changes that we scientists record when

we show study participants images from

the International Affective Picture System

(IAPS; Lang, Bradley, & Curthbert, 2008)

stimulus set (e.g., Bradley, Codispoti, Cuth-

bert, & Lang, 2001). They arise during a

prediction of how the body should respond

in a specific situation (what we have previ-

ously referred to as an “affective predic-

tion”; Barrett & Bar, 2009).

The fifth lesson from this example is that

the process of making meaning of external

sensations will always produce some kind of

automatic change in your physical state. It

is these internal sensations that likely form

the basis of your pleasant or unpleasant core

affective tone that accompanies any men-

tal states of which it is a part (Barrett &

Bliss- Moreau, 2009; Russell, 2003; Wundt,

1897); the actual visceral changes are not

necessary for feeling, of course, although

some representation of them in the brain is

required. In the same way that your brain

used prior experience to make meaning of

the visual sensations in Figure 27.2, it will

also use such knowledge to make mean-

ing of these bodily sensations. These two

meaning- making achievements are not hap-

pening in quick succession— they are occur-

ring simultaneously, as a function of how

the brain understands the current sensory

array to create a unified conscious moment

(cf. Barrett, 2009). They are not occurring

in a single instant, but they are evolving over

time. This meaning making rarely happens

deliberately, but more often occurs as instan-

taneously, continuously, and effortlessly for

internal sensations as it does for external

sensations. These insights form the basis of

our conceptual act theory of emotion (Bar-

rett, 2006). You experience a perception of

the situation versus an emotion as a function

of your attentional focus. When sensations

from the visual world are foregrounded (and

sensations from the body are in the back-

ground), you experience the bee as friendly

or wicked because you are focused on the

bee, and not on how your body is respond-

ing to the bee (e.g., Anderson, Siegel, White,

& Barrett, 2012). When sensations from

the body are foregrounded, either because

they are particularly intense, because such

focus has been useful and reinforced in a

prior situation like this one, or because you

focus explicitly on them, you will experience

either tranquility or distress.

The sixth lesson from this example is

that prior experiences seed the construction

of present and future experiences by shap-

ing the meaning of momentary, incoming

sensory input. Why might you automati-

cally experience the calm of a bee buzzing

in a bucolic garden, whereas another person

might automatically experience the terror of

a bee attacking and stinging the body? The

answer lies in the nature of prior experience.

Actual experiences with bees, movie scenes

that involve bees, stories, or simply instruc-

tion about bees constitute the knowledge

that is used to make sensations meaning-

ful. Your learning history predisposes you

to experience sensations from the world and

from your own body in particular modal

ways. All things being equal, you have

developed experiential “habits”—what you

have experienced in the past is very likely

what you will experience in the present,

because stored representations of the past

help to constitute the present (hence, the

phrase “the remembered present”; Edelman,

1998). It is now well known that the same

brain network (termed the default mode or

mentalizing network) involved in long-term

memory is also important for imagining the

future (Andrews- Hanna, Reidler, Sepul-

cre, Poulin, & Buckner, 2010), and recent

evidence suggests that these networks are

also important for constructing emotions in

the present (Kober et al., 2008). It is very

likely that when faced with the visual input

in Figure 27.2 your brain reconstituted a

number of different associations that were

in competition with one another, and that

via a variety of selection processes (Barrett,

Tugade, & Engle, 2004; Sporns, Tononi, &

Edelman, 2000a, 2000b), only one was fully

realized (perhaps according to the logic of

Emotion Regulation as Situated Conceptualizations 451

constraint satisfaction) (e.g., Barrett, Och-

sner, & Gross, 2007; Barsalou et al., 2003).

The same logic might hold for making mean-

ing of internal sensations. When is a high

arousal state fear, or anger, or excitement? It

might depend on your prior experience with

these sensations in different contexts, and in

particular, how those various instances were

paired with emotion words such as “fear,”

“anger,” or “excitement” (cf. Barrett, 2006;

Barrett, Lindquist, & Gendron, 2007). With

additional learning or training, it should be

possible to change your experiential habits.

By deliberately cultivating certain types of

experiences, it should be possible to modify

the population of representations that are

available for use in the present.

Situated Conceptualizations

In our prior writing, we have focused on

the process of meaning making as a psy-

chological construction of emotion that

involves creating situated conceptualiza-

tions of internal bodily sensations that are

highly context- dependent and coordinated

with the immediate situation (cf. Barrett,

2006; Wilson- Mendenhall et al., 2011). In

fact, however, the notion of a situated con-

ceptualization implies that people are mak-

ing meaning of both internal and external

sensations at the same time, to create a uni-

fied conscious field (cf. Barrett, 2009). Con-

ceptual knowledge is distributed throughout

the brain’s modal systems for perception and

action in the form of simulators that reenact

sensory, action, affect, and other elements

of situations captured through experience

(e.g., Barsalou, 1999; Simmons & Barsalou,

2003). From this perspective, knowledge is

central to not only the cognition involved in

thinking and imagining offline (reenacting

or simulating a situation that is not present)

but also to perceiving external sensations

from the world and internal sensations from

the body (in which case knowledge fuses

with impinging sensory input—this fusion

occurs seamlessly because knowledge is

stored and represented in the same format

or “language” as the sensations), both of

which are involved in predicting and guid-

ing one’s actions. In this sense, conceptual

knowledge is enactive. When your brain

was foregrounding your bodily sensations

while viewing the bee a few paragraphs ear-

lier, for example, perhaps you experienced

the moment as an emotion; when the focus

was on the visual sensations, perhaps you

experienced it merely as a perception of the

bee. In each case, the visual input was the

same—what differed was the situated con-

ceptualization.

In the past, we have referred to the cre-

ation of situated conceptualizations as an

act of categorization, because situated con-

ceptualizations are enactments that develop

for categories of experience (a variety of

situated conceptualizations develop for the

categories fear, anger, etc.; Barrett, 2006).

To understand how situated conceptualiza-

tions work, then, it is important to under-

stand how concepts and categories work.

Categorization is not a narrow, limited

process— it does not happen only when you

explicitly attempt to assign an object to one

grouping or another. Categorization plays a

central role in all cognitive activity, includ-

ing the sorts of high-level perceptions that

are involved in emotion and emotion regula-

tion. Categorizing is a fundamental cogni-

tive activity. To categorize sensory input is

to determine what it is, why it is, and what

to do with it.

A central property of human knowledge

is that it is organized categorically. Unlike

a recording device that simply stores each

individual, holistic, bitmapped image of

the world, the human brain is constantly

interpreting aspects of experience, using

concepts in memory to make sensations

meaningful. A concept can be viewed as

aggregated memories that accumulate

for a category across experiences with its

instances. By focusing attention on some

aspect of experience repeatedly, a concept

develops over time from instances of the

respective category experienced across situ-

ations (Barsalou, 1999; Barsalou & Hale,

1993; Murphy, 2002). The concept of bee,

for example, aggregates diverse information

about the category of bees across a variety

of situations into a loosely organized repre-

sentation that includes properties (e.g., yel-

low and black, with wings), relations (e.g.,

flowers), rules (for something to be a bee, it

must have black and yellow stripes, it must

fly, etc.), and exemplars (e.g., instances of

honey bees, carpenter bees, a queen bee,

etc.).

Concepts develop for all aspects of

452 PSYCHOPATHOLOGY

human experience related to bee, including

objects, settings, and actions (e.g., flowers,

honey, gardens, freezing, running, swatting,

flying, buzzing, stinging). From simpler con-

cepts, more complex concepts emerge for

events (e.g., strolling in a garden, fear of the

bee). Concepts also develop for a wide vari-

ety of internal states (e.g., aroused, quiet), as

well as for the properties and relations that

describe instances of concepts (e.g., yellow,

fast, sweet, above, after, cause). Although

concepts reflect experience to a considerable

extent, they undoubtedly have biological

bases that scaffold learning (Barsalou, 1999,

2008; Carey, 2009; Rips, 2010; Simmons &

Barsalou, 2003).

Extensive evidence now exists that an

instance of conceptual knowledge (an

instance of a concept, or a conceptualiza-

tion) emerges from different multimodal sys-

tems in the brain (e.g., McClelland, 2010).

Depending on the modalities relevant for

processing a concept’s instances, particu-

lar modal areas of the brain store informa-

tion about the category and can later rep-

resent the category in the absence of actual

instances. Martin (2001, 2007) reviews

evidence, for example, that different multi-

modal profiles represent living versus non-

living things. Other research has similarly

established the multimodal profiles that

represent the self and others (cf. Legrand

& Ruby, 2009; Northoff et al., 2006; Van

Overwalle, 2009), people, buildings, and

tools (e.g., Simmons, Reddish, Bellgowan,

& Martin, 2010), the external world versus

internal states (Golland, Golland, Bentin, &

Malach, 2008), and so forth.

Category instances (e.g., a bee) are never

encoded alone into conceptual knowledge,

even though their context may not explic-

itly be the focus of attention. Initially, when

encoding a category instance of a bee, for

example, from actual prior experience with

bees, observational learning about bees,

hearing stories about bees, or being told

rules about bees, the brain captures the ele-

ments of the setting in which the bee occurs

(i.e., other agents and objects), internal

sensory (i.e., somatovisceral) cues from the

body, as well as actions, instructions from

others (in the form of rules) and words (e.g.,

the phonological form for “bee”). Over time,

these situated conceptualizations create a

heterogeneous population of information

that is available to represent new instances

of the category “bee.”

Later, when your

brain requires conceptual knowledge to pro-

cess some incoming sensory input, it samples

from the populations of situated conceptual-

izations, associated with relevant concepts,

to create a novel situated conceptualiza-

tion, integrating current sensory input and

retrieved (modal) conceptual knowledge

(Barsalou, 2009). From this perspective,

conceptual processing is actually more like

scene perception, because the brain pro-

duces a conceptual state using multimodal

information about entire situations. In this

way, a situated conceptualization allows an

experiencer to interpret incoming informa-

tion and draw inferences that go beyond the

information given.

It is impossible to have conscious access

to the processes that create situated concep-

tualizations, because they are initiated in

the first milliseconds of perception (or per-

haps even before sensory input is actually

encountered), and evolve over time, but it is

possible to demonstrate the brain’s computa-

tional power in creating them by engaging in

a little imagination. For example, close your

eyes and create an image of a yellow and

black bee in your mind (i.e., simulate a bee).

In doing this, your brain is creating a rep-

resentation that includes the sights, sounds,

smells, and so forth, of the bee, along with

a situation in which the bee occurred, all of

which would prepare you for a certain type

of action (to run, to peer closer, to swat, to

freeze). This representation involves the acti-

vation of neurons throughout your brain,

including sensory and motor neurons, as

well as neurons that regulate and represent

an internal body (somatovisceral) state. All

these elements (activation of sensory and

motor neurons, changes in the physical

state of the body, preparations for action)

are examples of what it means to say that

a representation is “embodied” (Barrett &

Lindquist, 2008). This is also what it means

to say that the brain is making a predic-

tion about an object and how to act on it

(Lindquist, Wager, Kober, Bliss- Moreau, &

Barrett, 2012) or, as we noted before, to say

that the brain is simulating a bee. This sort

of simulation would occur if you were pre-

sented with an image of a bee and asked to

recognize it (as in the prior section of this

chapter), to categorize it explicitly (assign it

Emotion Regulation as Situated Conceptualizations 453

to one stimulus grouping over another), to

judge it in some way, or to perform any kind

of cognitive task with it. It would occur if

you were being asked to remember a bee,

talk about a bee, think about a bee, or when

perceiving bees during an outdoor walk.

Once concepts become established in

memory, they play central roles throughout

cognition and perception (e.g., Barsalou,

2003; Murphy, 2002), and, as we suggest,

emotion. As people experience incoming

sensory input from the world and the body,

they use prior experience to categorize the

agents, objects, setting, behaviors, events,

properties, relations, and bodily states

that are present. As described in Wilson-

Mendenhall et al. (2011), a situated concep-

tualization is the conceptualization of the

current situation across parallel streams of

conceptual processing for all of these ele-

ments. As information from the current situ-

ation registers simultaneously in these pro-

cessing streams, conceptual systems on each

of them categorize the respective informa-

tion and draw inferences. At a more global

level, abstract relational concepts integrate

conceptualizations on the individual pro-

cessing streams into coherent interpretations

of larger events taking place across the situ-

ation as a whole. Categorical inferences (i.e.,

predictions) follow, including inferences

about how an object, or entity, is likely to

behave, how one can best interact with it,

the likely value to be obtained from inter-

acting with it, and so forth, and on a larger

scale, about how situations may unfold

during an event. From the perspective of

grounded cognition, situated conceptual-

izations are responsible for producing the

action, internal states, and perceptual con-

struals that underlie goal- related activity in

the current situation. Because modalities for

action, internals states, and perceptual con-

struals are typically active when a concept is

learned, situated conceptualizations gener-

ate activity in these systems as they become

active on later occasions. On activating the

concept for bee, a situated conceptualization

might activate representations of situation-

specific approach– avoid actions (e.g., swat-

ting the bee), representations of internal

states such as pleasure or displeasure, and

perceptual construals that direct the body

toward a particular instance of pleasure or

displeasure. Not only does bee represent per-

ceptual instances of the concept, it also con-

trols interactions and predicts the resultant

events.

Emotions and Emotion Regulation

as Situated Conceptualizations

Initial work on situated conceptualizations

focused on how this theory of concepts can

be applied to perceiving or interacting with

concrete objects in relevant situations (for a

review, see Barsalou, 2009), with concep-

tual knowledge represented using the brain’s

modal systems for perception, action, and

internal bodily states. We further developed

these ideas into a theory of emotion (Barrett,

2006) and a broader theory of mental states

more generally (Barrett, 2009), although in

the present discussion we focus on emotion.

We hypothesize that situated conceptual-

izations have relevance for not only under-

standing the nature of emotion but also

presenting a computational framework for

understanding emotion regulation.

Emotions as

Situated Conceptualizations

In our view, an emotion concept typically

forms when a given emotion word (e.g.,

“fear”) is explicitly uttered (e.g., by a care-

giver or teacher) during many different

instances involving a variety of changes in

feelings, physiology, and actions, becoming

the statistical regularity that holds the con-

cept together across instances involving dif-

ferent sensory input and actions (cf. Barrett,

Lindquist, et al., 2007). Selectively attend-

ing with some consistency to components

of experience results in category knowledge

that is captured in memory (Schyns, Gold-

stone, & Thibaut, 1998). Because emotions

are abstract, language appears to guide

selective attention to the changes in inter-

nal states that characterize an emotion in

a given situation. For example, each time a

parent (or some other person) labels a child’s

internal state or behavior with an emotion

term, or a child observes the emotion term

being used to label someone else’s behavior,

the child extracts information about that

instance (including the phonological form of

the word) and integrates it with past infor-

mation associated with the same term that

454 PSYCHOPATHOLOGY

is stored in memory. In this way, the pho-

nological form for “fear” could become a

perceptual regularity that occurs repeatedly

across situations, and a concept fear forms

(it is certainly the case that young infants

can use abstract words to make conceptual

inferences about objects that differ in their

sensory properties; Dewar & Xu, 2009).

The consequence is that accumulating con-

ceptual knowledge for fear, for example,

will vary within a person over instances as

context and situated action demand. No sin-

gle situated conceptualization for fear need

give a complete account of the category fear.

There is not one script for fear or one abstract

representation for fear.

For example, fear

might occur when excitedly declaring a risky

bet, when lethargically sensing the first signs

of flu, when frantically fleeing a blazing fire,

or when casually flirting with an attractive

stranger. On any given occasion, the content

of a situated conceptualization for fear will

be constructed to contain mainly those prop-

erties of fear that are contextually relevant,

and it therefore contains only a small sub-

set of the knowledge available in long-term

memory about the category fear.

In a given

instance, then, the situated conceptualiza-

tion for fear has the potential to change the

internal state of the perceiver, because when

retrieving information about fear, sensory,

motor, and interoceptive states are partially

reinstated in the relevant aspects of cortex,

simulating an instance.

We have hypothesized that concepts and

categories for emotion work in essentially

the same way as other kinds of abstract con-

cepts in the conceptual system, where each

individual situated conceptualization for a

specific emotion (e.g., fear) refers to an entire

situation, including both the internal and

external sensations (Wilson- Mendenhall

et al., 2011). In this way, emotions can be

thought of as affective changes that are

linked to the situation in some way (cf. Bar-

rett, 2006; Clore & Ortony, 2008) and emo-

tions can be said to reflect the structure of

situations. The key hypothesis can be stated

as follows: A momentary array of sensations

from the world (light, sound, smell, touch,

and taste) combined with sensations from the

body (X) counts as perception of emotion (Y)

during a situated conceptualization (C) (Bar-

rett, 2012). Here, a “perception” is meant

to indicate perceiving an instance of sensa-

tions in the self as the experience of emo-

tion, or sensory input (from facial actions,

voice, etc.) coming from others as emotional

expressions. The meaning acquired by the

sensations is not based solely on the physical

properties of sensations alone (as body states

or actions, as represented in the physiol-

ogy of the body and/or in neural activations

within the brain). Conceptual knowledge is

required to give it additional functionality

and meaning. For example, an increase in

heart rate (X

) counts as feeling afraid (Y

)

when category knowledge about fear is acti-

vated as a specific, embodied representation

of fear, such as when a bee is attempting to

sting you (C

). In this example, the increase

in heart rate takes on a meaning and allows

a predicted behavior that it would not oth-

erwise have alone. Emotion regulation

might be characterized in the same way. A

decrease in heart rate (X

) counts as evidence

of reappraisal (Y

) when another embodied,

situation- specific representation of a bee is

activated, such as when it is floating above

a brightly colored flower petal (C

). In these

examples, the concept fear might be applied

to internal sensations from the body, because

they are in the focus of attention, or because

fear is part of a situated conceptualization

that is part of the concept bee. It is a mis-

nomer to refer to conceptual knowledge as

merely psychological or social. For physical

actions and body states (X) to count as an

emotion (Y), some kind of physical change

has to take place somewhere in the brain of

a perceiver to complete a situated conceptu-

alization in that perceiver at that moment

in time (C). So a psychological construc-

tion approach makes predictions about the

brain basis of emotion (and emotion regula-

tion), but one that is different from the typi-

cal machine metaphor illustrated in Figure

27.1 and found in most natural kind mod-

els of emotion (also see Jones, Kirkland, &

Cunningham, this volume). An instance of

emotion is hypothesized to correspond to an

entire brain state—or a series of states chang-

ing over time— including representations of

the body and/or actions and the additional

information that is necessary to create the

new meanings that make emotions real, that

is, the parts that are crucial for creating the

situated conceptualizations.

In our view, then, changes in heart rate

or blood pressure, facial actions such as

Emotion Regulation as Situated Conceptualizations 455

smiles or frowns, and behaviors such as cry-

ing or freezing, are not evidence of emotions

in and of themselves. Instead, they become

part of an emotional episode when they take

on a certain meaning in a certain situation

(Barrett, 2012). Via situated conceptualiza-

tions, physical changes acquire the ability to

perform functions that they do not have on

their own (creating social meaning, prescrib-

ing actions, allowing communication, aid-

ing social influence). In this view, category

knowledge about emotions does not cause

emotions per se—it constitutes emotions by

adding epistemologically novel functions to

sensory input and action. Said another way,

an emotion is constructed when embodied

conceptual knowledge is enacted to shape

the perception of sensory information from

the body and the world, binding a physical

state to an event in the world (as opposed to

being merely a physical sensation or action).

A body state or an action has a certain

physical function (e.g., changes in respira-

tion might regulate autonomic reactivity, or

widened eyes might increase the size of the

visual field), but these events do not intrinsi-

cally have certain functions as an emotion;

events are assigned those functions in the act

of categorizing them as emotion during the

construction of a situated conceptualization.

If a situated conceptualization is repre-

sented as a distributed brain state (with both

cortical and subcortical contributions), or

even a series of brain state transitions across

time, then mental causation is not mechanis-

tic per se, but probabilistic, such that Brain

State A at Time T (bee in the forest) increases

the probability of Brain State B at Time T

+ 1 (fear of the bee expressed as a racing

heart and sweaty hands and the perception

of a stick as a weapon), making swatting

more likely (but perhaps also a bee sting

more likely) (Figure 27.3). Alternatively, the

encounter with the bee might be followed

by situated conceptualization (an image of

bees making honey) as Brain State C at Time

T + 1, decreasing the probability of a rac-

ing heart and sweating, and so forth. From

this perspective, an emotion, such as fear,

is itself not a process but instead represents

a category of phenomena— a collection of

instances of probabilistic situated conceptu-

alizations. This example also illustrates that

situated conceptualizations are not indepen-

dent from one another in time—each occurs

in a context of what came before, and what

is predicted in the future.

Furthermore, we hypothesize that each

situated conceptualization (as a brain state

or series of states) can be understood as a

construction of more basic, domain- general

operations and their interactions. These

operations can themselves be characterized

at both the psychological level (e.g., Barrett,

FIGURE 27.3. A depiction of the probabilistic state-space metaphor of brain function.

456 PSYCHOPATHOLOGY

2006, 2012) and at the level of brain net-

works that emerge from neural integration

across time and space within the brain (e.g.,

Barrett & Satpute, 2013; Lindquist & Bar-

rett, 2012). Such basic operations are like

the “mental state variables” (see Salzman

& Fusi, 2010), facets or core systems that

describe the brain state, or, to return to our

kitchen metaphor, these can be thought of as

the mind’s “basic ingredients.” Rather than

presuming that these ingredients function

in a modular, mechanistic way, each oper-

ation can be thought of as a set of “func-

tional motifs” arising from the structural

motif that undergirds each network (e.g.,

Sporns & Kotter, 2004). Moreover, if these

operations serve as the functional architec-

ture for how mental events and behaviors

are constructed, then this implies that the

science of emotion should focus on mod-

eling emotions as high dimensional brain

states (reflecting the engagement of domain-

general networks, their internal operations,

and their interactions). Such a componen-

tial, constructionist functional architecture

of the human brain would not only reveal

the distinctions between social, affect, and

cognitive neuroscience to be artificial (Bar-

rett & Satpute, 2013), but it would also pres-

ent a set of hypotheses for how the phenom-

ena that we refer to as emotion and emotion

regulation are derived within a common

mechanistic framework.

Emotion Regulation as Changing

Situated Conceptualizations

To the extent that emotions are situated

conceptualizations grounded in the modal

systems of the brain, then shifting from

one situated conceptualization to another

intensifies, diminishes, or alters the auto-

nomic and endocrine responses that underlie

actions and feelings. We propose that a situ-

ated conceptualization framework offers an

account of emotion regulation that under-

girds the process model (Gross, this volume)

at a different level of analysis, which has the

potential to inspire new scientific research

and practical applications. Our hypoth-

esis is that stages of emotion regulation

are often describing the difference between

two consecutive situated conceptualizations

rather than individual processes that can be

chained together by a series of linear causal

linkages in which cognitive systems in the

brain modulate separate and anatomically

distinct affective or emotional systems.

Emotion regulation strategies describe the

changes from one mental state to another,

but these changes can themselves be decom-

posed into more basic facets (i.e., the men-

tal operations and their associated networks

that create the situated conceptualizations).

As a consequence, the process model (Gross,

this volume) can be thought of as offering

a more abstract description of what occurs

during emotion regulation, whereas the core

systems that implement situated conceptu-

alizations are a more mechanistic approach

that produces reappraisals, distraction, sup-

pression, and other instances of emotion

regulation.

This distinction between levels of analy-

sis maps onto the three levels of analysis

described by Marr (1982), which include: a

computational level that describes the phe-

nomenon at hand (What problem does the

system try to solve? What is the goal when

transforming input to output?), an algorith-

mic level that describes how the transforma-

tion from input to output is achieved (How

does the system do what it does? What are

the representations used by the system? What

processes act on these representations?) and

an implementation or physical level (How

is the system physically realized?). Our

hypothesis is that the process model, with

its emphasis on situation selection, situa-

tion modification, and so on, describes emo-

tion regulation at Marr’s computational

level, whereas our situated conceptualiza-

tion account describes emotion regulation

at Marr’s algorithmic and implementational

levels. Each class of regulatory strategies

discussed within the process model of emo-

tion regulation can be understood as situ-

ated conceptualizations that are constructed

from more basic domain- general core sys-

tems. The componential, constructionist

functional architecture of the human brain

for emotion is also the architecture that cre-

ates instances of emotion regulation.

Situation selection can be understood as a

case in which situated conceptualizations are

constructed to anticipate what will happen in

the future. Elsewhere, Barrett and colleagues

(2009; Barrett & Satpute, 2013; Lindquist &

Barrett, 2012; Lindquist et al., 2012) have

hypothesized that the nodes within the “men-

Emotion Regulation as Situated Conceptualizations 457

talizing” network (e.g., Andrews- Hanna et

al., 2010) interact to help guide the construc-

tion of situated conceptualizations by inte-

grating elements of prior experience (which

are represented modally across the brain).

These regions help to produce the multi-

modal simulations that are strongly situated

in a particular background context, mak-

ing sensory input meaningful and support-

ing specific courses of situated action. Using

prior knowledge to simulate possible future

situations may guide the decision making

that underlies situation selection. More spe-

cifically, situated conceptualizations support

simulating what it would be like to experi-

ence specific situations (by reenacting and

reassembling prior knowledge) that produce

information about their value and potential

outcomes (e.g., deciding whether to walk in

a meadow or a forest depending on the prob-

ability of encountering a bee). This hypoth-

esis is consistent with the idea that the “men-

talizing” network constructs mental models

or simulations that facilitate future behavior

(Buckner, 2011).

Because situated conceptualizations are

dynamically constructed when thinking

about future events, their dynamic assembly

is likely influenced by a number of factors,

including the current state of the individual

(and the situated conceptualization that is

being used to interpret this state) and the

executive control resources available (e.g.,

via the “salience” and “frontoparietal con-

trol” networks) to help guide the situated

conceptualization. These factors can influ-

ence elements of the situation that become

the focus of the simulation and how detailed

or vague the simulation becomes, both of

which would impact the inferred outcomes

and thus the decision making that underlies

situation selection. The complexity inherent

to situation selection is often acknowledged

in the literature on emotion regulation (e.g.,

Gross, 2008), but the dynamics involved in

creating such complexity remain unclear,

perhaps because these discussions tend

draw on traditional approaches to emotion

that overlook such dynamics. In contrast,

our approach highlights investigating the

dynamic integration of multimodal facets

involved in situated conceptualization as an

important goal for future research.

The predictive and inferential capacities

provided by situated conceptualizations also

allow for situation modification (i.e., they

provide a perceiver with the ability to pre-

dict what actions in the present will facili-

tate a change in mental state in the future;

for example, using a branch as a weapon

to swat a bee). A situated conceptualiza-

tion approach draws attention to the under-

lying processes that facilitate or detract

from taking actions to modify the external

environment to alter its emotional impact.

Because a situation is already in place dur-

ing situation modification, an individual is

drawing on prior knowledge about specific

facets present in the situated conceptual-

ization to modify the situation itself. For

example, when the individual focuses on

a nearby tree branch with the goal of kill-

ing the bee to avoid being stung, he or she

now infers that the branch could be used a

weapon because it can be manipulated much

like a baseball bat or a fly swatter (i.e., prior

knowledge about using a bat to strike an

object is being dynamically applied within

the situated conceptualization). In this way,

the situated conceptualization used to inter-

pret the environment is shifting dynamically

as its multimodal facets change (e.g., height-

ened arousal and hyperfocus on the environ-

ment), which guides action.

Cognitive change (e.g., a stinging bee

transformed into a flower- loving honey pro-

ducer) and response modulation (e.g., to keep

walking forward rather than to run away)

naturally unfold as the brain shifts from

one situated conceptualization to another,

making predictions about how to act (i.e., a

predicted action) and what the homeostatic

and metabolic consequences will be (i.e.,

affective changes). Cognitive framing and

response modulation are perhaps two of the

most obvious goals of the brain’s functional

architecture— knowing what the current sen-

sory array means and how to act on it. They

are not unique to emotion regulation; they

describe what happens during the construc-

tion of every mental state. During emotion

regulation, though, an individual is often

more aware of these changes because he or

she has an explicit goal to regulate through

cognitive change or response modulation.

An important prediction of a situated con-

ceptualization approach is that these types

of changes can also occur without aware-

ness if they become habitual. Bringing situ-

ated conceptualizations into awareness and

458 PSYCHOPATHOLOGY

manipulating them with effort, intention,

and a feeling of agency appears to be one key

characteristic that distinguishes the mental

events people refer to as “emotion regula-

tion” (vs. those they refer to as “emotion”).

If conceptual knowledge is enactive, and if

situated conceptualizations actually have the

capacity to shape the physiology and actions

that are observed in any mental state, then

changing a conceptualization via any core

system can modify said physiology and

action (as well as the feelings to which they

give rise). Such regulation might occur when

the same physical sensations and actions are

conceptualized as a different emotion (e.g.,

tears are not sadness but anger; a racing

heart is not fear but excitement), or when the

intensity of physical activation is enhanced

or reduced by changing the conceptualiza-

tion (e.g., a bee means the pain of a sting or

the tranquility of a meadow). In such cases,

our hypothesis is that emotion regulation

is the result of conceptual knowledge being

activated as part of a situated conceptualiza-

tion. At the level of subjective experience, it

may feel as if a special mechanism is being

used to down- regulate fear, such as reap-

praisal or suppression, or to up- regulate

anger. Our hypothesis is that these emo-

tion regulation constructs reflect changes in

emotions (as mental states) that result from

successive situated conceptualizations, using

the same operations that constitute an emo-

tion in the first place. Thus, an instruction

to reappraise, to distract by shifting atten-

tion, and so forth, actually manipulates the

underlying core systems of situated concep-

tualizations, which in turn alters the biologi-

cal signals that produce sensations, not just

how bodily sensations are understood (i.e., it

alters the experience of them).

A situated conceptualization framework

also suggests a novel hypothesis that is not

discussed within the process model: Decon-

structing an emotion, by attempting to undo

its situated conceptualization, is another

form of emotion regulation. When the per-

ception and experience of physical sensations

from the body are decoupled from the con-

cept knowledge (e.g., a deactivated unpleas-

ant feeling conceptualized more basically as

fatigue or glucose depletion as opposed to

sadness in a specific situation), they become

less potent and result in less suffering. This

suspension of conceptualization can be diffi-

cult to achieve, and it usually requires train-

ing. If you were to attempt to learn to paint

an image of a bee on a flower, you would

have to train yourself over a series of months

not to see objects (a bee and flower) but to

“undo” this perception and paint pieces of

light. Only by doing this can you render a

reasonable three- dimensional image on

a two- dimensional page. Similarly, when

learning to deconstruct emotion, you would

have to train yourself not to experience emo-

tions, but to experience physical sensations

instead. Meditation practices offer a variety

of tools for deconstructing emotion experi-

ence that may work in this manner (e.g., Hol-

zel et al., 2011; Papies, Barsalou, & Custers,

2012). In other meditation approaches, an

existing emotion is deconstructed and then

is replaced with an alternative, more positive

experience (Lutz, Brefczynski- Lewis, John-

stone, & Davidson, 2008; Lutz, Greischar,

Perlman, & Davidson, 2009).

Recent empirical evidence from our labo-

ratory also suggests that this may be a pro-

ductive strategy. During a neuroimaging

study (Wilson- Mendenhall et al., 2011),

participants immersed themselves in affec-

tively charged situations that involved either

physical danger or social evaluation. After

immersing in a situation, a word cued partic-

ipants to emote in the situation (experience

fear or anger) or to observe in the situation.

Significantly greater activity in visual cor-

tex and significantly less activity in medial

prefrontal cortex occurred when partici-

pants experienced situations by observing

the scenes from a third- person perspec-

tive rather than experiencing them as first-

person, self- relevant emotions. These results

suggest that sensations became the focus of

the affectively charged situation when par-

ticipants were observing in the situation. In

this study, observing was an explicit goal,

but a situated conceptualization approach

suggests that this process of observing could

eventually occur automatically (without

effort) if repeatedly used in specific situa-

tions (e.g., potential anger- inducing situa-

tions).

Finally, psychotherapy— particularly cognitive-

behavioral therapy (CBT) approaches—

might be understood as helping clients to

construct new situated conceptualizations

(thereby modifying their conceptual sys-

tem) that either reduce the intensity of their

Emotion Regulation as Situated Conceptualizations 459

physical responses, or better calibrate the

constructed meaning of those responses to

the situation at hand. CBT interventions

also appear to provide training for when to

use these alternative situated conceptualiza-

tions. The psychotherapeutic process might

be thought of as creating a new population

of learned neural assemblies (for the same

emotion categories, or for new categories)

that would be available to create new or dif-

ferent emotional meaning for the same sen-

sations, or that would modify those sensa-

tions (particularly those related to the body).

The emotional changes that occur with psy-

chotherapy, then, might result from changes

in the conceptual system, or how conceptual

knowledge is used to construct the situated

conceptualizations that are emotion.

Psychopathology

and Dysregulation from a Situated

Conceptualization Framework

From a situated conceptualization frame-

work, psychopathology would result from

two classes of problems. First, we hypoth-

esize that emotional deficits within certain

types of psychopathology (e.g., schizophre-

nia, autism spectrum disorders), and neuro-

degenerative diseases (e.g., frontotemporal

dementia) arise due to damage to the brain’s

structural architecture for situated concep-

tualizations, making it difficult to construct

meaning for sensory inputs that constitute

normal mental states. Perhaps deficits in

white matter connectivity, such as those

seen in autism (Zikopoulous & Barbas,

2010), compromise the ability to construct

and use the distributed conceptual structure

that underlies situated conceptualizations.

Similarly, autism is related to deficits in con-

nectivity that develop during the final stages

of cortical development in paralimbic areas,

particularly within the supragranular layers

of cortext (Zikopoulous & Barbas, 2010).

These layers mainly contain the corticocor-

tical connections that are important for syn-

chronizing the distributed neuronal assem-

blies responsible for constructing normal

situated conceptualizations.

In addition to structural consider-

ations, psychopathology could result from

entrenched conceptualizations that are overly

ritualized and not sufficiently situation-

specific. Deficits in the vocabulary or con-

tent of emotion concepts (perhaps due to

poor socialization), or problems in accessing

and using this knowledge (perhaps associ-

ated with problems with long-term memory

or executive function) might result in a fail-

ure to regulate autonomic (and therefore

affective) reactivity using situated concep-

tualizations, as in alexithymia (for a dis-

cussion, see Lindquist & Barrett, 2008), or

might produce inappropriate or ritualized

situated conceptualizations. To the extent

that repeated processing of a situated con-

ceptualization omits situational details and

focuses instead on general abstract themes,

chronic emotional responses develop that

operate inappropriately across too many sit-

uations. For example, imagine that a situated

conceptualization develops for shame asso-

ciated with performing poorly on math tests

during elementary school. Subsequently, if

attention focuses too much on shame associ-

ated with poor performance and omits the

situational details associated with elemen-

tary school math classes, a decontextualized

shame for poor intellectual performance

could develop that pervades experience

inappropriately. Psychopathology also arise

from problems in forming situated concep-

tualizations that are not well calibrated to

the immediate situation, resulting in dys-

regulated autonomic responses and less

effective actions. To the extent that situated

conceptualizations are learned assemblies of

perceptual, conceptual, interoceptive, and

action processes, psychological disorders of

one type or another might appear to be dis-

orders of specific emotions (e.g., posttrau-

matic stress disorder [PTSD] as a disorder

of fear) because a person’s learning history

has created a “conceptual habit” or regular-

ity of certain situated conceptualizations,

resulting in a sort of entrenchment of cer-

tain changes in bodily state, central repre-

sentations of that state, and meanings that

emerge regardless of the immediate situation

(e.g., even when no actual threat is present).

More generally, psychopathology might

also occur when sensations from the body

are overly personalized and inaccurately

construed to be self- evaluative as a func-

tion of how situated conceptualizations are

constructed. Even an overreliance on such

conceptual knowledge (e.g., conceptualizing

interoceptive cues as psychological instead of

460 PSYCHOPATHOLOGY

physical) would also result in psychopathol-

ogy, and might help explain sex differences

in certain disorders such as depression and

anxiety. Problems might also arise when sit-

uated conceptualizations are too internally

driven (from the body and prior experience)

and insufficiently incorporate external sen-

sory input, as in depression. For example,

the subgenual portion of the anterior cin-

gulate cortex (Brodmann Area 25), which

is an important cortical site for regulating

homeostasis and other autonomic functions

(Ongur, Ferry, & Price, 2003), appears to

keep the mentalizing network in a state of

continual engagement via its connections

to BA 10 in ventromedial prefrontal cortex;

this region is part of the mentalizing net-

work core (Andrews- Hanna et al., 2010) and

is a hub in a range of phenomena, including

homeostatic- and allostatic- related phenom-

ena (e.g., subjective emotional experiences,

autonomic and neuroendocrine function,

reward, pain), social cognition and self-

relevance, and memory- related phenomena

(e.g., memory, mind- wandering, etc.) (Roy,

Shohamy, & Wager, 2012). It is a region

that allows brainstem autonomic function

to be guided by conceptual information

about past, present and future outcomes,

and is important to the creation of affec-

tive meaning (Roy et al., 2012; Lindquist et

al., 2012). This connection between BA 25

and BA 10 keeps depressed people locked

“inside their own heads” and suffering a

constant state of anguish that is marked

by all consuming self-focus that paralyzes

them. Deep brain stimulation to the white

matter tract that connect these two regions

in effect releases the mentalizing network,

allowing people to experience relief and to

focus more on events in the world (May-

berg, personal communication; also see

Holtzheimer, Kelly, Gorss, Filkowski, Gar-

low, et al., 2012; Lujan, Chaturvedi, Choi,

Holdzheimer, Gross, et al., 2013). From

this research, it is easy to hypothesize that

overly internally focused situated concep-

tualizations might occur because a person

possesses a very reactive autonomic nervous

system, producing frequent and intense

internal sensations that demand conceptu-

alization, or because of limited executive

control resources. Moreover, conceptualiza-

tions that are not well- tailored to the situa-

tion in terms of sociocultural norms (which

could happen in a variety of ways) could

produce actions that are not effective in a

particular cultural context.

To understand how the content of disor-

dered situated conceptualizations emerge, it

is important to focus on the mechanisms of

the core systems or “ingredients” that cre-

ate instances of emotion or implement the

moment- to- moment changes that are expe-

rienced as emotion regulation, such as an

overly active autonomic nervous system that

is experienced as affective reactivity, and

other related problems with attention, work-

ing memory, and context insensitivity (e.g.,

Kring & Moran, 2008; Poch & Campo,

2012; Williamson & Allman, 2012). These,

in turn, can be understood in terms of the

dynamics and structure of core networks,

such as the “salience” network, the “fronto-

parietal control” network, and the “mental-

izing” network (Barrett & Satpute, 2013).

Indeed, these networks, which are intrin-

sic to the human brain and are structured

by anatomical connectivity (and which we

understand as the core systems that imple-

ment situated conceptualizations; Barrett

& Satpute, 2013), are implicated in a range

of psychopathologies, including not only

schizophrenia, autism, and frontotemporal

dementia, but also depression and anxi-

ety disorders (Menon, 2011). For example,

instead of understanding PTSD as an exag-

gerated activation of fear circuitry, it is pos-

sible that PTSD symptoms are the result of

hyperaffective reactivity (associated with the

“salience” network) combined with prob-

lems in conceptualization (associated with

the “mentalizing” network) related to work-

ing memory deficits (associated with the

“frontoparietal” control network) (Suvak &

Barrett, 2011).

These ideas present an alternative to the

traditional approach to mental illness, in

which all forms of psychopathology (and

many forms of physical illness, e.g., cardio-

vascular disease and cancer) are conceived

of as involving either excessive or deficient

amounts of one emotion or another. For

example, various anxiety disorders, such as

PTSD and panic disorder, are presumed to

be disorders of fear, thought to arise from

a hyperreactivity of fear processing. Depres-

sion is presumed to be a disorder of sadness

and guilt. Hypertension is thought to involve

an excess amount of anger. And so on. From

Emotion Regulation as Situated Conceptualizations 461

the perspective of the traditional machine

metaphor, each type of illness would arise

from problems with emotions being trig-

gered too frequently or not enough. Also, the

development and maintenance of psychiatric

disorders involve problems in emotion regu-

lation (Kring & Sloan, 2010), so psychopa-

thology might also arise from an inability

to regulate said emotions once they erupt.

Our situated conceptualization approach

connects these insights with transdiagnos-

tic approaches that attempt to identify psy-

chological and biological processes that are

common to many types of psychological

disorders (e.g., Fairholme, Boisseau, Ellard,

Ehrenreich, & Barlow, 2010; Harvey, Wat-

kins, Mansell, & Shafran, 2004; Haslam,

2002; Kendler, 2008; Kring, 2008; Krueger,

Watson, & Barlow, 2005; Millan, 2003;

Sanislow et al., 2010). Just as science is com-

ing to the conclusion that emotion categories

are not natural kinds (Barrett, 2006), clini-

cal science is also coming to the conclusion

that categories for disorders of emotion do

not cut nature at its joints (Haslam, 2002;

Kendler, 2008).

Summary

Situated conceptualizations can be thought

of as cognitive tools used by the human

brain to modify and regulate the body (i.e.,

homeostasis and allostasis, metabolism,

and/or inflammatory processes), to create

feelings, and to create dispositions toward

action. In this sense, they provide an alter-

native framework for describing how mental

states arise, and how actions and feelings,

and the physiological changes that support

them, are formulated and regulated. A focus

on how situated conceptualizations are con-

structed from patterns (or functional motifs)

across the brain’s core systems (or structural

motifs) adds utility to existing explana-

tory frameworks for emotion and emotion

regulation by focusing on the mechanistic

changes that produce emotional and regula-

tory phenomena to which we give abstract

names.

Perhaps the final lesson of the bee exam-

ple is that states and processes are easy to

confuse when it comes to meaning making.

Regardless of whether you automatically

experience the calm of a bee buzzing in a

bucolic garden or the terror of a bee attack-

ing and stinging the body, it is possible to

retrieve different associations of bees in the

next instance, which in turn has the capac-

ity to change the sensations that your brain

receives from your body. Our hypothesis is

that the same processes that were engaged

during the initial instance of meaning mak-

ing (creating tranquility or fear) are engaged

again, and again, and again. When your

bodily response changes, along with the cor-

responding feelings and actions, you experi-

ence this as emotion regulation. If this is cor-

rect, then what we call “emotion regulation”

is grounded in the more basic meaning-

making processes that are operating all the

time to create the flow of mental states that

constitutes your mind. Reappraisal, distrac-

tion, and other terms might refer not to

processes per se, but to changes that occur

as one mental state flows into another (and

one physical state transitions to another)

as meaning changes. A series of sequential

mental states that are experientially distinct

is easy to understand as distinct psychologi-

cal processes, even though scientists have

known for a long time that experiences don’t

reveal the processes that make them.

Notes

1. Hereafter in this chapter, we use italics to

indicate a concept (e.g., fear) and quotes to

indicate the word or phrase associated with it

(e.g., “fear”).

2. Theory and research strongly suggest that

concepts do not have conceptual cores (i.e.,

information that is necessary and sufficient

for membership in the associated category).

Instead, concepts are represented with loose

collections of situated exemplars that are

related by family resemblance. Exemplar

theories of categorization further illustrate

that loose collections of memories for cat-

egory members can produce sophisticated

classification behavior, demonstrating that

abstractions for prototypes and rules are not

necessary. Neural net systems similarly dem-

onstrate that only loose statistical coherence

is necessary for sophisticated categorization.

To the extent that abstraction does occur for

a category, it may only occur partially across

small sets of category instances, reflect the

abstraction of nondefining properties and

462 PSYCHOPATHOLOGY

relations that can be used to describe category

members in a dynamical manner, or reflect

an online abstraction at retrieval rather than

stored abstractions in memory. Nevertheless,

people often believe mistakenly that catego-

ries do have cores, perhaps because a word

can lead people to essentialize.

3. As goal- directed categories that develop to

guide action, the most typical member of a

category such as fear is not the one that is most

frequently encountered, but rather the one

that maximally achieves the theme or goal of

the category (Barsalou, 2003). As a result, the

most typical instances of a category contain

properties that represent the ideal form of the

category, that is, whatever is ideal for meeting

the goal around which the category is orga-

nized, not those that most commonly appear

as instances of the category. From a situated

conceptualization viewpoint, prototypes do

not exist as stored representations in memory,

but they can be constructed (or simulated)

when needed (Barsalou et al., 2003).

4. Highly different instances for the same cat-

egory can become integrated over time, and

become available to construct novel simula-

tions that have never been experienced before.

This, in part, may help to explain why people

believe that emotions such as anger, sadness,

fear, and so on, have specific response signa-

tures, even though the available data do not

support this view. A simulation of fear could

allow a person to go beyond the information

given to fill in aspects of a internal sensa-

tion that are not present at a given percep-

tual instance. In such a case, the simulation

essentially produces an illusory correlation

between response outputs, helping to explain

why researchers continue to search for coordi-

nated autonomic, behavioral, and experiential

aspects of a fear response.

References

Anderson, E., Siegel, E. H., White, D., & Bar-

rett, L. F. (2012). Out of sight but not out of

mind: Unseen affective faces influence evalu-

ations and social impression. Emotion, 12,

1210–1221.

Andrews- Hanna, J. R., Reidler, J. S., Sepulcre, J.,

Poulin, R., & Buckner, R. L. (2010). Functional–

anatomic fractionation of the brain’s default

network. Neuron, 65(4), 550–562.

Barrett, L. F. (2006). Solving the emotion para-

dox: Categorization and the experience of

emotion. Personality and Social Psychology

Review, 10(1), 20 – 46.

Barrett, L. F. (2009). The future of psychology:

Connecting mind to brain. Perspectives on

Psycholical Science, 4(4), 326–339.

Barrett, L. F. (2012). Emotions are real. Emo-

tion, 12(3), 413–429.

Barrett, L. F., & Bar, M. (2009). See it with feel-

ing: Affective predictions in the human brain.

Philosphical Transactions of the Royal Soci-

ety B: Biological Sciences, 364, 1325–1334.

Barrett, L. F., & Bliss- Moreau, E. (2009). Affect

as a psychological primitive. Advances in

Experimental Social Psychology, 41, 167–218.

Barrett, L. F., & Gross, J. J. (2001). Emotion rep-

resentation and regulation: A process model

of emotional intelligence. In T. Mayne & G.

Bonnano (Eds.), Emotion: Current issues and

future directions (pp. 286–310). New York:

Guilford Press.

Barrett, L. F., & Lindquist, K. (2008). The

embodiment of emotion. In G. Semin & E.

Smith (Eds.), Embodied grounding: Social,

cognitive, affective, and neuroscience

approaches (pp. 237–262). New York: Cam-

bridge University Press.

Barrett, L. F., Lindquist, K. A., & Gendron, M.

(2007). Language as context for the percep-

tion of emotion. Trends in Cognitive Sciences,

11(8), 327–332.

Barrett, L. F., Ochsner, K. N., & Gross, J. J.

(2007). On the automaticity of emotion. In J.

Bargh (Ed.), Social psychology and the uncon-

scious: The automaticity of higher mental

processes (pp. 173–217). New York: Psychol-

ogy Press.

Barrett, L. F., & Satpute, A. (2013). Large-scale

brain networks in affective and social neuro-

science: Towards an integrative architecture of

the human brain. Current Opinion in Neuro-

biology, 23, 1–12.

Barrett, L. F., Tugade, M. M., & Engle, R. W.

(2004). Individual differences in working

memory capacity and dual- process theories

of the mind. Psychological Bulletin, 130(4),

553–573.

Barsalou, L. W. (1999). Perceptual symbol sys-

tems. Behavioral and Brain Sciences, 22(4),

577–609.

Barsalou, L. W. (2003). Situated simulation in

the human conceptual system. Language and

Cognitive Processes, 18, 513–562.

Barsalou, L. W. (2008). Grounded cognition.

Annual Review of Psychology, 59, 617–645.

Emotion Regulation as Situated Conceptualizations 463

Barsalou, L. W. (2009). Simulation, situated con-

ceptualization, and prediction. Philosophical

Transactions of the Royal Society B: Biologi-

cal Sciences, 364(1521), 1281–1289.

Barsalou, L. W., & Hale, C. R. (1993). Compo-

nents of coceptual representation: From fea-

ture lists to recursive frames. In J. Hampton,

R. Michalski, & P. Theuns (Eds.), Categories

and concepts: Theoretical views and inductive

data analysis (pp. 97–144). San Diego, CA:

Academic Press.

Barsalou, L. W., Niedenthal, P. M., Barbey, A.,

& Ruppert, J. (2003). Social embodiment. In

B. Ross (Ed.), The psychology of learning and

motivation (Vol. 43, pp. 43–92). San Diego,

CA: Academic Press.

Bradley, M. M., Codispoti, M., Cuthbert, B. N.,

& Lang, P. J. (2001). Emotion and motivation

I: Defensive and appetitive reactions in picture

processing. Emotion, 1(3), 276–298.

Buckner, R. L. (2011). The serendipitous discov-

ery of the brain’s default network. NeuroIm-

age, 62, 1137–1145.

Carey, S. (2009). The origin of concepts. New

York: Oxford University Press.

Clore, G. L., & Ortony, A. (2008). Appraisal

theories: How cognition shapes affect into

emotion. In M. Lewis, J. M. Haviland- Jones,

& L. F. Barrett (Eds.), Handbook of emotions

(3rd ed., pp. 628–642). New York: Guilford

Press.

Dewar, K. M., & Xu, F. (2009). Do early nouns

refer to kinds or distinct shapes?: Evidence

from 10-month old infants. Psychological Sci-

ence, 20, 252–257.

Edelman, G. M. (1998). The remembered pres-

ent: A biological theory of consciousness.

New York: Basic Books.

Fairholme, C. P., Boisseau, C. L., Ellard, K. K.,

Ehrenreich, J. T., & Barlow, D. H. (2010).

Emotions, emotion regulation, and psycholog-

ical treatment: A unified perspective. In A. M.

Kring & D. M. Sloan (Eds.), Emotion regu-

lation and psychopathology (pp. 283–309).

New York: Guilford Press.

Fine, I., Wade, A. R., Brewer, A. A., May, M.

G., Goodman, D. F., Boynton, G. M., et al.

(2003). Long-term deprivation affects visual

perception and cortex. Nature Neuroscience,

6, 915–916.

Golland, Y., Golland, P., Bentin, S., & Malach,

R. (2008). Data- driven clustering reveals a

fundamental subdivision of the human cortex

into two global systems. Neuropsychologia,

46(2), 540–553.

Gross, J. J. (2008). Emotion regulation. In M.

Lewis, J. M. Haviland- Jones, & L. F. Bar-

rett (Eds.), Handbook of emotions (3rd ed.,

pp. 497–512). New York: Guilford Press.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Harvey, A., Watkins, E., Mansell, W., & Shafran,

R. (2004). Cognitive behavioural processes

across psychological disorders: A transdiag-

nostic approach to research and treatment.

New York: Oxford Univeristy Press.

Haslam, N. (2002). Kinds of kinds: A conceptual

taxonomy of psychiatric categories. Philoso-

phy, Psychiatry, and Psychology, 9, 203–217.

Holzel, B. K., Lazar, S. W., Gard, T., Schuman-

Oliver, Z., Vago, D. R., & Ott, U. (2011).

How does mindful meditation work?: Propos-

ing mechanisms of action from a conceptual

and neural perspective. Perspectives on Psy-

chological Science, 6(6), 537–559.

Holtzheimer, P. E., Kelley, M. E., Gross, R. E.,

Filkowski, M. M., Garlow, S. J., Barrocas, A.,

et al. (2012). Subcallosal cingulate deep brain

stimulation for treatment- resistant unipolar

and bipolar depression. Archives of General

Psychiatry, 69(2),150–158.

Jones, C. R., Kirkland, T., & Cunningham, W.

A. (this volume, 2014). Attitudes, evaluation,

and emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 251–266). New York: Guilford Press.

Kendler, K. S. (2008). Explanatory models for

psychiatric illness. American Journal of Psy-

chiatry, 165(6), 695–702.

Kober, H., Barrett, L. F., Joseph, J., Bliss-

Moreau, E., Lindquist, K., & Wager, T. D.

(2008). Functional grouping and cortical–

subcortical interactions in emotion: A meta-

analysis of neuroimaging studies. NeuroIm-

age, 42(2), 998–1031.

Kring, A. M. (2008). Emotion disturbances as

transdiagnostic processes in psychopathology.

In M. Lewis, J. M. Haviland- Jones, & L. F.

Barrett (Eds.), Handbook of emotion (3rd ed.,

pp. 691–705). New York: Guilford Press.

Kring, A. M., & Moran, E. K. (2008). Emotional

response deficits in schizophrenia: Insights

from affective science. Schizophrenia Bulletin,

34(5), 819–834.

Kring, A. M., & Sloan, D. M. (Eds.). (2010).

Emotion regulation and psychopathology.

New York: Guilford Press.

464 PSYCHOPATHOLOGY

Krueger, R. F., Watson, D., & Barlow, D. H.

(2005). Introduction to the special section:

Toward a dimensionally based taxonomy of

psychopathology. Journal of Abnormal Psy-

chology, 114(4), 491–493.

Lang, P. J., Bradley, M. M., & Curthbert, B. N.

(2008). International affective picture sys-

tem (IAPS): Affective ratings of pictures and

instruction manual. Gainsville: University of

Florida.

Legrand, D., & Ruby, P. (2009). What is self-

specific?: Theoretical investigation and critical

review of neuroimaging results. Psychological

Review, 116(1), 252–282.

Lindquist, K., & Barrett, L. F. (2008). Emotional

complexity. In M. Lewis, J. M. Haviland- Jones

& L. F. Barrett (Eds.), Handbook of emotion

(pp. 513–530). New York: Guilford Press.

Lindquist, K. A., & Barrett, L. F. (2012). A

functional architecture of the human brain:

Insights from the science of emotion. Trends

in Cognitive Sciences, 16, 533–540.

Lindquist, K. A., Wager, T. D., Kober, H., Bliss-

Moreau, E., & Barrett, L. F. (2012). The brain

basis of emotion: A meta- analytic review.

Behavioral and Brain Sciences, 35(3), 121–

143.

Lujan, J. L., Chaturvedi, A., Choi, K. S., Hold-

zheimer, P. E., Gross, R. E., Mayberg, H. S.,

et al. (2013). Tractography– activation models

applied to subcallosal cingulate deep brain

stimulation. Brain Stimulation.

Lutz, A., Brefczynski- Lewis, J., Johnstone, T., &

Davidson, R. J. (2008). Regulation of the neu-

ral circuitry of emotion by compassion medi-

tation: Effects of meditative expertise. PLoS

ONE, 3(3), e1897.

Lutz, A., Greischar, L. L., Perlman, D. M., &

Davidson, R. J. (2009). BOLD signal in insula

is differentially related to cardiac function

during compassion meditation in experts vs.

novices. NeuroImage, 47(3), 1038–1046.

Martin, A. (2001). Functional neuroimaging of

semantic memory. In R. Cabeza & A. King-

stone (Eds.), Handbook of functional neu-

roimaging of cognition (pp. 153–186). Cam-

bridge, MA: MIT Press.

Martin, A. (2007). The representation of object

concepts in the brain. Annual Review of Psy-

chology, 58, 25–45.

Marr, D. (1982). Vision: A computational inves-

tigation into the human representation and

processing of visual information. New York:

Freeman.

McClelland, J. L. (2010). Emergence in cogni-

tive science. Topics in Cognitive Science, 2,

751–770.

Menon, V. (2011). Large-scale brain networks

and psychopathology: A unifying triple net-

work model. Trends in Cognitive Sciences,

15(10), 483–506.

Mesquita, B., Barrett, L. F., & Smith, E. (Eds.).

(2010). The mind in context. New York: Guil-

ford Press.

Millan, M. J. (2003). The neurobiology and con-

trol of anxious states. Progress in Neurobiol-

ogy, 70(2), 83–244.

Murphy, G. L. (2002). The big book of concepts.

Cambridge, MA: MIT Press.

Neumeister, A., Henry, S., & Krystal, J. H.

(2007). Neural circuitry and neuroplasticity

in PTSD. In M. J. Friedman, T. M. Keane, &

P. A. Resick (Eds.), Handbook of PTSD: Sci-

ence and practice (pp. 151–165). New York:

Guilford Press.

Northoff, G., Heinzel, A., de Greck, M., Berm-

pohl, F., Dobrowolny, H., & Panksepp, J.

(2006). Self- referential processing in our

brain—A meta- analysis of imaging studies on

the self. NeuroImage, 31(1), 4 40 – 457.

Ongur, D., Ferry, A. T., & Price, J. L. (2003).

Architectonic subdivision of the human orbital

and medial prefrontal cortex. Journal of Com-

parative Neurology, 460, 425–449.

Papies, E. K., Barsalou, L. W., & Custers, R.

(2012). Mindful attention prevents mindless

impulses. Social Psychological and Personal-

ity Science 3, 291–299.

Poch, C., & Campo, P. (2012). Neocortical–

hippocampal dynamics of working memory

in healthy and diseased brain states based on

functional connectivity. Frontiers in Human

Neuroscience, 6, 36.

Rips, L. J. (2010). Lines of thought. New York:

Oxford University Press.

Roy, M., Shohamy, D., Wager, T. D. (2012). Ven-

tromedial prefrontal– subcortical systems and

the generation of affective meaning. Trends in

Cognitive Science, 16, 147–156.

Russell, J. A. (2003). Core affect and the psycho-

logical construction of emotion. Psychological

Review, 110, 145–172.

Salzman, C. D., & Fusi, S. (2010). Emotion,

cognition, and mental state representation

in amygdala and prefrontal cortex. Annual

Review of Neuroscience, 33, 173–202.

Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak,

M. J., Garvey, M. A., Heinssen, R. K., et al.

Emotion Regulation as Situated Conceptualizations 465

(2010). Developing constructs for psychopa-

thology research: research domain criteria.

Journal of Abnormal Psychology, 119(4),

631–639.

Schell, T. L., Marshall, G. N., & Jaycox, L. H.

(2004). All symptoms are not created equal:

The prominent role of hyperarousal in the

course of posttraumatic psychological dis-

tress. Journal of Abnormal Psychology,

113(2), 189–197.

Schyns, P. G., Goldstone, R. L., & Thibaut, J. P.

(1998). The development of features in object

concepts. Behavioral and Brain Sciences,

21(1), 1–17.

Simmons, W. K., & Barsalou, L. W. (2003). The

similarity- in- topography principle: Reconcil-

ing theories of conceptual deficits. Cognitive

Neuropsychology, 20(3), 451–486.

Simmons, W. K., Reddish, M., Bellgowan, P. S.,

& Martin, A. (2010). The selectivity and func-

tional connectivity of the anterior temporal

lobes. Cerebral Cortex, 20(4), 813–825.

Sporns, O., & Kotter, R. (2004). Motifs in brain

networks. PLoS Biology, 2, e369.

Sporns, O., Tononi, G., & Edelman, G. M.

(2000a). Connectivity and complexity: The

relationship between neuroanatomy and brain

dynamics. Neural Networks, 13(8–9), 909–

922.

Sporns, O., Tononi, G., & Edelman, G. M.

(2000b). Theoretical neuroanatomy: Relat-

ing anatomical and functional connectivity

in graphs and cortical connection matrices.

Cerebral Cortex, 10(2), 127–141.

Suvak, M. K., & Barrett, L. F. (2011). Consider-

ing PTSD from the perspective of brain pro-

cesses: A psychological construction approach.

Journal of Traumatic Stress, 24(1), 3–24.

Van Overwalle, F. (2009). Social cognition and

the brain: A meta- analysis. Human Brain

Mapping, 30(3), 829–858.

Williamson, P. C., & Allman, J. M. (2012). A

framework for interpreting functional net-

works in schizophrenia. Frontiers in Human

Neuroscience, 6, 184.

Wilson- Mendenhall, C. D., Barrett, L. F., &

Barsalou, L. W. (in preparation). Emoting vs.

observing: Conceptualizing affective situa-

tions as self- relevant emotions or sensory-

focused mental states.

Wilson- Mendenhall, C. D., Barrett, L. F., Sim-

mons, W. K., & Barsalou, L. W. (2011).

Grounding emotion in situated conceptualiza-

tion. Neuropsychologia, 49(5), 1105–1127.

Wundt, W. (1897). Outlines of psychology (C. H.

Judd, Trans.). Leipzig: Wilhelm Engelmann.

Zikopoulous, B., & Barbas, H. (2010). Changes

in prefrontal axons may disrupt the network

in autism. Journal of Neuroscience, 30,

14595–14609.

PART VIII

INTERVENTIONS

469

Over the past 25 years, considerable prog-

ress has been achieved in treating adult

psychiatric disorders (e.g., Butler, Chap-

man, Forman, & Beck, 2006). Despite these

significant advances, a sizable subgroup of

individuals with commonly co- occurring

disorders such as generalized anxiety dis-

order (GAD) and major depressive disorder

(MDD) fail to make sufficient treatment

gains, thereby prolonging their deficits in life

functioning and satisfaction. For example, in

a meta- analysis of cognitive- behavioral ther-

apy (CBT) for GAD, Borkovec and Ruscio

(2001) found that only 50–60% of treated

individuals demonstrated clinically mean-

ingful change. Furthermore, although more

efficacious, the difference between current

psychological treatments for MDD and non-

directive supportive therapy reflects only

a small effect size (Cuijpers, van Straten,

Andersson, & van Oppen, 2008). Also,

among individuals who have GAD with

comorbid MDD, gains in treating depres-

sion are not especially durable (Newman,

Przeworski, Fisher, & Borkovec, 2010).

Finally, in the recently concluded Sequenced

Treatment Alternatives to Relieve Depres-

sion Study,funded by the National Institute

of Mental Health (NIMH), the subgroup of

individuals with mixed anxiety– depressive

disorder (e.g., MDD + apprehensive anxious

symptoms) was most treatment refractory

(Farabaugh et al., 2010).

One characteristic common to these dis-

orders, which are often comorbid (Kessler,

Berglund, Demler, Jin, & Walters, 2005), is

that they both strongly (more so than other

conditions) reflect heightened emotional

experience (often referred to as emotional-

ity, neuroticism, or emotional intensity; see

Barlow, 2002; Mennin, Heimberg, Turk,

& Fresco, 2005; Mennin, Holaway, Fresco,

Moore, & Heimberg, 2007). Factor- analytic

evidence demonstrates that these disorders

jointly reflected a higher order factor of

prolonged negative affect or distress that

has been distinguished from a “fear” factor

that relates to disorders more characterized

by acute arousal (e.g., Krueger & Markon,

2006; Watson, 2005). Furthermore, both

GAD and MDD possess heritability factors

reflective of increased emotionality (e.g.,

Kendler, Gardner, Gatz, & Pedersen, 2006).

One possibility is that the “distress” in these

disorders reflects an inherent dispositional

tendency for heightened emotional salience

related to motivational impetuses such as the

need to avoid threat. These underlying emo-

tional and motivational factors may be more

difficult to ameliorate and change (Brown,

2007). Indeed, these higher order emotional

factors, in particular, have been found to

CHAPTER 28

Emotion Regulation Therapy

Douglas S. Mennin

David M. Fresco

470 INTERVENTIONS

account for the underperformance of other-

wise efficacious treatments (Olatunji, Cisler,

& Tolin, 2010).

Repetitive or perseverative thought (Wat-

kins, 2008) represents another characteristic

common to the distress disorders that may

arise as a desperate means of coping or com-

pensating with strongly felt emotional expe-

riences. For instance, pathological worry

(Borkovec, Alcaine, & Behar, 2004) func-

tions as a regulatory strategy aimed at reduc-

ing distress that arises from conflicting emo-

tional and motivational states (e.g., Mennin

& Fresco, 2009; Newman & Llera, 2011).

Similarly, depressive rumination represents

a perseverative cognitive process commonly

defined as repetitive thinking about past mis-

takes and failures, and is strongly associated

with worry (e.g., Nolen- Hoeksema, Wisco,

& Lyubomirsky, 2008; Watkins, 2008). In

essence, individuals with distress disorders

may be more prone to utilize perseverative

cognitive strategies (e.g., worry, rumination)

to escape or dampen emotionality at the cost

of accurately gleaning the motivational mes-

sage that is being conveyed, undermining

immediate behavioral action in response to

their emotions, and ultimately, losing sight

of the enriching and fulfilling aspects of life.

Thus, given the emerging profile of this

difficult to treat, distress- disordered patient

(e.g., strong motivational impetuses accom-

panied by excessive reliance on compen-

satory strategies to escape or avoid these

impetuses reactively, and impoverished

contextual learning repertoires), there is

increasing interest in understanding the

role of emotions and how this knowledge

might generate new targets for intervention,

particularly for more treatment- resistant

cases. The affective science field provides an

opportunity to expand paradigms regard-

ing the role of emotion- related processes in

conceptualizing and treating psychopathol-

ogy. Increasingly, treatments have adopted a

functional approach to emotions to improve

existing interventions a variety of disorders

(e.g., Barlow et al., 2011; Linehan, 1993).

Articulating a model of distress disorders

predicated on underlying emotional and

motivational mechanisms and processes

aligns with two recent initiatives promoted

by the NIMH with the goal of accelerat-

ing the payoff from basic and translational

research into treatment application and

identifying factors that promote or dimin-

ish the effectiveness of evidence- based treat-

ments. The first of these, called the Research

Domain Criteria Initiative (RDoC; Craske,

2012), aims to understand what is expected

in these domains at different levels of

inquiry, so that these normative findings can

be contrasted with disordered subgroups to

identify mechanistic regions of interest that

may in turn become the targets of treatment

development. The second initiative comes

from a recent NIMH’s National Advisory

Mental Health Council report emphasizing

“treatment personalization” as a means to

identify factors that predict who will ben-

efit from a given intervention process, then

to determine systematically ways of match-

ing patients to a particular treatment, as

well as to optimize and augment care. Taken

together, these initiatives highlight the need

to specify transdiagnostic mechanisms

within individuals to further the develop-

ment of treatment processes that specifically

target these mechanisms.

Congruent with current directions in

affect science, these NIMH initiatives, and

advances in the science of behavior therapy,

we have developed an emotion regulation

therapy (ERT; Mennin & Fresco, 2009)

to improve treatment of distress disorders

including GAD and MDD. ERT integrates

traditional and contemporary CBT principles

and practices, and emotion- focused inter-

ventions within a framework that reflects

basic and translational findings in affect sci-

ence. The result is a theoretically derived,

evidence- based treatment that builds on the

solid foundation of CBT by identifying and

targeting putative mechanisms common to

the distress disorders (e.g., motivational–

emotional activation, perseverative think-

ing, and resultant narrowed learning reper-

toires) while striving to normalize emotion

generation and regulation functioning. In

the remainder of this chapter, we (1) describe

and review relevant work related to norma-

tive and disordered motivation, regulation,

and contextual learning consequences; (2)

demonstrate how ERT reflects an approach

to treatment that draws from common prin-

ciples of CBT and affective science to target

proposed mechanisms directly and provide

preliminary efficacy and mechanism find-

ings; and (3) provide an overview of future

directions for ERT.

Emotion Regulation Therapy 471

Normative and Disordered

Emotional Processing

and Learning Consequences

An affect science perspective on adult psy-

chopathology and its treatment includes (1)

motivational mechanisms, reflecting the

functional and directional properties of an

emotional response tendency; (2) regula-

tory mechanisms, reflecting the alteration of

response trajectories to be more congruent

with contextual demands and constraints,

as well as one’s personal values or goals;

and (3) contextual learning consequences,

reflecting, optimally, the promotion of

broad and flexible behavioral repertoires.

In distress disorders, dysfunction may occur

via strong motivational salience and con-

flict, as well as deficits in systems of regula-

tion, which may result in diminished, nar-

row, and rigid behavioral repertoires. In the

remainder of this section, we discuss both

a normative account of these characteristics

and how these normative processes may go

awry in the emotional dysfunction of dis-

tress disorders.

Normative Emotional Functioning

Motivation

One of our most basic, primary directives

is to bring balance with respect to engag-

ing reward and minimizing loss, while

seeking safety and avoiding threat (Dol-

lard & Miller, 1950). As we increasingly

become creatures of habit over the course

of our lives, we are continually pushed and

pulled by motivations to maintain security

and gain reward. Our actions and prepara-

tion for actions are guided by the motiva-

tional salience of the stimuli we encounter

(Gray & McNaughton, 2000). In particu-

lar, a reward system mobilizes a behavioral

approach toward rewarding or appetitive

stimuli or to minimize loss. Reward can be

further specified in relation to consumma-

tory pleasure (i.e., liking, the hedonic impact

that a reward produces) and anticipatory

pleasure (i.e., wanting, the incentive salience

associated with a particular reward; Ber-

ridge, Robinson, & Aldridge, 2009). These

two facets of the reward system have shared

(e.g., nucleus accumbens, comprising a large

part of a region called the ventral striatum;

Stein & Paulus, 2009) and dissociable (e.g.,

the orbitofrontal cortex [OFC], involved in

assigning reward values to stimuli; Berridge

et al., 2009) neurobehavioral correlates. In

terms of neurochemistry, liking is primar-

ily associated with endogenous opioids and

endorphins (Stein & Paulus, 2009), whereas

wanting chiefly involves dopamine, which is

involved in marshaling organisms to exert

the effort required to obtain a reward (Ber-

ridge et al., 2009; Stein & Paulus, 2009).

By contrast, a security system instigates

avoidance of novel, potentially threatening,

or painful stimuli or end states, as well as

engagement of safety stimuli that protect

an individual from such perceived threats

and can reinstate a state of quiescence and

calm. This system encompasses both reflex-

ive motivational behavior and reflective,

goal- setting, behavior (Carver, Avivi, &

Laurenceau, 2008; Gray & McNaughton,

2000; Higgins, 1997) aimed toward avoid-

ance of threats and engagement of safety

signals. At the neural level, whereas the

amygdala is activated in response to novel

and immediate threats, the bed nucleus of

the stria terminalis is activated in response

to more distal or prolonged threats (Lang,

Davis, & Öhman, 2000). Furthermore, the

ventromedial prefrontal cortex (vmPFC) is

involved in higher order processing of goals

reflective of safety seeking and threat avoid-

ance. Neurochemically, norepinephrine and

gamma- aminobutyric acid (GABA) are cen-

trally involved in threat detection and safety

signaling (Stein & Paulus, 2009).

The security and reward systems are

relatively independent and can be activated

alone or in unison, in response to a prompt

(Stein & Paulus, 2009). In essence, norma-

tive functioning represents a constant state

of engaging and resolving situations that

provoke conflicts of motivational systems

in the service of taking effective behavioral

action. Stein and Paulus suggest that the

insula, in relation to the vmPFC, may be

important for detecting motivational con-

flict and helping to shape, and be shaped

by, goal intentions and implementation.

Similarly, Aupperle and Paulus (2010) pro-

pose that optimal balancing of approach

and avoidance systems is coordinated by a

network consisting of the OFC (valuation of

stimuli in service of making choices; inhibit-

ing limbic regions and behavioral responses

472 INTERVENTIONS

during fear processing), the ventral striatum

(orientation toward reward), amygdala (pro-

viding salience/intensity of fear and avoid-

ance stimuli), and the insula (monitoring

current and predicting future interoceptive

states in relation to reward and fear). Cor-

respondingly, engaging behavioral actions

to achieve or restore motivational balance

likely consists of responding in a manner

reflecting a contextually and situationally

appropriate balance of reward and safety–

threat systems, while also informing one’s

actions with higher order, values- based deci-

sion making (Wilson & Murrell, 2004).

Attaining goals that reflect motivational

salience and one’s personal values provides

feedback relating one’s behavioral effort to

an outcome.

Regulation

Emotions are part of a larger self- regulation

system that allows us to respond flexibly to

events in our lives in accordance with both

personal goals/values and changing con-

texts. In some instances, the optimal tuning

in a given situation results in the accentua-

tion (i.e., up- regulation) of the emotional

salience of the situation; in other instances,

toning down (i.e., dampening) the emotional

aspects of the situation is warranted. Neuro-

biological evidence supports the notion that

there are multiple pathways to emotion gen-

eration, including automated, “hard-wired”

or lower order systems (largely involving

physiological responses and their subcortical

control) and more controlled, higher order

systems (largely involving subjective, corti-

cal responses) that are separate but inter-

active and mutually essential for differing

aspects of emotional experience (LeDoux,

1996). These higher order and lower order

neural systems also actively regulate each

other (LeDoux, 1996). A functional systems

approach to emotion regulation argues that

these systems work together to maintain

dynamic homeostasis between bodily sys-

tems and internal and external stimuli in a

context- appropriate manner.

Gross (2002) highlights the importance of

the temporal unfolding of emotional expe-

rience in understanding how individuals

self- regulate. Specifically, one can impact an

emotional event via early selection or modi-

fication of a situation, early stages of emo-

tional processing chiefly involving attention,

later stages of emotional processing chiefly

involving verbal representation and cogni-

tive change, or, once an emotional response

has occurred, by attempting to impact the

quality of that response. Influencing the

information- processing aspects of an emo-

tion (i.e., antecedent- focused strategies) is

more effective than acting on the products

of that processing, such as physiological

responses (i.e., response- focused strategies).

Building on these structural and temporal

characteristics, regulation efforts can be dif-

ferentiated by degree of elaboration, which

essentially refers to the degree of cognitive

effort required to engage a particular capac-

ity, from less elaborative regulatory compo-

nents, such as attention, to more elaborative

regulatory components, such as working

memory and verbal representations (Badre

& D’Esposito, 2007), which, at the neural

level, are associated with greater recruit-

ment of dorsal and lateral areas of the PFC

(Ochsner, Bunge, Gross, & Gabrieli, 2002).

Activation of these elaborative areas is asso-

ciated with greater mental effort and can

result in greater resource depletion given

competition for these resources (Muraven &

Baumeister, 2000). Optimal emotion regu-

lation may begin by engaging less elabora-

tive capacities, followed by more elabora-

tive capacities as needed (Sheppes & Gross,

2011). Nonetheless, both less elaborative

and more elaborative regulation efforts

modify security- and reward- based moti-

vational patterns according to contextual

demands (e.g., Delgado, Gillis, & Phelps,

2008; Sokol- Hessner, Camerer, & Phelps,

2013).

Broad and Flexible Contextual Learning

Adaptation refers to the process by which

an organism becomes better suited to pros-

pering in their habitats (Dobzhansky, 1970).

Knowing and providing the contextually

appropriate behavioral response may mean

the difference between life and death, and

between love and loss. Adaptive and flexible

behavioral responses are dependent on the

ability to increase awareness of cues and con-

tingencies in the environment and respond in

ways to promote survival and success. Adap-

Emotion Regulation Therapy 473

tive motivational responses and regulatory

capacities provide a foundation for behav-

ioral flexibility in that they help us attain

maximal emotional clarity (e.g., Gohm &

Clore, 2002) and subsequently implement

effective and goal- relevant responses for

optimal behavioral outcomes.

Optimal reward learning requires us to

take behavioral actions that are informed by

the assignment of value to possibly reward-

ing stimuli and subsequent predictions about

when and where we might encounter these

stimuli (O’Doherty, 2004). Bogdan and Piz-

zagalli (2006) have examined factors such

as reward sensitivity (increased likelihood

of responding to “rich” rewarding stimuli

based on past learning history) as evidence

of the influence of emotion and accurate cue

detection on reward learning and behavior.

Similarly, reliably detecting and respond-

ing to cues that signal a clear and present

danger are crucial for survival (LeDoux,

1996). However, equally important is learn-

ing to detect safety cues accurately and dif-

ferentiate these signals from threat, so that

we do not expend valuable resources (e.g.,

time and energy) in attempts to escape from

“nonthreats.” Contemporary models of

threat and safety learning are predicated on

principles of Pavlovian conditioning and the

knowledge that successful fear extinction

represents new, inhibitory learning (Bouton,

Mineka, & Barlow 2001). Emotion regula-

tion plays an important role in inhibitory

learning via selection of optimal responses

that promote abolishment of a conditioned

emotional response. Commensurately, acti-

vation in the vmPFC, an area central to

implementation of emotion regulation inten-

tions, has been found to decrease during

acquisition of conditioned responses and

increase during fear extinction (Schiller &

Delgado, 2010).

Dysfunctional Emotional Functioning

Motivational Dysfunction

Individuals with distress disorders may be

subject to frequent conflicting pulls from

reward and safety– threat systems. How-

ever, unlike healthy individuals, they may

be relatively less effective in resolving these

motivation conflicts. Drawing upon the

Aupperle and Paulus (2010) model of moti-

vation balancing, individuals with anxi-

ety and mood disorders likely struggle to

overcome motivational conflicts because

they possess one or more of the follow-

ing deficits: (1) an over- representation of

safety– threat valuation as reflected in lim-

bic (amygdala, insula) overactivation; (2)

over- or underrepresentation of approach

valuation as a function of either attenuated

or exaggerated striatal activation, respec-

tively; and (3) insufficient mediation or arbi-

tration of approach and/or avoidance valu-

ations resulting from attenuated OFC and

vmPFC activation. Klenk, Strauman, and

Higgins (2011) offer a similar view of moti-

vational conflict, especially with respect to

GAD and MDD, by drawing from regula-

tory focus theory (RFT; Higgins, 1997), a

normative model of promotion (i.e., reward)

and prevention (i.e., security) motivations,

in which these two systems are conceptual-

ized as separate and mutually inhibitory of

one another. In accounting for GAD, espe-

cially when it co- occurs with MDD, Klenk

et al. (2011) postulate primary failure in the

prevention system (i.e., hyperactivation) that

in turn can lead to failure (e.g., hypoactiva-

tion) in the promotion system. One possibil-

ity is that salience in one or both of these

motivational systems may increase levels of

subjective intensity and corresponding dis-

tress. Although more rigorous experimental

and biobehavioral research is needed, pre-

liminary findings support a role for both

motivational dysfunction (i.e., Campbell-

Sills, Liverant, & Brown, 2004) and subjec-

tive intensity (i.e., Mennin, D. S., Heimberg,

R. G., Turk, C. L., & Fresco, D. M., 2005;

Mennin, Holaway, Fresco, Moore, & Heim-

berg, 2007) in the distress disorders.

Regulatory Dysfunction

Rather than processing emotion informa-

tion and utilizing its motivational value,

individuals with distress disorders often fail

to enhance or diminish emotional experi-

ences in a manner appropriate to a par-

ticular environmental context. Emotion

regulation deficits commonly occur in GAD

(Etkin, Prater, Hoeft, Menon, & Schatz-

berg, 2010; Etkin & Schatzberg, 2011; Men-

nin et al., 2005; Mennin et al., 2007) and

474 INTERVENTIONS

MDD (Johnstone, van Reekum, Urry, Kalin,

& Davidson, 2007). Rottenberg and Gross

(2003) recommend that investigators need

to parse emotion- generative processes from

regulation efforts and to recognize that,

similar to conceptualizations of healthy reg-

ulation, dysregulation occurs dynamically

throughout different points in the emotion-

generative process. Individuals with distress

disorders demonstrate deficits earlier in less

elaborative, attentional regulation, as well as

later in more verbally elaborative, regulation

in response to motivationally salient stimuli.

At a less elaborative level, these individu-

als are characterized by attentional rigidity

in processing both interoceptive and extero-

ceptive emotional stimuli (Clasen, Wells,

Ellis, & Beevers, 2013; Mogg & Bradley,

2005). For example, GAD with and with-

out MDD is characterized by a failure to

regulate emotional conflict spontaneously

by shifting attention in response to a moti-

vationally salient emotional stimulus in con-

flict adaptation tasks (Etkin et al., 2010;

Etkin & Schatzberg, 2011). Each day, we

are confronted with the simultaneous occur-

rence of emotionally conflicting information

that may perturb our goal- directed behavior,

requiring us to attend to, consider, and pos-

sibly inform our actions before completing

the task at hand. The ability to handle these

instances efficiently is called conflict moni-

toring (Botvinick, Braver, Barch, Carter, &

Cohen, 2001). This capacity represents a

facet of normative emotion regulation and

consistently corresponds to activation of the

anterior cingulate cortex (ACC), a region

associated with attentional and motivational

processes. By contrast, individuals with

GAD + MDD struggle to regulate emotional

conflict, fail to engage the ventral ACC in

ways that dampen amygdala activity, and

do not show regulation- related connectivity

between the ventral ACC and the amygdala

(Etkin et al., 2010).

Individuals with distress disorders also

struggle to implement more verbally elabo-

rative strategies. Aldao and Mennin (2012)

found that control individuals, while watch-

ing emotionally evocative films, demon-

strated increased heart rate variability

(HRV; an index of parasympathetic flex-

ibility; Porges, 2001) when instructed to

reappraise (i.e., employ a different cognitive

vantage point regarding an emotionally pro-

vocative event; see Gross, 2002) or accept

(i.e., defined as openly turning toward,

allowing, and remaining in personal contact

with an emotional experience; see Hayes,

Strosahl, & Wilson, 2012). Participants

with GAD showed a paradoxical pattern of

decreased HRV when trying to implement

these more elaborative strategies, suggesting

a failure of efficiency of these strategies for

these individuals. Furthermore, studies com-

paring individuals with MDD (Johnstone et

al., 2007) to healthy control participants

found dissociable patterns of neural activity

when participants were instructed to reap-

praise. Whereas control participants demon-

strated a negative relationship between acti-

vation in the vlPFC and the amygdala that

was mediated by the vmPFC, MDD partici-

pants showed a positive association between

the vmPFC and the amygdala as well as no

vlPFC activation. Rather than effectively

engaging adaptive strategies, there is consid-

erable evidence that individuals with distress

disorders alternatively employ perseverative

strategies to compensate for a negative emo-

tional state, chiefly by enveloping it in elab-

orative self- conscious processing (Borkovec

et al., 2004; Nolen- Hoeksema et al., 2008).

However, cognitively elaborative process-

ing, such as repetitive thought, is depleting

and requires an expenditure of resources

to employ (Muraven & Baumeister, 2000).

This depletion may come at the cost of not

only effective emotion management and

maintenance of distress but it also appears

to preclude effective emotional processing

and learning.

Narrow and Rigid Contextual Learning

Individuals with distress disorders often

exhibit impoverished and inflexible reper-

toires of behavior in response to the situ-

ations that typically function to promote

escape, avoidance, or inactivity as a means

of attempting to manage emotional–

motivational signals (e.g., Ferster, 1973).

These behavioral patterns negatively impact

reward learning. For example, in contrast to

healthy controls, depressed individuals are

less responsive to future opportunities for

reward, despite a firsthand learning history

for the availability of reward (Bogdan & Piz-

Emotion Regulation Therapy 475

zagalli, 2006). Similarly, depressed individu-

als, when given the choice between rewards

of different sizes, fail to distinguish between

options yielding large versus small rewards

(Forbes, Shaw, & Dahl, 2006). Bar (2009)

proposes a model of optimal functioning

characterized by broad and contextual asso-

ciative processing of historical and environ-

mental factors to imagine future events and

outcomes accurately. Depressive rumination

is one strategy common to distress disorders

that narrows associative processing, and in

turn decreases the likelihood of new reward-

based learning and obfuscates focusing on

purposeful action (Bar, 2009). In support of

this assertion, Whitmer and Gotlib (2012)

found that instructing depressed individuals

to ruminate during a laboratory- based task

reduced sensitivity to stimuli associated with

reward and punishment.

With respect to threat and safety learning,

adaptively attending to motivational and

emotional signals can facilitate inhibitory

learning. By contrast, one factor important

to achieving durable inhibitory learning is

the degree of stimulus generalization that an

individual displays in relation to the acquisi-

tion of a conditioned stimulus (CS; Lissek,

2012). In particular, individuals prone to

anxiety disorders are less successful in dis-

criminating the properties of stimuli that

share characteristics with a training CS,

thereby resulting in stimulus overgeneral-

ization and eliciting fear in response to a

broader array of stimuli. Similarly, for most

organisms, signals or cues in the environ-

ment of unambiguous safety from fear leads

to new inhibitory learning that helps to

abolish the conditioned emotional response.

Individuals prone to anxiety disorders are

less likely to achieve a durable and broad-

based abolishment of a conditioned fear

response because of deficits in detecting cues

of unambiguous safety. Instead, their search

for safety is often characterized by hyper-

vigilance and overactivity, thereby result-

ing in an inferior and less durable acquisi-

tion of inhibitory learning (Lohr, Olatunji,

& Sawchuck, 2007; Woody & Rachman,

1994). Further, resorting to worry to regu-

late perceived threat experiences has been

shown to encourage avoidance of emotional

processing (Borkovec et al., 2004; Newman

& Llera, 2011).

Clinical Application of the Emotion

Regulation Perspective

As we have argued elsewhere (Mennin,

Ellard, Fresco, & Gross, 2013), one impor-

tant step in advancing behavioral treatments

for refractory conditions such as distress

disorders is the delineation of core principles

that underlie various efficacious therapeutic

processes and corresponding mechanistic

targets refined from our growing knowledge

of normative behavioral, biological, and

social functioning. Change principles can

be defined as broad frameworks for guiding

both what is being targeted in a given inter-

vention recipient and characteristics of the

intervention itself. Target mechanisms refer

to the characteristics within the recipient of

the intervention that are the focus of change

for a given principle (Mennin et al., 2013).

ERT reflects these common principles and

target mechanisms by drawing therapeutic

processes from (1) CBT (e.g., psychoeduca-

tion, self- monitoring, cognitive perspective

taking, problem solving, relaxation and dia-

phragmatic breathing exercises; Borkovec et

al., 2004; Dugas & Robichaud, 2007); (2)

acceptance-, dialectic-, and mindfulness-

based behavioral treatments (e.g., mindful-

ness exercises to broaden awareness of sen-

sations, bodily responses, and emotions in

the present moment; exercises to increase

willingness to accept emotions, commitment

to action related to personal values; Hayes et

al., 2012; Linehan, 1993; Roemer & Orsillo,

2009; Segal, Williams, & Teasdale, 2002);

and (3) experiential therapy (e.g., a focus

on empathic attunement, the importance

of agency, delineation of emotion function,

engagement of experiential tasks, see Elliot,

Watson, Goldman, & Greenberg, 2004).

ERT also deliberately seeks to integrate find-

ings from basic and translational affect sci-

ence, while simultaneously being responsive

to emerging NIMH priorities. The net effect

is an integrated, mechanism- targeted CBT

that strives to improve the acute and endur-

ing treatment efficacy for individuals suffer-

ing from distress disorders such as GAD and

MDD, especially when the conditions are

comorbid.

ERT is organized around core principles

and target mechanisms related to an affect

science framework, which, specifically seeks

476 INTERVENTIONS

to (1) increase motivational awareness,

(2) develop regulatory capacities, and (3)

engage new contextual learning repertoires.

ERT comprises 16 weekly sessions and uti-

lizes a phasic structure that helps clients

build skills in the first half of treatment that

are deployed in the second half of therapy

during exposure exercises. This phasic

structure draws from Gross’s (2002) emo-

tion regulation model, which distinguishes

between efforts to regulate emotions ear-

lier (i.e., antecedent- focused strategies) and

later (i.e., response- focused strategies) in

the emotion- generative process. Specifically,

clients progress through ERT first by learn-

ing skills to increase mindful awareness of

emotional and motivational states; learning

skills to increase adaptive emotion regula-

tory responses congruent with contextual

demands (“counteractive” as an alternative

to reactive response- focused regulation);

and increasing values- informed behavioral

actions that strike a balance between secu-

rity and reward motivational pulls (“proac-

tive” regulation akin to antecedent- focused

regulation).

Motivational Awareness Skills Training

The first component of ERT is the cultiva-

tion of skills to increase motivational aware-

ness (i.e., the accurate and rapid detection of

cues that signal the arrival of motivational

pulls). The benefit of emotional and motiva-

tional clarity is a consistent finding across

numerous studies. For instance, Lanaj,

Chang, and Johnson (2012) offer meta-

analytic support for RFT (Higgins, 1997)

in relation to workplace performance, such

that a promotion (reward) focus was posi-

tively associated with task performance and

innovativeness in the workplace, and nega-

tively associated with counterproductive

workplace behaviors. In contrast, a preven-

tion (security) focus that was unrelated to

task performance but positively associated

with engaging in safe workplace practices

was also associated with counterproductive

workplace behaviors. Furthermore, Gohm

and Clore (2002), in a series of studies, have

consistently shown that emotional clarity,

assessed via self- report, is associated with a

variety of beneficial wellness characteristics

and the tendency to approach life circum-

stances with planful, active coping.

From a treatment perspective, motiva-

tional interviewing (MI) represents a stand-

alone or adjunctive intervention that strives

to bring awareness to one’s motivations, and

the discrepancies between one’s stated goals

and actions as a means of enhancing one’s

willingness to change. Westra, Arkowitz,

and Dozois (2009) reported that the addi-

tion of MI to traditional CBT was associated

with greater clinical efficacy in GAD, espe-

cially among clients with higher pretreat-

ment levels of pathological worry. Finally,

training in mindfulness meditation may be

one means of enhancing emotional aware-

ness and clarity. For example, Farb et al.

(2010) found that a sadness provocation is

associated with activation of self- referencing

neural circuits (e.g., medial PFC), but train-

ing in mindfulness meditation is associated

with activation of additional neural regions

associated with visual attention (e.g., pulvi-

nar nucleus), as well as visceral and somato-

sensory areas (e.g., right insula). Greater

activation of these neural regions was also

negatively correlated with concurrent levels

of depression.

Drawing from this empirical basis, ERT

helps clients develop motivational awareness

initially through psychoeducation aimed at

increasing understanding of emotions and

underlying motivations in the context of

personally relevant historical and proximal

events. Clients receive a rationale for the

benefits of observing emotions with greater

granularity and clarity (i.e., better differen-

tiation of each emotion even when multiple

emotions are present). For instance, clients

imagine a musical orchestra in which each

musical instrument represents a different

emotion. The orchestral composition rep-

resents the motivational pulls in their lives.

Ideally, the composition is harmonious and

the music moves clients to take some action

in their lives. Clients are encouraged to lis-

ten in such a way that each and every part of

the orchestra can be heard and discerned for

its contribution to the overall composition.

As noted by Aupperle and Paulus (2010),

individuals with distress disorders struggle

to resolve motivational conflicts that occur

in their lives, via overrepresentation of

threat valuation, inconsistent representa-

tion of approach valuation, and impaired

arbitration of these motivation systems. The

net result of this imbalance of motivational

Emotion Regulation Therapy 477

pulls is that the discrepancy becomes the

salient signal, and individuals with distress

disorders often respond reactively in a des-

perate attempt to resolve the discrepancy.

Thus, building on the orchestra metaphor,

clients also engage in a motivational anchor-

ing exercise that begins their training in cul-

tivating greater motivational and emotional

awareness. Specifically, clients imagine an

important but difficult situation in their lives

that likely is marked by pulls for approach

and avoidance. As clients imagine this situ-

ation, they envision the kinds of behavioral

responses they are likely to take from that

particular balance of approach and avoid-

ance motivations. ERT therapists then sys-

tematically help clients to envision this situ-

ation from various motivational stances,

with the goal of helping them see that most

life circumstances comprise both approach

and avoidance motivations, and different

responses are possible when one attends and

follows to differing degrees one’s emotions

and motivations.

As clients gain an appreciation and under-

standing for how emotions and motivations

can effectively inform their lives, they are

introduced to a metaphor designed to help

them improve the accuracy and rapidity of

detecting cues in their lives. This work is

predicated on the well- validated behavioral

interventions of self- monitoring (e.g., Line-

han, 1993) and functional analysis (e.g.,

Ferster, 1973), in which clients are taught to

increase their self- awareness of life situations

as a means of better identifying antecedents

(triggers), thoughts, feelings, and behaviors

that are prompted by these antecedents, and

the consequences of these behavioral actions.

Self- monitoring helps individuals identify

patterns of responding reactively, often with

little awareness of the emotional and moti-

vational pulls as a first step in bringing more

conscious, deliberate, and ideally effective

action when certain cues arise. In ERT, the

therapist begins self- monitoring and cue

detection by asking clients to imagine a pris-

tine snowball (i.e., a pure emotional experi-

ence) rolling down a hill, and in the course

of its travel, picking up dirt and twigs, and

becoming hard and icy (i.e., the unfolding

of emotional experience, particularly in the

aftermath of failures in nonelaborative and

elaborative emotion capacities). Essentially,

the snowball metaphor informs clients about

the temporal model of emotion regulation

and how less effort is required when emo-

tions are handled closer to their arrival in

the temporal unfolding.

Drawing from this snowball metaphor,

ERT clients are then encouraged to practice

a form of self- monitoring called Catch Your-

self Reacting (CYR). This practice begins as

a simple exercise to help identify triggers of

clients’ emotions, the actual emotions them-

selves (fear, anxiety, disgust, etc.), and the

intensity of each emotion they listed. Later

in ERT, the CYR is also utilized to practice

the emotion regulation skills clients will

learn in the course of treatment (see below).

CYRs are completed at home, then reviewed

in the subsequent session with the therapist.

When clients experience difficulties with

CYR, therapists may choose to conduct a

“Do-Over.” This activity resembles both the

cognitive rehearsal task, derived from tradi-

tional cognitive therapy of depression (Beck,

Rush, Shaw, & Emery, 1979), and evocative

unfolding in experiential therapy (Elliott et

al., 2004). The CYR “Do-Over” essentially

represents a therapist- supervised opportu-

nity to shape and solidify self- monitoring

and cue detection.

Regulatory Skills Training

A principle of regulatory skills training

assumes that individuals with psychopa-

thology do not have immutable regulation

deficits; rather, with appropriate training,

these capacities can be grown and utilized in

their lives. Based on Gross’s model and the

extant clinical and experimental literature,

ERT targets different regulatory capacities

by utilizing a number of CBT intervention

processes that vary in their entry points

along the trajectory of unfolding emotional

experience. Specifically, we promote four

increasingly elaborative (i.e., that use work-

ing memory/verbal representations and are

resource intensive; Badre & D’Esposito,

2007) regulatory capacities that rely on

antecedent- focused processing: attending

(i.e., the ability to focus, sustain, and flexibly

move attention); allowance (i.e., the ability

to openly turn toward, allow, and remain in

personal contact with an emotional experi-

ence); distancing (i.e., the ability to identify,

observe, and generate psychological perspec-

tive from inner experiences); and reframing

478 INTERVENTIONS

(i.e., the ability to change one’s evaluation of

an event such that the event is altered in its

emotional significance).

Attending

A capacity for directed attention implies

flexible responsivity to different contexts.

Whereas constricted, narrowly focused

attention is adaptive during times of poten-

tial threat, broadened attention facilitates

exploratory behavior, thereby allowing for

the possibility of increased detection of new

information and novel incentives (Friedman

& Forster, 2010). One facet of directed atten-

tion is focused attention, which involves

actively choosing the stimulus to which one

will attend (Kabat-Zinn, 1990). Similarly,

sustained attention refers to maintaining

this focus on the target stimulus (see Posner

& Rothbart, 1992), as well as actively redi-

recting attention back to the target stimulus

when attention has wandered (e.g., Small-

wood & Schooler, 2006). Finally, flexible

attention entails deliberately attending to

various aspects of an experience (Kabat-

Zinn, 1990). Converging lines of research

suggest that reduced attentional flexibility

and rigid attentional biases distinguish indi-

viduals with distress disorders from healthy

controls (Clasen et al., 2013; Mogg & Brad-

ley, 2005).

ERT targets directed attention by promot-

ing skills to encourage greater awareness

of emotions, including sensations, bodily

responses, and subjective experience. Mind-

ful attention training is utilized to increase

a healthy awareness of motivations and

emotional responding, with a particular

emphasis on less elaborative, less linguistic

processing of one’s experience (Kabat-Zinn,

1990). Both in- session and daily practices

are derived from mindfulness- based stress

reduction (MBSR; Kabat-Zinn, 1990)

and mindfulness- based cognitive therapy

(MBCT; Segal et al., 2002). ERT promotes

directed attention toward external stimuli by

increasing mindfulness of senses. A broad-

ened awareness of appetitive and aversive

stimuli alike is encouraged through practices

that increase mindful ingestion of senses

(e.g., eating a raisin mindfully; Kabat-Zinn,

1990). ERT also promotes directed attention

to internal, nonverbal stimuli or stimuli that

can be felt in the body (e.g., Craig, 2009),

thereby enhancing the ability to disengage

from elaborative processes about sensory

experiences. Clients are taught diaphrag-

matic breathing as a brief, nonelaborative

practice that focuses attention on sensa-

tions in the body (e.g., Roemer & Orsillo,

2009). Clients also learn a practice adapted

from the body scan work common in MBSR

(Kabat-Zinn, 1990) and MBCT (Segal et

al., 2002), coupled with an awareness- based

progressive muscle relaxation approach that

has been effectively utilized in the treatment

of GAD (Roemer & Orsillo, 2009). After

experiencing some success with directed

attention practices, clients learn an “on the

spot” skill of detecting tension and imple-

menting relaxation techniques to promote

greater flexibility in musculature response.

Finally, although not every emotion expe-

rienced is necessarily adaptive, broadening

awareness to the full spectrum of emotional

experience can help clients move through

“cloudy” (i.e., secondary emotional reac-

tions) toward “clear” (i.e., primary emo-

tions that convey initial action tendencies

and their associated meanings for behav-

ior) emotions that better reflect the array of

motivational cues that may be present (Elliot

et al., 2004; Linehan, 1993). Specifically, cli-

ents learn a mindfulness of emotions exer-

cise in which the goal is to bring to mind a

situation that possesses conflicting emotions

and motivations (i.e., simultaneous security

and reward impetuses), and they are invited

to sit with the experience until they can hold

and more clearly delineate the emotions and

motivational pulls in the situation.

Allowing

Emotional allowance involves maintaining

contact with feeling states, without being

dissuaded by elaborative thought processes,

such as judgments about the experience

(see Hayes et al., 2012). Individuals with

highly developed capacities to accept their

emotions are less likely to avoid certain

endeavors wherein difficult emotions could

arise and are more likely to stay in contact

with emotions associated with aversiveness,

increasing the possibility of updating con-

tingencies related to their valuation (Hayes

et al., 2012). Individuals with psychopathol-

Emotion Regulation Therapy 479

ogy demonstrate difficulties acknowledging

their emotional experiences, which includes

being dissuaded by negative beliefs about

difficult emotions, aversion toward difficult

emotional experiences, engaging in mal-

adaptive elaborative responses when diffi-

cult emotions arise (e.g., worrying, brood-

ing, self- criticizing), attempting to reduce

their awareness and limit their experience

of difficult emotions, and avoiding situa-

tions and activities that could provoke dif-

ficult emotions, even when such activities

are important to them (Barlow et al., 2011;

Hayes et al., 2012; Linehan, 1993; Roemer

& Orsillo, 2009; Segal et al., 2002).

By accepting and exploring emotions,

clients gain an ability to be present with

emotions and learn how to determine their

functional utility in guiding actions. Spe-

cifically, clients conduct an “offline” prac-

tice that involves imaginally engaging and

remaining in contact with sensations, emo-

tions, and cognitions that arise in pursuit

of a difficult to achieve but motivationally

enhancing action— in effect, a personally

salient approach– avoidance conflict. The

on-the-spot version of this practice involves

encouraging clients to “pause” by sustaining

their connection to a cloudy, diffuse situa-

tion until they are able to connect to the pri-

mary emotions that reflect both motivations

for reward and safety. Another borrowed,

on-the-spot practice, designed to sustain or

regain allowance is the 3-minute breathing

space (Segal et al., 2002), which helps clients

anchor themselves in an event with strong

pulls to respond reactively.

Distancing

Various theorists (e.g., Hayes et al., 2012;

Kross & Ayduk, 2009; Segal et al., 2002)

have emphasized the importance of distanc-

ing or decentering, the metacognitive abil-

ity to observe items that arise in the mind

(thoughts, feelings, memories, etc.) with

healthy psychological distance, greater self-

awareness, and perspective taking. Cogni-

tive distancing helps individuals disengage

from an intense emotion, its corresponding

motivational impetus, and associated mal-

adaptive self- referential processing, in favor

of adopting a more experiential perspec-

tive. This ability also involves recognizing

that one’s thoughts, feelings, and urges are

transient internal events rather than inher-

ent, permanent aspects of the self or accu-

rate representations of reality (Fresco et

al., 2007; Segal et al., 2002). Studies reveal

psychological benefits from promoting dis-

tance from the self in time (e.g., viewing

inner experiences as temporary; Watkins,

Teasdale, & Williams, 2000) and in space

(e.g., viewing inner experiences as physi-

cal objects that are separate from oneself;

Kalisch et al., 2005). Distress disorders have

been associated with deficits in cognitive

distancing (e.g., Fresco al., 2007) and can

be reduced by experimental techniques that

promote an observational distance from the

self (e.g., Kross & Ayduk, 2009).

Distancing is targeted through two offline

mindfulness practices and their correspond-

ing on-the-spot versions. In the mountain

meditation, derived from MBSR (Kabat-

Zinn, 1994), clients are invited to internal-

ize a living, breathing mountain to provide

solidarity and permanence in their lives to

help them “weather” the transient emotional

upheavals in their lives. The mountain medi-

tation provides a decentered perspective

through the lens of time— helping clients

tell themselves “This too will pass.” Clients

then practice a brief version of the mountain

meditation designed to be utilized on the

spot in moments that call for a security- first

response to help sustain or regain a decen-

tered stance. Similarly, drawing primarily

from acceptance and commitment therapy

(ACT; Hayes et al., 2012), ERT promotes

a focus on mental spatial distance and is

designed to teach clients to bring situations to

mind, then to granulize the constituent parts

of the situation by placing them externally

on objects in the room. This offline practice

is an invitation to create healthy distance in

one’s mind’s eye so that these products of

mind are more readily observable, and in

turn, can inform our deliberate actions from

a decentered perspective. This practice also

has a corresponding on-the-spot skill, where

clients imaginally place products of their

mind on objects that they ordinarily carry in

their daily lives. One of our clients actually

carried around a shoehorn he crafted, which

he used to “pry” himself away from prod-

ucts of his mind to promote better observa-

tion and nonjudgment.

480 INTERVENTIONS

Reframing

Reframing refers to the ability to change

one’s evaluation of an event so as to alter its

emotional significance (Gross, 2002). Three

of the most common methods include real-

istic reappraisal (e.g., reevaluating an event

in a more accurate, objective, factual man-

ner, while remaining sensitive to contextual

factors; Ray, Wilhelm, & Gross, 2008),

positive reappraisal (e.g., reevaluating an

event in a manner that emphasizes possible

desired, rewarding, or beneficial aspects of

the event or consequences of the event that

may have been overlooked in the original

appraisal; Ray et al., 2008), and compas-

sionate reappraisal (e.g., reevaluating an

event in a manner that appreciates and vali-

dates the presence of emotional pain and

desires to alleviate it, and identifies the pain

as a natural aspect of the human experience;

Leary, Tate, Adams, Batts, & Hancock,

2007). Researchers who have manipulated

changing cognitions in the laboratory have

found psychological benefits from instruct-

ing participants before they encounter a

stimulus or task to reappraise it in a manner

designed to promote personal detachment

or objectivity (e.g., Gross, 2002). A capac-

ity to change cognitions and relinquish one’s

original interpretation may undermine pas-

sive, repetitive elaborative processes central

to transdiagnostic psychopathology (e.g.,

rumination; Nolen Hoeksema et al., 2008)

and promote flexibility that allows more

effective, rather than habitual, behavioral

reactions. Indeed, reappraisal has been

found to be positively associated with a

number of indices of well-being, including

effective interpersonal functioning (Gross,

2002).

ERT employs several strategies to develop

cognitive change capacities to provide tem-

porary relief from emotional distress, facili-

tate a restoration of emotional clarity, and

promote effective action. Once clients have

obtained a decentered perspective from their

emotional and motivational pulls, they are

encouraged to adopt a courageous perspec-

tive wherein they can address any security-

driven responses and provide alternative

statements that reflect their strength in the

face of uncertainty. Clients are also encour-

aged to adopt a self- compassionate reap-

praisal stance wherein they can imagine

telling a very caring, interested, compassion-

ate individual about their difficult thoughts

and feelings, and reminding themselves of

their strengths and coping ability (Gilbert,

2009; Segal et al., 2002). Noticing one’s self-

critical thoughts is encouraged and “soften-

ing” them when they arise is accomplished

by invoking alternative, self- validating state-

ments. These courageous and compassionate

statements are typically written down and

carried with the patient in a pocket or put on

a smartphone as a recurrent reminder. After

committing these statements “to heart,” cli-

ents are then encouraged simply to tap their

pocket or bag containing the written state-

ment or smartphone to regain quickly this

sense of perspective.

Experiential Exposure

A hallmark goal of CBT is to assist clients

in “new learning” to promote the imagin-

ing or enacting of novel experiences that

counteract old and well-worn patterns of

maladaptive associations and reinforcement.

With respect to anxiety disorders, exposure

therapy, derived from principles of classical

conditioning, has demonstrated consider-

able acute and enduring treatment efficacy

(Craske et al., 2008). Exposure therapy is

often coupled with treatment components

that reduce the reliance on escape and avoid-

ance behaviors while cultivating repertoires

of behaviors designed to pursue and obtain

rewards (Craske et al., 2008; Ferster, 1973).

Additionally, informed by important basic

findings about the nature of classical extinc-

tion and inhibitory learning (e.g., Bouton,

Mineka, & Barlow, 2001) implementations

of exposure therapy have moved beyond

sustained fear reduction and habituation

accounts of extinction to promote supe-

rior inhibitory learning and extinction

retrieval (e.g., Craske, & Vervliet, 2013).

Similarly, behavioral accounts of depres-

sion depict depressed individuals as no lon-

ger able to engage the behavioral repertoires

capable of delivering positive reinforcement

(Lewinsohn, 1974) while they inordinately

orient their lives in service of escape and

avoidance of aversive situations (Ferster,

1973; Kanter et al., 2010). To overcome these

deficits, treatment typically consists of inter-

ventions that include activity scheduling,

contingency management, and skills training

Emotion Regulation Therapy 481

as ways to help individuals gain awareness

of the availability of positive reinforcement,

engage in behaviors capable of obtaining

the positive reinforcement contingently, and

ideally, effecting change in the environment

so that access to positive reinforcers remain

available when certain behavioral responses

are provided (Ferster, 1973; Kanter et

al., 2010; Lewinsohn, 1974). In addition,

recent innovative treatments for depression

have benefited from basic and translational

findings (e.g., Bouton et al., 2001) about

developing exposure- based treatments for

depression that deliberately provoke and

activate historical negative content, so that

this material can be explored alongside

information that is dissonant and serve to

facilitate broad-based change in maladap-

tive cognitive– affective– behavioral– somatic

patterns (e.g., Hayes et al., 2007).

Exposure therapy is most effective when

the fear stimulus is focal and difficult to

avoid (e.g., specific phobia). Traditional

exposure therapy may be less efficacious in

distress disorders. Whereas individuals with

uncomplicated presentations of anxiety have

relatively more discrete and circumscribed

fears, individuals with distress disorders

have difficulties confronting emotional

arousal irrespective of what external cue

provokes it. That is, conducting exposure

therapy in response to external fear cues

does not effectively target the source of the

difficulty for individuals with distress disor-

ders. Consistent with an emotion regulation

framework, some approaches promote expo-

sure to emotional experiences themselves to

increase acceptance of these experiences and

diminish the need to utilize strategies such

as worry or rumination in an attempt to

escape aversively perceived emotional states

(e.g., Barlow et al., 2011). However, this

approach may not fully address dysfunction

given that distress- disordered individuals

commonly resort to cognitively elaborative

responses such as worry and rumination to

help them escape emotional processing and

to preclude new inhibitory learning. Fur-

thermore, a focus on negative emotional

exposures may do less to expose individu-

als to core idiographic and schematic themes

that certain emotions may convey. Also, this

approach does not necessarily engage the

reward system by directly encouraging pro-

active behavior toward desired outcomes.

In other words, exposure in distress disor-

ders may be most fruitful when it involves

contexts that have recurrent themes such as

threat (i.e., security motivation system) and

encourage activation (i.e., reward motiva-

tion system).

In support of this contention, recent

work by Newman and Llera (2011) demon-

strates that worry is reinforced by creating

a fixed, invariable, and predictive defensive

emotional state that inevitably precludes

emotional processing. For individuals with

GAD, they argue, what they fear is a stark

emotional contrast, such as moving from a

positive state to a negative state, which may

disincline these individuals to engage a posi-

tive state if it means increased possibility for

a negative state. This conceptualization is

consistent with the emotion regulation model

in which individuals with distress disorders

resort to worry and rumination in response

to security motivations, which overshadow

reward motivations. Furthermore, it is con-

sistent with behavioral accounts of MDD

that view depressed individuals as withdraw-

ing to protect themselves from the aversion

of loss, thus gaining no new rewards to help

them counteract their depression. Taken as a

whole, these perspectives suggest that expo-

sure to rewarding contexts with the possi-

bility of high risk may be most ameliorative

for these individuals, since they simultane-

ously engage both the security and reward

systems.

In ERT, exposure to threat– reward con-

trasts are accomplished by focusing clients’

attention on their personal values (i.e., their

highest priorities and most cherished princi-

ples; Hayes et al., 2012; Wilson & Murrell,

2004). Values-based exposure involves turn-

ing a problem on its head: Rather than being

exposed to feared outcomes, one is exposed

to the way he or she would like to be living,

and the expected arrival of perceived fears,

disappointments, and judgments are treated

as obstacles to being able to live a valued life

(Hayes et al., 2012). ERT expands values-

based exposure commonly utilized in ACT

to address not only “top-down” decisions

about life goals but also “bottom– up” influ-

ences of security and reward motivational

pulls, as well as their interaction. During an

experiential exposure phase of ERT, clients

explore acting in accordance with their val-

ues and confronting any accompanying per-

482 INTERVENTIONS

ceived obstacles that arise both within and

between sessions. Specifically, new learning

is targeted with three main exposure inter-

ventions to promote valued living: (1) ima-

ginal exercises related to values- informed

goals; (2) experiential dialogue exercises

to explore perceived internal motivational

conflicts that impede engaging in valued

actions (Elliot et al., 2004); and (3) planned

between- session exercises wherein clients

engage valued actions outside of session. Cli-

ents also utilize regulatory capacity skills to

help in engagement of in- session experiential

tasks and to facilitate valued action outside

of session.

Proactive Valued Action

In ERT, therapists and clients collaborate

to identify cherished values in life domains

(e.g., family, friends, relationships, work,

personal care), with clients reporting dis-

crepancies between the importance they

place on this value and how consistently

they have been living accordingly (Wilson &

Murrell, 2004). Therapists then encourage

clients to think about a salient value with a

large discrepancy and how they want their

actions to reflect this value today, even if

it involves only a small action step. Specifi-

cally, imaginal exposure tasks that focus on

engaging in specific valued actions are con-

ducted to (1) provide clients with an experi-

entially rich rehearsal of the steps that might

be necessary to live by their values and (2)

confront the emotional challenges that are

likely to come up as clients imagine engage-

ment of valued action. In this imagery expo-

sure task, therapists help clients imagine

each step involved in engaging this action,

while noting changes in motivational lev-

els and encouraging utilization of skills to

address difficulties in awareness and bal-

ancing of emotional responses. Utilizing

imagery to consolidate skills and promote

functional action is also congruent with

traditional interventions such as cognitive

rehearsal (Beck et al., 1979).

Exploring Conflict Themes in Obstacles

to Valued Living

The second component of exposure work

in ERT involves addressing perceived obsta-

cles to taking valued action. Obstacles are

addressed through the lens of “conflict

themes” and include primarily (1) a motiva-

tional conflict (e.g., security motivations are

blocking or interrupting efforts that engage

the reward system) and (2) self- critical reac-

tive responses to emotions (i.e., judgmen-

tal negative beliefs about one’s emotional

responses and associated motivations are

interrupting self- acceptance and engage-

ment of reward). These conflict themes

are addressed within the session using an

experiential dialogue exercise derived from

emotion- focused therapy (Elliot et al.,

2004). The motivational conflict is most

central to interrupting valued action and is

addressed by encouraging clients to engage

in a dialogue between the part of themselves

strongly motivated to obtain security, and the

part motivated toward self- actualization, to

arrive at a more unified motivational stance

that is conducive to valued action. Resolution

comes when expressions from both sides of

the dialogue demonstrate acknowledgment

of the needs of the other and an agreement

to commit to the valued action while allow-

ing a place for a softened obstacle voice to be

present without total control. The purpose

of these tasks is to reduce negative emotional

responses that are activated when obstacles

reflecting these conflicts are perceived (i.e.,

exposure), to generate a new perspective

(i.e., new meaning) on these obstacles, and

to engage more adaptive emotions that are

facilitative of valued action engagement.

Engaging Proactive Valued Action

Outside of Session

Valued action is also promoted between ses-

sions by building upon the in- session valued

action exploration and obstacles confronta-

tion exposure tasks. Therapists encourage

clients to engage both planned (i.e., spe-

cific valued actions related to salient val-

ues explored in session and to which clients

commit in the presence of therapists) and

spontaneous (i.e., any other valued actions

in which clients notice themselves engaging)

valued actions outside of session (Hayes et

al., 2012). Furthermore, clients are encour-

aged to utilize skills both proactively (in

an antecedent- focused manner) when they

are planning to engage valued actions and

counteractively (in a response- focused man-

ner) when they notice themselves getting

Emotion Regulation Therapy 483

unexpectedly distressed and feel pulled to

respond reactively with worry, reassurance

seeking, self- criticism, or behavioral avoid-

ance. Finally, external barriers (i.e., obstacles

in the environment that are outside the cli-

ent’s control) that might have been deferred

during exposure tasks can also be addressed

more actively in between- session exercises.

Therapists can help clients problem- solve

these obstacles or utilize skills such as accep-

tance to further facilitate valued action.

Research Findings

To date, we have tested the efficacy and pur-

ported mechanisms of ERT in a number of

trials at various sites. These findings have

been presented in greater detail at a number

of recent conference sessions (e.g., Mennin

& Fresco, 2011; Mennin, Fresco, & Aldao,

2012) and are the focus of submitted manu-

scripts currently under review.

Preliminary Outcome Results

To date, ERT’s efficacy has been demon-

strated in a recently concluded NIMH-

funded project that comprises an open trial

(N = 19) and a randomized control trial

(RCT; N = 60). In both trials, clients toler-

ated ERT, as evidenced by high ratings of

personal satisfaction and low rates of attri-

tion in the course of treatment. For instance,

18 of 19 open-trial clients and 26 of 30

RCT clients completed treatment. In terms

of clinical outcomes, open-trial clients evi-

denced reductions in both clinician- assessed

and self- report measures of GAD severity,

worry, and trait- anxious and depression

symptoms, and corresponding improve-

ments in quality of life, with within- subjects

effect sizes well exceeding conventions for

large effects (Cohen’s d’s = 1.5 to 4.5). These

gains were maintained for 9 months follow-

ing treatment.

The RCT study compared ERT to a modi-

fied attention control (MAC) condition,

which involved clients periodically speak-

ing via telephone to a clinician who pro-

vided supportive listening. Clients received

assessments at baseline, midtreatment, and

postacute treatment. MAC clients were

offered ERT in an open-label fashion follow-

ing the immediate RCT period. RCT find-

ings revealed that ERT clients, compared to

MAC clients, evidenced significantly greater

reductions in GAD severity, worry, trait

anxiousness, and depression symptoms, and

corresponding improvements in functional-

ity and quality of life, with between- subjects

effect sizes in the medium to large range (d

= 0.50 to 2.0). These gains were maintained

for 9 months following the end of treatment.

In addition, these effect size estimates also

take into account clients who dropped out

of treatment.

Finally, a sizable subgroup of clients with

GAD and comorbid MDD (N = 30) were

enrolled and treated. Within- subjects effect

sizes in both clinician- assessed and self-

report measures of GAD severity, worry,

trait anxiousness, and depression symptoms,

and corresponding improvements in func-

tionality and quality of life, were comparable

to overall trial findings— thereby suggesting

that MDD comorbidity did not interfere

with treatment efficacy (Cohen’s d’s = 1.5 to

4.0). Furthermore, rumination and anhedo-

nia also decreased (Cohen’s d’s = 1.5 to 2.0).

Preliminary Mechanisms Results

We argue that efforts to demonstrate the

mechanisms by which one’s treatment pro-

duces clinical improvement are best tied

to common target mechanisms such as

those that reflect the capacities described

earlier (e.g., directed attention, emotional

acceptance, cognitive distancing, cognitive

change). Furthermore, target mechanism

change should be demonstrated with biobe-

havioral marker assessments (e.g., behavioral

tasks, functional magnetic resonance imag-

ing [fMRI], psychophysiology) that have

established reliability and validity in labora-

tory and analogue studies. This approach is

aligned with the growing multidisciplinary

field of intervention science and with NIMH

priorities (e.g., RDoC; Craske, 2012), which

seek to elucidate biobehavioral markers that

are reliably dissociable in patient subgroups

compared to healthy controls. Also, assess-

ing common target mechanisms in various

approaches may help us better understand

patient characteristics that predict treatment

success and failure (e.g., treatment match-

ing, treatment optimization/augmentation;

NIMH Council’s treatment personalization

initiative; Kraemer, Wilson, Fairburn, &

Agras, 2002).

484 INTERVENTIONS

Commensurate with this viewpoint, ERT

has been designed to target mechanisms of

affective dysfunction that we have argued

are central to refractory distress disorders.

Thus, we have been interested in examining

whether these treatment outcomes are the

result of changes in purported motivational,

regulatory, and contextual learning mecha-

nisms. One promising preliminary finding

is related to emotional conflict adaptation

(Etkin & Schatzberg, 2011). A subset of our

ERT clients (N = 15) completed the Etkin

emotional conflict task (described earlier)

at pretreatment and at the midpoint of ERT.

Findings indicate that by midtreatment, cli-

ents improved in ability to shift their atten-

tion in the face of emotional conflict (pre- to

midtreatment d = 0.74) to levels comparable

to healthy controls (Etkin et al., 2010). Fur-

thermore, clients who showed the greatest

gains in conflict adaptation by midtreat-

ment, showed the greatest pre- to posttreat-

ment response in anxiety, anhedonic depres-

sion, and worry. These preliminary data are

supportive of our hypotheses that ERT may,

in part, exert its therapeutic impact through

normalization of less elaborative emotion

regulatory mechanisms such as ability to

shift attention by adapting to conflict.

Although we have not yet tested changes in

more elaborative regulatory mechanisms, we

have examined responses to more complex

emotional stimuli, which likely require more

effort and elaboration to manage. Specifi-

cally, we assessed HRV during a fearful film

paradigm at pre- and midtreatment. Eigh-

teen clients were assessed during the neutral

film, the fearful film, and, a recovery period.

At pretreatment, these clients displayed a

flattened response throughout the experi-

mental period— suggesting reduced flex-

ibility. At midtreatment, clients displayed a

quadratic pattern of vagal withdrawal (i.e.,

reactivity) and vagal rebound (d

pre to mid-tx

0.81) reflecting a more normative response

to these changing emotional contexts.

Period- averaged HRV levels at midtreatment

also increased to within 1 SD of levels in a

healthy control sample. Furthermore, clients

who showed the greatest increases in para-

sympathetic flexibility from pre- to midtreat-

ment showed the greatest pre to posttreat-

ment gains in diagnostic severity, anxiety,

worry, anhedonic depression, impairment,

and life quality. These data suggest that ERT

normalizes emotional response patterns,

and that this normalization plays a role in

the therapeutic effects of ERT. However, it

is unclear how clients were able to improve

their response to the film, because spontane-

ous utilization of ERT-related or other strate-

gies was not assessed. It will be important in

future research to determine whether these

improvements are indeed due to implementa-

tion of the skills learned in ERT.

Conclusions and Future Directions

Individuals with distress disorders (i.e.,

GAD, MDD) are commonly comorbid and

appear to be characterized by higher order

negative emotional factors (e.g., Krueger &

Markon, 2006; Watson, 2005) that reflect

activation of underlying motivational sys-

tems related to threat– safety and reward–

loss (Campbell- Sills et al., 2004; Klenk

et al., 2011; Woody & Rachman, 1994).

Furthermore, they tend to perseverate (i.e.,

worry, ruminate) as a way to manage this

motivationally relevant distress (Borkovec

et al., 2004; Nolen- Hoeksema et al., 2008)

and often utilize these self- conscious pro-

cesses to the detriment of engaging new

learning repertoires. ERT (Mennin &

Fresco, 2009) integrates principles from tra-

ditional and contemporary CBT (e.g., skills

training and exposure) with basic and trans-

lational findings from affect science to offer

a blueprint for improving intervention by

focusing on the motivational responses and

corresponding regulatory characteristics

of individuals with distress disorders. This

emphasis on affect science permits identifi-

cation of mechanisms of treatment in terms

of core disruptions of normative cognitive,

emotional, and motivational systems, which

in turn helps generate more targeted solu-

tions to help clients utilize adaptive ways to

cope or compensate for these core deficits.

In essence, contrasting a client’s difficulties

with what we understand as normative func-

tioning allows us to generate theory- driven

hypotheses that form that basis of our case

conceptualization and treatment planning

(e.g., Craske, 2012).

A summary of the conceptual model of

ERT as presented in this chapter appears in

Figure 28.1. However, ERT continues to be

developed and tested. For up-to-date infor-

485

Motivation

security system; reward system

Regulation

Less Elaborative → More Elaborative

Contextual Learning

flexible responding to simultaneous

risk and reward context

(i.e., approach–avoidance conflict)

Target Mechanisms

Change Principles and

Therapeutic Processes

Regulation Skills Training

mindfulness of sensations, body, and emotions;

allowance metaphors and practices; distancing in

time and space; courageous and

compassionate self-statements

Awareness Skills Training

psychoeducation of motivations/emotions;

improved detection of and attendance to

motivational cues

Experiential Exposure

values delineation; experiential imagery and conflict

dialogue exercises; valued action homework

FIGURE 28.1. Conceptual model of target mechanisms, change principles, and therapeutic processes in emotion regulation therapy.

486 INTERVENTIONS

mation about ERT, please visit www.emo-

tionregulationtherapy.com. Our emotion

regulation model is based on current find-

ings in affect science and the psychopathol-

ogy of distress disorders. However, many

of the central tenets of our model await

further careful experimental inquiry using

multimethod biobehavioral approaches.

Nonetheless, preliminary data are support-

ive of our hypotheses that ERT may exert its

therapeutic impact in part through normal-

ization of emotional processes, and there-

fore be most effective for individuals with

distress disorders in whom this system is

most impaired. Building on these pilot find-

ings on biobehavioral mechanisms of ERT,

we are currently examining neural changes

related to ERT utilizing fMRI procedures

while administering paradigms examining

motivational engagement and regulatory

responses at less and more elaborate levels.

Furthermore, we are currently developing a

portable, computer- based “emotion regula-

tion training” to target mechanisms of ERT

in a briefer, more rapid, and cost- effective

method of intervention, which may be par-

ticularly useful for certain populations and

geographical locations in which standard

treatment efforts are less feasible (Kazdin

& Blase, 2011). Through this work, we are

eager to continue testing motivational and

regulatory mechanisms in the distress dis-

orders and to demonstrate their role in tar-

geted treatments such as ERT.

References

Aldao, A., & Mennin, D. S. (2012). Paradoxical

cardiovascular effects of implementing adap-

tive emotion regulation strategies in general-

ized anxiety disorder. Behaviour Research

and Therapy, 50, 122–130.

Aupperle, R. L., & Paulus, M. P. (2010). Neural

systems underlying approach and avoidance in

anxiety disorders. Dialogues in Clinical Neu-

roscience, 12, 517–531.

Badre, D., & D’Esposito, M. (2007). Functional

magnetic resonance imaging evidence for a

hierarchical organization of the prefrontal

cortex. Journal of Cognitive Neuroscience,

19, 2082–2099.

Bar, M. (2009). A cognitive neuroscience hypoth-

esis of mood and depression. Trends in Cogni-

tive Sciences, 13, 456–463.

Barlow, D. H. (2002). Anxiety and its disorders

(2nd ed.). New York: Guilford Press.

Barlow, D. H., Farchione, T. J., Fairholme, C.

P., Ellard, K. K., Boisseau, C. L., Allen, L. B.,

et al. (2011). The unified protocol for trans-

diagnostic treatment of emotional disorders:

Therapist guide. New York: Oxford Univer-

sity Press.

Barlow, D. H., Gorman, J. M., Shear, M. K., &

Woods, S. W. (2000). Cognitive- behavioral

therapy, imipramine, or their combination for

panic disorder. Journal of the American Medi-

cal Association, 283, 2529–2536.

Beck, A. T., Rush, J., Shaw, B. F., & Emery, G.

(1979). Cognitive therapy of depression: A

treatment manual. New York: Guilford Press.

Berridge, K. C., Robinson, T. E., & Aldridge,

J. W. (2009). Dissecting components of reward:

“Liking,” “wanting,” and learning. Current

Opinion in Pharmacology, 9(1), 65–73.

Bogdan, R., & Pizzagalli, D. A. (2006). Acute

stress reduces reward responsiveness: Impli-

cations for depression. Biological Psychiatry,

60, 1147–1154.

Borkovec, T. D., Alcaine, O., & Behar, E. (2004).

Avoidance theory of worry and generalized

anxiety disorder. In R. G. Heimberg, C. L.

Turk, & D. S. Mennin (Eds.), Generalized

anxiety disorder: Advances in research and

practice (pp. 77–108). New York: Guilford

Press.

Borkovec, T. D., & Ruscio, A. M. (2001). Psy-

chotherapy for generalized anxiety disorder.

Journal of Clinical Psychiatry, 62(Suppl. 11),

37–42.

Botvinick, M., Braver, T., Barch, D., Carter, C.,

& Cohen, J. (2001). Conflict monitoring and

cognitive control. Psychological Review, 108,

624–652.

Bouton, M. E., Mineka, S., & Barlow, D. H.

(2001). A modern learning theory perspective

on the etiology of panic disorder. Psychologi-

cal Review, 108, 4–32.

Brown, T. A. (2007). Temporal course and struc-

tural relationships among dimensions of tem-

perament and DSM-IV anxiety and mood

disorder constructs. Journal of Abnormal

Psychology, 116(2), 313–328.

Butler, A. C., Chapman, J. E., Forman, E. M.,

& Beck, A. T. (2006). The empirical status

of cognitive- behavioral therapy: A review of

meta- analyses. Clinical Psychology Review,

26, 17–31.

Campbell- Sills, L., Liverant, G. I., & Brown,

T. A. (2004). Psychometric evaluation of the

Emotion Regulation Therapy 487

behavioral inhibition/behavioral activation

scales in a large sample of outpatients with

anxiety and mood disorders. Psychological

Assessment, 16, 244–254.

Carver, C. S., Avivi, Y. E., & Laurenceau, J.-P.

(2008). Approach, avoidance, and emotional

experiences. In A. Elliot (Ed.), Handbook of

approach and avoidance motivation (pp. 385–

397). New York: Psychology Press.

Clasen, P. C., Wells, T. T., Ellis, A. J., & Beev-

ers, C. G. (2013). Attentional biases and the

persistence of sad mood in major depressive

disorder. Journal of Abnormal Psychology,

122(1), 74–85.

Craig, A. D. (2009). How do you feel—now?:

The anterior insula and human awareness.

Nature Reviews Neuroscience, 10, 59–70.

Craske, M. G. (2012). THE R-DOC Initiative:

Science and practice. Depression and Anxiety,

29, 253–256.

Craske, M. G., Kircanski, K., Zelikowsky, M.,

Mystkowski, J., Chowdhury, N., & Baker, A.

(2008). Optimizing inhibitory learning during

exposure therapy. Behaviour Research and

Therapy, 46, 5–27.

Craske, M. G., & Vervliet, B. (2013). Extinction

learning and its retrieval. In D. Hermans, B.

Rimé, & B. Mesquita (Eds.), Changing emo-

tions (pp. 53–59). Hove, UK: Psychology

Press.

Cuijpers, P., van Straten, A., Andersson, G.,

& van Oppen, P. (2008). Psychotherapy for

depression in adults: A meta- analysis of com-

parative outcome studies. Journal of Consult-

ing and Clinical Psychology, 76, 909–922.

Delgado, M. R., Gillis, M. M., & Phelps, E. A.

(2008). Regulating the expectation of reward

via cognitive strategies. Nature Neuroscience,

11, 880–881.

Dobzhansky, T. (1970). Genetics of the evolu-

tionary process. New York: Columbia Univer-

sity Press.

Dollard, J., & Miller, N. E. (1950). Personality

and psychotherapy. New York: McGraw-Hill.

Dugas, M. J., & Robichaud, M. (2007).

Cognitive- behavioral treatment for general-

ized anxiety disorder: From science to prac-

tice. New York: Routledge.

Elliott, R., Watson, J. C., Goldman, R., & Green-

berg, L. (2004). Learning emotion- focused

therapy: The process– experiential approach

to change. Washington, DC: American Psy-

chological Association.

Etkin, A., Prater, K. E., Hoeft, F., Menon, V.,

& Schatzberg, A. F. (2010). Failure of anterior

cingulate activation and connectivity with the

amygdala during implicit regulation of emo-

tional processing in generalized anxiety dis-

order. American Journal of Psychiatry, 167,

545–554.

Etkin, A., & Schatzberg, A. F. (2011). Common

abnormalities and disorder- specific compen-

sation during implicit regulation of emotional

processing in generalized anxiety and major

depressive disorders. American Journal of

Psychiatry, 168, 968–978.

Farabaugh, A. H., Bitran, S., Witte, J., Alpert, J.,

Chuzi, S., Clain, A. J., Baer, L., et al. (2010).

Anxious depression and early changes in the

HAMD-17 anxiety- somatization factor items

and antidepressant treatment outcome. Inter-

national Clinical Psychopharmacology, 25,

214–217.

Farb, N. A. S., Anderson, A. K., Mayberg, H.,

Bean, J., McKeon, D., & Segal, Z. V. (2010).

Minding one’s emotions: Mindfulness train-

ing alters the neural expression of sadness.

Emotion, 10, 25–33.

Ferster, C. B. (1973). A functional analysis of

depression. American Psychologist, 28, 857–

870.

Forbes, E. E., Shaw, D. S., & Dahl, R. E. (2006).

Alterations in reward- related decisions in boys

with depressive and anxiety disorders. Biolog-

ical Psychiatry, 59, 126S–126S.

Fresco, D. M., Moore, M., van Dulmen, M.,

Segal, Z., Ma, S., Teasdale, J., et al. (2007).

Initial psychometric properties of the Expe-

riences Questionnaire: Validation of a self-

report measure of decentering. Behavior Ther-

apy, 38, 234–246.

Friedman, R. S., & Forster, J. (2010). Implicit

affective cues and attentional tuning: An inte-

grative review. Psychological Bulletin, 136,

875–893.

Gilbert, P. (2009). The compassionate mind: A

new approach to life’s challenges. Oakland,

CA: New Harbinger.

Gohm, C. L., & Clore, G. L. (2002). Four

latent traits of emotional experience and their

involvement in well-being, coping, and attri-

butional style. Cognition and Emotion, 16,

495–518.

Gray, J. A., & McNaughton, N. (2000). The

neuropsychology of anxiety: An enquiry into

the functions of the septo- hippocampal system

(2nd ed.). Oxford, UK: Oxford University Press.

Gross, J. (2002). Emotion regulation: Affective,

cognitive, and social consequences. Psycho-

physiology, 39(3), 281–291.

488 INTERVENTIONS

Hayes, A. M., Feldman, G. C., Beevers, C. G.,

Laurenceau, J.-P., Cardaciotto, L., & Lewis-

Smith, J. (2007). Discontinuities and cognitive

changes in an exposure- based cognitive ther-

apy for depression. Journal of Consulting and

Clinical Psychology, 75, 409–421.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G.

(2012). Acceptance and commitment therapy:

The process and practice of mindful change

(2nd ed.). New York: Guilford Press.

Higgins, E. T. (1997). Beyond pleasure and pain.

American Psychologist, 52, 1280–1300.

Johnstone, T., van Reekum, C. M., Urry, H. L.,

Kalin, N. H., & Davidson, R. J. (2007). Failure

to regulate: Counterproductive recruitment of

top-down prefrontal– subcortical circuitry in

major depression. Journal of Neuroscience,

27, 8877–8884.

Kabat-Zinn, J. (1990). Full catastrophe living:

Using the wisdom of your body and mind to

face stress, pain, and illness. New York: Delta

Trade.

Kabat-Zinn, J. (1994). Wherever you go, there

you are. New York: Hyperion Press.

Kalisch, R., Wiech, K., Critchley, H. D., Sey-

mour, B., O’Doherty, J. P., Oakley, D. A., et

al. (2005). Anxiety reduction through detach-

ment: Subjective, physiological, and neural

effects. Journal of Cognitive Neuroscience,

17, 874–883.

Kanter, J. W., Manos, R. C., Bowe, W. M.,

Baruch, D. E., Busch, A. M., & Rusch, L.

C. (2010). What is behavioral activation?: A

review of the empirical literature. Clinical Psy-

chology Review, 30, 608–620.

Kazdin, A. E., & Blase, S. L. (2011). Rebooting

psychotherapy research and practice to reduce

the burden of mental illness. Perspectives on

Psychological Science, 6, 21–37.

Kendler, K. S., Gardner, C. O., Gatz, M., &

Pedersen, N. L. (2006). The sources of co-

morbidity between major depression and gen-

eralized anxiety disorder in a Swedish national

twin sample. Psychological Medicine, 37,

453–462.

Kessler, R., Berglund, P., Demler, O., Jin, R., &

Walters, E. E. (2005). Lifetime prevalence and

age-of-onset distributions of DSM-IV disor-

ders in the National Comorbidity Survey Rep-

lication. Archives of General Psychiatry, 62,

593–602.

Klenk, M. M., Strauman, T. J., & Higgins, E.

T. (2011). Regulatory focus and anxiety: A

self- regulatory model of GAD–depression

comorbidity. Personality and Individual Dif-

ferences, 50, 935–943.

Kraemer, H., Wilson, G., Fairburn, C., & Agras,

W. (2002). Mediators and moderators of treat-

ment effects in randomized clinical trials.

Archives of General Psychiatry, 59, 877–883.

Kross, E., & Ayduk, Ö. (2009). Boundary con-

ditions and buffering effects: Does depressive

symptomology moderate the effectiveness of

self- distancing for facilitating adaptive emo-

tional analysis? Journal of Research in Person-

ality, 43(5), 923–927.

Krueger, R. F., & Markon, K. E. (2006). Reinter-

preting comorbidity: A model-based approach

to understanding and classifying psychopa-

thology. Annual Review of Clinical Psychol-

ogy, 2, 111–133.

Lanaj, K., Chang, C.-H., & Johnson, R. E.

(2012). Regulatory focus and work- related

outcomes: A meta- analysis. Psychological Bul-

letin, 138, 998–1034.

Lang, P. J., Davis, M., & Öhman, A. (2000).

Fear and anxiety: Animal models and human

cognitive psychophysiology. Journal of Affec-

tive Disorders, 61, 137–159.

LeDoux, J. E. (1996). The emotional brain: The

mysterious underpinnings of emotional life.

New York: Simon & Schuster.

Leary, M. R., Tate, E. B., Adams, C. E., Allen,

A. B., & Hancock, J. (2007). Self- compassion

and reactions to unpleasant self- relevant

events: The implications of treating oneself

kindly. Journal of Personality and Social Psy-

chology, 92, 887–904.

Lewinsohn, P. M. (1974). A behavioral approach

to depression. In R. M. Friedman & M. M.

Katz (Eds.), The psychology of depression:

Contemporary theory and research (pp. 157–

185). Washington, DC: Winston- Wiley.

Linehan, M. (1993). Skills training manual for

treating borderline personality disorder. New

York: Guilford Press.

Lissek, S. (2012). Toward an account of clinical

anxiety predicated on basic, neurally mapped

mechanisms of Pavlovian fear- learning: The

case for conditioned overgeneralization.

Depression and Anxiety, 29, 257–263.

Lohr, J. M., Olatunji, B., & Sawchuk, C. (2007).

A functional analysis of danger and safety sig-

nals in anxiety disorders. Clinical Psychology

Review, 27, 114–126.

Mennin, D. S., Ellard, K. K., Fresco, D. M., &

Gross, J. J. (2013). United we stand: Emphasiz-

ing commonalities across cognitive- behavioral

Emotion Regulation Therapy 489

therapies within a broadening field of inter-

vention science. Behavior Therapy, 44(2),

234–238.

Mennin, D. S., & Fresco, D. M. (2009). Emotion

regulation as an integrative framework for

understanding and treating psychopathology.

In A. M. Kring & D. M. Sloan (Eds.), Emo-

tion regulation in psychopathology: A transdi-

agnostic approach to etiology and treatment

(pp. 356–379). New York: Guilford Press.

Mennin, D. S., & Fresco, D. M. (2011, Novem-

ber). Emotion regulation therapy for complex

and refractory presentations of anxiety and

depression. A spotlight presentation at the

annual meeting of the Association for Behav-

ioral and Cognitive Therapies, Toronto, Can-

ada.

Mennin, D. S., Fresco, D. M., & Aldao, A.

(2012, November). Increasing vagal flexibility

predicts improved clinical outcomes in emo-

tion regulation therapy for GAD. A paper

delivered at the annual meeting of the Associa-

tion for Behavioral and Cognitive Therapies,

National Harbor, MD.

Mennin, D. S., Heimberg, R. G., Turk, C. L., &

Fresco, D. M. (2005). Preliminary evidence

for an emotion dysregulation model of gener-

alized anxiety disorder. Behaviour Research

and Therapy, 43, 1281–1310.

Mennin, D. S., Holaway, R. M., Fresco, D. M.,

Moore, M. T., & Heimberg, R. G. (2007).

Delineating components of emotion and its

dysregulation in anxiety and mood psycho-

pathology. Behavior Therapy, 38(3), 284–

302.

Mogg, K., & Bradley, B. P. (2005). Attentional

bias in generalized anxiety disorder versus

depressive disorder. Cognitive Therapy and

Research, 29, 29–45.

Muraven, M. R., & Baumeister, R. F. (2000).

Self- regulation and depletion of limited

resources: Does self- control resemble a mus-

cle? Psychological Bulletin, 126, 247–259.

Newman, M. G., & Llera, S. (2011). A novel

theory of experiential avoidance in general-

ized anxiety disorder: A review and synthesis

of research supporting a contrast avoidance

model of worry. Clinical Psychology Review,

31, 371–382.

Newman, M. G., Przeworski, A., Fisher, A. J.,

& Borkovec, T. D. (2010). Diagnostic comor-

bidity in adults with generalized anxiety dis-

order: Impact of comorbidity on psychother-

apy outcome and impact of psychotherapy on

comorbid diagnoses. Behavior Therapy, 41,

59–72.

Nolen- Hoeksema, S., Wisco, B. E., & Lyubomir-

sky, S. (2008). Rethinking rumination. Per-

spectives on Psychological Science, 3, 400–

424.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. (2002). Rethinking feelings: An

fMRI study of the cognitive regulation of emo-

tion. Journal of Cognitive Neuroscience, 14,

1215–1229.

O’Doherty, J. P. (2004). Reward representations

and reward- related learning in the human

brain: Insights from neuroimaging. Current

Opinion in Neurobiology, 14, 769–776.

Olatunji, B. O., Cisler, J. M., & Tolin, D. F.

(2010). A meta- analysis of the influence of

comorbidity on treatment outcome in the anx-

iety disorders. Clinical Psychology Review,

30, 642–654.

Porges, S. (2001). The polyvagal theory: Phylo-

genetic substrates of a social nervous system.

International Journal of Psychophysiology,

42, 123–146.

Posner, M. I., & Rothbart, M. K. (1992). Atten-

tional regulation— from mechanism to cul-

ture. International Journal of Psychology, 27,

41–57.

Ray, R. D., Wilhelm, F. H., & Gross, J. J. (2008).

All in the mind’s eye?: Anger rumination and

reappraisal. Journal of Personality and Social

Psychology, 94, 133–145.

Roemer, L., & Orsillo, S. M. (2009). Mindful-

ness- and acceptance- based behavioral thera-

pies in practice. New York: Guilford Press.

Rottenberg, J., & Gross, J. J. (2003). When emo-

tion goes wrong: Realizing the promise of

affective science. Clinical Psychology Science

and Practice, 10, 227–232.

Schiller, D., & Delgado, M. R. (2010). Over-

lapping neural systems mediating extinction,

reversal and regulation of fear. Trends in Cog-

nitive Sciences, 14, 268–276.

Segal, Z. V., Williams, J. M. G., & Teasdale, J.

D. (2002). Mindfulness- based cognitive ther-

apy for depression: A new approach to pre-

venting relapse. New York: Guilford Press.

Sheppes, G., & Gross, J. J. (2011). Is timing

everything?: Temporal considerations in emo-

tion regulation. Personality and Social Psy-

chology Review, 15(4), 319–331.

Smallwood, J., & Schooler, J. W. (2006). The

restless mind. Psychological Bulletin, 132,

946–958.

490 INTERVENTIONS

Sokol- Hessner, P., Camerer, C. F., & Phelps, E.

A. (2013). Emotion regulation reduces loss

aversion and decreases amygdala responses to

losses. Social Cognitive and Affective Neuro-

science, 8(3), 341–350.

Stein, M. B., & Paulus, M. P. (2009). Imbalance

of approach and avoidance: The yin and yang

of anxiety disorders. Biological Psychiatry,

66(12), 1072–1074.

Watkins, E., Teasdale, J. D., & Williams, R. M.

(2000). Decentering and distraction reduce

overgeneral autobiographical memory in depres-

sion. Psychological Medicine, 30, 911–920.

Watkins, E. R. (2008). Constructive and uncon-

structive repetitive thought. Psychological

Bulletin, 134, 163–206.

Watson, D. (2005). Rethinking the mood and

anxiety disorders: A quantitative hierarchical

model for DSM-V. Journal of Abnormal Psy-

chology, 114(4), 522–536.

Westra, H., Arkowitz, H., & Dozois, D. (2009).

Adding a motivational interviewing pretreat-

ment to cognitive behavioral therapy for gen-

eralized anxiety disorder: A preliminary ran-

domized controlled trial. Journal of Anxiety

Disorders, 23, 1106–1117.

Whitmer, A. J., & Gotlib, I. H. (2012). Switching

and backward inhibition in major depressive

disorder: The role of rumination. Journal of

Abnormal Psychology, 121(3), 570–578.

Wilson, K. G., & Murrell, A. R. (2004). Values

work in acceptance and commitment therapy.

In S. C. Hayes, V. M. Follette, & M. Linehan

(Eds.), Mindfulness and acceptance: Expand-

ing the cognitive- behavioral tradition. New

York: Guilford Press.

Woody, S., & Rachman, S. (1994). Generalized

anxiety disorder (GAD) as an unsuccessful

search for safety. Clinical Psychology Review,

14, 745–753.

491

Our aim in this chapter is to describe a set of

emotion regulation skills developed within

the context of dialectical behavior therapy

(DBT; Linehan, 1993a, 1993b) and their

potential to serve as a transdiagnostic inter-

vention. DBT is a comprehensive cognitive-

behavioral treatment originally developed

for suicidal individuals and later expanded

to suicidal individuals meeting criteria for

borderline personality disorder (BPD). DBT

has since been adapted to treat BPD with

several comorbidities and other psychologi-

cal disorders in which problems in emotion

regulation lead to psychopathology. Data for

the efficacy of DBT are extensive, including

43 clinical trials conducted across 21 inde-

pendent research teams (for a review, see

Neacsiu & Linehan, in press).

DBT conceptualizes difficulties with emo-

tion regulation as a consequence of biosocial

transactions: A biological sensitivity to emo-

tions interacts with aversive or invalidating

experiences during childhood and adoles-

cence, and leads to neurobiological malfunc-

tion and to insufficient skills to manage the

emotional system (Linehan, 1993a; Crowell,

Beauchaine, & Linehan, 2009). Therefore, a

primary focus in DBT is to teach clients how

to regulate emotional responses actively.

In this chapter we present a model of

emotion regulation that we teach in DBT.

We argue that BPD is a disorder of perva-

sive emotion dysregulation, and also provide

examples of how this model is relevant to

people without BPD who have difficulties

managing emotions. We then present how

the DBT skills map onto the model of emo-

tion regulation, and how they can be used

systematically to change dysregulation. We

conclude by describing the research needed

to evaluate the model proposed.

Emotion and Emotion Dysregulation

The DBT Model of Emotion Regulation

Similar to many others (e.g., Ekman & David-

son, 1994), in DBT we consider emotions to

be complex, brief, involuntary, patterned,

full- system responses to internal and exter-

nal stimuli. DBT emphasizes the importance

of the evolutionary adaptive value of emo-

tions (Tooby & Cosmides, 1990). Although

emotional responses are viewed as systemic,

we present them to clients as comprising six

transacting subsystems that are practical in

both understanding and learning to regu-

late emotions: (1) emotion vulnerability fac-

tors; (2) internal and/or external events that

serve as emotional cues; (3) interpretations

CHAPTER 29

Dialectical Behavior Therapy: An Intervention

for Emotion Dysregulation

Andrada D. Neacsiu

Martin Bohus

Marsha M. Linehan

492 INTERVENTIONS

of cues; (4) emotional response tendencies,

including physiological responses, cogni-

tive processing, experiential responses, and

action urges; (5) nonverbal– verbal expres-

sive responses and actions; and (6) afteref-

fects of the initial emotion, including sec-

ondary emotions (see Linehan, 1993a).

Although the DBT emotion model was

developed to serve a clinical population, it

is interesting to note the similarities it has to

the modal model of emotions that evolved

in basic science (Gross & Thompson, 2007).

Briefly, in the modal model, emotions origi-

nate from person– situation transactions that

are relevant to one’s goals and values. Such

a situation acts as a cue and draws the indi-

vidual’s attention, gives rise to an appraisal

of the event, and leads to an emotional

response. This response is associated with

behavioral displays and action tendencies,

and is malleable, in that the course of the

emotion is not fixed when it starts (Gross &

Thompson, 2007).

Both the DBT and the modal model

include the importance of attending to a

cue within a relevant context, highlight

appraisals as potentially influencing the

course of the emotion and present how

emotions directly affect context. Never-

theless, DBT places more emphasis on dif-

ficulties regulating the emotional response

after it has already been initiated, espe-

cially when it is past the point at which it

could be suppressed. Therefore, one differ-

ence between the models is that in DBT the

emotional response is broken into experien-

tial and expressive responses. Research sup-

porting the importance of this distinction

for clinical populations suggests that pro-

cesses occurring after the emotional firing

are key for psychopathology (Aldao, Nolen-

Hoeksema, & Schweizer, 2010).

An additional difference is the inclusion

of emotion vulnerability factors. The con-

struct of emotion vulnerability refers to the

effects of distal and proximal prior events

on the initiation, course, and intensity of

emotional responses. For example, individu-

als diagnosed with BPD who meet diagnos-

tic criteria for co- occurring posttraumatic

stress disorder (PTSD; a distal vulnerability

factor) report significantly higher emotion

dysregulation (Harned, Rizvi, & Linehan,

2010). Similarly, sufficient sleep (a proximal

vulnerability factor) leads to less emotional

intensity when compared to lack of sleep

(Gujar, Yoo, Hu, & Walker, 2011).

In this chapter, we reorganize Linehan’s

original model (1993a) to be applicable to a

wider range of disorders and to use termi-

nology consistent with basic research mod-

els (Figure 29.1; Table 29.1). Briefly, in this

model, emotions start within the context of

a situation, where a cue grabs the individu-

al’s attention. The cue is appraised or inter-

preted, which triggers an emotional response

that comprises biological– experiential

changes (including urges or response ten-

dencies) and expressions– actions changes

(including body language, facial expression,

and actions). All components are affected by

proximal and distal emotion vulnerability

FIGURE 29.1. DBT extended model of emotion regulation. Adapted to be consistent with Gross and

Thompson (2007).

Dialectical Behavior Therapy 493

factors. The emotional response is followed

by aftereffects, including secondary emo-

tions.

To give an example: A depressed woman

has a fight with her partner over house

chores, followed by a night of poor sleep.

Within the context of these emotion vulner-

ability factors, she walks into the kitchen

and a pile of dirty dishes [situation] in the

sink captures her attention. She appraises

the situation by thinking “The dishes are

dirty”; “I should have washed them”; and “I

didn’t so I’m a terrible wife.” The emotion

continues, with her heart beating faster, her

body slumping lower; she has the urge to go

to bed and hide under the covers [biological

response– action urge] and she starts crying

[expression– action response]. Her atten-

tion narrows [aftereffect] and, as she walks

around the house, she sees the clothes [situ-

ation] she did not iron [appraisal], which

refires her emotion of shame. She goes to

bed and covers her head with the blanket

[action response] and subsequently becomes

angry with herself [secondary emotion].

Figure 29.1 and Table 29.1 present types

of strategies that can be used to change each

emotion component. Like Davidson (1998)

we contend that emotion regulation can be

both automatic and effortful, and that regu-

latory processes are an integral part of emo-

tional responding.

Pervasive Emotion Dysregulation

Emotion dysregulation is the inability,

even when one’s best efforts are applied,

to change in a desired way emotional cues,

experiences, actions, verbal responses, and/

or nonverbal expressions under norma-

tive conditions. Characteristics of emotion

dysregulation include an excess of aversive

emotional experiences, an inability to regu-

late intense physiological arousal, problems

turning attention away from stimuli, cogni-

tive distortions and failures in information

TABLE 29.1. Emotion Regulation Tasks and Corresponding DBT Skills

Emotion components Regulation strategies DBT skills

A. Emotion Vulnerability Factors Managing Vulnerability Factors

(Biological and Contextual)

Change Biological Sensitivity

(PLEASE skills)

Accumulate Positives

Build Mastery

Cope Ahead by Covert Rehearsal

[Mindfulness Skills]

B. Situation (emotional cue) Situation Selection

Situation Modification

Problem Solving

Interpersonal Effectiveness Skills

[Mindfulness Skills]

C. Attention Attention Deployment Distract

Crisis Survival Skills

[Mindfulness Skills]

D. Appraisal Cognitive Change Check the Facts

Reality Acceptance

[Mindfulness Skills]

E. Biological/ Experiential

Response

Biological Change Change Physiology (TIP skills)

Self-Soothe

Half-Smile/Willing Hands

[Mindfulness Skills]

F. Expression/ Action Response Expression and Action Change Opposite Action

[Mindfulness Skills]

G. Emotional After-Effects

(including emotional awareness)

Emotional Processing Identify and Label Emotions

[Mindfulness Skills]

Note. See text for explanation of acronyms.

494 INTERVENTIONS

processing, insufficient control of impulsive

behaviors related to strong emotions, diffi-

culties organizing and coordinating activi-

ties to achieve non-mood- dependent goals

when emotionally aroused, and a tendency

to “freeze” or dissociate under very high

stress (Ray et al., 2006). Pervasive emo-

tion dysregulation refers to an inability to

regulate emotions that occurs across a wide

range of emotions and situational contexts.

BPD: A Disorder of Pervasive

Emotion Dysregulation

The Disorder

BPD is a severe mental disorder with a seri-

ous dysregulation of the emotion system at

its core. Clients show a characteristic pat-

tern of instability in emotion regulation,

impulse control, interpersonal relationship,

and self-image. The often severe functional

impairment leads to substantial treatment

utilization and a mortality rate by suicide

of almost 10%, which is 50% higher than

the rate in the general population (American

Psychiatric Association, 2001). BPD affects

approximately 3% of the general popula-

tion, up to 10% of outpatients treated for

mental disorders, and up to 20% of inpa-

tients (Trull, Jahng, Tomko, Wood, & Sher,

2010). Because of the severity of the distur-

bance and the intensive treatment use, cli-

ents with BPD constitute a disproportion-

ately large subset of psychiatric patients,

consuming considerably more mental health

resources than most other psychiatric groups

(Soeteman, Hakkaart- van Roijen, Verheul,

& Busschbach, 2008).

BPD as a Disorder

of Emotion Regulation

Based on clinical experience, Linehan

(1993a) proposed that pervasive emo-

tion dysregulation in BPD is caused by an

interplay between biological (e.g., genetic,

intrauterine factors; trauma to the biologi-

cal system) vulnerability and aversive socio-

biographical experiences. According to this

biosocial theory, a child born with height-

ened biological sensitivity to emotional

cues encounters emotionally aversive expe-

riences (e.g., interpersonal violence, social

rejection, emotional neglect, invalidation)

and consequently develops biological and

psychological alterations of the emotion

regulation system (Linehan, 1993a; Distel

et al., 2011). The neurobiological alterations

in the emotion circuitry manifest in adult-

hood as heightened emotional sensitivity

(low threshold for recognition of/response

to emotional stimuli), heightened reactivity

(high amplitude of emotional responses),

and a slow return to baseline after emotion

induction (Linehan, 1993a; Crowell et al.,

2009). The psychological alterations involve

maladaptive or insufficient learning in how

to understand, label, regulate, or tolerate

emotional responses effectively. A BPD diag-

nosis is hypothesized to emerge from such

biological alterations, coupled with insuffi-

cient knowledge about emotion regulation.

Existing evidence provides emerging

support for this theory. First, 60% of cli-

ents with BPD report sexual abuse and

severe interpersonal violence during child-

hood (Hernandez, Arntz, Gaviria, Labad,

& Gutiérrez-Zotes, 2012; Bornovalova

et al., 2013), which leads to significantly

higher suicidality and emotion dysregula-

tion (Harned et al., 2010). Second, animal

research shows that traumatization during

early life stages leads to morphological alter-

ations of the central frontolimbic system and

to behavioral and epigenetic modifications

(Pryce & Feldon, 2003; Cirulli et al., 2009).

Third, preliminary data connect genetic fac-

tors with the development of borderline fea-

tures (Distel et al., 2009).

Neurobiological Dysfunction in BPD

Numerous studies have tested biological

alterations in the emotion circuitry in BPD,

with the majority of studies assessing reac-

tivity and return to baseline. Findings are

extensive and somewhat mixed; next, we

present some highlights of this body of lit-

erature.

Functional and structural data support

enhanced reactivity and slow return to

baseline in BPD. In this population, volume

reduction of the amygdala (Nunes et al.,

2009) was correlated with amygdala hyper-

reactivity to emotional stimuli (e.g., Her-

pertz et al., 2001; Niedtfeld et al., 2012).

This heightened amygdala activation was

more prominent in BPD and took longer to

return to baseline when compared to clini-

Dialectical Behavior Therapy 495

cal and nonclinical controls (Hazlett et al.,

2012). In addition to amygdala dysfunction,

volume reductions in brain areas hypoth-

esized to serve emotion regulation func-

tions were also found (Tebartz van Elst et

al., 2003; Minzenberg, Fan, New, Tang,

& Siever, 2008). Recent studies also report

reduced neural connectivity between such

brain areas and the amygdala at baseline

(New et al., 2007) or during emotional dis-

tress (Niedtfeld et al., 2012). Furthermore,

research indicates a reduced activation of

prefrontal areas after emotional induction

(Minzenberg, Fan, New, Tang, & Siever,

2007; Schulze et al., 2011). These findings

suggest that in BPD amygdala hyperactivity

in the presence of emotional stimuli takes

longer to return to baseline, partly because

of insufficient modulation from brain cen-

ters responsible for emotion regulation.

Self- report and psychophysiological find-

ings are less clear with regard to heightened

reactivity in individuals diagnosed with BPD

(for a detailed review, see Rosenthal et al.,

2008). Across several samples, people diag-

nosed with BPD self- report being more reac-

tive, having more negative emotions, and

experiencing more emotional instability than

non-BPD controls (Rosenthal et al., 2008;

Lobbestael & Arntz, 2010). Additional stud-

ies using heart rate as a psychophysiologi-

cal measures of distress (Gratz, Rosenthal,

Tull, Lejuez, & Gunderson, 2010; Reitz et

al., 2012), or electrophysiological recordings

(Marissen, Meuleman, & Franken, 2010)

also found greater emotional reactivity for

participants with BPD. Nevertheless, studies

using different psychophysiological indices

of distress (i.e., skin conductance response)

failed to show enhanced reactivity (e.g., Kuo

& Linehan, 2009; Rosenthal et al., 2008).

Thus, additional research is needed to better

understand the mixed findings on reactivity.

Self- report and psychophysiological data

support a prolonged return to baseline.

Applying ambulatory assessments under daily

life conditions, Stiglmayr, Shapiro, Stieglitz,

Limberger, and Bohus (2001) reported signif-

icantly longer intervals of activated aversive

emotions but no nonspecific arousal for peo-

ple with BPD compared to healthy controls.

In addition, in a laboratory study participants

diagnosed with BPD evidenced prolonged

return to baseline after induced anger (Jacob

et al., 2008) and stress (Reitz et al., 2012).

Emotion Dysregulation in BPD

It is important to highlight that the con-

struct of emotion dysregulation is indepen-

dent from neurobiological alterations in

the emotion circuitry that are thought to

underlie BPD. Having increased sensitiv-

ity, reactivity and a slow return to baseline

may make it more difficult for individuals

to regulate emotions. At the same time,

persistent use of dysfunctional regulation

strategies may lead to continued biological

alteration. Whether neurobiological altera-

tions precede dysregulation, or vice versa,

remains an empirical question. Neverthe-

less, both constructs are crucial for under-

standing difficulties with emotions as pre-

sented in DBT.

We propose that individuals with BPD

have pervasive emotion dysregulation. In

support, below we summarize evidence

suggesting that individuals diagnosed with

BPD have problems with each set of emotion

regulation strategies described in the DBT

model. Difficulties with reducing emotion

vulnerability are highlighted by findings

suggesting dysregulated sleep patterns in

BPD individuals (Schredl et al., 2012), high

prevalence of abuse history and substance

use disorders (Trull et al., 2010; Distel et al.,

2012), as well as chronic health problems

and poor lifestyle choices (Frankenburg &

Zanarini, 2004).

Self- inflicted injuries (including suicide

attempts) and most other dysfunctional

behaviors (i.e., suicide threats, impulsive

behaviors, dissociation) are hypothesized

to be maladaptive problem- solving strate-

gies (Reitz et al., 2012), an escape mecha-

nism (Chapman, Gratz, & Brown, 2006), or

a way to communicate distress (Koerner &

Linehan, 1997). These behaviors may sug-

gest problems with regulating the biological

and expressive components of the emotion,

or with selecting effective situation modifi-

cation strategies. Problems with emotion-

induced dissociation have also consistently

been shown and suggest impairments in

the attention regulation component (Ebner-

Priemer et al., 2009). In addition, research

has documented problems with cognitive

flexibility (Ruocco, 2005), cognitive change

(Selby & Joiner, 2009), emotional aware-

ness (Levine, Marzialli, & Hood, 1997),

and aftereffects (Korfine & Hooley, 2000),

496 INTERVENTIONS

suggesting difficulties with regulation of all

the remaining emotion components.

The DBT Model and Other Disorders

Emotional dysregulation has been reported

to underlie etiological and maintenance

mechanisms for a large number of mental

health problems (Kring & Sloan, 2010).

Literature reviews have demonstrated that

mood disorders, anxiety disorders, sub-

stance use disorders (SUDs), eating disor-

ders, schizophrenia, and even psychotic

disorders are directly linked to emotion

dysregulation (Cisler, Olatunji, Feldner, &

Forsyth, 2010; Harrison, Sullivan, Tchan-

turia, & Treasure, 2009; Kring & Werner,

2004; Thorberg, Young, Sullivan, & Lyvers,

2009).

Individuals diagnosed with a variety of

Axis I disorders also appear to reveal emo-

tion dysregulation patterns. Increased reac-

tivity when compared to controls has been

connected to generalized anxiety disorder

(GAD; Mennin, Heimberg, Turk, & Fresco,

2005), substance dependence (Thorberg et

al., 2009), social anxiety disorder (SAD),

and specific phobias (Etkin & Wager, 2007).

Furthermore, the transaction between neu-

robiological dysfunction (e.g., anxiety sen-

sitivity) and lack of skills to manage it is

similar to the etiological theories presented

in panic disorder (Barlow, Allen, & Choate,

2004), GAD (Mennin et al., 2005), and some

specific phobias (Cisler et al., 2010). It can

therefore be hypothesized that in cases where

emotion dysregulation is involved, reactivity

to emotional cues coupled with insufficient

regulation strategies may result in psychopa-

thology. Thus, emotion dysregulation may

be a transdiagnostic phenomenon.

People diagnosed with BPD have difficul-

ties with regulating all of the emotion sub-

systems described in the DBT model. Similar

difficulties can be found in many additional

Axis I disorders, as described in the fifth edi-

tion of the Diagnostic and Statistical Man-

ual of Mental Disorders (DSM-5). Difficul-

ties managing emotion vulnerability factors

are common in mood and anxiety disorders

and in SUDs (e.g., Monti & Monti, 2000;

Wong, Brower, Fitzgerald, & Zucker, 2004).

Individuals diagnosed with anxiety and

mood disorders also make negative inter-

pretations (e.g., catastrophizing) that lead to

dysregulated emotions, and use maladaptive

situation selection and situation modifica-

tion strategies (e.g., avoidance, use of safety

cues; Kring & Werner, 2004; Aldao et al.,

2010). Experimental evidence also makes

a strong link between depression and anxi-

ety, and difficulties regulating attention in

emotional contexts. For example, depressed

individuals have a reduced capacity to sus-

tain positive emotions (Heller et al., 2009)

and more difficulties finding attentional

distracters in the context of a distressing

emotion (Koole, 2009) when compared with

controls. Similarly, when presented with

social threat stimuli, participants with SAD

report more negative emotions than do con-

trols, suggesting attention deployment and/

or cognitive change dysregulation (Goldin,

Manber, Hakimi, Canli, & Gross, 2009).

Finally, difficulties with emotion pro-

cessing have been linked to PTSD (Frewen,

Dozois, Neufeld, & Lanius, 2012).

DBT Emotion Regulation Skills

Rationale

Linehan (1993a) included in DBT a set of

concrete skills translated from behavioral

research and other evidence- based treat-

ments, aimed to address emotion dysregula-

tion in BPD. It was therefore hypothesized

that increases in skills use led to improve-

ments in emotion regulation, which in turn

led to positive outcomes in treated popula-

tions. Empirical findings indeed suggest that

use of DBT skills explains changes in depres-

sion, anger regulation, and suicidal behavior

across BPD treatments (Neacsiu, Rizvi, &

Linehan, 2010). Therefore, behavioral skills

are likely a potent mechanism of change for

emotion dysregulation.

In addition to the five sets of regulatory

processes proposed by Gross and Thomp-

son (2007), DBT targets five additional

processes: managing emotion vulnerability

factors, biological change, expression and

action change, and emotional processing (at

the point of emotional aftereffects). We next

present the skills that directly map onto the

DBT model of emotions, organizing them

according to regulation process to which

they primarily relate, although the functions

Dialectical Behavior Therapy 497

of each set of skills can be applied across

many of the regulation processes (see Table

29.1). This is particularly the case for mind-

fulness skills, which can be viewed as criti-

cal at every juncture in the emotion regula-

tion process.

Strategies for Managing Emotion

Vulnerability Factors

DBT teaches clients to decrease emotion

vulnerability factors by increasing happi-

ness and resilience (“building a life worth

living”) through a set of skills that target

biological homeostasis and influence emo-

tional reactivity. The PLEASE skills target

treating Physical iLlness (Anderson, Hack-

ett, & House, 2004), balancing nutrition

and Eating (Smith, Williamson, Bray, &

Ryan, 1999), staying off nonprescribed

mood-Altering drugs, getting sufficient but

not excessive Sleep (Gujar et al., 2011), and

getting adequate Exercise (Cox, Thomas,

Hinton, & Donahue, 2004).

In addition, DBT promotes resilience by

teaching skills for accumulating positive life

events and for building a sense of general-

ized mastery. Increasing the number of plea-

surable events in one’s life is one approach

to increasing positive emotions. In the short

term, this involves increasing daily posi-

tive experiences. In the long term, it means

working on goals related to important life

values, so that pleasant events will occur

more often. Building mastery is achieved by

engaging in activities that increase a sense

of competence and self- efficacy. The focus is

very similar to activity and mastery schedul-

ing in psychotherapy for depression (Martell,

Addis, & Jacobson, 2001). Both skills have

been shown to predict decreased vulner-

ability to negative emotional states (Joiner,

Lewinsohn, & Seeley, 2002; de Beurs et al.,

2005).

Coping ahead (Linehan, in press) is an

additional skill that promotes contextual

resiliency. Individuals learn to use imaginal

exposure and rehearsal to cope successfully

with a difficult situation ahead of time. For

people who are prone to dysregulation, cop-

ing ahead via covert rehearsal can be help-

ful in building the coping skills necessary

for problem solving (see Fourkas, Avenanti,

Urgesi, & Aglioti, 2006). Thus, this skill is

likely to increase peoples’ appraisal of their

own ability to cope with an emotional event,

effectively increasing a sense of mastery and

self- efficacy.

Situation Selection–

Modification Strategies

Situation selection and modification are

two classes of emotion regulation strategies

through which emotions are modulated via

stimulus control (i.e., avoiding or modify-

ing situations that generate unwanted emo-

tions). To promote effective situation selec-

tion skills, DBT teaches how to generate a

list of pros and cons to guide a course of

action. To improve situation modification,

DBT teaches a simple set of problem- solving

skills (Linehan, in press) aimed at chang-

ing or developing strategies for eliminating,

reducing, or avoiding emotionally problem-

atic situations. The focus here is on defining

those situations that cue unwanted emotions,

then applying standard problem- solving

steps, such as those outline by D’Zurilla and

Nezu (1999) and others.

Because many problems are interpersonal

(and even if they are not may require inter-

personal interactions to solve), DBT also

includes a set of interpersonal effectiveness

skills. These skills focus on how to obtain

a wanted objective without hurting the

interpersonal relationship or one’s own self-

respect. Coping ahead as a way to practice

these skills and to manage intense emotional

arousal before it happens is often a helpful

addition to problem solving.

DBT also includes a set of mindfulness

skills that emphasize observing, describing,

and participating in the present moment

effectively and without judgment. These

skills may also promote adaptive situation

selection by nonjudgmentally expanding

awareness regarding situations that in the

past have evoked emotional experience.

This awareness is hypothesized to increase

sensitivity to the current contingencies in

the environment, allowing the opportunity

for new learning. Thus, by seeing reality

“as it is” (i.e., being in the present moment

without historical filters), mindfulness may

enhance the ability of an individual to decide

what situations to avoid, when to attempt to

problem- solve, or when to cope ahead.

498 INTERVENTIONS

Attentional Deployment Strategies

Mindfulness skills are often used in DBT

to promote attentional control, which can

reduce problems with attentional deploy-

ment. Mindfulness involves learning to con-

trol the focus of attention, not the object to

which one attends (e.g., observing a thought

as a thought or emotion as emotion, with-

out attempting to change the thought or

emotion). Being able to disengage from

emotional stimuli may reduce the tendency

to experience negative affect (Ellenbogen,

Schwartzman, Stewart, & Walker, 2002),

and redeploying attention has been postu-

lated to lead to a “flexibility of attention”

(Teasdale, Segal, & Williams, 1995) needed

for successful attention modulation in emo-

tional contexts. Thus, mindfulness may help

modulate emotional experience by enhanc-

ing the practioner’s ability to turn his or her

attention away from that which is not useful

(or effective) and attend to what is (Lynch,

Rosenthal, et al., 2006).

Cognitive Change Strategies

DBT focuses on analyzing and correcting

situation appraisals by checking the facts

(Linehan, in press). These skills focus on

discriminating assumptions, interpretations,

ruminative thoughts, and worries from the

actual observed facts of situations. Support

for this set of skills comes from a number

of studies comparing different reappraisal

strategies, including nonappraisal control

conditions, following presentation of emo-

tional cues (e.g., Lazarus & Abramovitz,

1962).

An additional set of strategies (reality

acceptance) targets changing one’s appraisal

of emotions as experiences that cannot be

tolerated or experienced willingly. Emo-

tion acceptance, when compared to emotion

suppression, or a control, has been shown

to result in less subjective anxiety or avoid-

ance in clients diagnosed with panic disor-

der undergoing a carbon dioxide challenge

(Levitt, Brown, Orsillo, & Barlow, 2004). In

addition, coaching in an acceptance mind-

set, compared to coaching in a control- your-

emotions mindset or a placebo condition,

significantly increased the amount of time a

subject was willing to spend in a cold pres-

sor task (Hayes et al., 1999). With respect

to emotions, DBT reality acceptance skills

(“turning the mind” toward acceptance,

radical acceptance, and willingness over

willfulness) focus on radical (meaning full

and complete) acceptance of the current

emotion and willingness to experience even

aversive emotions.

Mindfulness skills may also alter situa-

tion appraisal by reducing literal belief in

emotional appraisals. Mindfulness teaches

individuals to observe appraisals as only

thoughts that are not necessarily literally

true. This is hypothesized to increase sen-

sitivity to the current contingencies in the

environment, allowing the opportunity for

new learning. In this context, mindfulness

in DBT would not be predicted to reduce the

frequency of distressing thoughts but instead

to decrease the influence these thoughts have

on subsequent behavior and emotions.

Biological–Experiential

Change Strategies

In DBT, an important part of the biologi-

cal component of an emotion is the action

tendency, or urge, to act in a specific man-

ner. DBT provides a range of distress toler-

ance skills whose aim is to inhibit acting on

maladaptive urges that interfere with long-

term emotion regulation. These skills are

also designed to down- regulate the extreme

physiological arousal that often accompa-

nies intense emotions. The function of these

skills is to impact high arousal quickly, with-

out requiring a high level of cognitive pro-

cessing to complete. Grouped under the term

TIP skills (Linehan, in press) these skills tar-

get activation of the parasympathetic ner-

vous system.

The first skill (Temperature change with

ice water) has to do with using cold, icy

water on the face to trigger the human dive

reflex (which is typically elicited to aid sur-

vival when falling into a frozen lake). This

reflex can be triggered by a combination of

breath holding and face immersion in cold

water. The physiological response that fol-

lows involves both branches of the auto-

nomic nervous system and reduces emotional

arousal for a short period of time (Hurwitz

& Furedy, 1986).

Intense exercise is also recommended if

arousal is very high. Most important here

is the intensity of the exercise. Cox and col-

Dialectical Behavior Therapy 499

leagues (2004) compared intensity of bouts

of exercise and found that while intensity

of exercise conditions did not differ in state

anxiety immediately after exercise, a sig-

nificant difference favoring the most intense

exercise condition over the control condition

emerged at 30 minutes postexercise.

Additional distress tolerance strategies are

Paced breathing and Progressive relaxation,

soothing one of the five senses, adopting an

opened posture with palms facing the ceiling

(willing hands), or adopting a serene facial

expression (half smile).

Expression and Action

Change Strategies

Changing expression and action components

of emotions implies preventing emotional

actions, or acting in a way that opposes or

is inconsistent with the emotion. The DBT

skill of opposite action is based on the idea

that not only is changing action tendencies

essential for reducing emotional disorders,

but also that deliberate actions opposite to

those associated with unwanted emotions

can effectively change emotions as well as

action tendencies. Others have made this

same point (e.g., Barlow, 1988, p. 313). Izard

(1977) stated that treatment for anxiety dis-

orders involves “the individual learn[ing] to

act his way into a new feeling” (cited in Bar-

low, 1988, p. 410).

Opposite action in DBT applies principles

of exposure- based treatments for anxiety

disorders across the entire domain of emo-

tions. All exposure- based interventions

include this one common element: Individu-

als have to approach the object/situation

that is fearful, thus acting counter to (and

inhibiting) their prominent urges to avoid.

Effective treatments for anger also require

individuals to act counter to the urges asso-

ciated with anger (attack physically or ver-

bally) by leaving the situation. Anger inter-

ventions also focus on taking the opposite

perspective, and shifting from aggression

and blame to gentleness and forgiveness

(e.g., Tafrate, Kassinove, & Dundin, 2002).

A number of researchers have observed that

effective therapies for depression also share

a common thread: They activate behavior.

For example cognitive therapy (Beck, Rush,

Shaw, & Emery, 1979) and behavioral acti-

vation (BA; Martell et al., 2001) require that

the individual galvanize him- or herself to

engage in activities that result in a sense of

mastery or pleasure. This engagement runs

counter to the depression urge to withdraw

and shut down.

Opposite action “all the way” (Linehan,

in press) targets changing the entire range of

physical responses that accompany action,

including visceral responses, body postures,

facial expressions, and movements. A large

literature has demonstrated that the activa-

tion of specific physical states activates the

other facets of the corresponding emotion

responses, whether via the face (e.g., Duclos

& Laird, 2001), posture (Stepper & Strack,

1993) or respiration. To the contrary, there

is ample empirical evidence that modulat-

ing one’s physical state alters one’s emo-

tional state (Philippot, Baeyenes, Douilliez,

& Francart, 2004). Also implied by “all the

way” are emotion- linked thought patterns

and verbal responses. The idea here is to act

contrary to an emotion, not to mask or hide

emotions.

In part, opposite action is hypothesized to

work by influencing classically conditioned

emotional responses (Lynch, Chapman,

Rosenthal, Kuo, & Linehan, 2006). Oppo-

site action may also create sensory feedback

from facial muscles and skin that can be

transformed directly into emotional expe-

rience without cognitive mediation (Izard,

1977). Finally, self- perception of expressive

behavior, action, and appraisals regarding

proprioceptive sensations has been proposed

to influence subjective emotional experience

(Laird, 1974). Opposite action may influence

emotion by changing the perception of the

emotional event. Thus, behavior that is the

opposite of the automatic response or action

urge of an emotion is intended to alter the

meaning of the emotional event automati-

cally and without conscious effort (Lynch,

Rosenthal, et al., 2006). In essence, people

conclude that they feel safe because they are

“acting as if” all is safe.

Strategies for Changing

Emotional Aftereffects

Aftereffects of emotions, which include

changes in attention, memory, and reason-

ing, are fairly well established (see Dolan,

2002, for a review). These aftereffects can

increase the probability that the emotion

500 INTERVENTIONS

will reoccur. Interrupting the cycle can be

enhanced if the individual notices and iden-

tifies a current, ongoing emotion, which can

then guide application of relevant change

strategies.

Therefore, DBT included a skill (Observe

and Describe Emotions) through which

increased awareness of the emotional expe-

rience is promoted. This skill is supported

by research showing that processing emo-

tional experience with greater specificity has

advantages for improved emotion regulation

over emotional processing that is overgen-

eral or nonspecific (e.g., Williams, Stiles, &

Shapiro, 1999). Indeed, recent research has

demonstrated that priming individuals with

overgeneral emotional memories results in

more intense emotional experience com-

pared to priming specific emotional memo-

ries or a control condition (Schaefer et al.,

2003). In addition, experimentally manipu-

lated social anxiety has been shown to be

reduced by observing and describing spe-

cifically the fear producing cues, in contrast

to general impressions regarding cues that

resulted in higher fear (Philippot, Burgos,

Verhasselt, & Baeyens, 2002).

Drawing from the work of many, includ-

ing both Shaver (e.g., Shaver, Schwartz, Kir-

son, & O’Connor, 1987) and Hupka (e.g.,

Hupka, Lenton, & Hutchinson, 1999), Line-

han (in press) expanded the original list of

six emotions to a taxonomy of 10 basic emo-

tions: anger, disgust, envy, fear, jealousy,

joy, love, sadness, shame, and guilt. For

each emotion the following characteristics

are listed: (1) family of emotion names asso-

ciated with the basic emotion, (2) typical

prompting events (cues), (3) interpretations

or appraisals, (4) biological changes and

experiences, (5) expressions and actions,

(6) aftereffects, and (7) secondary emotions

associated with each family of emotions.

Using the taxonomy, clients are coached in

learning to observe and describe their emo-

tions relative to various events.

Evidence for DBT Skills as a

Treatment for Emotion Dysregulation

Problems with regulating each component of

the emotion system can be connected with

BPD and with other disorders. As we argued

in the previous section, there are DBT skills

to target each of the types of emotion dys-

regulation our model presented. Therefore,

DBT skills training is a promising candidate

for treating emotion dysregulation in BPD

and other Axis I disorders.

Treatment trials, albeit fraught with

methodological flaws, offer some support

that DBT skills training is effective in reduc-

ing emotion dysregulation in various clinical

presentations. A DBT skills training inter-

vention improved pre- to posttreatment rat-

ings of depression in abuse victims (Iverson,

Shenk, & Fruzzetti, 2009), and depression

and anger in vocational rehabilitation cli-

ents (Koons et al., 2006). When compared

to treatment as usual (TAU) or a wait-list

condition, DBT skills training decreased

depression in treatment- resistant depressed

individuals (Harley, Sprich, Safren, Jacobo,

& Fava, 2008) and self- reported anger in a

forensic sample (Evershed et al., 2003). DBT

skills training was also superior to standard

group therapy in improving depression,

anger and affect instability in a BPD sample

(Soler et al., 2009).

Therefore, although originally developed

to be part of a comprehensive intervention,

skills training by itself may be the mecha-

nism through which change occurs in a vari-

ety of populations with emotion regulation

difficulties. Indeed, skills training has been

linked to the reduction of emotion dysreg-

ulation indices (Neacsiu et al., 2010) and

emotion dysregulation has, in turn, been

related to a variety of mental health prob-

lems (Kring & Sloan, 2010). Although this

research area is in its infancy and more find-

ings are needed, the evidence suggests that

DBT skills are a promising intervention for

emotion dysregulation across psychopathol-

ogy.

Directions for Future Research

Psychopathology Research

Construct Validity of Emotion Regulation

We have refined the construct of emotion

regulation as applicable to psychopathology

and presented a testable model. Although we

have defined dysregulation as dysfunction

at either level in the emotion generation–

regulation process, we do not know whether

one or more “tipping” points differentiate

Dialectical Behavior Therapy 501

normative difficulties regulating extreme

emotional arousal versus non- normative

difficulties that predict serious emotional

disturbance. In addition, how difficulties

as emphasized by this model vary with each

mental disorder is also not yet clear.

Construct Validity of Pervasive

Emotion Dysregulation

We have proposed the construct of pervasive

emotion dysregulation and conceptualized it

as a combination of a tendency to high emo-

tionality across a wide array of both posi-

tive and negative emotions, together with an

inability to regulate intense emotion- linked

responses. The validity of this construct

has not been evaluated, nor are there mea-

sures of the construct. The high incidence

of comorbidity across emotional disorders

suggests that the construct may be a useful

one. Research is needed both to validate and

identify the parameters of the construct. We

further have proposed BPD as a model of

pervasive emotion dysregulation. Research

designed specifically to evaluate this conten-

tion, particularly research comparing BPD

to other emotional disorders, is needed.

Research on BPD and emotions outside of

anxiety, depression, and anger is also needed

to support or refute the pervasiveness of

emotion dysregulation in this disorder.

Neurobiological Dysfunction

of the Emotion Circuitry in BPD

We have defined neurobiological dysfunc-

tion of the emotion system in BPD as sensi-

tivity to emotional stimuli; intense reactions

to such stimuli; and a slow, delayed return to

an emotional baseline. First, more research

is needed to assess whether individuals with

BPD do have a heightened sensitivity to emo-

tional stimuli. Second, although it appears

evident that the intensity of all emotions is

enhanced in BPD, the empirical evidence that

clients with BPD are reactive to emotion-

eliciting cues is mixed. Additional research

clarifying the inconsistent findings on emo-

tional reactivity in BPD is sorely needed.

Furthermore, it is unclear whether mode of

stimulation (visual, auditory, somatic, etc.)

makes a difference.

We have highlighted clear evidence for

both structural and functional alterations in

the frontolimbic circuits of clients with BPD.

However, it remains unclear whether these

findings are specific to clients with BPD or

characteristic of individuals with emotion

regulation difficulties in general. It is also

unclear how neurobiological alterations

interact with pervasive emotion dysregula-

tion, especially in the case of social emo-

tions such as shame or guilt. There is only

beginning research on restitution of these

neurobiological alterations after successful

treatment.

Emotion Dysregulation

as a Transdiagnostic Phenomenon

As we have highlighted, emotion dysregula-

tion and alterations of the biological archi-

tecture of the emotion system are issues not

entirely unique to BPD. Therefore, future

research should further examine the rela-

tionship between problems with emotions

and other disorders. Furthermore, much of

the research assessing emotion dysregula-

tion in BPD has compared people with BPD

to healthy controls (for a review, see Rosen-

thal et al., 2008). There is a great need for

research examining the specificity of emo-

tion dysregulation in BPD, by comparing

people with BPD to those with other mental

disorders. This could help refine nuances

of how emotion dysregulation manifests in

psychopathology and how it can be more

effectively targeted.

Intervention Research

As noted previously, emerging data indicate

that the skills training component of DBT

is a successful stand-alone intervention for

emotion dysregulation in a variety of clini-

cal samples. What we do not know yet is

whether we can use DBT skills training as a

transdiagnostic treatment for emotion dys-

regulation.

In addition, we do not know whether some

DBT skills are more useful than others, nor

are there data regarding the role of compe-

tence of skills application (i.e., whether appli-

cation of the “right skill at the right time” is

important). It is also not clear which skills

are the right skills for various situations.

Given the propensity for emotional avoid-

ance in many emotionally disturbed indi-

viduals, it is extremely important to find out

502 INTERVENTIONS

when to teach clients to distract themselves

from unwanted emotions and cues and when

to expose themselves to emotions and emo-

tional stimuli. In DBT we make a distinction

between moderate and extreme emotional

responses. Extreme emotional responses are

defined as those accompanied by cognitive

processing that is so compromised that skills

requiring high use of cognitive resources

(e.g., problem solving, checking the facts)

are unlikely to be successful. With extreme

responses, skills that more directly impact

somatic arousal (e.g., deep breathing, using

ice water) or attention (e.g., distraction) are

recommended. Data verifying the wisdom of

these recommendations are sorely lacking.

This is particularly important in light of the

increasing use of mindfulness- based treat-

ment interventions, which teach individu-

als to notice and accept ongoing emotional

responses. The question might be reframed

as follows: When is mindfulness of current

emotions (a DBT skill) more or less impor-

tant?

Although there is a fair amount of basic

research supporting the specific skills taught

in DBT, there is little evidence on their indi-

vidual effectiveness as treatment interven-

tions in clinical populations. The systematic

examination of the DBT skills, both indi-

vidually and in combination, is an essen-

tial first step in improving treatment for

deregulated individuals. This is particularly

important for the skill of opposite action.

Linehan (1993a) has suggested that opposite

action will be effective across a wide range

of both dysfunctional positive (e.g., loving

the wrong person) and negative emotions.

One study found promising results for oppo-

site action with shame (Rizvi & Linehan,

2006), but other emotions have not been

studied explicitly. Thus, although DBT has

been thoroughly evaluated in efficacy stud-

ies, there has been substantially less empha-

sis on the treatment mechanisms of change,

and future research must work to narrow

this gap.

Conclusion

To sum up, we propose a framework for

emotion dysregulation that is applicable to

BPD and in theory can be extended to other

psychological disorders. We argue that emo-

tion dysregulation is prevalent beyond BPD

and invite research to support our model

in other disorders in which problems with

emotions have been identified. Furthermore,

we offer a set of skills aimed at addressing

directly common components of dysregu-

lation and illustrate how such skills have

been used with individuals diagnosed with

BPD. We propose additional ways in which

intervention research, as directly relevant

to emotion dysregulation, can advance our

knowledge and help make treatments for

this problem more effective.

Acknowledgment

The authors would like to thank Thomas R.

Lynch, PhD, for his contribution to the previous

version of this chapter.

References

Aldao, A., Nolen- Hoeksema, S., & Schweizer, S.

(2010). Emotion- regulation strategies across

psychopathology: A meta- analytic review.

Clinical Psychology Review, 30, 217–237.

American Psychiatric Association. (2001). Prac-

tice guideline for the treatment of patients

with borderline personality disorder. Ameri-

can Journal of Psychiatry, 158(Suppl. 10),

1–52.

Anderson, C. S., Hackett, M. L., & House, A. O.

(2004). Interventions for preventing depres-

sion after stroke. Cochrane Database Systems

Review, 2, CD003689.

Barlow, D. H. (1988). Anxiety and its disorders:

The nature and treatment of anxiety and

panic. New York: Guilford Press.

Barlow, D. H., Allen, L. B., & Choate, M. L.

(2004). Toward a unified treatment for emo-

tional disorders. Behavior Therapy, 35, 205–

230.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G.

(1979). Cognitive therapy of depression. New

York: Guilford Press.

Bornovalova, M. A., Huibregtse, B. M., Hicks,

B. M., Keyes, M., McGue, M., & Iacono, W.

(2013). Tests of a direct effect of childhood

abuse on adult borderline personality disorder

traits: A longitudinal discordant twin design.

Journal of Abnormal Psychology, 122(1),

180–194.

Chapman, A. L., Gratz, K. L., & Brown, M.

Dialectical Behavior Therapy 503

Z. (2006). Solving the puzzle of deliberate

self-harm: The experiential avoidance model.

Behaviour Research and Therapy, 44, 371–

394.

Cirulli, F., Francia, N., Berry, A., Aloe, L.,

Alleva, E., & Suomi, S. J. (2009). Early life

stress as a risk factor for mental health: Role

of neurotrophins from rodents to non-human

primates. Neuroscience and Biobehavioral

Review, 33, 573–585.

Cisler, J. M., Olatunji, B. O., Feldner, M. T., &

Forsyth, J. P. (2010). Emotion regulation and

the anxiety disorders: An integrative review.

Journal of Psychopathology and Behavioral

Assessment, 32, 68–82.

Cox, R. H., Thomas, T. R., Hinton, P. S., &

Donahue, O. M. (2004). Effects of acute 60

and 80% VO2max bouts of aerobic exercise

on state anxiety of women of different age

groups across time. Research Quarterly for

Exercise and Sport, 75, 165–175.

Crowell, S. E., Beauchaine, T. P., & Linehan, M.

M. (2009). A biosocial developmental model

of borderline personality: Elaborating and

extending Linehan’s theory. Psychological

Bulletin, 135, 495–510.

Davidson, R. J. (1998). Anterior electrophysio-

logical asymmetries, emotion, and depression:

Conceptual and methodological conundrums.

Psychophysiology, 35, 607–614.

de Beurs, E., Comijs, H., Twisk, J. W., Sonnen-

berg, C., Beekman, A. T., & Deeg, D. (2005).

Stability and change of emotional functioning

in late life: Modelling of vulnerability profiles.

Journal of Affective Disorders, 84, 53–62.

Distel, M. A., Middeldorp, C. M., Trull,

T. J., Derom, C. A., Willemsen, G., &

Boomsma, D. I. (2011). Life events and bor-

derline personality features: The influence

of gene– environment interaction and gene–

environment correlation. Psychological Medi-

cine, 4(4), 849–860.

Distel, M. A., Trull, T. J., de Moor, M. M., Vink,

J. M., Geels, L. M., et al. (2012). Borderline

personality traits and substance use: Genetic

factors underlie the association with smoking

and ever use of cannabis, but not with high

alcohol consumption. Journal of Personality

Disorders, 26(6), 867–879.

Distel, M. A., Trull, T. J., Willemsen, G., Vink, J.

M., Derom, C. A., Lynskey, M., et al. (2009).

The five- factor model of personality and bor-

derline personality disorder: A genetic analysis

of comorbidity. Biological Psychiatry, 66(12),

1131–1138.

Dolan, R. J. (2002). Emotion, cognition, and

behavior. Science, 298, 1191–1194.

Duclos, S. E., & Laird, J. D. (2001). The delib-

erate control of emotional experience through

control of expressions. Cognition and Emo-

tion, 15, 27–56.

D’Zurilla, T. J., & Nezu, A. M. (1999). Problem-

solving therapy: A social competence

approach to clinical intervention (2nd ed.).

New York: Springer.

Ebner- Priemer, U. W., Mauchnik, J., Kleindienst,

N., Schmahl, C., Peper, M., Rosenthal, Z., et

al. (2009). Emotional learning during disso-

ciative states in borderline personality disor-

der. Journal of Psychiatry and Neuroscience,

34(3), 214–222.

Ekman, P., & Davidson, R. J. (1994). The nature

of emotion. New York: Oxford University

Press.

Ellenbogen, M. A., Schwartzman, A. E., Stewart,

J., & Walker, C. D. (2002). Stress and selec-

tive attention: The interplay of mood, cortisol

levels, and emotional information processing.

Psychophysiology, 39, 723–732.

Etkin, A., & Wager, T. D. (2007). Functional

neuroimaging of anxiety: A meta- analysis of

emotional processing in PTSD, social anxiety

disorder, and specific phobia. American Jour-

nal of Psychiatry, 164, 1476–1488.

Evershed, S., Tennant, A., Boomer, D., Rees, A.,

Barkham, M., & Watson, A. (2003). Practice-

based outcomes of dialectical behaviour

therapy (DBT) targeting anger and violence,

with male forensic patients: A pragmatic and

non- contemporaneous comparison. Criminal

Behavior and Mental Health, 13, 198–213.

Fourkas, A. D., Avenanti, A., Urgesi, C., &

Aglioti, S. M. (2006). Corticospinal facilita-

tion during first and third person imagery.

Experimental Brain Research, 168(1–2), 143–

151.

Frankenburg, F. R., & Zanarini, M. C. (2004).

The association between borderline person-

ality disorder and chronic medical illnesses,

poor health- related lifestyle choices, and

costly forms of health care utilization. Journal

of Clinical Psychiatry, 65(12), 1660–1665.

Frewen, P. A., Dozois, D. A., Neufeld, R. J., &

Lanius, R. A. (2012). Disturbances of emo-

tional awareness and expression in posttrau-

matic stress disorder: Meta-mood, emotion

regulation, mindfulness, and interference

of emotional expressiveness. Psychological

Trauma: Theory, Research, Practice, and Pol-

icy, 4(2), 152–161.

504 INTERVENTIONS

Goldin, P. R., Manber, T., Hakimi, S., Canli, T.,

& Gross, J. J. (2009). Neural bases of social

anxiety disorder: Emotional reactivity and

cognitive regulation during social and physi-

cal threat. Archives of General Psychiatry, 66,

170–180.

Gratz, K. L., Rosenthal, M. Z., Tull, M. T.,

Lejuez, C. W., & Gunderson, J. G. (2010).

An experimental investigation of emotional

reactivity and delayed emotional recovery

in borderline personality disorder: The role

of shame. Comprehensive Psychiatry, 51(3),

275–285.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp. 3–24). New York: Guilford Press.

Gujar, N., Yoo, S., Hu, P., & Walker, M. P.

(2011). Sleep deprivation amplifies reactiv-

ity of brain reward networks, biasing the

appraisal of positive emotional experiences.

Journal of Neuroscience, 31(12), 4466–4474.

Harley, R., Sprich, S., Safren, S., Jacobo, M.,

& Fava, M. (2008). Adaptation of dialecti-

cal behavior therapy skills training group

for treatment- resistant depression. Journal of

Nervous and Mental Disease, 196(2), 136–

143.

Harned, M. S., Rizvi, S. L., & Linehan, M. M.

(2010). Impact of co- occurring posttraumatic

stress disorder on suicidal women with border-

line personality disorder. American Journal of

Psychiatry, 167(10), 1210–1217.

Harrison, A., Sullivan, S., Tchanturia, K., &

Treasure, J. (2009). Emotion recognition and

regulation in anorexia nervosa. Clinical Psy-

chology and Psychotherapy, 16, 348–356.

Hayes, S. C., Bissett, R. T., Korn, Z., Zettle,

R. D., Rosenfarb, I. S., Cooper, L. D., et al.

(1999). The impact of acceptance versus con-

trol rationales on pain tolerance. Psycholog-

cial Reports, 49, 33 – 47.

Hazlett, E. A., Zhanga, J., New, A. S., Zel-

manovaa, Y., Goldstein, K. E. M., Haznedar,

M. M., et al. (2012). Potentiated amygdala

response to repeated emotional pictures in

borderline personality disorder. Biological

Psychiatry, 72(6), 448–456.

Heller, A. S., Johnstone, T., Shackman, A. J.,

Light, S. N., Peterson, M. J., Kolden, G. G., et

al. (2009). Reduced capacity to sustain positive

emotion in major depression reflects dimin-

ished maintenance of fronto- striatal brain

activation. Proceedings of the National Acad-

emy of Sciences USA, 106, 22445–22450.

Hernandez, A., Arntz, A., Gaviria, A. M., Labad,

A., & Gutiérrez-Zotes, J. A. (2012). Relation-

ships between childhood maltreatment, par-

enting style, and borderline personality disor-

der criteria. Journal of Personality Disorders,

26(5), 727–736.

Herpertz, S. C., Dietrich, T. M., Wenning, B.,

Krings, T., Erberich, S. G., Willmes, K., et al.

(2001). Evidence of abnormal amygdala func-

tioning in borderline personality disorder: A

functional MRI study. Biological Psychiatry,

50, 292–298.

Hupka, R. B., Lenton, A. P., & Hutchinson, K.

A. (1999). Universal development of emotion

categories in natural language. Journal of Per-

sonality and Social Psychology, 77, 247–278.

Hurwitz, B. E., & Furedy, J. J. (1986). The

human dive reflex— an experimental, topo-

graphical and physiological analysis. Physiol-

ogy and Behavior, 36, 287–294.

Iverson, K. M., Shenk, C., & Fruzzetti, A.

E. (2009). Dialectical behavior therapy for

women victims of domestic abuse: A pilot

study. Professional Psychology: Research and

Practice, 40, 242–248.

Izard, C. E. (1977). Distress— Anguish, grief,

and depression. In C. Izard (Ed.), Human

emotions (pp. 285–288). New York: Plenum

Press.

Jacob, G. A., Guenzler, C., Zimmermann, S.,

Scheel, C. N., Rüsch, N., Leonhart, R., et al.

(2008). Time course of anger and other emo-

tions in women with borderline personal-

ity disorder: A preliminary study. Journal of

Behavior Therapy and Experimental Psychia-

try, 39(3), 391–402.

Joiner, T. E., Jr., Lewinsohn, P. M., & Seeley, J.

R. (2002). The core of loneliness: Lack of plea-

surable engagement— more so than painful

disconnection— predicts social impairment,

depression onset, and recovery from depres-

sive disorders among adolescents. Journal of

Personality Assessment, 79, 472–491.

Koerner, K., & Linehan, M. M. (1997). Case

formulation in dialectical behavior therapy

for borderline personality disorder. In T. Eells

(Ed.), Handbook of psychotherapy case for-

mulation (pp. 340–367). New York: Guilford

Press.

Koole, S. (2009). The psychology of emotion reg-

ulation: An integrative review. Cognition and

Emotion, 23, 4–41.

Koons, C. R., Chapman, A. L., Betts, B. B.,

O’Rourke, B., Morse, N., & Robins, C. J.

(2006). Dialectical behavior therapy adapted

Dialectical Behavior Therapy 505

for the vocational rehabilitation of signifi-

cantly disabled mentally ill adults. Cognitive

and Behavioral Practice, 13, 146–156.

Korfine, L., & Hooley, J. M. (2000). Directed

forgetting of emotional stimuli in borderline

personality disorder. Journal of Abnormal

Psychology, 109(2), 214–221.

Kring, A. M., & Sloan, D. M. (2010). Emotion

regulation and psychopathology: A transdi-

agnostic approach to etiology and treatment.

New York: Guilford Press.

Kring, A. M., & Werner, K. H. (2004). Emotion

regulation and psychopathology. In P. Philip-

pot & R. S. Feldman (Eds.), The regulation

of emotion (pp. 359–408). Mahwah, NJ: Erl-

baum.

Kuo, J. R., & Linehan, M. M. (2009). Disentan-

gling emotion processes in borderline person-

ality disorder: Physiological and self- reported

assessment of biological vulnerability, baseline

intensity, and reactivity to emotionally evoca-

tive stimuli. Journal of Abnormal Psychology,

118(3), 531–544.

Laird, J. D. (1974). Self- attribution of emotion:

The effects of expressive behavior on the qual-

ity of emotional experience. Journal of Per-

sonality and Social Psychology, 29, 475–486.

Lazarus, A. A., & Abramovitz, A. (1962). The

use of “emotive imagery” in the treatment of

children’s phobias. Journal of Mental Science,

108, 191–195.

Levine, D., Marziali, E., & Hood, J. (1997).

Emotion processing in borderline personal-

ity disorders. Journal of Nervous and Mental

Disease, 185(4), 240–246.

Levitt, J. T., Brown, T. A., Orsillo, S. M., & Bar-

low, D. H. (2004). The effects of acceptance

versus suppression of emotion on subjective

and psychophysiological response to carbon

dioxide challenge in patients with panic disor-

der. Behavior Therapy, 25, 747–766.

Linehan, M. M. (1993a). Skills training manual

for treating borderline personality disorder.

New York: Guilford Press.

Linehan, M. M. (1993b). Cognitive- behavioral

treatment of borderline personality disorder.

New York: Guilford Press.

Linehan, M. M. (in press). Skills training for dia-

lectical behavior therapy. New York: Guilford

Press.

Lobbestael, J., & Arntz, A. (2010). Emotional,

cognitive and physiological correlates of

abuse- related stress in borderline and antiso-

cial personality disorder. Behaviour Research

and Therapy, 48(2), 116–124.

Lynch, T. R., Chapman, A. L., Rosenthal, M. Z.,

Kuo, J. R., & Linehan, M. M. (2006) Mecha-

nisms of change in dialectical behavior ther-

apy: Theoretical and empirical observations.

Journal of Clinical Psychology, 62, 459–480.

Lynch, T. R., Rosenthal, M. Z., Kosson, D.,

Cheavens, J. S., Lejuez, C. W., & Blair, R.

J. R. (2006). Heightened sensitivity to facial

expressions of emotion in borderline personal-

ity disorder. Emotion, 6, 647–655.

Marissen, M. E., Meuleman, L., & Franken,

I. A. (2010). Altered emotional information

processing in borderline personality disor-

der: An electrophysiological study. Psychiatry

Research: Neuroimaging, 181(3), 226–232.

Martell, C. R., Addis, M., & Jacobson, N. S.

(2001). Depression in context: Strategies for

guided action. New York: Norton.

Mennin, D. S., Heimberg, R. G., Turk, C. L., &

Fresco, D. M. (2005). Preliminary evidence

for an emotion dysregulation model of gener-

alized anxiety disorder. Behaviour Research

and Therapy, 43, 1281–1310.

Minzenberg, M. J., Fan, J., New, A. S., Tang, C.

Y., & Siever, L. J. (2007). Fronto- limbic dys-

function in response to facial emotion in bor-

derline personality disorder: An event- related

fMRI study. Psychiatry Research, 155(3),

231–243.

Minzenberg, M. J., Fan, J., New, A. S., Tang,

C. Y., & Siever, L. J. (2008). Frontolimbic

structural changes in borderline personality

disorder. Journal of Psychiatric Research, 42,

727–733.

Monti, J. M., & Monti, D. (2000). Sleep distur-

bance in generalized anxiety disorder and its

treatment. Sleep Medicine Reviews, 4, 263–

276.

Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M.

(2010). Dialectical behavior therapy skills use

as a mediator and outcome of treatment for

borderline personality disorder. Behaviour

Research and Therapy, 48(9), 832–839.

Neacsiu, A. D., & Linehan, M. M. (in press).

Dialectical behavior therapy for borderline

personality disorder. In D. Barlow (Ed.), Clini-

cal handbook of psychological disorders (5th

ed.). New York: Guilford Press.

New, A. S., Hazlett, E. A., Buchsbaum, M. S.,

Goodman, M., Mitelman, S. A., Newmark,

R., et al. (2007). Amygdala– prefrontal dis-

connection in borderline personality disorder.

Neuropsychopharmacology, 32, 1629–1640.

Niedtfeld, I., Kirsch, P., Schulze, L., Herpertz, S.

C., Bohus, M., & Schmahl, C. (2012). Func-

506 INTERVENTIONS

tional connectivity of pain mediated affect

regulation in borderline personality disorder.

PLoS ONE, 7(3), e33293.

Nunes, P. M., Wenzel, A., Borges, K. T., Porto,

C. R., Caminha, R. M., & de Oliveira., I.

R. (2009). Volumes of the hippocampus and

amygdala in patients with borderline person-

ality disorder: A meta- analysis. Journal of Per-

sonality Disorders, 23, 333–345.

Philippot, P., Baeyenes, C., Douilliez, C., & Fran-

cart, B. (2004). Cognitive regulation of emotion:

Application to clinical disorders. In P. Philippot

& R. S. Feldman (Eds.), The regulation of emo-

tion (pp. 71–100). New York: Erlbaum.

Philippot, P., Burgos, A. I., Verhasselt, S., &

Baeyens, C. (2002). Specifying emotional

information: Modulation of emotional inten-

sity via executive processes. Paper presented

at the 2002 International Society for Research

on Emotion Conference, La Cuenca, Spain.

Pryce, C. R., & Feldon, J. (2003). Long-term

neurobehavioural impact of the postnatal

environment in rats: Manipulations, effects

and mediating mechanisms. Neuroscience and

Biobehavioral Review, 27, 57–71.

Ray, W. J., Odenwald, M., Neuner, F., Schauer,

M., Ruf, M., Wienbruch, C., et al. (2006).

Decoupling neural networks from reality:

Dissociative experiences in torture victims

are reflected in abnormal brain waves in left

frontal cortex. Psychological Science, 17(3),

825–829.

Reitz, S., Krause-Utz, A., Pogatzki- Zahn, E. M.,

Ebner- Priemer, U., Bohus, M., & Schmahl, C.

(2012). Stress regulation and incision in bor-

derline personality disorder— a pilot study

modeling cutting behavior. Journal of Person-

ality Disorders, 26(4), 605–615.

Rizvi, S. L., & Linehan, M. M. (2006). The

treatment of maladaptive shame in borderline

personality disorder: A pilot study of “Oppo-

site Action.” Cognitive and Behavioral Prac-

tice, 12, 437– 4 47.

Rosenthal, M. Z., Gratz, K. L., Kosson, D. S.,

Cheavens, J. S., Lejuez, C. W., & Lynch,

T. R. (2008). Borderline personality disor-

der and emotional responding: A review of

the research literature. Clinical Psychology

Review, 28, 75–91.

Ruocco, A. C. (2005). The neuropsychology

of borderline personality disorder: A meta-

analysis and review. Psychiatry Resource,

137(3), 191–202.

Schaefer, A., Collette, F., Philippot, P., van der,

L. M., Laureys, S., Delfiore, G., et al. (2003).

Neural correlates of “hot” and “cold” emo-

tional processing: A multilevel approach to the

functional anatomy of emotion. NeuroImage,

18, 938–949.

Schredl, M., Paul, F., Reinhard, I., Ebner- Priemer,

U., Schmahl, C., & Bohus, M. (2012). Sleep

and dreaming in patients with borderline per-

sonality disorder: A polysomnographic study.

Psychiatry Research, 200(2–3), 430–436.

Schulze, L., Domes, G., Krüger, A., Berger, C.,

Fleischer, M., Prehn, K., et al. (2011). Neuro-

nal correlates of cognitive reappraisal in bor-

derline patients with affective instability. Bio-

logical Psychiatry, 69(6), 564–573.

Selby, E. A., & Joiner, T. E. (2009). Cascades of

emotion: The emergence of borderline person-

ality disorder from emotional and behavioral

dysregulation. Review of General Psychology,

13, 219–229.

Shaver, P., Schwartz, J., Kirson, D., & O’Connor,

C. (1987). Emotion knowledge: Further explo-

ration of a prototype approach. Journal of Per-

sonality and Social Psychology, 52, 1061–1086.

Smith, C. F., Williamson, D. A., Bray, G. A., &

Ryan, D. H. (1999). Flexible vs. rigid dieting

strategies: Relationship with adverse behav-

ioral outcomes. Appetite, 32, 295–305.

Soeteman, D. I., Hakkaart- van Roijen, L., Ver-

heul, R., & Busschbach, J. J. (2008). The eco-

nomic burden of personality disorders in men-

tal health care. Journal of Clinical Psychiatry,

69(2), 259–265.

Soler, J., Pascual, J. C., Tiana, T., Cebria, A.,

Barrachina, J., Campins, M. J., et al. (2009).

Dialectical behaviour therapy skills training

compared to standard group therapy in bor-

derline personality disorder: A 3-month ran-

domised controlled clinical trial. Behaviour

Research and Therapy, 47, 353–358.

Stepper, S., & Strack, F. (1993). Proprioceptive

determinants of emotional and nonemotional

feelings. Journal of Personality and Social

Psychology, 64, 211–220.

Stiglmayr, C. E., Shapiro, D. A., Stieglitz, R. D.,

Limberger, M. F., & Bohus, M. (2001). Expe-

rience of aversive tension and dissociation in

female patients with borderline personality

disorder— a controlled study. Journal Psychi-

atric Research, 35, 111–118.

Tafrate, R. C., Kassinove, H., & Dundin, L.

(2002). Anger episodes in high- and low-trait-

anger community adults. Journal of Clinical

Psychology, 58, 1573–1590.

Teasdale, J. D., Segal, Z., & Williams, J. M.

(1995). How does cognitive therapy prevent

Dialectical Behavior Therapy 507

depressive relapse and why should attentional

control (mindfulness) training help? Behav-

iour Research and Therapy, 33, 25–39.

Tebartz van Elst, L., Hesslinger, B., Thiel, T.,

Geiger, E., Haegele, K., Lemieux, L., et al.

(2003). Frontolimbic brain abnormalities in

patients with borderline personality disorder:

A volumetric magnetic resonance imaging

study. Biological Psychiatry, 54, 163–171.

Thorberg, F. A., Young, R. M., Sullivan, K. A.,

& Lyvers, M. (2009). Alexithymia and alco-

hol use disorders: A critical review. Addictive

Behaviors, 34, 237–245.

Tooby, J., & Cosmides, L. (1990). The past

explains the present: Emotional adaptations

and the structure of ancestral environment.

Ethology and Sociobiology, 11, 375–424.

Trull, T. J., Jahng, S., Tomko, R. L., Wood, P.

K., & Sher, K. J. (2010). Revised NESARC

personality disorder diagnoses: Gender, preva-

lence, and comorbidity with substance depen-

dence disorders. Journal of Personality Disor-

ders, 24(4), 412–426.

Williams, J. B. W., Stiles, W. B., & Shapiro,

D. A. (1999). Cognitive mechanisms in the

avoidance of painful and dangerous thoughts:

Elaborating the assimilation model. Cognitive

Therapy and Research, 23, 285–306.

Wong, M. M., Brower, K. J., Fitzgerald, H. E.,

& Zucker, R. A. (2004). Sleep problems in

early childhood and early onset of alcohol and

other drug use in adolescence. Alcoholism:

Clinical and Experimental Research, 28(4),

578–587.

508

Emotions tend to be triggered by situations

and generally operate to facilitate adaptive

functioning (Werner & Gross, 2010). How-

ever, the nature and intensity of emotional

experience is not determined by situational

factors alone. As clearly evidenced by the

extensive work reviewed in this handbook, a

range of psychological operations can mod-

erate emotional responses to environmental

circumstances. Collectively these have been

termed emotion regulation processes. Gross

and others have emphasized that emotion

regulation results from a heterogeneous

array of processes exerting their influence

at differing points in the emotion generation

continuum (Gross, 1998; Gross & Thomp-

son, 2007). Antecedent- focused components

operate prior to the generation of emotion,

and response- focused components operate

subsequent to emotion generation, while

other emotion regulation processes exert

a direct influence on emotion generation

itself. The combined impact of these emo-

tion regulation processes shapes the nature

of emotional experience, with individual dif-

ferences in emotional regulation giving rise

to variation in emotional disposition. Thus,

emotional resilience has been attributed to

the effective use of adaptive emotion regu-

lation (Troy & Mauss, 2011), while height-

ened vulnerability to negative emotions and

to emotional pathology have been attributed

to maladaptive emotional regulation (Moses

& Barlow, 2006). Such accounts carry the

implication that a better understanding of

the specific processes that functionally con-

tribute to emotion regulation, coupled with

the ability to systematically influence these

processes, could potentially enhance such

regulation in ways that ameliorate emo-

tional vulnerability and dysfunction.

Since variation in emotion regulation gives

rise to individual differences in emotional

disposition, it follows that information-

processing biases theoretically implicated

in the determination of emotional disposi-

tion represent plausible emotion regulation

mechanisms. Numerous influential mod-

els have proposed that biased attentional

selectivity contributes both to dispositional

emotional vulnerability and emotional

pathology (cf. Mathews & MacLeod, 2005).

Hence, it is unsurprising that selective atten-

tion has been widely implicated in models of

emotion regulation (Gross & Barrett, 2011).

Kring and Werner (2004) contend that

selective attentional deployment is a criti-

cal emotion regulation process that causally

contributes both to variability in normal

emotional experience and to emotional dys-

function. Thompson and Goodman (2010)

echo this view, arguing that certain types

of attentional selectivity contribute to good

emotional regulation and therefore to emo-

CHAPTER 30

Regulation of Emotion

through Modification of Attention

Colin MacLeod

Ben Grafton

Regulation of Emotion through Modification of Attention 509

tional resilience, while other patterns of

attentional deployment compromise emo-

tional regulation in ways that give rise to

emotional pathology. Many other theorists

have similarly proposed that attentional bias

to negative information makes a maladap-

tive contribution to emotion regulation that

elevates emotional vulnerability and the risk

of emotional pathology (White, Helfinstein,

Reeb- Sutherland, Degnan, & Fox, 2009),

while attentional avoidance of negative

information serves to enhance emotional

resilience (Troy & Mauss, 2011).

This idea that selective attentional

response to negative information makes a

causal contribution to emotional regula-

tion, and therefore functionally influences

emotional vulnerability and dysfunction, is

our focus in this chapter. Here we examine

how use of cognitive technologies that have

proven capable of systematically training

attentional change has served to illumi-

nate the causal role of selective attentional

deployment in the regulation of emotion. We

also review evidence that the enhancement

of emotion regulation, through the applica-

tion of such attentional bias modification

procedures, can yield tangible benefits for

people experiencing emotional difficulties.

Before describing the attentional bias modi-

fication approach, we first briefly summa-

rize the evidence that attentional preference

for negative information represents a reli-

able characteristic of emotional vulnerabil-

ity and dysfunction. This also enables us to

communicate how the types of cognitive–

experimental tasks previously employed to

assess attentional bias recently have been

adapted to create attentional bias modifica-

tion procedures.

Assessing the Association

between Attentional Bias

and Emotion Regulation

Some investigators have sought to assess

attention simply by asking people to intro-

spectively reflect upon and self- report the

manner in which their attention operates

(e.g., Derryberry & Reed, 2002). However,

the limitations of relying on verbal reports

to assess cognitive processes have been well

documented (cf. Nisbett & Wilson, 1977).

In response to these limitations, many

researchers investigating whether individ-

ual differences in emotion regulation are

systematically associated with variation in

selective attentional responding to negative

information have drawn upon cognitive–

experimental methodologies, to appraise

more objectively the attentional processes of

interest (Mathews & MacLeod, 2005). The

resulting assessment procedures infer atten-

tional selectivity not from self- report mea-

sures but from performance measures, such

as response latencies to make particular

decisions, that necessarily will be influenced

in particular ways by underlying patterns of

attentional selectivity. Several such atten-

tional assessment tasks have been widely

used in studies designed to establish whether

biased attention to negative information is

characteristic of people who display evi-

dence of poor emotion regulation. We now

briefly describe these assessment techniques

and illustrate how each has lent support to

the veracity of this hypothesis.

One of the earliest methodologies devel-

oped to objectively assess the association

between selective attentional responding to

negative information and emotional vulner-

ability is the emotional Stroop task. In this

assessment approach, the participant must

rapidly name the color of emotionally toned

words displayed in differing ink colors, while

ignoring their semantic content. The degree

to which color naming is disproportionately

slow on negative words compared to neutral

words is taken as a measure of attentional

bias to negative information, as it suggests

particular difficulty ignoring the negative

content of these words. Individuals who

display heightened emotional vulnerabil-

ity, or who suffer from emotional dysfunc-

tion, commonly show this pattern of emo-

tional Stroop performance (e.g., Williams,

Mathews, & MacLeod, 1996), leading to

the conclusion that variation in the capac-

ity to regulate emotion is indeed related to

differential attentional responding to nega-

tive information (Ashley & Swick, 2009).

Another technique commonly used to assess

the association between selective attentional

response to negative information and indi-

vidual difference in emotion regulation is

the visual search task. In this approach, par-

ticipants are exposed to an array of stimuli

and are required to locate a specified target

stimulus as quickly as possible. An index of

510 INTERVENTIONS

attentional bias to negative information is

provided by their relative speeding to detect

emotionally negative targets compared to

neutral or positive targets. It has repeatedly

been found that participants with height-

ened emotional vulnerability or dysfunction

display greater evidence of such speeding

(c.f. Cisler & Koster, 2010). Investigators

employing this visual search approach have

concluded that variation in attentional

responding to emotional information is sys-

tematically related to variation in the ability

to regulate emotion effectively (Leclerc &

Kensinger, 2008).

Probably the most widely used method

of assessing biased attention to negative

information is the attentional probe task

(MacLeod, Mathews, & Tata, 1986). In

this task, the participant is briefly exposed

to stimulus pairs whose members differ in

emotional valence. These stimuli can be

words or images, and most commonly one

member of each pair is emotionally nega-

tive, while the other is neutral in emotional

tone. Immediately following stimulus offset,

a small visual probe is presented in the locus

of one the previously displayed stimuli, and

the participant is required to rapidly execute

a discriminatory response to this probe. It

is assumed that the probe will be processed

fastest when it appears in the locus where

participants already are attending. Hence,

the degree to which this discrimination

response is speeded when the probe appears

in the locus of the negative information,

rather than the locus of neutral informa-

tion, provides a measure of attentional bias

toward negative information. A reliable

finding from studies using this task is that

emotionally vulnerable individuals, and

those suffering from emotional pathology,

display an attentional bias to negative infor-

mation (c.f. Bar-Haim, Lamy, Pergamin,

Bakermans- Kranenburg, & van IJzendoorn,

2007). Once again, this has led theorists to

conclude that an attentional bias to nega-

tive information is characteristic of deficient

emotion regulation (e.g., Bradley, Mogg,

White, Groom, & de Bono, 1999).

While the weight of evidence leaves little

room for doubt that impaired emotion regu-

lation, as evidenced by heightened emotional

vulnerability or the presence of emotional

pathology, is reliably characterized by an

attentional bias favoring negative informa-

tion, this does not permit the conclusion that

such attentional deployment makes a direct

functional contribution to emotion regula-

tion. This association could instead reflect

the influence of emotion regulation on

attentional selectivity. Alternatively, it could

be that attentional selectivity and emotion

regulation represent the independent conse-

quence of some third individual- difference

variable. To determine whether selective

attention exerts a causal influence on emo-

tion regulation, it is necessary to system-

atically alter attentional selectivity. Adop-

tion of the attentional bias modification

approach has served both to confirm, and to

capitalize on, the contribution of attentional

selectivity to emotion regulation.

The Attentional Bias

Modification Approach

The most powerful way to evaluate the

hypothesis that patterns of selective atten-

tional response to emotional information

make a functional contribution to individ-

ual differences in emotion regulation is to

systematically manipulate such attentional

selectivity, in order to test the prediction

that the modification of attentional bias

will alter emotion regulation, as revealed by

changes in emotional reactivity and dysfunc-

tion. Confirmation of this prediction would

lend powerful support to the contention that

attentional bias is causally involved in emo-

tion regulation. It also would introduce the

possibility that dysfunctional patterns of

emotional symptomatology, resulting from

deficiencies in emotion regulation, might be

therapeutically attenuated by clinical inter-

ventions that appropriately exploit such

attentional bias modification procedures.

A number of early studies designed to

appraise the possibility that emotion regu-

lation may be influenced by altering atten-

tional selectivity have employed only ver-

bal instruction as the intended method

of attentional manipulation. Participants

instructed to alter their attentional style not

uncommonly report that this alters their

emotional experience (Richards & Gross,

2006). However, while such findings are

certainly encouraging, reliance on verbal

instruction to modify attentional selectiv-

ity has a number of significant limitations

Regulation of Emotion through Modification of Attention 511

(MacLeod & Bucks, 2011). For one thing,

such an approach at best could only influ-

ence attentional processes amenable to voli-

tional control, and it is well established that

the patterns of attentional bias that char-

acterize emotional vulnerability and dys-

function commonly operate automatically

within the cognitive system (Mathews &

MacLeod, 2005). Relatedly, while partici-

pants may report that they comply with such

attentional instructions, in the absence of

objective attentional measures it is difficult

to exclude the potential influence of demand

effects. Hence, it would be highly desirable

to induce attentional change in a manner

that does not assume the targeted atten-

tional process to be under voluntary control,

and to objectively verify the efficacy of this

attentional manipulation without relying on

self- report measures of attentional selectiv-

ity.

Recent years have witnessed the develop-

ment and implementation of new cognitive

technologies designed to achieve these objec-

tives by redesigning cognitive– experimental

tasks previously employed to assess patterns

of attentional bias relevant to emotion regu-

lation, in ways that transform them into pro-

cedures capable of instead training change

in such attentional selectivity (Mathews &

MacLeod, 2002). Collectively referred to

as cognitive bias modification for attention

(CBM-A), or more simply as attentional

bias modification (ABM) tasks, this general

approach has involved introducing system-

atic contingencies into the original assess-

ment tasks, such that task performance will

be enhanced by the acquisition of a biased

attentional response to a target category of

emotional information. Following extensive

practice in the execution of such tasks, sub-

sequent performance on conventional atten-

tional bias assessment procedures has served

to confirm that these ABM procedures can

systematically alter selective attentional

responding to emotional information.

MacLeod, Rutherford, Campbell,

Ebsworthy, and Holker (2002) developed

the earliest and most widely used ABM

task by transforming the attentional probe

task into a training procedure. The assess-

ment version of this task presents probes

with equal frequency in the screen locations

where either negative or neutral members

of a stimulus word pair have just been pre-

sented. In their ABM version of the task,

however, MacLeod et al. either presented all

probes in the loci where the negative words

appeared, in order to induce attentional

vigilance for negative information (attend-

negative training), or in the loci where the

neutral words appeared, in order to induce

attentional avoidance of negative informa-

tion (avoid- negative training). Across several

studies, MacLeod and colleagues showed

that following the delivery of 576 such ABM

trials, participants who received these alter-

native training conditions came to differ as

intended in the pattern of attentional bias

they subsequently displayed on the conven-

tional assessment version of the probe task.

Dandeneau and Baldwin (2004) devel-

oped an ABM variant of the visual search

procedure previously employed to assess

patterns of attentional selectivity associated

with individual differences in emotion regu-

lation. Their attentional training version was

designed to enhance attentional vigilance for

positive information, while inducing atten-

tional avoidance of negative information by

having participants repeatedly search for a

single emotionally positive target image (a

smiling face) in a matrix of emotionally neg-

ative distracter images (frowning faces). Fol-

lowing exposure to 112 trials of this ABM

procedure, participants evidenced a change

in attentional bias consistent with the train-

ing objective, as assessed using the emotional

Stroop task. Once again, this effect has been

replicated across subsequent studies (Dan-

deneau, Baldwin, Baccus, Sakellaropoulo,

& Pruessner, 2007).

Because the attentional impact of ABM

procedures has been demonstrated using

performance- based rather than self- report

measures of attentional selectivity, there

are good grounds for confidence that they

induce genuine attentional change. Further

support for the authenticity of their atten-

tional impact comes from the breadth of

attentional measures that are influenced by

these bias modification procedures. Thus,

for example, ABM tasks alter attentional

selectivity as assessed using eye movement

measures (Wadlinger & Isaacowitz, 2008),

and they also modulate event- related poten-

tial (ERP) indices of attentional selectivity

(Eldar & Bar-Haim, 2010). Using func-

tional magnetic resonance imaging (fMRI),

Browning, Holmes, Murphy, Goodwin, and

512 INTERVENTIONS

Harmer (2010) have demonstrated that the

attentional change elicited by ABM proce-

dures is mediated by altered patterns of acti-

vation in the lateral frontal cortex.

This powerful new capacity to directly

modify selective attentional responding to

emotional information has enabled research-

ers not only to evaluate the hypothesis that

such attentional bias causally contributes to

emotion regulation but also to exploit thera-

peutically the capacity of these ABM pro-

cedures to enhance emotion regulation (cf.

Bar-Haim, 2010; Hertel & Mathews, 2011;

MacLeod & Mathews, 2012). In reviewing

this work, we focus first on laboratory- based

research that has employed single- session

ABM, with the principal aim of illuminat-

ing the functional nature of the associa-

tion between attentional bias and emotion

regulation. We next consider work that has

delivered extended ABM, with the aim of

enhancing emotion regulation in ways that

can reduce emotional vulnerability and dys-

function in real-world settings.

Single-Session ABM Studies:

Determining the Causal

Contribution of Attentional Bias

to Emotion Regulation

Studies employing single- session ABM

procedures have examined the impact of

transiently induced change in attentional

responding to emotional information on

emotional experience within controlled lab-

oratory settings. In some cases, investigators

have studied the effect of such ABM proce-

dures on normal emotional reactions to con-

trived stress. In others, the focus has been

on the capacity of ABM to attenuate dys-

functional emotional symptoms in partici-

pants selected because of their disposition to

experience particular types of emotional dif-

ficulties, such as worry, obsessive concerns,

or social anxiety. The following sections

review the outcomes of these investigations.

Impact of Single‑Session

ABM on Affective Reactivity

to Laboratory‑Based Mood Induction

In two early studies, MacLeod et al. (2002)

employed a single session of the probe-based

ABM task to successfully induce a differen-

tial attentional response to negative verbal

stimuli in students who obtained midrange

scores on a measure of emotional vulnera-

bility. These participants were subsequently

exposed to a stressful anagram task, and

their emotion regulation capability was

determined by assessing the degree to which

this elicited anxious and depressed mood.

While the anagram stressor increased levels

of anxiety and depression across all partici-

pants, the magnitude of this dysphoric emo-

tional response was significantly attenuated

for the participants who had just completed

ABM in the avoid- negative rather than the

attend- negative training condition. Further-

more, the degree to which the ABM proce-

dure influenced the emotional impact of this

stressor was a direct function of the degree

to which it influenced selective attentional

responding to negative stimuli. These find-

ings confirm that selective attentional avoid-

ance of negative information can enhance

down- regulation of dysphoric responses to

stressful experiences, which is a characteris-

tic of good emotion regulation.

Using a single session of their visual search

ABM variant, Dandeneau and Baldwin

(2009) have provided further support for

the idea that attentional selectivity causally

influences emotion regulation. Unselected

workers at an adult education center com-

pleted a single session of this ABM task

either in a condition designed to induce

attentional vigilance for socially positive

information (smiling faces) and avoidance

of socially negative information (frowning

faces), or in a control condition designed to

leave attentional selectivity unaltered. A sub-

sequent attentional probe assessment task

confirmed that participants given the ABM

training, but not those receiving the control

condition, came to display attentional avoid-

ance of information related to social rejec-

tion. The former participants also evidenced

enhanced emotion regulation when exposed

to a variety of stressor tasks. For example,

they felt less subjective rejection than did

control participants following a simulated

interaction in which they were treated coldly,

and this was particularly evident in partici-

pants who initially had scored low in self-

esteem. Participants who had received the

ABM training also reported less rejection-

related thoughts when attempting to com-

plete a subsequent insoluble anagram task.

Regulation of Emotion through Modification of Attention 513

Furthermore, failure on this task exerted a

less negative impact on self- esteem in partici-

pants who received the ABM than was the

case for those in the control condition. Dan-

deneau and Baldwin reasonably concluded

from these findings that selective attentional

responding to emotional information makes

a direct functional contribution to the self-

regulation of emotional experience.

These aforementioned studies indicate

that attentional bias can causally influence

emotion regulation in participants whose

emotional experiences fall within the nor-

mal range. Researchers have gone on to

investigate whether a single session of ABM

can transiently ameliorate dysfunctional

emotion in participants selected on the basis

of preexisting emotional problems.

Impact of Single‑Session ABM

on Negative Thought Intrusions

in Worriers

Hayes, Hirsch, and Mathews (2010)

recruited volunteers who defined themselves

as high worriers, and who scored high on

a conventional worry questionnaire. Half of

these participants were given an ABM proce-

dure that delivered the probe ABM task and

a novel dichotic ABM task, both configured

to induce attentional avoidance of negative

information. The remaining participants

were given control versions of these tasks

without any training contingency. When

attentional bias was subsequently measured,

it was found that participants receiving

ABM differed significantly from the control

participants in terms of attentional bias, and

now demonstrated the intended avoidance of

negative information. A thought- sampling

procedure was then employed to assess neg-

ative thought intrusions before and after a

final worry induction. Although there was

no significant difference between the groups

in terms of negative thought intrusions

before the worry induction, the control par-

ticipants, but not the experimental partici-

pants, evidenced an increase in such intru-

sions following this worry manipulation.

The finding that participants who received

avoid- negative ABM experienced less nega-

tive thought intrusions than did those who

received the no- training control procedure

verifies that attentional bias can make a

casual contribution to worry.

In an extension of this work, using wor-

riers selected in the same manner, Hirsch et

al. (2011) compared the impact of two vari-

ants of ABM. Both employed verbal stimuli,

but one was designed to modify the degree

to which attention is captured by negative

information, while the other was designed

to instead modify the degree to which atten-

tion is held by negative information. These

two procedures altered attentional selectiv-

ity to an equivalent degree, but only the for-

mer ABM variant influenced subsequently

assessed negative thought intrusions. On the

basis of these findings, Hirsch et al. argue

that heightened attentional engagement with

negative information may contribute more

than impaired attentional disengagement

from such information to the evocation of

worry- related negative thought intrusion.

This study illustrates the capacity for care-

fully designed implementations of the ABM

approach to illuminate which aspects of

attentional bias make the greatest contribu-

tions to dysfunctional symptoms reflecting

impaired emotion regulation.

Impact of Single‑Session ABM on

Behavioral Avoidance in Subclinical

Obsessive–Compulsive Disorder

The studies reported so far have assessed

the impact of ABM only on self- report mea-

sures of emotion. However, the modification

of attentional bias to negative information

also has been shown to influence behavioral

indices of dysfunctional emotion. Najmi

and Amir (2010) recruited individuals who

reported excessive concern about germs, dirt,

or contamination, and scored high on a con-

ventional measure of obsessive– compulsive

symptomatology. Half these participants

received a single session of probe-based

ABM, delivered in the avoid- negative train-

ing condition, while the other half received

this task in a control condition that did not

include any training contingencies. The

emotionally negative information presented

in these tasks was words chosen on the basis

of their relevance to contamination- related

concerns. As intended, the former group, but

not the latter, came to exhibit attentional

avoidance of this contamination- related neg-

ative information. A behavioral approach

task was then given, which required par-

ticipants to take as many steps as possible

514 INTERVENTIONS

toward a contamination- related stimulus

(e.g., potting soil mixed with cat hair and

dead crickets). Those who had received

the avoid- negative ABM training exhib-

ited greater levels of behavioral approach

than did those who instead received the

control condition. Moreover, Najmi and

Amir were able to show that the degree to

which this ABM training increased behav-

ioral approach was mediated by the degree

to which it reduced attentional bias to the

negative information. Thus, selective atten-

tional responding to negative information

makes a contribution to not only the regula-

tion of emotion itself but also the regulation

of emotionally relevant patterns of behavior.

Impact of Single‑Session ABM on

Affective, Somatic, and Behavioral

Symptoms of Social Anxiety

Amir, Weber, Beard, Bomyea, and Taylor

(2008) have shown that ABM also influ-

ences emotionally relevant patterns of

behavior in socially anxious people with

a fear of public speaking. Included in the

study were individuals who responded to an

advertisement seeking volunteers who had

difficulty giving speeches, and who scored

high on a questionnaire measure of social

anxiety. They were exposed to a single-

session attentional probe procedure that

presented faces displaying either negative

emotion (disgust) or neutral expressions,

delivered in either the avoid- negative ABM

condition or a no- training control condi-

tion. As intended, the former participants

alone displayed a significant reduction in

attention to the socially relevant negative

information, coming to show less atten-

tion to such negative information than did

control participants. When subsequently

required to give a short speech, the partici-

pants who had received avoid- negative ABM

were rated as performing better than con-

trol participants. They also reported lower

levels of anxiety during speech presentation

than did control participants. The superior

speech performance exhibited by the par-

ticipants who received avoid- negative ABM

was statistically mediated by the emotional

impact of this ABM procedure. This sug-

gests that the induced attentional avoidance

of negative information adaptively regulated

emotional response to the speech stressor,

with beneficial behavioral consequences for

speech performance.

Using a somewhat more complex design,

which involved having participants engage in

physical exercise during the ABM sessions,

Julian, Beard, Schmidt, Powers, and Smits

(2012) recently failed to replicate Amir et al.’s

(2008) finding that ABM designed to reduce

attention to negative information served to

attenuate emotional reactivity to a subse-

quent speech stressor. However, it should be

emphasized that Julian et al.’s (2012) ABM

procedure actually failed to modify selective

attentional responding to negative infor-

mation. Hence, the results of this study do

not challenge the hypothesis that selective

attentional deployment influences emotion

regulation. Other investigators who have

succeeded in modifying this attentional bias

have been able to verify Amir et al.’s (2008)

original conclusion that such attentional

bias modification influences both subjective

and behavioral measures of socially anx-

ious participants’ stress response to a speech

task. Heeren, Lievens, and Philippot et al.

(2011) delivered a range of attentional train-

ing variants to socially anxious participants

and found that an ABM procedure designed

specifically to increase attentional disen-

gagement from faces displaying negative

expressions was most effective in enhancing

independently rated speech performance,

while also reducing self- reported anxiety.

Thus, the pattern of attentional selectivity

that most contributes to the adaptive regula-

tion of social anxiety may involve the ready

disengagement of attention from socially rel-

evant negative information.

The weight of evidence from single- session

ABM studies firmly favors the conclusion

that selective attentional responding to emo-

tional information can make a causal contri-

bution to emotion regulation. Single sessions

of ABM can moderate the intensity of nor-

mal affective reactions to laboratory stress-

ors, and attenuate dysfunctional emotional

symptoms such as excessive worry, elevated

social anxiety, and undue concerns over

contamination within the laboratory set-

ting. Such findings offer empirical support

to the hypothesis that attentional selectiv-

ity contributes to the regulation of emotion.

They also raise the prospect that appropri-

ately designed extensions of single- session

ABM procedures may be capable of enhanc-

Regulation of Emotion through Modification of Attention 515

ing emotion regulation within real-world

settings in ways that may deliver practical

therapeutic benefits. In the next section,

we consider ABM studies that have directly

evaluated this exciting possibility.

Extended-Delivery ABM Studies:

The Therapeutic Enhancement

of Emotion Regulation

in Real-World Settings

While the results of single- session ABM

studies have confirmed that selective atten-

tional responding to emotional information

can influence emotion regulation within the

laboratory, this does not mean that atten-

tional bias necessarily contributes to real-

world emotion regulation. Nor do these

finding permit the conclusion that ABM has

the capacity to enhance emotion regulation

in ways that can reduce dysfunctional emo-

tional experience outside the experimen-

tal setting. Both of these issues have been

addressed, however, by studies designed to

evaluate whether repeated exposure to ABM

procedures can enhance regulation of emo-

tional reactions to naturalistic stressors, and

can improve emotion regulation to an extent

that ameliorates the clinical symptoms of

emotional pathology in the real-world.

Impact of Extended ABM on Affective

Reactivity to Real‑Life Stressors

See, MacLeod, and Bridle (2009) employed

an online procedure to deliver 10-minute

sessions of a probe-based ABM task on each

of 15 consecutive days, to high school grad-

uates approaching the stressor of migrating

overseas to commence tertiary education.

Half received this task in the avoid- negative

training condition, while the other half

received it in a control condition containing

no attentional training contingency. The for-

mer participants, unlike the latter, displayed

a reduction in attention to negative informa-

tion across the duration of the study. Emo-

tional measures taken immediately after par-

ticipants subsequently experienced the stress

of migration were compared with measures

taken prior to the commencement of the

study. As anticipated, this real-world stress

event substantially increased state anxiety.

However, the magnitude of this negative

emotional reaction was attenuated in partic-

ipants who had received the avoid- negative

ABM, compared to control participants.

Furthermore, a measure of trait anxiety,

reflecting general disposition to experience

anxiety symptoms, also was attenuated by

the ABM procedure. The degree to which

ABM reduced attention to negative infor-

mation statistically mediated the degree to

which it reduced trait anxiety, which in turn

mediated its impact on emotional reactivity

to the stressful transition event. Thus, the

reduction of attention to negative informa-

tion through extended exposure to ABM

served to enhance the regulation of emotion

within the naturalistic setting in ways that

decreased negative emotional reactivity to a

real-world stressor.

Similar conclusions are invited by the find-

ings of Dandeneau et al. (2007), who exam-

ined the impact of 5 consecutive days of their

visual search ABM task on self- report and

physiological indices of negative emotional

experience in participants who experienced

stressful real-world situations. Compared

to those who received a no- training con-

trol procedure, students who completed this

extended ABM in the condition designed to

inhibit attention to negative and increase

attention to positive information reacted to

a subsequent school examination with lower

levels of subjective stress and anxiety. When

telemarketers, employed within a stress-

ful work environment, received this 5-day

ABM procedure, they reported an increase

in self- esteem and decrease in subjective

stress, compared to colleagues given a no-

training control procedure. They also evi-

denced a reduction in physiological signs of

stress, were rated as more confident by their

supervisors, and even showed higher levels

of sales performance. Such findings strongly

support the involvement of attentional selec-

tivity in real-world emotion regulation and

demonstrate that attentional bias modifica-

tion procedures can enhance the regulation

of normal emotional experience in ways that

benefit people in stressful real-world situa-

tions.

Impact of Extended ABM

on Pathological Worry

The extended delivery of ABM also has

been shown to attenuate dysfunctional emo-

516 INTERVENTIONS

tional symptoms experienced outside the

laboratory by people who report worry-

ing excessively. Hazen, Vasey, and Schmidt

(2009) recruited participants who exhibited

extreme levels of worry, and across a 2-week

period completed five sessions, each lasting

for 30 minutes, of either probe-based ABM

in the avoid- negative condition or a control

task that contained no training contingency.

The attentional vigilance for negative infor-

mation initially shown by these worriers was

reversed by the avoid- negative ABM. Partici-

pants who received this ABM, unlike con-

trol participants, also displayed a significant

reduction in worry, anxiety, and depression.

Hazen et al. contend, on the basis of their

findings, that the enhancement of emotion

regulation using attentional training may

make a therapeutic contribution to the treat-

ment of generalized anxiety disorder (GAD),

in which pathological worry is the hallmark

symptom.

Subsequent research has lent empiri-

cal weight to this contention. Amir, Beard,

Burns, and Bomyea (2009) directly assessed

whether ABM produced clinically significant

benefits when given to treatment- seeking

individuals meeting diagnostic criteria for

GAD. All patients completed an attentional

probe task twice weekly across a 4-week

period. For one group, this task was given

in the avoid- negative ABM condition, con-

figured to induce attentional avoidance of

negative information, while another group

received a control condition that contained

no training contingency. Clinical symp-

tomatology was assessed before and after

this 4-week period, using both question-

naire measures and diagnostic interview.

Patients who received avoid- negative ABM

procedure displayed the expected decrease

in attention to negative information, which

was not shown by patients in the control

condition, resulting, as intended, in a post-

training group difference in selective atten-

tional responding to negative information.

Across the 4 weeks of the study, patients in

the control condition evidenced no decline in

either questionnaire measures or interview-

based measures of symptomatology that

assessed worry, anxiety, and depression. In

contrast, patients who received the avoid-

negative ABM procedure demonstrated reli-

able reductions in all these symptom mea-

sures. The clinical significance of the change

was such that, after this 4-week period, only

50% of the participants who had received

avoid- negative ABM continued to meet

diagnostic criteria for GAD, compared

with 87% of those in the control condition.

Amir et al. concluded that biased attentional

responding to negative information func-

tionally contributes to the emotional pathol-

ogy observed in GAD. Moreover, on the

basis of their findings, they advocate the use

of ABM as a clinical tool in the treatment of

this emotional disorder.

Impact of Extended ABM on Social

Anxiety Dysfunction

There is compelling evidence that extended

exposure to ABM can enhance emotional

functioning in people experiencing problem-

atic levels of social anxiety. After recruiting

participants who scored high on a question-

naire measure of social anxiety, Li, Tan,

Qian, and Liu (2008) gave them seven con-

secutive daily sessions that presented either

probe-based ABM in the avoid- negative con-

dition, or a control version of this procedure

that contained no training condition. Only

those who received the avoid- negative ABM

came to display reduced attention to nega-

tive information, and only they evidenced

a significant reduction in Social Interaction

Anxiety Scale (SIAS) scores. Li et al.’s find-

ings suggest that the regulation of real-world

social anxiety can be improved by the modi-

fication of attentional bias in nonclinical

participants. Later work carried out with

clinical samples indicates that such ABM

procedures also can therapeutically alleviate

the clinical symptoms of patients with psy-

chological disorders that involve excessive

levels of social anxiety.

Amir, Beard, Taylor, et al. (2009) exam-

ined whether ABM could enhance emo-

tional functioning in patients meeting diag-

nostic criteria for generalized social phobia

(GSP). Patients who received eight sessions

of avoid- negative ABM across a 4-week

period evidenced reduced levels of attention

to socially relevant negative facial expres-

sions, which was not the case for those who

instead received a no- training control ver-

sion of the procedure. Over these 4 weeks,

the former patients, relative to the latter,

also exhibited disproportionate reductions

across all measures of social anxiety, which

Regulation of Emotion through Modification of Attention 517

included the Liebowitz Social Anxiety Scale

(LSAS), the Social Phobia and Anxiety

Inventory (SPAI) and the Sheehan Disability

Scale (SDS). At the end of this period, only

50% of the individuals who had received the

avoid- negative ABM training continued to

meet diagnostic criteria, compared to 86%

of those who received the control condition.

This improvement in social anxiety symp-

toms experienced by the patients given ABM

was maintained at 4-month follow- up.

Carlbring et al. (2012) recently failed to

replicate Amir, Beard, Taylor, et al. (2009)

findings when delivering ABM online to

Internet- recruited volunteers who met diag-

nostic criteria for social anxiety disorder

(SAD). However, it is important to note

that this intended ABM procedure failed to

induce any reduction in selective attention

to negative information. Hence, while Carl-

bring et al.’s study raises questions concern-

ing the most effective methods of bringing

about attentional change, its negative find-

ings do not challenge Amir, Beard, Taylor,

et al.’s (2009) conclusion that attentional

bias causally contributes to impaired emo-

tion regulation in SAD. Moreover, converg-

ing support for the conclusion that ABM can

alleviate such clinical dysfunction has been

independently obtained by other investiga-

tors. For example, Schmidt, Richey, Buck-

ner, and Timpano (2009) evaluated the

impact of avoid- negative ABM on the clini-

cal symptoms of patients diagnosed with

generalized social anxiety disorder (GSAD),

using the same experimental design as Amir,

Beard, Taylor, et al. (2009). Patients who

received eight such ABM sessions across a

4-week period demonstrated reduced levels

of emotional dysfunction compared to par-

ticipants who received the no- training con-

trol condition on all measures of social anxi-

ety, which included the SPAI, the LSAS, and

the Brief Social Phobia Scale. At the end of

this 4-week period only 28% of those who

received the avoid- negative ABM continued

to meet diagnostic criteria for GSAD, com-

pared to 75% of participants in the control

condition. Again, these gains were largely

maintained at 4-month follow- up.

Heeren, Reese, McNally, and Philippot

(2012) have shown that extended exposure

to avoid- negative ABM reduces the negative

emotional symptoms experienced by patients

with social anxiety dysfunction in naturalis-

tic environments and enhances their capacity

to regulate their emotional reaction to exper-

imentally delivered social stress. Patients

diagnosed with GSAD were given four daily

sessions of ABM training in either the avoid-

negative condition or a no- training control

version of the task. Attentional bias to nega-

tive information was significantly attenu-

ated at a posttraining assessment point for

the former participants relative to the latter.

Participants receiving ABM also exhibited

a disproportionate decline in social anxi-

ety, as assessed by the LSAS and the Fear of

Negative Evaluation Scale (FNE). Prior to,

and after, the 4 days of attentional training

participants were exposed to a speech task,

in which they delivered a 2-minute oral pre-

sentation, and the impact of this stressor on

self- report, behavioral, and physiological

measures of emotion was assessed. Partici-

pants who received the avoid- negative ABM

displayed a disproportionate reduction, rela-

tive to control participants, in the degree to

which this stressor evoked negative emotion

at the posttraining assessment point. Those

who had received ABM reported experienc-

ing less distress than did control participants

during the speech task. They also performed

the task with less evidence of negative emo-

tion, as assessed by behavioral ratings and

galvanic skin response (GSR).

Impact of Extended ABM

on Depression

An attentional bias to negative information

is generally considered a more robust char-

acteristic of anxiety than depression, raising

uncertainty concerning whether such atten-

tional selectivity contributes to the regula-

tion of depression. Nevertheless, a few ABM

studies suggest that this is the case, at least

when depression is not severe. For example,

Wells and Beevers (2010) recruited under-

graduate students whose questionnaire

scores indicated mild to moderate levels of

depression. Across a 2-week period they

received four sessions of either probe-based

ABM in the avoid- negative training condi-

tion or a control probe task that contained

no training contingency. Across this period,

the former participants alone displayed a

reduction in attention to negative informa-

tion, and by the end of the 2 weeks they

were displaying significantly lower levels

518 INTERVENTIONS

of attention to negative information than

was the case for control participants. Like-

wise, only the participants who received the

avoid- negative ABM showed a reduction in

depressive symptoms across these 2 weeks,

and at the end of the period their depression

scores were significantly lower than those

of control participants. This ABM-induced

difference in depression levels remained evi-

dent at a follow- up assessment 2 weeks later.

The influence of the training procedure on

depressive symptomatology was statistically

mediated by its impact on attentional bias.

These findings suggest that attentional

selectivity causally contributes to the regula-

tion of depression, as well as anxiety, rais-

ing the possibility that ABM may potentially

yield benefits in the treatment of depressive

dysfunction. It would be premature, how-

ever, to draw conclusions concerning the

responsiveness of clinical depression to this

type of attentional manipulation. Baert, De

Raedt, Schacht, and Koster (2010) reported

finding no therapeutic impact of a novel

probe-based ABM procedure they deliv-

ered, across 10 daily sessions, to students

reporting severe depression, and to patients

receiving concurrent conventional treatment

for clinical depression. It must be noted,

however, that the probe-based procedure

employed by these researchers not only dif-

fered in significant ways from the ABM task

adopted by most other researchers (e.g.,

presenting only single stimuli rather than

stimulus pairs) but also prove ineffective in

altering selective attentional responding to

negative emotional information. We concur

with the authors that their failure to induce

differential attentional selectivity using this

intended bias modification procedure begs

a cautious interpretation of the accompany-

ing failure to influence emotional symptom-

atology in severely depressed students and

clinically depressed patients. It remains to

be seen whether the successful reduction of

attention to negative information can serve

to therapeutically attenuate clinically signif-

icant depression.

Impact of Extended ABM

on Dysfunctional Affect in Children

and Adolescents

Across recent years, growing concern over

emotional dysfunction in childhood and

adolescence has led researchers to recognize

the importance of better understanding the

factors that contribute to emotion regula-

tion in young people and identifying ways

of enhancing this. ABM studies suggest that

selective attentional responding to negative

information causally influences emotion

regulation in children as well as adults, and

provide grounds for optimism that ABM

procedures can be used to enhance emotion

regulation in younger populations. Early

support for the hypothesis that attentional

selectivity contributes to emotion regulation

in children was provided by Eldar, Ricon,

and Bar-Haim (2008). These researchers’

recruited children ages 7–12 years, whose

questionnaire scores placed them midrange

in terms of emotional vulnerability. Across

two sessions, these children completed a

probe-based ABM procedure in either an

avoid- negative or an attend- negative train-

ing condition. Following this, they were

exposed to a stressor, which involved their

being videotaped while trying to solve a dif-

ficult puzzle. Children who had been given

the differing ABM procedures exhibited dis-

crepant emotional reactivity to this stressor.

Those who had received the attend- negative

ABM experienced a pronounced elevation

of negative emotion following exposure to

the stressor, relative to a prestressor base-

line mood measure. In contrast, children

who had received the avoid- negative ABM

showed no elevation of negative emotion

in response to the stressor. Thus, altering

attentional responding to negative informa-

tion influenced the regulation of the emo-

tional reactions to stress exhibited by the

children. In addition to confirming the role

of attentional selectivity in childhood emo-

tion regulation, these findings highlight the

potential value of ABM as a technique for

enhancing such regulation in children with

dysfunctional emotional symptomatology.

More recently, two published randomized

controlled trials further strengthen the con-

clusion that improving emotion regulation

through direct modification of attentional

selectivity can therapeutically alleviate dys-

functional emotional experience in anxious

children. The first of these was carried out

by Bar-Haim, Morag, and Glickman (2011)

on a sample of 10-year-old children who

scored high on a questionnaire instrument

screening for childhood emotional disor-

Regulation of Emotion through Modification of Attention 519

ders. These children were randomly assigned

to receive either a probe-based ABM avoid-

threat training, or a control version of the

task containing no training contingency, on

two occasions separated by 4–6 days. Pre-

training attentional bias was assessed prior

to the first ABM session, while posttrain-

ing attentional bias was assessed 5–8 days

after the second ABM session. At this latter

assessment point, participants were exposed

to the puzzle stressor employed by Eldar et

al. (2008) to ascertain whether ABM influ-

enced regulation of their emotional reactivity

to stress. The avoid- negative ABM training

changed attentional selectivity as intended,

with the children who received this train-

ing displaying reduced attention to negative

information compared to control children.

It also enhanced emotion regulation dur-

ing performance of the stressor task. While

children in the control condition displayed a

significant elevation of negative emotion in

response to the final stressor, no elevation of

negative affect was elicited by this stressor in

children who had undergone avoid- negative

ABM training. Hence, despite their initially

high levels of emotional vulnerability, these

children became more resilient to stress

when they acquired the ability to attention-

ally avoid- negative information, indicat-

ing that this style of attentional selectivity

improves emotion regulation in younger

populations also.

Eldar et al. (2012) recently conducted

the first randomized controlled trial evalu-

ating the impact of ABM on children with

formally diagnosed pediatric emotional dis-

orders. Their sample comprised treatment-

seeking children, ages 8–14 years, recruited

from a hospital- based child anxiety clinic.

All met diagnostic criteria for at least one

anxiety disorder (i.e., separation anxiety

disorder, social phobia, specific phobia, or

GAD), with 75% meeting diagnostic criteria

for more than one such disorder. These clini-

cally anxious children received four weekly

sessions of either probe-based ABM in the

avoid- negative condition or a control ver-

sion of the task containing no training con-

tingency. Children who received the avoid-

negative ABM, but not those who received

the control condition, demonstrated a sig-

nificant decline in both the number of anxi-

ety symptoms recorded at clinical interview

and the rated severity of these symptoms.

Well over twice as many of children who

received avoid- negative ABM, as those who

received the control condition, showed full

remission. Specifically, 33.3% no longer met

diagnostic criteria for any anxiety disorder

after receiving the 4 weeks of avoid- negative

ABM, compared to only 13.3% of those in

the control condition. Hence, for children

who suffer from emotional dysfunction,

as for adults, modification of attentional

selectivity to increase avoidance of negative

information serves to improve emotion regu-

lation, as evidenced by the significant reduc-

tion of dysfunctional emotional experience.

Future Directions for ABM

Approaches to Emotion Regulation

The studies reviewed in this chapter have

demonstrated that ABM procedures can

serve to attenuate dysfunctional emotional

symptoms. It may seem paradoxical that

ABM-induced attentional avoidance of

negative information can be therapeutically

beneficial given that many models implicate

avoidance in the etiology of psychopathol-

ogy. However, such accounts often pertain

to behavioral rather than to cognitive avoid-

ance (see Barlow, 2002). Furthermore, with

respect to cognitive avoidance, it is impor-

tant to distinguish effortful attempts to

suppress negative thoughts from the type

of attentional avoidance induced by ABM.

The former appears to be emotionally coun-

terproductive, probably because effortful

thought suppression commonly fails to pro-

duce the intended pattern of cognitive avoid-

ance and can instead paradoxically increase

the very thoughts one tries to suppress (Weg-

ner, Schneider, Carter, & White, 1987).

In contrast, ABM procedures designed to

reduce attention to negative information

without effort or intention have proven suc-

cessful in inducing attentional avoidance

of such information, with consequent emo-

tional benefits.

The conclusion that ABM procedures

can effectively modify attentional response

to negative information and therapeutically

alleviate dysfunctional emotion has been

bolstered by the outcomes of recent meta-

analyses. One such meta- analysis by Hal-

lion and Ruscio (2011), which did not distin-

guish between bias modification procedures

520 INTERVENTIONS

designed to alter attentional vs. interpretive

selectivity, revealed that cognitive bias mod-

ification exerts a medium- size effect on both

cognitive bias (g = 0.49) and clinical symp-

tomatology (g = 0.39). Other meta- analyses

that have focused specifically on the modifi-

cation of attentional bias (Hakamata et al.,

2010; Beard, Sawyer, & Hofmann, 2012)

have concluded that ABM exerts a large

effect on attention bias (g = 1.06–1.15), and

a medium- to-large effect on clinical symp-

tomatology (g = 0.48–0.77). Meta- analysis

also has identified some clinically relevant

variables that may moderate the magni-

tude of both effects. For example, Beard et

al. report that ABM alters attentional bias

to the greatest degree in participants who

show highest initial levels of negative emo-

tional symptomatology. Bias modification

appears to influence anxiety more than

depression (Hallion & Ruscio, 2011). Haka-

mata et al. (2010) found that ABM has a

greater impact on anxious disposition than

on anxious mood state per se, and that this

emotional impact is nominally greater in

anxiety patients than in nonclinical partici-

pants. This overall pattern lends weight to

the potential value of ABM in the treatment

of emotional dysfunction, particularly in the

case of anxiety disorders.

Having established that attentional avoid-

ance of negative information can success-

fully be induced by ABM procedures, and

serves to increase emotional resilience and

alleviate dysfunction emotional experience,

future research can now build on this firm

foundation in a number of important ways.

We close this chapter by considering several

directions that we believe will prove to be

particularly profitable.

Improving ABM Techniques to Better

Enhance Emotion Regulation

The degree to which emotion is influenced

by ABM procedures is largely determined

by the extent of change in negative atten-

tional bias that they induce (Hakamata

et al., 2010). Therefore, an obvious way

potentially to increase the beneficial impact

of ABM techniques on emotion regulation

will be to improve their capacity to modify

selective attentional responding to nega-

tive information. This endeavor will likely

involve the future development of new CBM

procedures, in ways guided by deeper under-

standing of the mechanisms through which

existing ABM tasks exert their influence.

Additionally, the capacity of existing ABM

tasks to modify attentional selectivity effec-

tively may be further enhanced by refining

the manner in which they are delivered. We

briefly consider, in turn, each of these poten-

tial approaches to the future improvement of

ABM techniques.

One important issue will be to establish

whether ABM tasks exert a highly specific

effect on attentional bias alone, or whether

their emotional benefits reflect change in

more general cognitive control systems, such

as working memory. Consistent with this lat-

ter possibility, Hirsch, Hayes, and Mathews

(2009) reported that their cognitive bias

modification procedure not only reduced the

selective process of negative information but

also improved working memory. Klumpp

and Amir (2010) argued, on the basis of

their findings, that the impact of ABM tasks

on attentional bias may be mediated by a

general improvement in cognitive control.

Whether any such training induces improve-

ment in working memory, directly influences

emotion regulation, or instead facilitates

adaptive change in attentional bias, must

be determined by future research. However,

such considerations suggest that develop-

ing ABM tasks in ways that maximize their

capacity to improve working memory, or

perhaps supplementing the delivery of ABM

tasks with training procedures designed to

directly improve working memory (Owens,

Koster, & Derakshan, 2013), may augment

their capacity to enhance emotion regula-

tion.

The refinement of ABM procedures also

will likely benefit from better understanding

of the particular juncture(s) in the emotion

regulation continuum where ABM exerts

its effect(s). Gross and Thompson (2007)

propose that the influence of selective atten-

tional deployment on emotion regulation

occurs at the emotion generation stage. The

finding that ABM influences emotional

reactivity to stressors is consistent with the

possibility that it affects the generation of

negative emotion. However, ABM also may

exert an influence subsequent to initial emo-

tion generation, at the response- focused

stage of emotional regulation, by operat-

ing to prolong or curtail negative emotional

Regulation of Emotion through Modification of Attention 521

experience. This, too, could contribute to

its observed impact on emotional reactiv-

ity measures, which typically involve the

assessment of emotional experience at least

several minutes after commencing exposure

to an emotion- generating stressor. Indeed,

it may be that modifying certain aspects of

attentional selectivity, such as initial atten-

tional engagement with negative informa-

tion, could influence the emotion- generation

stage, while modifying other aspects of

attentional selectivity, such as the degree

to which negative information holds atten-

tion over time, instead could influence the

longevity of generated emotions (Hirsch

et al., 2011). Determining where alterna-

tive ABM variants exert their influence on

emotion regulation will require fine- grained

assessment of the temporal dynamics of the

resulting change in emotional experience,

and physiological measures such as GSR

and heart rate variability may prove useful

in this regard. Future research of this type

could potentially lead to the development of

new ABM batteries designed either to exert

a broader influence across multiple stages of

emotion regulation or selectively target par-

ticular stages of emotional regulation, per-

haps in an individually tailored manner.

While the creation of new of attentional

training procedures, guided by better under-

standing of the mechanisms through which

ABM influences emotion regulation, will

likely contribute to future progress, it also

seems probable that the efficacy of existing

ABM tasks could be improved by identify-

ing the most effective delivery formats. Most

obviously, increasing the number and length

of ABM sessions may amplify the resulting

attentional change, and it has been suggested

that such change may be more enduring if

ABM sessions are widely distributed across

time rather than grouped in close tempo-

ral proximity (Hertel & Mathews, 2011).

Another interesting possibility is that the

impact of ABM procedures on attentional

bias may be affected by nature of instruc-

tions given to participants. Researchers

commonly have assumed that ABM alters

attention implicitly, and so typically have

not explicitly communicated either the train-

ing contingency or intention to participants

(MacLeod & Mathews, 2012). Consistent

with this assumption, participants often

are unable to subsequently report the train-

ing contingency, or to identify the training

condition to which they have been exposed

(Beard, 2011). However, this represents only

weak evidence that ABM influences atten-

tional selectivity implicitly. Furthermore,

even if attentional change is trained implic-

itly by existing ABM approaches, the pos-

sibility remains that explicit training may

more effectively induce therapeutic change

in attentional bias. Hence, we suggest that

future investigators should empirically con-

trast the impact of implicit and explicit ver-

sions of ABM, which differ with respect

to whether they provide participants train-

ing contingency information and directly

instruct practice in the target pattern of

attentional selectivity. Future research of

this type will identify which approach yields

the greatest emotional benefit, and in doing

so will also illuminate whether implicit or

explicit attentional change more strongly

governs the impact of ABM on emotional

regulation.

Enhancing the power of ABM procedures

must involve not only increasing the size

and longevity of the attentional effects they

evoke but also ensuring good generalization

of this training. Generalization is revealed

by the transfer of training effects beyond

the original training task. A distinction has

been drawn between “far- transfer” and

“near- transfer” where, respectively, train-

ing effects are observed under conditions

that differ either greatly, or only slightly,

from the initial training experience (Her-

tel & Mathews, 2011). Most ABM studies

have confirmed near- transfer of training by

showing that the attentional impact of ABM

can be detected on new stimulus materi-

als not employed in the training task (e.g.,

MacLeod et al., 2002; Hirsch et al., 2011).

However, the practical value of ABM clearly

depends on also ensuring the far- transfer of

training. Given that the effect of ABM can be

detected on emotional assessment tasks very

different in nature from the original training

procedures, it seems clear such far- transfer

can occur (MacLeod & Mathews, 2012).

Further evidence of far- transfer comes from

studies demonstrating that ABM-induced

training effects can be detected across quite

different measures of attentional selectivity

(e.g., Dandeneau & Baldwin, 2004), and

also on measures of interpretive selectivity

(e.g., White, Suway, Pine, Bar-Haim, & Fox,

522 INTERVENTIONS

2011). Nevertheless, occasional transfer fail-

ures (e.g., Bockstaele, Koster, Verschuere,

Crombez, & De Houwer, 2012) underscore

the importance of identifying how best to

optimize far- transfer. It has been proposed

that the prospect of ABM training generaliz-

ing to new contexts and to new tasks might

best be ensured by delivering ABM training

sessions across a variety of differing con-

texts, and varying the task procedures and

parameters employed within them to induce

attentional change (MacLeod, Koster, &

Fox, 2009). As yet, this proposal has not

been formally tested, so it remains to be seen

whether these innovations would indeed

increase such generalization.

While the purpose of ABM in clinical

studies conducted to date has been to induce

general attentional avoidance of negative

information, such a pattern of selectivity

may not be optimal across all contexts. For

example, there will likely be advantages

associated with attending to threat cues in

situations where the risk of genuine danger

is high. Maximal well-being may result from

attentional vigilance to negative informa-

tion in high-risk contexts, and attentional

avoidance of such information in low-risk

contexts. It would therefore be appropriate

for future researchers to investigate whether

ABM can be delivered in ways that induce

situation- specific patterns of attentional

selectivity, such that the optimal attentional

response to negative information becomes

operational within each of these differing

types of context. While undoubtedly ambi-

tious, the viability of this objective is sup-

ported by recent demonstrations that when

alternative patterns of implicit processing

each are trained within a differing situa-

tional context, reinstatement of either train-

ing context favors expression of the spe-

cific pattern of cognition originally trained

within that same context (e.g., D’Angelo,

Milliken, Jimenez, & Lupianez, 2013).

Extending the Application of ABM

to Other Forms of Self‑Regulation

Because this review describes research moti-

vated by the hypothesis that attentional bias

to negative information underpins emo-

tional vulnerability and dysfunction, the

focus has been on ABM procedures designed

specifically to modify attentional response

to negative information. However, the ABM

approach could potentially be employed to

enhance other forms of self- regulation that

plausibly are affected by attentional selec-

tivity. For example, the hypothesis that

heightened positive affectivity reflects an

attentional bias toward positive information

(Taylor, Bomyea, & Amir, 2011), suggests

that ABM designed to modify attentional

responding to positive information could

influence positive emotional reactivity to

happy events. Grafton, Ang, and MacLeod

(2012) recently confirmed this by demon-

strating that participants exposed to an

ABM procedure that increased attention to

positive words, compared to those given an

ABM procedure that reduced attention to

such words, displayed disproportionately

intense positive emotional reactions to a

subsequent success experience.

The potential therapeutic benefits of

ABM need not be restricted to the regula-

tion of emotional experience. In many types

of psychological dysfunction that involve

biased patterns of attentional selectivity, the

primary symptom that could benefit from

better regulation is not emotion. There is

growing evidence that ABM procedures may

prove beneficial in enhancing these other

clinically relevant aspects of self- regulation.

For example, people with chronic pain syn-

drome display an attentional bias toward

pain- related information, and theorists con-

tend that this pattern of attentional selectiv-

ity makes a functional contribution to their

heightened perceptions of pain (Eccleston

& Crombez, 1999). A long- standing aim

of psychological interventions for this con-

dition has been to enhance self- regulation

of pain sensation. Recent work examining

whether ABM can contribute to the regula-

tion of pain experience has yielded promis-

ing outcomes. For example, Sharpe et al.

(2010) gave participants either a conven-

tional relaxation manipulation or a probe-

based ABM procedure designed to induce

attentional avoidance of pain- related infor-

mation, before exposing them to a cold

pressor task designed to induce painful sen-

sation. Those who received the attentional

training reported later onset of pain than did

those given the relaxation procedure. Such

findings should encourage future research-

Regulation of Emotion through Modification of Attention 523

ers to investigate whether the use of ABM

to directly manipulate selective attentional

responding to pain- relevant information can

enhance the regulation of pain sensation in

ways that yield therapeutic benefits for peo-

ple who suffer from this clinical condition.

Another clinical disorder that involves

impaired self- regulation, but in which nega-

tive emotional experience is incidental to the

symptoms of primary concern, is substance

dependency. Addictions are characterized

by biased patterns of attentional selectivity

that favor information related to the abused

substance, and theorists contend that this

bias contributes to associated craving and

consumption (Wiers et al., 2007). This has

led some investigators to examine whether

ABM variants designed to reduce attention

to such information can serve to attenu-

ate craving and/or regulate consumption,

and positive findings have been reported

for both tobacco dependency and alcohol

abuse. After exposure to a single- session

of probe-based ABM, configured to either

increase or decrease attention to smoking

cues, Attwood, O’Sullivan, Leonards, Mack-

intosh, and Munafo (2008) found that male

smokers in the latter group reported reduced

craving for tobacco, and this reduction in

craving was predicted by the magnitude of

the induced attention change. Fadardi and

Cox (2009) gave a sample of problem drink-

ers four weekly sessions of ABM, configured

to reduce attention to alcohol- related infor-

mation. This successfully modified atten-

tional selectivity as intended and led also to

a significant decline in alcohol consumption,

which was maintained at 3-month follow- up.

Thus, it would appear that the modifica-

tion of attentional bias carries the potential

to enhance other forms of self- regulation,

beyond the direct regulation of emotional

experience, so future research could prof-

itably seek to extend the application of the

ABM approach across a wider range of such

conditions. Of course, given that distressing

conditions such as chronic pain and sub-

stance dependency contribute to negative

emotional experience, ABM procedures that

increase the capacity to regulate pain, addic-

tive symptomatology, and other maladaptive

aspects of experience and behavior also will

likely indirectly benefit emotion regulation

itself.

Refining the Clinical Utility of ABM

in the Remediation of Dysfunctional

Emotion Regulation

Given the wealth of evidence that supports

the capacity of ABM approaches to influ-

ence emotion regulation beneficially, it is

no surprise that investigators now are seek-

ing to exploit its therapeutic potential in

the treatment of emotional dysfunction and

other psychological disorders that involve

deficient self- regulation. This approach now

has passed the proof-of- concept stage as a

viable means of therapeutically attenuating

clinically relevant symptoms, warranting

its further development as a practical tool

that can be employed in the clinical setting.

Already, several small-scale studies have

confirmed that ABM configured to induce

attentional avoidance of negative informa-

tion can be employed effectively within con-

ventional psychology clinics to treat patients

suffering from anxiety disorders and/or clin-

ical depression (Brosan, Hoppitt, Shelfer,

Sillence, & Mackintosh, 2011; Beard, Weis-

berg, & Amir, 2011).

The more widespread adoption of ABM

within the clinical setting will partly depend

upon patients’ perceived acceptability of the

approach. Hence, it is reassuring that patient

feedback has generally been favorable. Fol-

lowing delivery of their 12-session ABM

program to socially anxious 10- to 17-year-

olds, Rozenman, Weersing, and Amir (2011)

had recipients and their parents rate the

acceptability of this intervention procedure.

Responses ranged from acceptable to excel-

lent, with mean participant and parent rat-

ings of 4.2 and 4.5, respectively, on a 5-point

scale. Beard (2011) likewise reported that

primary care patients receiving ABM were

generally quite satisfied with the procedure

on average, rating its acceptability at level 3

on 4-point scale. Beard also noted that drop-

out rates from treatment trials delivering

such bias modification have typically been

low, ranging from 0 to 8%, suggesting that

recipients find the procedures acceptable.

Nevertheless, qualitative interviews car-

ried out by Beard and her colleagues (2011)

revealed that some recipients experience

ABM as overly repetitive. Hence, one type

of refinement to ABM that may increase

patient acceptability could involve the intro-

524 INTERVENTIONS

duction of features that sustain interest and

motivation. For example, this might involve

delivering ABM in shorter blocks and pro-

viding performance feedback, so that par-

ticipants can strive to improve across blocks.

Beard (2011) also reports that some patients

express a desire to better understand how

ABM could help with their emotional dif-

ficulties. Therefore, another refinement that

might enhance patient acceptance would be

provision of a rationale that communicates

how this procedure can contribute to the

regulation of negative emotion.

One feature of ABM that Beard’s inter-

view data (2011) identified as being partic-

ularly highly valued by patients is the flex-

ibility and convenience with which it can be

accessed by recipients, due to its computer-

based method of delivery. Recent years have

witnessed the growing use of computer tech-

nology to facilitate the transport of conven-

tional psychological interventions into the

community (Marks & Cavanagh, 2009).

Given its amenability to Internet delivery

(e.g., See et al., 2009), ABM could readily be

integrated into such forms of intervention.

Remotely accessed computerized treatments

that include ABM components already are

beginning emerge. For example, Amir and

Taylor (2012) recently evaluated the effi-

cacy of a home-based treatment that pro-

vided treatment- seeking GAD patients with

both ABM and computerized cognitive-

behavioral therapy (CBT), accessed online

as often as desired across a 6-week period.

Patients who completed this intervention

evidenced reduced attention to negative

information and displayed significant reduc-

tions in both self- reported and clinician-

rated symptoms of anxiety, worry, and

depression. Symptom change was related

to the magnitude of the observed reduction

in attentional bias. At completion of the

6-week intervention, 79% of participants no

longer met diagnostic criteria for GAD. This

study was not designed to distinguish the

contributions made by the CBT and ABM

components of the online package. It will be

important for future investigators to directly

compare the efficacy of CBT and ABM pro-

cedures, and also to determine whether the

combination of these two types of cognitive

intervention can deliver greater therapeutic

benefit than does either approach alone.

Nevertheless, we agree with Amir and Tay-

lor that the incorporation of ABM into com-

puterized, home-based treatments for emo-

tional dysfunction, represents a promising

future method of effectively exploiting its

demonstrated capacity to enhance emotion

regulation.

Closing Comments

The use of ABM procedures to test hypoth-

eses concerning the contributions of atten-

tional selectivity to emotion regulation and

therapeutically enhance such regulation in

people experiencing emotional dysfunction

is still a young area of research. Well over

70% of all the research published in this

field has appeared only within the past 3 or

4 years (MacLeod & Mathews, 2012). Nev-

ertheless, this early work already has clearly

established that biased attentional respond-

ing to negative information does causally

contribute to emotion regulation, affecting

emotional reactivity to stress and influenc-

ing the symptoms of emotional dysfunction.

The research reviewed in this chapter also

has convincingly demonstrated that the use

of ABM procedures to reduce attention to

negative information can improve emotion

regulation. Inducing such attention change

serves to attenuate the degree to which

stress elicits dysphoric emotional responses

and also to alleviate the negative emo-

tional symptoms associated with subclini-

cal or clinical manifestations of emotional

pathology. By drawing upon increasingly

sophisticated contemporary approaches to

attentional bias assessment, designed to

assess progressively more precise dimen-

sions of attention, it should be possible to

develop novel training variants that target

highly specific aspects of selective attention

for modification. Hence, we anticipate that

future ABM research will illuminate the

ways in which particular facets of attention

selectivity functionally contribute to differ-

ent features of emotion regulation. Further-

more, if these evolving ABM technologies

become more widely embedded in the types

of computerized treatment programs now

being used to deliver psychological inter-

ventions, we also can expect that they will

make a growing future contribution to the

effective remediation of emotional dysfunc-

tion.

Regulation of Emotion through Modification of Attention 525

Acknowledgments

Preparation of this chapter was supported

by Australian Research Council Grant No.

DP0879589, and by a grant from the Roma-

nian National Authority for Scientific Research,

CNCS–UEFISCDI, Project No. PNII-ID-

PCCE-2011-2-0045.

References

Amir, N., Beard, C., Burns, M., & Bomyea, J.

(2009). Attention modification program in

individuals with generalized anxiety disor-

der. Journal of Abnormal Psychology, 118(1),

28–33.

Amir, N., Beard, C., Taylor, C. T., Klumpp, H.,

Elias, J., Burns, M., et al. (2009). Attention

training in individuals with generalized social

phobia: A randomized controlled trial. Jour-

nal of Consulting and Clinical Psychology,

77(5), 961–973.

Amir, N., Weber, G., Beard, C., Bomyea, J., &

Taylor, C. T. (2008). The effect of a single-

session attention modification program on

response to a public- speaking challenge

in socially anxious individuals. Journal of

Abnormal Psychology, 117(4), 860–868.

Amir, T., & Taylor, C. (2012). Combining com-

puterized home-based treatments for gener-

alized anxiety disorder: An attention modi-

fication program and cognitive behavioral

therapy. Behavior Therapy, 43, 546–559.

Ashley, V., & Swick, D. (2009). Consequences of

emotional stimuli: Age differences on pure and

mixed blocks of the emotional Stroop. Behav-

ioral and Brain Functions, 5(14).

Attwood, A. S., O’Sullivan, H., Leonards, U.,

Mackintosh, B., & Munafo, M. R. (2008).

Attentional bias training and cue reactivity in

cigarette smokers. Addiction, 103(11), 1875–

1882.

Baert, S., De Raedt, R., Schacht, R., & Koster, E.

H. (2010). Attentional bias training in depres-

sion: Therapeutic effects depend on depression

severity. Journal of Behavior Therapy and

Experimental Psychiatry, 41(3), 265–274.

Bar-Haim, Y. (2010). Attention bias modifica-

tion (ADM): A novel treatment for anxiety

disorders. Journal of Child Psychology and

Psychiatry, 51(8), 859–870.

Bar-Haim, Y., Lamy, D., Pergamin, L.,

Bakermans- Kranenburg, M. J., & van IJzen-

doorn, M. H. (2007). Threat- related atten-

tional bias in anxious and nonanxious indi-

viduals: A meta- analytic study. Psychological

Bulletin, 133, 1–24.

Bar-Haim, Y., Morag, I., & Glickman, S. (2011).

Training anxious children to disengage atten-

tion from threat: A randomized controlled

trial. Journal of Child Psychology and Psy-

chiatry, 52(8), 861–869.

Barlow, D. (2002). Anxiety and its disorders:

The nature and treatment of anxiety and

panic (2nd ed.). New York: Guilford Press.

Beard, C. (2011). Cognitive bias modification as

a treatment for anxiety: Current evidence and

future directions. Expert Review of Neuro-

therapeutics, 11(2), 299–311.

Beard, C., Sawyer, A., & Hofmann, S. (2012).

Efficacy of attention bias modification using

threat and appetitive stimuli: A meta- analytic

review. Behavior Therapy, 43, 724–740.

Beard, C., Weisberg, R. B., & Amir, N. (2011).

Combined cognitive bias modification treat-

ment for social anxiety disorder: A pilot trial.

Depression and Anxiety, 28(11), 981–988.

Bockstaele, V., Koster, E., Verschuere, B., Crom-

bez, G., & de Houwer, J. (2012). Limited

transfer of threat bias following attentional

retraining. Journal of Behavior Therapy and

Experimental Psychiatry, 43, 794–800.

Bockstaele, V., Verschuere, B., Koster, E. H.,

Tibboel, H., De Houwer, J., & Crombez, G.

(2011). Journal of Behavioral Therapy and

Experimental Psychiatry, 42(2), 211–218.

Bradley, B. P., Mogg, K., White, J., Groom, C.,

& de Bono, J. (1999). Attentional bias for

emotional faces in generalized anxiety disor-

der. British Journal of Clinical Psychology,

38, 267–278.

Brosan, L., Hoppitt, L., Shelfer, L., Sillence, A., &

Mackintosh, B. (2011). Cognitive bias modifi-

cation for attention and interpretation reduces

trait and state anxiety in anxious patients

referred to an out- patient service: Results from

a pilot study. Journal of Behavior Therapy and

Experimental Psychiatry, 42(3), 258–264.

Browning, M., Holmes, E. A., Murphy, S. E.,

Goodwin, G. M., & Harmer, C. J. (2010).

Lateral prefrontal cortex mediates the cogni-

tive modification of attentional bias. Biologi-

cal Psychiatry, 67(10), 919–925.

Carlbring, P., Apelstrand, M., Sehlin, H., Amir,

A., Rousseau, A., Hofmann, et al. (2012).

Internet- delivered attention bias modifiction

training in individuals with social anxiety

disorder: A double blind randomized control

trial. BMC Psychatry, 12, 66.

526 INTERVENTIONS

Cisler, J., & Koster, E. H. (2010). Mechanisms

of attentional biases towards threat in anxiety

disorders: An integrative review. Clinical Psy-

chology Review, 30, 203–216.

Dandeneau, S. D., & Baldwin, M. W. (2004).

The inhibition of socially rejecting informa-

tion among people with high versus low self-

esteem: The role of attentional bias and the

effects of bias reduction training. Journal of

Social and Clinical Psychology, 23(4), 584–

602.

Dandeneau, S. D., & Baldwin, M. W. (2009).

The buffering effects of rejection- inhibiting

attentional training on social and performance

threat among adult students. Contemporary

Educational Psychology, 34(1), 42–50.

Dandeneau, S. D., Baldwin, M. W., Baccus, J. R.,

Sakellaropoulo, M., & Pruessner, J. C. (2007).

Cutting stress off at the pass: Reducing vigi-

lance and responsiveness to social threat by

manipulating attention. Journal of Personality

and Social Psychology, 93(4), 651–666.

D’Angelo, M., Milliken, B., Jimenez, L., & Lupi-

anez, J. (2013). Implementing flexibility in

automaticity: Evidence from context- specific

implicit sequence learning. Consciousness and

Cognition, 22(1), 64–81.

Derryberry, D., & Reed, M. A. (2002). Anxiety-

related attentional biases and their regulation

by attentional control. Journal of Abnormal

Psychology, 111(2), 225–236.

Eccleston, C., & Crombez, G. (1999). Pain

demands attention: A cognitive- affective

model of the interruptive function of pain.

Psychological Bulletin, 125(3), 356–366.

Eldar, S., Apter, A., Lotan, D., Edgar, K. P.,

Naim, R., Fox, N. A., & Bar-Haim, Y. (2012).

Attention bias modification treatment for

pediatric anxiety disorders: A randomized

controlled trial. American Journal of Psychia-

try, 169, 213–220.

Eldar, S., & Bar-Haim, Y. (2010). Neural plastic-

ity in response to attention training in anxiety.

Psychological Medicine, 40(4), 667–677.

Eldar, S., Ricon, T., & Bar-Haim, Y. (2008).

Plasticity in attention: Implications for stress

response in children. Behaviour Research and

Therapy, 46(4), 450–461.

Fadardi, J. S., & Cox, W. M. (2009). Reversing

the sequence: Reducing alcohol consumption

by overcoming alcohol attentional bias. Drug

and Alcohol Dependence, 101(3), 137–145.

Grafton, B., Ang, C., & MacLeod, C. (2012).

Always look on the bright side of life: The

attentional basis of positive affectivity. Euro-

pean Journal of Personality, 26, 133–144.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J., & Barrett, L. F. (2011). Emotion

generation and emotion regulation: One or

two depends on your point of view. Emotion

Review, 3, 8–16.

Gross, J. J., & Thompson, R. A. (2007). Emotion

regulation: Conceptual foundations. In J. J.

Gross (Ed.), Handbook of emotion regulation

(pp. 3–24). New York: Guilford Press.

Hakamata, Y., Lissek, S., Bar-Haim, Y., Brit-

ton, J. C., Fox, N. A., Leibenluft, E., et al.

(2010). Attention bias modification treatment:

A meta- analysis toward the establishment of

novel treatment for anxiety. Biological Psy-

chiatry, 68(11), 982–990.

Hallion, L., & Ruscio, A. (2011). A meta- analysis

of the effect of cognitive bias modification on

anxiety and depression. Psychological Bulle-

tin, 6, 940–958.

Hayes, S., Hirsch, C. R., & Mathews, A. (2010).

Facilitating a benign attentional bias reduces

negative thought intrusions. Journal of Abnor-

mal Psychology, 119(1), 235–240.

Hazen, R. A., Vasey, M. W., & Schmidt, N. B.

(2009). Attentional retraining: A randomized

clinical trial for pathological worry. Journal of

Psychiatric Research, 43(6), 627–633.

Heeren, A., Lievens, L., & Philippot, P. (2011).

How does attention training work in social

phobia: Disengagement from threat or re-

engagement to non- threat? Journal of Anxiety

Disorders, 25, 1108–1115.

Heeren, A., Reese, H. E., McNally, R. J., &

Philippot, P. (2012). Attention training toward

and away from threat in social phobia: Effects

on subjective, behavioral, and physiological

measures of anxiety. Behaviour Research and

Therapy, 50, 30–39.

Hertel, P. T., & Mathews, A. (2011). Cognitive

bias modification: Past, perspective, current

findings, and future applications. Perspectives

in Psychological Science, 6(6), 521–536.

Hirsch, C., Hayes, S., & Mathews, A. (2009).

Looking on the bright side: Accessing benign

meanings reduces worry. Journal of Abnormal

Psychology, 118, 44–54.

Hirsch, C., MacLeod, C., Mathews, A., Sandher,

O., Siyani, A., & Hayes, S. (2011). The con-

tribution of attentional bias to worry: Distin-

guishing the roles of selective engagement and

Regulation of Emotion through Modification of Attention 527

disengagement. Journal of Anxiety Disorders,

25, 272–277.

Julian, K., Beard, C., Schmidt, N. B., Powers, M.

B., & Smits, J. A. J. (2012). Attention train-

ing to reduce attention bias and social stressor

reactivity: An attempt to replicate and extend

previous findings. Behavior Research and

Therapy, 50, 350–358.

Klumpp, H., & Amir, N. (2010). Preliminary

study of attention training to threat and neu-

tral faces on anxious reactivity to a social

stressor in social anxiety. Cognitive Therapy

and Research, 34, 263–271.

Kring, A. M., & Werner, K. H. (2004). Emotion

regulation and psychopathology. In P. Philip-

pot & R. S. Feldman (Eds.), The regulation of

emotion (pp. 359–385). Oxford, UK: Psychol-

ogy Press.

Leclerc, C. M., & Kensinger, E. A. (2008). Effects

of age on detection of emotional information.

Psychology and Aging, 23(1), 209–215.

Li, S., Tan, J., Qian, M., & Liu, X. (2008). Con-

tinual training of attentional bias in social

anxiety. Behaviour Research and Therapy,

46(8), 905–912.

MacLeod, C., & Bucks, R. S. (2011). Emotion

regulation and the cognitive- experimental

approach to emotional dysfunction. Emotion

Review, 3(1), 62–73.

MacLeod, C., Koster, E., & Fox, E. (2009).

Whither cognitive bias modification research?:

Commentary on the special section articles.

Journal of Abnormal Psychology, 118, 89–99.

MacLeod, C., & Mathews, A. (2012). Cogni-

tive bias modification approaches to anxiety.

Annual Review of Clinical Psychology, 8,

189–217.

MacLeod, C., Mathews, A., & Tata, P. (1986).

Attentional bias in emotional disorders. Jour-

nal of Abnormal Psychology, 95, 15–20.

MacLeod, C., Soong, L. Y., Rutherford, E. M.,

& Campbell, L. W. (2007). Internet- delivered

assessment and manipulation of anxiety-

linked attentional bias: Validation of a free-

access attentional probe software package.

Behavior Research Methods, 39, 533–538.

MacLeod, C., Rutherford, E., Campbell, L.,

Ebsworthy, G., & Holker, L. (2002). Selec-

tive attention and emotional vulnerability:

Assessing the causal basis of their association

through the experimental manipulation of

attentional bias. Journal of Abnormal Psy-

chology, 111, 107–123.

Mathews, A., & MacLeod, C. (2002). Induced

processing biases have causal effects on anxi-

ety. Cognition and Emotion, 16, 331–354.

Mathews, A., & MacLeod, C. (2005). Cognitive

vulnerability to emotional disorders. Annual

Review of Clinical Psychology, 1, 167–195.

Marks, I., & Cavanagh, K. (2009). Computer-

aided psychological treatments: Evolving

issues. Annual Review of Clinical Psychology,

5, 121–141.

Moses, E. B., & Barlow, D. H. (2006). A new

unified treatment approach for emotional

disorders based on emotion science. Current

Directions in Psychological Science, 15(3),

146–150.

Najmi, S., & Amir, N. (2010). The effect of

attention training on a behavioral test of con-

tamination fears in individuals with subclini-

cal obsessive– compulsive symptoms. Journal

of Abnormal Psychology, 119(1), 136–142.

Nisbett, R. E., & Wilson, T. D. (1977). Telling

more than we can know: Verbal reports on

mental processes. Psychological Review, 84,

231–259.

Owens, M., Koster, E., & Derakshan, N. (2013).

Improving attention control in dysphoria

through cognitive training: Transfer effects on

working memory capacity and filtering effi-

ciency. Psychophysiology, 50(3), 297–307.

Reese, H. E., McNally, R. J., Najmi, S., & Amir,

N. (2010). Attention training for reducing spi-

der fear in spider- fearful individuals. Journal

of Anxiety Disorders, 24, 1–8.

Richards, J. M., & Gross, J. J. (2006). Person-

ality and emotional memory: How regulat-

ing emotion impairs memory for emotional

events. Journal of Research in Personality, 40,

631–651.

Rozenman, M., Weersing, V., & Amir, N. (2011).

A case series of attention modification in clini-

cally anxious youths. Behaviour Research and

Therapy, 49(5), 324–330.

Schmidt, N. B., Richey, J., Buckner, J. D., &

Timpano, K. R. (2009). Attention training for

generalized social anxiety disorder. Journal of

Abnormal Psychology, 118(1), 5–14.

See, J., MacLeod, C., & Bridle, R. (2009). The

reduction of anxiety vulnerability through the

modification of attentional bias: A real-world

study using a home-based cognitive bias modi-

fication procedure. Journal of Abnormal Psy-

chology, 118(1), 65–75.

Sharpe, L., Perry, K. N., Rodgers, P., Dear, B. F.,

Nicholas, M. K., & Refshauge, K. (2010). A

comparison of the effect of attentionl training

528 INTERVENTIONS

and relaxation responses to pain. Pain, 150(3),

469–476.

Taylor, C., Bomyea, J., & Amir, N. (2011). Mal-

leability of attentional bias for positive emo-

tional information and anxiety vulnerability.

Emotion, 11, 127–138.

Thompson, R. A., & Goodman, M. (2010).

Development of emotion regulation: More

than meets the eye. In A. Kring & D. Sloan

(Eds.), Emotion regulation and psychopathol-

ogy (pp. 38–58). New York: Guilford Press.

Troy, A. S., & Mauss, I. B. (2011). Resilience in

the face of stress: Emotion regulation as a pro-

tective factor. In S. M. Southwick, B. T. Litz,

D. Charney, & M. J. Friedman (Eds.), Resil-

ience and mental health: Challenges across the

lifespan (pp. 30–44). New York: Cambridge

University Press.

Wadlinger, H. A., & Isaacowitz, D. M. (2008).

Looking happy: The experimental manipula-

tion of a positive visual attention bias. Emo-

tion, 8(1), 121–126.

Wegner, D. M., Schneider, D. J., Carter S. R.,

& White, T. L. (1987). Paradoxical effects of

thought suppression. Journal of Personality

and Social Psychology, 53, 5–13.

Wells, T. T., & Beevers, C. G. (2010). Biased

attention and dysphoria: Manipulating selec-

tive attention reduces subsequent depressive

symptoms. Cognition and Emotion, 24(4),

719–728.

Werner, K., & Gross, J. J. (2010). Emotion regu-

lation and psychopathology: A conceptual

framework. In A. Kring & D. Sloan (Eds.),

Emotion regulation and psychopathology

(pp. 13–37). New York: Guilford Press.

White, L. K., Helfinstein, S. M., Reeb-

Sutherland, B. C., Degnan, K. A., & Fox, N.

A. (2009). Role of attention in the regulation

of fear and anxiety. Developmental Neurosci-

ence, 31, 309–317.

White, L. K., Suway, J. G., Pine, D. S., Bar-Haim,

Y., & Fox, N. A. (2011). Cascading effects:

The influence of attention bias to threat on

the interpretation of ambiguous information.

Behaviour Research and Therapy, 49(4), 244–

251.

Wiers, R., Bartholow, B., van den Wildenberg,

E., Thush, C., Engels, R., Sher, K., et al.

(2007). Automatic and controlled processes

and the development of addictive behaviors

in adolescents: A review and a model. Phar-

macology Biochemistry and Behavior, 86(2),

263–283.

Williams, M. G., Mathews, A., & MacLeod, C.

(1996). The emotional Stroop task and psy-

chopathology. Psychological Bulletin, 120(1),

3–24.

529

Deficits in emotion regulation skills are

a putative risk and maintaining factor in

various forms of psychopathology (Berking

& Wupperman, 2012; Hofmann, Sawyer,

Fang, & Asnaani, 2012; Werner & Gross,

2010). The defining criteria for many disor-

ders listed in the Diagnostic and Statistical

Manual of Mental Disorders (DSM-5; Amer-

ican Psychiatric Association, 2013) include

undesired emotions, such as sadness, anxi-

ety, or anger, that exceed the intensity and/

or duration of what is considered adaptive.

For other disorders, core symptoms can be

conceptualized as dysfunctional attempts to

avoid or down- regulate undesired emotions.

For example, bingeing in eating disorders

and substance use in alcohol dependence are

often seen as dysfunctional attempts to cope

with states of sadness, anger, boredom, or

other forms of emotional anguish (Berking

et al., 2011; Dingemans, Martijn, Jansen, &

Furth, 2009).

In a similar fashion, the development and

maintenance of depressive thinking can be

conceptualized as dysfunctional emotion

regulation. Appraising a situation as aver-

sive, uncontrollable, and unlikely to change

over time (Teasdale & Barnard, 1993) may

help to reduce the pressure actively to solve

personal problems (because working on

unattainable goals would be pointless) and

provide protection against hurtful disap-

pointments (because hope is an antecedent

of disappointment). In a situation in which

an individual is under high pressure to solve

numerous problems but neither feels able to

do so nor to bear another disappointment, a

depressogenic type of thinking that reduces

the pressure associated with unsolved prob-

lems and/or the pain associated with unful-

filled hopes may become an irresistible temp-

tation. Giving in to this type of thinking may

result in a small and short-lived reduction of

negative affect. In turn, this type of thinking

is reinforced and more likely to occur again

in similar situations in the future. Eventu-

ally, this process may lead into a clinically

significant depression. Adaptive affect reg-

ulation skills present an alternative way of

coping with undesired affective states that

may prevent such depressogenic cognitive

processes or facilitate disengagement from

such processes (Berking & Whitley, 2013).

Given the increasing amount of evidence

favoring such theories across various men-

tal disorders, enhancing emotion regulation

skills can be considered a promising transdi-

agnostic treatment target (Berking, Wupper-

man, et al., 2008; Mennin & Fresco, 2009;

Moses & Barlow, 2006). Others have also

argued that undifferentiated stress responses

(Bogdan & Pizzagalli, 2006), negative mood

states (Van Rijsbergen, Bockting, Berk-

ing, Koeter, & Schene, 2012), motivational

CHAPTER 31

Affect Regulation Training

Matthias Berking

Jeanine Schwarz

530 INTERVENTIONS

impulses (Grawe, 2006), and even appraisal

processes, which are defined through a

strong intrinsic affective component (e.g.,

“feelings” of hopelessness; Gibb, Beevers,

Andover, & Holleran, 2006; Teasdale &

Barnard, 1993), constitute a serious health

risk when the individual is unable to cope

successfully with these phenomena. Based

on the feasibility of applying “emotion” reg-

ulation skills to these other affective states,

we propose that the same arguments that

indicate the importance of emotion regu-

lation skills also apply to undesired affec-

tive states in general (i.e., emotions, stress

responses, moods, and urges; Gross, this

volume). Thus, the potential of targeting

emotion regulation skills in treatment can be

hypothesized to generalize to affect regula-

tion skills in general.

Almost all psychotherapeutic treat-

ments implicitly or explicitly work to

improve affect regulation skills in one way

or another. However, in some treatments

(e.g., person- centered psychotherapy, psy-

chodynamic treatments) general emotion

regulation skills are not explicitly addressed

and directly targeted but are assumed to be

enhanced through the application of strat-

egies considered to stimulate the healing

process in general (e.g., personal growth,

self- understanding, insight into uncon-

scious motives). In other treatments, such as

cognitive- behavioral therapy (CBT), these

efforts often focus on affective states that

are thought to be strongly related to the cli-

ent’s symptoms. For example, clients suffer-

ing from anxiety are primarily taught skills

to cope successfully with anxiety. Although

patients are usually encouraged to apply the

acquired skills to other emotions, specific

attempts to (1) systematically train patients

to apply acquired coping skills in the context

of other challenging affective states or (2) to

teach and practice additional skills that are

not relevant in the context of anxiety but

are relevant for successful coping with other

undesired affective states (e.g., distraction

as a strategy to reduce anger; engagement in

positive activities to reduce dysphoric mood

and feelings of hopelessness) are rare. If these

additional undesired affective states are rel-

evant for the maintenance of the anxiety dis-

order, focusing only on anxiety- managing

skills may not be sufficient to solve the prob-

lem effectively. On such occasions (e.g., if

anger, dysphoric mood, and/or hopelessness

significantly reduce the client’s motivation

and capacity to confront feared stimuli and/

or to draw helpful conclusions from such

exercises or habituate to feared stimuli; e.g.,

Foa, Riggs, Massie, & Yarczower, 1995), a

systematic focus on general affect regulation

skills might be warranted.

Moreover, many patients suffer from more

than one mental disorder (Kessler, Chiu,

Demler, & Walters, 2005). Particularly in

highly comorbid patients, “transaffective”

deficits in adaptive coping skills (e.g., the

inability to accept various undesired affec-

tive states if they cannot be modified) might

be at the core of many of their problems. For

these patients, a systematic focus on affect

regulation skills in general might be a more

efficient way of treatment than a compila-

tion of various disorder- specific manuals.

Minimally, an additional focus on strength-

ening affect regulation skills in addition

to providing disorder- specific treatments

should be considered when there is evidence

that general affect regulation deficits have

contributed to various psychopathological

symptoms. Thus, there is a need for inter-

ventions focusing on general affect regula-

tion skills that may complement disorder-

focused interventions.

Treatments such as emotion regulation

therapy (ERT; Mennin & Fresco, this vol-

ume), the emotion regulation module used

in dialectic behavior therapy (DBT; Neacsiu,

Bohus, & Linehan, this volume), and some

mindfulness- based treatments (Farb, Ander-

son, Irving, & Segal, this volume; Wup-

perman et al., 2012) are based on a similar

conceptualization of mental disorders as

affect regulation training (ART) and, conse-

quently, also address affect regulation skills

in a more general fashion. The main differ-

ence between these treatments and ART is

that ART has from its beginning focused on

communalities across various mental disor-

ders with regard to deficits in general emo-

tion regulation skills. To improve such skills,

ART systematically integrates techniques

from various psychotherapeutic approaches,

such as CBT (e.g., Beck, 1995), compassion-

based therapy (Gilbert, 2011; Weissman &

Weissman, 1996), DBT (Neacsiu et al., this

volume), emotion- focused therapy (EFT;

Greenberg, 2004), ERT (Mennin & Fresco,

this volume), mindfulness- based interven-

Affect Regulation Training 531

tions (Farb et al., this volume), neuropsy-

chotherapeutic translational approaches

(Grawe, 2006), principles used in problem-

solving therapies (D’Zurilla & Nezu, 2010),

and strength- focused interventions (Duck-

worth, Steen, & Seligman, 2005; Grawe,

2002), into a highly standardized and trans-

diagnostically oriented training program.

This program can be utilized (1) as a stand-

alone intervention (when working with

patients suffering from less severe or sub-

threshold mental disorders, with individuals

at risk for developing mental health prob-

lems, or with healthy individuals who sim-

ply desire to enhance their well-being) or (2)

as an adjunctive intervention complement-

ing any empirically validated treatment of

mental disorders whenever a stronger focus

on enhancing general affect regulation skills

is desired. Although ART certainly shares

some theoretical assumptions with many of

the approaches just described and also uses

some of the interventions applied in these

approaches, we believe that the uniqueness

and advantage of ART lies with its compre-

hensive approach of incorporating specific

strategies, interventions, and exercises into

a consistent training program that explic-

itly and exclusively focuses on enhancing

general affect regulation skills— regardless

of the patient’s particular disorder(s) (for

details see Berking & Whitley, 2013).

Inspired by Klaus Grawe’s (2006) trans-

lational ideas on the development of mental

disorders, as well as the lack of transdiagnos-

tic interventions to enhance general affect

regulation skills at the time, we began to

develop ART in 2004. Since then, the train-

ing has become quite popular in the German-

speaking parts of Europe, where it is known

as Training Emotionaler Kompetenzen

(TEK; Berking, 2010; www. tekonline.info).

The training was primarily developed as a

group-based intervention (four to eight par-

ticipants), but it can also be used in individ-

ual therapy. Although the program has only

been evaluated in adults, its application for

adolescents is practicable after adapting the

procedures and materials to the needs and

capacities of this age group. The training,

which takes at least 18 hours to complete,

can be partitioned in various ways (e.g., two

1.5-hour sessions or one 3-hour session per

week over a 6-week period). From our expe-

rience, however, participants should have at

least 4 to 6 weeks time to practice the skills-

building exercises. ART can be delivered by

an ART-trained mental health professional,

such as a licensed psychotherapist with a

master’s degree in medicine or psychology.

Other, nonlicensed mental health profes-

sionals can also be trained to administer

ART, albeit not to individuals suffering from

acute mental disorders. Subsequently, we

outline the theoretical and empirical back-

ground of ART before we provide practical

explanations of how the relevant skills are

delivered to participants. At the end of the

chapter, we review empirical evidence for

the effectiveness of ART and suggest future

directions for our research.

The ART Model of Adaptive

Affect Regulation

The ART model of adaptive affect regu-

lation was developed by synthesizing (1)

established affect regulation theories (e.g.,

Gottman & DeClaire, 1997; Grawe, 2002,

2006; Gross, 1998; Larsen, 2000; Lazarus,

1991; Leahy, 2002; Saarni, 1999; Salovey

& Mayer, 1990), (2) findings from studies

on the association between affect regulation

and psychopathology (Berking & Wupper-

man, 2012), and (3) our extensive clinical

experience. The purpose of this develop-

ment was to provide a normative (i.e., pre-

scriptive) model explaining common failures

in affect regulation and directions for inter-

ventions to enhance affect regulation. In the

resulting model, adaptive affect regulation

is conceptualized as a situation- dependent

interaction between several affect regulation

skills. Figure 31.1 illustrates an overview of

the model. The skills included in the model

are described below.

1. The ability to consciously perceive

and be aware of affective states. The abil-

ity to consciously perceive and be aware of

affective states is the basis of every effortful

attempt to regulate affective states. Effort-

ful and conscious regulation may only play a

small role in the daily routine of regulation

in a healthy individual, because implicit or

highly automatized processes are likely to

dominate the regulation process as long as

these processes are able to maintain the indi-

vidual’s affect in the comfort zone (Koole &

532 INTERVENTIONS

Rothermund, 2011; Gyurak & Etkin, this

volume). However, if undesired affective

states cannot be down- regulated through

implicit processes, conscious information

processing will be activated as a precious

resource reserved for solving problems in the

self- management process (Mauss & Tamir,

this volume). Becoming aware of affective

states may facilitate the use of affect regula-

tion skills requiring cognitive resources (e.g.,

evaluating the degree of undesirability of the

emotion, labeling the emotion, identifying

its causes) and hence foster adaptive regu-

lation. Conversely, the inability to become

aware of one’s emotions impedes the utili-

zation of cognitive problem- solving capaci-

ties, thus intensifying and prolonging the

unwanted affective state (e.g., Lane et al.,

1996; Swart, Kortekaas, & Aleman, 2009).

2. The ability to identify and correctly

label affective states. Identifying and label-

ing affective states refers to matching emo-

tional experiences with the appropriate

semantic categories (e.g., “This feeling I am

experiencing is anger”). The availability of

a differentiated system of cognitive repre-

sentations of affective states and the ability

to correctly assign an experience to a spe-

cific category helps the individual to build

and use knowledge about this state, which

is often helpful for adaptive regulation. For

example, recognizing an emotion as anger

provides information about the nature and

purpose of the emotion (e.g., enhancing

assertive behavior; fighting for one’s rights),

its potential risks (cueing aggression leading

to sanctions through others) and benefits

(getting what one wants, even if one has to

fight for it), as well as information on regu-

lation strategies that are likely to be effec-

tive (potentially effective: distraction, relax-

ation, reappraisal and compassion; likely to

be ineffective: prolonged exposure). Recog-

nizing the emotion facilitates adaptive cog-

FIGURE 31.1. The ART model of adaptive affect regulation.

Affect Regulation Training 533

nitive processing. Thus, this ability should

foster effective affect regulation and hence

mental health and well-being (Feldman-

Barrett, Gross, Christensen, & Benvenuto,

2001).

3. The ability to identify relevant main-

taining factors for current affective states.

Identifying relevant maintaining factors

refers to development of an inner working

model to explain factors that initially cued

the current affective state and, more impor-

tantly, to identify the factors that maintain

the emotional state at that moment. In gen-

eral, psychological treatment for mental

health problems should (a) normalize the

client’s experiences, (b) help to explain the

occurrence of the problem, and (c) pro-

vide direction for successful coping. With

an additional focus on affective states, the

model should include relevant and change-

able factors such as the internal or exter-

nal stimuli or situation cueing the emotion,

appraisal of the stimuli or situation, as well

as desires, beliefs, and goals relevant for the

appraisal. Understanding factors that ini-

tially elicit and maintain an affective state

helps to (a) give meaning to an aversive expe-

rience, thereby making it easier to bear; (b)

clarify whether the emotion can or cannot

be changed (thus enhancing the acceptance

of an emotion when necessary); and (c) iden-

tify targets for effective modification of the

affective state.

4. The ability to modify affective states

actively. To modify affective states actively

is to effectively change the quality, intensity,

and/or duration of an affective state into

a desired direction with the help of strate-

gies that have no unwanted, long-term side

effects. This ability provides one of the most

effective means for preventing the use of

dysfunctional strategies (i.e., strategies that

have unwanted side effects). Moreover, effec-

tive modification skills provide an empirical

basis for the expectation of being able to

modify unwanted affective states whenever

necessary. Such an emotional self- efficacy is

likely to reduce both anxiety about future

aversive events and avoidance tendencies

toward affective states. As a result, this

expectation reduces general anxiety and the

willingness to experience emotionally chal-

lenging situations, thus facilitating further

skills building. Evidence for this hypothesis

comes from studies demonstrating that an

individual’s expectation of successfully alle-

viating negative mood states is significantly

associated with mental health (Catanzaro

& Greenwood, 1994). In this context, it is

noteworthy that ART skills should be under-

stood as categories that include various sub-

skills. This is particularly relevant for the

ability to modify affective states. For exam-

ple, most of the long list of positive activities

used in behavioral therapy for depression

can be seen as modification skills. It is also

noteworthy that the effectiveness of specific

modification skills differs across individuals

and situations, and is likely to be moderated

by numerous individual and contextual fac-

tors (Bonanno, Papa, Lalande, Westphal, &

Coifman, 2004).

5. The ability to accept and tolerate nega-

tive affective states when necessary. Accep-

tance and tolerance of unwanted affective

states is a crucial skill whenever affective

states cannot be changed or when changing

them would involve too high a cost (e.g., in

terms of time and energy). Although an opti-

mistic perspective about one’s abilities to

modify affective states has clear advantages,

acknowledging that affective states are

often very difficult to modify, or that they

sometimes cannot be modified, is equally

advantageous (Hayes, Strosahl, & Wilson,

1999). Modifying undesired affective states

is often difficult— particularly for patients

suffering from mental disorders— and hence

may threaten the need for control. To end

the aversive affective state and/or to restore

a sense of control, the individual may engage

in dysfunctional strategies (e.g., suppres-

sion) that help to avoid the aversive experi-

ence but likely lead to unwanted long-term

outcomes (e.g., Feldner, Zvolensky, Stickle,

Bonn- Miller, & Leen- Feldner, 2006; Lev-

itt, Brown, Orsillo, & Barlow, 2004). Con-

versely, the availability to accept, bear, or

tolerate aversive affective states reduces

this need and hence the risk of engaging in

maladaptive affect regulation (e.g., Wupper-

man, Neumann, & Axelrod, 2008).

6. The ability to approach and confront

situations that may cue negative affective

states. Approaching and confronting situa-

tions that may cue negative affective states

is often necessary to accomplish personally

relevant goals (Hayes et al., 1999). More-

534 INTERVENTIONS

over, confronting these situations provides

an opportunity to improve existing affect

regulation skills and to develop new ones

(arrows 6a and 6b in Figure 31.1). Willingly

encountering occasional situations that cue

negative affective states to attain important

goals when necessary, ensures that one’s

affect regulation skills are practiced on a

regular basis and will be available and effec-

tive in times of emotional anguish. More-

over, as this ability facilitates goal attain-

ment, it helps to satisfy relevant needs and

thus reduces negative affect in the long run.

7. The ability to support oneself compas-

sionately in distressing situations. All of

the skills just described have the potential

to increase emotional suffering in the short

term. For example, consciously perceiving

unwanted affective states is usually associ-

ated with an increase in the perceived inten-

sity of the emotional suffering. Identifying

momentary feelings such as stress, fear,

anger, sadness, dysphoria, shame, and guilt

activates semantic concepts that likely to cue

further negative feelings. Working to under-

stand undesired affective states can lead to

the processing of problems and the acknowl-

edgment of one’s inabilities to solve them,

which is likely to cue further deterioration

of mood. Efforts to modify undesired affec-

tive states are often unsuccessful, or at least

not as successful as expected or desired,

hence cueing disappointment, frustration,

and eventually despair. Attempts to accept

and tolerate an emotion are often associated

with feelings of helplessness and hopeless-

ness, and unrealistic fears of catastrophic

consequences assumed to occur when nega-

tive affective states are no longer suppressed.

Moreover, confronting situations that cue

negative affective states to attain important

goals, by definition, cues negative affective

states. As illustrated by these examples, the

process of applying adaptive affect regula-

tion skills could lead to deterioration of

mood and trigger the use of dysfunctional

strategies. Therefore, self- soothing or self-

encouraging strategies are needed as part

of the regulation process to prevent one’s

mood from deteriorating. Unfortunately,

many individuals with mental disorders

have a tendency to be strongly self- critical

of perceived failures. In the process of affect

regulation, this self- critical tendency is likely

to manifest when individuals perceive that

they have failed to regulate their emotions

successfully. Such a critique usually cues

further (secondary) negative affective states

(see Greenberg, 2004) that impede efforts to

cope with the undesired primary affective

states. Conversely, a compassionate stance

toward oneself can help reduce the risk of

being caught up in such a vicious cycle (Gil-

bert, 2011).

In addition to the list of skills and assump-

tions about why these skills are important

and how they interact, the ART model

includes the hypothesis that modification

and acceptance/tolerance skills are the

only skills in the model that are ultimately

relevant for mental health. All other skills

are not considered relevant by themselves

but only to the extent that they facilitate

the successful application of modification

or acceptance/tolerance. This idea is based

on research on rumination (e.g., Morrow

& Nolen- Hoeksema, 1990) and our clini-

cal observation that many clients obviously

experience their affective states consciously,

analyze them, and work to explain them

but are unable to benefit from these activi-

ties. On the contrary, excessive use of these

strategies seemed to be partly responsible for

maintaining the mental disorder. Empirical

studies on the ART model, reviewed in the

next section, provide further preliminary

support for this assumption.

Empirical Evidence for the ART

Model of Affect Regulation

After we conceptualized the ART model, we

developed and validated the Emotion Regu-

lation Skills Questionnaire (ERSQ; Berking

& Znoj, 2008) to assess the skills included

in the model. This self- report instrument

utilizes a 5-point Likert scale to assess each

skill of the ART model (plus an additional

subscale assessing the ability to use body

sensations to identify experienced affective

states) with three items per scale. Addition-

ally, a total score can be computed as the

average of all items. In several studies, the

ERSQ displayed adequate to good internal

consistencies (Cronbach’s alpha = .82–.94).

Results from exploratory and confirma-

tory factor analyses provide support for the

Affect Regulation Training 535

assumed dimensionality of the measure.

Moreover, sensitivity to change has been

demonstrated in multiple samples of clients

undergoing psychotherapy, and all scales

have demonstrated positive associations with

measures of well-being and mental health,

and negative associations with measures of

psychopathology and ER deficits (Berking,

Ebert, Cuijpers, & Hofmann, 2013; Berking

et al., 2011, 2012; Berking, Meier, & Wup-

perman, 2010; Berking, Orth, Wupperman,

Meier, & Caspar, 2008; Berking, Wupper-

man, et al., 2008; Berking & Znoj, 2008;

Ebert, Christ, & Berking, 2013).

More specifically, all skills in the ART

model have been shown to be cross-

sectionally associated with mental health in

nonclinical samples (Berking et al., 2012;

Berking, Wupperman, et al., 2008; Berking

& Znoj, 2008), and clinical samples and non-

clinical controls report less successful appli-

cation of all skills than do patients treated

for mental disorders (Berking et al., 2011;

Berking, Wupperman, et al., 2008; Berking

et al., 2013). Additionally, an increase in

successful affect regulation during CBT was

shown to be associated with greater symp-

tom reduction (Berking, Wupperman, et

al., 2008). The differences and correlations

reported in these studies were particularly

strong for modification and acceptance/tol-

erance. This finding provides preliminary

support for assumption that these skills

are particularly relevant for mental health.

Moreover, multivariate regression analyses

identified only these two skills areas as mak-

ing a unique contribution when predicting

treatment outcome from changes in affect

regulation skills (e.g., Berking, Wupperman,

et al., 2008). Further research indicated that

affect regulation skills assessed through the

ERSQ predicted subsequent indicators of

psychopathology over a 2-week and a 5-year

period, whereas these indicators did not pre-

dict subsequent success in applying affect

regulation skills (Berking, Orth, et al., 2008;

Berking, Wirtz, Svaldi, & Hofmann, under

review). This finding suggests that deficits

in affect regulation skills are not merely a

symptom of mental health problems but a

relevant antecedent factor.

In two other studies, affect regulation

skills assessed through the ERSQ predicted

relapse during and after inpatient treatment

for alcohol dependency (Berking et al., 2011)

and the reduction of depressive symptoms in

patients treated for major depressive disor-

der (MDD; Radkovsky, McArdle, Bockting,

& Berking, under review). Finally, in both

a clinical and a nonclinical sample, success-

ful modification of undesired affective states

(partly) mediated the relationship between

most ERSQ skills and psychopathology, but

not for acceptance and psychopathology

(Berking et al., 2012), which suggests that

only acceptance and tolerance are relevant

for mental health, regardless of whether

these skills facilitate the modification of

affective states. In summary, a growing

body of evidence supports the hypotheses

that the skills included in the ART model

help maintain or restore mental health and

are thus promising for treatments of mental

health problems.

Brief Description

of the ART Program

Support for the ART model led to the devel-

opment of the ART program, which inte-

grates principles and interventions from

various psychotherapeutic approaches to

foster general affect regulation skills in indi-

viduals likely to benefit from more adap-

tive ways of coping with unwanted affective

states. The following sections provide a brief

description of the ART program (for a more

detailed description, see Berking & Whitley,

2013).

General Structure

ART first introduces participants to the

nature of affective states and their evolution-

ary background, purposes, potential risks,

and benefits, as well as the mechanisms

involved in regulating affective processing.

From our understanding of the mechanisms

involved, seven skills have demonstrated

effectiveness in facilitating adaptive coping

with affective states that are particularly

challenging to manage. These skills include

muscle relaxation, breathing relaxation,

nonjudgmental awareness, acceptance and

tolerance, compassionate self- support, anal-

ysis of affective states, and modification of

affective states. Each skill is practiced in a

long version, then shortened to a version

that can be applied in very short periods of

536 INTERVENTIONS

time (3 seconds to 3 minutes). The shortened

ART skills are then chained together, creat-

ing the ART sequence (see Figure 31.2). This

sequence can be used whenever participants

suffer from any undesired affective state.

ART heavily relies on an intensive train-

ing regimen in which participants practice

the whole ART sequence for 20–30 minutes

daily and additionally engage in at least three

short exercises (for 3 seconds to 3 minutes)

over a period of at least 6 weeks. To sup-

port this practice, participants receive work-

sheets, handouts, and an information book-

let during the training. Additionally, they

receive specific audio files that guide them

through the exercises of the ART sequence,

and a set of 140 text messages is automati-

cally sent to participants throughout the

training. After participants have mastered

the skills, the focus shifts to practicing in

daily life the learned skills to cope success-

fully with challenging situations.

Muscle and Breathing Relaxation

Every skills building module starts with a

short psychoeducation that explains how

different areas of the brain may mutually

activate each other, thus forming neuroaf-

fective vicious cycles that can override

processes responsible for down- regulating

undesired affective states. For example,

when the amygdala is activated by a situa-

tion that is interpreted as a potential threat,

it initiates physiological changes such as

an increase in muscle tension and an accel-

eration of breathing. Because such changes

have occurred in the past when encountering

threatening situations, the muscle tension

and rapid breathing themselves may in turn

have become danger signals to the amyg-

dala (i.e., classical conditioning or the con-

cept of somatic markers; Damasio, 2000).

As a result, a vicious cycle may develop in

which the activation of the amygdala causes

increased muscle tension and rapid breath-

ing, which in turn causes further activation

of the amygdala and even more muscle ten-

sion and further rapid breathing (for details

on how somatic processes are integrated into

information processing relevant for emotion

elicitation and maintenance, see Stemmler,

2004; Teasdale & Barnard, 1993). When

participants realize that they are experienc-

ing stress or negative affective states, they

can break through these vicious cycles by

consciously relaxing their muscles and pur-

posefully calming their breathing. By engag-

ing in these exercises, they can reduce acti-

vation of the sympathetic system, the limbic

system, and the brainstem (Porges, 2007).

After this vicious cycle has been intro-

duced and discussed with participants, we

introduce participants to progressive mus-

cle relaxation techniques (Jacobson, 1964)

combined with a simple exercise to calm

breathing. Studies have consistently shown

the effectiveness of muscle and breathing

relaxation in the treatment of a variety of

mental and physical disorders (e.g., Öst,

1987; Conrad & Roth, 2007). Addition-

ally, with reduced limbic activity through

breathing and muscle relaxation, a shift can

occur that changes the focus from primar-

ily amygdala- driven limbic- and brainstem-

focused responses back to more prefrontal,

cortical responses that are reflective rather

than reactive (Arnsten, 2009). Thus, reduc-

ing psychophysiological arousal with the

help of muscle and breathing relaxation

facilitates the subsequent use of techniques

requiring more cognitive resources.

Nonjudgmental Awareness

When the amygdala detects potential

threats, it alerts the prefrontal cortex (PFC),

FIGURE 31.2. ART skills and ART sequence.

This is the prescriptive model of affect regulation

as it is presented to participants. It includes the

same skills as the ART model of adaptive affect

regulation (Figure 31.1); however, for didactic

purposes, it presents them in a more concrete

fashion, providing a step-by-step guideline for

coping with undesired affective states.

Affect Regulation Training 537

which then focuses attention and con-

scious processing on threat- relevant stimuli

(LeDoux, 2012). Such effortful process-

ing aims to more validly evaluate potential

threats and determine behavioral responses

most likely to be effective. However, if this

processing does not lead to a solution of

the problem, an ongoing focus on aversive

experiences may lead to an ongoing activa-

tion of the amygdala. This activation may

cause the PFC to focus even more attention

on the problem (Amaral, Price, Pitkänen, &

Carmichael, 1992; Gray & McNaughton,

2000; Vuilleumier, Richardson, Armony,

Driver, & Dolan, 2004), thus potentially

resulting in a cyclical reaction of even more

intense processing of problematic stimuli

and further activation in the amygdala. In

attempt to prevent such a negative cycle,

some individuals try to rigidly suppress

“negative” thinking (Ottenbreit & Dob-

son, 2004). However, this strategy is likely

to have a paradoxical effect of increasing

the intensity of negative thinking instead

of reducing it (Wenzlaff & Wegner, 2000).

Thus, instead of fighting negative thinking,

we encourage participants simply to observe

the situation and their affective states with-

out interpreting, judging, or reacting. This

kind of mindfulness- based affect labeling

has been shown to disrupt amygdala activity

(Lieberman et al., 2007) and to be effective

as a reappraisal or distraction in the regula-

tion of negative affect (Lieberman, Inagaki,

Tabibnia, & Crockett, 2011).

When applying this technique as ART

Skill 3, participants start by switching from

regulating their breathing to simply observ-

ing it. Then, they start focusing on their

sensual experiences (sensations in the body,

sounds, odors, and visual perceptions); their

thoughts (“What is the next thought that

comes to mind?”); and their current salient

wishes, desires, and goals (“If everything

was going exactly according to your wishes,

where would you be now? What would you

be doing now? Imagine this perfect scene. . . .

Briefly name the wish or goal expressed in

this image”). At the end of this sequence,

participants are invited to be aware of

their affective states without judging them.

Instead, they are instructed to (1) find a

matter- of-fact label for this emotion (e.g.,

anger), (2) rate its intensity on a scale from

1 to 10, and (3) identify where the emotion

is felt in the body. Finally, participants are

invited to check for additional feelings that

might lie behind the most prominent one and

repeat the same three-step process on them.

This technique of becoming aware of one’s

affective states in nonjudgmental ways aims

to recruit cognitive resources to facilitate

effective affect regulation (Gyurak & Etkin,

this volume; Hariri, Mattay, Tessitore, Fera,

& Weinberger, 2003). Evidence for the effi-

cacy of nonjudgmental awareness includes

studies on the effectiveness of mindfulness-

based interventions (Farb et al., this volume).

Acceptance and Tolerance

of Affective States

Challenging affective states, such as fear or

anger, constitute threats to the goals of feel-

ing good and of being in control (Grawe,

2006). Reponses of the amygdala toward

such threats likely include the activation

of areas responsible for avoidance motiva-

tion (Grawe, 2006). Under the influence

of avoidance goals (Grawe, 2002, 2006),

people may rigidly focus on eliminating the

“threatening” affective states. However, the

goal of getting rid of an undesired emotion

is often difficult to attain. The emotion-

generating system often acts autonomously

of the areas of the brain that initiate con-

sciously controlled behavior (Amaral et al.,

1992; see also the concept of core valuations

outlined by Ochsner & Gross, this volume).

Such a design can be hypothesized to have

provided a significant evolutionary advan-

tage to our ancestors. If negative affective

states could simply be switched off through

conscious control, a strong temptation to

simple down- regulate unpleasant emotions

without going through the trouble of engag-

ing in the behavior the emotion is supposed

to facilitate could interfere with the emo-

tions cueing adaptive behavior. Additionally,

emotional reactions often cause significant

changes in the body that take some time to

dissipate and, as long as they are present,

may impede the ability to make emotional

changes (Teasdale & Barnard, 1993). It can

also been hypothesized that areas such as the

ventromedial PFC and the anterior cingulate

cortex, which are assumed to help in down-

regulation of undesired emotions under the

influence of dorsal or lateral areas of the

PFC, may get “hijacked” by strong emotions

538 INTERVENTIONS

in a way that leads to ruminative processing

of emotion- related information and impedes

effective top-down emotion regulation

(Johnstone & Walter, this volume).

In summary, for various reasons, it is

often very difficult to control affective states

consciously. Thus, rigid attempts to shut

down an undesired affective state instantly

through sheer willpower may fail. Such

unsuccessful attempts at attaining the salient

goal of eliminating an undesired affective

state will likely cue amygdala activation and

increase the salience of the goal (Martin,

Tesser, & McIntosh, 1993; Rothermund,

2003). Because of the resulting increase in

negative arousal, the likelihood of attaining

an increasingly salient goal is significantly

reduced. Thus, a vicious cycle may develop

in which fighting against the emotion only

makes it stronger. To prevent this vicious

cycle, developing the ability to accept and

tolerate negative affective states is impor-

tant (at least as long as such states cannot be

changed). To enhance acceptance and toler-

ance skills, ART first works to help partici-

pants find a helpful definition of acceptance/

tolerance and to understand why these skills

are important. Then, participants develop

their personal, five-step Acceptance and

Tolerance Plan, which includes the follow-

ing steps: (1) Consciously decide to work

on accepting the emotion; (2) strengthen

this decision by finding at least one reason

why acceptance is helpful; (3) work to see

affective states as allies providing impor-

tant information and supporting behavior

that might be used for effective coping with

challenging situations (e.g., for an adap-

tive conceptualization of affective states,

see Cosmides & Tooby, 2000); (4) become

aware of your ability to tolerate negative

affective states for a certain period of time;

and (5) realize that affective states are usu-

ally impermanent experiences that do not

last forever and are likely to fade away (or at

least decrease in intensity).

At the end of the Acceptance and Toler-

ance Plan, participants devise a Personal

Acceptance and Tolerance Statement, such

as the following, to use as self-talk, until

they feel that they can allow affective states

to exist:

“I will work to accept this unpleasant emo-

tion because this is the smartest thing to

do as long as I cannot change it; I know

that this emotion wants to provide me

with very relevant information; it wants to

point out that . . . ; it aims to help me by

enhancing my ability to . . . ; I also know

that I have experienced many unpleas-

ant emotions in the past and have always

been able to get through this in one way or

another; finally, I know that this emotion

will not last forever, I will only have to

tolerate it for so long.”

In the ART sequence, this kind of

acceptance- enhancing self-talk is applied

to affective states that have been perceived

nonjudgmentally at the end of ART Skill

3. Preliminary evidence for the therapeutic

potential for the skills of acceptance and tol-

erance comes from research on the relevance

of avoidance for the development and main-

tenance of mental disorders (e.g., Berking,

Neacsiu, Comtois, & Linehan, 2009), from

studies demonstrating the effectiveness of

mindfulness- based approaches (Farb et al.,

this volume), and from acceptance and com-

mitment therapy, in which acceptance of

negative affective states and willingness to

experience them is one of the primary aims

of therapy (Hayes, Luoma, Bond, Masuda,

& Lillis, 2006).

Compassionate Self‑Support

in Emotionally Challenging Situations

The next vicious cycle starts when someone

who feels stressed or upset begins to self-

blame or self- criticize. That person might

think, “I can’t do anything right. I am a

complete failure. Something is wrong with

me.” These statements are self- inflicted

attacks that threaten the need to feel valued

(Grawe, 2002), cueing additional negative

affective states (e.g., anger, shame, guilt)

associated with further activation of the

amygdala (Longe et al., 2010). The activa-

tion of the amygdala through self- criticism

and additional negative feelings increases

the stress response, likely leading to more

negative feelings, which in turn lead the per-

son to be even more self- critical. Activating

a compassionate attitude toward oneself and

engaging in self- supportive behaviors is an

effective strategy to preclude this vicious

cycle (Gilbert, 2011). ART participants learn

how to provide compassionate self- support

Affect Regulation Training 539

by imagining themselves in a burdensome

situation accompanied by negative feelings.

While reexperiencing these feelings, they

learn to self- assess from the perspective of

a kind and caring (albeit somewhat distant)

inner observer. They are instructed to “let

the feeling of compassion toward themselves

arise from within,” which creates a strong

and warm feeling of self- empathy, accompa-

nied by the desire to help and to end their

suffering (Weissman & Weissman, 1996).

The observing part should then approach

the suffering part of the participant, sup-

porting and comforting that part by nor-

malizing the negative affective states, pro-

viding encouragement, and maybe adding a

physical gesture of compassion (e.g., giving

oneself an imaginary hug). Preliminary evi-

dence for the effectiveness of interventions

that enhance compassionate self- support

has been found in several empirical studies

(Hofman, Grossman, & Hinton, 2011).

Constructive Analysis

of Affective States

Under stress, the amygdala activates pro-

cesses that release stress hormones into the

brain. An excessive release of such hormones

can impair cognitive processing in other

brain areas, including the PFC and the hip-

pocampus (Huether, 1998; LeDoux, 2012),

which play important roles in the analysis

of affective states. The ability to identify

the causes of one’s current feelings correctly

leads to a greater sense of self- mastery and

control over one’s affective states. If through

weakened prefrontal and hippocampal

functioning, the ability to self- analyze one’s

affective states is diminished, a vicious cycle

develops in which the loss of orientation

and control further activates the amygdala,

which in turn perpetuates the cycle. Thus,

maintaining or regaining a sense of mastery

and control over one’s affective states in

stressful situations helps prevent the escala-

tion of negative affect.

In ART Skill 6, participants are trained

to utilize the Analyzing Affective States

Worksheet (depicted in Figure 31.3) to

enhance the ability to identify correctly

the causes of one’s current emotions. The

worksheet is based on an integrative model

of how affective states are cued and main-

tained. It focuses on emotions and feelings

as crucial affective states, but we broadly

define these terms in the training (to avoid

burdening patients with the academic need

for clear classifications). Thus, these terms

include other affective states, such as stress

responses or moods. The general model

of how emotions (i.e., affective states) are

elicited includes external or internal events

that cue the emotion; attention deployment

toward and appraisals of these events; needs,

wishes, and goals that are relevant for these

appraisals; secondary emotions (Greenberg,

2004) cued by appraising the primary emo-

tion in a certain way; and body sensations,

motivational impulses, and behavior associ-

ated with the emotion, all of which provide

feedback into the emotion generating system

and thus affect the subsequent course of the

emotion. To clarify the course of subsequent

action, the worksheet ends with a summary

of the short- and long-term advantages and

disadvantages of the emotion.

ART trainers explain the model and help

participants to apply it to their own affective

states. Eventually, the skill will be included

in the ART sequence in the form of the car-

ing inner observer from ART Skill 5, who

guides the suffering part of the client through

the analysis (“What situation prompted this

feeling?”; ”How did you interpret and evalu-

ate the situation?”; “What was at stake in

this situation?”). Partly based on the find-

ing that insight- oriented psychological

treatments have been shown to be effective

(e.g., Gibbons, Crits- Christoph, Barber,

& Schamberger, 2007) and our own clini-

cal experience, we hypothesize that simply

understanding challenging affective states

with the help of a model normalizes and

hence validates such states; that the impres-

sion of having understood the problem cues

a general feeling of control and hope; and

that offers of specific and promising ways

to cope successfully with undesired states

significantly contributes to the (short-term)

reduction and/or acceptance of undesired

affective states.

Effective Modification

of Affective States

ART Skill 7 aims to empower participants

to actively modify quality, intensity, or dura-

tion of an undesired emotion and restore

their sense of control. This skill, which pro-

540 INTERVENTIONS

vides a step-by-step process to modify affec-

tive states, is based on the general problem-

solving model (D’Zurilla & Nezu, 2010)

and utilizes the Modification of Affective

States Worksheet depicted in Figure 31.4.

Based on the long- and short-term advan-

tages and disadvantages of the emotion sum-

mary from the Analyzing Affective States

Worksheet, the Modifying Affective States

Worksheet first requires participants to set

as a goal how they would rather feel. Then,

for each relevant maintaining factor (i.e.,

each box of the worksheet), participants

brainstorm how changes in these areas could

help cue the target emotion. After partici-

pants have identified as many helpful ideas

as possible for each box, they select the most

promising ideas to plan specific behaviors

that cue the target emotion. Then, they put

the plan into practice and evaluate the out-

come. With regard to the latter, patients are

also taught a plan for how to deal effectively

with unsuccessful modification attempts

(see bottom right-hand corner of Figure

31.4), because such failures often lead to a

complete disengagement from functional

regulation endeavors and the use instead of

impulsive strategies that might effectively

improve one’s mood in the short run but are

associated with negative long-term outcomes

(e.g., engaging in avoidance, substance use,

worry, depressogenic thinking).

After the model is introduced and prac-

ticed with a couple of examples, Skill 7

is included in the ART sequence. At this

point, the compassionate, helping part of

FIGURE 31.3. The Analyzing Affective States Worksheet. To reduce the complexity wherever possible,

the distinction between affect and emotions is not addressed in the training. Instead, the terms emo-

tions and feelings are used in a very broad sense (e.g., with regard to feeling stressed out and relative

to various mood states). Although the worksheet is fairly complex, participants who have been trained

intensively in its use have rated it as one of the most helpful components of ART. Typical explanations

for its popularity include “It gets everything I somehow felt was relevant for how I feel on one sheet of

paper.”

1211

Short-term Long-term Short-term Long-term

How do I appraise the primary emotion?

How does this make me feel about my

emotion?

What happened? (facts only!)

How did I feel emotionally & physically at the

time the situation occurred?

Why is this so important to me?

What is at stake?

How and where do I feel the emotion in

my body?

Is the emotion part of an old pattern?

What can I call this pattern?

What caught my attention?

How did I interpret the situation?

What was my evaluation of the situation?

Prompting

Situation

Needs

Goals

Desires

Expectations

Emotion

Impulses to Act

Preceding Emotional Vulnerability

Behavior

Secondary Emotion

Analyzing Emotions

Attention, Interpretation,

& Evaluation

Advantages of Emotion

Disadvantages of Emotion

Emotion in the Body

Old Response Pattern

Affect Regulation Training 541

the self (established in Skill 5) guides the

vulnerable part of the self (also established

in Skill 5) in modifying negative affective

states (“How do you actually want to feel in

this situation?”; “What is your target emo-

tion?”; “How could you change the situa-

tion to achieve your target emotion?”). As

such, ART Skill 7 builds on the other skills

of the ART sequence and utilizes the gen-

eral problem- solving framework to modify

undesired affective states.

Efficacy of ART

Research on the effectiveness of ART is still

in the early stages. However, several stud-

ies have been conducted in a variety of psy-

chotherapeutic settings and early results

are promising. One published study (Berk-

ing, Wupperman, et al., 2008) involved 289

patients from a mental health hospital. The

patients all received 6 weeks of CBT supple-

mented with additional multidisciplinary

treatment as necessary. A randomly selected

subgroup of patients was offered the option

to replace four treatment sessions of CBT per

week with an abbreviated version of ART

during a 3-week period. Results showed that

at the end of the 6-week treatment, patients

who had participated in ART displayed sig-

nificantly greater improvement of affect reg-

ulation skills than patients who had received

CBT only. Additionally, patients participat-

Prompting

Situation

Needs

Goals

Desires

Expectations

Emotion

Behavior

Old Response Pattern

Modifying Emotions

Attention, Interpretation,

and Evaluation

How can I change the situation?

How can I improve my physical and emotional

health?

Are other needs, goals, etc. really

more important?

Can I reduce the significance of this

need, goal, etc. to a lower level of

significance?

What would be a more adaptive new pattern?

What can I call this new pattern?

How else can I look at this situation?

Effective change process:

1. Identify target feeling

2. Brainstorm ideas about how

to activate target feeling

3. Make a plan

4. Put plan into action

5. Success:Rewardyourself

Failure/Partial Success:

1. Reward yourself for trying!

2. Try more of the same

3. Try other strategies

4. Change target or

accept and tolerate

Strategy #3 (Distraction) – Do something pleasurable to distract yourself. The

goal is distraction, NOT avoidance!

Strategy #1 (Use the B

lues) – Identify the helpful actions suggested

by the emotion and then implement them.

Strategy #2 (Opposite Action) – Identify the unhelpful action suggested by

the emotion and then engage in the opposite behavior.

Preceding Emotional Vulnerability

Secondary Emotion

Can I change how I think about the

emotion (in order to feel better about the

emotion)?

Emotion in the Body

How can I foster changes in my body

that would trigger the target emotion?

FIGURE 31.4. The Modifying Affective States Worksheet. When using distraction as a behavior-

oriented modification strategy, it is explained to participants that the same behavior can be considered

(dysfunctional) avoidance or distraction, which can be a very effective modification strategy, depend-

ing on one’s willingness to experience the affective state to be regulated (“As long as we could also face

the undesired state we are free to use distraction”); ART facilitates the adaptive use of distraction by

focusing on experiencing and accepting unwanted affective states in ART Skills 3 and 4 prior to focus-

ing on modification. “Opposite Action”: See Linehan (1993).

542 INTERVENTIONS

ing in ART showed a significantly greater

decrease in symptoms of depression and

negative affect, as well as greater treatment

gains in positive affect.

Similar results were found during a recent,

completely randomized controlled trial with

a sample of over 400 inpatient participants

who met diagnostic criteria for MDD. In

this study, the effectiveness of CBT was sig-

nificantly improved by supplementing tradi-

tional CBT with the ART program (Berking

et al., 2013 ). Additional gains in the CBT

+ ART condition were particularly strong

with regard to the abilities of acceptance,

tolerance, compassionate self- support, and

modification. All these strategies have been

hypothesized to be particularly important

for mental health (see the section on empiri-

cal evidence for the ART model). In another

study (Berking et al., 2010), a group of police

officers participated in ART. Prior to the

training, their affect regulation skills were

significantly lower than those of a control

sample. After participation in the training,

the police officers’ affect regulation skills

had increased to the point that they no lon-

ger differed from the controls. These effects

did not occur in the control condition.

Moreover, in a recent quasi- experimental

study, a combination of ART and CBT was

effective for treating patients with medically

unexplained somatic symptoms (Gottschalk

& Rief, 2012).

Finally, in experimental studies with

clinical and nonclinical samples, we found

evidence for the short-term effectiveness of

specific ART skills. For these studies, we

developed an experimental paradigm in

which health- relevant affective states are

repeatedly induced with the help of a combi-

nation of music and the Velten Mood Induc-

tion Procedure (1968). After each induc-

tion phase, participants are instructed to

use affect regulation skills, such as the ones

included in the ART model. Before and after

each induction and regulation, participants

rate the intensity and acceptability of the

affective state. To control for order effects,

the complete permutation of all possible

combinations of strategies and control con-

ditions is implemented over the total sample.

Using this paradigm in a healthy sample of

undergraduates and a clinically depressed

sample, we found that in both samples the

ART-based audio instructions on how to

cope with an experimentally induced depres-

sive mood were more effective in reducing

the mood’s intensity than the spontane-

ous regulation control condition (Fischer,

Kirchner, Kandl, Hiller, & Berking, 2012;

Kowalsky et al., 2013). Although all these

studies provide significant support for the

assumed efficacy of ART, additional stud-

ies are dearly needed to clarify further the

populations that benefit from ART, and

whether and to what extent these benefits

exceed those of other bona fide treatments.

Future Directions for ART

Several limitations in our basic research on

affect regulation, ART as a clinical inter-

vention, and our studies evaluating the effi-

cacy of ART need to be addressed in future

research. For example, basic research initi-

ated by our group has made extensive use of

self- reports in an area that, at least in part,

is difficult to assess through introspection

(e.g., the ability to identify one’s emotions

correctly). Moreover, the ERSQ asks partici-

pants whether they can successfully apply

certain skills to their feelings or emotions.

Because a depressed patient might refer to

different emotions than would a partici-

pant suffering from an anxiety disorder, the

instrument refers to different affective states

in different participants, and the extent that

these particular difficulties are valid indi-

cators of their general emotion regulation

skills is unclear. Additionally, many assump-

tions in our model (e.g., that the application

of promising affect regulation skills itself

can contribute to short-term mood deterio-

ration) are largely grounded in theory and/

or clinical experience, and need to be inves-

tigated in more detail empirically.

With regard to ART as a clinical inter-

vention, it is noteworthy that in spite of

the obvious advantages of transdiagnostic

interventions (e.g., easier to disseminate in

a cost- effective group setting), the disad-

vantages of potentially neglecting relevant

characteristics of particular disorders have

to be carefully considered. Moreover, from

our clinical work, we developed the impres-

sion that using theories and findings from

the neurosciences to derive health- relevant

affect regulation skills helps to engage par-

ticipants in the systematic training routine.

Affect Regulation Training 543

However, we also learned that finding the

right balance between a clinically help-

ful and a scientifically valid neuroaffective

model of affect regulation is often difficult

to attain. For example, anthropomorphiz-

ing relevant brain areas (e.g., by using the

expression “The amygdala only wants to

protect you”) can be a very effective psycho-

therapeutic intervention, but the approach

is inadequate in the context of pure scien-

tific explanations. Additionally, we have to

acknowledge that remaining up-to-date with

the latest findings in the rapidly developing

field of the neurosciences, while simultane-

ously conducting large randomized clinical

trials, represents a remarkable challenge.

During the time it takes to develop a treat-

ment program, write a treatment manual,

raise the funds for efficacy trials, and con-

duct and publish the results of those trials,

neuroscientific findings and theories used

for developing the treatment program are

likely to be out of date.

With regard to efficacy research, it is of

note that in clinical populations we have

investigated ART exclusively as an adjunc-

tive intervention, which is in line with our

assumption that the characteristics of spe-

cific disorders must also be considered

when offering transdiagnostic interventions

enhancing general emotion regulation skills.

However, the current lack of studies evaluat-

ing ART as a stand-alone intervention also

prevents us from clarifying which disorders

can be treated effectively with interventions

focusing exclusively on enhancing such skills.

We should also note that because of the lack

of multiple assessments and untreated con-

trol conditions, we have not yet been able

to conduct meaningful mediation analyses

clarifying the extent to which ART exerts

positive effects through improving affect

regulation skills as hypothesized. Finally,

it is noteworthy that the current ART pro-

gram teaches a broad range of affect regu-

lation skills, which takes about 18 hours to

complete. From a theoretical and a treat-

ment dissemination perspective, an essential

subsequent step will be to clarify whether all

parts of the program are necessary to obtain

the desired effects.

To overcome these limitations, we have

initiated several research projects. For

example, to address the measurement prob-

lems, we have recently developed and vali-

dated a modified version of the ERSQ called

the Affect Regulation Skills Questionnaire

(ARSQ; Ebert et al., 2013), which assesses

affect regulation skills separately for various

affective states.

This measure helps to clar-

ify whether individuals differ in their affect

regulation skills across different affective

states, and it helps to identify which skills

for which affective states are most important

for maintaining or restoring mental health.

Currently we are also limited in our

attempts to use findings from the affective

neurosciences to improve psychotherapeutic

interventions. We acknowledge that we are

unlikely to become cutting- edge experts in

two research fields as vast as the neurosci-

ences and treatment development and evalu-

ation. Thus, we are currently looking for

neuroscience experts who share our inter-

est in translational research. By collaborat-

ing with experts in the neurosciences, we

aim to enhance further the validity of the

translational approach used in ART and

thereby bridge the current gap between basic

research and clinical application.

With regard to the need for more efficacy

trials, in two, large, multicenter trials we are

currently investigating whether ART can

also be used as an effective stand-alone treat-

ment for MDD and/or binge- eating disorder

(BED). In these trials we use experimental,

biological, observer- based, and ambulatory

momentary assessments of affect regula-

tion skills, in addition to retrospective self-

report measures. Moreover, through mul-

tiple assessments and designs that include an

untreated control condition, we will be able

to conduct meaningful mediation analyses.

To clarify whether all parts of the program

are necessary to obtain the desired effects,

we are currently conducting a dismantling

study, in which we compare an ART version

that focuses exclusively on acceptance and

versions that focus exclusively on modifica-

tion or on both acceptance and modifica-

tion. Additionally, we acquired funding for a

large, multicenter trial in which the efficacy

of CBT + ART is compared with traditional

CBT in a sample of patients suffering from

medically unexplained somatic symptoms.

We are also exploring technology enhance-

ments to ART. Text messages have been

used since 2004 to support participants in

their daily skills practice. Since then, numer-

ous innovations have been presented in the

544 INTERVENTIONS

rapidly developing field of computerized

psychological treatment. For example, we

are currently finalizing an interactive online

version of ART, as well as several serious

games that can be used to practice ART

skills in a leisurely fashion. We hope that

these endeavors will help individuals in need

of more effective affect regulation to acquire

and continuously practice the most effective

strategies and thereby overcome their mental

health problems and thereby improve their

well-being and satisfaction with life.

Note

1. An English version of the ARSQ can be

obtained from Matthias Berking.

References

Amaral, D. G., Price J. L., Pitkänen, A., & Car-

michael, S. T. (1992). Anatomical organiza-

tion of the primate amygdaloid complex. In

J. P. Aggleton (Ed.), The amygdala: Neuro-

biological aspects of emotion, memory and

mental dysfunction (pp. 1–66). New York:

Wiley-Liss.

American Psychiatric Association. (2013). Diag-

nostic and statistical manual of mental disor-

ders (5th ed.). Washington, DC: Author.

Arnsten, A. F. T. (2009). Stress signaling path-

ways that impair prefrontal cortex structure

and function. Nature Reviews Neuroscience,

10(6), 410– 422.

Beck, J. S. (1995). Cognitive therapy: Basics and

beyond. New York: Guilford Press.

Berking, M. (2010). Training emotionaler

Kompetenzen (2nd ed.). Berlin/Heidelberg:

Springer- Verlag.

Berking, M., Ebert, D., Cuijpers, P., & Hofmann,

S. (2013). Emotion- regulation skills training

enhances the efficacy of cognitive behavioral

therapy for major depressive disorder. Psycho-

therapy and Psychosomatics, 82, 234–245.

Berking, M., Margraf, M., Ebert, D., Wupper-

mann, P., Hofmann, S., & Junghanns, K.

(2011). Emotion regulation skills as a predic-

tor of relapse during and after treatment of

alcohol dependence. Journal of Consulting

and Clinical Psychology, 79(3), 307–318.

Berking, M., Meier, C., & Wupperman, P.

(2010). Enhancing emotion- regulation skills

in police officers: Results of a pilot controlled

study. Behavior Therapy, 41(3), 329–339.

Berking, M., Neacsiu, A., Comtois, K. A., &

Linehan, M. M. (2009). The impact of expe-

riential avoidance on the reduction of depres-

sion in treatment for borderline personality

disorder. Behaviour Research and Therapy,

47(8), 663–670.

Berking, M., Orth, U., Wupperman, P., Meier,

L., & Caspar, F. (2008). Prospective effects of

emotion regulation on emotional adjustment.

Journal of Counseling Psychology, 55(4),

485–494.

Berking, M., Poppe, C., Luhmann, M., Wup-

permann, P., Jaggi, V., & Seifritz, E. (2012).

Emotion- regulation skills and psychopathol-

ogy: Is the ability to modify one’s negative

emotions the ultimate pathway by which all

other skills affect symptoms of mental disor-

ders? Journal of Behavior Therapy and Exper-

imental Psychiatry, 43, 931–937.

Berking, M., & Whitley, B. (2013). Affect regula-

tion training. New York: Springer.

Berking, M., Wirtz, C., Svaldi, J., & Hofmann,

S. (under review). Emotion regulation skills

predict symptoms of depression over five years

in individuals at risk for depression. Behav-

iour Research and Therapy.

Berking, M., & Wupperman, P. (2012). Emotion

regulation and mental health: Recent findings,

current challenges and future directions. Cur-

rent Opinion in Psychiatry, 25(2), 128–134.

Berking, M., Wupperman, P., Reichardt, A.,

Pejic, T., Dippel, A., & Znoj, H. (2008).

Emotion- regulation skills as a treatment tar-

get in psychotherapy. Behaviour Research and

Therapy, 46(11), 1230–1237.

Berking, M., & Znoj, H. (2008). Entwicklung

und Validierung eines Fragebogens zur stan-

dardisierten Selbsteinschätzung emotionaler

Kompetenzen (SEK-27) [Development and val-

idation of a standardized self- report measure

assessing emotional competencies]. Zeitschrift

für Psychiatrie Psychologie und Psychothera-

pie, 56(2), 141–153.

Bogdan, R., & Pizzagalli, D. A. (2006). Acute

stress reduces reward responsiveness: Impli-

cations for depression. Biological Psychiatry,

60(10), 1147–1154.

Bonanno, G. A., Papa, A., Lalande, K., Westphal,

M., & Coifman, K. (2004). The importance of

being flexible: The ability to both enhance and

suppress emotional expression predicts long-

term adjustment. Psychological Science, 15(7),

482–487.

Catanzaro, S. J., & Greenwood, G. (1994).

Expectancies for negative mood regulation,

coping, and dysphoria among college students.

Affect Regulation Training 545

Journal of Counseling Psychology, 41(1),

34–44.

Conrad, A., & Roth, W. T. (2007). Muscle relax-

ation therapy for anxiety disorders: It works

but how? Journal of Anxiety Disorders, 21,

243–264.

Cosmides, L., & Tooby, J. (2000). Evolutionary

psychology and the emotions. In M. Lewis &

J. M. Haviland- Jones (Eds.), Handbook of

emotions (2nd ed., pp. 91–115). New York:

Guilford Press.

Damasio, A. (2000). The feeling of what hap-

pens: Body and emotion in the making of con-

sciousness. New York: Harcourt Brace.

Dingemans, A. E., Martijn, C., Jansen, A., &

Furth, E. F. (2009). The effect of suppressing

negative emotions on eating behavior in binge

eating disorder. Appetite, 52, 51–57.

Duckworth, A. L., Steen, T. A., & Seligman, M.

E. P. (2005). Positive psychology in clinical

practice. Annual Review of Clinical Psychol-

ogy, 1, 629–651.

D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-

solving therapy. In K. S. Dobson (Ed.), Hand-

book of cognitive behavioral therapies (Vol.

39, pp. 197–226). New York: Guilford Press.

Ebert, D., Christ, O., & Berking, M. (2013). Ent-

wicklung und Validierung eines Fragebogens

zur emotionsspezifischen Selbsteinschätzung

emotionaler Kompetenzen (SEK-ES) [Develop-

ment and validation of a self- report instrument

for the assessment of affect- specific regulation

skills]. Diagnostica, 59(1), 17–32.

Farb, N. A. S., Anderson, A. K., Irving, J. A., &

Segal, Z. V. (this volume, 2014). Mindfuless

interventions and emotion regulation. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 548–568). New York: Guilford

Press.

Feldman- Barrett, L., Gross, J., Christensen, T.

C., & Benvenuto, M. (2001). Knowing what

you’re feeling and knowing what to do about

it: Mapping the relation between emotion dif-

ferentiation and emotion regulation. Cogni-

tion and Emotion, 15(6), 713–724.

Feldner, M. T., Zvolensky, M. J., Stickle, T. R.,

Bonn- Miller, M. O., & Leen- Feldner, E. W.

(2006). Anxiety sensitivity- physical concerns

as a moderator of the emotional consequences

of emotion suppression during biological chal-

lenge: An experimental test using individual

growth curve analysis. Behaviour Research

and Therapy, 44(2), 249–272.

Fischer, A., Kirchner, M., Kandl, M., Hiller, W.,

& Berking, M. (2012, May). Effektivität von

Emotionsregulationsstrategien zur Reduk-

tion dysphorischer Stimmung bei Depression

[Effects of emotion regulation strategies on

the reduction of depressive mood in depressed

patients]. Poster presented at the 30th annual

conference of the Section Clinical Psychology

and Psychotherapy of the German Psychologi-

cal Association, Luxembourg.

Foa, E. B., Riggs, D. S., Massie, E. D., & Yar-

czower, M. (1995). The impact of fear acti-

vation and anger on the efficacy of exposure

treatment for posttraumatic stress disorder.

Behavior Therapy, 26, 487– 499.

Gibb, B. E., Beevers, C. G., Andover, M. S., &

Holleran, K. (2006). The hopelessness theory

of depression: A prospective multi-wave test of

the vulnerability– stress hypothesis. Cognitive

Therapy and Research, 30(6), 763–772.

Gibbons, M. B. C., Crits- Christoph, P., Barber,

J. P., & Schamberger, M. E. (2007). Insight in

psychotherapy: A review of empirical litera-

ture. In L. G. Castonguay & C. E. Hill (Eds.),

Insight in psychotherapy (pp. 143–165). Wash-

ington, DC: American Psychological Associa-

tion.

Gilbert, P. (2011). Compassion focused therapy:

The distinctive features. London: Routledge.

Gottman, J., & DeClaire, J. (1997). The heart of

parenting: Raising an emotionally intelligent

child. New York: Simon & Schuster.

Gottschalk, J.-M., & Rief, W. (2012). Psycho-

therapeutische Ansätze für Patienten mit

somatoformen Störungen [Psychotherapeutic

treatments for patients with somatoform dis-

orders]. Der Nervenarzt, 83, 1115–1127.

Grawe, K. (2002). Psychological therapy. Cam-

bridge, MA: Hogrefe & Huber.

Grawe, K. (2006). Neuropsychotherapy. New

York: Psychology Press.

Gray, J. A., & McNaughton, N. (2000). The

neuropsychology of anxiety: An enquiry into

the functions of the septo- hippocampal system

(2nd ed.). Oxford, UK: Oxford University Press.

Greenberg, L. S. (2004). Emotion- focused ther-

apy. Clinical Psychology and Psychotherapy,

11(1), 1–2.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2(3), 271–299.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gyurak, A., & Etkin, A. (this volume, 2014). A

neurobiological model of implicit and explicit

emotion regulation. In J. J. Gross (Ed.),

546 INTERVENTIONS

Handbook of emotion regulation (2nd ed.,

pp. 76–90). New York: Guilford Press.

Hariri, A. R., Mattay, V. S., Tessitore, A., Fera,

F., & Weinberger, D. R. (2003). Neocortical

modulation of the amygdala response to fear-

ful stimuli. Biological Psychiatry, 53, 494–

501.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda,

A., & Lillis, J. (2006). Acceptance and com-

mitment therapy: Model, processes and out-

comes. Behaviour Research and Therapy,

44(1), 1–25.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G.

(1999). Acceptance and commitment therapy.

New York: Guilford Press.

Hofmann, S. G., Grossman, P., & Hinton, D.

E. (2011). Loving- kindness and compassion

meditation: Potential for psychological inter-

ventions. Clinical Psychology Review, 31(7),

1126–1132.

Hofmann, S. G., Sawyer, A. T., Fang, A., &

Asnaani, A. (2012). Emotion dysregulation

model of mood and anxiety disorders. Depres-

sion and Anxiety, 29, 409–412.

Huether, G. (1998). Stress and the adaptive self-

organization of neuronal connectivity dur-

ing early childhood. International Journal of

Developmental Neuroscience, 16, 297–306.

Jacobson, E. (1964). Anxiety and tension con-

trol: A physiologic approach. Philadelphia:

Lippincott.

Johnstone, T., & Walter, H. (this volume, 2014).

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 58–75). New York:

Guilford Press.

Kessler, R. C., Chiu, W. T., Demler, O., & Wal-

ters, E. E. (2005). Prevalence, severity, and

comorbidity of 12-month DSM-IV disorders

in the National Comorbidity Survey Replica-

tion. Archives of General Psychiatry, 62(6),

617– 627.

Koole, S. L., & Rothermund, K. (2011). “I feel

better but I don’t know why”: The psychology

of implicit emotion regulation. Cognition and

Emotion, 25(3), 389–399.

Kowalsky, J., Schwarz, J., Tauch, C., Ruppert,

M., Wert, H., & Berking, M. (2013, May).

Effektivität von Emotionsregulationsstrat-

egien—eine experimentelle Untersuchung

[Efficacy of emotion regulation strategies— an

experimental investigation]. Poster presented

at the 31th annual conference of the Section

Clinical Psychology and Psychotherapy of the

German Psychological Association in Trier.

Lane, R. D., Sechrest, L., Reidel, R., Weldon, V.,

Kaszniak, A. W., & Schwartz, G. E. (1996).

Impaired verbal and nonverbal emotion rec-

ognition in alexithymia. Psychosomatic Medi-

cine, 58, 203–210.

Larsen, R. J. (2000). Toward a science of mood

regulation. Psychological Inquiry, 11(3) 129–

141.

Lazarus, R. S. (1991). Emotion and adaptation.

In L. A. Pervin (Ed.), Handbook of person-

ality theory and research (Vol. 21, pp. 609–

637). Oxford, UK: Oxford University Press.

Leahy, R. L. (2002). A model of emotional sche-

mas. Cognitive and Behavioral Practice, 9(3),

177–190.

LeDoux, J. E. (2012). Evolution of human emo-

tion: A view through fear. Progress in Brain

Research, 195, 431–442.

Levitt, J. T., Brown, T. A., Orsillo, S. M., & Bar-

low, D. H. (2004). The effects of acceptance

versus suppression of emotion on subjective

and psychophysiological response to carbon

dioxide challenge in patients with panic disor-

der. Behavior Therapy, 35(4), 747–766.

Lieberman, M. D., Eisenberger, N. I., Crockett,

M. J., Tom, S. M., Pfeifer, J. H., & Way, B.

M. (2007). Putting feelings into words: Affect

labeling disrupts amygdala activity in response

to affective stimuli. Psychological Science,

18(5), 421–428.

Lieberman, M. D., Inagaki, T. K., Tabibnia, G.,

& Crockett, M. J. (2011). Subjective responses

to emotional stimuli during labeling, reap-

praisal, and distraction. Emotion, 11(3), 468–

480.

Linehan, M. M. (1993). Cognitive- behavioral

treatment of borderline personality disorder.

New York: Guilford Press.

Longe, O., Maratos, F. A., Gilbert, P., Evans, G.,

Volker, F., Rockliff, H., et al. (2010). Having a

word with yourself: Neural correlates of self-

criticism and self- reassurance. NeuroImage,

49(2), 1849–1856.

Martin, L. L., Tesser, A., & McIntosh, W. D.

(1993). Wanting but not having: The effects of

unattained goals on thoughts and feelings. In

E. Daniel, M. Wegner, E. James, & W. Pen-

nebaker (Eds.), Handbook of mental control

(pp. 552–572). New York: Prentice Hall.

Mauss, I. B., & Tamir, M. (this volume, 2014).

Emotion goals: How their content, structure,

and operation shape emotion regulation. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 361–375). New York: Guil-

ford Press.

Mennin, D. S., & Fresco, D. M. (2009). Emotion

regulation as an integrative framework for

understanding and treating psychopathology.

Affect Regulation Training 547

In A. M. Kring & D. M. Sloan (Eds.), Emotion

regulation and psychopathology: A transdi-

agnostic approach to etiology and treatment

(pp. 356–379). New York: Guilford Press.

Mennin, D. S., & Fresco, D. M. (this volume,

2014). Emotion regulation therapy. In J. J.

Gross (Ed.), Handbook of emotion regulation

(2nd ed., pp. 469–490). New York: Guilford

Press.

Morrow, J., & Nolen- Hoeksema, S. (1990).

Effects of responses to depression on the reme-

diation of depressive affect. Journal of Person-

ality and Social Psychology, 58(3), 519–527.

Moses, E. B., & Barlow, D. H. (2006). Current

directions in psychological science: Approach

for emotional disorders based on emotion sci-

ence. Psychological Science, 15(3), 146–150.

Neasciu, A. D., Bohus, M., & Linehan, M. (this

volume, 2014). Dialectical behavir therapy:

An intervention for emotion dysregulation.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 491–507). New York:

Guilford Press.

Ochsner, K. N., & Gross, J. J. (this volume,

2014). The neural bases of emotion and emo-

tion regulation: A valuation perspective. In J.

J. Gross (Ed.), Handbook of emotion regula-

tion (2nd ed., pp. 23–42). New York: Guilford

Press.

Öst, L.-G. (1987). Applied relaxation: Descrip-

tion of a coping technique and review of con-

trolled studies. Behaviour Research and Ther-

apy, 25(5), 397– 409.

Ottenbreit, N. D., & Dobson, K. S. (2004).

Avoidance and depression: The construction

of the cognitive behavioral avoidance scale.

Behaviour Research and Therapy, 42, 293–

313.

Porges, S. W. (2007). The polyvagal perspective.

Biological Psychology, 74, 116–143.

Radkovsky, A., McArdle, J., Bockting, C., &

Berking, M. (under review). Emotion regula-

tion skills predict subsequent reduction of

symptom severity in patients suffering from

major depressive disorder: A latent change

analysis. Journal of Consulting and Clinical

Psychology.

Rothermund, K. (2003). Automatic vigilance for

task- related information: Perseverance after

failure and inhibition after success. Memory

and Cognition, 31, 343–352.

Saarni, C. (1999). The development of emo-

tional competence. New York: Guilford Press.

Salovey, P., & Mayer, J. D. (1990). Emotional

intelligence. Imagination, Cognition, and Per-

sonality, 9, 185–211.

Stemmler, G. (2004). Physiological processes dur-

ing emotion. In P. Philippot & R. S. Feldman

(Eds.), The regulation of emotion (pp. 33–70).

Mahwah, NJ: Erlbaum.

Swart, M., Kortekaas, R., & Aleman, A. (2009).

Dealing with feelings: Characterization of

trait alexithymia on emotion regulation strate-

gies and cognitive- emotional processing. PLoS

ONE, 4(6), e5751.

Teasdale, J. D., & Barnard, P. J. (1993). Affect,

cognition and change: Re- modelling depres-

sive thought. Hove, UK: Erlbaum.

Van Rijsbergen, G. D., Bockting, C. L. H.,

Berking, M., Koeter, M. W. J., & Schene,

A. H. (2012). Can a one-item mood scale do

the trick?: Predicting relapse over 5.5-years

in recurrent depression. PloS ONE, 7(10),

e46796.

Velten, E. (1968). A laboratory task for the induc-

tion of mood states. Behavioral Research and

Therapy, 6, 473–482.

Vuilleumier, P., Richardson, M. P., Armony, J.

L., Driver, J., & Dolan, R. J. (2004). Distant

influences of amygdala lesion on visual corti-

cal activation during emotional face process-

ing. Nature Neuroscience, 7(11), 1271–1278.

Weissman, S., & Weissman, R. (1996). Medi-

tation, compassion and lovingkindess. An

approach to Vipassana practice. York Beach,

ME: Weiser.

Wenzlaff, R. M., & Wegner, D. M. (2000).

Thought suppression. Annual Review of Psy-

chology, 51, 59–91.

Werner, K., & Gross, J. J. (2010). Emotion regu-

lation and psychopathology: A conceptual

framework. In A. M. Kring & D. M. Sloan

(Eds.), Emotion regulation and psychopathol-

ogy: A transdiagnostic approach to etiology

and treatment (pp. 13–37). New York: Guil-

ford Press.

Wupperman, P., Marlatt, G. A., Cunningham,

A., Bowen, S., Berking, M., Mulvihill- Rivera,

N., et al. (2012). Mindfulness and modifica-

tion therapy for behavioral dysregulation:

Results from a pilot study targeting alcohol

use and aggression in women. Journal of Clin-

ical Psychology, 67, 1–17.

Wupperman, P., Neumann, C. S., & Axelrod, S.

R. (2008). Do deficits in mindfulness underlie

borderline personality features and core diffi-

culties? Journal of Personality Disorders, 22,

466–482.

548

Mindfulness training (MT) represents the

secular adaptation of Buddhist contem-

plative practices aimed to reduce suffer-

ing and foster well-being. Over the past

three decades, MT interventions have been

increasingly recognized for their ability to

reduce psychological distress across a vari-

ety of clinical disorders (Baer, 2003; Bohl-

meijer, Prenger, Taal, & Cuijpers, 2010;

Grossman, Niemann, Schmidt, & Walach,

2004). They have been particularly effective

in promoting adaptive emotion regulation

in affective disorders such as anxiety and

depression (Hofmann, Sawyer, Witt, & Oh,

2010; Piet & Hougaard, 2011), and appear

to promote self- regulated behavior and posi-

tive emotional states (Brown, Ryan, & Cre-

swell, 2007). Our understanding of mind-

ful emotion regulation is imperfect, but it is

supported by a recent groundswell of exper-

imental and clinical research (for detailed

reviews, see Holzel et al., 2011; Shapiro,

Carlson, Astin, & Freedman, 2006).

This chapter outlines the theoretical foun-

dations of mindfulness, the mechanisms by

which MT appears to support adaptive emo-

tion regulation, and its most prevalent forms

of delivery. We begin by exploring definitions

of mindful emotion regulation, integrating

contributions from Western psychological

research and Buddhist contemplative theory.

From these perspectives, mindfulness can be

viewed as a regulatory strategy that operates

primarily at the level of attention deployment,

subsequently promoting a unique blend of

regulatory techniques. Next, we discuss how

mindfulness is developed through attention

training, reviewing emergent research on the

cognitive and neural mechanisms associated

with MT interventions. Psychologically, the

primary mechanism in MT interventions is

the promotion of present- moment awareness,

which is realized through the cultivation of

interoceptive attention and an attitude of

acceptance toward experience. Neurosci-

entifically, three mechanisms of training

are evident: (1) increased access to sensory

representation; (2) decreased activation of a

network for habitual self- elaboration; and,

in longer term practitioners, (3) increased

attentional stability and decreased reactivity

to emotion provocation. Finally, we review

some of the best- validated MT interventions,

discussing their clinical benefits and limita-

tions, and exploring future directions for

research in this field.

CHAPTER 32

Mindfulness Interventions

and Emotion Regulation

Norman A. S. Farb

Adam K. Anderson

Julie A. Irving

Zindel V. Segal

Mindfulness Interventions and Emotion Regulation 549

What Is Mindful

Emotion Regulation?

Mindfulness has been described as “the

awareness that arises from paying attention

on purpose, in the present moment and non-

judgmentally to things as they are” (Wil-

liams, 2007, p. 47). This definition distin-

guishes mindfulness from regulatory efforts

to improve the hedonic tone of experience,

such as using cognitive reappraisal to make

an image of suffering appear less aversive

(Gross, 2002). Instead, mindfulness pro-

motes exploratory attention to momentary

experience regardless of its unpleasantness.

Such exploration creates opportunities for

insight into one’s mental habits, reducing

automatic efforts to control or manipulate

feeling states. Indeed, the Pali term vipas-

sana, which is the origin of the English

term mindfulness, literally means “insight”

(Bischoff, 1996). To describe how such

insight occurs, we present a mindfulness

theory that is consistent with both Buddhist

and secular models of emotion regulation.

Mindfulness from a Buddhist/

Contemplative Model of Mind

Much of Buddhist theory on mindfulness

is contained in a discourse known as the

Maha Sattpatthana Sutta, which translates

to “the Great Discourse on the Foundations

on Mindfulness” (Silananda, 2002). Within

this history of the Buddha’s teachings, mind-

fulness rests upon four contemplative foun-

dations that represent necessary targets for

attentional focus. These foundations are (1)

the body, (2) feelings, (3) the mind or con-

sciousness, and (4) the Dhammas, or mental

qualities. It is telling that these first three

foci explicitly exclude conceptual elabora-

tion or judgment but instead entail the allo-

cation of attention to concretely perceived

experiences, such as physical sensations,

emotional responses, and thoughts. The

fourth category, the Dhammas, describes

the optimal attitudes and common pitfalls

surrounding mindful attention to objects

in these first three categories. In effect, this

fourth category serves as a set of top-down

regulatory goals for effective mindfulness

practice. It is asserted that it is only through

the correct practice of attention deployment

that the pinnacle of emotion regulation may

be achieved: the complete extinction of suf-

fering.

Mechanistically, the primary tenet of

the Buddhist psychological framework is

that the mind may only hold one object at

a time. Therefore, attention deployment to

the firt three foundations limits conceptual

elaboration that triggers or extends nega-

tive emotion (Silananda, 1998). Thus, in the

face of an emotional challenge, mindfulness

includes the somewhat paradoxical regula-

tory instruction to focus directly upon one’s

negative feelings; by focusing on a feeling

rather than its inciting attentional object, a

person diminishes the elaborative appraisal

that iteratively incites negative feeling. Over

time, it is argued, the habitual tendency

to engage in negative appraisals will itself

diminish, as one internalizes the practice

of nonjudgmental attention. Of course, let-

ting go of past events, particularly aversive

ones, is often easier said than done. Thus,

Buddhist psychology has a rationale for

using meditation formally to train attention.

Mindfulness from a Buddhist perspective

is therefore a practical rather than mystical

regulatory strategy, complete with its own

psychological account of emotion regula-

tion. The phenomenological description of

how attention deployment leads to the atten-

uation of negative emotions provides a rich

set of hypotheses compatible with Western

psychological models of emotion regulation.

Mindfulness from a Psychological

Science Perspective

The idea of attention deployment as emo-

tion regulation is not foreign to scientific

accounts of emotion regulation. For exam-

ple, the process model distinguishes between

multiple strategies for regulation that can

occur before and after emotional awareness,

distinguishing broadly between antecedent-

focused and response- focused regulation

(Gross, this volume). Generally speaking,

the earlier one regulates emotion following

stress perception the better: For example,

the antecedent- focused strategy of cognitive

reappraisal appears to be a healthier regu-

latory strategy than the response- focused

strategy of expressive suppression, leading

to lower stress- related symptoms (Gross

& John, 2003; Moore, Zoellner, & Mol-

lenholt, 2008). However, most research

550 INTERVENTIONS

on antecedent- focused emotion regulation

focuses on appraisal processes, a relatively

late regulation strategy for cognitive change.

Few studies have examined earlier forms of

regulation such as attention deployment, and

those that do tend to focus on distraction

(Gross, this volume), a withdrawal- oriented

strategy often employed in the face of high-

intensity emotional challenge (Sheppes, this

volume).

Mindfulness substantively contributes

to psychological models of emotion regu-

lation by advancing a regulatory model of

approach- oriented attention deployment

(Figure 32.1A). Unlike distraction, mindful-

ness is characterized by acceptance rather

than withdrawal from aversive emotional

experience (Kabat-Zinn, 1982). Through

MT, participants learn nonjudgmental

attention to present- moment sensation,

returning attention their situation rather

than progressing to appraisal processes

and responses (Figure 32.1B). By engaging

cognitive resources in effortful attention

deployment, mindfulness limits the recruit-

ment of habitual secondary appraisals and

reactions. The disruption of automatic reac-

tions and return to sensory attention allows

new aspects of a situation to be perceived,

effectively altering situation construal. This

altered situation perception then permits the

generation of novel responses rather than

mapping experiences into a preexisting con-

ceptual field. The iteration between “top-

down” attentional control and “bottom- up”

sensation forms the basis for how mindful-

ness promotes insight and limits appraisals

of suffering (Teasdale & Chaskalson, 2011).

Since responses following such iteration

are more finely tuned to the idiosyncratic

demands of the situation, they can be more

adaptive and appropriate than habitual reac-

tions (Figure 32.1C). Thus, despite its pri-

mary focus on the deployment of attention,

mindfulness appears to impact additional

stages of the regulatory process: It intro-

duces novel regulatory intentions, facilitates

novel appraisals of emotional experience,

and promotes expression rather than sup-

pression of emotional responses.

What Makes Mindful Emotion

Regulation Unique?

Framing mindfulness within the process

model does not undermine the unique con-

FIGURE 32.1. A process model account of mindful emotion regulation. Mindfulness can be situated

in Gross’s (2002) process model of emotion regulation, acting primarily on attention deployment (Panel

A). Attention redeployment allows new situation perception, without requiring an immediate emo-

tional response, thereby promoting the flexible generation of novel appraisals and responses (Panel B).

The repeated redeployment of attention to sensation serves to interfere with and eventually extinguish

habitual appraisals (Panel C).

Antecedent-Focused

Emotion Regulation

Response-Focused

Emotion Regulation

Mindfulness Interventions and Emotion Regulation 551

tribution of mindfulness to existing mod-

els of emotion regulation. Mindfulness is

unique in promoting meta- awareness of

emotion regulation strategies, detecting and

disrupting rumination, and in creating a tra-

jectory for self- change. We describe each of

these capacities in detail below.

First, mindfulness serves as a meta-

strategy: While MT practices begin with an

emphasis on attention deployment, this atten-

tional focus is designed to cultivate awareness

of regulatory habits. In acknowledging these

habits, a person is then better able to choose

flexibly between regulatory responses rather

than automatically defaulting to particular

strategies. Perhaps because of its adaptive

nature, mindfulness often leads to superior

regulatory effects when compared to exist-

ing forms of regulation mentioned in the

process model, such as expressive suppres-

sion (Liverant, Brown, Barlow, & Roemer,

2008), rumination (Arch & Craske, 2006),

or distraction (Goldin & Gross, 2010). This

is not to disparage the value of any of the

aforementioned techniques, but rather to

suggest that mindfulness may enhance regu-

lation by increasing flexibility in regulatory

strategy selection. By cultivating an attitude

of curiosity in response to an emotional chal-

lenge, mindfulness provides an opportunity

to tailor regulatory responses to address

both personal coping capacity and fluctuat-

ing situational demands.

A second unique contribution of mindful-

ness to emotion regulation is its ability to

disrupt rumination or rehearsal of negative

emotional triggers. By widening attention to

focus on the evolving nature of emotional

experience, mindful attention disrupts cog-

nitive elaboration on negative events. Many

of us have had the experience of ruminating

at length over a perceived slight. By mind-

fully attending to momentary experience

rather than rehearsing an upsetting memory,

negative emotions are permitted to subside.

Consistent with this theory, research sug-

gests that mindfulness is particularly effec-

tive for reducing dysphoric rumination,

outperforming relaxation training control

groups in several cases (Feldman, Gree-

son, & Senville, 2010; Jain et al., 2007). By

attending to negative emotions rather than

treating them as a problem to be solved,

mindfulness reduces suffering by limiting

cognitive elaboration on aversive events.

A third unique contribution of mindful

emotion regulation is its ability to promote

a trajectory of self- change. Mindfulness

requires an intensive investment: As dis-

cussed below, participants in MT interven-

tions are asked to engage in meditative prac-

tices for about an hour a day for 8 weeks

or more, with the explicit goal of increasing

mindfulness throughout daily life. Partici-

pants are asked to take on attitudinal quali-

ties in a trait-like manner. While salutary

MT effects have been observed after train-

ing periods as brief as 20 minutes a day for 3

days (Zeidan, Gordon, Merchant, & Gool-

kasian, 2010), longitudinal benefits of mind-

fulness are more frequently reported follow-

ing training periods of weeks or more. It is

unknown whether formal training regimens

involving reappraisal or suppression gener-

ate similar levels of self- reported change,

although there is reason to believe that that

MT employs unique mechanisms for effect-

ing change, as discussed more fully below.

How Does MT Work?

Attending nonjudgmentally to negative

emotion is often easier said than done.

For this reason, mindfulness is viewed as

a skill that requires training and practice.

Like other traditions in the growing “third

wave” of cognitive psychotherapy tech-

niques (Hayes, 2004), MT is designed to

promote self- awareness of the interpretive

context that drives a person’s maladaptive

reactions. Yet, unlike talk- therapy interven-

tions, MT employs formal meditation prac-

tice to achieve these aims. In mainstream

interventions such as cognitive- behavioral

therapy (CBT), insight is a stepping- stone to

the main therapeutic focus: The recognition

of maladaptive patterns of appraisal allows

their replacement with adaptive alternatives.

In MT, however, increased awareness into

automatic reaction patterns is itself the goal

of the intervention. It is fair to wonder then:

How does awareness alone promote adap-

tive behavior? In this section, we outline

how MT impacts attention, and through

such effects improves the well-being of its

practitioners.

To strengthen attention, MT begins with

concentrative attention practices that often

focus on physical sensations, such as fine-

552 INTERVENTIONS

grained “body scans,” in which individuals

attend to physical sensation from specific

body parts, or feelings of respiration (Kabat-

Zinn, 1990). Such concentrative practices

may already hold some regulatory benefits,

because intense focal attention on a particu-

lar object may help to dissolve self– object

boundaries (Lutz, Slagter, Dunne, & David-

son, 2008), and thereby help to suspend pat-

terns of self- absorbed rumination. However,

mindfulness practices then transition from

focal attention to open monitoring, wide-

spread attention to all sensations, thoughts,

and emotions. Open- monitoring practices

aim to increase awareness of the transi-

tory nature of experience, yielding insight

into one’s own habitual patterns of distrac-

tion and reaction. Encouragingly, short-

term mindfulness interventions appear to

increase the ability to notice changes in the

sensory field and refocus attention appro-

priately (Jha, Krompinger, & Baime, 2007;

Schmertz, Anderson, & Robins, 2009), and

may preserve working memory capacity that

would ordinarily degrade in times of stress

(Jha, Stanley, Kiyonaga, Wong, & Gelfand,

2010).

Of course, the ability to engage in open,

mindful attention is not purely an acquired

skill; we are all mindful of different things

during the day. Nonjudgmental, open

awareness has been shown to arise natu-

ralistically, particularly in conjunction with

positive moods (Fredrickson & Branigan,

2005). The tendency to be mindful may vary

widely from person to person, as attested to

by recently developed mindfulness scales,

which also demonstrate that these trait indi-

ces of mindfulness appear to increase with

meditative practice (Baer et al., 2008; Lau et

al., 2006; Walach, Buchheld, Buttenmuller,

Kleinknecht, & Schmidt, 2006). Conversely,

trait mindfulness may also predict respon-

siveness to MT and the specific attention

tasks therein (Shapiro, Brown, Thoresen, &

Plante, 2011), suggesting a reinforcing cycle

among central components of mindful inten-

tions, attention practice, and attitudes.

Central Components of MT

Mindfulness- based interventions appear to

operate at multiple stages of emotion regu-

lation. At a higher- order, conceptual level,

MT represents an interplay between par-

ticipants’ intentions for self- improvement,

the attentional practices themselves, and the

use of these practices to foster an attitude

of acceptance and nonreactivity to negative

emotion (Shapiro, Carlson, Astin, & Freed-

man, 2006). At a mechanistic level, mind-

fulness can be explained by the effects of the

attentional practices themselves, detailing

how mindful attention alters the preexist-

ing relationship between events and subse-

quent self- attribution, limiting automatic

self- evaluative processing (Frewen, Evans,

Maraj, Dozois, & Partridge, 2008). To pro-

vide a complete account of how mindfulness

impacts each aspect of emotion regulation,

we present intention, attention, perception,

implication, and attitude in a single concep-

tual model (Figure 32.2).

While empirical research has focused on

how mindfulness alters cognition through

attention training, it is important to rec-

ognize that the success of such practices

depends on a participant’s motivation and

expectations for such training. The gen-

eration of a proper intention is critical to

the success of contemporary MT practices

(Kabat-Zinn, 1990; Shapiro & Schwartz,

2000); participants must expect to have

some benefit from the practice to engage

consistently in a novel and intensive practice

of restructuring cognitive habits. Within the

meditative practices themselves, intentions

serve as a foundation for the direction of

attention; by formally setting an intention to

attend to one’s body or breath, a wander-

ing mind becomes indicative of a correctable

loss of attention. Central to holding “right

intention” in mindfulness is the promotion

of participant autonomy, that participants

are ultimately accountable to themselves for

their self- improvement efforts. For example,

in therapeutic contexts, MT emphasizes

daily, self- directed practice rather than rely-

ing on the clinician for directing inquiry

and generating new appraisals. Mindfulness

teachers provide the occasional reminder to

check for mind wandering during these prac-

tices, but with decreasing frequency over the

weeks of a mindfulness course. Instead, par-

ticipants are entrusted with an increasing

responsibility for monitoring and reallocat-

ing attention during meditation. Indeed, it

has been argued that one yardstick of mind-

ful intentions may be participants’ willing-

ness to ascribe personal responsibility for

their reactions to stressful events (Lakey,

Kernis, Heppner, & Lance, 2008).

Mindfulness Interventions and Emotion Regulation 553

The second major factor in MT inter-

ventions is attention. The distinguishing

characteristic of MT is a set of meditative

practices focusing on sensory experiences of

the body. These meditative practices serve

at least three major functions in promoting

adaptive emotion regulation. First, atten-

tion to momentary changes in body sensa-

tion creates a broad awareness of experience

than extends beyond a vigilant or ruminative

focus on stressors. By attending to a broader

set of experiences from moment to moment,

participants learn to reperceive the world

(Shapiro et al., 2006). Reperceiving refers

to the developed capacity to disengage from

“the drama of our personal experience” and

attend to novel sensations and interpreta-

tions (p. 377). Second, this broader atten-

tional focus creates a psychological distance

between dysphoric feelings and broader self-

attributions about efficacy or value. This

psychological distancing is known as decen-

tering, in which self- and situational apprais-

als are experienced as momentary events

rather than immutable facts (Fresco, Segal,

Buis, & Kennedy, 2007). Finally, the novel

perspective afforded by decentering may

serve to disrupt habitual interpretations,

creating a broadened context for appraisal

(Garland, Gaylord, & Fredrickson, 2011).

An increased ability to disengage from rumi-

native self- elaboration in favor of sensory

exploration constitutes a broader context

from which to view the world. From this

broadened context, participants are able to

explore novel interpretations for events and

more skillful means for responding to emo-

tional challenges.

The final major factor in MT is attitude.

Negative emotions naturally arise during

both meditative practice and in everyday life.

However, it is one’s attitude toward these

emotions that determines whether they are

appraised as self- diagnostic. For example,

attention and reflection on negative emotions

can be beneficial when approached with an

attitude of curiosity and openness, leading

to constructive cognitive reappraisal; how-

ever, this same reflective process can be mal-

adaptive when accompanied by an attitude

that negative emotions are unacceptable

and problematic, breeding rumination and

dysphoric self- evaluation (Gotlib & Joor-

mann, 2010). To counter this maladaptive

tendency, nonjudgment is espoused as a core

attitudinal goal in MT, a goal supported by a

constitutive attentional practice. To cultivate

nonjudgment, participants strive to direct

attention away from judging the validity

of experience and toward attending to the

sense of the experience itself. Over time, the

habitual reorienting of attention to sensation

FIGURE 32.2. Broader regulatory consequences of mindfulness. Mindfulness effects extend beyond

attention deployment in modulating stress responses. Different stages of the process model for emotion

regulation are displayed for conventional (top panel) and mindful (bottom panel) stress responses. Con-

ventionally, stressful situations are construed as demanding a regulatory response, prompting attention

to the stressor, dysphoric appraisals, and generation of negative emotional responses. Mindfulness

acts on all four of these phases: Mindful intentions cast stressful situations as opportunities to prac-

tice; mindful attention broadens the field of awareness to include changes in sensation; and mindful

attitudes promote appraisals of engagement and responses of acceptance rather than an obligatory

dysphoric stance.

554 INTERVENTIONS

disengages automatic evaluative responses

to sensations, feelings, and thoughts. In this

fashion, a negative emotion or disparaging

thought about oneself is treated as a momen-

tary experience with no more self- diagnostic

value than an itch upon the skin.

While the relationship between intention,

attentional practices, and attitude can be

seen as a linear progression in the cultiva-

tion of mindful emotion regulation skills,

realistically these components are mutually

reinforcing (Shapiro et al., 2006). Below we

discuss how the interplay among these com-

ponents creates a mechanism for promoting

stress tolerance and well-being.

Psychological Mechanisms

of Mindfulness Training

A recent review of the research literature

links MT to improved attention, body

awareness, emotion regulation, and altered

self- perception (Holzel et al., 2011). How

MT practices generate these positive changes

may, however, benefit from further clarifica-

tion. It may seem strange, for instance, that

repeated attention to body sensations should

provide widespread therapeutic benefits.

How can attention to the breath and other

physical sensations promote a broadening

of attention and reduction of automatic pat-

terns of reactivity? Furthermore, one may

question the importance of attending to emo-

tional appraisals in the first place. Emotions

hold a natural capacity to capture attention

(Ohman, Flykt, & Esteves, 2001); why then

would practice in attending to emotions help

in regulating them? To address these ques-

tions, we expand upon a theoretical model

(Bishop et al., 2004) of how mindful atten-

tion directly supports adaptive emotion reg-

ulation based on two major principles: (1)

attention to the present: broad attention to

present- moment sensation, with an empha-

sis on body sensation rather than cognitive

deliberation; and (2) nonjudgment: the sus-

pension of judging experience to be intrinsi-

cally good or bad in favor of a more general

attitude of acceptance. Together, these prin-

ciples mutually support the gradual process

of reconfiguring attention and cognition,

extinguishing maladaptive patterns of reac-

tivity, and introducing cognitive flexibility

in the response to stress (Figure 32.3).

FIGURE 32.3. The two foundations of mindful attention: Attention to the present and nonjudgment.

Together they support a suspension of self- critical evaluation and are revelatory of reactivity habits.

Over time, such information can yield insights that afford the creation of novel and more adaptive

stress responses, help to dismantle existing patterns of reactivity, and can prevent the formation of

novel conditioned or “knee-jerk” reactions to stress.

Mindfulness Interventions and Emotion Regulation 555

Attention to the Present

The cultivation of momentary awareness is

central to mindfulness practices. Through

repeated exercises in attending to the sensa-

tions of the breath or different regions of the

body, participants are encouraged to develop

interoception, an awareness of momentary

sensations from inside the body. These sen-

sations then act as an access point for under-

standing one’s reactions to the world as

they unfold; rather than conceptually inter-

preting or predicting responses to events,

participants are encouraged to explore

their actual reactions “in real time,” using

interoceptive attention to monitor changes

in body sensation from moment to moment.

While myriad factors determine the efficacy

of a mindfulness intervention, attention to

interoceptive sensation is important for sev-

eral reasons. First, focusing on body sensa-

tion helps to suspend evaluative processes,

disrupting the habitual progression from

sensation to appraisal by redirecting atten-

tional resources from such processes. Sec-

ond, in the absence of habitual evaluation, a

person extends the time course of appraisal,

reducing the need to quickly map events on a

preexisting conceptual field, thereby disem-

powering deeply entrenched dysphoric inter-

pretations. Third, interoception serves as an

indication of physiological stress: By notic-

ing one’s breathing, heartbeat, muscle tone,

or digestion change, one can gain insight into

one’s own emotional appraisals and notice

the kinds of situations that trigger automatic

reactions. Finally, this sensitivity to environ-

mental triggers allows for the revelation of

reactive habits, because intrusive cognitive

failures of interoceptive attention provide an

opportunity to notice where the mind goes

when it wanders. Perhaps because interocep-

tive perceptual details are so distinct from

thoughts and evaluations, these details act

as attentional “anchors” for perception that

make mind wandering more apparent.

Nonjudgment

The cultivation of present- moment attention

is complemented by an intention to refrain

from judgment and cognitive reactivity.

Nonjudgment supports formal meditation

practice, and also works with attention to

the present moment to regulate emotional

challenge adaptively. The formal practice of

mindfulness meditation offers ample oppor-

tunity to cultivate nonjudgment. Mind wan-

dering is inevitable during the attempted

maintenance of interoceptive attention,

prompting from participants a range of

negative reactions, such as self- criticism,

anxiety, frustration, or dejection. Rather

than deny, suppress, or distract attention

from these lapses and subsequent feelings,

participants are encouraged to notice and

accept all experience, including attentional

lapses and feelings of frustration. This atti-

tude of acceptance then allows a more rapid

return to present- moment sensation than

would be expected from digression into self-

recrimination.

The practice of nonjudgment also has

important implications for emotion regula-

tion beyond formal meditation practices.

By focusing on noticing changes in experi-

ence rather than formulating reactions, an

attitude of nonjudgment limits the asso-

ciation between initial appraisals of failure

or challenge and subsequent dysphoric or

avoidant secondary appraisals. This cur-

tailing feature of nonjudgment is critical to

recovery from affective and substance use

disorders, in which inciting mental apprais-

als habitually lead to self- destructive men-

tal and behavioral habits (Scher, Ingram,

& Segal, 2005). Indeed, both dispositional

and treatment- related increases in mindful-

ness predict greater facility in letting go of

negative thoughts (Frewen et al., 2008), and

lower levels of avoidance and rumination

(Kumar, Feldman, & Hayes, 2008). This

development of nonjudgment can be thought

of as two complementary and related capaci-

ties: acceptance of experience and decenter-

ing from attributing self- relevance to experi-

ence, which together support the outcomes

of interoceptive attention described ear-

lier. First, acceptance indicates a willing-

ness to tolerate outcomes even when they

diverge from intentions, limiting the auto-

matic expansion of evaluative reactions. For

example, one study of a mindfulness inter-

vention reported improved quality- of-life,

depression, and fatigue scores in a multiple

sclerosis population, but unaltered ratings of

physical symptoms, such as lower and upper

limb mobility (Grossman et al., 2010), sug-

gesting that the symptom acceptance train-

ing reduced broader secondary appraisals to

556 INTERVENTIONS

produce a training benefit. Second, decenter-

ing involves reducing reliance on conceptual

self- appraisal as the primary determinant

of well-being. Instead, such self- appraisal

is viewed on par with physical sensation, a

momentary experience that does not imply

the existence of a temporally extended,

enduring self. Recent research suggests that

the ability to view one’s emotional reac-

tions from a more objective viewpoint is a

critical determinant of whether reflection on

emotion can be constructive or degenerate

into maladaptive rumination (Kross, Gard,

Deldin, Clifton, & Ayduk, 2012).

Together, attending to the present and

cultivating a nonjudgmental attitude mutu-

ally reinforce one another: Present- moment

attention provides a context in which to

practice nonjudgment, and nonjudgment

enhances the stability of attention. Beyond

supporting each other, these two principles

can account for many of the benefits attrib-

uted to MT. First, mindfulness enables the

extinction of reactive habits by removing

conditioned appraisal responses from their

triggering stimuli and replacing them with

interoceptive attention. For example, MT

has helped chronic pain sufferers to reduce

subjective reports of distress, although the

intensity of pain sensation ratings themselves

did not change (Morone, Greco, & Weiner,

2008; Rosenzweig et al., 2010). Second, by

reducing reactive habits, mindfulness affords

new, creative appraisals, allowing a person

to approach experiences with a sense of

curiosity and exploration. Novel appraisals

then may extend to include previously unat-

tended positive elements, including inter-

personal relationships, enjoyment of daily

activities, or compassion toward oneself and

others (Allen, Bromley, Kuyken, & Sonnen-

berg, 2009; Kuyken et al., 2010). Third, con-

tinued mindfulness practice prevents future

stress conditioning and provides competing

knowledge of constantly changing intero-

ceptive sensations that weakens the need

to turn to conceptual evaluations (Kabat-

Zinn, 1990). The suspension of engagement

in automatic conceptual evaluation during

stress can thereby prevent further condition-

ing of dysphoric cognition. For example,

participants completing MT reported signif-

icant reduction in their experience of daily

hassles and distress compared to a control

group (Williams, Kolar, Reger, & Pearson,

2001). Together, these psychological mecha-

nisms promote and sustain flexibility in the

regulatory response to emotional challenge.

Neural Mechanisms

of Mindfulness Training

The notion that MT cultivates a qualita-

tively distinct approach to emotion regula-

tion is supported by emerging neuroscience

research. Traditionally, emotion regulation

such as reappraisal has been associated with

the prefrontal cortex (PFC), which tends

to be active during the manipulation and

evaluation of information (Ochsner, Bunge,

Gross, & Gabrieli, 2002). The PFC in turn

appears to be component of a broader fron-

toparietal attention network associated with

directing attention to external objects, fil-

tering the endless stream of sensory infor-

mation based on its motivational relevance

(Corbetta & Shulman, 2002). In a sense,

this well- defined attention system seeks to

fix sensory information as a set of objective

facts that can be judged as being good or bad

depending upon their relationship to a per-

son’s goals. In the case of an undesired out-

come, cognitive reappraisal directs attention

toward changing one’s interpretive context

to mitigate the obligatory emotional impact

of contextually derived failure appraisal on

the self.

Mindfulness, however, argues for a quali-

tative shift away from attachment to exter-

nal outcomes. To do so, there is an attempt

to shift attention away from attentional hab-

its that link external sensations to concep-

tual manipulation and elaboration. Instead,

MT teaches individuals to direct attention

internally, to representation of visceral

components of emotion, as supported by a

distinct neural pathway for interoception,

the sensation of the body’s internal state,

including signals from the breath (Farb,

Segal, & Anderson, 2013; Farb et al., 2007),

and heartbeat (Lutz, Greischar, Perlman, &

Davidson, 2009). Through reliance on the

transitory and unelaborated representations

of internal body states, MT may appeal to a

relatively unconditioned system in the sense

that such physical sensations do not have the

same level of association with conceptual

elaboration or regulatory reactivity. Indeed,

one reason that many mindfulness practices

involve interoceptive attention is that such

Mindfulness Interventions and Emotion Regulation 557

practices improve the stability and frequency

with which one perceives the transitory and

reinterpretable nature of human experience

(Baer, Smith, Hopkins, Krietemeyer, &

Toney, 2006; Brown et al., 2007; Ivanovski

& Malhi, 2007; Kabat-Zinn, 1982).

Recent research evidence supports the

idea that MT improves interoceptive access

by decoupling sensory cortices from brain

networks involved in the habitual evaluation

and elaboration of experience. Activation of

cortical midline regions such as the medial

prefrontal cortex (mPFC) appear are asso-

ciated with self- referential evaluation (Farb

et al., 2007; Kelley et al., 2002), depres-

sive rumination (Farb, Anderson, Bloch, &

Segal, 2011), and negative mood (Farb et al.,

2010; Goldin & Gross, 2010). MT appears

to reduce both rumination (Ramel, Goldin,

& Carmona, 2004) and cortical midline

activation (Farb et al., 2010; Goldin, Ramel,

& Gross, 2009); furthermore, mindful

attention can begin to reduce mPFC acti-

vation even in untrained individuals (Farb

et al., 2007). Meditation has been linked

to extensive cortical deactivations (Baeren-

sten et al., 2010; Ives- Deliperi, Solms, &

Meintjes, 2011; Lazar et al., 2000), suggest-

ing its importance for disengaging concep-

tual processing. Following training, par-

ticipants demonstrate a reduced connection

between sensory and evaluative cortices, but

greater connectivity within sensory cortices

and between the brain’s executive control

regions and sensory cortices (Farb et al.,

2007, 2013; Kilpatrick et al., 2011).

A third important neural mechanism by

which MT promotes effective emotion regu-

lation is by enhancing attention control in

more experienced meditators. In one study,

3 months of intensive meditation training

was associated with reduced variability in

low frequency brain signal electroencepha-

lographic (EEG) activity (Lutz, Slagter, et

al., 2009). These brain changes were cor-

related with reduced variability in reaction

time in a focused attention task, suggesting

that this stabilization of neural activity rep-

resents a more stable cognitive workspace in

which to perceive and manipulate sensory

objects. Furthermore, long-term meditators

demonstrated reduced network strength in

the cortical midline default network associ-

ated with conceptual elaboration and mind

wandering but enhanced connectivity within

attention- controlling brain regions (Brewer

et al., 2011), again denoting an improved

ability to resist distraction and to effectively

deploy attention.

In advanced stages, there is evidence

to suggest that mindfulness training may

itself become automatic and promote trait-

like effects. An intriguing neuroimaging

study examined the meditative state across

a range of practice experience (Brefczynski-

Lewis, Lutz, Schaefer, Levinson, & David-

son, 2007). Relatively novice meditators

demonstrated pervasive cortical and limbic

activation relative to controls when entering

a meditative state, typical of engagement in

an effortful and resource intensive cogni-

tive process. However, advanced meditators

(with more than 10,000 hours of practice)

showed little neural change during medita-

tion, suggesting that their default state may

have become something akin to mindful

attention. Thus, the long-term effects of MT

may involve a reconfiguration of the brain’s

information processes to dwell primarily in

unelaborated sensation, in contrast to the

highly automated pattern of cognitive elabo-

ration found in most studies of Westerners

to date.

Therapeutic Applications

of Mindfulness

The first documented clinical effect of MT

was reducing the suffering of patients with

chronic pain (Kabat-Zinn, 1982). Sub-

sequent research has confirmed that the

affective appraisal of pain is altered when

experienced through an open, mindful state

(Perlman, Salomons, Davidson, & Lutz,

2010). Freed from pain- reactive, negative

appraisals about one’s self-worth and quality

of life, cognition can be engaged construc-

tively toward the cultivation of empathy and

compassion (Leary, Tate, Adams, Allen, &

Hancock, 2007).

The reframing of painful or otherwise

upsetting experiences is especially impor-

tant in mood disorders. The effortful down-

regulation of negative emotion is perceived

as more difficult by patients with a mood

disorder (Keightley et al., 2003), for whom

self- compassion seems like a worthwhile but

unachievable strategy (Pauley & McPherson,

2010). An important clinical implication of

558 INTERVENTIONS

these findings is that for patients with mood

disorders, instructions to reappraise cogni-

tively or otherwise regulate negative emotion

may be ineffective. In depression, powerful

and habitual dysphoric interpretations may

be activated during such regulatory efforts,

leading to rumination, in which elaborating

on negative affect ironically perpetuates dys-

phoric mood (Nolen- Hoeksema, 2000; Wat-

kins, Moberly, & Moulds, 2008).

If the engagement of a patient’s cognitive

faculties only serves to exacerbate negative

mood states, one might question how any

behavioral intervention can effect positive

change. Since cognitive elaboration efforts

may automatically trigger negative self-

judgments that cannot be voluntarily over-

ridden, MT provides an alternative to such

elaborative habits. Through the cultiva-

tion of attention to unelaborated, present-

moment sensation, mindfulness presents

patients with a task that does not require

the deployment of cognitive evaluation and

elaboration. Furthermore, by explicitly

practicing nonjudgment, patients can begin

to recognize and disengage from conceptual

judgment in response to their sensory expe-

riences.

Critically, mindful emotion regulation

does not aim to inhibit elaborative process-

ing through thought avoidance, a regulatory

strategy that ironically predicts dysphoric

affect (Ottenbreit & Dobson, 2004). In

MT, attention is instead positively directed

toward present- moment sensation, pro-

viding a nonconceptual and nonthreaten-

ing attentional focus that does not rely on

cortical midline activity. Depression can

be thought of as a combination of both

approach deficits and heightened avoidance

motivation (Trew, 2011); mindfulness tar-

gets both types of motivation, replacing the

tendency to avoid negative experiences with

an exploration of these experiences’ constit-

uent sensations.

As one might expect from such a funda-

mental mechanism of action, mindful emo-

tion regulation strategies can be applied

to a variety of contexts extending beyond

pain and depression. One recent review

catalogued beneficial psychological effects

of mindfulness- based interventions in the

treatment of anxiety disorders, substance

abuse, cancer, heart disease, arthritis, fibro-

myalgia, multiple sclerosis, psoriasis, and

HIV (Chiesa & Serretti, 2010). MT has also

been of benefit in older populations, par-

ticularly in improving the coping skills of

familial caregivers (Oken et al., 2010).

The recent proliferation of MT in clinical

contexts has been supported by the creation

of manualized therapeutic interventions.

Customized interventions now exist that

employ MT techniques to address the needs

of specific clinical populations, such as those

suffering from issues of pain, depression,

and addiction. The standardization of these

interventions has been critical for clinical

research, allowing a consistent application

MT to be evaluated in specific clinical con-

texts. Below, we discuss some of the most

widely researched therapeutic interventions

of mindfulness, detailing their background,

format, and target populations.

Mindfulness‑Based Stress Reduction

Background

Mindfulness- based stress reduction (MBSR)

was developed as an outpatient program

at the University of Massachusetts Medi-

cal School in 1979, based on creator Jon

Kabat-Zinn’s personal experience with

vipassana (insight) meditation, a practice

that originated in the millennia- old Thera-

vada Buddhist tradition. The first published

report on MBSR described reduced pain and

symptoms of negative mood in a group of

51 patients with chronic pain (Kabat-Zinn,

1982). Since that time, MBSR has been stan-

dardized with broad efficacy in reducing

chronic pain and stress.

Format

MBSR is delivered as an 8-week program.

Participants attend weekly group sessions

with between 10 and 30 participants, where

they are introduced to formal mediation

practices, gentle yoga, and psychosocial

education. The program also includes a day

of silent meditation retreat that falls in the

latter half of the course. Group members

are asked to practice yoga and/or medita-

tion for approximately 40 minutes a day for

homework, along with reflection and journ-

aling exercises. Formal meditation practices

Mindfulness Interventions and Emotion Regulation 559

include breath monitoring; body scans (the

progressive direction of attention to differ-

ent parts of the body); and diffuse direction

of attention to sounds, thoughts, feelings,

and bodily sensations. Group sessions gen-

erally last for 2.5 hours and focus on group

meditation practice and discussion of these

practices. However, other commonly dis-

cussed themes include stress and the body,

habitual patterns of reactivity, and creative

ways to respond to stress. Group dialogue

on difficulties in performing practices and

insights gained are also valuable compo-

nents of an MBSR course. During these dia-

logues, instructors model key components

of mindful awareness, such as noticing the

body sensations that accompany different

thoughts and impulses.

As part of the weekly homework, courses

often include diary exercises, which are later

discussed in the group setting. Commonly,

participants spend a week taking notice of

pleasant events, then a week on unpleasant

events, and another week on monitoring

stressful communications. However, com-

mon even to these externalized practices,

there is an emphasis on how these events

occurred from an interoceptive perspective

(i.e., how one felt in one’s body during these

events). There are no hard-and-fast rules for

course compliance, although participants

who are absent are typically contacted by

course instructors to probe commitment to

course participation. Participant retention

in MBSR is generally high, with 80% of

enrolled participants generally completing

the course (Farb et al., 2007; Kabat-Zinn,

Lipworth, & Burney, 1985).

Target Population

In healthy individuals (i.e., those without

a specific medical or psychiatric diagno-

sis), MBSR appears to yield substantial but

nonspecific reductions in reported levels of

stress, in addition to specific reductions in

levels of rumination and anxiety (Chiesa

& Serretti, 2009). Research suggests that

MBSR promotes well-being across a vari-

ety of clinical conditions, including chronic

pain, anxiety, fibromyalgia, cancer, psoria-

sis, and coronary artery disease (Baer, 2003;

Grossman et al., 2004). A third stream of

research suggests that MBSR benefits extend

to health care professionals, improving their

ability to cope with stress (Irving, Dobkin,

& Park, 2009). Finally, adapted forms of the

MBSR program have improved mental func-

tion and reduced stress in primary caregiv-

ers of people with terminal diseases such as

dementia (Oken et al., 2010) and advanced-

stage cancer (Lengacher et al., 2012).

Mindfulness‑Based Cognitive Therapy

Background

Mindfulness- based cognitive therapy

(MBCT) was developed to target the specific

challenges inherent in chronic mood disor-

ders. Major depressive disorder, a leading

cause of disability worldwide (Gelenberg,

2010), has a chronic, cyclical nature due to

high risk of relapse. Presently, maintenance

pharmacotherapy is the most widely imple-

mented approach to reducing relapse risk in

depression (Kupfer et al., 1992). However,

long-term antidepressant use involves prob-

lems with drug tolerance and side effects,

and does not target the dysphoric cognition

that contributes to relapse risk in response

to future stressors. Individuals with a his-

tory of depressive illness, including those

in remission, are prone to increased cogni-

tive reactivity, a pattern of increased nega-

tive self- judgment in response to emotion

challenge. Dysphoric cognitive reactivity

appears to be an important determinant

of depressive relapse, along with genetics,

environment, and social support (Segal et

al., 2006). However, such reactivity may

be modifiable; addressing these patterns of

dysphoric thinking may provide posttreat-

ment protection against relapse (Paykel et

al., 1999).

While Beck’s (1979) formulation of cogni-

tive therapy focused on modifying underly-

ing dysfunctional attitudes and core beliefs,

Ingram and Hollon (1986) argued that pro-

phylactic effects following remission are

dependent on enhancing an individual’s abil-

ity to take a distanced, disidentified perspec-

tive from depressive thoughts (i.e., decenter-

ing). To create a therapy that maximized

long-term prophylactic effects, Segal, Wil-

liams, and Teasdale (2002) expanded on the

existing CBT framework to create MBCT,

which uses mindfulness practices to develop

560 INTERVENTIONS

participant ability to engage in decentered

attention.

Format

The MBCT program involves medium- size

groups (between eight and 13 participants).

The length of sessions ranges between 2 and

2.5 hours in order to accommodate session

content flexibly and any clinical issues that

may arise. Participants are also offered a

full-day “silent retreat” between the sixth

and seventh weeks of the program. Every

session is initiated with a meditation to

ground participants in “being” mode and

help them to transition out of the business

and “doing” mode of their everyday lives.

Meditation practices include the body scan,

gentle yoga, and mindful walking, as well as

sitting meditation practices with foci such

as the breath, sounds, body sensations, and

thoughts. Each session includes a review of

the home practice, in addition to group dis-

cussion of insession mindfulness practices.

MCBT also features the 3-minute breath-

ing space, a condensed version of formal

mindfulness meditation in which partici-

pants broadly inventory mood and quality

of thought, shift attention to the breath,

then return to broad attention on sensation

and cognition. The inclusion of the 3-min-

ute breathing space offers an opportunity to

integrate practice mindfulness in situations

where entrenched patterns of dysphoric cog-

nition make extended meditation difficult

or impossible. It also affords participants a

chance to “check in” with themselves dur-

ing the day, limiting patterns of rumination.

While initially incorporated into MBCT,

the 3-minute breathing space is increasingly

making its way into MBSR and related MT

interventions.

Target Population

MBCT was designed as prophylactic sup-

port in prevention of depressive relapse. In

two large, randomized control trials, MBCT

has been shown to be efficacious for patients

with three or more past episodes of depres-

sion by halving relapse rates better than did

a treatment- as-usual control condition (Ma

& Teasdale, 2004; Teasdale et al., 2000).

In a more recent, large-scale trial, MBCT

was been shown to be as effective as mainte-

nance antidepressant medication in prevent-

ing depressive relapse, with both surpassing

the performance of a placebo control condi-

tion (Segal et al., 2010).

While originally designed to prevent

relapse during remission, MBCT has also

shown efficacy in the treatment of acutely

depressed patients, including those with

treatment- resistant depression (Barnhofer et

al., 2009; Eisendrath, Chartier, & McLane,

2011). MBCT has also been adapted for

children ages 9–13 (Semple, Lee, Rosa, &

Miller, 2010), and for adults over age 65

(Smith, Graham, & Senthinathan, 2007).

MBCT may be appropriate for patients

with other mood disorders, but special

care must be taken to ensure that patients

have adequate capacity to cope with nega-

tive emotions during the meditation process

(Germer, Siegel, & Fulton, 2005).

Mindfulness‑Based

Relapse Prevention

Background

Mindfulness- based relapse prevention

(MBRP), an intervention developed to target

relapse vulnerability in substance use disor-

ders (Marlatt & Gordon, 1985), is modeled

after MBCT to help people recognize inter-

nal triggers to addictive behavior without

responding to them. The course features a

central theme of distinguishing between pri-

mary emotional experience and secondary

appraisals, with an emphasis on the idea that

if the primary experiences can be accepted,

secondary appraisals of coping inadequacy

will lose power to trigger relapse behaviors.

Format

The intervention takes place over eight

weekly sessions and introduces many of

the same formal meditation techniques

described in MBSR and MBCT. The focus

of the group sessions centers on three major

themes: Sessions 1–3 employ MT to provide

awareness of how automatic patterns of

reactivity lead to relapse behavior; Sessions

4–6 focus on implementing mindfulness

techniques in high-risk or trigger situations

to prevent thoughts from triggering relapse

behaviors; Sessions 7 and 8 focus on inte-

grating mindfulness practice into daily life

Mindfulness Interventions and Emotion Regulation 561

to provide continued development of self-

care skills to protect against relapse in the

future.

Similar to the 3-minute breathing space

that is central to MBCT, MBRP introduces

a “SOBER” breathing space (Stop, Observe,

Breathe, Expand, Respond) designed to

allow participants to observe the arousal

of urges and respond skillfully rather than

habitually. By maintaining awareness of the

urge, the participant somewhat ironically

prevents his or her response to the urge,

allowing it to follow a homeostatic time

course and eventually subside. Similar to the

positive and negative events diary in MBSR,

MBRP employs an “awareness of triggers”

diary. By fostering awareness of thoughts,

feelings, sensations, and behaviors during

the arousal of drug cravings, the diary helps

to create recognition of triggering situations.

Target Population

MBRP targets people with a history of sub-

ject use disorders, generally subsequent to

completion of an intensive detoxification

and rehabilitation program. In a recent study

comparing the effects of MBRP to stan-

dard relapse- prevention treatment, MBRP

group participants showed lower rates of

relapse and greater levels of acceptance and

mindful awareness than those in the stan-

dard treatment group (Bowen et al., 2009).

Importantly, subsequent research suggests

that reductions in craving following MBRP

were mediated by increases in acceptance

and mindful awareness (Witkiewitz, Bowen,

Douglas, & Hsu, 2013).

Other Interventions

Incorporating Mindfulness

Many other contemporary therapeutic

interventions incorporate aspects of MT

in a broader clinical protocol. Dialectical

behavior therapy (DBT; see Neacsiu, Bohus,

& Linehan, this volume) is modeled on the

central struggle between acceptance of the

present moment and desire for change. MT

is an important facet of this therapy, help-

ing participants develop radical acceptance

of a problematic situation in order to direct

efforts skillfully toward adaptive change.

Unlike the interventions discussed earlier,

DBT does not require extensive formal med-

itation practice but instead includes a variety

of meditative exercises that may be custom-

ized to a client’s needs and abilities. Accep-

tance and commitment therapy (ACT) also

eschews formal meditation techniques but

places a strong emphasis on viewing expe-

riences with a sense of acceptance or non-

judgment, while focusing efforts on chang-

ing behaviors rather than thoughts, feelings,

and sensations. In both DBT and ACT, there

is much greater emphasis on the adjustment

of behavior than in mindfulness- based inter-

ventions, providing more therapist- led struc-

ture around plans of action.

Contraindications

Despite the promise of MT interventions in

a variety of clinical domains, it is important

to remember that these techniques have only

been validated with specific ailments. In fact,

original MT studies excluded individuals

with active substance abuse, psychotic disor-

ders, eating disorders, obsessive– compulsive

disorder (OCD), and borderline personality

disorder (BPD). The reasons for such exclu-

sion criteria were manifold; individuals with

acute depression often experience compro-

mised attention and concentration, which

may pose significant challenges when learn-

ing an already challenging practice, while

individuals with OCD, BPD, and active sub-

stance abuse might find long formal medi-

tation practices difficult to tolerate due to

intensively distressing intrusive thoughts,

impulses, cravings, or a general tendency

toward states of emotional dysregulation

(Hayes, 2004; Linehan, 1993). Moreover, in

these populations, reliance on emotion regu-

lation strategies such as avoidance may be

deeply ingrained, and the approach- oriented

nature of mindfulness practices may initially

be difficult to tolerate. Effective treatments

such as cognitive therapy for acute depres-

sion or DBT for BPD exist and have a strong

evidence base (Beck, 1979; Linehan, 1993).

Moreover, they are tailored to fit the needs

and tolerances of the individuals enrolled in

such programs. For example, the develop-

ment of mindfulness skills is a significant

component of training in DBT skills. How-

ever, skills practices are shorter and more

varied, building up over the course of sev-

eral months rather than in 8 weeks as in the

formats of MBSR and MBCT.

562 INTERVENTIONS

Clinicians and expert meditation teach-

ers alike have suggested various precau-

tions when treating individuals who have

a significant history of trauma with MBSR

and MBCT. Crane and Williams (2010)

have discussed the importance of preexist-

ing “grounding skills” for those individuals

who may be at-risk of experiencing intrusive

thoughts or being particularly cognitively

reactive. Additionally, they suggest prepar-

ing such individuals for the fact that distress

may arise, in light of evidence that a tendency

toward brooding and cognitive reactivity

is predictive of dropout in MBCT. Patients

planning to engage in this type of intensive

MT require the skills necessary to redirect

their attention should it become drawn into

destabilizing memories or overwhelming

affective states prior to commencing the

MBCT program. A recent review of the lit-

erature examining reports of adverse events

and contraindications for mindfulness- based

approaches found that the topic had been rel-

atively neglected (Dobkin, Irving, & Amar,

2012) and warrants further investigation.

Concluding Remarks

Interest in mindful emotion regulation has

increased rapidly in recent years, especially

as contemplative models of mind have been

increasingly supported by modern psy-

chological science. This has enhanced our

understanding of emotion regulation in two

major ways: (1) It informs research on atten-

tion deployment as a form of emotion regu-

lation, without resorting to distraction from

emotion; and (2) it has begun substantively

to connect scientific inquiry to broader

issues in emotion regulation, such as how

flexibility in regulation techniques serves

as a “meta- regulatory” skill, or how inten-

tion and commitment to a regulatory goal

increase realization of longitudinal improve-

ments in regulatory capacity. Psychologi-

cally, the study of MT provides a window

into the mechanisms of personal growth,

combining elements of attention, intention,

and attitude to form an upward spiral of reg-

ulatory efficacy. Neurobiologically, the study

of mindfulness helps to validate the idea that

sensory attention recruits a distinct intero-

ceptive attention pathway. This pathway

appears to be amenable to voluntary access,

and such access can be facilitated through

attention training. Critically, engagement of

sensory attention seems to disengage brain

networks involved in habitual elaborative

processing, allowing for the extinction of

automatic stress reactions while strengthen-

ing networks for the control of attention.

With elements of mindfulness now being

identified in a variety of other “new wave,”

health- promoting practices such as Tai Chi,

yoga, and, more generally, in psychothera-

peutic practice, the challenge before us is

to justify the spread of these techniques. As

such, it is increasingly necessary to provide

an empirically replicable model of the core

components of mindful emotion regula-

tion. Such a model will distinguish neces-

sary regulatory elements from intervention

elements that are simply customary, and

help to assuage criticisms that mindfulness

involves ushering mysticism into Western,

evidence- based medicine. For example, the

relative contributions of attitude, intention,

and attention are unknown. It may be the

case that daily exercises in setting benefi-

cial self- intentions account for many of the

salutary effects of mindfulness, allowing

one to dispense with much of the medita-

tive practice and instead engage in habits

of self- affirmation. Alternatively, it may be

that attentional improvements are necessary

precursors to the experience of insight and

improvements in well-being. Finally, it may

be the commitment to regulating experience

with an attitude of acceptance that really

pays benefits, with meditative exercises

simply helping to reinforce this commit-

ment. While there is suggestive evidence that

the three core elements of mindfulness—

attitude, intention, and attention— are criti-

cal ingredients, it will be important to find

better ways to measure their relative contri-

butions to advance the science of mindful-

ness and determine its potential for integra-

tion into secular Western life.

References

Allen, M., Bromley, A., Kuyken, W., & Sonnen-

berg, S. J. (2009). Participants’ experiences

of mindfulness- based cognitive therapy: “It

changed me in just about every way possible.”

Behavioral and Cognitive Psychotherapy,

37(4), 413–430.

Mindfulness Interventions and Emotion Regulation 563

Arch, J. J., & Craske, M. G. (2006). Mechanisms

of mindfulness: Emotion regulation follow-

ing a focused breathing induction. Behaviour

Research and Therapy, 44(12), 1849–1858.

Baer, R. A. (2003). Mindfulness training as a

clinical intervention: A conceptual and empir-

ical review. Clinical Psychology Science and

Practice, 10(2), 125–143.

Baer, R. A., Smith, G. T., Hopkins, J., Kriete-

meyer, J., & Toney, L. (2006). Using self-

report assessment methods to explore facets of

mindfulness. Assessment, 13(1), 27–45.

Baer, R. A., Smith, G. T., Lykins, E., Button, D.,

Krietemeyer, J., Sauer, S., et al. (2008). Con-

struct validity of the five facet mindfulness

questionnaire in meditating and nonmeditat-

ing samples. Assessment, 15(3), 329–342.

Baerensten, K. B., Stodkilde- Jorgensen, H.,

Summerlund, B., Hartmann, T., Damsgaard-

Madsen, J., Fosnaes, M., et al. (2010). An

investigation of brain processes support-

ing meditation. Congitive Processing, 11(1),

57–84.

Barnhofer, T., Crane, C., Hargus, E., Amar-

asinghe, M., Winder, R., & Williams, J. M.

(2009). Mindfulness- based cognitive therapy

as a treatment for chronic depression: A pre-

liminary study. Behavioural Research and

Therapy, 47(5), 366–373.

Beck, A. T. (1979). Cognitive therapy of depres-

sion. New York: Guilford Press.

Bischoff, R. (1996). Some notes concerning the

entry “Vipassana” in the Oxford English Dic-

tionary Additions Series, Vol. 2 (Clarendon

Press, Oxford, UK: 1993). International Jour-

nal of Lexicography, 9(1), 35–37.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L.,

Anderson, N. D., Carmody, J., et al. (2004).

Mindfulness: A proposed operational defin-

tion. Clinical Psychology: Science and Prac-

tice, 11(3), 230–241.

Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers,

P. (2010). The effects of mindfulness- based

stress reduction therapy on mental health of

adults with a chronic medical disease: A meta-

analysis. Journal of Psychosomatic Research,

68(6), 539–544.

Bowen, S., Chawla, N., Collins, S. E., Wit-

kiewitz, K., Hsu, S., Grow, J., et al. (2009).

Mindfulness- based relapse prevention for

substance use disorders: A pilot efficacy trial.

Substance Abuse, 30(4), 295–305.

Brefczynski- Lewis, J. A., Lutz, A., Schaefer, H.

S., Levinson, D. B., & Davidson, R. J. (2007).

Neural correlates of attentional expertise in

long-term meditation practitioners. Proceed-

ings of the National Academy of Sciences

USA, 104(27), 11483–11488.

Brewer, J. A., Worhunsky, P. D., Gray, J. R., Tang,

Y. Y., Weber, J., & Kober, H. (2011). Medita-

tion experience is associated with differences

in default mode network activity and connec-

tivity. Proceedings of the National Academy

of Sciences USA, 108(50), 20254–20259.

Brown, K. W., Ryan, R. M., & Creswell, J. D.

(2007). Mindfulness: Theoretical foundations

and evidence for salutary effects. Psychologi-

cal Inquiry, 18(4), 211–237.

Chiesa, A., & Serretti, A. (2009). Mindfulness-

based stress reduction for stress management

in healthy people: A review and meta- analysis.

Journal of Alternative and Complementary

Medicine, 15(5), 593–600.

Chiesa, A., & Serretti, A. (2010). A systematic

review of neurobiological and clinical features

of mindfulness meditations. Psychological

Medicine, 40(8), 1239–1252.

Corbetta, M., & Shulman, G. L. (2002). Control

of goal- directed and stimulus- driven attention

in the brain. Nature Reviews Neuroscience,

3(3), 201–215.

Crane, C., & Williams, J. M. (2010). Factors

associated with attrition from mindfulness-

based cognitive therapy in patients with a his-

tory of suicidal depression. Mindfulness, 1(1),

10–20.

Dobkin, P. L., Irving, J. A., & Amar, S. (2012).

For whom may participation in a mindfulness-

based stress reduction program be contraindi-

cated? Mindfulness, 3(1), 44–50.

Eisendrath, S., Chartier, M., & McLane, M.

(2011). Adapting mindfulness- based cognitive

therapy for treatment- resistant depression: A

clinical case study. Cognitive and Behavioral

Practice, 18(3), 362–370.

Farb, N. A., Anderson, A. K., Bloch, R. T., &

Segal, Z. V. (2011). Mood- linked responses

in medial prefrontal cortex predict relapse in

patients with recurrent unipolar depression.

Biological Psychiatry, 70(4), 366–372.

Farb, N. A., Anderson, A. K., Mayberg, H.,

Bean, J., McKeon, D., & Segal, Z. V. (2010).

Minding one’s emotions: Mindfulness train-

ing alters the neural expression of sadness.

Emotion, 10(1), 25–33.

Farb, N. A., Segal, Z. V., & Anderson, A. K.

(2013). Mindfulness meditation training alters

cortical representations of interoceptive atten-

tion. Social Cognitive and Affective Neurosci-

ence, 8(1), 15–26.

564 INTERVENTIONS

Farb, N. A., Segal, Z. V., Mayberg, H., Bean, J.,

McKeon, D., Fatima, Z., et al. (2007). Attend-

ing to the present: Mindfulness meditation

reveals distinct neural modes of self- reference.

Social Cognitive and Affective Neuroscience,

2(4), 313–322.

Feldman, G., Greeson, J., & Senville, J. (2010).

Differential effects of mindful breathing,

progressive muscle relaxation, and loving-

kindness meditation on decentering and nega-

tive reactions to repetitive thoughts. Behaviour

Research and Therapy, 48(10), 1002–1011.

Fredrickson, B. L., & Branigan, C. (2005). Posi-

tive emotions broaden the scope of attention

and thought– action repertoires. Cognition

and Emotion, 19(3), 313–332.

Fresco, D. M., Segal, Z. V., Buis, T., & Ken-

nedy, S. (2007). Relationship of posttreatment

decentering and cognitive reactivity to relapse

in major depression. Journal of Consulting

and Clinical Psychology, 75(3), 447–455.

Frewen, P. A., Evans, E. M., Maraj, N., Dozois,

D. J., & Partridge, K. P. (2008). Lettting go:

Mindfulness and negative auotmatic think-

ing. Cognitive Therapy and Research, 32(6),

758–774.

Garland, E. L., Gaylord, S. A., & Fredrickson,

B. L. (2011). Positive reappraisal mediates

the stress- reductive effects of mindfulness:

An upward spiral process. Mindfulness, 2(1),

59– 67.

Gelenberg, A. J. (2010). The prevalence and

impact of depression. Journal of Clinical Psy-

chiatry, 71(3), e06.

Germer, C. K., Siegel, R. D., & Fulton, P. R.

(2005). Mindfulness and psychotherapy. New

York: Guilford Press.

Goldin, P., Ramel, W., & Gross, J. (2009). Mind-

fulness meditation training and self- referential

processing in social anxiety disorder: Behav-

ioral and neural effects. Journal of Cognitive

Psychotherapy, 23(3), 242–257.

Goldin, P. R., & Gross, J. J. (2010). Effects of

mindfulness- based stress reduction (MBSR)

on emotion regulation in social anxiety disor-

der. Emotion,10(1), 83–91.

Gotlib, I. H., & Joormann, J. (2010). Cogni-

tion and depression: Current status and future

directions. Annual Review of Clinical Psy-

chology, 6, 285–312.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39(3), 281–291.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85(2), 348–362.

Grossman, P., Kappos, L., Gensicke, H., D’Souza,

M., Mohr, D. C., Penner, I. K., et al. (2010).

MS quality of life, depression, and fatigue

improve after mindfulness training: A ran-

domized trial. Neurology, 75(13), 1141–1149.

Grossman, P., Niemann, L., Schmidt, S., &

Walach, H. (2004). Mindfulness- based

stress reduction and health benefits. A meta-

analysis. Journal of Psychosomatic Research,

57(1), 35– 43.

Hayes, S. C. (2004). Acceptance and commit-

ment therapy, relational frame theory, and the

third wave of behavioral and cognitive thera-

pies. Behavior Therapy, 35, 639–665.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., &

Oh, D. (2010). The effect of mindfulness-

based therapy on anxiety and depression: A

meta- analytic review. Journal of Consulting

and Clinical Psychology, 78(2), 169–183.

Holzel, B. K., Lazar, S. W., Gard, T., Schuman-

Olivier, Z., Vago, D. R., et al. (2011). How

does mindfulness meditation work?: Propos-

ing mechanisms of action from a conceptual

and neutral perspective. Perspectives on Psy-

chological Science, 6(6), 537–559.

Ingram, R. E., & Hollon, S. D. (1986). Informa-

tion processing approaches to clinical psychol-

ogy. In R. E. Ingram (Ed.), Personality, psy-

chopathology, and psychotherapy series (Vol.

xi, pp. 259–281). San Diego, CA: Academic

Press.

Irving, J. A., Dobkin, P. L., & Park, J. (2009).

Cultivating mindfulness in health care pro-

fessionals: A review of empirical studies of

mindfulness- based stress reduction (MBSR).

Complementary Therapies in Clinical Prac-

tice, 15(2), 61–66.

Ivanovski, B., & Malhi, G. S. (2007). The psy-

chological and neurophysiological concomi-

tants of mindfulness forms of meditation.

Acta Neuropsychiatrica, 19, 76–91.

Ives- Deliperi, V. L., Solms, M., & Meintjes, E.

M. (2011). The neural substrates of mindful-

ness: An fMRI investigation. Journal of Neu-

roscience, 6(3), 231–242.

Jain, S., Shapiro, S. L., Swanick, S., Roesch, S.

C., Mills, P. J., Bell, I., et al. (2007). A ran-

Mindfulness Interventions and Emotion Regulation 565

domized controlled trial of mindfulness medi-

tation versus relaxation training: Effects on

distress, positive states of mind, rumination,

and distraction. Annals of Behavioral Medi-

cine, 33(1), 11–21.

Jha, A. P., Krompinger, J., & Baime, M. J.

(2007). Mindfulness training modifies sub-

systems of attention. Cognitive, Affective, and

Behavioral Neuroscience, 7(2), 109–119.

Jha, A. P., Stanley, E. A., Kiyonaga, A., Wong,

L., & Gelfand, L. (2010). Examining the

protective effects of mindfulness training on

working memory capacity and affective expe-

rience. Emotion, 10(1), 54–64.

Kabat-Zinn, J. (1982). An outpatient program in

behavioral medicine for chronic pain patients

based on the practice of mindfulness medita-

tion: Theoretical considerations and prelimi-

nary results. General Hospital Psychiatry,

4(1), 33 – 47.

Kabat-Zinn, J. (1990). Full catastrophe living:

Using the wisdom of your body and mind to

face stress, pain and illness. New York: Dela-

corte.

Kabat-Zinn, J., Lipworth, L., & Burney, R.

(1985). The clinical use of mindfulness medi-

tation for the self- regulation of chronic pain.

Journal of Behavioral Medicine, 8(2), 163–

190.

Keightley, M. L., Seminowicz, D. A., Bagby, R.

M., Costa, P. T., Fossati, P., & Mayberg, H. S.

(2003). Personality influences limbic– cortical

interactions during sad mood induction. Neu-

roImage, 20(4), 2031–2039.

Kelley, W. M., Macrae, C. N., Wyland, C. L.,

Caglar, S., Inati, S., & Heatherton, T. F.

(2002). Finding the self?: An event- related

fMRI study. Journal of Cognitive Neurosci-

ence, 14(5), 785–794.

Kilpatrick, L. A., Suyenobu, B. Y., Smith, S. R.,

Bueller, J. A., Goodman, T., Creswell, J. D., et

al. (2011). Impact of mindfulness- based stress

reduction training on intrinsic brain connec-

tivity. NeuroImage, 56(1), 290–298.

Kross, E., Gard, D., Deldin, P., Clifton, J., &

Ayduk, O. (2012). “Asking why” from a

distance: Its cognitive and emotional con-

sequences for people with major depressive

disorder. Journal of Abnormal Psychology,

121(3), 559–569.

Kumar, S., Feldman, G., & Hayes, A. (2008).

Changes in mindfulness and emotion regu-

lation in an exposure- based cognitive ther-

apy for depression. Cognitive Therapy and

Research, 32(6), 734–744.

Kupfer, D. J., Frank, E., Perel, J. M., Cornes, C.,

Mallinger, A. G., Thase, M. E., et al. (1992).

Five-year outcomes for maintenance therapies

in recurrent depression. Archives of General

Psychiatry, 49, 769–773.

Kuyken, W., Watkins, E., Holden, E., White, K.,

Taylor, R. S., Byford, S., et al. (2010). How

does mindfulness- based cognitive therapy

work? Behavioural Research and Therapy,

48(11), 1105–1112.

Lakey, C. E., Kernis, M. H., Heppner, W. L., &

Lance, C. E. (2008). Individual differences in

authenticity and mindfulness as predictors of

verbal defensiveness. Journal of Research in

Personality, 42(1), 230–238.

Lau, M. A., Bishop, S. R., Segal, Z. V., Buis, T.,

Anderson, N. D., Carlson, L., et al. (2006).

The Toronto Mindfulness Scale: Development

and validation. Journal of Clinical Psychol-

ogy, 62(12), 1445–1467.

Lazar, S. W., Bush, G., Gollub, R. L., Fricchi-

one, G. L., Khalsa, G., & Benson, H. (2000).

Functional brain mapping of the relaxation

response and meditation. NeuroReport, 11(7),

1581–1585.

Leary, M. R., Tate, E. B., Adams, C. E., Allen,

A. B., & Hancock, J. (2007). Self- compassion

and reactions to unpleasant self- relevant

events: The implications of treating oneself

kindly. Journal of Personality and Social Psy-

chology, 92(5), 887–904.

Lengacher, C. A., Kip, K. E., Barta, M. K.,

Post-White, J., Jacobsen, P., Groer, M., et al.

(2012). A pilot study evaluating the effect of

mindfulness- based stress reduction on psycho-

logical status, physical status, salivary corti-

sol, and interleukin-6 among advanced- stage

cancer patients and their caregivers. Journal of

Holistic Nursing, 30(3), 170 –185.

Linehan, M. (1993). Cognitive- behavioral treat-

ment of borderline personality disorder. New

York: Guilford Press.

Liverant, G. I., Brown, T. A., Barlow, D. H.,

& Roemer, L. (2008). Emotion regulation in

unipolar depression: The effects of acceptance

and suppression of subjective emotional expe-

rience on the intensity and duration of sadness

and negative affect. Behavioural Research and

Therapy, 46(11), 1201–1209.

Lutz, A., Greischar, L. L., Perlman, D. M., &

Davidson, R. J. (2009). BOLD signal in insula

is differentially related to cardiac function

during compassion meditation in experts vs.

novices. NeuroImage, 47(3), 1038–1046.

Lutz, A., Slagter, H. A., Dunne, J. D., & David-

566 INTERVENTIONS

son, R. J. (2008). Attention regulation and

monitoring in meditation. Trends in Cognitive

Sciences, 12(4), 163–169.

Lutz, A., Slagter, H. A., Rawlings, N. B., Fran-

cis, A. D., Greischar, L. L., & Davidson, R. J.

(2009). Mental training enhances attentional

stability: Neural and behavioral evidence.

Journal of Neuroscience, 29(42), 13418–

13427.

Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-

based cognitive therapy for depression: Repli-

cation and exploration of differential relapse

prevention effects. Journal of Consulting and

Clinical Psychology, 72(1), 31– 40.

Marlatt, G. A., & Gordon, J. R. (1985). Relapse

prevention: Maintenance strategies in the

treatment of addictive behaviors. New York:

Guilford Press.

Moore, S. A., Zoellner, L. A., & Mollenholt, N.

(2008). Are expressive suppression and cogni-

tive reappraisal associated with stress- related

symptoms? Behavioural Research and Ther-

apy, 46(9), 993–1000.

Morone, N. E., Greco, C. M., & Weiner, D. K.

(2008). Mindfulness meditation for the treat-

ment of chronic low back pain in older adults:

A randomized controlled pilot study. Pain,

134(3), 310–319.

Neacsiu, A. D., Bohus, M., & Linehan, M. M.

(this volume, 2014). Dialectical behavior ther-

apy: An intervention for emotion dysregula-

tion. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp. 491–507). New

York: Guilford Press.

Nolen- Hoeksema, S. (2000). The role of rumina-

tion in depressive disorders and mixed anxi-

ety/depressive symptoms. Journal of Abnor-

mal Psychology, 109(3), 504–511.

Ochsner, K. N., Bunge, S. A., Gross, J. J., &

Gabrieli, J. D. (2002). Rethinking feelings:

An fMRI study of the cognitive regulation of

emotion. Journal of Cognitive Neuroscience,

14(8), 1215–1229.

Ohman, A., Flykt, A., & Esteves, F. (2001).

Emotion drives attention: Detecting the snake

in the grass. Journal of Experimental Psychol-

ogy: General, 130(3), 466–478.

Oken, B. S., Fonareva, I., Haas, M., Wahbeh,

H., Lane, J. B., Zajdel, D., et al. (2010). Pilot

controlled trial of mindfulness meditation and

education for dementia caregivers. Journal of

Alternative and Complementary Medicine,

16(10), 1031–1038.

Ottenbreit, N. D., & Dobson, K. S. (2004).

Avoidance and depression: The construction

of the Cognitive- Behavioral Avoidance Scale.

Behavioural Research and Therapy, 42(3),

293–313.

Pauley, G., & McPherson, S. (2010). The expe-

rience and meaning of compassion and self-

compassion for individuals with depression

or anxiety. Psychology and Psychotherapy:

Theory, Research and Practice, 83(Pt. 2),

129–143.

Paykel, E. S., Scott, J., Teasdale, J. D., Johnson,

A. L., Garland, A., Moore, R., et al. (1999).

Prevention of relapse in residual depression by

cognitive therapy: A controlled trial. Archives

of General Psychiatry, 56(9), 829–835.

Perlman, D. M., Salomons, T. V., Davidson, R.

J., & Lutz, A. (2010). Differential effects on

pain intensity and unpleasantness of two med-

itation practices. Emotion, 10(1), 65–71.

Piet, J., & Hougaard, E. (2011). The effect of

mindfulness- based cognitive therapy for pre-

vention of relapse in recurrent major depres-

sive disorder: A systematic review and meta-

analysis. Clinical Psychology Review, 31(6),

1032–1040.

Ramel, W., Goldin, P. R., & Carmona, P. E.

(2004). The effects of mindfulness meditation

on cognitive processes and affect in patients

with past depression. Cognitive Therapy and

Research, 28, 433–455.

Rosenzweig, S., Greeson, J. M., Reibel, D.

K., Green, J. S., Jasser, S. A., & Beasley, D.

(2010). Mindfulness- based stress reduction

for chronic pain conditions: Variation in treat-

ment outcomes and role of home meditation

practice. Journal of Psychosomatic Research,

68(1), 29–36.

Scher, C. D., Ingram, R. E., & Segal, Z. V.

(2005). Cognitive reactivity and vulnerability:

Empirical evaluation of construct activation

and cognitive diatheses in unipolar depression.

Clinical Psychology Review, 25(4), 487–510.

Schmertz, S. K., Anderson, P. L., & Robins, D.

L. (2009). The relation between self- report

mindfulness and performance on tasks of sus-

tained attention. Behavioral Science, 31(1),

60–66.

Segal, Z. V., Bieling, P., Young, T., MacQueen,

G., Cooke, R., Martin, L., et al. (2010). Anti-

depressant monotherapy vs sequential phar-

macotherapy and mindfulness- based cognitive

therapy, or placebo, for relapse prophylaxis in

recurrent depression. Archives of General Psy-

chiatry, 67(12), 1256–1264.

Segal, Z. V., Kennedy, S., Gemar, M., Hood, K.,

Pedersen, R., & Buis, T. (2006). Cognitive

Mindfulness Interventions and Emotion Regulation 567

reactivity to sad mood provocation and the

prediction of depressive relapse. Archives of

General Psychiatry, 63(7), 749–755.

Segal, Z. V., Williams, J. M. G., & Teasdale, J.

D. (2002). Mindfulness- based cognitive ther-

apy for depression: A new approach to pre-

venting relapse. New York: Guilford Press.

Semple, R. J., Lee, J., Rosa, D., & Miller, L. F.

(2010). A randomized trial of mindfulness-

based cognitive therapy for children: Pro-

moting mindful attention to enhance social–

emotional resiliency in children. Journal of

Child and Family Studies, 19, 218–229.

Shapiro, S. L., Brown, K. W., Thoresen, C.,

& Plante, T. G. (2011). The moderation of

mindfulness- based stress reduction effects by

trait mindfulness: Results from a randomized

controlled trial. Journal of Clinical Psychol-

ogy, 67(3), 267–277.

Shapiro, S. L., Carlson, L. E., Astin, J. A., &

Freedman, B. (2006). Mechanisms of mind-

fulness. Journal of Clinical Psychology, 62(3),

373–386.

Shapiro, S. L., & Schwartz, G. E. (2000). Inten-

tional systemic mindfulness: An integrative

model for self- regulation and health. Advances

in Mind–Body Medicine, 16(2), 128–134.

Sheppes, G. (this volume, 2014). Emotion regula-

tion choice: Theory and findings. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp. 126–139). New York: Guilford Press.

Silananda, S. U. (1998). The four foundations of

mindfulness (A summary). Retrieved Novem-

ber 18, 2012, from www.buddhanet.net/bud-

sas/ebud/ebmed063.htm.

Silananda, S. U. (2002). The four foundations of

mindfulness (2nd ed.). Boston: Wisdom.

Smith, A., Graham, L., & Senthinathan, S.

(2007). Mindfulness- based cognitive therapy

for recurring depression in older people: A

qualitative study. Aging and Mental Health,

11(3), 346–357.

Teasdale, J. D., & Chaskalson, M. (2011). How

does mindfulness transform suffering?: II.

The transformation of Dukka. Contempo-

rary Buddhism: An Interdisciplinary Journal,

12(1), 103–124.

Teasdale, J. D., Segal, Z. V., Williams, J. M.,

Ridgeway, V. A., Soulsby, J. M., & Lau, M.

A. (2000). Prevention of relapse/recurrence in

major depression by mindfulness- based cogni-

tive therapy. Journal of Consulting and Clini-

cal Psychology, 68(4), 615–623.

Trew, J. L. (2011). Exploring the roles of approach

and avoidance in depression: An integrative

model. Clinical Psychology Review, 31(7),

1156–1168.

Walach, H., Buchheld, N., Buttenmuller, V.,

Kleinknecht, N., & Schmidt, S. (2006). Mea-

suring mindfulness— The Freiburg Mindful-

ness Inventory (FMI). Personality and Indi-

vidual Differences, 40, 1543–1555.

Watkins, E., Moberly, N. J., & Moulds, M.

L. (2008). Processing mode causally influ-

ences emotional reactivity: Distinct effects of

abstract versus concrete construal on emo-

tional response. Emotion, 8(3), 364–378.

Williams, J. M. G. (2007). The mindful way

through depression: Freeing yourself from

chronic unhappiness. New York: Guilford

Press.

Williams, K. A., Kolar, M. M., Reger, B. E., &

Pearson, J. C. (2001). Evaluation of a wellness-

based mindfulness stress reduction interven-

tion: A controlled trial. American Journal of

Health Promotion, 15(6), 422–432.

Witkiewitz, K., Bowen, S., Douglas, H., & Hsu,

S. H. (2013). Mindfulness- based relapse pre-

vention for substance craving. Addictive

Behaviors, 38(2), 1563–1571.

Zeidan, F., Gordon, N. S., Merchant, J., & Gool-

kasian, P. (2010). The effects of brief mindful-

ness meditation training on experimentally

induced pain. Journal of Pain, 11(3), 199–209.

PART IX

HEALTH IMPLICATIONS

571

Inhibiting the expression of emotions has

long been believed to undermine physi-

cal health, and recent developments in our

ability to map neural– immune interactions

at the genomic level have begun to identify

potential biological bases for such effects.

This chapter reviews basic research linking

emotional inhibition (or suppression; I use

the terms interchangeably) to physical ill-

ness and outlines an emerging theoretical

paradigm in “social genomics” that sheds

light on both the biological mechanisms

of such effects and their potential evolu-

tionary origin. This perspective construes

emotion regulation as one component of a

broader set of biobehavioral adaptations

that have emerged in response to the evo-

lution of a hypersocial “life history strat-

egy” for humans (Darwin, 1872; McDade,

2003; Richerson, Boyd, & Henrich, 2010;

Wilson, 2012). The social– neural– genomic

programs that evolved to mediate this adap-

tation likely held little health cost under

primordial conditions in which trauma and

infection were our primary causes of death

(Finch, 2010). However, in the very differ-

ent social, physical, and cultural environ-

ments that we now inhabit, these biological

programs may functionally connect every-

day “civilized” social behavior to low-level

anticipatory threat reactions that can aggra-

vate many drivers of “modern mortality,”

such as cardiovascular, neurodegenerative,

metabolic, and neoplastic diseases (Finch,

2007; Sterling, 2004).

Emotion Regulation

and Human Health

As far back as the second century A.D., the

Greek physician Galen noted that people

who were emotionally inexpressive seemed

to be at increased risk of cancer (Siegel,

1968). Subsequent epidemiological studies

underscored this observation (Gross, 1989;

Mund & Mitte, 2012) and expanded the

range of health risks associated with emo-

tional inhibition to include cardiovascular

and immune- related diseases (Bell, Jas-

noski, Kagan, & King, 1990; Cohen, Doyle,

Skoner, Rabin, & Gwaltney, 1997; Cohen,

Doyle, Turner, Alper, & Skoner, 2003; Cole,

Kemeny, & Taylor, 1997; Cole, Kemeny,

Taylor, & Visscher, 1996; Denollet, Gidron,

Vrints, & Conraads, 2010; Denollet, Ped-

ersen, Vrints, & Conraads, 2006; Denol-

let et al., 1996; Ironson, O’Cleirigh, Weiss,

Schneiderman, & Costa, 2008; Kagan,

1994; Kagan, Snidman, Julia- Sellers, &

Johnson, 1991; Mund & Mitte, 2012).

Recent experimental studies also suggest

that the active expression of emotions can

mirror the effects of suppression and reduce

CHAPTER 33

Emotion Regulation and Gene Expression

Steven W. Cole

572 HEALTH IMPLICATIONS

the risk of minor illnesses (Booth, 2012;

Frattaroli, 2006; Pennebaker, 1988). The

disease risks associated with emotional inhi-

bition range widely in their specific biology

and in their overall health significance, but

they share in common one basic teleological

puzzle: Why has the human body evolved to

lose vitality when we inhibit the expression

of our emotions?

Surprisingly, mechanistic answers to this

question have emerged more rapidly than

true functional explanations. It is now easer

to understand how emotional inhibition

might affect human health than why that

should be so. Much of our growing mecha-

nistic insight stems from dramatic techni-

cal advances in molecular genetics, and our

growing ability to understand physical dis-

ease in terms of changing patterns of human

gene expression (Cole, 2009; Finch, 2007;

Miller, Chen, & Cole, 2009). The equation

of disease with gene expression dynamics

represents an oversimplification to be sure.

However, construing health and disease

through the lens of molecular genetics has

the significant heuristic advantage of con-

necting these dynamics to theoretical and

teleological perspectives derived from evo-

lutionary biology. Harnessing the tremen-

dous technical infrastructure of molecular

genomics offers opportunities to understand

not only how social inhibition affects health

but also why that connection should have

emerged in the first place. The keys to real-

izing this opportunity lie in understanding

how genes change their behavior in response

to our psychological experiences.

Genetics versus Genomics

As genes have come to be understood as con-

crete DNA sequences rather than abstrac-

tions inferred from inheritance, it has

become increasingly apparent that social

and psychological factors can regulate the

activity or expression of human genes (Cole,

2009). DNA encodes the potential for cellu-

lar behavior, but that potential is only real-

ized if the gene is expressed— if the DNA

is transcribed into RNA (Figure 33.1). It is

RNA and its subsequent translation into

protein that shapes a cell’s structure and

identity, and endows its functional capaci-

ties such as movement, metabolism, and bio-

chemical response to external stimuli (e.g.,

neurotransmission or immune response).

Absent their transcription, DNA genes have

no effect on health or behavioral pheno-

types. With the advent of a sequenced human

genome and the emergence of DNA microar-

ray and sequencing technologies, scientists

can now survey the expression of all human

genes simultaneously and map the specific

subset of genes that is actively expressed in

RNA within a given cell at a given point in

time. One surprising finding from such stud-

ies of functional genomics is that the expres-

sion of a given gene is often more an excep-

tion than the rule. Cells are highly selective

about which genes they express, and our

DNA encodes a great deal more genetic

potential than is realized in RNA and pro-

tein (Djebali et al., 2012). As such, the subset

of genes that is expressed in RNA—the cell’s

transcriptome—can be interpreted as the

product of a cellular decision- making pro-

cess regarding which particular sets of genes

would be most adaptive to express under the

prevailing circumstances. Mechanistically,

these decisions are mediated by protein tran-

scription factors that bind to specific DNA

sequences in the regulatory region (or pro-

moter) of a gene. Most transcription factors

target a large number of genes that contrib-

ute in different and often partially overlap-

ping ways to a common biological process

(e.g., multiple genes encoding receptors, sig-

naling molecules, and transcription factors

that collectively allow a particular cell to

recognize and respond to a neurotransmit-

ter or microbe). As such, transcription fac-

tors are best construed as activating general

gene transcriptional programs or gene mod-

ules rather than acting on specific individual

genes in isolation.

What evolutionary theory adds to this

mechanistic picture is a set of principles for

determining which genes should be coacti-

vated by a given transcription factor (i.e.,

the inclusion– exclusion structure or inten-

sion of a particular gene module) and which

transcription factors should be activated in

response to the stimuli present in the cell’s

environment. In other words, transcription

factors and their “target gene modules”

constitute a biochemical stimulus– response

program, and the development of the whole

system of such programs encoded in a

genome represents the product of evolution-

Emotion Regulations and Gene Expression 573

ary trial and error in adapting to changing

environmental conditions. Some “constitu-

tive” transcription factors show steady levels

of activity and act mainly to continue the

expression of genes that confer a cell’s par-

ticular biological identity (e.g., maintaining

the expression of neuron- defining genes in a

particular neuron, so it continues to be a neu-

ron). Other transcription factors are “induc-

ible” and can dramatically up- regulate their

activity from almost total quiescence to

levels 10–100 times above baseline. These

inducible transcription factors act mainly to

alter gene expression in response to chang-

ing environmental conditions as detected by

cellular receptor systems (e.g., increasing the

expression of immune response genes when

a microbe is detected, or changing gene

expression profiles in response to cellular

growth factors, hormones, or neurotrans-

mitters).

For both types of transcription factor,

the mapping of an individual factor onto its

distinctive subset of “target genes” confers

a sort of biological “meaning” to the tran-

scription factor— an intension set of tran-

scriptional responses that presumably have

helped the organism thrive under basal con-

ditions and adapt to emerging challenges.

This connection between the biological

characteristics of coregulated gene modules

and the nature of the upstream transcrip-

tion factors and receptor systems that acti-

vate those gene modules provides a concep-

tual strategy for extracting organismic- level

meaning and teleological design principles

from genomewide transcriptional profiles of

RNA (Cole, 2010). These mappings reflect

FIGURE 33.1. Social signal transduction. Socioenvironmental processes regulate human gene expres-

sion by activating CNS processes that subsequently influence hormone and neurotransmitter activity

in the periphery of the body. Peripheral signaling molecules interact with cellular receptors to activate

transcription factors, which bind to characteristic DNA motifs in gene promoters to initiate (or repress)

gene expression. Only genes that are transcribed into RNA actually impact health and behavioral

phenotypes. Individual differences in promoter DNA sequences (e.g., the [G/C] polymorphism shown

here) can affect the binding of transcription factors and thereby influence genomic sensitivity to socio-

environmental conditions. Adapted from Cole (2009).

Peripheral nervous system

Endocrine system

Receptor

Signal transduction

Transcription

factor

Promoter

Coding region

TGA[G/C]TCA

Gene

DNA

RNA

Protein

Health &

Behavior

Social Environment

Central

nervous system

574 HEALTH IMPLICATIONS

a sort of evolutionarily acquired program-

ming, or a “wisdom of the genome” regard-

ing which genes are most adaptive to express

in a given type of environment.

Accumulating data on the specific recep-

tor systems that activate particular tran-

scription factors also allow a set of more

specific inferences regarding the extracel-

lular physiological signaling pathways that

may trigger observed changes in the cellular

transcriptome. These mappings allow us, for

example, to translate genomewide transcrip-

tional profiles into theories regarding the

specific hormones and neurotransmitters

that may distribute central nervous system

(CNS)-mediated experiences of social or

emotional stimuli into changes in the periph-

eral gene expression dynamics that underlie

health and disease (see Ochsner & Gross;

Proudfit, Dunning, Foti, & Weinberg; John-

stone & Walter; and Gyurak & Etkin, this

volume, for more on the CNS mechanisms

of emotion regulation). These bioinformat-

ics projections essentially reverse the normal

flow of biological information from outside

the body to inside (Figure 33.1), thus pro-

viding a “bottom- up” strategy for detect-

ing the physiological signaling pathways

that may mediate the effects of emotion

regulation on health. Such approaches can

complement a more “top-down” strategy

that surveys known health- relevant periph-

eral neural and endocrine signals, such as

the sympathetic nervous system (SNS) or

hypothalamic– pituitary– adrenal (HPA) axis

(Sapolsky, 1994), to determine their poten-

tial contributions to the health effects of

emotional suppression. So, where might the

top-down effects of emotional suppression

meet up with the bottom- up programming

of the human genome?

Emotion Regulation and Peripheral

Neural Function

Some of the earliest research in human psy-

chophysiology found that people who were

relatively inexpressive of their emotions

nevertheless showed elevated autonomic

responses to stressful or threatening stim-

uli (Buck, 1979; Jones, 1935, 1950, 1960;

Notarius & Levenson, 1979; Weinberger,

Schwartz, & Davidson, 1979). More recent

studies have also noted inhibition- related dif-

ferences in basal levels of SNS activity (Cole,

Kemeny, Fahey, Zack, & Naliboff, 2003;

Kagan, 1994; Kagan, Reznick, & Snidman,

1988), suggesting that dispositional differ-

ences in peripheral autonomic activity might

potentially act on a tonic, daily basis to alter

basal physiological homeostasis. A growing

body of experimental research largely paral-

lels findings from the individual- differences

literature in linking emotional suppression

to increased SNS activity. Asking people

to inhibit the expression or experience of

an emotion in response to emotionally

arousing stimuli can increase SNS activity

(Dan- Glauser & Gross, 2011; Gross, 1998,

2002; Gross & Levenson, 1993, 1997; Har-

ris, 2001; Jackson, Malmstadt, Larson, &

Davidson, 2000; Lissek et al., 2007; Pen-

nebaker & Chew, 1985; Robinson & Dema-

ree, 2009), and actively inducing emotional

expressions in written or spoken form can

reduce inhibition- related SNS responses

(Hughes, Uhlmann, & Pennebaker, 1994;

Pennebaker, Barger, & Tiebout, 1989; Pen-

nebaker, Hughes, & O’Heeron, 1987) and

transiently increase indicators of physi-

cal health (e.g., self- reported illnesses or

objectively reported health care utilization,

vaccine- induced antibody responses, wound

healing, and immune system biological

parameters; Booth, 2012).

Although some inconsistent results exist,

the majority of published research sug-

gests that emotional suppression is associ-

ated with SNS activation. Moreover, in the

one study of individual differences that has

simultaneously assessed psychological inhi-

bition, SNS activity, and biological indi-

cators of disease progression, individual

differences in SNS activity emerged as a

statistically plausible mediator of relation-

ships between psychological inhibition and

HIV-1 viral load (Cole, 2008; Cole et al.,

2001, 2003). A key role for the SNS is also

supported by a growing body of data show-

ing that other manipulations of SNS activity

can aggravate a wide variety of disease pro-

cesses, including the growth and metastasis

of cancer (Cole & Sood, 2012; Sloan et al.,

2010; Thaker et al., 2006). In fact, it was

in studies of disease pathogenesis that the

human genome was first found to be modu-

lated in a broad and systematic way by psy-

chological processes and their effects on the

autonomic nervous system.

Emotion Regulations and Gene Expression 575

Neural Regulation of Human

Gene Expression

The potential for psychosocial regulation

of human gene expression first emerged in

the context of studies analyzing the effect of

social stress and SNS neurotransmitters on

viral genomes such as herpes simplex viruses

(Glaser, Kiecolt- Glaser, Speicher, & Holli-

day, 1985; Jenkins & Baum, 1995; Kupfer

& Summers, 1990; Leib, Nadeau, Rundle,

& Schaffer, 1991; Padgett et al., 1998; Ras-

mussen, Marsh, & Brill, 1957; Schuster,

Chasserot- Golaz, Urier, Beck, & Sergeant,

1991), human immunodeficiency virus (HIV-

1; Capitanio, Mendoza, Lerche, & Mason,

1998; Cole et al., 1997; Cole, Kemeny, Tay-

lor, Visscher, & Fahey, 1996; Sloan et al.,

2007), Epstein– Barr virus (Glaser et al.,

1985; Yang et al., 2010), cytomegalovirus

(Glaser et al., 1985; Prosch et al., 2000), and

the Kaposi’s sarcoma- associated human her-

pesvirus 8 (Chang et al., 2005). As obligate

parasites of human host cells, viruses have

evolved within a microenvironment struc-

tured by our own genome. If social processes

and SNS neurotransmitters can regulate the

expression of viral genes, it stands to reason

that our own complement of roughly 21,000

genes might be modulated as well.

Over the past 5 years, a series of genome-

wide transcriptional profiling studies has

found that extended periods of psycho-

logical or social stress are often associated

with a specific pattern of change in gene

expression within immune cells. Across

several distinct types of adversity such as

social isolation (Cole, Hawkley, Arevalo,

& Cacioppo, 2011; Cole et al., 2007; Cre-

swell et al., 2012), imminent bereavement

(Miller et al., 2008), low socioeconomic

status (SES; Chen, Miller, Kobor, & Cole,

2011; Chen et al., 2009), early life social

deprivation (Miller, Chen, Fok, et al., 2009),

late life social adversity (Cole et al., 2010),

traumatic stress (O’Donovan et al., 2011),

diagnosis with a life- threatening illness

(Antoni et al., 2012; Cohen et al., 2012),

and experimentally imposed social threat

(Cole et al., 2010; Cole, Arevalo, Rugge-

rio, Heckman, & Suomi, 2012; Sloan et al.,

2007, 2010), circulating immune cells (leu-

kocytes) show a conserved transcriptional

response to adversity (CTRA) involving

increased expression of genes involved in

inflammation (e.g., IL1B, IL6, IL8, TNF)

and decreased expression of genes involved

in innate antiviral responses (IFNB and

IFI, MX, and OAS gene families), and the

production of a specific type of antibody

(immunoglobulin G1 [IgG1]) (Cole, 2009,

2010; Irwin & Cole, 2011; Miller, Chen, &

Cole, 2009). Each type of adversity is also

associated with other transcriptional altera-

tions that are relatively unique to that condi-

tion. However, this core CTRA pattern of

proinflammatory and anti- antiviral tran-

scriptome shift has emerged much more con-

sistently than would be expected by chance.

Similar patterns also emerge in response to

experimentally imposed adversity in ani-

mal models of social instability, low social

rank, and social threat or defeat (Cole et al.,

2010, 2012; Irwin & Cole, 2011; Sloan et

al., 2007; Tung et al., 2012).

Given the statistical challenges of mul-

tiple hypothesis testing across roughly

21,000 genes, different “social genomics”

studies rarely find identical sets of differ-

entially expressed genes. Where consistent

patterns do become salient is in subsequent

bioinformatic analyses extracting common

functional themes from the lists of tens to

hundreds of differentially expressed genes in

each study (e.g., Gene Ontology annotations

regarding shared biological functions and

analyses of transcription control pathways

regulating expression of multiple genes)

(Cole, 2010). The recurrence of these core

proinflammatory– anti- antiviral biological

themes across both different adverse envi-

ronments and different mammalian species

suggests that the immune system of social

mammals is programmed to generate a

CTRA response whenever individuals expe-

rience extended periods of stress, threat, or

uncertainty (Antoni et al., 2012; Cole et al.,

2012; Irwin & Cole, 2011). This general

transcriptional program may be expressed

somewhat variably at the level of individual

gene transcripts depending upon specifics

of individual history, genetic background,

and particulars of the current environment

(Cole, 2010). However, the broader bio-

logical principle of increase inflammation

and suppress interferons and IgG1 seems

to be programmed into the basic stimulus–

response logic of the human genome (at least

as expressed in the receptor/transcription

factor logic of leukocytes).

576 HEALTH IMPLICATIONS

A key role for psychological experience in

triggering the CTRA dynamic is suggested

by results from several small randomized

controlled experiments showing that stress-

reducing interventions can reverse CTRA

transcriptional dynamics in human immune

cells (Antoni et al., 2012; Black et al., 2013;

Creswell et al., 2012). A key role for the SNS

in mediating these effects is suggested by

cellular studies showing that CTRA-related

transcriptional dynamics can be mimicked

by pharmacological agents that activate

the beta- adrenergic receptor systems tar-

geted by SNS neurotransmitters and can be

blocked by pharmacological antagonists of

those receptors (Cole et al., 2010; Collado-

Hidalgo, Sung, & Cole, 2006; Hanke, Pow-

ell, Stiner, Bailey, & Sheridan, 2012; Wohleb

et al., 2011). Moreover, the specific pattern

of up- regulated inflammatory gene expres-

sion and down- regulated antiviral- and

antibody- related gene expression observed

in studies of human social adversity maps

very closely to the effects of SNS pharma-

cology in laboratory experimental studies,

whereas other stress- responsive systems

that might potentially mediate such effects,

such as glucocorticoid hormone release from

the HPA axis, activate very different gene

expression programs (Irwin & Cole, 2011).

In fact, several studies have implicated a

selective reduction in glucocorticoid signal-

ing in contributing to the proinflammatory

component of the CTRA profile (Cole et al.,

2007; Hanke et al., 2012; Miller et al., 2008;

Wohleb et al., 2011). These observations do

not rule out a potential effect of glucocorti-

coids in other types of stress- mediated gene

expression dynamics (e.g., responses to more

severe, overwhelming stressors that elicit

defeat/withdrawal responses; Henry, 1992;

Lundberg & Frankenhaeuser, 1980; Sapol-

sky, 1994). However, the general patterns of

transcriptional alteration associated with the

chronic and highly prevalent socioenviron-

mental risk factors for human disease (social

isolation, low SES, etc.) appear to parallel

most closely the profiles of gene expression

induced by beta- adrenergic receptor sig-

naling in experimental cellular and animal

models (Irwin & Cole, 2011).

Why should CTRA-related gene modules

have evolved to become sensitive to beta-

adrenergic signaling from the SNS? CTRA

transcriptional dynamics appear to represent

an evolutionarily adaptive “defensive pro-

gram” that redeploys the immune system’s

transcriptional resources to “allostatically

anticipate” (Sterling, 2004) the changing

patterns of microbial exposure historically

associated with changing life circumstances

(e.g., increased risk of wound- related bacte-

rial infection during periods of acute threat

vs. increased risk of viral contagion during

extended periods of close social contact;

Cole et al., 2011; Irwin & Cole, 2011).

Because antiviral and proinflammatory gene

modules are, to some extent, mutually exclu-

sive (Amit et al., 2009; Negishi et al., 2012;

O’Connell et al., 2004; Shahangian et al.,

2009; Tian et al., 2012), the immune system

must “choose” which gene module to favor

at any given time. The CTRA dynamic sug-

gests that that choice is informed in part by

the broader physiological and environmental

conditions surrounding the individual (i.e.,

organism- level adaptive fitness), as perceived

by the CNS and distributed into peripheral

tissues via the SNS (Cole et al., 2011; Irwin

& Cole, 2011). However, when the CTRA

defensive program is chronically stimu-

lated, the resulting proinflammatory– anti-

antiviral shift in leukocyte transcriptional

equilibrium may promote the complex pat-

tern of “modern mortality” diseases involv-

ing elements of both up- regulated immune

function (e.g., inflammation- related diseases

such as heart disease, neurodegenerative dis-

eases, and some types of cancer) and down-

regulated immune function (e.g., impaired

response to vaccines and viral infections)

(Finch, 2007). The complex pattern of up-

and down- regulated gene modules associ-

ated with the CTRA underscores the fact

that stress is not broadly immunosuppres-

sive, but instead selectively suppresses some

groups of immune response genes (e.g., Type

I interferons and some immunoglobulin

genes) while simultaneously activating oth-

ers (e.g., proinflammatory cytokines) (Irwin

& Cole, 2011).

Beyond the CTRA dynamic in leuko-

cytes, stress biology can also regulate gene

expression in a wide variety of other tissues,

including the CNS (Karelina et al., 2009;

Karssen et al., 2007; Weaver, Meaney, &

Szyf, 2006), peripheral immune system

organs such as the lymph nodes and spleen

(Cole et al., 2010; Sloan et al., 2007), and

diseased tissues such as ovarian cancers and

Emotion Regulations and Gene Expression 577

stroke- wounded brain tissues (Karelina et

al., 2009; Lutgendorf et al., 2009). Given

the much smaller number of social genomics

analyses targeting such solid tissues, and the

relative difficulty in ascertaining the func-

tional significance of specific transcriptional

alterations outside the well- charted terri-

tories of the immune response, it has been

much more difficult to map the specific gene

programs modulated in these tissues and to

deduce their associated teleological rationale

(e.g., are these tissue “defensive programs”

analogous to the leukocyte CTRA, or do

they represent some other type of functional

adaptation specific to the organ system

involved?). However, it is clear that the social

environment surrounding an individual can

modulate broad swaths of gene activity in

a diverse array of bodily tissues via CNS-

mediated interpretations of the environment

as safe/accommodating or threatening/hos-

tile/uncertain.

Emotion Regulation

and Gene Regulation

At the time of this writing, no published

studies have directly examined the effects of

emotional inhibition on human gene expres-

sion. However, coupling the two domains

of research reviewed here suggests a natural

hypothesis regarding how chronic emotional

suppression might influence physical health

via systematic changes in gene expression.

To the extent that (1) emotional suppres-

sion activates the SNS and (2) the SNS acti-

vates gene expression programs such as the

CTRA, chronic emotional suppression may

induce a repetitive or temporally extended

bias in basal gene expression profiles that

simultaneously increases vulnerability to

inflammation- related diseases (e.g., car-

diovascular and neoplastic diseases) and

decreases immune response to vaccines and

viral infections. Assuming this plausible

conjunction holds true empirically, emotion

regulation can be construed as an indirect

form of gene regulation. Moreover, the spe-

cific pattern of gene expression modula-

tions that would be predicted based on this

hypothesis corresponds quite closely to the

profile of specific disease risks that has been

linked to inhibition in empirical epidemio-

logical studies. Beyond providing a plausible

biological mechanism for effects of emo-

tion regulation on human health (Miller,

Chen, & Cole, 2009), however, this equa-

tion of emotion regulation with gene regula-

tion also suggests a broader set of questions

regarding the origins and consequences of

emotion regulation in general physiological

function (i.e., independent of its impacts on

somatic disease).

One distinctive feature of gene transcrip-

tion as an “output” from psychological pro-

cesses is its simultaneous role as an “input”

into the future biological characteristics of

the individual (Cole, 2009). Genes can act

recursively in the sense that they alter the

nature of the molecular machinery that con-

trols their own expression. Figure 33.2 out-

lines some of the developmental implications

of such recursion in allowing environmental

conditions (including psychological percep-

tions and emotional expression) to become

embedded in the molecular biology of the

individual in ways that affect subsequent

perceptual, emotional, and neurobiological

responses to future environmental condi-

tions. For example, if one period of emo-

tional suppression results in altered patterns

of gene expression in the brain, and some

of those regulated genes include molecules

that mediate the perception of social threat

and its transduction into gene expression

(receptors, signal transduction molecules,

transcription factors, etc.), then the individ-

ual’s subsequent psychological response to a

fixed social or emotional stimulus may well

differ from what it would have been other-

wise, purely as a function of that individu-

al’s history of exposures earlier in life. This

recursive feedback dynamic provides one

biological pathway by which early life social

and psychological conditions can become

embedded in an individual’s basic neuro-

biological characteristics and subsequently

influence later patterns of psychological

experience and biological development

(Cole, 2009). Recursive feedback dynamics

also help clarify how particularly acute tran-

sient events can induce persisting alterations

in neurobiological homeostasis (e.g., as in

posttraumatic stress disorder [PTSD]).

Because genes can recursively regulate

their own molecular triggers and produc-

tion machinery, there exists great potential

for nonlinear regulatory dynamics in which

initially small stimuli have quantitatively

578 HEALTH IMPLICATIONS

or temporally disproportionate effects.

Whether this actually happens or not in any

given situation depends largely on the feed-

back structure of the specific gene networks

involved. To the extent that receptors, signal

transduction molecules, and transcription

factors number among those genes empiri-

cally modulated by a given stimulus, some

form of feedback recursion is likely to occur.

However, recursion alone does not guaran-

tee nonlinear amplification. Whether that

feedback is positive (amplifying), negative

(damping), or nonexistent depends largely

on the empirical pattern of connections

among gene products, or the “wiring dia-

gram” of the human genome as expressed

in a given cell type (i.e., the specific set of

receptors, signaling molecules, and tran-

scription factors expressed in a given cell, or

potentially induced in that cell in response

to environmental stimuli). Outside of the

immune system, the wiring diagram of the

human genome remains almost completely

unknown. However, as studies of CNS

gene expression grow in number, sophis-

tication, and neuroanatomical precision,

new insights will rapidly emerge regarding

the recursive architecture of the genome as

expressed in the brain structures mediating

emotional experience and behavior. Even

in the absence of ideal longitudinal studies

that directly map system dynamics, much

may be learned by simply observing the pat-

tern of changes induced by a single stimulus

event. To the extent that stimulus changes

the expression of genes with known recur-

sive capacity (e.g., genes encoding receptors,

signal transduction molecules, transcription

factors, or epigenetic modulators) the poten-

tial for feedback and nonlinear dynam-

ics becomes substantially greater, and the

specific pattern of up- and down- regulated

recursive molecules can provide some indi-

cations regarding the positive versus nega-

tive feedback elements of the system. As

those wiring diagrams become increasingly

FIGURE 33.2. RNA as a molecular medium of recursive development. Social conditions at one point

in time (Environment

) are transduced into changes in behavior (Behavior

) and gene expression

(RNA

) via CNS perceptual processes that trigger systemic neural and endocrine responses (medi-

ated by Body

). Those RNA transcriptional dynamics can alter the molecular characteristics of cells

involved in environmental perception or response, resulting in a functionally altered Body

. Body

may respond differently to a given environmental challenge than would the previous Body

, resulting

in different behavioral (Behavior

) and transcriptional responses (RNA

). The effect of RNA tran-

scriptional dynamics on persisting cellular protein and functional characteristics provides a molecular

framework for understanding how socioenvironmental conditions in the past may continue to affect

current behavior and health, and how those historical conditions interact with current environments

to shape our future trajectories (e.g., Body

, Behavior

, RNA

). Because gene transcription serves as

both a cause of social behavior (by shaping Body) and a consequence of social behavior (a product of

Environment × Body), RNA serves as the physical medium for a recursive developmental trajectory that

integrates genetic characteristics and historical– environmental regulators to shape individual biologi-

cal and behavioral responses to current environmental conditions. Adapted from Cole (2009).

Body

1Environment

Behavior

RNA

Time 1

Body

2Environment

Behavior

RNA

Time 2

Body

3Environment

Behavior

RNA

Time 3

Emotion Regulations and Gene Expression 579

well mapped, the network structure of such

systems may identify particularly influen-

tial recursive regulators that would provide

highly leveraged targets for interventions to

block the temporally propagating effects of

early life adversity and acute trauma in adult

life. Beyond such clinical implications, there

also emerges a much broader set of questions

regarding how the gene regulation inherent

in emotion regulation might developmen-

tally modify the “behavior factory” of the

CNS, and the role that occasional tactical

suppression may play in laying a molecu-

lar foundation for chronic suppression or

dampened emotional experience.

Given that emotion regulation is an intrin-

sically social adaptation (Darwin, 1872),

how might suppression affect an individual’s

social relationships? A growing body of evi-

dence suggests that chronic emotional sup-

pression may significantly undermine the

number and quality of one’s social connec-

tions to others (Butler et al., 2003; English,

John, Srivastava, & Gross, 2012; Gross,

2002; Gross & John, 2003; Mauss et al.,

2011; Srivastava, Tamir, McGonigal, John,

& Gross, 2009). Experiences of social con-

nection vs. disconnection can also affect

gene expression (Cole et al., 2007, 2011), and

were in fact the context in which the CTRA

gene expression dynamic was first observed.

As such, the health effects of emotional sup-

pression may stem at least in part from their

effects in reducing an individual’s sense of

social connection to others. Indeed, micro-

acts of emotional suppression may kindle a

broader change in other people’s regard for

the individual that comes to assume a tem-

poral scope and situational breadth much

greater than original biological insult cre-

ated by a transient act of suppression. In

this sense, the most significant biological

implications of emotion regulation may

well stem from its impact on an individual’s

social identity and degree of healthy attach-

ment to others. Moreover, individual acts of

emotional suppression can also activate the

SNS in surrounding social partners (Butler

et al., 2003), implying a contagious dimen-

sion extending beyond the suppressor’s own

body. A wide variety of theoretical perspec-

tives note the fundamental role of secure

social bonds in maintaining human health

and well-being (Berkman & Kawachi, 2000;

Bowlby, 1983; Cacioppo & Hawkley, 2009;

Hofer, 1984). To the extent that emotional

suppression undermines one’s sense of true

connection to others and more general faith

in humanity, the social costs of suppression

may well represent its most caustic health

effect.

The bulk of the research on emotion regu-

lation and health has focused on the long-

observed relationship between emotional

suppression and illness. However, it is worth

considering how health and biology might

be affected by the other broad class of emo-

tion regulation strategies involving refram-

ing or reappraisal (Gross, 2002). Much of

the psychophysiological research suggests

that reappraisal has relatively little impact

on SNS activity (Gross, 2002; Gross & Lev-

enson, 1993), and the equation of gene reg-

ulation with SNS activation might thus be

taken to imply that reappraisal- based emo-

tion regulation has relatively little effect on

gene expression and health. A separate lit-

erature on the psychology of stress and the

role of reappraisal- based coping strategies

would also support that hypothesis (Laza-

rus & Folkman, 1984; Sapolsky, 1994).

However, at the level of the CNS, where

gene expression dynamics may also play a

role in establishing the basic machinery of

perception, interpretation, and behavioral

response, it does seem likely that the habit-

ual use of reappraisal strategies may poten-

tially affect the molecular biology of neural

development and plasticity. This might be

particularly true within the brain struc-

tures involved in appraisal itself, the struc-

tures involved in metacognition or executive

function processes that would control the

deployment of reappraisal processes into

the ongoing stream of conscious experience,

and potentially also in the neurobiologi-

cal structures that mediate stress responses

(e.g., involving functional down- regulation

or desensitization of these structures). To

the extent that habitual and adaptive reap-

praisal processes build a different brain at

the neuromolecular level, those biological

developments themselves will likely be struc-

tured at least in part by differential activa-

tion of specific gene modules. Moreover, the

general modularity of brain function implies

that these neurogenomic impacts of habitual

reappraisal (e.g., in down- regulating threat

circuits in the limbic system, up- regulating

analytic or appraisal systems, and possibly

580 HEALTH IMPLICATIONS

reducing the need for intense conscious con-

trolled inhibitory processes) may well spill

over into other domains of experience, thus

altering the activity of any other response

systems that make use of the same func-

tional brain modules. Again, the specific

empirical structure of the gene networks

involved remains to be mapped. However,

we now have available a growing analytic

and technical infrastructure for discovering

the genomic mechanisms of appraisal- based

emotion regulation once empirical transcrip-

tome data become available. These consider-

ations underscore the importance of devel-

oping experimental animal models that can

potentially recapitulate at least some basic

features of the perception/appraisal and sup-

pression/reappraisal systems. More broadly,

to the extent that reappraisal produces a

more fundamentally human and behavior-

ally adaptive CNS, it may well have salutary

effects on peripheral gene expression and

health that extend far beyond a neutral basal

state of physiological homeostasis.

Much remains to be learned about the

molecular mechanisms and biological impli-

cations of human emotion regulation. How-

ever, what we can say from the data already

at hand is that, in a highly social species

such as humans, issues of expressing and

concealing emotional reactions cut deeply

and fundamentally to the core of what it

means to be a participant in the human race.

In that sense, it is perhaps not so surprising

that our conscious and unconscious efforts

to manage the experience and expression

of our emotions may have deep implica-

tions for our health. If the genome is a lens

through which health can be understood, it

is even more surely a molecular blueprint for

helping humans navigate the complexities of

our physical and social worlds (Fox Keller,

2012). In that regard, it comes as no surprise

if the deepest regions of our internal biology,

and the very function of our own individual

human genomes, are inextricably bound

up in our experience of the external social

world around us, the emotional experiences

it evokes in us, and our emotional expres-

sions back to that world. Genomes exist fun-

damentally to help us succeed as humans,

and to the extent that requires the effective

regulation of our emotional experience, the

human genome must carry some molecular

blueprints that help us do that. And to the

extent that we fail to adaptively manage the

experience and expression of our emotions,

the genome also appears to carry molecular

blueprints that may help defend us against

the near-term social– biological costs of that

failure, but only by mortgaging the molecu-

lar underpinnings of our long-term vitality.

Acknowledgments

Preparation of this chapter was supported by

grants from the National Institutes of Health

(Nos. AG028748, AG033590, CA116778) and

benefited greatly from the insightful comments

of James Gross. This review is dedicated to

George Freeman Solomon, a pioneer in the field

of psychoneuroimmunology and a deeply wise,

compassionate, and curious observer of human

nature and its braided strands of emotion, inhibi-

tion, and health.

References

Amit, I., Garber, M., Chevrier, N., Leite, A.

P., Donner, Y., Eisenhaure, T., et al. (2009).

Unbiased reconstruction of a mammalian

transcriptional network mediating pathogen

responses. Science, 326(5950), 257–263.

Antoni, M. H., Lutgendorf, S. K., Blomberg,

B., Stagl, J., Carver, C. S., Lechner, S., et al.

(2012). Transcriptional modulation of human

leukocytes by cognitive- behavioral stress man-

agement in women undergoing treatment for

breast cancer. Biological Psychiatry, 71(4),

366–372.

Appleton, A. A., & Kubzansky, L. D. (this vol-

ume, 2014). Emotion regulation and car-

diovascular disease risk. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 596–612). New York: Guilford Press.

Bell, J. R., Jasnoski, M. L., Kagan, J., & King, D.

S. (1990). Is allergic rhinitis more frequent in

adults with extreme shyness?: A preliminary

study. Psychosomatic Medicine, 52, 517–525.

Berkman, L. F., & Kawachi, I. (2000). Social

epidemiology. New York: Oxford University

Press.

Black, D. S., Cole, S. W., Irwin, M. R., Breen,

E., St. Cyr, N. M., Nazarian, N., et al. (2013).

Yogic meditation reverses NF-kappaB and

IRF-related transcriptome dynamics in leuko-

Emotion Regulations and Gene Expression 581

cytes of family dementia caregivers in a ran-

domized controlled trial. Psychoneuroendo-

crinology, 38(3), 348–355.

Booth, R. J. (2012). Emotional expression and

disclosure. In S. Segerstrom (Ed.), The Oxford

handbook of psychoneuroimmunology (pp.

105–125). New York: Oxford University Press.

Bowlby, J. (1983). Attachment. New York: Basic

Books.

Buck, R. W. (1979). Individual differences in non-

verbal sending accuracy and electrodermal

responding: The externalizing– internalizing

dimension. In R. Rosenthal (Ed.), Skill in non-

verbal communication (pp. 140–170). Cam-

bridge, MA: Oelgeschlager, Gunn & Hain.

Butler, E. A., Egloff, B., Wilhelm, F. H., Smith,

N. C., Erickson, E. A., & Gross, J. J. (2003).

The social consequences of expressive suppres-

sion. Emotion, 3(1), 48– 67.

Cacioppo, J. T., & Hawkley, L. C. (2009). Per-

ceived social isolation and cognition. Trends

in Cognitive Sciences, 13(10), 447–454.

Capitanio, J. P., Mendoza, S. P., Lerche, N. W.,

& Mason, W. A. (1998). Social stress results in

altered glucocorticoid regulation and shorter

survival in simian acquired immune deficiency

syndrome. Proceedings of the National Acad-

emy of Sciences USA, 95(8), 4714–4719.

Chang, M., Brown, H., Collado- Hidalgo, A.,

Arevalo, J., Galic, Z., Symensma, T., et al.

(2005). Beta- adrenoreceptors reactivate Kapo-

si’s sarcoma- related herpesvirus lytic replica-

tion via PKA-dependent control of viral RTA.

Journal of Virology, 72(21), 13538–13547.

Chen, E., & Miller, G. E. (this volume, 2014).

Early-life socioeconomic status, emotion regu-

lation, and the biological mechanisms of dis-

ease across the lifespan. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 586–595). New York: Guilford Press.

Chen, E., Miller, G. E., Kobor, M. S., & Cole,

S. W. (2011). Maternal warmth buffers the

effects of low early-life socioeconomic status

on pro- inflammatory signaling in adulthood.

Molecular Psychiatry, 16, 729–737.

Chen, E., Miller, G. E., Walker, H. A., Arevalo,

J. M., Sung, C. Y., & Cole, S. W. (2009).

Genome-wide transcriptional profiling linked

to social class in asthma. Thorax, 64(1),

38–43.

Cohen, L., Cole, S. W., Sood, A. K., Prinsloo, S.,

Kirschbaum, C., Arevalo, J. M., et al. (2012).

Depressive symptoms and cortisol rhythmicity

predict survival in patients with renal cell car-

cinoma: Role of inflammatory signaling. PLoS

ONE, 7(8), e42324.

Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B.

S., & Gwaltney, J. M. (1997). Social ties and

susceptibility to the common cold. Journal

of the American Medical Association, 227,

1940–1944.

Cohen, S., Doyle, W. J., Turner, R., Alper, C. M.,

& Skoner, D. P. (2003). Sociability and sus-

ceptibility to the common cold. Psychological

Science, 14(5), 389–395.

Cole, S. W. (2008). Psychosocial influences on

HIV-1 disease progression: Neural, endocrine,

and virologic mechanisms. Psychosomatic

Medicine, 70(5), 562–568.

Cole, S. W. (2009). Social regulation of human

gene expression. Current Directions in Psy-

chological Science, 18(3), 132–137.

Cole, S. W. (2010). Elevating the perspective on

human stress genomics. Psychoneuroendocri-

nology, 35, 955–962.

Cole, S. W., Arevalo, J. M., Ruggerio, A. M.,

Heckman, J. J., & Suomi, S. (2012). Tran-

scriptional modulation of the developing

immune system by early life social adversity.

Proceedings of the National Academy of Sci-

ences USA, 109(50), 20578–20583.

Cole, S. W., Arevalo, J., Takahashi, R., Sloan, E.

K., Lutgendorf, S., Sood, A. K., et al. (2010).

Computational identification of gene– social

environment interaction at the human IL6

locus. Proceedings of the National Academy

of Sciences USA, 107(12), 5681–5686.

Cole, S. W., Hawkley, L. C., Arevalo, J. M.,

& Cacioppo, J. T. (2011). Transcript origin

analysis identifies antigen- presenting cells

as primary targets of socially regulated gene

expression in leukocytes. Proceedings of the

National Academy of Sciences USA, 108(7),

3080–3085.

Cole, S. W., Hawkley, L. C., Arevalo, J. M., Sung,

C. Y., Rose, R. M., & Cacioppo, J. T. (2007).

Social regulation of gene expression in human

leukocytes. Genome Biology, 8(R189), 1–13.

Cole, S. W., Kemeny, M. E., Fahey, J. L., Zack,

J. A., & Naliboff, B. D. (2003). Psychological

risk factors for HIV pathogenesis: Mediation

by the autonomic nervous system. Biological

Psychiatry, 54, 1444–1456.

Cole, S. W., Kemeny, M. E., & Taylor, S. E.

(1997). Social identity and physical health:

Accelerated HIV progression in rejection-

sensitive gay men. Journal of Personality and

Social Psychology, 72, 320–336.

582 HEALTH IMPLICATIONS

Cole, S. W., Kemeny, M. E., Taylor, S. E., &

Visscher, B. R. (1996). Elevated physical

health risk among gay men who conceal their

homosexual identity. Health Psychology, 15,

243–251.

Cole, S. W., Kemeny, M. E., Taylor, S. E., Viss-

cher, B. R., & Fahey, J. L. (1996). Acceler-

ated course of human immunodeficiency virus

infection in gay men who conceal their homo-

sexual identity. Psychosomatic Medicine, 58,

219–231.

Cole, S. W., Naliboff, B. D., Kemeny, M. E.,

Griswold, M. P., Fahey, J. L., & Zack, J. A.

(2001). Impaired response to HAART in

HIV-infected individuals with high auto-

nomic nervous system activity. Proceedings of

the National Academy of Sciences USA, 98,

12695–12700.

Cole, S. W., & Sood, A. K. (2012). Molecular

pathways: Beta- adrenergic signaling in cancer.

Clinical Cancer Research, 18(5), 1201–1206.

Collado- Hidalgo, A., Sung, C., & Cole, S.

(2006). Adrenergic inhibition of innate anti-

viral response: PKA blockade of Type I inter-

feron gene transcription mediates catechol-

amine support for HIV-1 replication. Brain,

Behavior, and Immunity, 20(6), 552–563.

Creswell, J. D., Irwin, M. R., Burklund, L. J.,

Lieberman, M. D., Arevalo, J. M., Ma, J., et

al. (2012). Mindfulness- based stress reduc-

tion training reduces loneliness and pro-

inflammatory gene expression in older adults:

A small randomized controlled trial. Brain,

Behavior, and Immunity, 26(7), 1095–1101.

Dan- Glauser, E. S., & Gross, J. J. (2011). The

temporal dynamics of two response- focused

forms of emotion regulation: Experiential,

expressive, and autonomic consequences. Psy-

chophysiology, 48(9), 1309–1322.

Darwin, C. (1872). The expression of the emo-

tions in man and animals. London: John Mur-

ray.

Denollet, J., Gidron, Y., Vrints, C. J., & Con-

raads, V. M. (2010). Anger, suppressed anger,

and risk of adverse events in patients with

coronary artery disease. American Journal of

Cardiology, 105(11), 1555–1560.

Denollet, J., Pedersen, S. S., Vrints, C. J., & Con-

raads, V. M. (2006). Usefulness of type D per-

sonality in predicting five-year cardiac events

above and beyond concurrent symptoms of

stress in patients with coronary heart disease.

American Journal of Cardiology, 97(7), 970–

973.

Denollet, J., Sys, S. U., Stroobant, N., Rombouts,

H., Gillebert, T. C., & Brutsaert, D. L. (1996).

Personality as an independent predictor of

long-term mortality in patients with coronary

heart disease. Lancet, 347, 417– 421.

Djebali, S., Davis, C. A., Merkel, A., Dobin, A.,

Lassmann, T., Mortazavi, A., et al. (2012).

Landscape of transcription in human cells.

Nature, 489(7414), 101–108.

English, T., John, O. P., Srivastava, S., & Gross,

J. J. (2012). Emotion regulation and peer-

rated social functioning: A 4-year longitudi-

nal study. Journal of Research in Personality,

46(6), 780–784.

Finch, C. E. (2007). The biology of human lon-

gevity: Inflammation, nutrition, and aging in

the evolution of lifespans. Burlington, MA:

Academic Press.

Finch, C. E. (2010). Evolution in health and

medicine Sackler colloquium: Evolution of the

human lifespan and diseases of aging: Roles of

infection, inflammation, and nutrition. Pro-

ceedings of the National Academy of Sciences

USA, 1, 1718–1724.

Fox Keller, E. (2012). Genes, genomes, and

genomics. Biological Theory, 6(2), 132–140.

Frattaroli, J. (2006). Experimental disclosure

and its moderators: A meta- analysis. Psycho-

logical Bulletin, 132(6), 823–865.

Glaser, R., Kiecolt- Glaser, J. K., Speicher, C. E.,

& Holliday, J. E. (1985). Stress, loneliness,

and changes in herpesvirus latency. Journal of

Behavioral Medicine, 8(3), 249–260.

Gross, J. (1989). Emotional expression in can-

cer onset and progression. Social Science and

Medicine, 28, 1239–1248.

Gross, J. J. (1998). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74(1), 224–237.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39(3), 281–291.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships, and

well-being. Journal of Personality and Social

Psychology, 85(2), 348–362.

Gross, J. J., & Levenson, R. W. (1993). Emo-

tional suppression: Physiology, self- report,

and expressive behavior. Journal of Personal-

ity and Social Psychology, 64, 970–986.

Gross, J. J., & Levenson, R. W. (1997). Hiding

Emotion Regulations and Gene Expression 583

feelings: The acute effects of inhibiting nega-

tive and positive emotion. Journal of Abnor-

mal Psychology, 106(1), 95–103.

Gyurak, A., & Etkin, A. (this volume, 2014). A

neurobiological model of implicit and explicit

emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp. 76–90). New York: Guilford Press.

Hanke, M. L., Powell, N. D., Stiner, L. M., Bai-

ley, M. T., & Sheridan, J. F. (2012). Beta adren-

ergic blockade decreases the immunomodula-

tory effects of social disruption stress. Brain,

Behavior, and Immunity, 26(7), 1150–1159.

Harris, C. R. (2001). Cardiovascular responses

of embarrassment and effects of emotional

suppression in a social setting. Journal of Per-

sonality and Social Psychology, 81(5), 886–

897.

Henry, J. P. (1992). Biological basis of the stress

response. Integrative Physiological and

Behavioral Science, 27(1), 66–83.

Hofer, M. A. (1984). Relationships as regulators:

A psychobiologic perspective on bereavement.

Psychosomatic Medicine, 46(3), 183 –197.

Hughes, C. F., Uhlmann, C., & Pennebaker, J.

W. (1994). The body’s response to processing

emotional trauma: Linking verbal text with

autonomic activity. Journal of Personality,

62(4), 565–585.

Ironson, G. H., O’Cleirigh, C., Weiss, A.,

Schneiderman, N., & Costa, P. T., Jr. (2008).

Personality and HIV disease progression: Role

of NEO-PI-R openness, extraversion, and pro-

files of engagement. Psychosomatic Medicine,

70(2), 245–253.

Irwin, M. R., & Cole, S. W. (2011). Reciprocal

regulation of the neural and innate immune

systems. Nature Reviews Immunology, 11(9),

625–632.

Jackson, D. C., Malmstadt, J. R., Larson, C.

L., & Davidson, R. J. (2000). Suppression

and enhancement of emotional responses to

unpleasant pictures. Psychophysiology, 37(4),

515–522.

Jenkins, F. J., & Baum, A. (1995). Stress and

reactivation of latent herpes simplex virus: A

fusion of behavioral medicine and molecu-

lar biology. Annals of Behavioral Medicine,

17(2), 116–123.

Johnstone, T., & Walter, H. (this volume, 2014).

The neural basis of emotion dysregulation. In

J. J. Gross (Ed.), Handbook of emotion regu-

lation (2nd ed., pp.

58–75). New York: Guil-

ford Press.

Jones, H. E. (1935). The galvanic skin response as

related to overt emotional expression. Ameri-

can Journal of Psychology, 47, 241–251.

Jones, H. E. (1950). The study of patterns of

emotional expression. In M. L. Reymert (Ed.),

Feelings and emotions: The Mooseheart Sym-

posium. New York: McGraw-Hill.

Jones, H. E. (1960). The longitudinal method

in the study of personality. In I. Iscoe & H.

W. Stevenson (Eds.), Personality development

in children (pp.

–27). Austin: University of

Texas Press.

Kagan, J. (1994). Galen’s prophecy: Tempera-

ment in human nature. New York: Basic

Books.

Kagan, J., Reznick, J. S., & Snidman, N. (1988).

Biological bases of childhood shyness. Sci-

ence, 240, 167–171.

Kagan, J., Snidman, N., Julia-

ellers, M., &

Johnson, O. (1991). Temperament and aller-

gic symptoms. Psychosomatic Medicine, 53,

332–340.

Karelina, K., Norman, G. J., Zhang, N., Morris,

J. S., Peng, H., & DeVries, A. C. (2009). Social

isolation alters neuroinflammatory response

to stroke. Proceedings of the National Acad-

emy of Sciences USA, 106(14), 5895–5900.

Karssen, A. M., Her, S., Li, J. Z., Patel, P. D.,

Meng, F., Bunney, W. E., Jr., et al. (2007).

Stress-

nduced changes in primate prefrontal

profiles of gene expression. Molecular Psychi-

atry, 12(12), 1089–1102.

Kupfer, S. R., & Summers, W. C. (1990). Identi-

fication of a glucocorticoid-

esponsive element

in Epstein–

arr virus. Journal of Virology,

64(5), 1984–1990.

Lazarus, R. S., & Folkman, S. (1984). Stress,

appraisal, and coping. New York: Springer.

Leib, D. A., Nadeau, K. C., Rundle, S. A., & Schaf-

fer, P. A. (1991). The promoter of the latency-

ssociated transcripts of herpes simplex virus

type 1 contains a functional cAMP-response

element: Role of the latency-

ssociated tran-

scripts and cAMP in reactivation of viral

latency. Proceedings of the National Academy

of Sciences USA, 88(1), 48–52.

Lissek, S., Orme, K., McDowell, D. J., Johnson,

L. L., Luckenbaugh, D. A., Baas, J. M., et al.

(2007). Emotion regulation and potentiated

startle across affective picture and threat-

f-shock paradigms. Biological Psychology,

76(1–2), 124–133.

Lundberg, U., & Frankenhaeuser, M. (1980).

Pituitary–

adrenal and sympathetic–

adrenal

584 HEALTH IMPLICATIONS

correlates of distress and effort. Journal of

Psychosomatic Research, 24(3–4), 125–130.

Lutgendorf, S. K., Degeest, K., Sung, C. Y., Are-

valo, J. M., Penedo, F., Lucci, J., III, et al.

(2009). Depression, social support, and beta-

drenergic transcription control in human

ovarian cancer. Brain, Behavior, and Immu-

nity, 23(2), 176–183.

Mauss, I. B., Shallcross, A. J., Troy, A. S., John,

O. P., Ferrer, E., Wilhelm, F. H., et al. (2011).

Don’t hide your happiness!: Positive emotion

dissociation, social connectedness, and psy-

chological functioning. Journal of Personality

and Social Psychology, 100(4), 738–748.

McDade, T. W. (2003). Life history theory and

the immune system: Steps toward a human

ecological immunology. American Journal

Physical Anthropology, 37(Suppl.), 100–

125.

Miller, G., Chen, E., & Cole, S. W. (2009).

Health psychology: Developing biologically

plausible models linking the social world and

physical health. Annual Review of Psychol-

ogy, 60, 501–524.

Miller, G. E., Chen, E., Fok, A. K., Walker, H.,

Lim, A., Nicholls, E. F., et al. (2009). Low

early-life social class leaves a biological resi-

due manifested by decreased glucocorticoid

and increased proinflammatory signaling.

Proceedings of the National Academy of Sci-

ences USA, 106(34), 14716–14721.

Miller, G. E., Chen, E., Sze, J., Marin, T., Are-

valo, J. M., Doll, R., et al. (2008). A func-

tional genomic fingerprint of chronic stress in

humans: Blunted glucocorticoid and increased

NF-kappaB signaling. Biolical Psychiatry,

64(4), 266–272.

Mund, M., & Mitte, K. (2012). The costs of

repression: A meta-

nalysis on the relation

between repressive coping and somatic dis-

eases. Health Psychology, 31(5), 640–649.

Negishi, H., Yanai, H., Nakajima, A., Koshiba,

R., Atarashi, K., Matsuda, A., et al. (2012).

Cross-

nterference of RLR and TLR signal-

ing pathways modulates antibacterial T cell

responses. Nature Immunology, 13(7), 659–

666.

Notarius, C. I., & Levenson, R. W. (1979).

Expressive tendencies and physiological

response to stress. Journal of Personality and

Social Psychology, 37(7), 1204–1210.

Ochsner, K. N., & Gross, J. J. (this volume, 2014).

The neural bases of emotion and emotion regu-

lation: A valuation perspective. In J. J. Gross

(Ed.), Handbook of emotion regulation (2nd

ed., pp.

23–42). New York: Guilford Press.

O’Connell, R. M., Saha, S. K., Vaidya, S. A.,

Bruhn, K. W., Miranda, G. A., Zarnegar, B.,

et al. (2004). Type I interferon production

enhances susceptibility to Listeria monocy-

togenes infection. Journal of Experimental

Medicine, 200(4), 437–445.

O’Donovan, A., Sun, B., Cole, S., Rempel, H.,

Lenoci, M., Pulliam, L., et al. (2011). Tran-

scriptional control of monocyte gene expres-

sion in post-

raumatic stress disorder. Disease

Markers, 30(2–3), 123–132.

Padgett, D. A., Sheridan, J. F., Dorne, J., Bern-

tson, G. G., Candelora, J., & Glaser, R. (1998).

Social stress and the reactivation of latent her-

pes simplex virus type 1. Proceedings of the

National Academy of Sciences USA, 95(12),

7231–7235.

Pennebaker, J. W. (1988). Confession, inhibition,

and disease. In L. Berkowitz (Ed.), Advances

in experimental social psychology (Vol. 22,

pp.

211–242). Orlando, FL: Academic Press.

Pennebaker, J. W., Barger, S. D., & Tiebout,

J. (1989). Disclosure of traumas and health

among Holocaust survivors. Psychosomatic

Medicine, 51(5), 577–589.

Pennebaker, J. W., & Chew, C. H. (1985). Behav-

ioral inhibition and electrodermal activity

during deception. Journal of Personality and

Social Psychology, 49, 1427–1433.

Pennebaker, J. W., Hughes, C. F., & O’Heeron,

R. C. (1987). The psychophysiology of confes-

sion: Linking inhibitory and psychosomatic

processes. Journal of Personality and Social

Psychology, 52(4), 781–793.

Prosch, S., Wendt, C. E. C., Reinke, P., Priemer,

C., Pooert, M., Kruger, D. H., et al. (2000).

A novel link between stress and human cyto-

megalovirus (HCMV) infection: Sympathetic

hyperactivity stimulates HCMV activation.

Virology, 272, 357–365.

Proudfit, G., Dunning J. P., Foti, D., & Wein-

berg, A. (this volume, 2014). Temporal dynam-

ics of emotion regulation. In J. J. Gross (Ed.),

Handbook of emotion regulation (2nd ed.,

pp.

43–57). New York: Guilford Press.

Rasmussen, A. F., Marsh, J. T., & Brill, N. Q.

(1957). Increases susceptibility to hepres sim-

plex in mice subjected to avoidance-

earning

stress or restraint. Proceedings of the Society

for Experimental Biology and Medicine, 96,

183–189.

Richerson, P. J., Boyd, R., & Henrich, J. (2010).

Emotion Regulations and Gene Expression 585

Colloquium paper: Gene– culture coevolu-

tion in the age of genomics. Proceedings of

the National Academy of Sciences USA,

107(Suppl. 2), 8985–8992.

Robinson, J. L., & Demaree, H. A. (2009). Expe-

riencing and regulating sadness: Physiological

and cognitive effects. Brain and Cognition,

70(1), 13–20.

Sapolsky, R. M. (1994). Why zebras don’t get

ulcers: A guide to stress, stress-

related dis-

eases, and coping. New York: Freeman.

Schuster, C., Chasserot-

olaz, S., Urier, G.,

Beck, G., & Sergeant, A. (1991). Evidence for

a functional glucocorticoid responsive element

in the Epstein–

arr virus genome. Molecular

Endocrinology, 5(2), 267–272.

Shahangian, A., Chow, E. K., Tian, X., Kang, J.

R., Ghaffari, A., Liu, S. Y., et al. (2009). Type

I IFNs mediate development of postinfluenza

bacterial pneumonia in mice. Journal of Clini-

cal Investigation, 119(7), 1910–1920.

Siegel, R. E. (1968). Galen’s system of physiol-

ogy and medicine. New York: Karger.

Sloan, E. K., Capitanio, J. P., Tarara, R. P.,

Mendoza, S. P., Mason, W. A., & Cole, S. W.

(2007). Social stress enhances sympathetic

innervation of primate lymph nodes: Mecha-

nisms and implications for viral pathogenesis.

Journal of Neuroscience, 27(33), 8857–8865.

Sloan, E. K., Priceman, S. J., Cox, B. F., Yu, S.,

Pimentel, M. A., Tangkanangnukul, V., et

al. (2010). The sympathetic nervous system

induces a metastatic switch in primary breast

cancer. Cancer Research, 70(18), 7042–7052.

Srivastava, S., Tamir, M., McGonigal, K. M.,

John, O. P., & Gross, J. J. (2009). The social

costs of emotional suppression: A prospective

study of the transition to college. Journal of

Personality and Social Psychology, 96(4),

883 –897.

Sterling, P. (2004). Principles of allostasis: Opti-

mal design, predictive regulation, pathophysi-

ology and rational therapeutics. In J. Schulkin

(Ed.), Allostasis, homeostasis, and the costs of

physiological adaptation (pp.

7–64). Cam-

bridge, UK: Cambridge University Press.

Thaker, P. H., Han, L. Y., Kamat, A. A., Arevalo,

J. M., Takahashi, R., Lu, C., et al. (2006).

Chronic stress promotes tumor growth and

angiogenesis in a mouse model of ovarian car-

cinoma. Nature Medicine, 12(8), 939–944.

Tian, X., Xu, F., Lung, W. Y., Meyerson, C.,

Ghaffari, A. A., Cheng, G., et al. (2012). Poly

I:C enhances susceptibility to secondary pul-

monary infections by Gram-

ositive bacteria.

PLoS ONE, 7(9), e41879.

Tung, J., Barreiro, L. B., Johnson, Z. P., Han-

sen, K. D., Michopoulos, V., Toufexis, D., et

al. (2012). Social environment is associated

with gene regulatory variation in the rhesus

macaque immune system. Proceedings of the

National Academy of Sciences USA, 109(17),

6490–6495.

Wagner, D. D., & Heatherton, T. F. (this volume,

2014). Emotion and self-

egulation failure. In

J. J. Gross (Ed.), Handbook of emotion reg-

ulation (2nd ed., pp.

613–628). New York:

Guilford Press.

Weaver, I. C., Meaney, M. J., & Szyf, M. (2006).

Maternal care effects on the hippocampal

transcriptome and anxiety-

mediated behav-

iors in the offspring that are reversible in

adulthood. Proceedings of the National Acad-

emy of Sciences USA, 103(9), 3480–3485.

Weinberger, D. A., Schwartz, G. E., & Davidson,

R. E. (1979). Low anxious, high anxious, and

repressive coping styles: Psychometric patterns

and physiological responses to stress. Journal

of Abnormal Psychology, 88, 369–380.

Wilson, E. O. (2012). The social conquest of

Earth. New York: Liveright/Norton.

Wohleb, E. S., Hanke, M. L., Corona, A. W.,

Powell, N. D., Stiner, L. M., Bailey, M. T., et al.

(2011). Beta-

drenergic receptor antagonism

prevents anxiety-

like behavior and microglial

reactivity induced by repeated social defeat.

Journal of Neuroscience, 31(17), 6277–6288.

Yang, E. V., Webster Marketon, J. I., Chen, M.,

Lo, K. W., Kim, S. J., & Glaser, R. (2010).

Glucocorticoids activate Epstein–

arr virus

lytic replication through the upregulation

of immediate early BZLF1 gene expression.

Brain, Behavior, and Immunity, 24(7), 1089–

1096.

586

Health disparities—that is, differences in

disease outcomes by socioeconomic sta-

tus (SES)—remain one of the most press-

ing public health issues in our society. For

example, low-SES individuals— meaning

those who are low in education, income,

or occupational status—are 2.7 times more

likely to have repeated hospitalizations dur-

ing a 1-year period than high-SES individu-

als (National Center for Health Statistics,

2010), and 3.5 times more likely to suf-

fer activity limitations due to disease than

high-SES individuals (Braveman, Cubbin,

Egerter, Williams, & Pamuk, 2010). And by

age 25, those from the lowest SES group are

expected to live 6 fewer years compared to

those in the highest SES group (Braveman et

al., 2010).

This issue has become such a widespread

concern that Healthy People 2010, the

national health objectives from the U.S.

Department of Health and Human Services

(2000), lists eliminating health disparities as

one of two overarching goals. In addition,

the National Institutes of Health (NIH)

ranked the issue of health disparities third

among its top five priorities (Thomson,

Mitchell, & Williams, 2006).

Explanations for why health dispari-

ties are so pervasive have been difficult to

unearth, because commonly suggested fac-

tors, such as access to health care, have

not sufficiently explained existing dispari-

ties (Adler, Boyce, Chesney, Folkman, &

Syme, 1993). In addition, there is growing

consensus that social, and not just biomedi-

cal, determinants of disease are important

to identify (Dankwa- Mullan et al., 2010).

In this chapter, we explore the role that

emotion regulation may play in explaining

health disparities that emerge early in life.

We do this by first providing an overview

of links between childhood SES and disease

outcomes into adulthood. Second, we exam-

ine whether emotion regulation may serve

as one explanation for these associations by

discussing links between emotion regulation

and physiological processes implicated in

disease, as well as meditational evidence for

emotion regulation strategies in relationships

between low-SES and these physiological

processes. Third, we discuss the question of

moderation—that is, whether certain types

of emotion regulation strategies could also

serve as protective buffers for a subgroup of

those who are low in SES. Throughout this

chapter, our premise is that low early life

SES fosters certain emotion regulation strat-

egies that emerge during childhood and have

implications for physiological processes dur-

ing childhood and into adulthood; hence,

we discuss findings that provide potential

CHAPTER 34

Early‑Life Socioeconomic Status,

Emotion Regulation, and the Biological

Mechanisms of Disease across the Lifespan

Edith Chen

Gregory E. Miller

SES, Emotion Regulation, and Mechanisms of Disease 587

explanations for links between childhood

SES and both childhood and adult diseases.

Early Life Environments and Risk

for Disease

We begin by discussing epidemiological evi-

dence that low SES increases risk for disease.

Low SES in childhood confers greater risk

for disease, both throughout childhood and

into adulthood. A number of reviews have

documented that the effects of low SES start

early, and that low SES during childhood

is associated with a number of different

adverse health outcomes, including greater

asthma morbidity, obesity, and injury rates,

and poorer self- and parent- reports of health

(Chen, Matthews, & Boyce, 2002; Good-

man, 1999; Starfield, Riley, Witt, & Rob-

ertson, 2002; Starfield, Robertson, & Wiley,

2002).

In addition, the effects of low SES persist

into adulthood (Miller, Chen, & Parker,

2011). For example, two reviews of the lit-

erature reported that the vast majority of

studies found an increased risk of all-cause

mortality in individuals who grew up in low-

versus high-SES households (Galobardes,

Lynch, & Smith, 2004, 2008). Moreover,

controlling for adult SES did not eliminate

these associations, indicating that some-

thing specific to low SES in childhood con-

fers risk for early mortality. Another review

documented a heightened risk of cardiovas-

cular disease morbidity associated with low

SES in childhood (Galobardes, Shaw, Law-

lor, Lynch, & Smith, 2006). Again, associa-

tions held up after researchers controlled for

adult SES.

These studies are corroborated by quasi-

experimental evidence, such as the viral

challenge paradigm in humans (Cohen,

Doyle, Turner, Alper, & Skoner, 2004), in

which a sample of adults was quarantined

and exposed to rhinoviruses that cause

colds. Participants who came from low-SES

households in childhood were significantly

more likely to become infected with the rhi-

novirus and to develop cold symptoms com-

pared to those who came from high child-

hood SES households. These associations

held even after researchers controlled for

adult SES, suggesting again that experienc-

ing low SES specifically during the child-

hood years increases risk for adverse health

outcomes later in life.

In summary, a large body of epidemiolog-

ical evidence demonstrates that low SES dur-

ing childhood is associated with a variety of

poor health outcomes both during childhood

and into adulthood. In the next section, we

explore the idea that one psychological fac-

tor contributing to this association may be

difficulties with emotion regulation.

The Role of Emotion Regulation as

a Pathway Linking SES and Disease

In this section, we discuss the idea that

emotion regulation may serve as one psy-

chological pathway linking SES and dis-

ease outcomes. To make this argument, we

(1) provide a brief overview of associations

between SES and emotion regulation; (2)

discuss what types of emotion regulation

strategies are relevant to physiological out-

comes; (3) discuss physiological markers rel-

evant to disease; (4) provide an overview of

previous research on links between emotion

regulation and physiological outcomes; and

(5) describe studies that have tested emotion

regulation as a mediator of SES and physiol-

ogy relationships.

SES and Emotion Regulation

Emotion regulation refers to strategies to

increase, decrease, or maintain emotional

responses (Gross, 2001). Gross’s process

model of emotion regulation states that there

are various types of emotion regulation strat-

egies, including antecedent- focused emo-

tion regulation, that is, strategies employed

before emotional responses become fully

activated, and response- focused emotion

regulation, that is, strategies employed after

emotion response tendencies have been acti-

vated (Gross, 1998).

In the context of SES, extensive evidence

documents that low-SES individuals are

more prone to experience negative emotions,

and in turn that these negative emotions

are detrimental for health (for a review, see

Gallo & Matthews, 2003; but note that

the evidence of negative emotions actually

serving as a mediator of the SES–health

relationship is mixed; Matthews & Gallo,

2011). Nonetheless, in this context, effective

588 HEALTH IMPLICATIONS

emotion regulation strategies should reduce

experiences of negative emotions.

Implications of Emotion

Regulation Strategies

for Physiological Responses

Gross (1998) has documented that efforts

that fall under antecedent- focused emotion

regulation, such as reappraisal, have fewer

physiological costs than response- focused

emotion regulation strategies, such as sup-

pression. Hence, in the next sections, we

focus on the role that antecedent- focused

emotion regulation plays in linking SES to

physiological and health outcomes.

Antecedent- focused emotion regulation

involves strategies such as reappraisal—that

is, reevaluating a stressful situation in a way

that seeks to reduce its emotional impact. It

can also include strategies such as situation

selection, situation modification, and atten-

tion deployment; together with reappraisal,

all of these strategies occur temporally before

emotional responses are generated and can

alter behavioral, emotional, and physiologi-

cal response tendencies. Reappraisal is the

strategy that has been studied most fre-

quently with respect to affective, cognitive,

and social consequences (Gross, 2001), so in

the section below we focus below largely on

links between reappraisal and physiological

processes implicated in disease.

Relevant Physiological Markers

for Disease

Conceptualizing pathways to disease on

the biological end entails consideration of

both acute and longer-term physiological

responses. Below we provide a brief over-

view of the types of systems and processes

implicated in chronic diseases—with a focus

on diseases linked to inflammation, such as

cardiovascular disease and asthma, so that

readers will be familiar with the outcomes

we present later on in studies of emotion reg-

ulation and physiological processes. In this

section, we focus on physiological systems

that are capable of being altered by psycho-

social factors (e.g., stress) and hence could

be plausibly linked to variables such as emo-

tion regulation.

Acutely the hypothalamic– pituitary–

adrenal (HPA) axis and the sympathetic

nervous system (SNS) become activated with

many psychosocial stressors, releasing hor-

mones such as cortisol, epinephrine, and nor-

epinephrine (Cannon, 1932; Kemeny, 2003).

These hormones bind to receptors located on

a variety of bodily tissues, exerting effects

on the heart, vasculature, and metabolic

and immune systems. With respect to acute

physiological responses, profiles indicative

of lower disease risk include a reduced mag-

nitude of reactivity of these systems and/or

a quicker recovery time (quicker return to

baseline levels) (Krantz & Manuck, 1984;

Linden, Earle, Gerin, & Christenfeld, 1997;

Linden, Gerin, & Davidson, 2003; McE-

wen, 1998; Schwartz et al., 2003). We note

that much of the literature reviewed below

does not directly measure SNS and HPA

activity, but instead focuses on the responses

of end organs such as the heart and blood

vessels. However, because these organs are

influenced by SNS and HPA activity, and are

the source of eventual manifestations of car-

diovascular disease (CVD), their responses

to acute stressors are relevant here.

Over the long term, with excessive and

prolonged exposure to the hormones men-

tioned earlier, the structure and function of

tissues and organs are thought to be altered,

giving rise to pathogenic processes that drive

CVD, such as obesity, insulin resistance,

systemic inflammation, high blood pressure,

endothelial dysfunction, and platelet activa-

tion (Brotman, Golden, & Wittstein, 2007;

Everson-Rose & Lewis, 2005; Rozanski,

Blumenthal, Davidson, Saab, & Kubzansky,

2005). Hence, we also review links between

emotion regulation strategies and these lon-

ger-term mechanisms.

Longer-term cumulative physiological

risk has sometimes been encapsulated in

concepts such as allostatic load (McEwen,

1998), which is defined as instances when

individuals experience stressors repeatedly

and have more frequent activation of physi-

ological systems over time; or when physi-

ological systems do not show adaptation of

responses after repeated stressors; or when

shutdown mechanisms are delayed or insuf-

ficient, leading to prolonged physiological

responses over time. The strain on these

allostatic systems over years may eventu-

ally cause a breakdown of these systems that

ultimately leads to disease. Empirically, high

levels of obesity, insulin resistance, systemic

SES, Emotion Regulation, and Mechanisms of Disease 589

inflammation, blood pressure, endothelial

dysfunction, and platelet activation all pre-

dict CVD morbidity and mortality (Danesh

et al., 2005; Guh et al., 2009; Lindmark,

Diderholm, Wallentin, & Siegbahn, 2001;

Ridker, Hennedens, Buring, & Rifai, 2000;

Vasan et al., 2001; Yeboah et al., 2009). In

addition, the accumulation of these charac-

teristics, in constellations such as allostatic

load or metabolic syndrome, predicts even

more strongly an increased risk of CVD

later in life (Seeman, Singer, Rowe, Hor-

witz, & McEwen, 1997; Lakka et al., 2002;

Morrison, Friedman, & Gray-McGuire,

2007; Ridker, Buring, Cook, & Rifai, 2003;

National Cholesterol Education Program,

2002).

Emotion Regulation and Physiological

and Disease Outcomes

We focus here on links specifically between

the emotion regulation strategy of reap-

praisal and physiological responses, given

the existing evidence with respect to this

strategy. Physiologically, reappraisals reduce

cardiovascular reactivity to acute stressors.

For example, lower reappraisals of threat

have been associated with reduced blood

pressure reactivity during acute stressors

in both children and adults (El Sheikh &

Harger, 2001; Maier, Waldstein, & Syn-

owski, 2003), and lower ambulatory blood

pressure during daily life social interac-

tions (Chen, Matthews, & Zhou, 2007).

Similarly, individuals high in the ability to

reappraise stressful situations show reduced

vascular reactivity during acutely stress-

ful tasks (Mauss, Cook, Chang, & Gross,

2007), and lower blood pressure and corti-

sol responses to an acute stressor (Salovey,

Stroud, Woolery, & Epel, 2002). Experi-

mental evidence shows that interventions

aimed at changing appraisals in patient pop-

ulations produce increases in benefit find-

ing, as well as decreases in serum cortisol

levels from pre- to postintervention (Cruess

et al., 2000). Finally, consistent with the

idea that underlying positive beliefs about

others shape reappraisals and physiological

responses, those who believe that the world

is fair (high in just world beliefs) reappraise

an acute stressor as less threatening and

show less vascular reactivity to the stressor

(Tomaka & Blascovich, 1994).

Emotion regulation also mitigates longer-

term pathogenic processes implicated in

CVD. For example, better emotion regula-

tion abilities are linked to lower allostatic

load, including higher high- density lipo-

protein (HDL) cholesterol, lower triglycer-

ides, and lower basal systolic blood pres-

sure (Kinnunen, Kokkonen, Kaprio, &

Pulkkinen, 2005). Similarly, reappraisals

have been linked to longer-term markers

of immune processes. For example, HIV-

positive individuals who reported finding

benefit after experiencing a major negative

life event showed slower declines in cluster

of differentiation 4 (CD4) T cell levels over

2–3 years (indicating a slower progression

to the diagnosis of AIDS) (Bower, Kemeny,

Taylor, & Fahey, 1998). Finally, functional

indicators of poor emotion regulation, such

as the experience of high levels of depres-

sion and anger, have been associated with

higher levels of systemic inflammatory

markers that are implicated in CVD, such as

interleukin-6 (IL-6) and C-reactive protein

(CRP) (Kiecolt- Glaser, McGuire, Robles, &

Glaser, 2002; Miller, Maletic, & Raison,

2009).

Finally, emotion regulation strategies can

also alter clinical disease outcomes. Reap-

praisals such as finding benefit after a life-

threatening event predicts a lower likelihood

of having a future heart attack (Affleck, Ten-

nen, Croog, & Levine, 1987). Conversely,

the experience of high levels of negative

affect (arguably an indicator of inadequate

emotion regulation) has robust associations

with CVD-related outcomes (Brosschot,

Gerin, & Thayer, 2006; Everson-Rose &

Lewis, 2005; Krantz & McCeney, 2002;

Kubzansky, Kawachi, Weiss, & Sparrow,

1998). In addition, how effectively one can

manage emotions (emotional intelligence)

is linked to better general indicators of

physical health (better self- reported health

and fewer illnesses; Goldman, Kraemer,

& Salovey, 1996; Schutte, Malouff, Thor-

steinsson, Bhullar, & Rooke, 2007). Finally,

experimental data suggest that interventions

to help individuals process negative emo-

tions effectively, such as through written dis-

closure, produce fewer symptoms and health

center visits in healthy adults, and improve

disease indicators in patient populations

(Smyth, Stone, Hurewitz, & Kaell, 1999;

Smyth, 1998).

590 HEALTH IMPLICATIONS

Emotion Regulation as a Mediator

The previously discussed literature links

emotion regulation strategies to physiologi-

cal, endocrine, and immune processes impli-

cated in chronic diseases such as CVD. But

is there any evidence that emotion regulation

strategies actually mediate the relationship

between SES and these biological processes?

In a series of studies, our research group has

shown evidence for such mediation by focus-

ing on how children and adolescents reap-

praise stressful life situations.

In healthy adolescents, we have shown

that lower SES is associated with greater

cardiovascular reactivity to acute laboratory

stressors. We further showed that low-SES

adolescents were less likely to reappraise

ambiguous life situations (e.g., shopping

with an overly attentive sales clerk nearby)

in benign ways. Finally, we documented

that reappraisals of threat statistically medi-

ated the relationship between low SES and

heightened cardiovascular reactivity (Chen,

Langer, Raphaelson, & Matthews, 2004).

In patient populations, we have docu-

mented similar patterns with disease-

relevant markers. For example, in pediatric

patients with asthma, we have demonstrated

that low SES is associated with greater

asthma inflammation (e.g., greater produc-

tion of cytokines relevant to asthma, higher

eosinophil counts). We further demonstrated

that low SES is associated with being less

likely to reappraise ambiguous life situations

in benign ways in this patient population.

Finally, we documented that reappraisals of

threat statistically mediated the relationship

between low SES and heightened asthma

inflammation (Chen, Fisher, Bacharier, &

Strunk, 2003; Chen et al., 2006).

We further documented that effects of low

SES can be seen at the genomic level. Low

SES children with asthma showed indica-

tions of increased activity of proinflamma-

tory gene networks, and these associations

between low SES and gene expression pat-

terns were no longer significant once reap-

praisals of threat during ambiguous life situ-

ations were statistically controlled (Chen et

al., 2009).

Taken together, this set of studies illus-

trates how low-SES individuals are, on aver-

age, less able to engage in reappraisals of

life situations effectively. Furthermore, reap-

praisals of threat form one pathway explain-

ing why low-SES children show heightened

inflammatory and cardiovascular responses.

In turn, these inflammatory and cardiovas-

cular profiles are predictive of later disease.

The Role of Emotion Regulation

as Buffer

In the previous section we discussed how

emotion regulation strategies serve as one

psychological mediator explaining links

between low SES and detrimental profiles of

physiological processes relevant to disease.

In this section, we turn to the question of

whether emotion regulation could also serve

as a moderator of SES and health outcomes.

Despite the robust associations between low

SES and disease, there remains a subset of

individuals that displays physiologically

healthy profiles despite living under adver-

sity. What can explain this group of individ-

uals? That is, what factors might naturally

protect individuals who grow up in low-SES

environments from the physiological toll

and accumulation of health problems typi-

cally exacted by these environments? Our

research group has articulated a theory

about the psychological characteristics that

may be specifically beneficial to low-SES

individuals (Chen & Miller, 2012). Emotion

regulation plays a key role in this theory;

hence we discuss its role as a buffer for low-

SES individuals in this chapter. In this sec-

tion, we first provide an outline of the shift-

and- persist theory; then we describe the

empirical evidence in support of this theory.

Shift and Persist

The theory begins with the notion that a

lifetime of facing constraints with limited

options leads those living in a low-SES con-

text to place value on the ability to adjust in

response to stressors through emotion regu-

lation strategies such as reappraisals (shift-

ing). At the same time, in this context, suc-

cessful adaptation entails enduring adversity

with strength by finding meaning in difficult

situations and maintaining optimism in the

face of adversity (persisting). We proposed

that this combination of approaches to

dealing with adversity reduces physiologi-

cal responses to stressful situations acutely,

specifically among those who are low in

SES, and over the long term mitigates the

SES, Emotion Regulation, and Mechanisms of Disease 591

progression of pathogenic processes leading

to chronic diseases such as CVD (Chen &

Miller, 2012).

Hence, one of the key components of

this beneficial psychological profile centers

around the ability to regulate one’s emo-

tions through reappraisal strategies. Because

low-SES individuals on average have fewer

opportunities to select or modify their life

situations (alternative forms of emotion regu-

lation; Gross, 1998, 2001), reappraisals rep-

resent a realistic approach to emotion regula-

tion in this group. That is, given the myriad

day-to-day, largely uncontrollable stressors

experienced by many low-SES individuals,

in many instances their best option may be

to control the one thing they can—the self—

rather than engage in what may turn out to

be futile attempts to control their environ-

ment. By controlling the self, they engage in

emotion regulation strategies in which they

accept that a stressor has occurred and try to

change the effect that stressor has on them.

They do this by reappraising the meaning of

an event, so that the implications for their

lives become less negative. And they adjust

their emotional reactions, so that the event

evokes less distress in them. As they come to

see events as having less serious implications

and being less upsetting, the physiological

responses they elicit are mitigated. Hence,

we propose that low-SES individuals uphold

as an ideal the goal of utilizing emotion regu-

lation strategies related to reappraisals when

dealing with stress. The ability to do this suc-

cessfully comprises the “shift” part of our

shift-and- persist model.

Shifting is hypothesized to be neces-

sary but not sufficient for buffering low-

SES individuals from stressors. In addition

to shifting, we hypothesize that it will be

important to persist—that is, to endure

adversity with strength by finding meaning

in life and maintaining optimism about the

future. Finding meaning allows individuals

to understand adversity and to grow from

it. Optimism allows individuals to maintain

hope about the future, and can be essentially

thought of as reappraising the future (as

opposed to shifting, which entails reapprais-

als of events that have already happened).

Thus, reappraisals are an important compo-

nent of both shifting and persisting.

We further postulate that there is some-

thing important about the combination—

that is, it is not sufficient to be able to engage

in emotion regulation to deal with current

adversities; one also needs also to find

broader meaning in life and be able to reap-

praise the future. Hence the label that we

use, “shift and persist,” is intended to con-

note the fact that it is this combination of

characteristics that will be beneficial to low-

SES individuals with respect to their health.

In the next section, we discuss evidence sup-

porting the notion that when low-SES indi-

vidual engage in shift and persist, there are

benefits to the physiological mechanisms

that underlie disease.

Empirical Evidence for Shift

and Persist

In two studies from our research group, we

have documented the benefits of shift and

persist specifically for low-SES individuals.

In the first study, we assessed childhood

SES in a national sample of adults. We mea-

sured cumulative physiological risk via allo-

static load, based on 24 different measures

across seven physiological systems. Shift

and persist was measured using question-

naires probing reappraisal- related coping

styles (shift) and future orientation (persist).

We found a three-way interaction between

childhood SES, shift, and persist in predict-

ing allostatic load in this sample. Breaking

down this three-way interaction revealed

that there was a significant two-way inter-

action between shift and persist in those

from low childhood SES backgrounds, but

no two-way interaction of shift and persist

among those from high childhood SES back-

grounds. The two-way interaction revealed

that those participants with low childhood

SES backgrounds who were high on both

shifting and persisting had the lowest allo-

static load. In contrast, the combination of

shift and persist did not predict allostatic

load among those from high-SES childhood

backgrounds (Chen, Miller, Lachman, Gru-

enewald, & Seeman, 2012).

In a second study, using a clinical sample,

we investigated the effects of shift and per-

sist among children diagnosed with asthma,

using questionnaires that tapped both reap-

praisal styles of coping (for shifting) and

optimism about the future (for persisting).

Among those low in SES, the higher their

shift-and- persist scores, the lower their

asthma inflammation. Also, among low-SES

children, higher shift-and- persist scores pro-

592 HEALTH IMPLICATIONS

spectively predicted less functional impair-

ment (fewer school absences, less rescue

inhaler use) 6 months later, when we con-

trolled for baseline levels. In fact, low-SES

children who scored high on shift and persist

had inflammatory and clinical profiles more

similar to high-SES children with asthma

than to low-SES children who scored low in

shift and persist. Shift and persist was not

related to inflammatory or clinical profiles

in high-SES children with asthma (Chen et

al., 2011).

In summary, we find that low-SES indi-

viduals who are able to engage in emotion

regulation strategies involving reappraisals,

in combination with being optimistic and

future oriented, are the ones who show the

most beneficial physiological profiles and

the least clinical disease impairment. Shift

and persist is only beneficial to those who

are low in SES, not to those who are high

in SES, suggesting that there are context-

specific determinants of what types of strat-

egies will be beneficial physiologically for

whom. In particular, for low-SES individu-

als, engaging in reappraisals and focusing on

the future when encountering current daily

stressors that are largely uncontrollable may

be beneficial. In contrast, for those who are

high in SES, proactive attempts to eliminate

or mitigate stressful situations may be a

more beneficial approach given the greater

resources these individuals tend to have.

In addition, it is important to note that

the combination of shift and persist is criti-

cal to physiological profiles among low-SES

individuals. That is, neither shifting nor per-

sisting alone was predictive of physiological

outcomes; rather, it is only when individuals

combine shifting and persisting that one sees

physiological benefits. This suggests that

emotion regulation strategies of reappraisals

on their own are not sufficient; rather, they

need to be combined with a focus on the

future that emphasizes optimism and mean-

ing in order to derive physiological benefits

among those who are low in SES.

Conclusions

In summary, health disparities are a press-

ing issue in our society, and researchers

have been working to understand what fac-

tors account for such striking differences in

health outcomes across the SES gradient.

One possibility we suggest here is that on

the psychological end, low-SES children may

experience greater difficulties with emotion

regulation. In particular, low-SES children

may find themselves less able to reappraise

stressful situations in positive ways. In turn,

this leads them to be more likely to expe-

rience negative emotions and physiological

costs, both acutely and cumulatively, that

may contribute to risk for disease over the

long term. We note, however, that much of

this work is correlational, and cannot be

used to draw conclusions about causality.

We also document that emotion regula-

tion serves an important function in terms

of buffering low-SES children from detri-

mental physiological profiles. That is, those

low-SES children who are able to engage in

shift and persist (utilizing effective emotion

regulation strategies, such as reappraisals in

combination with persisting with hopes and

finding meaning with respect to one’s future)

exhibit physiological profiles that are more

similar to profiles of high-SES children than

to those of low-SES children who do not

engage in shift and persist. These children

also showed less clinical disease impairment

compared to low-SES children who did not

engage in shift and persist. These findings

suggest that shift and persist serves as a nat-

ural protective factor in low- but not high-

SES children.

Emotion regulation strategies are an

important factor to consider when inves-

tigating individual-level psychological

mechanisms underlying SES disparities in

health. These strategies provide an inter-

face between children and their broader

social environments, and play an important

role in shaping hormonal and inflamma-

tory responses to stress. In turn, these acute

responses appear to have longer-term impli-

cations for the pathogenic processes that

underlie chronic diseases across the lifespan.

References

Adler, N. E., Boyce, W. T., Chesney, M. A., Folk-

man, S., & Syme, S. L. (1993). Socioeconomic

inequalities in health: No easy solution. Jour-

nal of the American Medical Association 269,

3140–3145.

Affleck, G., Tennen, H., Croog, S., & Levine, S.

SES, Emotion Regulation, and Mechanisms of Disease 593

(1987). Causal attribution, perceived benefits,

and morbidity after a heart attack: An 8-year

study. Journal of Consulting and Clinical Psy-

chology, 55, 29–35.

Bower, J. E., Kemeny, M. E., Taylor, S. E.,

& Fahey, J. L. (1998). Cognitive process-

ing, discovery of meaning, CD4 decline, and

AIDS-related mortality among bereaved HIV-

seropositive men. Journal of Consulting and

Clinical Psychology, 66, 979–986.

Braveman, P. A., Cubbin, C., Egerter, S., Wil-

liams, D. R., & Pamuk, E. (2010). Socioeco-

nomic disparities in health in the United States:

What the patterns tell us. American Journal of

Public Health, 100, S186–S196.

Brosschot, J. F., Gerin, W., & Thayer, J. F.

(2006). The perseverative cognition hypothe-

sis: A review of worry, prolonged stress- related

physiological activation, and health. Journal

of Psychosomatic Research, 60, 113–124.

Brotman, D. J., Golden, S. H., & Wittstein, I. S.

(2007). The cardiovascular toll of stress. Lan-

cet, 370, 1089–1100.

Cannon, W. B. (1932). The wisdom of the body.

New York: Norton.

Chen, E., Fisher, E. B., Jr., Bacharier, L. B., &

Strunk, R. C. (2003). Socioeconomic status,

stress, and immune markers in adolescents

with asthma. Psychosomatic Medicine, 65,

984–992.

Chen, E., Hanson, M. D., Paterson, L. Q., Grif-

fin, M. J., Walker, H. A., & Miller, G. E.

(2006). Socioeconomic status and inflamma-

tory processes in childhood asthma: The role

of psychological stress. Journal of Allergy and

Clinical Immunology, 117, 1014–1020.

Chen, E., Langer, D. A., Raphaelson, Y. E., &

Matthews, K. A. (2004). Socioeconomic sta-

tus and health in adolescents: The role of

stress interpretations. Child Development, 75,

1039–1052.

Chen, E., Matthews, K. A., & Boyce, W. T.

(2002). Socioeconomic differences in chil-

dren’s health: How and why do these relation-

ships change with age? Psychological Bulletin,

128, 295–329.

Chen, E., Matthews, K. A., & Zhou, F. (2007).

Interpretations of ambiguous social situations

and cardiovascular responses in adolescents.

Annals of Behavioral Medicine, 34, 26–36.

Chen, E., & Miller, G. E. (2012). “Shift-and-

persist” strategies: Why being low in socio-

economic status isn’t always bad for health.

Perspectives on Psychological Science, 7,

135–158.

Chen, E., Miller, G. E., Lachman, M. E., Gru-

enewald, T. L., & Seeman, T. E. (2012). Pro-

tective factors for adults from low childhood

socioeconomic circumstances: The benefits of

shift-and- persist for allostatic load. Psychoso-

matic Medicine, 74, 178–186.

Chen, E., Miller, G. E., Walker, H. A., Arevalo,

J. M., Sung, C. Y., & Cole, S. W. (2009).

Genome-wide transcriptional profiling linked

to social class in asthma. Thorax, 64, 38–43.

Chen, E., Strunk, R. C., Trethewey, A., Schreier,

H. M., Maharaj, N., & Miller, G. E. (2011).

Resilience in low- socioeconomic- status chil-

dren with asthma: Adaptations to stress. Jour-

nal of Allergy and Clinical Immunology, 128,

970–976.

Cohen, S., Doyle, W. J., Turner, R. B., Alper,

C. M., & Skoner, D. P. (2004). Childhood

socioeconomic status and host resistance to

infectious illness in adulthood. Psychosomatic

Medicine, 66, 553–558.

Cruess, D. G., Antoni, M. H., McGregor, B. A.,

Kilbourn, K. M., Boyers, A. E., Alferi, S. M.,

et al. (2000). Cognitive- behavioral stress man-

agement reduces serum cortisol by enhancing

benefit finding among women being treated

for early stage breast cancer. Psychosomatic

Medicine, 62, 304–308.

Danesh, J., Lewington, S., Thompson, S. G.,

Lowe, G. D., Collins, R., Kostis, J. B., et al.

(2005). Plasma fibrinogen level and the risk of

major cardiovascular diseases and nonvascu-

lar mortality: An individual participant meta-

analysis. Journal of the American Medical

Association, 294, 1799–1809.

Dankwa- Mullan, I., Rhee, K. B., Williams, K.,

Sanchez, I., Sy, F. S., Stinson, N., et al. (2010).

The science of eliminating health disparities:

Summary and analysis of the NIH Summit

recommendations. American Journal of Pub-

lic Health, 100, S12–S18.

El Sheikh, M., & Harger, J. (2001). Appraisals

of marital conflict and children’s adjustment,

health, and physiological reactivity. Develop-

mental Psychology, 37, 875–885.

Everson-Rose, S. A., & Lewis, T. T. (2005).

Psychosocial factors and cardiovascular dis-

eases. Annual Review of Public Health, 26,

469–500.

Gallo, L. C., & Matthews, K. A. (2003). Under-

standing the association between socioeco-

nomic status and physical health: Do negative

emotions play a role? Psychological Bulletin,

129, 10–51.

Galobardes, B., Lynch, J. W., & Smith, G. D.

594 HEALTH IMPLICATIONS

(2004). Childhood socioeconomic circum-

stances and cause- specific mortality in adult-

hood: Systematic review and interpretation.

Epidemiologic Reviews, 26, 7–21.

Galobardes, B., Lynch, J. W., & Smith, G. D.

(2008). Is the association between childhood

socioeconomic circumstances and cause-

specific mortality established?: Update of a

systematic review. Journal of Epidemiology

and Community Health, 62, 387–390.

Galobardes, B., Shaw, M., Lawlor, D. A., Lynch,

J. W., & Smith, G. D. (2006). Indicators of

socioeconomic position (Part 2). Journal of

Epi demiology and Community Health, 60,

95–101.

Goldman, S. L., Kraemer, D. T., & Salovey, P.

(1996). Beliefs about mood moderate the

relationship of stress to illness and symptom

reporting. Journal of Psychosomatic Research,

41, 115–128.

Goodman, E. (1999). The role of socioeconomic

status gradients in explaining differences in

US adolescents’ health. American Journal of

Public Health, 89, 1522–1528.

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of

General Psychology, 2, 271–299.

Gross, J. J. (1998). Antecedent- and response-

focused emotion regulation: Divergent con-

sequences for experience, expression, and

physiology. Journal of Personality and Social

Psychology, 74, 224–237.

Gross, J. J. (2001). Emotion regulation in adult-

hood: Timing is everything. Current Direc-

tions in Psychological Science, 10, 214–219.

Guh, D. P., Zhang, W., Bansback, N., Amarsi,

Z., Birmingham, C. L., & Anis, A. H. (2009).

The incidence of co- morbidities related to obe-

sity and overweight: A systematic review and

meta- analysis. BMC Public Health, 9, 88.

Kemeny, M. E. (2003). The psychobiology of

stress. Current Directions in Psychological

Science, 12, 124–129.

Kiecolt- Glaser, J. K., McGuire, L., Robles, T.

F., & Glaser, R. (2002). Emotions, morbidity,

and mortality: New perspectives from psycho-

neuroimmunology. Annual Review of Psy-

chology, 53, 83 –107.

Kinnunen, M. L., Kokkonen, M., Kaprio, J.,

& Pulkkinen, L. (2005). The associations of

emotion regulation and dysregulation with the

metabolic syndrome factor. Journal of Psycho-

somatic Research, 58, 513–521.

Krantz, D. S., & Manuck, S. B. (1984). Acute

psychophysiologic reactivity and risk of car-

diovascular disease: A review and method-

ological critique. Psychological Bulletin, 96,

435–464.

Krantz, D. S., & McCeney, M. K. (2002). Effects

of psychological and social factors on organic

disease: A critical assessment of research on

coronary heart disease. Annual Review of

Psychology, 53, 341–369.

Kubzansky, L. D., Kawachi, I., Weiss, S. T., &

Sparrow, D. (1998). Anxiety and coronary

heart disease: A synthesis of epidemiological,

psychological, and experimental evidence.

Annals of Behavioral Medicine, 20, 47–58.

Lakka, H. M., Laaksonen, D. E., Lakka, T. A.,

Niskanen, L. K., Kumpusalo, E., Tuomilehto,

J., et al. (2002). The metabolic syndrome and

total and cardiovascular disease mortality in

middle-aged men. Journal of the American

Medical Association, 288, 2709–2716.

Linden, W., Earle, T. L., Gerin, W., & Christen-

feld, N. (1997). Physiological stress reactivity

and recovery: Conceptual siblings separated at

birth? Journal of Psychosomatic Research, 42,

117–135.

Linden, W., Gerin, W., & Davidson, K. (2003).

Cardiovascular reactivity: Status quo and a

research agenda for the new millennium. Psy-

chosomatic Medicine, 65, 5–8.

Lindmark, E., Diderholm, E., Wallentin, L., &

Siegbahn, A. (2001). Relationship between

interleukin 6 and mortality in patients with

unstable coronary artery disease: Effects of an

early invasive or noninvasive strategy. Journal

of the American Medical Association, 286,

2107–2113.

Maier, K. J., Waldstein, S. R., & Synowski, S.

J. (2003). Relation of cognitive appraisal to

cardiovascular reactivity, affect, and task

engagement. Annals of Behavioral Medicine,

26, 32–41.

Matthews, K. A., & Gallo, L. C. (2011). Psy-

chological perspectives on pathways linking

socioeconomic status and physical health.

Annual Review of Psychology, 62, 501–530.

Mauss, I. B., Cook, C. L., Cheng, J. Y., & Gross,

J. J. (2007). Individual differences in cogni-

tive reappraisal: Experiential and physiologi-

cal responses to an anger provocation. Inter-

national Journal of Psychophysiology, 66,

116–124.

McEwen, B. S. (1998). Protective and damaging

effects of stress mediators. New England Jour-

nal of Medicine, 338, 171–179.

Miller, A. H., Maletic, V., & Raison, C. L.

(2009). Inflammation and its discontents: The

SES, Emotion Regulation, and Mechanisms of Disease 595

role of cytokines in the pathophysiology of

major depression. Biological Psychiatry, 65,

732–741.

Miller, G. E., Chen, E., & Parker, K. J. (2011).

Psychological stress in childhood and suscep-

tibility to the chronic diseases of aging: Mov-

ing toward a model of behavioral and biologi-

cal mechanisms. Psychological Bulletin, 137,

959–997.

Morrison, J. A., Friedman, L. A., & Gray-

McGuire, C. (2007). Metabolic syndrome

in childhood predicts adult cardiovascular

disease 25 years later: The Princeton Lipid

Research Clinics Follow-Up Study. Pediatrics,

120, 340–345.

National Center for Health Statistics. (2010).

Health, United States, 2009. Hyattsville, MD:

Author.

National Cholesterol Education Program.

(2002). Third Report of the Expert Panel on

Detection, Evaluation, and Treatment of High

Blood Cholesterol in Adults (Adult Treatment

Panel III). Bethesda, MD: National Heart,

Lung, and Blood Institute.

Ridker, P. M., Buring, J. E., Cook, N. R., &

Rifai, N. (2003). C-reactive protein, the meta-

bolic syndrome, and risk of incident cardio-

vascular events. Circulation, 107, 391–397.

Ridker, P. M., Hennekens, C. H., Buring, J. E.,

& Rifai, N. (2000). C-reactive protein and

other markers of inflammation in the predic-

tion of cardiovascular disease in women. New

England Journal of Medicine, 342, 836–843.

Rozanski, A., Blumenthal, J. A., Davidson, K.

W., Saab, P. G., & Kubzansky, L. (2005). The

epidemiology, pathophysiology, and manage-

ment of psychosocial risk factors in cardiac

practice: The emerging field of behavioral car-

diology. Journal of the American College of

Cardiology, 45, 637–651.

Salovey, P., Stroud, L. R., Woolery, A., & Epel,

E. S. (2002). Perceived emotional intelligence,

stress reactivity, and symptom reports: Fur-

ther explorations using the Trait Meta-Mood

Scale. Psychology and Health, 17, 611– 627.

Schutte, N. S., Malouff, J. M., Thorsteinsson,

E. B., Bhullar, N., & Rooke, S. E. (2007). A

meta- analytic investigation of the relationship

between emotional intelligence and health.

Personality and Individual Differences, 42,

921–933.

Schwartz, A. R., Gerin, W., Davidson, K. W.,

Pickering, T. G., Brosschot, J. F., Thayer, J. F.,

et al. (2003). Toward a causal model of car-

diovascular responses to stress and the devel-

opment of cardiovascular disease. Psychoso-

matic Medicine, 65, 22–35.

Seeman, T. E., Singer, B. H., Rowe, J. W., Hor-

witz, R. I., & McEwen, B. S. (1997). Price

of adaptation— allostatic load and its health

consequences: MacArthur studies of success-

ful aging. Archives of Internal Medicine, 157,

2259–2268.

Smyth, J. M. (1998). Written emotional expres-

sion: Effect sizes, outcome types, and mod-

erating variables. Journal of Consulting and

Clinical Psychology, 66, 174–184.

Smyth, J. M., Stone, A. A., Hurewitz, A., &

Kaell, A. (1999). Effects of writing about

stressful experiences on symptom reduction in

patients with asthma or rheumatoid arthritis:

A randomized trial. Journal of the American

Medical Association, 281, 1304–1309.

Starfield, B., Riley, A. W., Witt, W. P., & Robert-

son, J. (2002). Social class gradients in health

during adolescence. Journal of Epidemiology

and Community Health, 56, 354–361.

Starfield, B., Robertson, J., & Riley, A. W. (2002).

Social class gradients and health in childhood.

Ambulatory Pediatrics, 2, 238–246.

Thomson, G. E., Mitchell, F., & Williams, M.

(2006). Examining the Health Disparities

Research Plan of the National Institutes of

Health: Unfinished business. Washington,

DC: National Academies Press.

Tomaka, J., & Blascovich, J. (1994). Effects of

justice beliefs on cognitive appraisal of and

subjective, physiological, and behavioral

responses to potential stress. Journal of Per-

sonality and Social Psychology, 67, 732–740.

U.S. Department of Health and Human Services.

(2000). Healthy People, 2010: Understanding

and improving health. Washington, DC: U.S.

Government Printing Office.

Vasan, R. S., Larson, M. G., Leip, E. P., Evans,

J. C., O’Donnell, C. J., Kannel, W. B., et al.

(2001). Impact of high- normal blood pressure

on the risk of cardiovascular disease. New

England Journal of Medicine, 345, 1291–

1297.

Yeboah, J., Folsom, A. R., Burke, G. L., Johnson,

C., Polak, J. F., Post, W., et al. (2009). Predic-

tive value of brachial flow- mediated dilation

for incident cardiovascular events in a popu-

lation-based study: The multi- ethnic study of

atherosclerosis. Circulation, 120, 502–509.

596

Cardiovascular disease (CVD) is a leading

cause of morbidity and mortality world-

wide (Mendis, Puska, & Norrving, 2011),

and it is increasingly clear that disease pro-

cesses initiate in childhood (Berenson &

Srnivasan, 2005; Lloyd-Jones et al., 2009;

National Heart, Lung, and Blood Institute,

2007). Poor cardiovascular health is defined

as having a combination of unhealthy levels

of lipids, blood pressure, and glucose, being

overweight or obese, smoking, being sed-

entary, and having an unhealthy diet. This

profile is highly prevalent among middle-

aged adults in the United States (Folsom et

al., 2011; Lloyd-Jones et al., 2010) and once

risk factors are elevated, they are difficult to

ameliorate (Lloyd-Jones et al., 2010). With

the growing awareness that major CVD risk

factors such as atherosclerosis and hyperten-

sion are often identifiable many years before

the disease is fully manifest, the Ameri-

can Heart Association recently revised its

national goals for cardiovascular health pro-

motion to emphasize the identification and

prevention of early life risk factors for CVD

(Lloyd-Jones et al., 2010). As such, consid-

ering CVD from a developmental or life

course perspective may provide new insights

into disease etiology and suggest novel ave-

nues for prevention and intervention efforts.

The notion that emotions are inextrica-

bly linked to heart health has been part of

popular discourse for centuries. Terms such

as “broken heart” and “heartsick” invoke

the well- understood sentiment that while

emotions may emanate from within the

psyche, emotions move the heart to behave

and respond in predictable ways. Moreover,

the idea that the control or regulation of

emotions also matter for heart health has

popularly endured as well, as evidenced

in the opening quotation. However, while

emotions and cardiovascular health have

long been recognized as intertwined, the

exact nature of the relationship is not well

understood. Much epidemiological and psy-

chological work describes cardiovascular

risk in association with negative emotions

(for a review, see Suls & Bunde, 2005),

and a growing body of work also describes

the potentially protective effects of posi-

tive emotions on cardiovascular health (for

CHAPTER 35

Emotion Regulation

and Cardiovascular Disease Risk

Allison A. Appleton

Laura D. Kubzansky

My tongue will tell the anger of my heart,

Or else my heart concealing it will break.

—William ShakeSpeare,

The Taming of the Shrew

(Act 4, Scene 3)

Emotion Regulation and Cardiovascular Disease Risk 597

a review, see Boehm & Kubzansky, 2012).

Despite this accumulation of evidence, key

questions remain, including whether or not

emotions truly cause CVD, or whether spe-

cific emotions are a product of the illness.

Additional questions revolve around under-

standing the different roles of positive and

negative emotion in determining CVD risk.

We suggest that examining CVD risk in

relation to emotion regulation will help to

address these issues. Thus, in this review we

consider what the extant literature tells us

about a relationship between emotion regu-

lation and CVD risk, and identify the poten-

tially harmful and health- promoting impact

of various emotion regulation strategies in

this context.

A large literature indicates that both posi-

tive and negative emotions are relevant in

terms of maintaining cardiovascular health

or developing CVD (Boehm & Kubzan-

sky, 2012; Suls & Bunde, 2005). Moreover,

research has increasingly indicated that

positive emotional functioning entails more

than the absence of emotional distress, and

that physical and mental health may depend

in part on our ability to meet environmen-

tal demands (Kubzansky, Park, Peterson,

Vokonas, & Sparrow, 2011). Drawing on

these findings, investigators have begun

to speculate that beyond the effects of any

specific emotion, it is the regulation of emo-

tion that is critical. Emotion regulation is

a higher order feature of emotional func-

tioning that involves the monitoring and

management of emotional experience and

response (Gross, this volume). Emotion

regulation can be conscious or unconscious

and involve both up- and down- regulation

of positive and negative emotions. Emotion

regulation is learned through socialization

and experience over time, with childhood

being an important period of development

as temperament, biology, and social factors

interact to build regulatory skills and strate-

gies that are then used across the life course

(Calkins & Hill, 2007; John & Gross, 2004;

Rothbart, Sheese, & Posner, and Thompson,

this volume). The research findings linking

emotions and CVD risk, the importance of

early life experience in learning to regulate

emotion, and the recent evidence indicating

that deterioration of cardiovascular health

begins in childhood (Berenson & Srnivasan,

2005), have raised the question of whether

emotion regulation may play an important

role in determining CVD risk over the life

course.

In this chapter, we first consider the labo-

ratory and population-based evidence sug-

gesting that emotion regulation may con-

tribute to CVD risk. The literature linking

emotion regulation to CVD has considered

cardiovascular conditions (e.g., cardiovas-

cular disease, hypertension) and the biologi-

cal markers that are considered indicative of

risk of developing CVD in individuals who

are too young to have developed actual dis-

ease. These include indicators of cardiovas-

cular function and risk that are measured in

response to acute stress, generally obtained

from laboratory-based studies (e.g., blood

pressure reactivity), predisease conditions

and markers of risk (e.g., hypertension,

C-reactive protein, metabolic syndrome),

and actual measures of disease (e.g., myo-

cardial infarction, death). The term cardio-

vascular disease refers to a group of dis-

orders of the heart and blood vessels, and

encompasses both coronary heart disease

and cerebrovascular disease (Mendis et al.,

2011), the two cardiovascular disease out-

comes most commonly considered in rela-

tion to emotion. We review work in these

areas, while limiting our discussion to exem-

plar studies that focus on objectively mea-

sured outcomes. Doing so mitigates a com-

mon concern about these associations that

self- report bias inflates or falsely suggests

that emotional factors are causally related

to health (i.e., more distressed individuals

report more symptoms). Also, we primarily

consider prospective studies that examine

longitudinal data in which emotion regula-

tion is assessed initially among individuals

who are disease-free, prior to development

of CVD. These study designs help to miti-

gate another common concern about these

associations: that health conditions actu-

ally drive emotions rather than the reverse.

We also discuss and apply a developmental

perspective to emotion regulation and CVD

risk associations, and consider the evidence

linking childhood emotion regulation to

CVD risk in adulthood. Finally, we close

with recommendations for future work.

Due to space constraints we do not consider

studies of emotion regulation and health risk

behaviors (e.g., smoking) in detail, although

we note that such behaviors are considered

598 HEALTH IMPLICATIONS

potential pathways through which emotion

regulation may influence CVD, and rec-

ommend these as areas for future research.

Also, while we focus on studies of emotion

regulation in relation to CVD etiology (i.e.,

development of disease), we recognize that

emotion regulation is also likely related to

CVD progression and survival. Finally, it is

important to note that while the effects of

emotion regulation are likely involved in the

pathophysiology of many diseases, the evi-

dence to date is strongest for CVD and, as

such, is reviewed specifically in this chapter.

Evidence Linking Emotion

Regulation to Cardiovascular

Function and Disease

Over the past several decades, the study

of emotion regulation and cardiovascular

function and disease has been taken up by

related but traditionally distinct disciplines

of psychology and epidemiology. Psycholog-

ical laboratory-based and epidemiological

population-based studies have documented

associations between emotion regulation

and cardiovascular function and risk. How-

ever, as each discipline has different goals

and generally relies on different methodolo-

gies, the evidence linking emotion regulation

to CVD has developed largely in two differ-

ent literatures, with limited crossover. Lab-

oratory-based studies of emotion regulation

and cardiovascular function tend to have

small sample sizes and focus on identifying

relevant biological alterations occurring in

association with experimentally manipu-

lated use of regulatory strategies. Epidemio-

logical studies tend to be observational and

employ large population-based samples, and

focus more on the diagnostic and health risk

implications of dysregulated emotion. More-

over, epidemiological work includes studies

that explicitly measure emotion regulation

and test associations with cardiovascular

risk (i.e., direct evidence), but these are lim-

ited in number. However, more numerous

are studies of cardiovascular risk that do

not measure emotion regulation directly but

assess aspects of emotional functioning (e.g.,

negative emotions) that may provide indica-

tion of poor emotion regulation. We include

these studies, because they provide relevant

but indirect evidence of the relationships of

interest. In this section, we bring together

important work from each area, integrat-

ing evidence across disciplines in order to

expand the evidence base and move the sci-

ence forward.

It is important to note that whether the use

of an emotion regulation strategy is adap-

tive or maladaptive is context- dependent.

However, based on the empirical findings to

date, we argue that the predominant use of a

particular set of strategies (e.g., suppression,

inhibition) may carry more cardiovascular

health risks than other strategies (e.g., reap-

praisal, disclosure), even though on occasion

the use of such strategies may well be adap-

tive. Thus, we acknowledge that there may

be contexts in which strategies such as reap-

praisal may not always be beneficial, and

strategies such as suppression may be useful.

The larger point is that effective regulation

(regardless of what regulatory strategy is

used in any given situation) versus emotion

dysregulation may have differential effects

on cardiovascular disease risk.

Laboratory‑Based Research

Laboratory-based work has found emotion

regulation strategies to be associated with

identifiable patterns in cardiovascular func-

tion and response to regulatory demands

that have implications for disease risk (see

also Chen & Miller, this volume). The gen-

eral hypothesis guiding work on emotion

regulation in this context is that failing

to manage emotions effectively requires a

certain degree of psychological and physi-

ological exertion, and is essentially a form

of stress exposure. Thus, such exertion is

thought to exact a physiological cost on the

body, which leads to “wear and tear” and

thereby increases vulnerability to disease

over time (Consedine, Magai, & Bonanno,

2002; Pennebaker & Beall, 1986).

Population-based research tends to focus

on clinically relevant risk markers (typi-

cally measured with resting levels) and inci-

dence of disease. In contrast, laboratory-

based work often focuses on indicators of

cardiovascular function and risk that are

measured in response to acute stress, such

as heart rate and blood pressure reactivity,

pulse transmission time, finger pulse ampli-

tude, and cardiac interbeat interval. Stress-

ful or demanding situations activate the

Emotion Regulation and Cardiovascular Disease Risk 599

hypothalamic– pituitary– adrenal (HPA) axis

and the sympathetic nervous system (SNS),

resulting in a cascade of related hormones

that in turn influence a range of end organ

responses, including heart rate and blood

pressure. High reactivity is typically inferred

by higher heart rate and blood pressure lev-

els, greater increases in sympathetic activa-

tion during acute stress, and slower return to

baseline levels of these parameters during a

recovery period, after the acute stress expe-

rience has ended. Reactivity has also been

measured by examining cortisol response to

stress (a marker of HPA activation) (Chida

& Hamer, 2008). Heart rate variability is

another parameter this work has considered;

at rest, lower levels of heart rate variability

have been linked with increased risk of devel-

oping CVD (Thayer & Lane, 2007), while

reduced heart rate variability in response to

stress or slower return to resting levels have

been linked with autonomic dysregulation

(Cohen et al., 2000). Other experimental

work manipulating emotion regulation has

also considered effects on immune- related

markers or alterations in relevant health

conditions.

Much work considering emotion sup-

pression and inhibition in these settings has

found some support for the idea that sup-

pression may alter acute cardiac response

in ways that could impair cardiovascular

health. For example, in two key studies,

participants were instructed to suppress

emotion expression when watching films

designed to elicit diverse emotions (Gross &

Levenson, 1993, 1997). Compared to con-

trols, those who actively suppressed both

positive (amusement) and negative emotion

(disgust, sadness) experienced significantly

increased activation of the autonomic sys-

tem, as measured by a composite variable of

pulse transit time to the finger, finger pulse

amplitude, pulse transit time to the ear, and

figure temperature. Similar patterns of asso-

ciation have been observed across a range

of physiological and health indicators, with

more reactivity or risk- related outcomes

associated with strategies of suppression

and inhibition (Consedine et al., 2002). One

recent study found divergent associations of

emotion suppression and reappraisal with

heart rate variability in response to an emo-

tion regulation task (Denson, Grisham,

& Moulds, 2011). Among 131 women

instructed to suppress, reappraise, or remain

neutral when viewing an anger- eliciting film,

those in the suppression condition exhibited

significantly reduced heart rate variability

compared with baseline, whereas those in

the reappraisal condition showed increased

heart rate variability. These studies suggest

that actively inhibiting or suppressing emo-

tional expression and experience is associ-

ated with deleterious autonomic function-

ing, which over time may take a toll on the

cardiovascular system.

Other laboratory-based work has consid-

ered whether effects of emotion regulation

strategies over a longer period of time may

be associated with beneficial effects on a

variety of other markers of cardiovascular

health. Many studies have found regula-

tory strategies such as emotional disclosure,

or the ability to discuss or disclose emo-

tions verbally or in writing, to have posi-

tive effects on a range of health outcomes,

although fewer studies have directly assessed

outcomes related to cardiovascular health.

In an early experimental study of trauma

disclosure, Pennebaker and Beall (1986)

instructed disease-free subjects to write

in journals over 4 consecutive days about

either a traumatic experience or a neutral-

control event. Compared to controls, those

who wrote about a trauma and related emo-

tions made significantly fewer health center

visits in the 6 months following the disclo-

sure experiment. Such benefits of emotional

disclosure have been replicated across a

variety of samples and with cardiovascular-

related health outcomes. For example, in a

randomized controlled trial of expressive

writing among 179 individuals who recently

experienced a first-time myocardial infarc-

tion, those randomized to the expressive

writing/emotional disclosure condition had

significantly lower blood pressure, reported

fewer cardiac symptoms, had fewer medi-

cal appointments, and used less medica-

tion than controls 5 months postinterven-

tion (Willmott, Harris, Gellaitry, Cooper,

& Horne, 2011). A recent meta- analysis of

146 experimental disclosure studies among

10,994 participants found a positive and

significant effect (small to moderate in size)

of disclosure specifically on cardiovascular

indicators related to CVD, such as lipids and

inflammation (Frattaroli, 2006). Among the

physiological parameters studied, the stron-

600 HEALTH IMPLICATIONS

gest beneficial effect of emotional disclosure

was evident for specific immune function

parameters. For example, experimental dis-

closure was associated with lower levels of

proinflammatory cytokines and C-reactive

protein, which in turn predict reduced risk

of CVD (Danesh et al., 2004; Pearson et al.,

2003).

While these studies generally suggest

potential divergent effects of inhibitive and

expressive forms of regulatory strategies on

cardiovascular function, other studies do

not find such differences, and suggest that

use of either type of strategy requires physi-

ological exertion. For example, in a study of

190 female college students, women were

instructed to suppress emotion, reappraise

emotion, or react naturally (control con-

dition) when discussing an upsetting film

with another participant. Participants in

both the suppression and reappraisal condi-

tions demonstrated larger increases in heart

rate variability compared to controls (But-

ler, Wilhelm, & Gross, 2006). Some stud-

ies linking emotion regulation with altered

cortisol responses in response to stress in

a laboratory setting have described similar

results whereby suppression and reappraisal

are each related to higher cortisol response

(Lam, Dickerson, Zoccola, & Zaldivar,

2009). However, in other studies reap-

praisal is associated with less cortisol reac-

tivity (Chen & Miller, this volume; Salovey,

Stroud, Woolery, & Epel, 2002). Given that

laboratory-based work explicitly consider-

ing potential divergent effects of these strat-

egies on a unified and comparable set of

cardiovascular- relevant outcomes remains

limited, additional work is needed to ascer-

tain whether and how these acute effects

might be informative in regard to long-term

risk. In addition, prospective work would be

useful to determine whether such patterns of

exertion affect health over time.

Population‑Based Work

Direct Evidence

Though capacity to regulate emotions may

influence cardiovascular health, few have

explicitly examined this question in popu-

lation-based research. While highly prom-

ising, evidence is limited to a handful of

studies, because emotion regulation is not

typically assessed in large-scale studies of

the determinants of CVD. Such epidemio-

logical studies generally consider CVD risk

across a set of related outcomes, including

angina (usually ascertained by self- reported

symptoms), myocardial infarction (usually

ascertained by hospital records and diagnos-

tic procedures), and coronary heart disease

death (ascertained by death certificates).

Studies of CVD may also consider hyper-

tension and stroke as relevant outcomes,

although we know of no epidemiological

studies of directly assessed emotion regula-

tion that have considered these conditions.

Incident disease refers to rate of new cases

developing disease rather than the number

of cases in a population at any given time.

Existing results are highly congruent

with those from laboratory and experimen-

tal work, and emerging evidence suggests

that emotion regulation strategies that fre-

quently involve suppression or inhibition

may increase CVD risk, whereas use of

other regulatory strategies may reduce CVD

risk. For example, one prospective study of

1,122 older male participants considered

the relation between self- regulation and the

development of CVD. Self- regulation was

assessed when men were disease-free, using

items from the Minnesota Multiphasic Per-

sonality Inventory assessing one’s ability to

manage impulses, feelings, and behaviors;

emotion regulation was identified as a cen-

tral feature of this measure of self- regulation.

Exemplary items used to construct the Self-

Regulation scale included “I control my

emotion”; “I am not easily angered”; and

“I am usually calm and not easily upset.”

Compared with men who had the lowest

levels of self- regulation, those with the high-

est levels had 62% reduced risk of experi-

encing a nonfatal myocardial infarction or

coronary heart disease (CHD) death over 13

years of follow-up (Kubzansky et al., 2011).

Moreover, the association appeared to be

additive, because each standard deviation

increase in self- regulation was associated

with a 20% reduced risk of incident angina,

nonfatal myocardial infarction, and CHD

death over the follow-up period. Findings

were maintained after adjusting for known

coronary risk factors, as well as main effects

of positive and negative affect.

Another study identified control over

anger as one mechanism linking anger to

Emotion Regulation and Cardiovascular Disease Risk 601

cardiovascular risk (for a review, see Ded-

ert, Calhoun, Watkins, Sherwood, & Beck-

ham, 2010). In a study of Finnish adults (n =

7,933), several dimensions of anger expres-

sion and control were assessed in relation to

incident CVD events (myocardial infarction,

stroke) over 10–15 years of follow-up (Hauk-

kala, Konttinen, Laatikainen, Kawachi, &

Uutela, 2010). Anger control was character-

ized by items related to the extent to which

anger is regulated (e.g., “I control my tem-

per”), and anger expression was character-

ized by how people generally react when

feeling angry (e.g., “I express my anger”).

While experiences of anger per se were not

associated with CVD, participants report-

ing the lowest levels of anger control had

35% significantly higher risk of experienc-

ing a fatal or nonfatal cardiovascular event

in the subsequent 10–15 years compared to

those with the highest levels of anger control

(Haukkala et al., 2010). These findings were

maintained even after researchers took into

account demographic and coronary risk fac-

tors, as well as depressive symptoms. While

not specifically addressing how the anger is

regulated (e.g., suppressed, situation reap-

praised), this study suggests that the occur-

rence of negative emotions such as anger

may not be sufficient to induce risk. Instead,

it is the failure to regulate the emotion effec-

tively that may help explain anger and CVD

risk associations.

Another study of 181 Finnish men and

women observed cross- sectional associa-

tions of adaptive and maladaptive emotion

regulation with metabolic syndrome (Kin-

nunen, Kokkonen, Kaprio, & Pulkkinen,

2005). Metabolic syndrome, which is char-

acterized by hypertension, elevated lipid

levels, central adiposity (a measure of body

fat distribution), and insulin resistance,

is a well- established risk marker for CVD

(Expert Panel on Detection Evaluation and

Treatment of High Blood Cholesterol in

Adults, 2001). In this study, the authors

examined whether use of certain emotion

regulation strategies including mood repair

(e.g., “I am imagining something nice to

keep my mood up”) and mood mainte-

nance (e.g., “I would not want to change

this mood”) were associated with meta-

bolic syndrome at age 42. The authors also

examined whether emotional ambivalence

(a specific form of emotion dysregulation;

“I try to suppress my anger but would like

to let others know how I feel”) was associ-

ated with midlife metabolic syndrome. The

authors found that mood repair and mood

maintenance were significantly associated

with reduced risk of metabolic syndrome,

whereas emotional ambivalence was associ-

ated with higher risk of metabolic syndrome

at age 42. This study suggests that effective

regulation of emotion may protect cardio-

vascular health, and emotion dysregula-

tion may contribute to CVD risk. However,

this study did not account for prior physi-

cal health or other relevant covariates such

as socioeconomic status that could provide

alternative explanations for the associations

observed.

A recent study by our group also observed

divergent associations of different emo-

tion regulation strategies as assessed by the

Emotion Regulation Questionnaire (Gross

& John, 2003) with C-reactive protein

(CRP). CRP, an inflammatory risk marker

for CVD, is associated with atherosclerosis

and incident coronary events (Danesh et al.,

2004; Pearson et al., 2003). CRP is often

used as a predisease marker of CVD by ref-

erencing a diagnostic cut point identified by

the Centers for Disease Control and Preven-

tion (CDC)/American Heart Association

(Pearson et al., 2003). We examined reap-

praisal (i.e., altering how one thinks about

an emotion- eliciting situation in order to

change its emotional impact) and suppres-

sion (i.e., inhibiting emotional expression

in response to an emotion eliciting event).

Among 379 U.S. adults, an increase of one

standard deviation in reappraisal was signif-

icantly associated with 20% lower odds of

having levels of CRP at or above the CDC/

American Heart Association’s high risk cut

point (Appleton, Buka, Loucks, Gilman, &

Kubzansky, 2013). Conversely, a one stan-

dard deviation increase in suppression was

significantly associated with 44% higher

odds of having systemic inflammation levels

indicating high CVD risk. Similarly, some

preliminary analyses by our research group

using the same sample found reappraisal

and suppression also be patterned differen-

tially with 10-year risk of developing CVD

in midlife (Appleton, Loucks, Buka, & Kub-

zansky, unpublished data). This emerging

body of work provides the first direct pop-

ulation-based evidence that emotion regula-

602 HEALTH IMPLICATIONS

tion may contribute significantly to cardio-

vascular health.

Indirect Evidence

While the evidence base explicitly linking

emotion regulation to CVD in the general

population is small, much indirect evidence

comes from studies of poor emotional func-

tioning and negative affective states, which

are characterized in part by dysregulated

emotion (Kubzansky et al., 2011; Taylor,

Lerner, Sage, Lehman, & Seeman, 2004).

Chronic distress is thought to influence car-

diovascular health by way of repeated and

excessive activation of the stress response

and impaired adaptation, which over time

may contribute to damaging the cardio-

vascular system (McEwen, 2003), and also

risk behaviors associated with poor men-

tal health (e.g., smoking) (Everson-Rose &

Lewis, 2005). Work in this area has pri-

marily focused on three negative affective

states in association with CVD risk: anger,

anxiety, and depression (Chida & Steptoe,

2009; Suls & Bunde, 2005). Though epide-

miological studies often consider depression

and anxiety as representing single emotions,

in fact they reflect complex constellations

of chronic elevations of maladaptive cogni-

tions, behaviors, and emotions, of which

dysregulated emotion is one feature (Laza-

rus, 1991). However, given the importance

of dysregulated emotion in these affective

states, we review studies linking them to

CVD, because we speculate that an emo-

tion regulation perspective could add insight

to understanding their observed associa-

tions. Studies reviewed in this section do

not explicitly measure emotion regulation;

we therefore characterize them as providing

indirect evidence that dysregulated emotion

may contribute to CVD.

In a review of 37 studies examining pro-

spective associations of negative emotions

with incident CHD events in initially healthy

individuals, high anger was associated

with 1.5- to threefold higher risk of CHD;

chronic anxiety was associated with 1.5- to

sevenfold higher risk of CHD; and clinically

relevant levels of depression was associated

with more than a 2.5-fold elevated risk, with

gradations in risk evident according to levels

of depressive symptoms (Kubzansky, 2007).

Posttraumatic stress disorder, a severe form

of distress marked by dysregulated emotion

in response to trauma, has also been linked

to incident cardiovascular events in mili-

tary veteran and community-based civilian

populations (for a review, see Dedert et al.,

2010). Taken together, these studies suggest

significantly increased cardiovascular risk

associated with experiencing chronic nega-

tive emotion and poor emotional function-

ing that likely derives in part from maladap-

tive emotion regulation.

Whereas experiencing chronic negative

emotions may indicate dysregulation, posi-

tive emotional functioning may be consid-

ered a marker of effective emotion regula-

tion. A recent review of studies of positive

psychological well-being and cardiovascu-

lar health identified a consistent protective

effect of positive emotions and psychological

attributes related to more frequent occur-

rence of positive emotions (e.g., optimism);

findings also suggested that positive emo-

tions and related factors are associated with

health- related behaviors that reduce risk of

CVD (e.g., increased physical activity) and

more resilient biological function (e.g., less

systemic inflammation) (Boehm & Kub-

zansky, 2012). The evidence of CVD buff-

ering attributable to positive functioning is

most well established for optimism (Boehm

& Kubzansky, 2012; Peterson & Bossio,

2000). For example, in a study of 97,253

participants of the Women’s Health Initia-

tive, women with high levels of dispositional

optimism had significantly lower risk of inci-

dent CHD and CHD mortality compared

to those with low levels of optimism over

8 years of follow-up, even after controlling

for health risk behaviors, obesity, lipids, and

depressive symptoms (Tindle et al., 2009).

Another domain of healthy psychological

functioning that may promote cardiovascu-

lar health is emotional vitality, which can

be defined as feeling energetic or full of pep,

and having a sense of positive well-being and

emotional self- control characterized in part

by effective emotion regulation (Kubzansky

& Thurston, 2007; Rozanski & Kubzansky,

2005). In a study of 6,025 healthy men and

women ages 25–74 years at baseline, those

with the highest levels of emotional vitality

had 19% reduced risk of developing CHD

over 15 years of follow-up compared to those

with the lowest levels of emotional vital-

ity (Kubzansky & Thurston, 2007). Effects

Emotion Regulation and Cardiovascular Disease Risk 603

were maintained after researchers took into

account known coronary risk factors, as

well as depression and psychological prob-

lems. Taken together, these studies suggest

that positive emotional and psychological

functioning protect cardiovascular health,

providing indirect evidence that effective

emotion regulation may increase cardiovas-

cular resilience.

Mechanisms by Which Emotion

Regulation Influences CVD

Emotion regulation may affect CVD risk

through both physiological and behav-

ioral pathways. As noted earlier, dysregu-

lated emotion is associated with increased

likelihood of engaging in deleterious

cardiovascular- related health behaviors such

as smoking, unhealthy diet, and low physical

activity (Kiecolt- Glaser, McGuire, Robles,

& Glaser, 2002). Emotion dysregulation is

also associated with deteriorative biological

functioning in terms of the development of

obesity (Blaine, 2008), high levels of cho-

lesterol and blood pressure, atherosclerosis,

and inflammation (Appleton, Buka, et al.,

2013; Boehm & Kubzansky, 2012). Labo-

ratory-based studies (see earlier sections for

examples) suggest that effects may occur via

heightened or repeated activation of stress–

response systems, including the HPA and

SNS. Such overactivation has been linked to

a variety of potentially damaging biological

alterations, including hemodynamic forces

such as increased turbulence and shear

stress leading to impaired endothelial func-

tion, and flow- related arterial injury leading

to increased atherogenesis, as well as altered

electrical stability of the heart and increased

inflammation (Kubzansky & Kawachi,

2000). For example, heightened HPA and

SNS activity and resultant stress hormones

(e.g., corticosteroids, catecholamines) initi-

ate an inflammatory response characterized

by the production of a number of inflamma-

tory markers, including CRP (Black & Gar-

butt, 2002). Inflammation is of increased

interest in studies of emotion regulation

and CVD, because it is strongly implicated

in the pathophysiology of CVD (Danesh

et al., 2004; Pearson et al., 2003) and has

also been linked with several factors related

to emotion regulation, including depres-

sion (Howren, Lamkin, & Suls, 2009), and

chronic and acute stress (Janicki- Deverts,

Cohen, Matthews, & Cullen, 2008; Steptoe,

Hamer, & Chida, 2007).

Moreover, beyond simply indicating the

absence of deterioration, the ability to regu-

late emotions effectively appears to enhance

cardiovascular health actively. Similar to

mechanisms associated with dysregulation,

effective emotion regulation may promote

cardiovascular health by not only preventing

deteriorative processes but also promoting

restorative health behaviors and biological

functioning. Important to note is that dete-

riorative and restorative processes are not

always on a continuum (for a more detailed

discussion, see Boehm & Kubzansky,

2012). Relevant health- promoting behaviors

include engaging in more opportunities for

rest and restoration (Rozanski & Kubzan-

sky, 2005), frequent consumption of fruits

and vegetables, improved problem solving,

and mobilization of social support (Eisen-

berg, Hofer, & Vaughan, 2007). Whereas

dysregulated emotion may heighten HPA

and SNS activity and initiate a cascade of

physiological risks for CVD, effectively

regulated emotion may prevent such activ-

ity and further enhance healthy cardiovas-

cular functioning, although few studies have

directly tested this hypothesis. In one of

the few empirical tests conducted, a recent

study (reviewed earlier) found support for

this hypothesis by demonstrating that reap-

praisal was associated with lower inflam-

matory risk and suppression was associated

with elevated inflammatory risk (Appleton,

Buka, et al., 2013). Other forms of healthy

psychological functioning that have been

identified as possible markers of adaptive

emotion regulation (e.g., positive well-being,

optimism) have also been linked to relevant

biological markers, such as slower rates of

progression of carotid atherosclerosis and

better endothelial function (Boehm & Kub-

zansky, 2012; Ikeda et al., 2011).

Important to consider is that emotion

regulation strategies are used at different

points during the emotion- generative pro-

cess (Gross, 2001; Gross & John, 2003;

John & Gross, 2004), and strategies can be

employed at any stage. Thus, it may be that

the effect of the emotion regulatory strategy

on physiological activation, inflammation,

and subsequent CVD risk is due in part to

604 HEALTH IMPLICATIONS

the timing of use of each strategy. For exam-

ple, reappraisal is antecedent- focused, which

means that it is employed before the emo-

tion occurs and involves changing cognitive

appraisals about the situation, which then

prevents or reduces the intensity of nega-

tive emotions (Gross, 2001; Gross & John,

2003; John & Gross, 2004). Therefore,

HPA or SNS dysregulation may be avoided,

potentially leading to lower levels of systemic

inflammation, which in turn may lower

CVD risk. On the other hand, suppres-

sion, a response- focused strategy employed

after the emotion has occurred, involves

the modification of behavioral manifesta-

tions of the emotion (Gross, 2001; Gross &

John, 2003; John & Gross, 2004). Though

individuals may appear outwardly tranquil,

chronic negative emotions and associated

HPA and SNS dysregulation may continue

internally unchecked, ultimately contribut-

ing to increased systemic inflammation and

CVD risk. Moreover, suppression has been

found to require significant mental exer-

tion (Consedine et al., 2002; Gross, 2001).

Thus, the act of suppression may further tax

body systems and contribute to elevations in

systemic inflammation and CVD risk. Emo-

tion regulation theory and research suggest

that regulating the emotion earlier in the

emotion- generative process may be more

effective than doing so in the later, response-

focused stage of the process (Gross, 2001).

As such, while the appropriateness of any

given strategy is context dependent, consis-

tent reliance on response- focused (e.g., sup-

pression) versus antecedent- oriented (e.g.,

reappraisal) regulation may differentially

impact biological processes and long-term

CVD risk.

The Way Forward

The confluence of evidence from laboratory-

and population-based research strongly sug-

gests that the association between emotion

regulation and CVD is not spurious. More-

over, risk and protective associations have

been consistently observed across a variety

of emotion regulation indicators, signify-

ing that emotion dysregulation may increase

CVD risk, whereas effective emotion regu-

lation may lower it. While all the evidence

reviewed thus far has been obtained with

adults during their middle to later adult-

hood, a time when CVD is likely to become

manifest, many studies indicate that loss of

cardiovascular health can begin in childhood

and progress over the life course (Berenson

& Srnivasan, 2005). Studies of emotion

regulation and CVD among adults are ill

equipped to answer important etiological

questions as to when these processes emerge

and begin to exert damaging or health-

promoting effects. Given that emotion regu-

lation strategies are learned over time, with

childhood being a major period of develop-

ment (Calkins & Hill, 2007; John & Gross,

2004), a more explicit consideration of these

relationships over the life course may be

highly fruitful. In this section, we argue that

the way forward in emotion regulation and

CVD research is to move toward framing

and evaluating hypotheses from a develop-

mental or life course perspective. Doing so

may not only answer important scientific

questions but also suggest novel avenues for

the prevention of CVD.

Applying a Developmental Perspective

Children are typically born with many of

the requisite components of ideal cardiovas-

cular health. They generally have healthy

blood pressure, lipid, and glucose levels;

they do not smoke and have the potential

for developing an ideal body weight, and

healthy dietary and physical activity prac-

tices. So how does the loss of cardiovascu-

lar health occur, and when does it begin to

become evident? What role does emotion

regulation play in the loss or promotion of

cardiovascular health over time? We believe

the answers to these questions are related

in part to achieving a key socioemotional

developmental milestone during childhood:

attaining emotion regulation skills.

Emotion regulation is not primarily an

inborn trait. Rather, it is a set of strategies

learned through socialization and expe-

rience over time, with childhood being a

key period of development (John & Gross,

2004). Temperament, maturation, and

social experiences shape core emotion regu-

lation competencies during childhood, with

refinements occurring over the lifespan in

accordance with new experiences (Calkins

& Hill, 2007; John & Gross, 2004; Zeman,

Cassano, Perry- Parrish, & Stegall, 2006).

Emotion Regulation and Cardiovascular Disease Risk 605

This developmental or life course perspective

can help us understand how achieving this

developmental milestone specifically influ-

ences CVD risk in adulthood. For example,

children who develop patterns of dysregu-

lated emotion regulation (e.g., impulsivity,

poor attention, depressed mood) generally

continue to exhibit such patterns through

adolescence and adulthood (Brame, Nagin,

& Tremblay, 2001; Caspi, Moffitt, & New-

man, 1996; Dekker et al., 2007). Thus, as

they age, children with such patterns of reg-

ulation are more likely to initiate and main-

tain a range of risk- related health behaviors

(e.g., cigarette smoking, sedentary behav-

ior, poor diet) that over time may contrib-

ute to disease development and progression

(Shonkoff & Phillips, 2000).

Developmental or life course epidemiol-

ogy is the study of chronic disease risk in

terms of the long-term effects of health-

relevant experiences that occur during gesta-

tion, childhood, adolescence, and adulthood

(Ben- Shlomo & Kuh, 2002). Experiences

can be biological, behavioral, environmen-

tal (physical and social), and psychological

in nature. Emotion regulation can be consid-

ered one such factor that may have positive

or negative health implications over time.

From this perspective, emotion regulation

may affect disease risk mainly in two ways.

First, a latency model suggests that both

adverse and health- promoting experiences

during particular sensitive or critical periods

of development will have lasting effects on

health and functioning, with effects emerg-

ing years or decades after the initial experi-

ence (Ben- Shlomo & Kuh, 2002; Shonkoff,

Boyce, & McEwen, 2009). Such a model

implies that early prevention and interven-

tion are crucial. Second, an accumulation

model specifies that the number and dura-

tion of experiences cumulatively add up to

affect health, again, often with a significant

amount of time passing before the effects

manifest as health outcomes (Ben- Shlomo

& Kuh, 2002; Shonkoff et al., 2009). This

perspective suggests multiple windows of

opportunity for prevention and intervention,

because an accumulation model would sug-

gest that positive and negative factors cumu-

latively build to determine disease resilience

and risk, respectively.

Because both latency and accumulation of

risk explanations are plausible and not mutu-

ally exclusive, it is possible that emotion reg-

ulation skills originating during childhood

shape developing brain architecture and

biological systems, as well as contribute to

behaviors that together and independently

influence later cardiovascular risk. Thus,

developing poor emotion regulation skills

during childhood may have lifelong cardio-

vascular consequences by negatively altering

biological systems during sensitive periods

of development and through accumulated

damage over time. For example, persistent

psychological distress (i.e., dysregulated

emotion) is associated with activation of the

HPA axis (Luppino et al., 2010). Prolonged

HPA activity is thought to up- regulate hor-

mones that influence appetite and promote

weight gain (Luppino et al., 2010). As such,

poor childhood emotion regulation may

alter developing metabolic processes during

a sensitive period of development, which in

turn may increase risk of obesity and other

conditions linked with increased suscep-

tibility to developing CVD (e.g., elevated

inflammation, dyslipidemia) later in life.

Conversely, learning effective emotion regu-

lation skills early in life may prevent such

risk and promote resiliency by helping to

buffer such deleterious stress reactivity and

prevent such damage to biological systems.

Also, psychological distress/dysregulated

emotion is associated with behaviors related

to higher risk of obesity that may emerge

even in childhood (and continue through

adolescence and into adulthood), such as

emotional eating, consumption of calorie-

dense foods, and decreased physical activity

(Blaine, 2008), whereas adaptive emotional

functioning is associated with greater like-

lihood of engaging in health- promoting

behaviors (Boehm & Kubzansky, 2012).

While the American Heart Association’s

national goals for cardiovascular health

promotion emphasize that cardiovascular

risk originates early in life and urge study

of early-life antecedents (Lloyd-Jones et al.,

2010), considering emotion regulation and

CVD risk from a developmental perspec-

tive is highly novel. While there is a grow-

ing literature on child emotion regulation

and adult CVD risk, we do not know how

early in life these processes may be evident,

because research examining emotion regula-

tion and biological markers of CVD risk are

scant. We turn now to the emerging empiri-

606 HEALTH IMPLICATIONS

cal evidence linking childhood emotion reg-

ulation to adult CVD risk.

Evidence Linking Child Emotion

Regulation to Adult CVD Risk

Among the limited set of prospective stud-

ies on associations between child emotion

regulation and adult CVD risk, most have

focused on upstream risk markers for CVD,

such as obesity and inflammation, rather

than on objectively measured clinical end-

points of disease (e.g., myocardial infarc-

tion, stroke). This may be due to (1) limited

availability of prospectively assessed infor-

mation on childhood emotional functioning

in cohort studies that were initiated decades

ago, and (2) the relative youth of participants

in the longitudinal cohorts that have col-

lected information on child emotional func-

tioning and adult health, so that actual CVD

outcomes have not yet developed. Moreover,

most studies assess primarily poor emo-

tional functioning, behavior problems, or

psychological disorders. These conditions

can be considered markers of or proxies for

dysregulated emotion, but they do not pro-

vide direct assessments of emotion regula-

tion. As discussed previously in our review

of studies of depression and anxiety with

CVD risk, we do not conflate poor emotion

regulation with psychopathology. Instead,

we acknowledge that child behavior dis-

orders and emotional functioning reflect a

complex set of factors that include problems

with emotion regulation. Thus, these stud-

ies are suggestive, and we encourage future

work to measure child emotion regulation

explicitly in relation to later cardiovascu-

lar risk. That said, findings from life course

studies of child emotional functioning and

behavior problems, and adult CVD risk are

congruent with associations observed in

studies of adults and suggest that cardiovas-

cular risk may have developmental origins in

child emotion regulation.

For example, while the direction of the

relation between emotional functioning and

obesity is debated and is likely to be bidi-

rectional (Atlantis & Baker, 2008; Luppino

et al., 2010), several studies have found that

poor child emotional functioning contrib-

utes to the development of obesity in adult-

hood (Duarte et al., 2010; Goodwin et al.,

2008; Mamun et al., 2009). Mamun et al., in

a prospective study of 2,278 Australian boys

and girls, found that child behavior prob-

lems (a marker of emotional dysfunction) at

ages 5 and 14 years were associated with 4.6

higher risk (95% confidence interval (CI):

2.36, 9.06) of obesity at age 21, once they

controlled for maternal demographic and

lifestyle variables, child dietary patterns, TV

viewing, family meals, and physical activity.

In a study of 2,209 Finnish boys, Duarte

et al. (2010) found that both moderate and

high levels of conduct problems (which may

also mark severely dysregulated emotion)

at age 8 years were associated with two- to

threefold higher risk of overweight and obe-

sity at ages 18–23, compared to low levels of

conduct problems. These associations were

maintained when the researchers controlled

for hyperactivity and sociodemographic

variables.

Similar findings have been observed in

studies of childhood emotional functioning

and systemic inflammation in adulthood.

For example, in a prospective study of 379

U.S. adults, multiple domains of child emo-

tional functioning (directly assessed by a

study psychologist when participants were

age 7) were examined in association with

CRP levels in middle adulthood. Poor child

self- regulation (i.e., unrestrained, impulsive

behavior) and distress proneness (i.e., emo-

tionally labile, easily frustrated) were each

associated with elevated CRP levels 35 years

later, after researchers controlled for demo-

graphics, being born small for gestational

age, child health status, child body mass

index, and child IQ (Appleton et al., 2011).

Associations were robust, because poor

child emotional functioning was associated

with 2.3- to 3.9-fold greater odds of having

CRP levels at or above the CDC/American

Heart Association’s cut point for being at

high-risk for CVD (Pearson et al., 2003).

Moreover, there was evidence that these

associations were mediated by adult weight

status and modified by early life socioeco-

nomic status (Appleton et al., 2011, 2012).

In other words, poor childhood emotional

functioning increased inflammatory risk

in adulthood by way of higher body mass

index, and such associations were more

robust for children growing up in poorer

environments than for those from higher

level socioeconomic environments (see also

Chen and Miller, this volume, for a more

Emotion Regulation and Cardiovascular Disease Risk 607

detailed discussion of the interrelationships

between socioeconomic status and adversity,

emotion regulation, and health). In a study

of 526 male participants of the Dunedin,

New Zealand cohort, Odgers et al. (2007)

examined childhood conduct problem levels

assessed repeatedly from ages 7–26 years in

association with various physical health out-

comes at age 32, including CVD risk factor

clustering (a composite of factors including

overweight, high blood pressure, and dys-

regulated lipid levels, among others) and

inflammation, as measured by CRP. Com-

pared to those with low levels, boys with

persistently high levels of conduct problems

had 2.9 higher odds (95% CI: 1.3–6.2) of

having high-risk CRP in adulthood. Adult-

hood CVD risk factor clustering was also

higher in those with persistent conduct prob-

lems than in better functioning children, but

the association was not significant (Odgers

et al., 2007).

While measures of behavior problems can

be considered markers of emotion dysregu-

lation, they ultimately provide somewhat

limited insight into the broader relationship

between emotion regulation and CVD risk,

since they measure emotional functioning

at only one end of the spectrum rather than

considering the range of functioning. Few

life course studies have considered whether

adaptive or effective emotion regulation in

childhood is associated with reduced CVD

risk in adulthood. This is a critical gap in the

literature. To address this issue, our research

group has conducted two preliminary stud-

ies that examine the potential cardiovascu-

lar benefit of effective emotion regulation in

childhood.

First, in a prospective study of 377 U.S.

adult men and women, we examined asso-

ciations of effective and poor emotion

functioning, assessed by a study psycholo-

gist when participants were age 7, with the

10-year risk of developing CVD in their 40s

(Appleton, Loucks, Buka, Rimm, & Kub-

zansky, 2013). For women, a one standard

deviation increase in child attention regula-

tion (ability to stay focused, considered an

effective regulatory strategy) was marginally

associated with 8% reduced risk (p = .09) of

developing CVD in the next 10 years, and a

one standard deviation increase in distress

proneness (considered poor functioning) was

significantly associated with 31% higher

risk. For men, no association was observed

for attention regulation and 10-year CVD

risk, but each standard deviation increase

in child distress proneness was significantly

associated with 17% higher risk. These

associations were maintained when we con-

trolled for childhood cardiovascular health,

body mass index, chronic conditions, IQ,

socioeconomic status, being born small for

gestational age, and demographic factors.

Next, in another prospective study within

this sample, we considered the role of atten-

tion regulation in association with the devel-

opment of a favorable cardiovascular health

profile at age 42 (Appleton et al., 2013). This

profile is characterized by low blood pres-

sure, low body mass index, healthy lipid

levels, not smoking, and not having diabetes

(Daviglus et al., 2004; Lloyd-Jones, Dyer,

Wang, Daviglus, & Greenland, 2007). A one

standard deviation increase in child atten-

tion regulation was significantly associated

with 40% higher odds of having favorable

cardiovascular health in midlife. Of note,

this association was maintained when we

adjusted for early life cardiovascular health,

socioeconomic status, and potential psy-

chosocial and behavioral pathway variables

from adulthood. These studies suggest that

earlier acquisition of effective emotion regu-

lation may reduce risk of CVD and promote

early development of healthy cardiovascular

functioning.

Summary and Recommendations

for Future Work

Taken together, the evidence from labo-

ratory- and population-based studies in

adulthood and over the life course suggest

that poor emotion regulation may impair

cardiovascular function and increase risk,

whereas effective emotion regulation may

reduce risk and promote cardiovascular

health. Moreover, evidence is accumulating

that CVD may have developmental origins

in child emotion regulation that influence

trajectories of risk or resilience earlier than

was previously considered. However, as is

evident from this examination of the litera-

ture, research in this area is still limited, and

additional work is needed to address critical

remaining issues. For example, studies that

explicitly measure emotion regulation in

608 HEALTH IMPLICATIONS

conjunction with cardiovascular health and

functioning over time (and across a range of

outcomes) will help to identify when these

processes emerge and exert damaging or

health- promoting effects. In addition, stud-

ies that consider not only dysregulation but

also effective emotion regulation in relation

to CVD outcomes would provide clearer

understanding of the spectrum of effects.

Moreover, epidemiological research should

be informed by experimental findings, and

vice versa, to ensure that causal inferences

are accurate and to guide efficient explo-

ration of how effects may occur. Research

on pathways, behavioral and biological,

also remain limited but could facilitate dis-

tinguishing between latency and cumula-

tive effects, thereby indicating key periods

for targeting prevention and intervention

strategies. In fact, the earlier reported find-

ings that effects of emotion regulation were

modified by socioeconomic status are par-

ticularly intriguing, suggesting that effects

of emotion regulation on health may well

be modifiable (Appleton et al., 2012). It may

be that when more resources are available

to children who are somewhat dysregu-

lated, regulatory capacity can be improved,

thereby leading to better health over the life

course (for related discussion of this issue,

see Chen and Miller, this volume).

We suggest that work in this area is excit-

ing and worth pursuing, because it has a

number of important implications, both for

understanding emotion regulation more gen-

erally and for thinking about it as a lifelong

critical asset. Capacity to regulate emotions

may have more far- reaching effects than

have previously been identified, and timing

of acquisition of this capacity may matter for

physical health and perhaps other outcomes

as well. Thus, capacity to regulate emotion is

important not only as an outcome in its own

right, but also as a determinant of health,

which suggests it could play an important

role in health- related prevention strategies.

True prevention of CVD must involve the

prevention of the development of CVD risk

factors in the first place. This “primordial

prevention” has become increasingly more

interesting in public health and medicine

(Lloyd-Jones et al., 2010). While experts

in cardiovascular health largely acknowl-

edge that childhood is a life stage particu-

larly amenable to CVD prevention, efforts

at modifying risk during this time are not

yet well established. In general, public health

and biomedicine have not focused on the

sensitivity of child emotion development to

help safeguard cardiovascular or other forms

of lifelong health, or prioritized emotional

development for resource allocation as a

way to reduce disease burden in adulthood.

Because we believe research in this area will

continue to indicate the central importance

of developing emotion regulatory capacity,

we suggest that greater resources be dedi-

cated to promoting the acquisition of healthy

emotion regulation strategies throughout

life, with a particular emphasis on early life

stages.

However, to our knowledge, programs

designed to promote the development of

healthy emotion regulation skills among

children in the general population are scant.

Work in this area is generally intervention-

focused rather than prevention- oriented.

Thus, efforts target pediatric populations

with identified mental health problems, with

the aim of building or improving emotion

regulation skills. For example, contextual

emotion regulation therapy, a developmen-

tally based treatment approach for pediat-

ric depression, involves learning to manage

emotional distress by identifying contexts

that elicit maladaptive emotional responses,

then incorporating more adaptive responses

that can be used even in challenging situa-

tions (Kovacs & Lopez-Duran, 2012). This

approach is developmentally focused, which

means that therapeutic approaches are

age- appropriate and tailored to the child’s

developmental stage. Moreover, there are a

number of effective school-based programs

designed to prevent anxiety and promote

emotional resilience in children through

cognitive- behavioral therapy and other

forms of psychotherapy (for a review, see Neil

& Christensen, 2009). Such programs might

provide the basis for thinking about preven-

tion strategies that could be implemented

on a larger scale, either in population-based

studies or with high-risk populations. Thus,

prevention programs could consider incor-

porating these and other skills- building

techniques typically used in traditional

psychological treatments for child emotion

dysregulation (e.g., guided practice in using

adaptive strategies, role playing, paren-

tal involvement) in the design of programs

Emotion Regulation and Cardiovascular Disease Risk 609

to build effective emotion regulation skills

and emotional resilience for children at all

levels of functioning in the general popula-

tion (Kovacs & Lopez-Duran, 2012; Zeman

et al., 2006). With future laboratory- and

population-based studies working from a

developmental perspective, we can continue

to build the evidence base in this area and

inform efforts to enhance adaptive emotion

regulation capacities at a population level.

Doing so will not only improve the emo-

tional health of children but may also pro-

tect their health for a lifetime.

References

Appleton, A. A., Buka, S. L., Loucks, E. B., Gil-

man, S. E., & Kubzansky, L. D. (2013). Diver-

gent associations of adaptive and maladaptive

emotion regulation strategies with inflamma-

tion. Health Psychology, 13, 748–756.

Appleton, A. A., Buka, S. L., Loucks, E. B., Mar-

tin, L. T., & Kubzansky, L. D. (2013). A pro-

spective study of positive early life psychoso-

cial factors and favorable cardiovascular risk

in adulthood. Circulation, 12, 905–912.

Appleton, A. A., Buka, S. L., McCormick, M. C.,

Koenen, K. C., Loucks, E. B., Gilman, S. E.,

et al. (2011). Emotional functioning at age 7

years is associated with C-reactive protein in

middle adulthood. Psychosomatic Medicine,

73(4), 295–303.

Appleton, A. A., Buka, S. L., McCormick, M. C.,

Koenen, K. C., Loucks, E. B., & Kubzansky,

L. D. (2012). The association between child-

hood emotional functioning and adulthood

inflammation is modified by early life socio-

economic status. Health Psychology, 31(4),

413–422.

Appleton, A. A., Loucks, E. B., Buka, S. L.,

Rimm, E., & Kubzansky, L. D. (2013). Child-

hood emotional functioning and the develop-

mental origins of cardiovascular disease risk.

Journal of Epidemiology and Community

Health, 67, 405–411.

Atlantis, E., & Baker, M. (2008). Obesity effects

depression: Systematic review of epidemiologi-

cal studies. International Journal of Obesity,

32, 881–891.

Ben- Shlomo, Y., & Kuh, D. (2002). A life course

approach to chronic disease epidemiology:

Conceptual models, empirical challenges and

interdisciplinary perspectives. International

Journal of Epidemiology, 31, 285–293.

Berenson, G. S., & Srnivasan, S. R. (2005). Car-

diovascular risk factors in youth with impli-

cations for aging: The Bogalusa heart study.

Neurobiology of Aging, 26, 303–307.

Black, P. H., & Garbutt, L. D. (2002). Stress,

inflammation and cardiovascular disease.

Journal of Psychosomatic Research, 52, 1–23.

Blaine, B. (2008). Does depression cause obe-

sity?: A meta- analysis of longitudinal studies

of depression and weight control. Journal of

Health Psychology, 13, 1190–1197.

Boehm, J. K., & Kubzansky, L. D. (2012). The

heart’s content: The association between posi-

tive psychological well-being and cardiovas-

cular health. Psychological Bulletin, 138(4),

655–691.

Brame, B., Nagin, D. S., & Tremblay, R. E.

(2001). Developmental trajectories of physical

aggression from school entry to late adoles-

cence. Journal of Child Psychology and Psy-

chiatry, 42(4), 503–512.

Butler, E. A., Wilhelm, F. H., & Gross, J. J.

(2006). Respiratory sinus arrhythmia, emo-

tion and emotion regulation during a social

interaction. Psychophysiology, 43(6), 612–

622.

Calkins, S. D., & Hill, A. (2007). Caregiver

influences on emerging emotion regulation:

Biological and environmental transactions in

early development. In J. J. Gross (Ed.), Hand-

book of emotion regulation (pp. 229–248).

New York: Guilford Press.

Caspi, A., Moffitt, T. E., & Newman, D. L.

(1996). Behavioral observations at age 3 years

predict adult psychiatric disorders: Longitudi-

nal evidence from a birth cohort. Archives of

General Psychiatry, 53, 1033–1039.

Chen, E., & Miller, G. (this volume, 2014).

Early-life socioeconomic status, emotion regu-

lation, and the biological mechanisms of dis-

ease across the lifespan. In J. J. Gross (Ed.),

Hanbook of emotion regulation (2nd ed.,

pp. 586–595). New York: Guilford Press.

Chida, Y., & Hamer, M. (2008). Chronic psy-

chosocial factors and acute physiological

responses to laboratory- induced stress in

healthy populations: A quantitative review of

30 years of investigations. Psychological Bul-

letin, 134(6), 829–885.

Chida, Y., & Steptoe, A. (2009). The associa-

tion of anger and hostility with future coro-

nary heart disease: A meta- analytic review of

prospective evidence. Journal of the American

College of Cardiology, 53(11), 936–946.

Cohen, H., Benjamin, J., Geva, A. B., Matgar,

610 HEALTH IMPLICATIONS

M. A., Kaplan, Z., & Kotler, M. (2000). Auto-

nomic dysregulation in panic disorder and in

post- traumatic stress disorder: Application of

power spectrum analysis of heart rate variabil-

ity at rest and in response to recollection of

trauma or panic attacks. Psychiatry Research,

25, 1–13.

Consedine, N. S., Magai, C., & Bonanno, G. A.

(2002). Moderators of the emotion inhibition-

health relationship: A review and research

agenda. Review of General Psychology, 6(2),

204–228.

Danesh, D., Wheeler, J. G., Hirschfield, G. M.,

Eda, S., Eiriksdottir, G., Rumley, A., et al.

(2004). C-reactive protein and other circulat-

ing markers of inflammation in the prediction

of coronary heart disease. New England Jour-

nal of Medicine, 350(14), 1387–1397.

Daviglus, M. L., Stamler, J., Pirzada, A., Yan,

L. L., Garside, D. B., Liu, K., et al. (2004).

Favorable cardiovascular risk profile in young

women and long-term risk of cardiovascular

and all-cause mortality. Journal of the Ameri-

can Medical Association, 292(13), 1588–

1592.

Dedert, E. A., Calhoun, P. S., Watkins, L. L.,

Sherwood, A., & Beckham, J. C. (2010). Post-

traumatic stress disorder, cardiovascular, and

metabolic disease: A review of the evidence.

Annals of Behavioral Medicine, 39(1), 61–78.

Dekker, M. C., Ferdinand, R. F., van Lang, N.

D., Bongers, I. L., van der Ende, J., & Verhulst,

F. C. (2007). Developmental trajectories of

depressive symptoms from early childhood to

late adolescence: Gender differences and adult

outcome. Journal of Psychology and Psychia-

try and Allied Disciplines, 48(7), 657–666.

Denson, T. F., Grisham, J. R., & Moulds, M. L.

(2011). Cognitive reappraisal increases heart

rate variability in response to an anger provo-

cation. Motivation and Emotion, 35, 14–22.

Duarte, C. S., Sourander, A., Nikolakaros, G.,

Pihlajamaki, H., Helenius, H., Piha, J., et al.

(2010). Child mental health problems and obe-

sity in early adulthood. Journal of Pediatrics,

156(1), 93 –97.

Eisenberg, N., Hofer, C., & Vaughan, J. (2007).

Effortful control and its socioemotional con-

sequences. In J. J. Gross (Ed.), Handbook of

emotion regulation (pp. 287–306). New York:

Guilford Press.

Everson-Rose, S. A., & Lewis, T. T. (2005). Psy-

chosocial factors and cardiovascular disease.

Annual Review of Public Health, 26, 469–

500.

Expert Panel on Detection Evaluation and Treat-

ment of High Blood Cholesterol in Adults.

(2001). Executive Summary of the Third

Report of the National Cholesterol Education

Program (NCEP) Expert Panel on Detection,

Evaluation, and Treatment of High Blood

Cholesterol in Adults (Adult Treatment Panel

III). Journal of the American Medical Asso-

ciation, 285(19), 2486–2497.

Folsom, A. R., Yatsuya, H., Nettleton, J. A.,

Lutsey, P. L., Cushman, M., & Rosamond,

W. (2011). Community prevalence of ideal

cardiovascular health, by the American Heart

Association definition, and relationship with

cardiovascular disease incidence. Journal of

the American Journal of Cardiology, 57(16),

1690–1696.

Frattaroli, J. (2006). Experimental disclosure

and its moderators: A meta- analysis. Psycho-

logical Bulletin, 132(6), 823–865.

Goodwin, R. D., Sourander, A., Duarte, C. S.,

Niemela, S., Multimaki, P., Nikolakaros, G.,

et al. (2008). Do mental health problems in

childhood predict chronic physical conditions

among males in early adulthood?: Evidence

from a community-based prospective study.

Psychological Medicine, 39(2), 301–311.

Gross, J. J. (2001). Emotion regulation in adult-

hood: Timing is everything. Current Direc-

tions in Psychological Science, 10(6), 214–219.

Gross, J. J. (this volume, 2014). Emotion regula-

tion: Conceptual and empirical foundations.

In J. J. Gross (Ed.), Handbook of emotion

regulation (2nd ed., pp. 3–20). New York:

Guilford Press.

Gross, J. J., & John, O. P. (2003). Individual dif-

ferences in two emotion regulation processes:

Implications for affect, relationships and well-

being. Journal of Personality and Social Psy-

chology, 85(2), 348–362.

Gross, J. J., & Levenson, R. W. (1993). Emo-

tion suppression: Physiology, self- report, and

expressive behavior. Journal of Personality

and Social Psychology, 64(6), 970–986.

Gross, J. J., & Levenson, R. W. (1997). Hiding

feelings: The acute effects of inhibiting nega-

tive and positive emotion. Journal of Abnor-

mal Psychology, 106(1), 95–103.

Haukkala, A., Konttinen, H., Laatikainen, T.,

Kawachi, I., & Uutela, A. (2010). Hostility,

anger control, and anger expression as predic-

tors of cardiovascular disease. Psychosomatic

Medicine, 72, 556–562.

Howren, M. B., Lamkin, D. M., & Suls, J. (2009).

Associations of depression with C-reactive

Emotion Regulation and Cardiovascular Disease Risk 611

protein, IL-1, and IL-6: A meta- analysis. Psy-

chosomatic Medicine, 71, 171–186.

Ikeda, A., Schwartz, J., Peters, J. L., Fang, S.,

Spiro, A., III, Sparrow, D., et al. (2011). Opti-

mism in relation to inflammation and endo-

thelial dysfunction in older men: The VA Nor-

mative Aging Study. Psychosomatic Medicine,

73(8), 664–671.

Janicki- Deverts, D., Cohen, S., Matthews, K. A.,

& Cullen, M. R. (2008). History of unemploy-

ment predicts future elevations in C-reactive

protein among male participants in the Cor-

onary Artery Risk Development in Young

Adults (CARDIA) study. Annals of Behavioral

Medicine, 36, 176–185.

John, O. P., & Gross, J. J. (2004). Healthy and

unhealthy emotion regulation: Personality

processes, individual differences, and life span

development. Journal of Personality, 72(6),

1301–1334.

Kiecolt- Glaser, J. K., McGuire, L., Robles, T.

F., & Glaser, R. (2002). Emotions, morbidity,

and mortality: New perspectives from psycho-

neuroimmunology. Annual Review of Psy-

chology, 53, 87–107.

Kinnunen, M., Kokkonen, M., Kaprio, J., &

Pulkkinen, L. (2005). The associations of

emotion regulation and dysregulation with the

metabolic syndrome factor. Journal of Psycho-

somatic Research, 58, 513–521.

Kovacs, M., & Lopez-Duran, N. L. (2012). Con-

textual emotion regulation therapy: A devel-

opmentally based intervention for pediatric

depression. Child and Adolescent Psychiatric

Clinics of North America, 21(2), 327–343.

Kubzansky, L. D. (2007). Sick at heart: The

pathophysiology of negative emotions. Cleve-

land Clinic Journal of Medicine, 74(S1), S67–

S72.

Kubzansky, L. D., & Kawachi, I. (2000). Going

to the heart of the matter: Do negative emo-

tions cause coronary heart disease? Journal of

Psychosomatic Research, 48, 323 –337.

Kubzansky, L. D., Park, N., Peterson, C.,

Vokonas, P., & Sparrow, D. (2011). Healthy

psychological functioning and incident cor-

onary heart disease: The importance of self-

regulation. Archives of General Psychiatry,

68(4), 400–408.

Kubzansky, L. D., & Thurston, R. C. (2007).

Emotional vitality and incident coronary heart

disease: Benefits of healthy psychological

functioning. Archives of General Psychiatry,

64(12), 1393–1401.

Lam, S., Dickerson, S. S., Zoccola, P. M., &

Zaldivar, F. (2009). Emotion regulation and

cortisol reactivity to a social- evaluative speech

task. Psychoneuroendocrinology, 34, 1335–

1362.

Lazarus, R. S. (1991). Emotion and adaptation.

New York: Oxford University Press.

Lloyd-Jones, D. M., Adams, R., Carnethon, M.,

De Simone, G., Ferguson, T. B., Flegal, K., et

al. (2009). Heart disease and stroke statistics

2009 update: A report from the American

Heart Association Statistics Committee and

Stroke Statistics Subcommittee. Circulation,

119, e21–e181.

Lloyd-Jones, D. M., Dyer, A. R., Wang, R., Davi-

glus, M. L., & Greenland, P. (2007). Risk fac-

tor burden in middle age and lifetime risks for

cardiovascular and non- cardiovascular death

(Chicago Heart Association Detection Project

in Industry). American Journal of Cardiology,

99, 535–540.

Lloyd-Jones, D. M., Hong, Y., Labarthe, D.,

Mozaffarian, D., Appel, L. J., Van Horn, L., et

al. (2010). Defining and setting national goals

for cardiovascular health promotion and dis-

ease reduction: The American Heart Associa-

tion’s strategic impact goal through 2020 and

beyond. Circulation, 121, 586–613.

Luppino, F. S., de Wit, L. M., Bouvy, P. F., Sti-

jnen, T., Cuijpers, P., Penninx, B. W., & Zit-

man, F. G. (2010). Obesity, overweight, and

depression: A systematic review and meta-

analysis of longitudinal studies. Archives of

General Psychiatry, 67(3), 220–229.

Mamun, A. A., O’Callaghan, M. J., Cramb, S.

M., Najman, J. M., Williams, G. M., & Bor,

W. (2009). Childhood behavioral problems

predict young adults’ BMI and obesity: Evi-

dence from a birth cohort study. Obesity, 17,

761–766.

McEwen, B. S. (2003). Mood disorders and allo-

static load. Biological Psychiatry, 54, 200–

207.

Mendis, S., Puska, P., & Norrving, B. (2011).

Global atlas on cardiovascular disease pre-

vention and control. Geneva: World Health

Organization.

National Heart Lung and Blood Institute.

(2007). Morbidity and mortality: 2007 chart

book on cardiovascular, lung, and blood dis-

eases. Bethesda, MD: Author.

Neil, A. L., & Christensen, H. (2009). Efficacy

and effectiveness of school-based prevention

and early intervention programs for anxiety.

Clinical Psychology Review, 29(3), 208–215.

Odgers, C. L., Caspi, A., Broadbent, J. M.,

612 HEALTH IMPLICATIONS

Dickson, N., Hancox, R. J., Harrington, H.,

et al. (2007). Prediction of differential adult

health burden by conduct problem subtypes

in males. Archives of General Psychiatry, 64,

476–483.

Pearson, T. A., Mensah, G. A., Alexander, R. W.,

Anderson, J. L., Cannon, R .O., Criqui, M.,

et al. (2003). Markers of inflammation and

cardiovascular disease: Application to clini-

cal and public health practice: A statement

for healthcare professionals from the Centers

for Disease Control and Prevention and the

American Heart Association. Circulation,

107, 499–511.

Pennebaker, J. W., & Beall, S. K. (1986). Con-

fronting a traumatic event: Toward an under-

standing of inhibition and disease. Journal of

Abnormal Psychology, 95(3), 274–281.

Peterson, C., & Bossio, L. M. (2000). Optimism

and physical well-being. In E. C. Chang (Ed.),

Optimism and pessimism: Implications for

theory, research, and practice (pp. 127–146).

Washington, DC: American Psychological

Association.

Rothbart, M., Sheese, B. E., & Posner, M. I.

(this volume, 2014). Temperament and emo-

tion regulation. In J. J. Gross (Ed.), Handbook

of emotion regulation (2nd ed., pp. 305–320).

New York: Guilford Press.

Rozanski, A., & Kubzansky, L. D. (2005). Psy-

chologic functioning and physical health: A

paradigm of flexibility. Psychosomatic Medi-

cine, 67(Suppl. 1), S47–S53.

Salovey, P., Stroud, L. R., Woolery, A., & Epel,

E. S. (2002). Perceived emotional intelligence,

stress reactivity, and symptom reports: Fur-

ther explorations using the trait meta-mood

scale. Psychology and Health, 17, 611–627.

Shonkoff, J. P., Boyce, W. T., & McEwen, B.

S. (2009). Neuroscience, molecular biology,

and the childhood roots of health disparities.

Journal of the American Medical Association,

301(21), 2252–2259.

Shonkoff, J. P., & Phillips, D. A. (Eds.). (2000).

From neurons to neighborhoods: The science

of early childhood development. Washington,

DC: National Academy Press.

Steptoe, A., Hamer, M., & Chida, Y. (2007).

The effects of acute psychological stress on

circulating inflammatory factors in humans:

A review and meta- analysis. Brain, Behavior,

and Immunity, 21, 910–912.

Suls, J., & Bunde, J. (2005). Anger, anxiety, and

depression as risk factors for cardiovascular

disease: The problems and implications of

overlapping affective dispositions. Psychologi-

cal Bulletin, 131(2), 260–300.

Taylor, S. E., Lerner, J. S., Sage, R. M., Lehman,

B. J., & Seeman, T. E. (2004). Early envi-

ronment, emotions, responses to stress, and

health. Journal of Personality 72(6), 1365–

1393.

Thayer, J. F., & Lane, R. D. (2007). The role of

vagal function in the risk for cardiovascular

disease and mortality. Biological Psychology,

74(2), 224–242.

Thompson, R. A. (this volume, 2014). Socializa-

tion of emotion and emotion regulation in the

family. In J. J. Gross (Ed.), Handbook of emo-

tion regulation (2nd ed., pp. 173–186). New

York: Guilford Press.

Tindle, H. A., Chang, Y., Kuller, L. H., Man-

son, J. E., Robinson, J. G., Rosal, M. C., et

al. (2009). Optimism, cynical hostility, and

incident coronary heart disease and mortality

in the Women’s Health Initiative. Circulation,

120, 656–662.

Willmott, L., Harris, P., Gellaitry, G., Cooper,

V., & Horne, R. (2011). The effects of expres-

sive writing following first myocardial infarc-

tion: A randomized controlled trial. Health

Psychology, 30(5), 642–650.

Zeman, J., Cassano, M., Perry- Parrish, C., &

Stegall, S. (2006). Emotion regulation in chil-

dren and adolescents. Developmental and

Behavioral Pediatrics, 27(2), 155–168.

613

As most people can attest, conquering vices

and changing bad habits are difficult. Even

when the motivation to change is strong,

self- control failures are common. Subjec-

tively, it often feels as though our capacity

to self- regulate waxes and wanes in the face

of new temptations, changing moods, and

fatigue. Contemporary investigations into

the causes of self- regulation failure have

demonstrated that the ability to self- regulate

can be undermined by a variety of threats

that act by impairing awareness, exhausting

limited resources, or increasing the salience

of temptations. Perhaps the most potent of

these threats is negative affect. When peo-

ple experience emotional distress, be it in

the form of a bad mood, disappointment,

or social rejection, they often find it more

difficult to resist temptations or to sup-

press unwanted impulses and may engage

in various forms of self- defeating behaviors

(for a review, see Baumeister, 1997). How-

ever, the relationship between emotions and

self- control is by no means all one-way; too

much self- regulation over a period of time

can increase emotional reactivity, as well as

impair an individual’s ability to regulate his

or her emotions.

Much like the experience of hunger or

thirst, emotions serve to motivate behavior

and predispose individuals toward certain

actions (e.g., Keltner & Gross, 1999; Lev-

enson, 1994). It has been suggested that one

function of emotion is to indicate whether

individuals are succeeding or failing to meet

their goals (Carver & Scheier, 1990). There-

fore, just as it would be fatally maladaptive

for an organism to have the ability to turn

off thirst, it would be just as detrimental to

be able to completely shut down emotions.

However, there are times when our emo-

tions interfere with our goals or may lead us

to further distress, such as when our mood

causes us to violate social norms (i.e., being

tragically depressed on a first date or over-

joyed at a funeral). Thus, it is often in our

best interests to be able to regulate our affec-

tive states.

In this chapter, we take the view that reg-

ulating emotions relies on much of the same

cognitive and neural machinery as regulating

other responses (e.g., thoughts, behaviors,

impulses) with the understanding that, all

things being equal, emotions are more dif-

ficult to suppress or inhibit. Unlike behav-

iors, thoughts, or cravings, all of which tend

to have a clear target of regulation (e.g., “I

must not grab the cigarette and light it”),

affect is typically more diffuse, with no clear

action to regulate. Indeed, one of the central

findings of research on emotion regulation

is that direct, response- focused attempts to

suppress the outward expression of emotion

are more cognitively taxing and less success-

CHAPTER 36

Emotion and Self‑Regulation Failure

Dylan D. Wagner

Todd F. Heatherton

614 HEALTH IMPLICATIONS

ful than antecedent- focused methods such

as distraction and reappraisal (Richards

& Gross, 2000). Although there may very

well be advantages to considering emotion

regulation as a separate domain (i.e., Gross,

2002), for the present discussion we consider

it fruitful to think of emotion regulation as

another type of self- regulation, thereby ren-

dering it subject to the same vulnerabilities

and threats as other forms of self- control

(see Heatherton & Wagner, 2011).

In the following sections, we examine the

relationship among emotions, emotion regu-

lation, and self- regulation failure. We focus

primarily on intrinsic forms of emotion reg-

ulation, in which individuals regulate their

own internal affective states, rather than

on extrinsic emotion regulation, in which

individuals attempt to influence the emo-

tions of others through affect displays or

other means. Along with an overview of the

mechanisms whereby emotions can derail

self- regulation, we also consider the case of

misregulation, for example, when individu-

als seek out temptations (e.g., food, drugs

or alcohol) as a misguided strategy to repair

their mood or escape from aversive self-

awareness resulting from overindulgence

of these same temptations. In addition, we

review findings that regulation of emotions

exerts a cost on self- regulatory capacity and,

conversely, that engaging in effortful self-

regulation can impair emotion regulation.

Finally, we highlight recent research sug-

gesting that emotional reactivity is increased

when self- regulatory resources are depleted.

The Role of Negative Affect

in Self-Regulation Failure

When dieters, substance abusers, or sexual

offenders are asked to describe their rea-

sons for engaging in harmful behaviors (e.g.,

binge eating, sexual aggression, smoking,

and drug use) they overwhelmingly report

that their actions were triggered by negative

affect (Haedt-Matt & Keel, 2011; Kassel,

Stroud, & Paronis, 2003; Pithers, Kashima,

Cumming, Beal, & Buell, 1988; Sinha,

2007). Among the general population,

negative affect is similarly associated with

impulsive and self- defeating behaviors, such

as alcohol consumption (Witkiewitz & Vil-

larroel, 2009), gambling (Raviv, 1993), risky

sexual behavior (Bousman et al., 2009; Rob-

erts et al., 2012), excessive Internet usage

(LaRose, Lin, & Eastin, 2003), and aggres-

sion (Berkowitz, 1989). Although multiple

emotions can be considered negative or posi-

tive in valence, the extant literature on the

role of affect in self- regulation seldom disso-

ciates them. Here, too, we employ the broad

categories of negative and positive affect,

noting that these necessarily subsume many

different emotion categories.

The role of negative affect in initiating

self- regulation failure has also been stud-

ied in experimental settings using a variety

of affect induction procedures. Generally,

these procedures involve exposure to sad

or aversive stimuli in the form of images,

music, or movie clips. Other commonly used

techniques include writing about negative

life events (i.e., a funeral) or reading a series

of increasingly negative self- referential state-

ments, such as in the Velten (1968) mood

induction procedure. Much of this work has

been conducted within the realm of drug

and alcohol addiction, where negative affect

has long been known to be the most potent

cause of relapse (e.g., Marlatt & J. Gor-

don, 1985). In smokers and other substance

abusers, inducing negative affect in the

laboratory has been shown to increase sub-

stance cravings (Childress et al., 1994; Fox,

Bergquist, Hong, & Sinha, 2007; Tiffany &

Drobes, 1990; Willner & Jones, 1996) and

the intensity of substance use (McKee et al.,

2011) when compared to neutral or positive

mood inductions.

Chronic dieters are another population

that has received considerable attention with

regards to the relationship between nega-

tive affect and self- regulation failure (i.e.,

disinhibited eating). Inducing negative emo-

tional states in dieters increases eating both

in comparison to non- dieters, but also to

dieters in a neutral mood (e.g., Baucom &

Aiken, 1981; Heatherton, Striepe, & Wit-

tenberg, 1998; Herman & Polivy, 1975). For

instance, Heatherton, Herman, and Polivy

(1991) induced negative affect either by giv-

ing participants negative performance feed-

back during a cognitive task or by instruct-

ing them that they would have to prepare a

speech that would be given in the presence

of their peers. In order to measure overeat-

ing, participants were asked to participate

in an unrelated taste-test of various flavors

Emotion and Self‑ Regulation Failure 615

of ice cream, which, unbeknownst to them,

had been weighed prior to the task so that

the amount of ice cream consumed could be

calculated afterwards. In both cases, dieters

ate significantly more ice cream than non-

dysphoric subjects. Moreover, this occurred

even when negative affect was induced by

having participants anticipate a future task

(i.e., public speaking). Similar findings have

been found for social drinkers, in whom fear

of future social evaluations increases alcohol

consumption relative to participants who

were not going to be evaluated (Higgins &

Marlatt, 1975).

Social rejection is another method of

inducing negative affect that has a rich his-

tory of being associated with behavioral

disinhibition, aggression, and violent crimes

(e.g., high school shootings; Leary, Kow-

alski, Smith, & Phillips, 2003). Labora-

tory studies in which subjects are induced

to feel socially excluded have found that

being rejected increases aggression (DeWall,

Twenge, Bushman, Im, & Williams, 2010;

Twenge, Baumeister, Tice, & Stucke, 2001;

Warburton, Williams, & Cairns, 2006)

and reduces the willingness to help others

(Twenge, Baumeister, DeWall, Ciarocco, &

Bartels, 2007). For example, when given the

opportunity to decide how much hot sauce

to administer to a group of people who

had previously been identified as disliking

spicy foods, rejected individuals assigned

four times more hot sauce than nonrejected

peers (Warburton et al., 2006). With respect

to self- regulation failures, social exclusion

has been shown to have the same effects as

other negative affect inductions, leading to

overeating (Baumeister, DeWall, Ciarocco,

& Twenge, 2005; Oaten, Williams, Jones,

& Zadro, 2008) and reduced persistence on

difficult tasks (Baumeister et al., 2005). Thus

it seems that, as with negative affect, social

rejection can lead to self- regulation failure,

although with an added dose of aggression.

Why Does Negative Affect Impair

Self-Control?

So far we have reviewed various lines of

evidence demonstrating that negative affect

can precipitate a variety of maladaptive

behaviors, most of which are indicative of

poor self- control. In the following sections

we consider a number of mechanisms that

have been proposed to explain the disinhib-

iting effects of negative affect. Many of these

mechanisms target specific aspects of self-

regulation, so it is important at this stage to

briefly review some of the core components

involved in theories of self- regulation.

Although the details vary, most models of

self- regulation can be said to deal with three

basic components. The first involves a target

state that is to be attained. This can be a

goal, such as the goal to quit smoking or to

avoid contaminating the palate with cheap

wines, but this may also be a set of standards,

such as rules of conduct (i.e., whenever pos-

sible, avoid drinking and teaching). The

second component involves an awareness of

one’s actions, often referred to as monitor-

ing. In cybernetic models of self- regulation

(e.g., Carver & Scheier, 1981), monitoring

involves comparing current behavior with

the desired goal state and signaling any dis-

crepancy. Monitoring is a particularly vul-

nerable component of self- regulation, as a

failure to monitor ongoing behavior neces-

sarily entails an inability to catch (and there-

fore control) unwanted actions. The final

component is regulation itself. Upon identi-

fying a thought or an emotion that conflicts

with his or her goals, that person must be

capable of implementing a strategy to inhibit

or otherwise disarm the unwanted impulse.

Limited capacity models of self- regulation

(Baumeister & Heatherton, 1996) empha-

size the ways in which this component oper-

ates like a muscle and is therefore subject to

improvement through training and also to

breakdowns through fatigue. Figure 36.1A

depicts a model of self- regulation wherein

monitoring, limited capacity resources, and

goals interact with the strength of impulses

and temptations, ultimately determining

self- regulatory success or failure.

In the following sections we turn to some

of the proposed mechanisms for how nega-

tive affect may impair self- control. As we

shall see, negative affect appears to have

the pernicious ability to operate on each

of the aforementioned components of self-

regulation. Acting like poison tendrils, it

reaches into all aspects of self- control (Fig-

ure 36.1B), interfering with monitoring,

exhausting the capacity to regulate behav-

ior, and increasing the strength of desires

and temptations.

616 HEALTH IMPLICATIONS

How Might Negative Affect Impair

Self‑Control?

Negative Affect Increases

the

Strength of

Temptations

In their dual- system model of self- control,

Metcalf and Mischel (1999) theorize that

negative affect may impair the cool system

involved in executing control, while simul-

taneously increasing the hot system that

responds to temptations and rewards. In sup-

port of this, studies of delay of gratification

have shown that negative affect increases the

frequency with which people accept imme-

diate gratification instead of waiting for

larger, delayed rewards (Mischel, Ebbesen,

& Zeiss, 1973; Seeman & Schwarz, 1974;

Tice, Bratslavsky, & Baumeister, 2001).

Interestingly, studies of nonhuman ani-

mals have revealed similar patterns in the

form of increased reward sensitivity in dis-

tressed animals. For example, the induc-

tion of emotional distress via social isola-

tion increases food and drug consumption

(Campbell Teskey, Kavaliers, & Hirst, 1984;

Ramsey & Van Ree, 1993). This heightened

reward sensitivity is thought to be due to the

release of glucocorticoids during distressing

situations that serve to sensitize the brain’s

reward circuitry to appetitive stimuli (Der-

oche et al., 1995; Piazza & Le Moal, 1996).

Although difficult to directly measure in

humans, research has demonstrated that

when people receive an artificial administra-

tion of glucocorticoids, they subsequently

eat more relative to a placebo group (Tata-

ranni et al., 1996).

In humans, negative affect has been

shown to increase the intensity of smoking

in smokers (McKee et al., 2011), as well as

how much pleasure people report experienc-

ing when smoking (Zinser, Baker, Sherman,

GOALS AND STANDARDS

MONITORING

(working memory,

self-awareness)

CAPACITY

(ego depletion,

strength)

SUCCESS

FAILURE

SELF-REGULATION

TEMPTATIONS

AND DESIRES

(food, drugs, media use, etc.)

GOALS AND STANDARDS

MONITORING

(working memory,

self-awareness)

CAPACITY

(ego depletion,

strength)

SUCCESS

FAILURE

SELF-REGULATION

TEMPTATIONS

AND DESIRES

(food, drugs, media use, etc.)

increases

misregulation

decreases

capacity

decreases

monitoring

increases

impulse strength

failure

increases

negative affect

Negative Affect

FIGURE 36.1. (A) Under normal circumstances, when a person is faced with temptations, successful

self-

egulation involves a balance between the strength of impulses and the capacity to monitor and

regulate behavior in the service of goals and standards. (B) Negative affect spreads poison tendrils into

every aspect of self-

egulation, amplifying desires, decreasing monitoring, depleting limited capacity,

and encouraging misregulation strategies (e.g., mood repair and escape from aversive self-

wareness),

which can relieve negative affect in the short term but often lead to further negative affect upon failure

to meet one’s goals.

Emotion and Self‑ Regulation Failure 617

& Cannon, 1992). Results from a recent

functional neuroimaging study of chronic

dieters offer further evidence that negative

affect may serve to increase the rewarding

properties of appetitive stimuli— in this case

of appetizing foods. Following a negative

or neutral mood induction, chronic diet-

ers were exposed to appetizing food cues

during functional neuroimaging (Wagner,

Boswell, Kelley, & Heatherton, 2012). Rela-

tive to nondieters, dysphoric dieters showed

increased brain activity in the orbitofrontal

cortex, a brain area implicated in represent-

ing the rewarding value of appetizing foods.

Moreover, activity in the orbitofrontal cor-

tex and ventral striatum was correlated with

a measure of how distressing subjects found

the negative mood induction, suggesting that

increases in reward- related brain activity to

food cues were dependent on the strength

of the negative emotional state (Wagner et

al., 2012). Taken together, these findings

from both human and animal studies sug-

gest that negative affect may sensitize people

to rewards, thereby rendering temptations

more difficult to regulate.

Negative Affect Reduces Monitoring

through Cognitive Load

Another mechanism whereby negative affect

may reduce self- control is by impairing the

monitoring component of self- regulation.

Specifically, research demonstrates that

when dieters overeat following a negative

mood induction, they are less aware than

nondieters of the precise amount of food

they have consumed (Heatherton, Polivy,

Herman, & Baumeister, 1993). Reasons for

this reduced awareness vary from a moti-

vated desire to escape from negative affect

(see the next section) to an increase in cogni-

tive load as a result of ruminating over one’s

mood. In this section we focus on the pos-

sibility that experiencing negative affect can

lead to increased working memory load as

people ruminate over their negative mood

and neglect to monitor their behavior (Fig-

ure 36.1B).

As monitoring entails the ability to main-

tain goals and standards in working memory

(Hofmann, Schmeichel, & Baddeley, 2012),

it follows that a concurrent working mem-

ory load (e.g., attempting to regulate mood

or ruminating over one’s performance anxi-

eties) will impair task- relevant monitoring.

Perhaps nowhere has this mechanism been

better studied than in research on the phe-

nomenon of stereotype threat. This work has

shown that reminding women of negative

stereotypes about their gender, or reminding

African Americans of negative stereotypes

about their race, can lead them to underper-

form on math or intelligence tests (Spencer,

Steele, & Quinn, 1999; Steele & Aronson,

1995). Studies demonstrate that this decre-

ment in performance is at least in part due

to a reduction in working memory capacity,

which is thought to result from concurrent

attempts to regulate affect (Johns, Inzlicht,

& Schmader, 2008). This phenomenon has

been shown to “spill over” into nonstereo-

typed domains, as shown in work by Inzli-

cht and Kang (2010), who demonstrate that

inducing stereotype threat in women results

in disinhibited eating of unhealthy foods.

Further evidence that working memory

is impacted by negative affect comes from

studies in which inducing emotional dis-

tress through the anticipation of an upcom-

ing evaluation (e.g., public speaking) leads

to poorer performance on working mem-

ory tests (Schoofs, Preuss, & Wolf, 2008).

Indeed, one imaging study found that ste-

reotype threat leads to increased activity

in brain regions associated with affect (i.e.,

ventral anterior cingulate cortex) but not in

areas that support working memory (Krendl,

Richeson, Kelley, & Heatherton, 2008). In

this case, the authors argued that it is likely

that emotional distress resulting from ste-

reotype threat has downstream effects on

working memory.

Outside of the realm of negative affect,

research on the effects of cognitive load

on self- regulation have shown that cogni-

tive loads impairs a variety of controlled

behaviors, from suppressing thoughts (Weg-

ner & Erber, 1992) to inhibiting food con-

sumption in dieters (Ward & Mann, 2000).

Mann and Ward (2007) proposed an atten-

tional myopia theory of cognitive load,

which posits that cognitive load restricts the

range of attention to targets in the imme-

diate environment, thereby rendering indi-

viduals vulnerable to a variety of external

cues. To the extent that negative affect

increases cognitive load through rumina-

tion or attempts to regulate affect (Johns et

al., 2008), a similar attentional myopia may

618 HEALTH IMPLICATIONS

occur when people are experiencing a nega-

tive emotional state.

Another means by which cognitive load

can bring about self- regulation failure comes

from research on ironic process theory (Weg-

ner, 1994) demonstrating that when mental

capacity is taxed by a concurrent cognitive

load, the likelihood of counterintentional

behavior increases. Within the realm of

emotion regulation, it has been shown that

attempting to change one’s mood (either

from happy to sad or vice versa) while under

a concurrent cognitive load leads to an ironic

increase in the opposite mood state. Specifi-

cally, participants who were instructed to

make themselves feel sad, felt happier if they

regulated their mood while under cognitive

load (Wegner, Erber, & Zanakos, 1993).

With respect to the role of affect in bringing

about self- regulation failure, what this sug-

gests is that to the degree that negative affect

exerts a cognitive load, attempts to regulate

behavior simultaneously, such as stopping

oneself from smoking, may bring about the

exact behavior one is trying to avoid.

Directing people’s attention toward the

self has a long history of being used as a

means to increase monitoring, and thereby

self- regulation. With regard to negative

affect inductions, exposure to mirrors or

to video clips of oneself has been shown to

eliminate the effects of negative mood on

disinhibited behavior. For example, having

dieters watch a video of themselves after a

mood induction eliminated the effects of

negative affect on overeating as compared

to dieters who watched a neutral video

(Heatherton et al., 1993). Similarly, being

forced to sit in front of a mirror has been

shown to eliminate the detrimental effects

of social rejection on a self- regulation task

(Baumeister et al., 2005). It appears then,

that increasing self- awareness tempers the

impact of negative affect on self- regulation

failures by restoring monitoring and increas-

ing the accessibility of behavioral standards

(e.g., Scheier & Carver 1983). However,

the timing of increased self- attention may

be important; for instance, increasing self-

attention during the experience of emotion

has been shown to heighten the intensity of

emotions (Scheier & Carver, 1983; Fenig-

stein, 1979) which in turn may exacerbate

the effects of negative affect on subsequent

self- regulation.

Managing Negative Affect Depletes

Self‑Regulatory

Strength

Over the last decade, considerable evidence

has been gathered in favor of a strength model

of self- regulation (for a recent meta- analysis,

see Hagger, Wood, Stiff, & Chatzisarantis,

2010). This model posits that self- regulation

relies on a common resource that can become

temporarily exhausted by effortful self-

regulation, and that when this resource is

exhausted, further attempts at self- regulation

are likely to fail (Baumeister & Heatherton,

1996). This phenomenon is typically studied

using a sequential task paradigm in which an

initial self- regulatory task is used to deplete

resources, thereby rendering subsequent self-

regulation attempts (even those in different

domains) less likely to succeed. Studies have

shown that tasks as varied as suppressing

thoughts and stereotypes (Gordijn, Hindriks,

Koomen, Dijksterhuis, & Van Knippenberg,

2004; Muraven, Collins, & Nienhaus, 2002),

making decisions (Vohs et al., 2008), and

managing impressions (Richeson & Shelton,

2003) all can lead to self- regulation failure on

subsequent tasks. In terms of relevance to this

chapter, it is interesting to note that one of the

methods most often used for depleting self-

regulatory resources is to have participants

engage in an emotion regulation task (typi-

cally inhibiting emotional responses). For

example, regulating emotional responses to

an emotionally provocative film reduces per-

sistence on difficult tasks (Baumeister, Brat-

slavsky, Muraven, & Tice, 1998), impairs

performance on executive tasks (Schmeichel,

Vohs, & Baumeister, 2003) and leads diet-

ers to break their diets and overeat (Vohs &

Heatherton, 2000). These findings strongly

suggest that emotion regulation exhausts a

common domain- general resource leading

to impairments on subsequent self- control

tasks.

As we have seen in the previous section,

negative affect is often accompanied by

concurrent attempts to regulate that affect.

To the degree that this emotion regulation

strategy is effortful, the strength mode of

self- regulation suggests that, above and

beyond the cost incurred to monitoring (see

previous section), regulating negative affect

would also deplete self-

egulatory strength,

increasing the likelihood of self-

egulation

failure. Indeed, in the previously mentioned

Emotion and Self‑ Regulation Failure 619

study by Vohs and Heatherton (2000) this

is precisely what was found when dieters

who were asked to inhibit their expression

of sadness while watching an emotionally

evocative video subsequently overindulged

themselves in appetizing ice cream.

Although the bulk of the research on self-

regulatory depletion and emotion examines

how emotion regulation can produce sub-

sequent self- regulation failure on nonemo-

tional tasks, studies shows that this effect

goes both ways, such that engaging in effort-

ful self- regulation also impairs subsequent

attempts at emotion regulation. The first

researchers who looked at this question had

participants engage in a thought suppression

task, followed by an emotion regulation task

that required participants to inhibit express-

ing emotions evoked by an emotional video

(Muraven, Tice, & Baumeister, 1998). They

found that participants whose resources

had been depleted by the thought suppres-

sion task were subsequently less successful at

inhibiting their emotions. In another study,

Schmeichel (2007) extended these findings

to more traditional tasks of executive func-

tion. In this experiment, participants com-

pleted a complex working memory task,

followed by an emotion inhibition task. As

in the Muraven et al. (1998) study, partici-

pants whose self- regulatory resources were

depleted by the complex working memory

task were impaired at suppressing their emo-

tions relative to a nondepleted control group

(Schmeichel, 2007).

More recently, the interplay between self-

regulatory strength and emotional regula-

tion was investigated using functional neu-

roimaging (Wagner & Heatherton, 2013).

In this study, participants were assigned to

either a depletion condition, in which they

completed a difficult attention control task,

or a control condition. Next, all participants

viewed a series of emotional scenes differ-

ing in valence. Compared to control par-

ticipants, those who were depleted exhib-

ited greater neural activity in the amygdala,

a region involved in the perception and

detection of emotion, when viewing nega-

tive emotional scenes. Moreover, depleted

participants exhibited reduced connectiv-

ity between the amygdala and prefrontal

regions implicated in top-down control, sug-

gesting a failure to engage in emotion regu-

lation (Wagner & Heatherton, 2013).

Taken together, the results of the studies

reviewed in this section offer both behav-

ioral and neural evidence that engaging in

self- regulation, be it in the emotional or

the cognitive domain, leads to transient

impairments in subsequent self- regulation

attempts. Thus, with respect to our poison

tendrils model of negative affect, ongoing

attempts to regulate negative affect serve

to reduce self- regulatory capacity, thereby

increasing the likelihood of self- regulation

failure (Figure 36.1B). Moreover, these find-

ings suggest that it is important to consider

the individual’s prior self- regulatory con-

text, as having to engage in other forms of

self- regulation can lead to transient impair-

ments of emotion regulation, which may

exacerbate the effects of negative affect on

self- regulation.

Depleting Self‑Regulatory Strength

Intensifies Emotions and Impulses

Although early models of self- regulation

tacitly assumed that the strength of impulses

and emotions remain essentially unchanged

during self- regulation failure, recent theo-

ries suggest that impulses and emotions

may increase in strength when self- control

is depleted (e.g., Heatherton & Wagner,

2011; Schmeichel, Harmon-Jones, & Har-

mon-Jones, 2010; Vohs et al., submitted).

For instance, the recent study by Vohs and

colleagues demonstrated that when partici-

pants are in a depleted state, they experi-

ence stronger cravings for appetizing food,

as well as rate emotions and pain as being

felt more acutely than do nondepleted par-

ticipants). The results of the brain imaging

study by Wagner and Heatherton (2013)

bear some similarities to these findings.

Although the results of this study were inter-

preted in terms of emotion dysregulation fol-

lowing depletion, it is equally plausible that

self- regulatory depletion served to amplify

people’s experience of affect, resulting in

greater amygdala activity in response to

negative scenes, thus making emotion regu-

lation more difficult.

This relatively new line of research sug-

gests that self- regulatory depletion not only

harms subsequent attempts at self- control

but also increases the strength of emotions

and desires. For the current discussion this

suggests that managing ongoing negative

620 HEALTH IMPLICATIONS

affect may not only reduce self- regulatory

capacity but also lead to a concurrent

increase in the intensity of currently experi-

enced affect, thereby amplifying its deleteri-

ous effects on all aspects of self- regulation,

as indicated by the path between depletion

and negative affect in Figure 36.1B.

Mood Repair and Escaping

Negative Affect Take Precedence

over Long‑Term Goals

One likely explanation for why people turn

to eating, smoking, and drinking in times

of emotional distress is that they believe

such activities can restore their mood (Say-

ette, 1993). Indeed, even in nonhuman ani-

mals, consuming pleasurable foods has been

shown to reduce neuroendocrine markers

of distress (Foster et al., 2009). In humans,

research has shown that merely being

exposed to appetizing stimuli (e.g., food,

drugs, alcohol) can activate positive hedonic

thoughts (Hofmann, van Koningsbrug-

gen, Stroebe, Ramanathan, & Aarts, 2010;

Sayette & Hufford, 1997). For instance, in

dieters, exposure to descriptions of appetiz-

ing foods has been shown to spontaneously

activate more hedonic thoughts about the

pleasurable aspects of eating than descrip-

tions of neutral foods (Papies, Stroebe, &

Aarts, 2007). This attention to the pleasur-

able aspects of temptations can have serious

consequences, especially in cases of alcohol

and substance use in which withdrawal from

the substance elicits negative affect that is

relieved only by further substance use. It

has been suggested that this need to cope

with—and escape from—negative affect

produced by withdrawal is one of the central

motivations underlying addiction (Baker,

Piper, McCarthy, Majeskie, & Fiore, 2004).

Moreover, through prolonged conditioning

of substance use and improved mood, any

experience of negative affect— whether due

to specific triggers or merely the vicissitudes

of daily life—can trigger the desire for drugs

or alcohol (Baker et al., 2004; Childress et

al., 1994).

Given people’s belief that consuming food

and alcohol or engaging in pleasurable activ-

ities will improve their mood, is there any

empirical evidence that people employ this

strategy when experiencing negative affect?

Studies examining a wide range of behav-

iors show that, upon experiencing negative

affect, people report consuming their favor-

ite substance (e.g., food, alcohol, or drugs) or

engaging in their favorite activity (e.g., shop-

ping, television, gambling) precisely because

they believe it will make them feel better (e.g.,

Faber & Christenson, 1996; Rook, 1987;

Sayette, 1993). Thus, when stuck in a nega-

tive emotional state, people will shirk their

long-term goals in order to address the more

immediate need to feel better. One particu-

larly disconcerting example of mood repair

following negative affect comes from a study

in which participants were asked to rate the

personalities of ethnic ingroup and outgroup

members. Participants who were induced to

experience negative affect— as a result of

negative performance feedback on an osten-

sibly unrelated test— subsequently rated the

ethnic outgroup members more negatively

than did control subjects (Fein & Spencer,

1997). Moreover, it was found that this ten-

dency to denigrate outgroup members led to

increased self- esteem in the negative affect

group, suggesting that participants deni-

grated outgroup members in order to make

themselves feel better. Likewise, when peo-

ple experience social rejection, they become

more willing to take illicit drugs or waste

money on goods that are liked by their peers,

but not necessarily by themselves, if doing so

increases their chances at fitting in (Mead,

Baumeister, Stillman, Rawn, & Vohs, 2011).

Other examples involve the effect of nega-

tive affect on spending. In these studies, neg-

ative affect has been shown to increase par-

ticipant’s willingness to pay more for goods,

as well as sell things they already own for

less money (Lerner, Small, & Loewenstein,

2004). These findings were taken to indicate

that people see buying new things or selling

old things as a way of changing their current

state and thereby escape negative affect.

Although attempting to repair one’s mood

through engaging in pleasurable activities

such as eating may seem like a good tem-

porary strategy to alleviate negative affect,

studies show that this form of mood repair

is often a case of misregulation. Unlike other

forms of self- regulation failure, misregu-

lation is not so much a lack of self- control

as the use of self- control in a misguided—

and often futile— attempt to improve one’s

state (Baumeister & Heatherton, 1996). For

instance, studies show that although diet-

ers may binge-eat in an attempt to improve

their mood, they often end up feeling worse

Emotion and Self‑ Regulation Failure 621

after eating than they did before (for a meta-

analysis, see Haedt-Matt & Keel, 2011).

Finally, a study by Tice and colleagues

(2001) elegantly demonstrated that cer-

tain cases of disinhibited behavior are due

entirely to a motivated attempt to improve

affective states. In this study, participants

were induced to experience negative affect,

but in one group they were given a pill

and told that it would freeze their mood.

Whereas participants who did not receive

the mood- freezing pill exhibited typical

signs of self- regulation failure, such as eat-

ing unhealthy foods or procrastinating with

pleasurable activity before a task, those who

took the mood- freezing pill showed no signs

of disinhibition (Tice et al., 2001). Thus,

when participants believed engaging in plea-

surable activities could not improve their

negative emotional state, they ceased trying

to change their mood by indulging in these

activities.

The case of misregulation is particularly

interesting, because it suggests that self-

regulation failure following negative affect

is not always due to a failure in the machin-

ery of self- regulation; rather it reflects a con-

scious shift in priorities as people focus on

improving their immediate affective state

at the expense of their long-term regulatory

goals. Indeed, it has been suggested that

sometimes people actually use self- control

to bring about personal harm, such as when

they smoke or use drugs to fit in and make

friends (Rawn & Vohs, 2011). However,

these short-term strategies often lead to

more negative affect as people move further

and further away from their goals, such as

when dieters overeat to improve their mood

but then finds themselves further from their

goal of weight loss (Heatherton & Polivy,

1992).

Intimately related to the notion of mis-

regulation is research on escape from self-

awareness (Baumeister, 1991; Heatherton &

Baumeister, 1991). In contrast to the mood

repair hypothesis outlined earlier, escape

theory posits that self- awareness is aver-

sive for people who possess negative self-

views (see Higgins, 1987). Unfortunately,

for those with negative self-views, increas-

ing self- awareness does not help them regu-

late, because self- awareness itself can lead to

negative affect as people’s attention becomes

focused on their perceived shortcomings

(Mor & Winquist, 2002). For these people,

escaping self- awareness becomes an effec-

tive strategy for reducing negative affect.

However, attempts to reduce self- awareness

come at the expense of the ability to focus

on long-term goals and an increased vulner-

ability to temptations in the immediate envi-

ronment. For example, dieters who experi-

ence a self- esteem threat are more likely

than nondieters to overeat (Heatherton et

al., 1993). Likewise, following self- esteem

threats, people drink more alcohol (Hull &

Young, 1983), watch more television (Mos-

kalenko & Heine, 2003) and avoid sitting in

front of mirrors (Twenge, Catanese, & Bau-

meister, 2003).

With respect to our model, this suggests

that, in some instances, negative affect inter-

feres with the machinery of self- regulation

(e.g., monitoring or capacity), but in other

circumstances, people chose to indulge in

temptations as a means of repairing their

mood. This form of misregulation may tem-

porarily relieve negative affect, but once the

awareness sets in that people have failed at

their regulatory goals, further negative affect

ensues, thus jeopardizing future attempts

at self- regulation (see also Heatherton and

Polivy’s [1992] spiral model describing the

relationship between negative affect and

chronic dieting).

Are All Negative Emotions

Equally Likely to Cause

Self-Regulation Failure?

In many of the studies we have reviewed,

negative affect refers primarily to any

unpleasurable or aversive emotional state,

thus subsuming a variety of emotional

categories— from frustration to shame

to social rejection. In some cases, nega-

tive affect is assessed through self- reports,

whereas in others the emotional state is

experimentally induced, affording more

control over the specific emotions produced.

That being said, differences between nega-

tive emotion types are seldom reported, with

two exceptions. The first involves research

in chronic dieters demonstrating that nega-

tive affect inductions that specifically target

an individual’s self- esteem (e.g., negative

performance feedback, social rejection) are

more effective at producing disinhibited eat-

ing (Heatherton et al., 1991, 1993, 1998;

Lattimore & Maxwell, 2004) than induc-

622 HEALTH IMPLICATIONS

tions targeting physical distress (e.g., fear of

electric shock; Heatherton et al., 1991; Her-

man & Polivy, 1975).

The second exception involves research on

the consequences of being socially excluded.

As described earlier, social rejection can

lead to poorer task performance, selfishness,

aggression, and increased eating in dieters.

Paradoxically, however, other studies indi-

cate that inducing feelings of social rejection

can increase affiliative behaviors (Maner,

DeWall, Baumeister, & Schaller, 2007; Wil-

liams & Sommer, 1997), as well as improve

memory for social information (Gardner,

Pickett, & Brewer, 2000). One explanation

for this discrepancy is that socially rejected

people are adaptively deploying both pro-

tective and affiliative strategies, such that

when the opportunity for forging new social

bonds appears low (as in some experiments)

they react with selfish and occasionally hos-

tile behaviors, whereas when there is an

opportunity for meaningful social contact,

they instead switch to an affiliative strat-

egy in an attempt to repair their self- esteem

(e.g., Baumeister, Brewer, Tice, & Twenge,

2007; Maner et al., 2007; Smart Richman

& Leary, 2009). Indeed, a recent imaging

study found that interpersonal distress led

to increased mental engagement for posi-

tive social stimuli (as indexed by activity in

medial prefrontal cortical regions associated

with mentalizing) and decreased engagement

for negative social stimuli (Powers, Wagner,

Norris, & Heatherton, 2013). Although

these reactions to social rejection have only

tangential bearing on self- regulation failure,

they do highlight the complexity of the rela-

tionship between negative affect and self-

regulation, demonstrating that reactions to

negative affect can strategically vary accord-

ing to the individual’s goals. As described

in the previous sections, what can appear

to be a failure to maintain self- control may

instead be a strategy to repair mood through

consuming foods or alcohol, or engaging in

pleasurable activities at the expense of other

regulatory goals.

Can Negative Affect Ever Increase

Self-Regulation Success?

Much of the work discussed here has exam-

ined the influence of affect on self- regulation

in “hot” contexts, such as when faced with

the opportunity to indulge in temptations

or pleasurable activities. Emotion can,

however, color behavior in other ways. For

instance, in Schwarz’s (1990) feelings as

information model, an individual’s current

emotional state can be used as information

in making evaluative judgments or resolving

ambiguities. For example, following a nega-

tive mood induction, people tend to judge

their current happiness and life satisfaction

less positively than when in a positive mood

(Schwarz & Clore, 1983). Other research

shows that people in a negative mood tend

to elaborate on information, demonstrat-

ing more accurate performance on tasks

requiring attention to details (reviewed in

Schwarz, 1990). Other theorists have sug-

gested that emotions signal the need for self-

regulation. For instance, Carver and Scheier

(1990) argued that positive emotions signal

that a person is achieving his or her goal

(e.g., successfully dieting), whereas nega-

tive emotions arise when a person is mov-

ing away from his or her goal (e.g., gaining

weight during a diet). From this perspective,

then, negative affect should serve to increase

rather than thwart efforts at self- regulation.

The discrepancy between the preceding the-

ories and the evidence reviewed in this chap-

ter can be resolved if we consider when in

time these effects are likely to take place. In

this chapter we have primarily focused on

the role of negative affect in eliciting self-

regulation failure “in the moment,” when

people are confronted with the immediate

need to regulate themselves, such as when

faced with temptations. Over longer time

frames, outside of these “hot” moments,

negative affect may very well serve to moti-

vate individuals to change their current state

for the better (Heatherton & Polivy, 1992).

The Role of Positive Affect

in Self-Regulation Success

and Failure

In the preceding sections we have focused

solely on the role of negative affect in self-

regulation failure, with scant mention of its

opposite, positive affect. This is largely for

two reasons: First, researchers have often

neglected positive affect in favor of negative

affect (see Ashby, Isen, & Turken, 1999);

second, of the research that does consider

positive affect, there is less evidence that it

Emotion and Self‑ Regulation Failure 623

plays a strong part in self- regulation failures

or successes, at least in the types of contexts

discussed in this chapter. For example, com-

pared to positive moods, negative moods and

events are typically found to be more memo-

rable and are experienced more intensely

(see Baumeister, Bratslavsky, Finkenauer, &

Vohs, 2001). Moreover, in the mood induc-

tion studies reviewed earlier, of those that

have directly compared negative and posi-

tive affect, negative always trump positive

(Willner & Jones, 1996; Tiffanny & Drobes,

1990). Thus, it appears that negative affect

is generally a much more potent force than

positive affect in self- regulation failure.

Does positive affect promote self-

regulation success? There is some research

suggesting that positive affect can serve

to momentarily increase self- regulation

strength. For instance, when people hold

the goal of self- improvement in mind, posi-

tive affect inductions lead to increased

use of self- control (Fishbach & Labroo,

2007). Based on these results, Fishbach and

Labroo suggest that positive affect pushes

people to strive toward a currently acti-

vated goal. If that goal happens to be about

self- improvement, then self- regulation may

follow; however, if the goal is mood regu-

lation, then self- regulation may suffer to

the degree that it is opposed to maintain-

ing a positive mood. Another study show-

ing beneficial effect of positive affect on

self- regulation found that inducing positive

affect restored self- regulation capacity fol-

lowing self- regulatory depletion (Tice, Bau-

meister, Shmueli, & Muraven, 2007). This

finding suggests that the capacity to engage

in self- control is at least partially moderated

by affect. In fact, to the degree that partici-

pants in the Tice et al. study hold the goal to

succeed at the tasks laid out by the experi-

menters, then the results of Fishbach and

Labroo (2007) would suggest that the posi-

tive affect induction reversed the effects of

self- regulatory depletion by pushing subjects

to expend whatever resources they had left

in the service of the goal of succeeding at the

task. It is worth pointing out that although

these studies suggest that positive affect can

increase self- control under certain circum-

stances, it is likely that under a different set

of circumstances (e.g., at a bar), with a dif-

ferent goal in mind (e.g., celebrating with

friends), positive affect may lead to greater

celebratory excess.

Conclusion

Negative affect may very well be the most

potent disinhibitor of restrained behavior.

When people feel worthless, depressed, or

rejected, they are more likely to engage in

a variety of self- defeating behaviors. Fol-

lowing negative affect, dieters overeat, for-

mer smokers smoke, and alcoholics fall into

relapse. More generally, people become more

likely to procrastinate, to be selfish or hos-

tile, and even go so far as to denigrate out-

group members. Negative affect appears to

accomplish this pernicious feat by poisoning

all facets of self- regulation (see Figure 36.1):

sensitizing people to rewards and tempta-

tions, decreasing monitoring of behavior,

reducing self- regulatory capacity, and caus-

ing people to focus on repairing their mood

at the expense of abandoning their goals and

giving in to their impulses and desires.

Although it often appears that our self-

control is entirely at the mercy of our emo-

tions, it is also the case that emotion regu-

lation can be derailed by prior attempts at

self- regulation in the cognitive domain. For

instance, engaging in effortful self- regulation

tasks can exhaust self- regulatory resources,

thereby jeopardizing subsequent emo-

tion regulation attempts. Moreover, recent

research has shown that when people are

cognitively depleted by prior attempts at self-

regulation, emotions and impulses appear to

increase in potency, rendering them a more

forceful adversary to self- control.

The interplay among emotions, emotion

regulation, and self- regulation has been dis-

cussed as though each of the myriad ways

that emotions can hijack self- control work

independently of the others. However, it is

far more likely that the multiple routes to

self- regulation failure are themselves inter-

active. For instance, negative affect can

lead to a desire to escape negative states by

reducing self- awareness and also to engage

in pleasurable activities, even if these activi-

ties conflict with long-term goals. Together,

these may serve to increase the pull of imme-

diately available rewards, because the ability

to monitor behavior is lessened as the focus

shifts to pleasure. Negative affect may also

place a load on working memory indepen-

dent of the desire to escape self- awareness,

thus further reducing the ability to monitor

behavior. Throw in the fact that prior self-

regulatory effort may leave the individual

624 HEALTH IMPLICATIONS

in a depleted state in which both resources

for further self- control are lacking and

the strength of impulses and temptations

is increased, and it is a small miracle that

people are not constantly acting out their

fantasies, drinking, smoking, or indulg-

ing every gastronomic desire. If the studies

reviewed in this chapter paint a dire picture,

it is important to note that emotion is not all

bad: For instance, it has been demonstrated

that experiencing positive emotions can

improve self- regulation by helping to buffer

against the depleting effects of prior tasks

(Tice et al., 2007).

In this chapter we reviewed evidence sug-

gesting that negative emotions are a potent

cause of self- regulation failure and we have

proposed a simple poison tendrils model in

which negative affect invades and disrupts

nearly every aspect of self- regulatory func-

tion. Moreover, results from a variety of

behavioral and neural studies suggest that

the relationship between emotions and self-

regulation is dynamic and interactive, such

that emotion- induced self- regulation fail-

ure serves not only to intensify currently

experienced emotions and desires but also

to increase negative affect as the individual

moves further and further away from his

or her goals. Negative affect is thus a par-

ticularly potent threat to self- regulation,

because it not only reduces the capacity for

control (increased working memory load,

reduced self- awareness and monitoring) but

it may also lead to increases in the strength

of experienced desires and emotions, render-

ing them all the more difficult to resist.

References

Ashby, F. G., Isen, A. M., & Turken, A. U. (1999).

A neuropsychological theory of positive affect

and its influence on cognition. Psychological

Review, 106(3), 529–550.

Baker, T. B., Piper, M. E., McCarthy, D. E.,

Majeskie, M. R., & Fiore, M. C. (2004).

Addiction motivation reformulated: An affec-

tive processing model of negative reinforce-

ment. Psychological Review, 111(1), 33–51.

Baucom, D. H., & Aiken, P. A. (1981). Effect of

depressed mood in eating among obese and

nonobese dieting and nondieting persons.

Journal of Personality and Social Psychology,

41(3), 577–585.

Baumeister, R. F. (1991). Escaping the self: Alco-

holism, spirituality, masochism, and other

flights from the burden of selfhood. New

York: Basic Books.

Baumeister, R. F. (1997). Esteem threat, self-

regulatory breakdown, and emotional distress

as factors in self- defeating behavior. Review of

General Psychology, 1(2), 145–174.

Baumeister, R. F., Bratslavsky, E., Finkenauer,

C., & Vohs, K. D. (2001). Bad is stronger than

good. Review of General Psychology, 5(4),

323–370.

Baumeister, R. F., Bratslavsky, E., Muraven, M.,

& Tice, D. M. (1998). Ego depletion: Is the

active self a limited resource? Journal of Per-

sonality and Social Psychology, 74(5), 1252–

1265.

Baumeister, R. F., Brewer, L. E., Tice, D. M., &

Twenge, J. M. (2007). Thwarting the need to

belong: Understanding the interpersonal and

inner effects of social exclusion. Social and

Personality Psychology Compass, 1(1), 506–

520.

Baumeister, R. F., DeWall, C. N., Ciarocco, N.

J., & Twenge, J. M. (2005). Social exclusion

impairs self- regulation. Journal of Personality

and Social Psychology, 88(4), 589–604.

Baumeister, R. F., & Heatherton, T. (1996). Self-

regulation failure: An overview. Psychological

Inquiry, 7(1), 1–15.

Berkowitz, L. (1989). Frustration– aggression

hypothesis: Examination and reformulation.

Psychological Bulletin, 106(1), 59–73.

Bousman, C. A., Cherner, M., Ake, C., Leten-

dre, S., Atkinson, J. H., Patterson, T. L., et al.

(2009). Negative mood and sexual behavior

among non- monogamous men who have sex

with men in the context of methamphetamine

and HIV. Journal of Affective Disorders,

119(1–3), 84–91.

Campbell Teskey, G., Kavaliers, M., & Hirst, M.

(1984). Social conflict activates opioid analge-

sic and ingestive behaviors in male mice. Life

Sciences, 35(3), 303–315.

Carver, C. S., & Scheier, M. (1981). Attention and

self- regulation: A control- theory approach to

human behavior. New York: Springer- Verlag.

Carver, C. S., & Scheier, M. F. (1990). Origins

and functions of positive and negative affect:

A control- process view. Psychological Review,

97(1), 19–35.

Childress, A. R., Ehrman, R., McLellan, A.

T., MacRae, J., Natale, M., & O’Brien, C.

P. (1994). Can induced moods trigger drug-

related responses in opiate abuse patients?

Emotion and Self‑ Regulation Failure 625

Journal of Substance Abuse Treatment, 11(1),

17–23.

Deroche, V., Marinelli, M., Maccari, S., Le

Moal, M., Simon, H., & Piazza, P. V. (1995).

Stress- induced sensitization and glucocorti-

coids: I. Sensitization of dopamine- dependent

locomotor effects of amphetamine and mor-

phine depends on stress- induced corticos-

terone secretion. Journal of Neuroscience,

15(11), 7181–7188.

DeWall, C. N., Twenge, J. M., Bushman, B.,

Im, C., & Williams, K. (2010). A little accep-

tance goes a long way applying social impact

theory to the rejection– aggression link. Social

Psychological and Personality Science, 1(2),

168–174.

Faber, R. J., & Christenson, G. A. (1996). In the

mood to buy: Differences in the mood states

experienced by compulsive buyers and other

consumers. Psychology and Marketing, 13(8),

803–819.

Fein, S., & Spencer, S. J. (1997). Prejudice as

self-image maintenance: Affirming the self

through derogating others. Journal of Person-

ality and Social Psychology, 73(1), 31– 44.

Fenigstein, A. (1979). Self- consciousness, self-

attention, and social interaction. Journal of Per-

sonality and Social Psychology, 37(1), 75–86.

Fishbach, A., & Labroo, A. A. (2007). Be better

or be merry: How mood affects self- control.

Journal of Personality and Social Psychology,

93(2), 158–173.

Foster, M. T., Warne, J. P., Ginsberg, A. B., Hor-

neman, H. F., Pecoraro, N. C., Akana, S. F., et

al. (2009). Palatable foods, stress, and energy

stores sculpt corticotropin- releasing factor,

adrenocorticotropin, and corticosterone con-

centrations after restraint. Endocrinology,

150(5), 2325–2333.

Fox, H. C., Bergquist, K. L., Hong, K., & Sinha,

R. (2007). Stress- induced and alcohol cue-

induced craving in recently abstinent alcohol-

dependent individuals. Alcoholism: Clinical

and Experimental Research, 31(3), 395–403.

Gardner, W. L., Pickett, C. L., & Brewer, M. B.

(2000). Social exclusion and selective memory:

How the need to belong influences memory for

social events. Personality and Social Psychol-

ogy Bulletin, 26(4), 486–496.

Gordijn, E. H., Hindriks, I., Koomen, W., Dijk-

sterhuis, A., & Van Knippenberg, A. (2004).

Consequences of stereotype suppression

and internal suppression motivation: A self-

regulation approach. Personality and Social

Psychology Bulletin, 30(2), 212–224.

Gross, J. J. (2002). Emotion regulation: Affec-

tive, cognitive, and social consequences. Psy-

chophysiology, 39(3), 281–291.

Haedt-Matt, A. A., & Keel, P. K. (2011). Revisit-

ing the affect regulation model of binge eating:

A meta- analysis of studies using ecological

momentary assessment. Psychological Bulle-

tin, 137(4), 660–681.

Hagger, M. S., Wood, C., Stiff, C., & Chatzisa-

rantis, N. L. D. (2010). Ego depletion and

the strength model of self- control: A meta-

analysis. Psychological Bulletin, 136(4), 495–

525.

Heatherton, T. F., & Baumeister, R. F. (1991).

Binge eating as escape from self- awareness.

Psychological Bulletin, 110(1), 86–108.

Heatherton, T. F., Herman, C. P., & Polivy, J.

(1991). Effects of physical threat and ego

threat on eating behavior. Journal of Person-

ality and Social Psychology, 60(1), 138–143.

Heatherton, T. F., & Polivy, J. (1992). Chronic

dieting and eating disorders: A spiral model.

In J. H. Crowther, D. L. Tennenbaum, S. E.

Hobfoll, & M. A. P. Stephens (Eds.), The eti-

ology of bulimia nervosa: The individual and

familial context (pp. 133–155). Washington,

DC: Hemisphere.

Heatherton, T. F., Polivy, J., Herman, C. P., &

Baumeister, R. F. (1993). Self- awareness, task

failure, and disinhibition: How attentional

focus affects eating. Journal of Personality,

61(1), 49–61.

Heatherton, T. F., Striepe, M., & Wittenberg,

L. (1998). Emotional distress and disinhibited

eating: The role of self. Personality and Social

Psychology Bulletin, 24(3), 301–313.

Heatherton, T. F., & Wagner, D. D. (2011). Cog-

nitive neuroscience of self- regulation failure.

Trends in Cognitive Sciences, 15(3), 132–139.

Herman, C. P., & Polivy, J. (1975). Anxiety,

restraint, and eating behavior. Journal of

Abnormal Psychology, 84(6), 666–672.

Higgins, E. T. (1987). Self- discrepancy: A theory

relating self and affect. Psychological Review,

94(3), 319–340.

Higgins, R. L., & Marlatt, G. A. (1975). Fear

of interpersonal evaluation as a determinant

of alcohol consumption in male social drink-

ers. Journal of Abnormal Psychology, 84(6),

644–651.

Hofmann, W., Schmeichel, B. J., & Baddeley,

A. D. (2012). Executive functions and self-

regulation. Trends in Cognitive Sciences,

16(3), 174–180

Hofmann, W., van Koningsbruggen, G. M.,

626 HEALTH IMPLICATIONS

Stroebe, W., Ramanathan, S., & Aarts,

H. (2010). As pleasure unfolds: Hedonic

responses to tempting food. Psychological Sci-

ence, 21(12), 1863–1870.

Hull, J. G., & Young, R. D. (1983). Self-

consciousness, self- esteem, and success- failure

as determinants of alcohol consumption in

male social drinkers. Journal of Personality

and Social Psychology, 44(6), 1097–1109.

Inzlicht, M., & Kang, S. K. (2010). Stereotype

threat spillover: How coping with threats to

social identity affects aggression, eating, deci-

sion making, and attention. Journal of Person-

ality and Social Psychology, 99(3), 467–481.

Johns, M., Inzlicht, M., & Schmader, T. (2008).

Stereotype threat and executive resource

depletion: Examining the influence of emotion

regulation. Journal of Experimental Psychol-

ogy: General, 137(4), 691–705.

Kassel, J. D., Stroud, L. R., & Paronis, C. A.

(2003). Smoking, stress, and negative affect:

Correlation, causation, and context across

stages of smoking. Psychological Bulletin,

129(2), 270–304.

Keltner, D., & Gross, J. J. (1999). Functional

accounts of emotions. Cognition and Emo-

tion, 13(5), 467–480.

Krendl, A. C., Richeson, J. A., Kelley, W. M., &

Heatherton, T. F. (2008). The negative con-

sequences of threat: A functional magnetic

resonance imaging investigation of the neural

mechanisms underlying women’s underperfor-

mance in math. Psychological Science, 19(2),

168–175.

LaRose, R., Lin, C., & Eastin, M. (2003). Unreg-

ulated Internet usage: Addiction, habit, or

deficient self- regulation? Media Psychology,

5(3), 225–253.

Lattimore, P., & Maxwell, L. (2004). Cognitive

load, stress, and disinhibited eating. Eating

Behaviors, 5(4), 315–324.

Leary, M. R., Kowalski, R. M., Smith, L., &

Phillips, S. (2003). Teasing, rejection, and vio-

lence: Case studies of the school shootings.

Aggressive Behavior, 29(3), 202–214.

Lerner, J. S., Small, D. A., & Loewenstein, G.

(2004). Heart strings and purse strings: Car-

ryover effects of emotions on economic deci-

sions. Psychological Science, 15(5), 337–341.

Levenson, R. W. (1994). Human emotion: A

functional view. In P. Ekman & R. J. Davidson

(Eds.), The nature of emotion: Fundamental

questions (pp. 123–126). New York: Oxford

University Press.

Maner, J. K., DeWall, C. N., Baumeister, R. F.,

& Schaller, M. (2007). Does social exclusion

motivate interpersonal reconnection?: Resolv-

ing the “porcupine problem.” Journal of Per-

sonality and Social Psychology, 92(1), 42–55.

Mann, T., & Ward, A. (2007). Attention, self-

control, and health behaviors. Current Direc-

tions in Psychological Science, 16(5), 280–283.

Marlatt, G. A., & Gordon, J. (1985). Relapse

prevention: Maintenance strategies in the

treatment of addictive behaviors. New York:

Guilford Press.

McKee, S. A., Sinha, R., Weinberger, A. H.,

Sofuoglu, M., Harrison, E. L., Lavery, M., et

al. (2011). Stress decreases the ability to resist

smoking and potentiates smoking intensity

and reward. Journal of Psychopharmacology,

25(4), 490–502.

Mead, N. L., Baumeister, R. F., Stillman, T. F.,

Rawn, C. D., & Vohs, K. D. (2011). Social

exclusion causes people to spend and consume

strategically in the service of affiliation. Jour-

nal of Consumer Research, 37(5), 902–919.

Metcalfe, J., & Mischel, W. (1999). A hot/

cool- system analysis of delay of gratifica-

tion: Dynamics of willpower. Psychological

Review, 106(1), 3–19.

Mischel, W., Ebbesen, E. B., & Zeiss, A. R.

(1973). Selective attention to the self: Situa-

tional and dispositional determinants. Journal

of Personality and Social Psychology, 27(1),

129–142.

Mor, N., & Winquist, J. (2002). Self- focused

attention and negative affect: A meta- analysis.

Psychological Bulletin, 128(4), 638–662.

Moskalenko, S., & Heine, S. J. (2003). Watch-

ing your troubles away: Television viewing as a

stimulus for subjective self- awareness. Person-

ality and Social Psychology Bulletin, 29(1),

76–85.

Muraven, M., Collins, R. L., & Nienhaus, K.

(2002). Self- control and alcohol restraint: An

initial application of the self- control strength

model. Psychology of Addictive Behaviors,

16(2), 113–120.

Muraven, M., Tice, D. M., & Baumeister, R. F.

(1998). Self- control as limited resource: Regu-

latory depletion patterns. Journal of Personal-

ity and Social Psychology, 74(3), 774–789.

Oaten, M., Williams, K. D., Jones, A., & Zadro,

L. (2008). The effects of ostracism on self-

regulation in the socially anxious. Journal of

Social and Clinical Psychology, 27(5), 471–

504.

Papies, E., Stroebe, W., & Aarts, H. (2007). Plea-

sure in the mind: Restrained eating and spon-

Emotion and Self‑ Regulation Failure 627

taneous hedonic thoughts about food. Journal

of Experimental Social Psychology, 43(5),

810–817.

Piazza, P. V., & Le Moal, M. L. (1996). Patho-

physiological basis of vulnerability to drug

abuse: Role of an interaction between stress,

glucocorticoids, and dopaminergic neurons.

Annual Review of Pharmacology and Toxi-

cology, 36, 359–378.

Pithers, W. D., Kashima, K. M., Cumming, G.

F., Beal, L. S., & Buell, M. M. (1988). Relapse

prevention of sexual aggression. Annals of

the New York Academy of Sciences, 528(1),

244–260.

Powers, K. E., Wagner, D. D., Norris, C. J., &

Heatherton, T. F. (2013). Socially excluded

individuals fail to recruit medial prefrontal

cortex for negative social scenes. Social Cog-

nitive and Affective Neuroscience, 8(2), 151–

157.

Ramsey, N. F., & Van Ree, J. M. (1993). Emo-

tional but not physical stress enhances intrave-

nous cocaine self- administration in drug-naive

rats. Brain Research, 608(2), 216–222.

Raviv, M. (1993). Personality characteristics of

sexual addicts and pathological gamblers.

Journal of Gambling Studies, 9(1), 17–30.

Rawn, C. D., & Vohs, K. D. (2011). People use

self- control to risk personal harm: An intra-

interpersonal dilemma. Personality and Social

Psychology Review, 15(3), 267–289.

Richards, J. M., & Gross, J. J. (2000). Emotion

regulation and memory: The cognitive costs of

keeping one’s cool. Journal of Personality and

Social Psychology, 79(3), 410–424.

Richeson, J. A., & Shelton, J. N. (2003). When

prejudice does not pay: Effects of interracial

contact on executive function. Psychological

Science, 14(3), 287–290.

Roberts, M. E., Gibbons, F. X., Gerrard, M.,

Weng, C.-Y., Murry, V. M., Simons, L. G., et

al. (2012). From racial discrimination to risky

sex: Prospective relations involving peers and

parents. Developmental Psychology, 48(1),

89–102.

Rook, D. W. (1987). The buying impulse. Jour-

nal of Consumer Research, 14(2), 189–199.

Sayette, M. A. (1993). An appraisal- disruption

model of alcohol’s effects on stress responses

in social drinkers. Psychological Bulletin,

114(3), 459–476.

Sayette, M. A., & Hufford, M. R. (1997). Effects

of smoking urge on generation of smoking-

related information. Journal of Applied Social

Psychology, 27(16), 1395–1405.

Scheier, M. F., & Carver, C. S. (1983). Self-

directed attention and the comparison of

self with standards. Journal of Experimental

Social Psychology, 19(3), 205–222.

Schmeichel, B. J. (2007). Attention control,

memory updating, and emotion regulation

temporarily reduce the capacity for executive

control. Journal of Experimental Psychology:

General, 136(2), 241–255.

Schmeichel, B. J., Harmon-Jones, C., & Har-

mon-Jones, E. (2010). Exercising self- control

increases approach motivation. Journal of Per-

sonality and Social Psychology, 99(1), 162–173.

Schmeichel, B. J., Vohs, K. D., & Baumeister, R.

F. (2003). Intellectual performance and ego

depletion: Role of the self in logical reason-

ing and other information processing. Journal

of Personality and Social Psychology, 85(1),

33–46.

Schoofs, D., Preuss, D., & Wolf, O. T. (2008).

Psychosocial stress induces working memory

impairments in an n-back paradigm. Psycho-

neuroendocrinology, 33(5), 643–653.

Schwarz, N. (1990). Feelings as information:

Informational and motivational functions

of affective states. In E. T. Higgins & R. M.

Sorrentino (Eds.), Handbook of motivation

and cognition: Foundations of social behav-

ior (Vol. 2, pp. 527–561). New York: Guilford

Press.

Schwarz, N., & Clore, G. L. (1983). Mood,

misattribution, and judgments of well-being:

Informative and directive functions of affec-

tive states. Journal of Personality and Social

Psychology, 45(3), 513–523.

Seeman, G., & Schwarz, J. C. (1974). Affective

state and preference for immediate versus

delayed reward. Journal of Research in Per-

sonality, 7(4), 384–394.

Sinha, R. (2007). The role of stress in addiction

relapse. Current Psychiatry Reports, 9(5),

388–395.

Smart Richman, L., & Leary, M. R. (2009).

Reactions to discrimination, stigmatization,

ostracism, and other forms of interpersonal

rejection: A multimotive model. Psychological

Review, 116(2), 365–383.

Spencer, S. J., Steele, C. M., & Quinn, D. M.

(1999). Stereotype Threat and Women’s Math

Performance. Journal of Experimental Social

Psychology, 35(1), 4 –28.

Steele, C. M., & Aronson, J. (1995). Stereotype

threat and the intellectual test performance

of African Americans. Journal of Personality

and Social Psychology, 69(5), 797–811.

628 HEALTH IMPLICATIONS

Tataranni, P. A., Larson, D. E., Snitker, S., Young,

J. B., Flatt, J. P., & Ravussin, E. (1996). Effects

of glucocorticoids on energy metabolism and

food intake in humans. American Journal of

Physiology: Endocrinology and Metabolism,

271(2), E317–E325.

Tice, D. M., Baumeister, R. F., Shmueli, D., &

Muraven, M. (2007). Restoring the self: Posi-

tive affect helps improve self- regulation fol-

lowing ego depletion. Journal of Experimen-

tal Social Psychology, 43(3), 379–384.

Tice, D. M., Bratslavsky, E., & Baumeister, R.

F. (2001). Emotional distress regulation takes

precedence over impulse control: If you feel

bad, do it! Journal of Personality and Social

Psychology, 80(1), 53 – 67.

Tiffany, S. T., & Drobes, D. J. (1990). Imag-

ery and smoking urges: The manipulation of

affective content. Addictive Behaviors, 15(6),

531–539.

Twenge, J. M., Baumeister, R. F., DeWall, C.

N., Ciarocco, N. J., & Bartels, J. M. (2007).

Social exclusion decreases prosocial behavior.

Journal of Personality and Social Psychology,

92(1), 56–66.

Twenge, J. M., Baumeister, R. F., Tice, D. M.,

& Stucke, T. S. (2001). If you can’t join them,

beat them: Effects of social exclusion on

aggressive behavior. Journal of Personality

and Social Psychology, 81(6), 1058–1069.

Twenge, J. M., Catanese, K. R., & Baumeister,

R. F. (2003). Social exclusion and the decon-

structed state: Time perception, meaning-

lessness, lethargy, lack of emotion, and self-

awareness. Journal of Personality and Social

Psychology, 85(3), 409–423.

Velten, E. (1968). A laboratory task for induc-

tion of mood states. Behaviour Research and

Therapy, 6(4), 473–482.

Vohs, K. D., Baumeister, R. F., Mead, N. L., Hof-

mann, W. J., Ramanathan, S., & Schmeichel,

B. J. (submitted). Engaging in self- control

heightens urges and feelings.

Vohs, K. D., Baumeister, R. F., Schmeichel, B. J.,

Twenge, J. M., Nelson, N. M., & Tice, D. M.

(2008). Making choices impairs subsequent

self- control: A limited- resource account of

decision making, self- regulation, and active

initiative. Journal of Personality and Social

Psychology, 94(5), 883–898.

Vohs, K. D., & Heatherton, T. F. (2000). Self-

regulatory failure: A resource- depletion

approach. Psychological Science, 11(3), 249–

254.

Wagner, D. D., Boswell, R. G., Kelley, W. M.,

& Heatherton, T. F. (2012). Inducing negative

affect increases the reward value of appetizing

foods in dieters. Journal of Cognitive Neuro-

science, 24(7), 1625–1633.

Wagner, D. D., & Heatherton, T. F. (2013). Self-

regulatory depletion increases emotional reac-

tivity in the amygdala. Social Cognitive and

Affective Neuroscience, 8(4), 410–417.

Warburton, W. A., Williams, K. D., & Cairns,

D. R. (2006). When ostracism leads to aggres-

sion: The moderating effects of control depri-

vation. Journal of Experimental Social Psy-

chology, 42(2), 213–220.

Ward, A., & Mann, T. (2000). Don’t mind if I

do: Disinhibited eating under cognitive load.

Journal of Personality and Social Psychology,

78(4), 753–763.

Wegner, D. M. (1994). Ironic processes of men-

tal control. Psychological Review, 101(1),

34–52.

Wegner, D. M., & Erber, R. (1992). The hyper-

accessibility of suppressed thoughts. Journal

of Personality and Social Psychology, 63(6),

903–912.

Wegner, D. M., Erber, R., & Zanakos, S. (1993).

Ironic processes in the mental control of mood

and mood- related thought. Journal of Per-

sonality and Social Psychology, 65(6), 1093–

1104.

Williams, K. D., & Sommer, K. L. (1997). Social

ostracism by coworkers: Does rejection lead

to loafing or compensation? Personality and

Social Psychology Bulletin, 23(7), 693–706.

Willner, P., & Jones, C. (1996). Effects of mood

manipulation on subjective and behavioural

measures of cigarette craving. Behavioural

Pharmacology, 7(4), 355–363.

Witkiewitz, K., & Villarroel, N. A. (2009).

Dynamic association between negative affect

and alcohol lapses following alcohol treat-

ment. Journal of Consulting and Clinical Psy-

chology, 77(4), 633–644.

Zinser, M. C., Baker, T. B., Sherman, J. E., &

Cannon, D. S. (1992). Relation between self-

reported affect and drug urges and cravings in

continuing and withdrawing smokers. Journal

of Abnormal Psychology, 101(4), 617–629.

629

Aaker, J. L., 288

Aarts, H., 244, 350, 354, 356,

362, 366, 367, 620

Abe, K., 435

Abela, J. R., 405

Aber, J. L., 116, 309

Abler, B., 11, 65, 82, 145, 325,

326, 327

Abramovitz, A., 498

Abramson, L. Y., 383

Abu-Lughod, L., 288

Ackerman, B. P., 163

Adams, C. E., 480, 557

Adams, C. M., 95

Adams, G., 285

Adamson, L., 277

Addis, D. R., 104

Addis, M., 497

Adler, N. E., 586

Affleck, G., 589

Aglioti, S. M., 497

Agras, W., 483

Ahadi, S. A., 159, 165, 308, 310

Ahrens, A. H., 383

Aiken, P. A., 116, 117, 614

Ainslie, G., 99

Ainsworth, M. D. S., 226, 229,

237, 273, 277

Akerstedt, A. M., 212

Akiyama, T., 403

Aksan, N., 160, 313

Akutsu, S., 325

Albert, D., 9, 189, 284

Alberts, H. J. E. M., 352

Alcaine, O. M., 84, 403, 470

Aldao, A., 127, 135, 271, 327,

396, 398, 399, 401, 404, 405,

417, 418, 474, 483, 492, 496

Aldridge, J. W., 96, 471

Alea, N., 207

Aleman, A., 141, 148, 532

Alexander, R. D., 225

Algom, D., 132

Alicata, D., 435

Allan, C. L., 69

Allan, N. P., 164, 166

Allen, A. B., 379, 480, 557

Allen, A. H., 81

Allen, J. P., 192, 225, 228

Allen, J. S., 195

Allen, L. B., 496

Allen, M., 556

Allen, N. B., 187, 188, 190, 191,

352

Allman, J. M., 460

Alloy, L. B., 383, 416

Allport, G. W., 252, 306

Almeida, D. M., 209, 210, 211,

212

Alonso-Alonso, M., 355

Alper, C. M., 571, 587

Als, H., 277

Altamirano, L. J., 127

Alvarez, J., 405

Amar, S., 562

Amaral, D. G., 537

Ambady, N., 259

Amiaz, R., 355

Amir, M., 241, 242

Amir, N., 424, 513, 514, 516,

517, 520, 522, 523

Amir, T., 524

Amit, I., 576

Amodio, D. M., 362

An, S. K., 52

Anderson, A. K., 14, 252, 352,

530, 548, 556, 557

Anderson, B., 46

Anderson, C., 325

Anderson, C. L., 370

Anderson, C. S., 497

Anderson, E., 450

Anderson, J. R., 28

Anderson, M. C., 104

Anderson, P. L., 552

Anderson, S. W., 143

Andersson, G., 469

Andover, M. S., 530

Andrade, E. B., 141, 193

Andrade, J., 348

Author Index

630 Author Index

Andrew, C., 66

Andrews-Hanna, J. R., 450, 457,

460

Ang, C., 522

Angstadt, M., 83, 145

Ansell, E., 384

Anstiss, V., 353

Antonenko, O., 11, 341

Antoni, M. H., 575, 576

Antonucci, T. C., 210

Appleton, A. A., 596, 601, 603,

606, 607, 608

Apter, A., 399

Arbuckle, N. L., 260

Arch, J. J., 399, 551

Arellano, C. M., 276

Arevalo, J. M., 575

Ariely, D., 141, 369

Arkowitz, H., 476

Armony, J. L., 537

Arnsten, A. F. T., 230, 536

Arntz, A., 494, 495

Aron, A. R., 28, 33, 227, 273

Aron, E. N., 273

Aronson, E., 381

Aronson, J. A., 98, 141, 617

Asensio, S., 435

Ashby, F. G., 622

Asher, E. R., 226

Ashley, V., 509

Askegaard, S., 346

Aslin, R. N., 121

Asmussen, L., 187

Asnaani, A., 398, 529

Aspinwall, L. G., 291

Astin, J. A., 548, 552

Atlantis, E., 606

Atlas, L. Y., 36, 66

Attwood, A. S., 351, 523

Auerbach, R. P., 405

August, G. J., 431

Auksztulewicz, R., 104

Aupperle, R. L., 471, 473, 476

Austin, S. N., 259

Avenanti, A., 497

Avery, S. N., 81

Avihou-Kanza, N., 239

Avivi, Y. E., 471

Axelrod, S. R., 533

Aycock, J., 213

Ayduk, O., 93, 111, 112, 118,

119, 127, 129, 158, 161, 162,

190, 312, 378, 431, 479, 556

Azuma, H., 285, 294

Baars, B. J., 350

Babuscio, T., 439

Baccus, J. R., 384, 511

Bacharier, L. B., 590

Baddeley, A. D., 348, 617

Badiani, A., 429

Badre, D., 28, 33, 472, 477

Baer, R. A., 548, 552, 557, 559

Baerensten, K. B., 557

Baert, S., 422, 424, 518

Baeyens, C., 499, 500

Baeyens, F., 256, 353

Bagby, R. M., 329

Bailey, M. T., 576

Baime, M. J., 552

Baker, C. I., 24

Baker, L., 226

Baker, M., 606

Baker, N., 352

Baker, R., 396, 399

Baker, S. C., 97

Baker, T. B., 432, 616, 620

Bakermans-Kranenburg, M. J.,

63, 229, 510

Bakker, M. P., 164

Baldwin, M. W., 384, 511, 512,

513, 521

Ball, T. M., 398, 399, 400, 401,

402

Balzarotti, S., 325, 326, 327, 330

Banaji, M. R., 254, 352

Band, G. P. H., 53

Bandler, R., 26

Bandstra, N. F., 165

Bandura, A., 361

Banjeree, R., 296

Banks, S. J., 83, 145

Bannister, T., 241

Banton, T., 222

Bar, M., 176, 223, 450, 475

Barbas, H., 61, 459

Barber, B., 188

Barber, J. P., 539

Barbey, A., 448

Barch, D. M., 98, 230, 311, 474

Barden, J., 256

Bargas-Avila, J., 354

Barger, S. D., 574

Bargh, J. A., 31, 77, 254, 255,

288, 366, 367, 377

Bar-Haim, Y., 63, 510, 511, 512,

518, 521

Bariola, E., 189, 190, 191, 322,

328

Barkley, R. A., 98

Barlow, D. H., 14, 62, 134, 135,

370, 377, 393, 394, 395, 396,

397, 401, 406, 417, 424, 461,

469, 470, 473, 479, 481, 496,

498, 499, 508, 519, 529, 533,

551

Barnard, P. J., 529, 530, 536, 537

Barndollar, K., 366

Barnes, R. D., 353

Barnett, W. S., 167

Barnhofer, T., 560

Baron, R. M., 226

Baron, R. S., 227

Barrett, L. F., 5, 12, 13, 14, 24,

26, 27, 28, 29, 176, 223, 224,

252, 289, 447, 448, 449, 450,

451, 452, 453, 454, 455, 456,

459, 460, 461, 508

Barrig, P. S., 309

Barrios, V., 370

Barry, R. A., 167

Barsalou, L. W., 14, 447, 448,

449, 451, 452, 453, 458, 462

Bartels, A., 226

Bartels, J. M., 615

Bartholomew, K., 243

Bartholow, B., 45

Bartley, M., 241

Bassett, H. H., 181

Bastian, B., 385

Bates, J. E., 113, 158, 159, 161,

167, 305, 307, 310, 315

Bateson, G., 296

Baucom, D. H., 116, 117, 614

Baum, A., 575

Baumeister, R. F., 111, 116, 117,

128, 131, 132, 135, 230, 321,

348, 349, 350, 354, 355, 362,

366, 378, 381, 386, 472, 474,

613, 615, 616, 617, 618, 619,

620, 621, 622, 623

Baumgartner, T., 227

Bayles, K., 113

Beach, S. R., 276

Beal, L. S., 614

Beall, S. K., 598, 599

Beard, C., 514, 516, 517, 520,

521, 523, 524

Beauchaine, T. P., 491

Beaulieu-Pelletier, G., 379

Beauregard, M., 64, 84, 311

Author Index 631

Beaver, J. D., 309

Bebko, G. M., 396, 398

Becerra, L., 36, 82

Bechara, A., 101, 102, 141, 143,

223, 230

Beck, A. T., 395, 414, 469, 477,

482, 499, 559, 561

Beck, G., 575

Beck, J. E., 181

Beck, J. S., 530

Becker, E. S., 353

Beckers, T., 353

Beckes, L., 222, 224, 225, 226

Beckham, J. C., 601

Bedny, M., 28

Beer, J. S., 23, 27

Beers, M., 271, 338

Beesdo, K., 82

Beevers, C. G., 424, 474, 517,

530

Bégin, J., 278

Behar, E., 84, 403, 470

Behne, T., 223

Belin, D., 429

Belk, R. W., 346

Bell, J. R., 571

Bell, K. L., 188, 190, 191, 228

Bell, M. A., 316

Bellgowan, P. S., 452

Belloiu, A., 383

Belsky, J., 312

Bemis, J., 229

Benartzi, S., 105

Benca, R. M., 66

Benedict, R., 286

Bennett, S. M., 95, 394

Ben-Shlomo, Y., 605

Bentall, R. P., 418

Bentin, S., 452

Benvenuto, M., 13, 533

Berant, E., 240, 245

Berenson, G. S., 596, 597, 604

Berg, C. A., 204

Berger, A., 311

Berglund, P., 469

Bergman, A. J., 355

Bergquist, K. L., 436, 614

Berking, M., 14, 433, 529, 531,

534, 535, 538, 541, 542, 544

Berkman, E. T., 436, 437

Berkman, L. F., 579

Berkowitz, L., 614

Berlia, N., 293

Berlin, L. J., 241

Berman, M. G., 431

Berman, S., 36

Bernier, A., 229

Berns, G. S., 96, 145

Berntson, G. G., 259

Bernzweig, J., 313

Berridge, K. C., 96, 141, 145,

349, 356, 471

Berry, E. V., 8

Berscheid, E., 222

Bertram, B. C. R., 225

Besser, A., 243

Bessette-Symons, B., 207

Best, J. R., 166, 189

Bettinger, R. L., 222

Bettman, J. R., 134

Betts, J., 195

Bexkens, A., 316

Bhanji, J. P., 66

Bhullar, N., 589

Bickel, W. K., 98, 106

Bigman, Y., 364

Bijttebier, P., 164

Bilkei-Gorzo, A., 61

Billotti, D., 398

Bimson, W. E., 223

Birbaumer, N., 45

Birmingham, W., 204

Birnbaum, G. E., 244, 245

Bischoff, R., 549

Bishop, S. J., 31, 63, 64, 223,

395

Bishop, S. R., 439, 554

Bisighini, R. M., 433

Bixby, W. R., 230

Björntorp, P., 204, 205, 212

Black, D. S., 576

Black, P. H., 603

Blackburn, T. C., 292

Blackford, J. U., 81

Blackstock, E., 11

Blagov, P. S., 328

Blaine, B., 603, 605

Blair, C., 160, 163, 176

Blair, C. B., 161

Blair, K. S., 61, 84

Blanchard, D. C., 96

Blanchard, F. A., 116

Blanchard, R. J., 96

Blanchard-Fields, F., 195, 208,

210, 211, 213

Blankenburg, F., 104

Blascovich, J., 223, 367, 589

Blase, S. L., 486

Blechert, J., 49, 128, 129, 130,

131

Bleckley, M. K., 354

Blehar, M. C., 226, 237, 273,

277

Bliss-Moreau, E., 27, 450, 452

Bloch, L., 6, 267

Bloch, R. T., 557

Block, J., 119, 159, 308, 310, 321

Block, J. H., 159, 321

Blom, J. D., 69

Bluck, S., 207

Blumenthal, J. A., 588

Bocknek, E., 114

Bockstaele, V., 522

Bockting, C. L. H., 529, 535

Boden, M. T., 405

Bodenhausen, G. V., 255, 256,

257, 377

Boehm, J. K., 597, 602, 603, 605

Bogdan, R., 473, 474, 529

Boggio, P. S., 355

Bohlmeijer, E., 548

Böhm, G., 142

Bohner, G., 252

Bohus, M., 14, 491, 495, 530,

561

Boiger, M., 289, 292, 294

Bois, K., 379

Boisseau, C. L., 461

Boissy, A. A., 376

Bokhorst, C., 188

Boland, M., 370

Boldt, L. J., 166

Bolger, N., 36

Bolla, K. I., 436

Bomyea, J., 424, 514, 516, 522

Bonanno, G. A., 127, 128, 135,

245, 363, 368, 369, 371, 398,

415, 533, 598

Bond, F. W., 538

Boney-McCoy, S., 276

Bongers, A., 11, 314

Bonini, N., 141, 146, 147, 148,

149, 150

Bonn-Miller, M. O., 405, 433,

533

Bookheimer, S. Y., 82

Booth, R. J., 572, 574

Bora, E., 435, 437

Borkovec, T. D., 84, 379, 401,

403, 469, 470, 474, 475, 484

Born, L., 198

Bornovalova, M. A., 494

632 Author Index

Borras, C., 36, 82

Borsook, D., 36, 82

Bos, M. G., 316

Bossio, L. M., 602

Bösterling, A., 65

Boswell, J. F., 395

Boswell, R. G., 617

Botvinick, M. M., 79, 98, 103,

132, 311, 474

Bourgouin, P., 311

Bousman, C. A., 614

Bouton, M. E., 34, 61, 473, 480,

481

Bowen, S., 439, 440, 561

Bower, G. H., 140

Bower, J. E., 589

Bowie, B. H., 197

Bowlby, J., 3, 226, 228, 237,

238, 239, 240, 241, 246, 272,

273

Boyce, W. T., 167, 586, 587, 605

Boyd, R., 222, 571

Bradfield, E., Jr., 243

Bradizza, C. M., 433

Bradley, B. P., 309, 395, 422,

474, 478, 510

Bradley, M. M., 5, 44, 45, 46, 47,

132, 270, 310, 450

Braeckman, J., 384

Brame, B., 605

Brammer, M. J., 66, 120

Brandtstaedter, J., 368, 369

Branigan, C., 386, 552

Brasil-Neto, J. P., 70

Bratslavsky, E., 616, 618, 623

Brault, M., 278

Braungart-Rieker, J. M., 161,

165

Braveman, P. A., 586

Braver, T. S., 98, 189, 230, 311,

474

Bray, G. A., 497

Brazelton, T. B., 277

Brefczynski-Lewis, J. A., 458,

557

Brennan, K. A., 238, 243, 276

Brett, M., 63, 223, 395

Brewer, A. A., 449

Brewer, J. A., 439, 440, 557

Brewer, L. E., 622

Brewer, M. B., 222, 256, 622

Brewin, C. R., 353, 355

Bricker, J. B., 440

Bridges, L. J., 161

Bridle, R., 515

Brill, N. Q., 575

Briner, R. B., 6

Briñol, P., 253, 258, 259

Britton, J., 46

Broderick, J. E., 205

Brody, A. L., 435

Bromley, A., 556

Brooks, D., 111

Brooks, J. C. W., 223

Brophy-Herb, H. E., 114

Brosan, L., 523

Brosschot, J. F., 589

Brotman, D. J., 588

Brower, K. J., 496

Brown, C. M., 378

Brown, J. R., 182

Brown, K. W., 548, 552, 557

Brown, L. L., 273

Brown, M. Z., 495

Brown, S. B. R. E., 53

Brown, S. M., 395

Brown, S. P., 222

Brown, T. A., 370, 396, 397,

401, 417, 469, 473, 498, 533,

551

Browning, M., 511

Bruce, G., 351

Bruner, J., 284

Brunstein, J. C., 371

Bryant, D., 166

Bryant, F. B., 378

Bryson, S. E., 161

Bublatzky, F., 45

Büchel, C., 94, 101, 104, 105

Buchheld, N., 552

Buck, R. W., 5, 6, 574

Buckley, M., 188

Buckner, J. D., 517

Buckner, R. L., 104, 450, 457

Bucks, R. S., 511

Buell, M. M., 614

Buhle, J. T., 28, 29

Buhrmester, M. D., 381

Buis, T., 553

Buka, S. L., 601, 603, 607

Bukay, E., 49

Bukowski, W. M., 395

Bulik, C. M., 353

Bulka, D., 194

Bull, R., 213

Bullis, J. R., 396

Bullmore, E., 97

Bullock, B. M., 192

Bunde, J., 596, 597, 602

Bunge, S. A., 83, 120, 144, 189,

229, 244, 262, 288, 311, 361,

366, 398, 472, 556

Burgess, N., 104

Burgess, P. W., 97

Burghy, C. A., 68

Burgos, A. I., 500

Buring, J. E., 589

Burkley, M. A., 253

Burmeister, M., 67

Burnette, J. L., 243, 244

Burney, R., 559

Burns, B. M., 311

Burns, L. R., 355

Burns, M., 516

Burnstein, E., 263

Burrows, C. L., 46

Burton, C., 368, 371

Burton, R., 163

Bush, G., 311

Bush, N. R., 162, 167

Bushman, B., 615

Buss, K., 178

Busschbach, J. J., 494

Butler, A. C., 469

Butler, E. A., 11, 33, 275, 277,

278, 295, 579, 600

Butler, T., 82

Butner, J., 276

Buttenmuller, V., 552

Buttermore, N. E., 376, 379

Buunk, B. P., 382

Buysse, A., 243

Cabeza, R., 71, 204, 207

Cacioppo, J. T., 227, 259, 274,

308, 575, 579

Cadet, J. L., 436

Cafferty, T. P., 244

Cahill, S. P., 377

Cairns, D. R., 615

Calhoun, P. S., 601

Calkins, S. D., 176, 178, 188,

190, 191, 309, 597, 604

Call, J., 223

Calu, D., 429

Camerer, C. F., 23, 35, 93, 98,

141, 146, 472

Campbell, L., 511

Campbell Teskey, G., 616

Author Index 633

Campbell-Sills, L., 14, 62, 134,

135, 370, 393, 397, 398, 399,

400, 401, 417, 424, 473, 484

Campo, P., 460

Campos, J. J., 12, 84, 267, 268,

271, 275, 293, 306

Camprodon, J. A., 27, 355

Camras, L., 12, 84

Cancedda, L., 228

Canli, T., 84, 400, 496

Cannon, D. S., 617

Cannon, W. B., 588

Cantor, N., 361

Capitanio, J. P., 575

Caplovitz, B. K., 306

Caporeal, L. R., 222

Caraco, T., 225

Carelli, M. G., 190

Carey, S., 452

Carl, J. R., 396

Carlbring, P., 517

Carlson, E. A., 273

Carlson, G.., 316

Carlson, L. E., 548, 552

Carlson, S. M., 119, 163

Carmichael, S. T., 537

Carmona, P. E., 557

Carnelley, K. B., 243

Carpenter, M., 223

Carrere, S., 272

Carroll, K. M., 433, 434, 436,

438, 439

Carstensen, L. L., 13, 203, 204,

205, 206, 207, 208, 209, 210,

213, 214, 270, 272, 274, 275,

278, 366

Carter, B. L., 351

Carter, C. S., 35, 79, 97, 98, 311,

474

Carter S. R., 519

Carthy, T., 399, 400

Carulli-Rabinowitz, V., 177

Caruso, D. R., 323, 338

Carver, C. S., 159, 251, 321, 323,

328, 330, 331, 332, 334, 340,

349, 350, 361, 362, 364, 366,

369, 377, 378, 471, 613, 615,

618, 622

Casey, B. J., 68, 105, 111, 120,

121, 167, 189, 190, 431

Caspar, F., 535

Caspi, A., 67, 119, 178, 271, 306,

395, 605

Cassano, M. C., 181, 188, 604

Cassidy, J., 173, 182, 226, 238,

240, 244

Catanese, K. R., 621

Catanzaro, S. J., 323, 333, 533

Cato, M. A., 27

Catran, E., 11, 127, 230, 420

Cavanagh, K., 524

Chabris, C. F., 224

Chaiken, S., 93, 252

Chajut, E., 132

Chambers, C. T., 165

Chambers, R., 352

Chang, C.-H., 476

Chang, F., 311

Chang, L. J., 141, 142, 435

Chang, M., 575

Chapman, A. L., 495, 499

Chapman, D., 205

Chapman, J. E., 469

Chappell, K. D., 244

Charles, S. T., 13, 203, 204, 205,

206, 207, 208, 209, 210, 211,

212, 213, 274, 366

Chartier, M., 560

Chartrand, É., 278

Chase, H. W., 434

Chaskalson, M., 550

Chasserot-Golaz, S., 575

Chatterjee, N., 227

Chaturvedi, A., 460

Chatzisarantis, N. L. D., 618

Chawla, N., 439

Chen, E., 572, 575, 577, 586,

587, 589, 590, 591, 592, 598,

600, 606, 608

Chen, K. H., 46

Cheng, C., 368

Cheng, J. Y., 589

Cherek, D. R., 119

Chesney, M. A., 586

Cheung, R. Y. M., 295

Chew, C. H., 574

Chiao, J. Y., 396

Chida, Y., 599, 602, 603

Chiesa, A., 558, 559

Childress, A. R., 430, 433, 614,

620

Chirkov, V., 288

Chiu, W. T., 530

Choate, M. L., 496

Choi, K. S., 460

Chorpita, B. F., 401

Christ, O., 535

Christakou, A., 120

Christenfeld, N., 588

Christensen, A., 270

Christensen, H., 608

Christensen, T. C., 533

Christenson, G. A., 620

Christianson, R., 351

Chugani, H. T., 228

Ciarocco, N. J., 615

Ciarrochi, J., 190

Cicchetti, D., 178

Ciesielski, B. R. G., 133

Cirulli, F., 494

Cisler, J. M., 63, 470, 496, 510

Clark, C. L., 238, 276

Clark, D. A., 395

Clark, L., 431

Clark, M. S., 140

Clarke, R. J., 61, 62

Clasen, P. C., 474, 478

Claudio, V., 422

Claxton, L. J., 163

Clifton, J., 556

Cloak, C., 435

Clore, G. L., 23, 222, 223, 230,

363, 454, 473, 476, 622

Clyburn, A., 115

Coan, J. A., 13, 221, 222, 223,

224, 225, 226, 227, 228, 229,

230, 272, 274, 277, 278

Coats, A. H., 195

Codispoti, M., 45, 46, 132, 310,

450

Coffino, B., 273

Cohen, D., 285

Cohen, H., 599

Cohen, J., 474

Cohen, J. B., 193

Cohen, J. D., 30, 35, 79, 85, 93,

94, 97, 98, 103, 112, 141, 145,

148, 311, 435

Cohen, J. R., 119, 120

Cohen, L., 575

Cohen, N., 400

Cohen, S., 221, 224, 571, 587,

603

Coifman, K., 128, 368, 398, 415,

533

Cole, P. M., 6, 84, 175, 273, 275,

291

Cole, S. W., 190, 571, 572, 573,

574, 575, 576, 577, 578, 579

Coles, M. G., 79, 103

Collado-Hidalgo, A., 576

Collins, A., 23

634 Author Index

Collins, R. L., 382, 618

Collins, W. A., 273

Colombo, J. A., 230

Colvin, P., 352

Compas, B. E., 159, 194, 195

Compton, R. J., 189

Comtois, K. A., 538

Connally, E., 209

Connell, J. P., 161

Conner, O. L., 227

Conner, T., 13

Connolly, C. I., 96

Connolly, T., 386

Connor-Smith, J. K., 159

Conover, K., 96

Conraads, V. M., 571

Conrad, A., 536

Conrey, F. R., 260

Conroy, M., 294

Consedine, N. S., 206, 214, 598,

599, 604

Contreras, J. M., 183

Conway, A. R. A., 354

Cook, C. L., 367, 589

Cook, N. R., 589

Cools, J., 117

Cooney, N. L., 430

Cooney, R. E., 66

Cooper, J. C., 31

Cooper, V., 599

Corbetta, M., 148, 556

Corbin, W., 429

Corcoran, K. A., 34

Cordovil de Sousa Uva, M., 433

Corkin, S., 209

Corr, P. J., 384

Corson, H., 58

Cortina, K. S., 180

Cosmides, L., 491, 538

Costa, P. T., Jr., 571

Côté, S., 271, 338

Covert, M. V., 377

Cowan, C. P., 267, 274

Cowan, P. A., 267, 274

Cowan, R. L., 81

Cox, R. H., 497, 498

Cox, W. M., 52, 351, 523

Coy, K. C., 161, 165

Cozzarelli, C., 241, 242

Craig, A. D., 27, 28, 478

Crandall, C. S., 251

Crane, C., 562

Craske, M. G., 399, 470, 480,

483, 484, 551

Crauthers, D. M., 430

Creswell, J. D., 548, 575, 576

Crişan, L. G., 143

Crisp, V. W., 179

Critchley, H. D., 27, 28, 314

Crits-Christoph, P., 433, 539

Crockenberg, S. C., 161, 309

Crockett, M. J., 11, 396, 537

Crombez, G., 353, 395, 522

Crone, E. A., 61

Croog, S., 589

Crowell, S. E., 229, 491, 494

Cruess, D. G., 589

Csikszentmihalyi, M., 276

Cubbin, C., 586

Cuijpers, P., 469, 535, 548

Cullen, M. R., 603

Culver, C., 114

Cumberland, A., 179

Cumming, G. F., 614

Cummings, E. M., 178, 179

Cunningham, W. A., 23, 27, 251,

252, 260, 261, 262, 454

Curthbert, B. N., 450

Custers, R., 362, 366, 367, 450

Cuthbert, B. N., 44, 45, 132, 310

Cutrona, C. E., 227

Dadhkah, A., 296

Dahl, A., 267

Dahl, R. E., 188, 189, 190, 475

Dakof, G. A., 382

Dale, R., 259

Dalgleish, T., 141, 398, 401, 422,

424

Damasio, A. R., 101, 102, 141,

143, 536

Damasio, H., 28, 101, 141, 143

Dandeneau, S. D., 511, 512, 513,

515, 521

D’Andrade, R. G., 284, 289

Danesh, D., 600, 601, 603

Danesh, J., 589

D’Angelo, M., 522

Dan-Glauser, E. S., 7, 574

Dankwa-Mullan, I., 586

Dapretto, M., 432

Darley, J. M., 98

Darwin, C., 571, 579

Daselaar, S. M., 204

Daskalakis, Z. J., 64, 68

Daubman, K. A., 140

Daughters, S. B., 433

Daumann, J., 435, 437

Davachi, L., 27

D’Avanzato, C., 418

David, D., 383

Davidson, B. J., 63

Davidson, K. W., 588

Davidson, M. L., 33, 52, 62, 83,

403

Davidson, R. E., 574

Davidson, R. J., 5, 29, 52, 59, 61,

63, 66, 177, 208, 223, 263,

274, 398, 458, 474, 491, 493,

552, 556, 557, 574

Davies, N. B., 221

Davies, P. T., 178, 179

Daviglus, M. L., 607

Davis, B., 191

Davis, D. E., 243, 245

Davis, J. I., 27, 31

Davis, K. E., 244

Davis, L. S., 225

Davis, M., 60, 63, 471

Davis, S. W., 190, 204

Davis, T., 70

Dawe, S., 93

Dayan, P., 34, 96

de Beurs, E., 497

de Bono, J., 510

De Cesarei, A., 46

de Groot, A. D., 134

De Houwer, J., 77, 243, 254,

256, 353, 522

De Leersnyder, J., 9, 189, 284,

287, 293, 294

De Leonardis, D. M., 207

De Martino, B., 35

De Raedt, R., 422, 424, 518

de Ridder, D. T. D., 332,

349–350

de Rover, M., 46, 53

de Villers-Sidani, E., 86

Deater-Deckard, K., 307

Deaton, A., 205

DeBoer, D. D., 225

Deci, E. L., 361, 369

Decicco, J. M., 52

DeClaire, J., 531

DeCoster, J., 263

Dedert, E. A., 601, 602

Dedovic, K., 223

DeFronzo Dobkin, R., 383

Degnan, K. A., 509

Dekker, M. C., 605

Del Giorno, J. M., 230

Deldin, P., 556

Author Index 635

DeLeone, C. M., 435, 436

Delgado, M. R., 26, 31, 34, 35,

61, 62, 66, 78, 80, 81, 85, 96,

144, 145, 146, 148, 149, 472,

473

Delvaux, E., 284, 295

Demaree, H. A., 11, 189, 354,

574

DeMarree, K. G., 259

Demetrovics, Z., 433

Demler, O., 469, 530

Denham, S. A., 163, 181, 275

Dennis, N. A., 204

Dennis, T. A., 6, 46, 52, 84, 175

Denny, B. T., 27

Denollet, J., 571

Denson, T. F., 599

Derakshan, N., 520

Deroche, V., 616

Derryberry, D., 115, 159, 160,

306, 307, 308, 309, 509

Desimone, R., 28

Désiré, L. L., 376

D’Esposito, M., 472, 477

DeSteno, D. A., 386

Deutsch, R., 257, 262, 263, 352,

353

Devine, P. G., 255

DeVito, E. E., 436, 439

DeVoe, M., 194

DeWall, C. N., 367, 615, 622

Dewar, K. M., 454

Dewitte, M., 243

Dewitte, S., 99

Dhawan, N., 293

di Pellegrino, G., 80, 142

Di Sclafani, V., 435

Di Simplicio, M., 401

Di Tella, C., 49, 129

Diamond, A., 161, 167, 315

Diamond, L. M., 242, 244, 276,

291

Dichiara, G., 437

Dickerson, S. S., 384, 600

Diderholm, E., 589

Dien, J., 44

Diener, E., 205, 285, 286, 363

Diener, M. L., 161, 165

Dietrich, A., 230

Dijksterhuis, A., 80, 366, 618

Dillon, D. G., 129

Dingemans, A. E., 529

Dishion, T. J., 164, 192

Distel, M. A., 494, 495

Ditzen, B., 242

Djebali, S., 572

Dobkin, P. L., 559, 562

Dobson, K. S., 537, 558

Dobzhansky, T., 472

Dodson, J. D., 270

Dolan, R. J., 28, 35, 101, 499,

537

Dolcos, F., 207

Dolev, T., 245

Dollard, J., 471

Donahue, O. M., 497

Donchin, E., 79, 103

Donelan-McCall, N., 182

Donzella, B., 315

Dorris, M., 146

Doss, B. D., 274

Dougherty, D. M., 119

Douglas, H., 561

Douilliez, C., 499

Dovidio, J. F., 255

Downey, G., 118

Downs, D. L., 381

Doyle, W. J., 571, 587

Dozois, D. A., 476, 496

Dozois, D. J., 552

Drabant, E. M., 11, 81, 395

Dragone, D., 142

Drake, R. M., 28

Drevets, W. C., 23, 64, 311

Driver, J., 537

Drobes, D. J., 614, 623

Duarte, C. S., 606

Duchesne, S., 229

Duckworth, A. L., 531

Duclos, S. E., 499

Dudley, A., 195

Dugas, M. J., 395, 475

Duka, T., 351

Dum, R. P., 28

Dumas, J. E., 275

Dunbar, K., 97

Duncan, J., 28, 63, 97, 141, 223,

395

Dundin, L., 499

Dunn, B. D., 398, 401

Dunn, E. W., 198, 259

Dunn, G., 384

Dunne, J. D., 182, 552

Dunning, J. P., 43, 46, 47, 48,

52, 129, 574

Dunton, B. C., 253

Durant, S. M., 226

Durazzo, T. C., 435

Durso, G. R. O., 258

Durston, S., 68

Dutra, L., 438

Duval, S., 377

Dvorak, R. D., 99

Dweck, C. S., 105

Dyer, A. R., 607

Dyson, M. W., 316

D’Zurilla, T. J., 497, 531, 540

Eagly, A. H., 252

Earle, T. L., 588

Eastin, M., 614

Eaton, K. L., 179

Ebbesen, E. B., 114, 616

Eberl, C., 353

Ebert, D., 535, 543

Ebmeier, K. P., 69

Ebner-Priemer, U. W., 495

Ebstein, R. P., 229

Ebsworthy, G., 511

Eccles, J. S., 188

Eccleston, C., 522

Eckhardt, C. I., 351

Eddy, K. T., 83, 145

Edelman, G. M., 450

Edge, M. D., 399

Edwards, E. P., 113

Edwards, G., 98

Eftekhari, A., 399

Egerter, S., 586

Eggert, L. D., 243

Eggum, N. D., 158, 164

Egner, T., 31, 61, 78, 79, 80, 81,

316

Ehlert, U., 227

Ehrenberg, M. F., 225

Ehrenreich, J. T., 461

Ehrenthal, J. C., 245

Ehring, T., 65, 83, 127, 396, 399,

418, 419, 420

Ehrlich, A. H., 230

Ehrlich, I., 81

Ehrlich, P. R., 230

Ehrman, R., 433

Eickhoff, S. B., 27, 434

Eid, M., 285, 286, 363

Eidelman, P., 416

Eiden, R. D., 113

Eifert, G. H., 397, 398, 401,

403

Eigsti, I., 111

Eimer, M., 47

Eippert, F., 145

636 Author Index

Eisenberg, N., 114, 115, 119,

157, 158, 159, 160, 161, 162,

163, 164, 165, 166, 168, 179,

181, 313, 603

Eisenberger, N. I., 82, 227, 228,

240

Eisendrath, S., 560

Eiser, J. R., 253

Ekman, P., 294, 325, 491

El Sheikh, M., 589

Eldar, S., 511, 518, 519

Eldreth, D. A., 436

Elgar, M. A., 224

Ellard, K. K., 14, 62, 393, 395,

396, 403, 406, 461, 475

Ellenbogen, M. A., 498

Elliott, A., 288

Elliott, R., 475, 477, 478, 482

Ellis, A. J., 474

Ellis, L. K., 305, 312

Ellsworth, P. C., 5, 291, 292,

363, 383

El-Sheikh, M., 176

Ely, R. J., 116

Ely, T. D., 24, 96

Emery, G., 414, 477, 499

Emery, L., 208

Emery, R. E., 244

Emmons, R. A., 380

Emslie, H., 141

Endler, N. S., 329

Eng, J. S., 14, 192, 321, 325,

326, 343, 399

Engell, A. D., 98

Engle, R. W., 354, 355, 450

English, T. E., 11, 209, 325, 327,

331, 335, 340, 341, 579

Epel, E. S., 589, 600

Epstein, D. H., 429, 433

Epstein, J., 66

Epstein, N. B., 383

Epstein, W., 222

Erath, S. A., 176

Erber, R., 132, 192, 378, 617,

618

Ericson, K. M., 35, 94

Erikson, E. E., 188

Erikson, E. H., 274

Erikson, J., 274

Erk, S., 11, 61, 65, 66, 82, 145

Ernst, T., 435

Ersche, K. D., 437

Erskine, J. A. K., 353

Ersner-Hershfield, H., 274

Erthal, F., 61

Eshleman, A., 251

Eslinger, P. J., 102

Essex, M. J., 164

Esteves, F., 554

Estrada, M. J., 379

Etkin, A., 7, 31, 59, 61, 63, 64,

76, 78, 80, 81, 268, 288, 316,

352, 366, 403, 473, 474, 484,

496, 532, 537, 574

Evans, D., 310

Evans, E. M., 552

Evans, J. St. B. T., 141

Evans, K., 384

Everitt, B. J., 31, 434

Evers, C., 257, 366

Evershed, S., 500

Everson-Rose, S. A., 588, 589,

602

Eves, F., 81

Faber, R. J., 620

Fabes, R. A., 114, 161, 165, 179,

181, 313

Fadardi, J. S., 351, 523

Fahey, J. L., 574, 575, 589

Fair, D. A., 311

Fairburn, C., 483

Fairholme, C. P., 461

Falk, E. B., 436

Fan, J., 312, 495

Fan, M., 315

Fang, A., 529

Farabaugh, A. H., 469

Farach, F. J., 396

Farb, N. A. S., 14, 352, 476, 530,

531, 537, 538, 548, 556, 557,

559

Farchione, T. J., 395, 406

Fava, M., 500

Fazio, R. H., 252, 253, 254, 255,

256, 260, 262

Fearnow, M. D., 182

Feeney, J. A., 245, 271

Fehr, E., 35, 148

Fein, G., 435

Fein, S., 620

Feinberg, M., 11, 341

Feinstein, J. S., 309

Feldman, G. C., 416, 551, 555

Feldman, R., 178

Feldman, S. I., 118, 361

Feldman-Barrett, L., 533

Feldner, M. T., 401, 496, 533

Feldon, J., 494

Fendrich, M., 114

Fenigstein, A., 618

Fera, F., 67, 121, 537

Ferdinand, R. F., 164

Ferguson, M. F., 361, 362, 364,

365, 366

Ferguson, M. J., 259

Fernald, A., 269

Ferrari, V., 45, 46

Ferrer, E., 276

Ferri, J., 46, 48, 50, 53

Ferry, A. T., 27, 460

Ferster, C. B., 474, 477, 480, 481

Ferstl, E. C., 27

Festinger, L., 256

Feuerstein, R., 212

Fiebach, C. J., 394

Field, M., 52, 351

Field, N. P., 245, 378

Figner, B., 35, 93, 94, 100, 104

Filkowski, M. M., 460

Finch, C. E., 571, 572, 576

Fine, I., 449

Fine, S. E., 163

Finkel, E. J., 230, 244, 351

Finkenauer, C., 623

Finucane, M. L., 141

Fiore, M. C., 432, 620

Fischer, A., 542

Fischer, E. F., 273

Fischer, S., 65, 83, 127, 418

Fischman, M. W., 429

Fishbach, A., 353, 361, 362, 364,

365, 366, 367, 623

Fisher, A. J., 469

Fisher, E. B., Jr., 590

Fisher, H. E., 273

Fisher, M., 86

Fisher, P., 81, 159, 310

Fisher, R. R., 349

Fissell, K., 79

Fitzgerald, D. A., 96

Fitzgerald, H. E., 496

Fitzgerald, P. B., 64, 68

Fitzsimons, G. M., 230

Flaisch, T., 45

Flanagan, T. J., 396

Fleck, M. S., 204

Fletcher, K., 98

Floerke, V. A., 370

Flombaum, J. I., 312

Flood, M. F., 178

Flor, H., 81

Author Index 637

Florian, V., 229, 241, 242, 244

Florsheim, P., 352

Flykt, A., 554

Flynn, E., 163

Foa, E. B., 134, 377, 530

Focquaert, F., 384

Fok, A. K., 575

Folkman, S., 194, 321, 323, 328,

329, 330, 579, 586

Føllesdal, H., 339

Folsom, A. R., 596

Foltin, R. W., 429

Fong, G. W., 95

Forbes, E. E., 475

Ford, B. Q., 193, 365, 366, 369,

370, 371

Forgas, J. P., 140

Forman, E. M., 179, 352, 469

Forman, H., 189

Förster, G., 348

Forster, J., 478

Forsyth, D. R., 243

Forsyth, J. P., 370, 496

Foster, M. T., 620

Foti, D., 43, 44, 45, 46, 47, 48,

50, 51, 129, 574

Fountain, S., 68

Fourkas, A. D., 497

Fowler, J. S., 434

Fox, E., 522

Fox, H. C., 432, 614

Fox, N. A., 159, 308, 509, 521

Fox, P. T., 27

Fox Keller, E., 580

Fraley, R. C., 229, 238, 245

Francart, B., 499

Franceschini, M. A., 228

Francis, S., 227

Franconeri, S. L., 396

Frank, D., 45

Frankel, C. B., 12, 84

Franken, I. H. A., 52, 53, 347,

354, 434, 495

Frankenburg, F. R., 495

Frankenhaeuser, M., 576

Frankenstein, U. N., 33

Frankforter, T. L., 433

Franklin, S., 350

Franklin, T. R., 435

Franks, M. M., 225

Frattaroli, J., 572, 599

Frazier, P., 229

Frederick, S., 98, 106

Fredrickson, B. L., 117, 275, 363,

386, 552, 553

Freedman, B., 548, 552

Freeman, J. B., 259

Freeman, P., 223

Freer, C., 141

Frenn, K., 188

Fresco, D. M., 14, 396, 406, 469,

470, 473, 475, 479, 483, 484,

496, 529, 530, 553

Freud, A., 366, 367

Freud, S., 3

Freund, A. M., 208, 209

Frewen, P. A., 496, 552, 555

Friedel, E., 67

Friederich, H. C., 245

Friedlmeier, W., 294

Friedman, B. H., 401

Friedman, L. A., 589

Friedman, R. S., 353, 367, 478

Friese, M., 347, 348, 352, 354

Friesen, W. V., 294

Frijda, N. H., 4, 58, 77, 284,

288, 292, 295, 296, 298, 363,

365, 377

Friston, K., 224

Frith, C. D., 28

Frodl, T., 68

Fromme, K., 429

Fromson, P. M., 378

Frost, R. O., 116, 117

Fruzzetti, A. E., 500

Fry, A. F., 98, 111

Fu, L., 436

Fucito, L. M., 433

Fujita, K., 105, 252, 352

Fulton, P. R., 560

Funder, D. C., 119

Fung, H. H., 204, 285, 286,291,

363

Furedy, J. J., 498

Furth, E. F., 529

Fusi, S., 448, 456

Fuster, J. M., 230

Gable, P. A., 117, 362

Gable, S. L., 226, 228, 273

Gabrieli, J. D. E., 31, 83, 120,

145, 311, 398, 472, 556

Gagnon, K. T., 223

Gaines, S. O., Jr., 243

Gale, S., 78

Gallagher, H. L., 28

Gallagher, M., 26, 27

Gallistel, C. R., 96

Gallo, L. C., 587

Galloway, G. P., 433

Gallup, G. G., Jr., 384

Galobardes, B., 587

Galvan, A., 121, 189

Gamble, S. A., 433

Gao, W., 204, 311

Garavan, H., 436

Garbutt, L. D., 603

Gard, D., 556

Gardner, C. O., 469

Gardner, W. L., 259, 288, 622

Garland, E. L., 553

Garlow, S. J., 460

Garnefski, N., 127, 195, 323,

331, 332, 368, 416, 417

Garner, M., 395

Garner, P. W., 114, 115

Garon, N., 161, 166

Garvin, E., 363

Gaschke, Y. N., 334

Gasper, K., 363

Gatchalian, K. M., 98

Gatenby, J. C., 95

Gatz, M., 205, 469

Gaunt, R., 93

Gaviria, A. M., 494

Gawronski, B., 253, 255, 256,

257, 262

Gaylord, S. A., 553

Gazzola, V., 227

Gearing-Small, M., 225

Gekoski, M., 177

Gelenberg, A. J., 559

Gelernter, J., 395

Gelfand, L., 552

Gellaitry, G., 599

Gendron, M., 451

Gentzler, A. L., 183

George, M. S., 69

Ger, G., 346

Gerardi-Caulton, G., 311, 312

Gerin, W., 588, 589

Germer, C. K., 560

Gerstorf, D., 212, 213

Getz, S., 189

Ghahremani, D. G., 436

Ghashghaei, H. T., 61

Gianaros, P. J., 27

Gianino, A., 178

Gianotti, L. R., 35

Gibb, B. E., 530

Gibbons, M. B. C., 539

Gidron, Y., 571

638 Author Index

Giedd, J. N., 432

Giesler, R. B., 382

Gilbert, D. G., 430

Gilbert, D. T., 35, 93, 129, 130,

131, 259, 379, 380

Gilbert, P., 480, 530, 534, 538

Gillath, O., 229, 239, 243, 244

Gilligan, C., 119

Gillihan, S. J., 67

Gilliom, M., 181, 182

Gillis, M. M., 35, 66, 145, 472

Gilman, S. E., 601

Gilovich, T., 380

Giordano, L. A., 99

Giorgetta, C., 141, 146, 147, 148,

149, 150

Glaser, R., 575, 589, 603

Glickman, S., 518

Glimcher, P. W., 25, 85, 94, 104,

227

Glover, G., 145

Gnys, M., 430

Goeke-Morey, M. C., 179

Goeleven, E., 422

Gohar, D., 376

Gohm, C. L., 473, 476

Goldberg, R. F., 28

Golden, S. H., 182, 588

Goldin, P. R., 11, 14, 33, 83, 84,

397, 398, 400, 402, 403, 406,

496, 551, 557

Goldman, R., 475

Goldman, S. L., 589

Goldsmith, D., 285

Goldsmith, H. H., 177, 306

Goldstein, C. R., 394

Goldstein, M., 316

Goldstein, R. Z., 51, 230, 433,

434

Goldstone, R. L., 453

Goldwyn, R., 276

Golland, P., 452

Golland, Y., 452

Gollwitzer, P. M., 255, 361, 366,

367, 377

Golub, S. A., 380

Gonzaga, G. C., 226, 273

Goodkind, M. S., 269, 277, 400

Goodman, D. F., 449

Goodman, E., 587

Goodman, M., 175, 177, 508

Goodwin, G. M., 511

Goodwin, R. D., 178, 606

Goolkasian, G. A., 116

Goolkasian, P., 551

Gordijn, E. H., 618

Gordon, J. R., 560, 614

Gordon, N. S., 551

Gore, J. C., 95

Goren, D., 208

Gorman, J. M., 31

Gormley, B., 241

Gotlib, I. H., 66, 134, 378, 416,

417, 418, 419, 422, 423, 431,

475, 553

Gottman, J. M., 179, 180, 181,

206, 270, 271, 272, 274, 277,

278, 279, 531

Gottman, J. S., 272, 279

Gottschalk, J.-M., 542

Goubert, L., 243

Gouzoulis-Mayfrank, E., 437

Graff, J., 270

Graham, B. M., 14, 81, 351, 508,

522

Graham, L., 560

Granqvist, P., 239

Grässman, R., 371

Grasso, D. J., 45

Gratton, G., 79, 103

Gratz, K. L., 275, 323, 333, 337,

338, 495

Grawe, K., 530, 531, 537, 538

Gray, J. A., 307, 308, 354, 471,

537

Gray, J. R., 115, 189, 367

Gray, M. A., 27, 28

Graybiel, A. M., 96

Gray-McGuire, C., 589

Graziano, W. G., 314

Greco, C. M., 556

Grecucci, A., 140, 141, 142, 146,

147, 148, 149, 150, 190

Green, J. D., 243

Green, L., 98, 111

Green, M. J., 418

Greenbaum, C. W., 178

Greenberg, L. S., 475, 530, 534,

539

Greene, J. D., 98

Greenland, P., 607

Greenwald, A. G., 253, 254, 366

Greenwald, M. K., 270

Greenwood, G., 533

Greeson, J., 551

Grégoire, J., 121

Greicius, M. D., 403

Greischar, L. L., 458, 556

Greiveldinger, L. L., 376

Grich Stevens, J., 229

Griffin, K. M., 350

Griggs, C., 188

Grisham, J. R., 384, 599

Grolnick, W. S., 161

Groom, C., 510

Gross, J. J., 3, 4, 5, 6, 7, 8, 9, 10,

11, 12, 13, 14, 15, 23, 24, 28,

30, 31, 33, 43, 45, 47, 48, 49,

58, 59, 60, 65, 76, 77, 78, 83,

84, 94, 105, 106, 118, 120,

121, 127, 128, 129, 130, 131,

133, 134, 136, 142, 145, 146,

157, 158, 187, 189, 194, 195,

196, 210, 252, 257, 268, 269,

270, 271, 274, 275, 276, 277,

287, 288, 290, 295, 311, 314,

321, 322, 323, 324, 325, 326,

327, 328, 329, 330, 334, 335,

337, 341, 350, 351, 354, 361,

365, 366, 367, 368, 382, 394,

395, 397, 398, 399, 400, 405,

415, 416, 417, 418, 420, 423,

432, 434, 441, 447, 451, 456,

457, 472, 474, 475, 476, 477,

480, 492, 496, 508, 510, 520,

529, 531, 533, 537, 549, 550,

551, 556, 557, 571, 574, 579,

587, 588, 589, 591, 597, 599,

600, 601, 603, 604, 613, 614

Gross, R. E., 460

Grossman, P., 539, 548, 555, 559

Grossmann, I., 291

Gruber, J., 84, 127, 341, 370,

414, 416, 417, 420

Gruenewald, T. L., 591

Grühn, D., 205, 206, 209, 213,

214

Grunewald, T. L., 384

Grunhaus, L., 355

Gruzelier, J., 81

Gschwendner, T., 253, 352

Guest, D. E., 384

Guh, D. P., 589

Gujar, N., 492, 497

Gullone, E., 189, 195, 322, 323,

328

Günaydin, G., 240

Gunderson, J. G., 495

Gunnar, M. R., 176, 178, 188,

315

Gupta, S., 128

Gurwitz, V., 239

Guth, W., 146

Guthrie, I. K., 161, 165

Gutiérrez-Zotes, J. A., 494

Author Index 639

Gwaltney, J. M., 571

Gyurak, A., 7, 59, 76, 78, 268,

269, 271, 276, 277, 288, 352,

366, 400, 532, 537, 574

Haaga, D. A. F., 383

Haase, C. M., 6, 267

Häcker, F., 45

Hackett, M. L., 497

Haedt-Matt, A. A., 614, 621

Hagan, R., 395

Hagemann, T., 277

Haggard, P., 403

Hagger, M. S., 618

Hagtvet, K. A., 339

Haidt, J., 76, 363

Hajcak, G., 10, 44, 45, 46, 47,

48, 49, 50, 51, 52, 53, 129,

130

Hakamata, Y., 520

Hakimi, S., 83, 400, 496

Hakkaart-van Roijen, L., 494

Halberstadt, A. G., 179

Hale, C. R., 451

Halford, G. S., 230

Hall, E. E., 230

Hallion, L. S., 421, 519, 520

Halperin, E., 14, 15

Hamann, S. B., 11, 24,66, 96,

225

Hamby, S. H., 276

Hamer, M., 242, 599, 603

Hammond, G., 421

Hampshire, A., 424

Hamre, B. K., 163

Han, H. A., 105, 352

Hancock, J., 480, 557

Hänel, M., 274

Haney, M., 429, 432

Hanke, M. L., 576

Hannon, P. A., 244

Hansenne, M., 8

Harber, K. D., 224

Hardaway, C. R., 164

Hardin, C. D., 255

Hare, T. A., 35, 79, 81, 85, 93,

94, 100, 101, 104, 121, 167

Harger, J., 589

Hariri, A. R., 67, 82, 100, 120,

121, 395, 537

Harlan, E. T., 119, 161, 309

Harlé, K. M., 141, 148

Harley, R., 500

Harlow, H. F., 229

Harman, C., 306, 308

Harmer, C. J., 512

Harmon-Jones, C., 347, 362, 619

Harmon-Jones, E., 117, 347, 362,

619

Harned, M. S., 492, 494

Harold, G. T., 179

Harris, C. R., 11, 574

Harris, J. D., 165

Harris, P., 599

Harrison, A., 496

Harrison, N. A., 27, 28

Hart, C. L., 52, 429, 433, 435,

437

Hart, D., 378

Hart, S. L., 209

Harter, S., 381

Hartley, C. A., 23, 33

Hartman, C. A., 164

Harvey, A. G., 84, 127, 341, 416,

417, 461

Hasher, L., 422

Hashmi, N., 224

Haslam, N., 461

Hasselmo, K., 224

Hatfield, B. E., 163

Hatzenbuehler, M. L., 188, 404

Haukkala, A., 601

Hauser, M., 27

Hauser, S. T., 192

Havermans, R. C., 353

Havighurst, R. J., 273

Hawkley, L. C., 274, 575, 579

Haydon, K. C., 273

Hayes, A. M., 481, 555

Hayes, J. P., 11

Hayes, S. C., 378, 474, 475, 478,

479, 481, 482, 498, 513, 520,

533, 538, 551, 561

Hazan, C., 240

Hazen, R. A., 516

Hazlett, E. A., 494

Head, J., 241

Heatherton, T. F., 116, 119, 135,

230, 362, 366, 613, 614, 615,

617, 618, 619, 620, 621, 622

Heaven, P. C., 190

Heavin, S., 352

Hebb, D. O., 228

Heckman, J. J., 575

Heekeren, H. R., 104

Heeren, A., 514, 517

Heering, S., 398

Heffner, M., 397, 398, 403

Heilman, R. M., 143, 149, 150

Heim, C., 176

Heimberg, R. G., 84, 396, 400,

469, 473, 496

Heimpel, S. A., 363

Heine, S. J., 285, 286, 289, 621

Heinrichs, M., 227

Heinz, A., 67, 145, 436

Heinz, S. P., 128

Heishman, S. J., 433

Heissler, J., 11, 65, 314

Hektner, J. M., 276

Helfinstein, S. M., 509

Heller, A. S., 66, 263, 496

Hellmuth, J. C., 271

Henik, A., 400

Hennekens, C. H., 589

Henrich, J., 571

Henry, B., 271

Henry, J. D., 206, 210

Henry, J. P., 576

Heppner, W. L., 552

Herbert, C., 45, 257

Herman, C. P., 116, 614, 617,

622

Hermann, A. D., 81, 253

Hermans, D., 353, 424

Hernandez, A., 494

Hernández-López, M., 440

Herpertz, S. C., 494

Herrmann, L. L., 69

Herrmann, M. J., 52

Hershberger, W. A., 97

Hershey, K. L., 159, 165, 308,

310

Hertel, P. T., 422, 512, 521

Herwig, U., 65, 82

Heslenfeld, D. J., 61, 223

Hess, R. D., 294

Hess, T. M., 208, 214

Hester, R., 436

Hickcox, M., 430

Hicklin, D., 227

Hicks, A. M., 242, 244, 276

Higashi, M., 225

Higgins, E. T., 348, 377, 380,

471, 473, 476, 621

Higgins, R. L., 615

Hilgard, J., 45

Hilgetag, C. C., 61

Hill, A. L., 165, 597, 604

Hill, C. L., 398

Hill, K. R., 222

Hillegaart, V., 96

640 Author Index

Hiller, W., 542

Hillyard, S. A., 48

Hilmert, C. J., 228

Hilt, L. M., 383

Hilton, J. L., 253, 256

Hindriks, I., 618

Hinton, D. E., 539

Hinton, P. S., 497

Hiraoka, R., 352

Hirsch, C. R., 513, 520, 521

Hirsch, J., 31, 61, 78, 79, 316

Hirschberger, G., 239

Hirst, M., 616

Hobdy, J., 241

Hoberman, H. M., 221

Hoch, S. J., 99

Hochschild, A. R., 9

Hochschild, J. L., 284, 285

Hoeft, F., 80, 403, 473

Hoek, H. W., 69

Hoeksma, J. B., 189

Hofer, C., 119, 157, 162, 163,

164, 603

Hofer, M. A., 229, 579

Hoffman, J. M., 24, 96

Hofmann, S. G., 11, 370, 395,

397, 398, 417, 520, 535, 529,

539, 548

Hofmann, W., 253, 346, 347,

348, 349, 350, 351, 352, 353,

354, 355, 617, 620

Hofstede, G. H., 295

Hogarth, L., 434

Holaway, R. M., 469, 473

Holdzheimer, P. E., 460

Holker, L., 511

Holland, P. C., 26, 27

Holland, R. W., 353

Holleran, K., 530

Hollerman, J. R., 145

Holley, S. R., 6, 267, 270, 275

Holliday, J. E., 575

Hollon, S. D., 559

Holloway, J., 396

Holmberg, D., 241, 242

Holmes, A., 47, 67

Holmes, E. A., 511

Holmes, J. G., 243

Holt-Lunstad, J., 222

Holtzheimer, P. E., 62, 65, 70

Holzel, B. K., 439, 458, 548,

554

Hommer, D., 95

Hong, K. A., 432, 614

Hong, Y., 291

Honorado, E., 162

Hood, J., 495

Hooley, J. M., 178, 495

Hooven, C., 179, 180

Hopkins, J., 557

Hopp, H., 368

Hoppitt, L., 523

Horesh, N., 241, 399

Horne, R., 599

Horodynski, M. A., 114

Horwitz, R. I., 589

Hosein, V. L., 433

Hoshino-Browne, E., 285

Hosie, J. A., 206, 210

Hot, P., 46

Houben, K., 353

Houck, G. M., 113

House, A. O., 497

Houser, D., 143, 146, 150

Houston, A. I., 221

Hovland, C. I., 253

Howard, A., 255

Howland, M., 229

Howren, M. B., 603

Hrapczynski, K. M., 383

Hsu, S. H., 561

Hu, P., 492

Huang, C., 224

Hubbard, J. A., 180

Huber, O., 13, 27

Hübner, R., 128

Huether, G., 539

Huettel, S. A., 71

Hufford, M. R., 620

Hughes, A. E., 229

Hughes, B. L., 31, 33, 52, 62,

83, 403

Hughes, C. F., 574

Hughes, E. K., 189, 195, 322

Huizenga, H. M., 316

Hull, J. G., 621

Hunter, J. J., 242

Hunter, M. A., 225

Huot, J. R., 209

Hupka, R. B., 500

Huppert, F. A., 205

Huppert, J. D., 377

Hurewitz, A., 589

Hurwitz, B. E., 498

Husarek, S. J., 161

Huss, M., 114

Hutcherson, C. A., 94, 105

Hutchinson, K. A., 500

Huygens, K., 395

Hyman, S. E., 145

Ikeda, A., 603

Ikemoto, S., 96

Illingworth, K. S. S., 380

Im, C., 615

Imada, T., 297

Imperato, A., 437

Impett, E. A., 226

Inagaki, T. K., 11, 396, 537

Ingram, R. E., 555, 559

Inzlicht, M., 11, 617

Ippolito, M. F., 114

Ironson, G. H., 571

Irvine, W. B., 352

Irving, J. A., 14, 352, 530, 548,

559, 562

Irwin, M. R., 575, 576

Isaacowitz, D. M., 13, 206, 208,

213, 274, 366, 511

Isen, A. M., 140, 622

Israel, S., 243

Ito, T. A., 308

Ivanov, I., 431, 432

Ivanovski, B., 557

Iverson, K. M., 500

Ives-Deliperi, V. L., 557

Izard, C. E., 163, 499

Jackson, A. L., 222

Jackson, D. C., 59, 208, 398, 574

Jackson, J. R., 253

Jackson, R. J., 395

Jacob, G. A., 495

Jacobo, M., 500

Jacobs, S. E., 326, 354, 420

Jacobsen, T., 114

Jacobson, E., 536

Jacobson, N. S., 497

Jaffe, F. K., 429

Jaffe, J. H., 429

Jäger, T., 206

Jahng, S., 494

Jahromi, L. B., 114

Jain, S., 551

James, W., 77

Jamieson, J. P., 11

Janicki-Deverts, D., 603

Janis, I. L., 253

Jankowiak, W. R., 273

Jansen, A. T. M., 351, 529

Jarcho, J. M., 27, 36, 82

Author Index 641

Jarmolowicz, D. P., 98

Jarvis, W. B. G., 258

Jasnoski, M. L., 571

Jaynes, J., 379

Jenkins, F. J., 575

Jensen, R. A., 430

Jerga, C., 245, 246

Jha, A. P., 552

Jimenez, L., 522

Jin, R., 469

Jochem, R. A., 181

Jog, M. S., 96

John, O. P., 8, 11, 14, 65, 127,

192, 268, 271, 275, 321, 322,

323, 324, 325, 326, 327, 328,

330, 331, 333, 334, 335, 337,

339, 340, 341, 343, 354, 368,

399, 415, 416, 420, 549, 579,

597, 601, 603, 604

Johns, M. J., 11, 617

Johnson, B. D., 129, 255

Johnson, C., 255

Johnson, E. J., 134

Johnson, K. L., 259

Johnson, M. C., 178

Johnson, M. H., 309

Johnson, M. K., 27, 207, 260

Johnson, O., 571

Johnson, R. E., 141, 476

Johnson, S. L., 230, 367, 414,

415, 416, 419

Johnson, S. M., 272, 279

Johnston, L., 353

Johnston, W. A., 128

Johnstone, T., 4, 24, 29, 52, 58,

59, 61, 62, 65, 84, 432, 458,

474, 538, 574

Joiner, T. E., Jr., 379, 495, 497

Jones, A., 615

Jones, B. T., 351, 429, 430

Jones, C. R., 251, 255, 256, 454,

614, 623

Jones, D. L., 349

Jones, H. E., 574

Jones, L. B., 311

Jonides, J. J., 28, 30, 141, 148

Joormann, J., 14, 134, 378, 379,

397, 413, 416, 417, 418, 419,

420, 421, 422, 423, 553

Joseph, D. L., 339

Jou, R. L., 26

Joudy, R., 378

Julian, K., 514

Juliano, L. M., 433

Julia-Sellers, M., 571

Julien, D., 278

Junghofer, M., 45

Jurivich, D. A., 204

Kabat-Zinn, J., 378, 478, 479,

550, 552, 556, 557, 558, 559

Kable, J. W., 85, 94, 104, 227

Kacelnik, A., 221

Kaell, A., 589

Kagan, J., 63, 159, 273, 308,

381, 571, 574

Kahn, R. L., 274

Kahn, R. S., 141, 148

Kahneman, D., 95, 97, 98, 136,

144

Kalin, N. H., 29, 52, 61, 208,

474

Kalisch, R., 23, 28, 33, 61, 78,

79, 81, 83, 131, 479

Kamholz, B. W., 417

Kamphuis, J. H., 196

Kandel, E. R., 31, 61, 79, 316

Kandl, M., 542

Kane, M. J., 354, 355

Kang, S. K., 617

Kanske, P., 11, 65, 309, 314, 316

Kanter, J. W., 480, 481

Kaplan, H. I., 6

Kappas, A., 12, 298

Kaprio, J., 589, 601

Karasawa, M., 285, 288, 363

Karau, S. J., 230

Karelina, K., 576, 577

Karg, K., 67

Karpinski, A., 253, 256

Karremans, J. C., 223, 244

Karssen, A. M., 576

Kashdan, T. B., 127, 134, 368,

370, 394, 405, 414

Kashima, K. M., 614

Kashiwagi, K., 294

Kassel, J. A., 430

Kassel, J. D., 614

Kassinove, H., 499

Kastner, S., 28

Katz, L. F., 179, 180

Kaufman, M., 145

Kavaliers, M., 616

Kavanagh, D. J., 348, 350, 356

Kawachi, I., 579, 589, 601, 603

Kawakami, K., 255

Kazdin, A. E., 486

Keay, K. A., 26

Keedwell, P. A., 66

Keel, P. K., 614, 621

Keener, A. D., 66

Keightley, M. L., 557

Keil, A., 45, 47, 48, 209, 367

Kelley, H. H., 253

Kelley, M. E., 460

Kelley, W. M., 557, 617

Kelsey, R. M., 223, 367

Keltner, D., 76, 77, 127, 224,

325, 341, 363, 613

Kemeny, M. E., 384, 571, 574,

575, 588, 589

Kemps, E., 351

Kendler, K. S., 461, 469

Kennedy, C., 230

Kennedy, Q., 208

Kennedy, S., 553

Kenny, D. A., 226

Kensinger, E. A., 207, 209, 510

Kentish, J., 422

Keough, M. E., 395

Kernis, M. H., 552

Kerns, J. G., 103

Kerns, K. A., 183

Kessler, E., 210

Kessler, H., 325, 326, 327

Kessler, R. C., 413, 430, 469,

530

Kety, S. S., 230

Khantzian, E. J., 430, 432

Kidd, C., 121

Kidd, T., 242

Kiecolt-Glaser, J. K., 227, 575,

589, 603

Kieras, J. E., 314

Kilpatrick, L. A., 557

Kilts, C. D., 24, 96

Kiluk, B. D., 439

Kim, B., 93, 113

Kim, D., 165

Kim, H., 285, 287

Kim, J.-H., 46, 416

Kim, M., 118

Kim, S. H., 11, 66, 166, 167,

225, 416

Kim, Y.-H., 11, 288, 295

Kindt, M., 395

King, D. S., 571

King, R. A., 294

Kinnunen, M. L., 589, 601

Kirby, K. N., 99

Kirchner, M., 542

Kirkland, T., 251, 454

642 Author Index

Kirsch, P., 394

Kirschbaum, C., 227

Kirson, D., 500

Kisley, M. A., 46

Kissler, J., 45

Kitayama, S., 284, 285, 286,

287, 288, 290, 292, 294, 297,

363

Kivnick, H., 274

Kiyonaga, A., 552

Kleczar, A., 61

Klein, D. N., 46, 316

Kleinknecht, N., 552

Klenk, M. M., 473, 484

Kliegel, M., 206

Kliewer, W., 182

Klipker, K., 187

Klonsky, E., 321, 337

Klumpp, H., 520

Knaack, A., 112, 163, 164, 165,

167

Knetsch, J. L., 144

Knierim, K., 403

Knight, R. T., 141

Knill, D. C., 224

Knobloch, L. K., 325

Knoch, D., 35, 148

Knowles, R., 418

Knudsen, E. I., 351

Knutson, B., 66, 95, 96, 145,

285, 363

Kobak, R. R., 238, 241

Kobau, R., 205

Kobayashi, T., 46

Kober, H., 14, 27, 29, 33, 52,

120, 121, 176, 428, 429, 433,

434, 435, 436, 437, 439, 450,

452

Kobor, M. S., 575

Koch, H. E., 213

Kochanska, G., 112, 119, 160,

161, 163, 164, 165, 166, 167,

182, 308, 309, 310, 313

Koenigs, M., 78, 142

Koerner, K., 495

Koestner, R., 379

Koeter, M. W. J., 529

Koffarnus, M. N., 98

Kokkonen, M., 589, 601

Kolar, M. M., 556

Kolarz, C. M., 205

Koningsbruggen, G. M., 350

Konttinen, H., 601

Koob, G. F., 430, 437

Kool, W., 132

Koole, S. L., 3, 61, 127, 128,

132, 133, 288, 351, 362, 367,

368, 496, 531

Koomen, W., 618

Koons, C. R., 500

Kordts, R., 353

Korfine, L., 495

Kornadt, H., 293

Kortekaas, R., 532

Koster, E. H. W., 63, 243, 395,

422, 424, 510, 518, 520, 522

Kotabe, H., 346, 349

Kotter, R., 456

Kotter-Grühn, D., 205

Kotz, S. A., 309, 316

Koutsouleris, N., 68

Kovacs, M., 608, 609

Kowalski, R. M., 615

Kowalsky, J., 542

Kozak, M. J., 134

Kraaij, V., 195, 323, 331, 332,

368, 416, 417

Kraemer, D. T., 589

Kraemer, H., 483

Kramer, J. H., 269, 400

Krantz, D. S., 588, 589

Kraus, M. W., 224

Krause, J., 224

Kravitz, D. J., 24

Krebs, J. R., 221

Kreifelts, B., 207

Krendl, A. C., 209, 617

Krietemeyer, J., 557

Kring, A. M., 321, 325, 460,

461, 496, 500, 508

Krivoshekova, Y. S., 206

Kroger, J. K., 97

Krompinger, J., 49, 552

Kross, E. F., 52, 127, 129, 240,

378, 433, 434, 439, 479, 556

Krueger, R. F., 119, 461, 469,

484

Kruesi, M. J. P., 114

Krug, M. K., 35

Kruglanski, A. W., 350, 353,

356, 365, 367

Kübler, A., 257

Kubota, Y., 96

Kubzansky, L. D., 588, 589, 596,

597, 600, 601, 602, 603, 605,

607

Kudadjie-Gyamfi, E., 206

Kugler, T., 386

Kuh, D., 605

Kuhl, J., 242

Kuipers, P., 284

Kujawa, A., 46

Kumar, S., 293, 555

Kumashiro, M. A., 244

Kummel, P., 241

Kun, B., 433

Kunda, Z., 350, 382

Kunzmann, U., 205, 206, 209,

214, 269

Kuo, J. R., 495, 499

Kuperminc, G., 228

Kupersmidt, J., 166

Kupfer, D. J., 559

Kupfer, S. R., 575

Kuppens, P., 11, 417

Kupperbusch, C. S., 269

Kurth, F., 27

Kurzban, R., 230

Kuyken, W., 556

Kwang, T., 382

La Greca, A. M., 228

Laatikainen, T., 601

Labad, A., 494

LaBar, K. S., 71, 95, 129

Labouvie-Vief, G., 194, 213, 242

Labroo, A. A., 623

Lachman, M. E., 591

Ladouceur, C. D., 23, 191

LaFreniere, P. J., 275

Lagattuta, K. H., 167

Laible, D. J., 165, 182

Laibson, D. I., 35, 85, 93, 94,

99, 112

Laird, A. R., 27, 64, 97, 434

Laird, J. D., 499

Lakey, C. E., 552

Lakka, H. M., 589

Lalande, K., 128, 368, 398, 415,

533

Lam, D., 419

Lam, S., 600

Lamb, M. E., 177, 306

Lambrecht, L., 207

Lamkin, D. M., 603

Lampman-Petraitis, C., 187

Lamy, D, 63, 510

Lanaj, K., 476

Lancaster, K., 352

Author Index 643

Lance, C. E., 552

Lancee, W. J., 242

Landy, F., 339

Lane, R. D., 31, 532, 599

Lane, S. D., 119

Laneri, M., 98

Lang, F. R., 210

Lang, P. J., 5, 6, 44, 45, 47, 132,

270, 310, 450, 471

Langer, D. A., 590

Langer, S. K., 225

Langeslag, S. J. E., 46

Langston, C. A., 226

Lanius, R. A., 496

Lansford, J. E., 210

Laptook, R. S., 316

Larkin, G. R., 208

LaRose, R., 614

Larose, S., 229

Larsen, H., 313

Larsen, R. J., 8, 341, 363, 531

Larson, C. L., 59, 398, 574

Larson, E. B., 9

Larson, J., 331

Larson, R., 187, 190

LaTaillade, J. J., 383

Lattimore, P., 621

Lau, H. C., 403

Lau, M. A., 552

Laugesen, N., 395

Laurenceau, J.-P., 471

Laurent, H., 278

Lavy, S., 244

Lawlor, D. A., 587

Lawrence, A. D., 63, 223, 395

Lawrence, A. J., 431

Lawrence, J. W., 377

Lawson, C., 421

Lawton, M. P., 210

Layton, J. B., 222

Lazar, S. W., 557

Lazarus, A. A., 498

Lazarus, R. S., 3, 4, 6, 194, 321,

323, 328, 329, 330, 531, 579,

602

Le, H., 253

Le Moal, M. L., 430, 432, 616

Leahy, R. L., 531

Leary, M. R., 376, 378, 379, 381,

384, 385, 480, 557, 615, 622

LeBel, E. P., 256, 262

Lebra, T. S., 285

Leclerc, C. M., 207, 510

Lecours, S., 379

Lecuyer-Maus, E. A., 113

LeDoux, J. E., 26, 27, 29, 31, 34,

61, 62, 77, 78, 80, 81, 95, 96,

145, 306, 307, 309, 472, 473,

537, 539

Lee, A. Y., 288, 289

Lee, B. O., 52

Lee, C. H., 52

Lee, D. S., 416

Lee, E. A., 11, 52, 295

Lee, G. P., 101

Lee, H., 263

Lee, J., 560

Lee, K., 315

Lee, T. L., 11

Lee-Chai, A., 366, 377

Leen-Feldner, E. W., 533

Leerkes, E. M. J., 161, 309

Legerstee, J., 195, 417

Legrand, D., 452

Lehle, C., 128

Lehman, B. J., 82, 602

Lehman, D. R., 285

Lehrer, J., 111

Leib, D. A., 575

Leibowitz, R. Q., 433

Leith, K. P., 386

Leitten, C. L., 223, 367

Lejuez, C. W., 143, 495

Leland, D. S., 121

Lemche, E., 242

Lemery, K. S., 164

Lemogne, C., 67

LeMoult, J., 422

Lengacher, C. A., 559

Lengua, L. J., 162, 164, 310

Lenton, A. P., 500

Leonard, K. E., 113

Leonards, U., 351, 523

Leotti, L. A., 36

Lerche, N. W., 575

Lerew, D. R., 395

Lerner, J. S., 141, 602, 620

Leroy, V., 121

Lessard, D. A., 223

Leu, J., 285

Leung, A. K.-Y., 285

Leutgeb, V., 52, 395

Levenson, R. W., 4, 5, 6, 10, 11,

24, 28, 76, 77, 83, 117, 206,

211, 213, 267, 268, 269, 270,

271, 272, 274, 275, 276, 277,

278, 321, 397, 400, 574, 579,

599, 613

Leventhal, H., 23, 26

Levesque, J., 64, 68, 84, 311

Levin, F. R., 430

Levine, B., 97

Levine, D., 495

Levine, L. J., 208

Levine, S., 589

Levinson, D. B., 557

Levinthal, D. J., 28

Levitt, J. T., 397, 398, 399, 403,

498, 533

Levy, B. J., 104

Levy, D. J., 25, 355

Levy, R. I., 292, 298

Lewinsohn, P. M., 480, 481, 497

Lewis, C. C., 289

Lewis, M. D., 176

Lewis, T. T., 588, 589, 602

Li, C. S. R., 430, 432, 433, 436

Li, S., 516

Li, X., 99

Liberman, N., 105

Liberzon, I., 46, 64, 395

Lieberman, M. D., 11, 27, 28, 35,

36, 79, 82, 93, 119, 120, 228,

255, 396, 432, 436, 537

Liebowitz, M., 396

Lievens, L., 514

Lillis, J., 538

Limberger, M. F., 495

Lin, C., 614

Linden, D. E. J., 66

Linden, W., 588

Lindenberger, U., 187, 192, 212,

214, 366

Lindenmeyer, J., 353

Lindmark, E., 589

Lindquist, K. A., 27, 28,

224,448, 451, 452, 453, 456,

459, 460

Lindquist, M. A., 33, 36, 52, 62,

83, 403

Lindsey, S., 254

Linehan, M. M., 14, 136, 378,

470, 475, 477, 478, 479, 491,

492, 494, 495, 496, 497, 498,

499, 500, 502, 530, 538, 541,

561

Lin-Stein, T., 241

Lipina, S. J., 230

Lipkus, I., 243

Lipworth, L., 559

Lissek, S., 81, 475, 574

Liston, C., 68

644 Author Index

Litt, M. D., 430

Littel, M., 52, 53, 434

Little, T. D., 205

Liu, E. H., 46

Liu, H., 435, 437

Liu, X., 516

Liverant, G. I., 417, 473, 551

Livneh, U., 81

Liwag, M., 284

Llera, S., 470, 475, 481

Lloyd-Jones, D. M., 596, 605,

607, 608

Lo, B. C. Y., 352

Lobbestael, J., 495

Löckenhoff, C. E., 209

Lockwood, P, 382

Loewenstein, G. F., 35, 85, 93,

94, 98, 99, 112, 141, 369, 620

Logan, G. D., 161

Lohr, J. M., 475

Löken, L. S., 227

Loman, M. M., 176

Lomore, C. D., 241

London, E. D., 436

Long, J. D., 188

Longe, O., 538

Lonigan, C. J., 164, 166

Loo, C. K., 69

Lopes, P. N., 271, 338, 339

Lopez, A. D., 62

Lopez, F. G., 241

Lopez-Duran, N. L., 608, 609

Loucks, E. B., 601, 607

Lovibond, P. F., 80

Lowery, B. S., 255

Loxton, N. J., 93

Lozano, A. M., 70

Lu, Q., 315

Lubaroff, D. M., 227

Luciano, M. C., 440

Luck, S., 44

Luerssen, A., 111, 190, 431

Luhmann, M., 349

Lujan, J. L., 460

Lukon, J. L., 181

Luna, B., 190

Lundberg, U., 576

Lundh, L.-G., 11

Lunkenheimer, E. S., 180

Luo, X., 436

Luoma, J. B., 538

Luong, G., 210

Lupianez, J., 522

Lupien, S. J., 176

Luppino, F. S., 605, 606

Lüscher, C., 437

Luterek, J. A., 396

Lutgendorf, S. K., 577

Lutz, A., 458, 552, 556, 557

Lutz, C., 284

Luu, P., 311

Lynch, J. W., 587

Lynch, T. R., 498, 499

Lyubomirsky, S., 127, 382, 414,

415, 470

Lyvers, M., 496

Ma, S. H., 560

MacArthur, R. H., 221, 224

Maccari, S., 432

MacDonald, A. W., 97, 98

MacGregor, D. G., 141

MacKay-Soroka, S., 182

Mackey, S., 227

Mackie, D. M., 258

Mackintosh, B., 351, 523

MacLean, P. D., 6

MacLeod, C., 14, 62, 63, 351,

395, 421, 422, 508, 509, 510,

511, 512, 515, 521, 522, 524

MacNamara, A., 44, 45, 46, 48,

50, 51, 53, 129, 130

MacPherson, L., 433

Macrae, C. N., 377

Madden, D. J., 71

Maddux, W. W., 256

Madey, S. E., 380

Magai, C., 206, 214, 598

Magen, E., 105, 121

Maguire, E. A., 104

Mahoney, A. E., 395

Mahoney, M. J., 351

Maier, K. J., 589

Maier, M. E., 80

Main, A., 267

Main, M., 229, 276

Majeskie, M. R., 432, 620

Major, B., 241

Makkar, S. R., 384

Malach, R., 452

Malatesta, C. Z., 114

Malenka, R. C., 437

Maletic, V., 589

Malhi, G. S., 557

Maliken, A. C., 179

Malkin, C., 177

Maller, J., 64

Malmaud, J., 85

Malmstadt, J. R., 59, 398, 574

Malone, T. W., 224

Malouff, J. M., 589

Mamun, A. A., 606

Manber, T., 83, 400, 402, 496

Manber-Ball, T., 84, 400, 402

Mandai, O., 46

Maner, J. K., 622

Mangelsdorf, S. C., 161, 178

Mangold, R., 230

Mann, T., 353, 617

Mansell, W., 461

Mäntylä, T., 190

Manuck, S. B., 588

Manwell, L. A., 363

Maraj, N., 552

Marco-Pallarés, J., 103

Marcovitch, S., 167

Maresh, E. L., 13, 221

Marinetti, C., 284

Marissen, M. E., 495

Mark Eddy, J., 188

Markman, H. J., 274, 276

Markon, K. E., 469, 484

Marks, I., 524

Markus, H. R., 284, 285, 286,

292, 293, 380

Marlatt, G. A., 432, 439, 560,

614, 615

Marr, D., 456

Marrone, G. F., 433

Marsh, J. T., 575

Marshall, R. D., 379

Marshall-Berenz, E. C., 433

Martell, C. R., 497, 499

Martijn, C., 529

Martin, A., 452

Martin, L. L., 10, 379, 538

Martin, L. N., 85, 144, 146, 148,

149

Martin, R. A., 270

Martin, S. E., 6, 84, 175

Martinez-Raga, J., 355

Marvin, C. B., 435

Marziali, E., 495

Marzolf, D., 161

Masicampo, E. J., 350

Mason, W. A., 575

Massie, E. D., 530

Master, S. L., 240

Masters, J. C., 7

Masuda, A., 538

Masuda, T., 285, 290, 294

Matarazzo, O., 196

Author Index 645

Mather, M., 207, 208, 274

Mathers, C. D., 62

Mathews, A., 62, 395, 421, 422,

508, 509, 510, 511, 512, 513,

520, 521, 524

Mathias, C. W., 119

Matochik, J. A., 436

Matsumoto, D., 294, 295, 297,

325

Matsuzaka, Y., 403

Mattay, V. S., 67, 121, 537

Matthews, K. A., 587, 589, 590,

603

Maunder, R. G., 242

Mauss, I. B., 4, 9, 11, 14, 24, 29,

76, 127, 189, 257, 276, 288,

295, 331, 332, 341, 361, 366,

367, 368, 370, 382, 406, 508,

509, 532, 579, 589

Maxwell, L., 621

May, C. P., 422

May, J., 348

May, M. G., 449

Mayberg, H. S., 62, 65, 70

Mayer, J. D., 13, 323, 334, 338,

531

Mayo, R., 263

Mayr, U., 205

Mazziotta, J. C., 82

Mbirkou, S., 257

McArdle, J., 535

McCandliss, B. D., 312, 315

McCarter, L., 4, 24, 76, 276

McCarthy, D. E., 432, 620

McCeney, M. K., 275, 277, 589

McClelland, J. L., 97, 452

McClernon, F. J., 430

McClure, E. B., 83

McClure, S. M., 35, 85, 93, 94,

96, 99, 100, 103, 104, 106,

112, 113, 120, 121, 145

McComb, K., 226

McConnell, A. R., 257, 258, 259,

378

McCrae, R. R., 306

McCulloch, K. C., 367

McDade, T. W., 571

McEvoy, P. M., 395

McEwen, B. S., 176, 588, 589,

602, 605

McGee, R. O., 271

McGhee, D. E., 253, 366

McGlone, F., 47

McGonigal, K. M., 11, 327

McGowan, P. O., 229

McGrath, P. J., 165

McGuire, J. T., 132

McGuire, L., 589, 603

McIntosh, W. D., 538

McIntyre, M. C., 33

McKay, G., 221, 224

McKee, S. A., 614, 616

McKenzie, G., 416

McLane, M., 560

McLaughlin, K. A., 188, 189,

396, 399, 404

McMillan, K. M., 97

McMurrich, S., 416

McNally, L., 222

McNally, R. J., 117, 517

McNaughton, N., 307, 308, 471,

537

McNulty, J. K., 271

McPherson, R., 206

McPherson, S., 558

McRae, K., 11, 33, 83, 133, 196,

197, 203, 204, 326, 341, 354,

397, 416, 420, 432

Mead, M., 296

Mead, N. L., 620

Meaney, M. J., 576

Mearns, J., 323, 333

Medvec, V. H., 380

Medway, F. J., 244

Meehl, P. E., 66

Meier, C., 535

Meier, L., 535

Meintjes, E. M., 557

Meiran, N., 11, 127, 129, 230,

420

Meisenzahl, E. M., 68

Mele, A., 348

Melzer, D., 205

Mendes, W. B., 11

Mende-Siedlecki, P., 212, 434, 439

Mendis, S., 596, 597

Mendoza, S. P., 575

Mendoza-Denton, R., 93

Mennin, D. S., 14, 188, 379, 396,

398, 399, 401, 404, 406, 469,

470, 473, 474, 475, 483, 484,

496, 529, 530

Menon, V., 80, 403, 460, 473

Mensink, W., 350, 356

Mentzel, H.-J., 81

Merchant, J., 551

Merckelbach, H., 395

Mesquita, B., 9, 28, 189, 284,

285, 287, 288, 289, 292, 293,

294, 295, 296, 298, 363

Metalsky, F. I., 383

Metcalfe, J., 119, 616

Metevia, L., 98

Metts, S., 325

Meuleman, L., 495

Meyer, K., 35, 148

Meyer, S. C., 174, 180, 181

Meyerhoff, D. J., 435

Miao, F., 286

Michelena, P., 225

Miclea, M., 143

Mienaltowski, A., 210

Miers, A., 188

Mikels, J. A., 207, 208, 209, 274

Mikolajczak, M., 8, 121

Mikulincer, M., 114, 182, 189,

226, 229, 237, 238, 239, 240,

241, 242, 243, 244, 245, 246,

273, 274, 328

Milad, M. R., 61, 78, 79, 81

Miles, E., 10, 321, 361, 368

Miles, L. K., 213

Millan, M. J., 461

Miller, A. H., 589

Miller, B. L., 269, 277, 400

Miller, E. K., 30, 97, 113, 141,

148, 435

Miller, E. M., 93, 187, 188

Miller, G. E., 369, 572, 575, 576,

577, 586, 587, 590, 591, 598,

600, 606, 608

Miller, L. F., 560

Miller, N. E., 471

Miller, P. A., 182

Miller, P. C., 230

Miller, P. H., 166, 189

Miller, P. J., 291

Miller, R. S., 384

Milliken, B., 522

Milne, A. B., 206, 210, 377

Milner, B., 104

Miltner, W. H. R., 81

Mineka, S., 395, 473

Minnick, M. R., 11, 295

Mintz, J., 291

Mintz, T. M., 163

Minzenberg, M. J., 495

Miranda, R., 379

Mischel, W., 3, 35, 52, 93, 105,

111, 112, 114, 115, 116, 117,

119, 158, 161, 162, 271, 309,

310, 312, 352, 361, 431, 433,

616

Mishkin, M., 24

Mitchell, C., 365

646 Author Index

Mitchell, D. G. V., 61, 142, 148

Mitchell, F., 586

Mitchell, J. P., 27, 28

Mitchell, M. A., 395

Mitte, K., 571

Miu, A. C., 143

Miyake, A., 127

Miyake, K., 285

Miyamoto, Y., 292

Mobbs, D., 28, 30, 78, 82, 225

Moberly, N. J., 558

Mocaiber, I., 51, 53

Moeller, F. G., 119

Moffitt, T. E., 67, 119, 271, 431,

605

Mogenson, G. J., 349

Mogg, K., 309, 395, 422, 474,

478, 510

Mohammadi, B., 103

Mohanty, A., 189

Moll, H., 222, 223

Mollenholt, N., 11, 405, 549

Moneta, G., 187

Monin, B., 9

Monk, C. S., 68, 82

Monson, C. M., 230

Monsour, M., 167

Montag, C., 394

Montague, P. R., 23, 34, 96, 98,

145

Monterosso, J., 436

Montesinos, F., 440

Monti, D., 496

Monti, J. M., 496

Mooney, D. K., 430

Moore, B. S., 115, 117

Moore, C., 165, 228

Moore, L. J., 223

Moore, M. T., 469, 473

Moore, S. A., 11, 405, 549

Moors, A., 77, 254

Mor, N., 621

Morag, I., 518

Moran, E. K., 460

Morasco, B. J., 430

Moratti, S., 46, 47

Morelli, G. A., 285

Moretti, L., 142

Moriarty, D. G., 205

Morling, B., 292

Morone, N. E., 556

Morrell, B., 382

Morris, A. S., 159, 162, 174, 181,

187, 190, 191, 321, 322

Morrison, I., 227

Morrison, J. A., 589

Morrow, J., 134, 534

Morse, P., 430

Morton, K., 431

Moscovitch, M., 209

Moser, J. S., 49

Moses, E. B., 508, 529

Moses, L. J., 163

Moskalenko, S., 621

Moskowitz, G. B., 255

Moss, C., 226

Moulds, M. L., 415, 420, 558,

599

Moyal, N., 400

Moylan, S. J., 140

Mroczek, D. K., 205, 211, 212

Mueller, E. T., 98

Muhlberger, A., 31

Mulkens, S., 352

Müller, V., 212

Munafo, M. R., 351, 395, 523

Mund, M., 571

Munoz, R. F., 14

Munro, S., 167

Münte, T. F., 103

Muraven, M., 117, 128, 131,

132, 135, 230,472, 474, 618,

619, 623

Murnighan, J. K., 146

Murphy, B. C., 114, 161, 181

Murphy, G. L., 451, 453

Murphy, S. E., 511

Murphy, V., 398

Murray, C. J. L., 62

Murray, E. A., 23, 27, 33

Murray, K. T., 119, 161, 165, 309

Murray, S. L., 277

Murrell, A. R., 472, 481, 482

Mushiake, H., 403

Myers, S. S., 174, 190, 321

Myerson, J., 98, 111

Myerson, R. B., 146

Myers-Schulz, B., 78

Naaman, S., 230

Nachmias, M., 178, 183

Nachmias, O., 239

Nadeau, K. C., 575

Nagin, D. S., 605

Naidu, N. V. R., 293

Naidu, R. K., 293

Najmi, S., 513, 514

Naliboff, B. D., 574

Namkoong, K., 52

Nathan, P. J., 83, 96, 145

Naumann, L. P., 326

Neacsiu, A. D., 14, 491, 496,

500, 530, 538, 561

Nearing, K. I., 35, 61, 62, 78, 80,

81, 145, 148

Neely, J. H., 28

Negel, L., 384

Negishi, H., 576

Neil, A. L., 608

Nelis, D., 271

Nelis, S., 416

Nelson, B., 263

Nelson, E. E., 68

Nelson, S. N., 192

Nesse, R. M., 363

Nesselroade, J. R., 205, 276

Nestor, L. J., 436

Neufeld, R. J., 496

Neumann, C. S., 533

Neumann, R., 31

New, A. S., 400, 402, 495

Newcorn, J., 431

Newman, D. A., 339

Newman, D. L., 605

Newman, M. G., 469, 470, 475,

481

Newton, E. K., 173

Neyer, F. J., 274

Nezlek, J. B., 11, 417

Nezu, A. M., 497, 531, 540

Nich, C., 433, 439

Niedenthal, P. M., 377, 448

Niedtfeld, I., 494, 495

Niemann, L., 548

Nienhaus, K., 618

Nieuwenhuis, S., 49, 53, 61, 129

Nikitin, J., 208

Nisbett, R. E., 289, 509

Nitschke, J. B., 63, 81, 82

Nocera, C. C., 367

Nolan, R. P., 242

Nolen-Hoeksema, S., 127, 134,

135, 188, 271, 327, 331, 337,

396, 399, 404, 405, 414, 415,

417, 419, 470, 474, 480, 484,

492, 534, 558

Nordgren, L. F., 354

Nordin, S., 45

Nordling, J. K., 166

Norem, J. K., 380

Norman, D. A., 307

Norrholm, S. D., 81

Author Index 647

Norris, C. J., 622

Norrving, B., 596

Northoff, G., 452

Notarius, C. I., 574

Novin, S., 296

Nowicka, A., 45

Nunes, E. V., 430

Nunes, P. M., 494

Nurius, P., 380

Nurmikko, T. J., 223

Nyland, J. E., 355

Nyman, M., 313

Nystrom, L. E., 79, 98, 141

Oaten, M., 615

O’Boyle, C. G., 10, 309

Obradović, J., 167

O’Brien, C. P., 433

O’Brien, L, 251

Ochsner, K. N., 5, 11, 12, 13,

23, 24, 27, 28, 29, 30, 31, 33,

35, 43, 51, 52, 58, 59, 60, 62,

76, 78, 83, 120, 121, 130, 131,

133, 142, 144, 146, 148, 176,

189, 212, 269, 278, 311, 314,

396, 398, 403, 416, 432, 433,

434, 451, 472, 537, 556, 574

O’Cleirigh, C., 571

O’Connell, K. A., 433

O’Connell, R. M., 576

O’Connor, C., 500

Odgers, C. L., 607

O’Doherty, J. P., 23, 473

O’Donoghue, T., 98

O’Donovan, A., 575

Oh, D., 548

O’Hearn, R. E., 244

O’Heeron, R. C., 574

Öhman, A., 471, 554

O’Keefe, J., 104

Oken, B. S., 558, 559

Olatunji, B. O., 395, 470, 475,

496

Olausson, H., 227

Oldehinkel, A. J., 164

Olds, J., 96

O’Leary, K. C., 230

Olino, T. M., 316

Olofsson, J., 45, 46

Olson, M. A., 253, 256

Olson, S. L., 113

Olsson, A., 27, 28, 30, 34

Olvet, D. M., 44, 45, 46, 129

Ong, A. D., 212, 213

Ongur, D., 27, 460

Oosterlaan, J., 189

Opitz, P. C., 13, 187, 197

Oppenheim, D., 285

Orbach, I., 229

Ordaz, S., 190

Ordóñez, L. D., 386

Ormel, J., 164

Orr, I., 244

Orsel, B., 106

Orsillo, S. M., 370, 397, 398,

475, 478, 479, 498, 533

Orth, U., 535

Ortony, A., 23, 29, 454

Öst, L.-G., 536

O’Sullivan, H., 351, 523

Ottenbreit, N. D., 537, 558

Otter-Henderson, K. A., 242,

244

Otto, P. E., 134

Owen, A. M., 97

Owens, M., 396, 520

Paas, N. D., 433

Packard, M. G., 26

Packer, D. J., 260, 261

Padberg, F., 69

Padgett, D. A., 575

Palau, C., 435

Palmeri, H., 121

Pamuk, E., 586

Panfile, T. M., 165

Panksepp, J., 96

Papa, A., 128, 368, 398, 415,

533

Papageorgiou, C., 414, 415

Papies, E. K., 352, 354, 356, 458,

620

Paquette, V., 64, 84, 395

Paradise, M. J., 378

Parekh, N., 222

Paret, C., 83

Park, I. J. K., 295

Park, J., 559

Park, L. E., 243

Park, N., 597

Parke, S., 227

Parker, J. D. A., 329, 330

Parker, K. J., 587

Parker, L. E., 331

Parkinson, B., 6, 8, 135, 293,

368

Paronis, C. A., 614

Parritz, R. H., 178

Parrott, W. G., 9, 363

Partridge, K. P., 552

Parvaz, M., 51, 53

Pascual-Leone, A., 27, 35, 148,

355

Pashler, H., 128

Passingham, R. E., 403

Pasupathi, M., 205

Paty, J. A., 430

Pauley, G., 558

Pauli, P., 31, 257

Paulus, M. P., 121, 309, 398,

471, 473, 476

Paxton, J. L., 230

Paykel, E. S., 559

Payne, B. K., 253

Payne, J. W., 134

Paz, R., 81

Peake, P. K., 112, 310

Pearson, J. C., 556

Pearson, T. A., 600, 601, 603

Pedersen, N. L., 469

Pedersen, S. S., 571

Pejic, T., 81

Pennebaker, J. W., 572, 574, 598,

599

Pentland, A., 224

Peraza, D. M., 31, 61, 79, 316

Pereg, D., 229

Perez, C. R., 11, 295

Pérez-Edgar, K., 309

Pergamin, L., 63, 510

Perkins, K. A., 433

Perlman, D. M., 458, 556, 557

Perlman, G., 68

Perry-Parrish, C., 188, 197, 604

Perugini, M., 353

Perunovic, M., 243

Pessiglione, M., 96

Pessoa, L., 23, 28, 31, 33, 77

Peters, E., 141

Peters, J., 94, 101, 104, 105

Peterson, C., 597, 602

Peterson, R., 145

Petrican, R., 209

Petrocelli, J. V., 378

Petty, R. E., 253, 256, 258, 259,

271

Pezawas, L., 67, 395

Pfefferbaum, A., 435

Pfeifer, J. H., 190, 432

648 Author Index

Pfister, H.-R., 142

Phan, K. L., 46, 83, 96, 145

Phelps, E. A., 23, 26, 29, 33, 34,

35, 61, 62, 66, 78, 80, 81, 95,

96, 141, 145, 472

Philiastides, M. G., 104

Philibert, R. A., 167

Philippe, F. L., 379

Philippot, P., 499, 500, 514, 517

Phillips, A. G., 377, 378

Phillips, D. A., 605

Phillips, L. H., 206, 210, 211, 213

Phillips, M. L., 23, 33, 66, 141

Phillips, R. G., 96

Phillips, S., 230, 615

Pianka, E. R., 221, 224

Piazza, J. R., 205, 210, 212

Piazza, P. V., 616

Piazza J. R., 206

Pickett, C. L., 622

Piguet, O., 209

Pillutla, M. M., 146

Pine, A., 101

Pine, D. S., 521

Pineles, S. L., 395

Pinulas, A., 313

Piper, M. E., 432, 620

Pithers, W. D., 614

Pitkänen, A., 537

Pizarro, D. A., 208

Pizzagalli, D. A., 63, 473,

474–475, 529

Plante, T. G., 552

Plassmann, H., 94

Platek, S. M., 384

Ploghaus, A., 36, 82

Pluess, M., 312

Poch, C., 460

Poldrack, R. A., 28, 70

Pole, N., 81

Polich, J., 45, 46

Polivy, J., 116, 614, 617, 621, 622

Polk, T. A., 28

Pollack, P. R., 115, 117

Pollak, S. D., 176, 177

Ponesse, J. S., 161

Porat, R., 15

Porges, S. W., 474, 536

Posner, M. I., 63, 93, 115, 161,

167, 228, 305, 306, 307, 308,

309, 310, 311, 312, 313, 314,

315, 399, 478, 597

Potenza, M. N., 434, 436, 438,

439

Pott, M., 285

Pouget, A., 224

Poulin, R., 450

Pourtois, G., 351

Powell, N. D., 576

Power, M. J., 422

Powers, K. E., 622

Powers, M. B., 514

Powers, S., 278

Prater, K. E., 80, 403, 473

Pratt, F. J., 116

Prenger, R., 548

Prescott, T. J., 253

Preston, K. L., 433

Preuss, D., 617

Price, E. L., 241

Price, J. L., 27, 460, 537

Priel, B., 243

Prinstein, M. J., 228

Prochaska, J. J., 117

Proffitt, D. R., 222, 224

Prosch, S., 575

Proudfit, G., 43, 574

Proudfoot, J. G., 384

Pruessner, J. C., 242, 243, 511

Pryce, C. R., 494

Przeworski, A., 469

Pulkkinen, L., 589, 601

Pulliam, H. R., 225

Puska, P., 596

Putnam, K. M., 63, 66

Putnam, S. P., 305

Pyke, G. H., 225

Qian, M., 516

Quack, D., 396, 399

Quinn, D. M., 617

Quirin, M., 242, 243

Quirk, G. J., 23, 27, 34, 61, 81

Quoidbach, J., 8

Rabin, B. S., 571

Rachman, S., 475, 484

Racine, C. A., 230

Radke-Yarrow, M., 294

Radkovsky, A., 535

Radu, P. T., 106, 128

Radwan, K., 230

Raes, F., 164, 416, 424

Raffa, S. D., 370

Rahman, J., 106

Raichle, M. E., 311, 313, 314

Raikes, A., 180, 181

Raikes, H. A., 182

Raison, C. L., 589

Ramanathan, S., 350, 620

Ramel, W., 11, 33, 83, 397, 557

Ramsawh, H. J., 398

Ramsden, S. R., 180

Ramsey, N. F., 616

Rando, K., 435

Rangel, A., 23, 24, 25, 27, 33,

34, 35, 85, 93, 94, 98

Raphaelson, Y. E., 590

Raskin, P. M., 241

Rasmussen, A. F., 575

Rauch, S. L., 63

Rauers, A., 198

Rauss, K., 351

Raver, C. C., 160

Raviv, M., 614

Rawn, C. D., 259, 620, 621

Ray, R. D., 11, 84, 326, 354,

398, 403, 416, 420, 480

Ray, R. R., 27, 28

Ray, W. J., 494

Raye, C. L., 27

Razza, R. P., 163

Read, D., 106

Reading, S., 30

Ready, R. E., 212

Rebucal, K. A., 213

Reddish, M., 452

Redick, T. S., 355

Redish, A. D., 96

Reeb-Sutherland, B. C., 509

Reed, A. E., 209

Reed, M. A., 307, 309, 509

Reese, H. E., 517

Reger, B. E., 556

Reichardt, L. F., 228

Reidler, J. S., 450

Reijntjes, A., 196

Reinhold, E., 68

Reis, H. T., 226

Reisenzein, R., 422

Reiser, M., 68, 162

Reitz, S., 495

Rempel, J. K., 252

Remy, F., 33

Renner, B., 45

Repetti, R. L., 177, 278

Rettek, S., 293

Reuter, M., 395

Reuter-Lorenz, P., 208

Author Index 649

Reynolds, B., 134, 177

Reynolds, C. A., 205

Reynolds, S., 6

Reznick, J. S., 574

Rhoades, G. K., 274

Rhoades, H., 119

Rhodes, E., 363

Rholes, W. S., 229

Riccardi, C. J., 395

Richards, J. M., 8, 11, 33, 129,

268, 277, 295, 324, 327, 334,

416, 510, 614

Richards, M. H., 187

Richardson, M. P., 537

Richerson, P. J., 222, 571

Richeson, J. A., 617, 618

Richey, J., 517

Richter, D., 206

Richter, W., 33

Richters, J. E., 178

Ricon, T., 518

Ridderinkhof, K. R., 61, 102

Ridker, P. M., 589

Riediger, M., 187, 192, 193, 198,

212, 214, 366

Rief, W., 542

Rieffe, C., 296

Rieskamp, J., 134

Rifai, N., 589

Riggs, D. S., 530

Riley, A. W., 587

Riley, H., 433

Rilling, J. K., 36, 98, 141

Rimm, E., 607

Rinck, M., 353

Ringo Ho, M. H., 405

Rips, L. J., 452

Riskind, J. H., 242

Ritchey, M., 129

Rizvi, S. L., 492, 496, 502

Roales-Nieto, J. G., 440

Robbins, S. J., 433

Robbins, T. W., 28, 434

Roberts, G., 224

Roberts, M. E., 614

Roberts, N. A., 223, 277

Robertson, E. R., 31

Robertson, J., 587

Robichaud, M., 475

Robins, D. L., 552

Robinson, J. L., 574

Robinson, L. R., 174, 190, 321

Robinson, M. D., 189

Robinson, T. E., 96, 145, 471

Robles, T. F., 177, 589, 603

Rochester, M., 182

Röcke, C., 205

Rockstroh, B., 367

Rodriguez, C., 93, 113

Rodriguez, M. L., 35, 105, 111,

112, 113, 116, 309

Roemer, L., 275, 323, 333, 337,

338, 370, 379, 396, 398, 399,

406, 417, 475, 478, 479, 551

Rogers, R. D., 403

Rogers, S. J., 225

Rogoff, B., 285

Rogosch, F., 178

Rohlfing, T., 435

Rolls, E. T., 25, 27, 64

Romero, F. J., 435

Romero, M. J., 435

Rook, D. W., 620

Rooke, S. E., 589

Rosa, D., 560

Rosaldo, M. Z., 288, 296

Roseman, I., 293

Rosen, Z., 132

Rosenbloom, M., 435

Rosenthal, M. Z., 495, 498, 499,

501

Rosenzweig, S., 556

Roskos-Ewoldsen, D. R., 262

Ross, L., 382

Ross, M., 208

Roth, W. T., 536

Rothbart, M. K., 10, 115, 158,

159, 160, 161, 165, 167, 228,

305, 306, 307, 308, 309, 310,

311, 312, 313, 314, 315, 317,

399, 478, 597

Rothbaum, F. M., 194, 285, 290,

292, 380

Rothermund, K., 367, 368, 369,

532, 538

Rothstein,, J. D., 212

Rottenberg, J., 127, 134, 367,

368, 394, 414, 474

Rounsaville, B. J., 434

Rovee-Collier, C., 177

Rowe, J. W., 274, 589

Roy, M., 460

Rozanski, A., 588, 602, 603

Rozenman, M., 523

Rubia, K., 120

Ruby, P., 452

Rucker, L., 396

Rueda, M. R., 305, 310, 311,

312, 315

Ruef, A. M., 276

Ruff, H. A., 161

Ruggerio, A. M., 575

Rule, N. O., 259

Rumbaugh, D. M., 315

Rundle, S. A., 575

Ruocco, A. C., 495

Ruppert, J., 448

Rusbult, C. E., 243, 244

Ruscio, A. M., 421, 469, 519,

520

Rush, A. J., 414, 499

Rush, J., 477

Russell, D. W., 227

Russell, J. A., 27, 251, 450

Rusting, C. L., 363

Rutherford, E., 511

Ruxton, G., 224

Ryan, D. H., 497

Ryan, E., 365

Ryan, R. M., 361, 369, 548

Rydell, R. J., 257, 258

Rydstrom, A., 49, 129

Saab, P. G., 588

Saarni, C., 173, 175, 188, 333,

334, 337, 339, 531

Sabatinelli, D., 45, 47

Saccomanno, L., 315

Saddoris, M. P., 27

Sadock, B. J., 6

Safran, M. A., 205

Safren, S., 500

Sage, R. M., 602

Saito, Y., 46

Sakellaropoulo, M., 511

Saleem, K. S., 24

Salerno, J., 363

Salinas, E., 224

Salisch, M. V., 194

Salomons, T. V., 557

Salovey, P., 13, 271, 323, 334,

337, 338, 386, 531, 589, 600

Salters, K., 370

Salters-Pedneault, K., 396, 398,

399

Salthouse, T. A., 274

Saltzman, H., 159

Salzman, C. D., 448, 456

Samanez-Larkin, G. R., 207

Samii, A., 103

Samson, A. C., 10, 13, 27

Sanchez, A., 435

650 Author Index

Sanfey, A. G., 98, 140, 141, 142,

146, 147, 148, 149, 190

Sanislow, C. A., 461

Santucci, A. K., 118

Sapir-Lavid, Y., 239

Sapolsky, R. M., 574, 576, 579

Sarinopoulos, I., 82

Sassenberg, K., 255

Satpute, A. B., 27, 456, 460

Sauer-Zavala, S. E., 396

Saugar, C., 46

Savani, K., 293

Savino, N. S., 370

Savitz, J., 64

Sawchuk, C., 475

Sawyer, A. T., 398, 520, 529, 548

Saxbe, D., 82, 278

Saxe, R., 27

Sayette, M. A., 350, 620

Sayfan, L., 167

Sayialel, S., 226

Sbarra, D. A., 244

Schaal, B., 255

Schachar, R. J., 161

Schacht, R., 518

Schachter, S., 382

Schacter, D. L., 35, 104

Schaefer, A., 500

Schaefer, H. S., 66, 223, 274, 557

Schäfer, A., 52, 395

Schaffer, P. A., 575

Schaller, M., 622

Schamberger, M. E., 539

Schardt, D. M., 67

Scharfe, E., 243

Schatzberg, A. F., 80, 403, 473,

474, 484

Schauenburg, H., 245

Scheibe, S., 13, 128, 130, 208,

209, 211, 399, 423

Scheier, M. F., 251, 321, 323,

328, 330, 334, 340, 349, 350,

361, 362, 364, 366, 369, 377,

378, 613, 615, 618, 622

Schene, A. H., 529

Scher, C. D., 555

Scherer, K. R., 4, 5, 23, 24, 26,

28, 29, 59, 383

Schienle, A., 52, 395

Schiller, D., 473

Schimmack, U., 209, 309

Schipper, E. M., 189

Schmader, T., 11, 617

Schmälzle, R., 45

Schmeichel, B. J., 189, 347, 348,

354, 617, 618, 619

Schmertz, S. K., 552

Schmidhempel, P, 221

Schmidt, J. A., 276

Schmidt, N. B., 395, 514, 516,

517

Schmidt, S., 81, 548, 552

Schmiedek, F., 187, 192, 214,

366

Schmitt, M., 253, 352

Schmittberger, R., 146

Schmittner, J., 433

Schnall, S., 224, 230

Schneider, D. J., 519

Schneiderman, N., 571

Schnülle, J., 65, 83, 127, 418

Schnur, J., 383

Schoenbaum, G., 23, 27, 34

Schoenmakers, T., 351

Schonberg, M. A., 181

Schönfelder, S., 11, 65, 314

Schönfeldt-Lecuona, C., 70

Schoofs, D., 617

Schoofs, H., 416

Schooler, J. W., 35, 369, 478

Schooler, T. Y., 254

Schorr, A., 4, 24, 59

Schotte, D. E., 117

Schredl, M., 495

Schreier, J., 363

Schroeder, D. G., 363

Schroeder, S. A., 346

Schryer, E., 208

Schul, Y., 263

Schultheiss, O. C., 371

Schultz, D., 163

Schultz, W., 34, 96, 145

Schulz, M. S., 191

Schulz, R., 369

Schulze, L., 495

Schupp, H. T., 45

Schuster, C., 575

Schut, H., 350, 356

Schutte, N. S., 433, 589

Schutter, D. J. L. G., 69

Schwartz, A. R., 588

Schwartz, C. E., 63

Schwartz, G. E., 552, 574

Schwartz, J. E., 205, 433, 500

Schwartz, J. L. K., 253, 366

Schwartz, S., 351

Schwartzman, A. E., 498

Schwarz, B., 146

Schwarz, J., 14, 529

Schwarz, J. C., 113, 115, 116,

117, 616

Schwarz, N., 117, 223, 252, 622

Schweiger Gallo, I. S., 367

Schweizer, S., 127, 271, 327, 396,

401, 417, 424, 492

Schyns, P. G., 453

Scissors, L. E., 244

Scott, W. A., 263

Scoville, W. B., 104

Seay, R. B., 210

Sebanc, A. M., 315

See, J., 515, 524

Seeley, J. R., 497

Seeman, G., 113, 115, 117, 616

Seeman, T. E., 589, 591, 602

Segal, Z. V., 14, 352, 475, 478,

479, 480, 498, 530, 548, 553,

555, 556, 557, 559, 560

Seibt, B., 257

Seider, B. H., 6, 206, 267

Seivert, N. H., 128, 369

Selby, E. A., 495

Selcuk, E., 240

Seligman, M. E. P., 531

Semegon, A. B., 207

Semple, R. J., 560

Sen, S., 67

Senthinathan, S., 560

Senville, J., 551

Seppala, E., 286

Sepulcre, J., 450

Sequeira, H., 45, 46

Sergeant, A., 575

Serketich, W. J., 275

Serretti, A., 558, 559

Sethi, A., 116, 309, 313

Seymour, B., 101

Shackman, A. J., 63

Shafran, R., 461

Shah, J. Y., 353

Shaham, Y., 429

Shahangian, A., 576

Shallcross, A. J., 341, 368, 370,

406, 420

Shallcross, S. L., 229

Shallice, T., 97, 307

Shamaskin, A. M., 209

Shamosh, N. A., 100

Shapiro, D. A., 495, 500

Shapiro, J. R., 161

Shapiro, S. L., 548, 552, 553,

554

Author Index 651

Sharot, T., 35

Sharpe, L., 522

Shaver, P. R., 113, 182, 189, 226,

229, 237, 238, 239, 240, 241,

242, 243, 244, 245, 246, 273,

274, 276, 328, 500

Shaw, B. F., 414, 477, 499

Shaw, D. S., 164, 181, 475

Shaw, M., 587

Shedden, K., 67

Sheeber, L., 187, 188, 191

Sheeran, P., 10, 321, 361, 367

Sheese, B. E., 115, 167, 305, 309,

312, 313, 399, 597

Shefrin, H., 93

Sheldon, K., 288

Shelfer, L., 523

Shelton, J. N., 618

Shenk, C., 500

Shepard, B., 114

Shepard, S., 161

Shepperd, J. A., 380

Sheppes, G., 6, 11, 13, 47, 48, 49,

126, 127, 128, 129, 130, 131,

132, 133, 136, 230, 268, 287,

362, 399, 420, 423, 472, 550

Sher, K. J., 494

Sheridan, J. F., 576

Sherman, A. M., 210

Sherman, J. E., 616

Sherwood, A., 601

Sherwood, C. C., 230

Shields, A. M., 180

Shields, S. A., 187, 188

Shiffman, S., 349, 428, 430, 433,

434

Shiffrin, R. M., 93

Shih, M. C., 355

Shin, L. M., 63, 64, 81, 395

Shiner, R. L., 305, 306

Shiner, T., 35, 101

Shiota, L., 341

Shiota, M. N., 11, 206, 211, 213,

274, 277

Shipstead, Z., 355

Shizgal, P., 96

Shmueli, D., 117, 623

Shoda, Y., 35, 105, 111, 112,

116, 118, 309, 310, 312

Shohamy, D., 460

Shonkoff, J. P., 605

Shorck, N. J., 395

Shortt, J. W., 188, 191

Shrestha, S., 291

Shulman, G. L., 148, 556

Shweder, R. A., 285

Siegbahn, A., 589

Siegel, E. H., 450

Siegel, R. D., 560

Siegel, R. E., 571

Siegfried, W. R., 225

Siegle, G. J., 395

Siegler, R. S., 134

Siemer, M., 6, 14, 134, 378, 382,

397, 413, 418, 419, 422

Siever, L. J., 495

Silananda, S. U., 549

Silk, J. S., 174, 187, 188, 189,

190, 196, 321

Sillence, A., 523

Silva, K. M., 164

Silva, P. A., 271

Silver, R., 435

Silverman, I. W., 114

Silvers, J. A., 29, 196, 432

Silvia, P. J., 377, 378

Sim, L., 189

Simmons, A., 309

Simmons, W. K., 448, 451, 452

Simon, H., 432

Simons, G., 293

Simons, R. F., 45, 49

Simpson, J. A., 229, 273

Sinclair, S., 255

Singer, B. H., 589

Singer, D. H., 204

Singer, J. E., 382

Singh, K. D., 223

Singleton, E. G., 433

Sinha, R., 430, 432, 433, 436,

614

Skinner, E. A., 194, 195

Skoner, D. P., 571, 587

Slagter, H. A., 552, 557

Slav, K., 243

Slessor, G., 213

Sliwinski, M. J., 211, 213

Sloan, D. M., 417, 461, 496,

500

Sloan, D. S., 321

Sloan, E. K., 575, 576

Sloman, S. A., 257

Slotema, C. W., 69

Slovic, P., 141

Slovik, L. F., 243

Small, B. J., 225

Small, D. A., 141, 620

Smallwood, J., 478

Smart, L., 353, 355

Smart Richman, L., 622

Smeets, M., 352

Smeets, T., 242

Smeetsa, P. A. M., 350

Smets, J., 416

Smider, N. A., 164

Smith, A., 560

Smith, B., 416

Smith, C. A., 383

Smith, C. F., 497

Smith, C. L., 162

Smith, E. A., 221

Smith, E. E., 28, 30, 141, 148,

435

Smith, E. R., 260, 263, 378

Smith, G. D., 587

Smith, G. T., 557

Smith, I. M., 161

Smith, J., 205

Smith, L., 615

Smith, M. R., 28

Smith, P. K., 80

Smith, T. B., 222

Smith-Shine, J. N., 188

Smits, J. A. J., 514

Smyth, J. M., 211, 589

Snidman, N., 571, 574

Snyder, C. R. R., 63, 93

Snyder, D. K., 276

Snyder, S. S., 194, 380

Snyder, W., 93

Soeteman, D. I., 494

Sofuoglu, M., 434

Sokol-Hessner, P., 141, 144, 146,

148, 149, 150, 472

Sokoloff, L., 230

Soler, J., 500

Solms, M., 557

Solomon, A., 416

Solomon, B., 52

Solomon, R. C., 284

Somerville, L. H., 63

Sommer, I. E. C., 69

Sommer, K. L., 622

Sonnenberg, S. J., 556

Sood, A. K., 574

Sorensen, E., 191

Sorg, S. F., 435

Soto, C. J., 326

Soto, J. A., 11, 295, 296

Soucy, N., 229

Sparrow, D., 589, 597

Speer, A. M., 69

652 Author Index

Speicher, C. E., 575

Speilberg, J. M., 403

Spencer, S. J., 617, 620

Spinrad, T. L., 119, 157, 158,

160, 161, 162, 163, 164, 165,

168, 179

Spira, A. P., 401

Spivey, M. J., 259

Sporns, O., 450, 456

Sprich, S., 500

Springer, C., 384

Srivastava, S., 11, 14, 327, 335,

337, 341, 579

Srnivasan, S. R., 596, 597, 604

Sroufe, L. A., 273

Srull, T. K., 367

St. Jacques, P. L., 207, 208

Stafford, T., 253

Stalnaker, T. A., 27

Stanley, E. A., 552

Stanley, S. M., 274

Stansbury, K., 114

Stansfeld, S., 241

Starfield, B., 587

Stark, R., 81, 223

Stasiewicz, P. R., 433

Staudinger, M. R., 11, 66, 145,

146, 148, 149, 150

Staudinger, U. M., 210

Stawski, R. S., 211, 212

Steele, C. M., 617

Steen, T. A., 531

Stefanucci, J. K., 222, 223, 224,

230

Stegall, S., 188, 604

Steger, M. F., 370

Stegge, H., 196

Stein, M. B., 309, 395, 398, 471

Stein, N. L., 284

Steinberg, L., 174, 187, 189, 190,

321, 432

Steiner, M., 198

Steinhauser, M., 128

Stein-Seroussi, A., 382

Stemmler, G., 11, 536

Stenberg, C., 293, 306

Stenger, V. A., 97

Stepper, S., 10, 499

Steptoe, A., 242, 602, 603

Sterling, P., 571, 576

Stern, Y., 212

Sternberg, R. J., 274

Stettler, N. M., 179

Stewart, J., 498

Stickle, T. R., 533

Stieglitz, R. D., 495

Stiff, C., 618

Stifter, C. A., 114, 161

Stiglmayr, C. E., 495

Stiles, W. B., 500

Stillman, T. F., 620

Stiner, L. M., 576

Stockburger, J., 45

Stokes, M. B., 253

Stone, A. A., 205, 589

Stone, M., 188

Stoolmiller, M., 188

Story, T. N., 206

Stouthamer-Loeber, M., 119

Strachman, A., 226, 273

Strack, F., 10, 256, 257, 263,

347, 353, 499

Strain, L. M., 258

Strange, B. A., 46

Straube, T., 79, 81, 82

Strauman, T. J., 473

Straus, M. A., 276

Streubel, B., 209

Strick, P. L., 28

Striepe, M., 614

Stroebe, W., 350, 354, 356, 620

Stroop, J. R., 79

Strosahl, K. D., 378, 474, 533

Strotz, R., 94, 104

Stroud, L. R., 187, 188, 589,

600, 614

Strunk, R. C., 590

Stucke, T. S., 615

Sturm, V. E., 270

Stuss, D. T., 97, 141

Suárez, L. M., 394

Sugarman, D. B., 276

Suh, E. M., 205

Sulik, M. J., 119, 157, 166

Sullivan, E. V., 435

Sullivan, K. A., 496

Sullivan, S., 274, 496

Suls, J., 382, 596, 597, 602, 603

Sumer, N., 241

Summers, W. C., 575

Sumter, S., 188

Sundin, E. C., 245

Sung, C., 576

Sunstein, C. R., 351

Suomi, S., 575

Supavadeeprasit, S., 190

Suri, G., 13, 128, 130, 399, 423

Sütterlin, S., 257

Sutton, R. E., 9, 145

Sutton, R. I., 9

Suvak, M. K., 460

Suway, J. G., 521

Svaldi, J., 535

Swann, W. B., Jr., 363, 381, 382

Swanson, C., 272

Swart, M., 532

Sweeny, K., 380

Swick, D., 509

Syme, S. L., 586

Synowski, S. J., 589

Szasz, P. L., 11

Szczurek, L., 9

Sze, J. A., 276

Szentagotai, A., 11

Szyf, M., 576

Taal, E., 548

Tabibnia, G., 11, 396, 435, 537

Tacikowski, P., 45

Taffe, J., 323, 328

Tafrate, R. C., 499

Tai, S., 418

Taioli, E., 432

Takacs, T. A., 241

Tamang, B. L., 291

Tambor, E. S., 381

Tamir, M., 3, 9, 11, 14, 15, 127,

192, 193, 223, 230, 297, 327,

335, 337, 361, 363, 364, 365,

366, 369, 370, 371, 532

Tan, J., 516

Tan, P. Z., 402

Tancer, M. E., 96

Tang, C. Y., 495

Tang, Y.-Y., 314, 315

Tangney, J. P., 377, 378, 384

Tanji, J., 403

Tannenbaum, D., 242

Tannock, R., 161

Tantleff-Dunn, S., 353

Tarter, R. E., 431, 432

Tata, P., 62, 395, 422, 510

Tate, E. B., 480, 557

Taylor, C. T., 514, 516, 517, 522,

524

Taylor, G. J., 13

Taylor, J., 145

Taylor, K., 243

Taylor, S. E., 46, 82, 83, 228,

382, 571, 575, 589, 602

Tchanturia, K., 496

Teachman, B. A., 205, 213

Author Index 653

Teasdale, J. D., 370, 414, 475,

479, 498, 529, 530, 536, 537,

550, 559, 560

Tebartz van Elst, L., 495

Teerds, J., 195, 417

Telch, M. J., 196

Tellegen, A., 251

Templeton, J., 188

Tennen, H., 589

Tenney, N., 395

Terdal, S. K., 381

Terschure, E., 284

Terwogt, M. M., 196

Tesman, J. R., 114

Tesser, A., 132, 538

Tessitore, A., 67, 121, 537

Testa, A., 118

Teti, L. O., 273

Thaker, P. H., 574

Thaler, R. H., 93, 99, 105, 106,

144, 351

Thapa, K., 293

Thayer, J. F., 401, 589, 599

Thewissen, R., 352

Thibaut, J. P., 453

Thiruchselvam, R., 10, 45, 48,

49, 51, 129, 130

Thomas, J., 167, 418

Thomas, K. M., 312

Thomas, P. W., 396

Thomas, S., 256, 396

Thomas, T. R., 497

Thompson, E., 252

Thompson, R. A., 5, 7, 12, 76,

77, 115, 118, 127, 128, 133,

173, 174, 175, 176, 177, 178,

180, 181, 182, 190, 191, 272,

322, 361, 368, 371, 399, 492,

496, 508, 520, 597

Thompson-Holland, J., 395

Thompson-Schill, S. L., 28, 33

Thomsen, A. H., 159

Thomson, G. E., 586

Thorberg, F. A., 496

Thoresen, C. E., 351, 552

Thorne, A., 188

Thorsteinsson, E. B., 589

Thurston, R. C., 602

Tian, X., 576

Tice, D. M., 111, 116, 117, 135,

230, 321, 615, 616, 618, 619,

621, 622, 623, 624

Tiebout, J., 574

Tiffany, S. T., 351, 352, 614, 623

Tiggemann, M., 351

Timpano, K. R., 395, 517

Tindle, H. A., 602

Tjebkes, T. L., 161

Tobin, R. M., 314

Todd, R. M., 252, 260

Tolin, D. F., 470

Toll, B. A., 433

Tomaka, J., 223, 367, 589

Tomarken, A. J., 66

Tomasello, M., 222, 223

Tomasi, D., 434

Tomich, P. L., 183

Tomko, R. L., 494

Toner, K., 208

Toney, L., 557

Tonge, B., 195

Tononi, G., 450

Tooby, J., 491, 538

Tormala, Z. L., 258

Torpey, D., 46

Toth, S., 178

Tottenham, N., 68, 167

Totterdell, P., 6, 135, 368

Toufexis, D. J., 63

Tout, K., 315

Townsend, A. L., 225

Trabasso, T., 284

Tracey, I., 33

Tracy, J. L., 384

Tran, S., 273

Tranel, D., 28, 141, 142

Treasure, J., 496

Tremblay, R. E., 605

Trew, J. L., 558

Treyer, V., 35, 148

Tricamo, M., 431

Trommsdorff, G., 293, 294

Tronick, E. Z., 178, 273, 277,

278

Trope, Y., 93, 105

Trötschel, R., 366

Troy, A. S., 127, 341, 368, 370,

406, 420, 508, 509

Trull, T. J., 494, 495

Tsai, A., 292

Tsai, J. L., 9, 206, 209, 285, 286,

287, 295, 363, 364

Tucker, A. M., 212

Tugade, M. M., 450

Tull, M. T., 396, 399, 495

Tung, J., 575

Turk, C. L., 396, 399, 469, 473,

496

Turk-Charles, S., 207

Turken, A. U., 622

Turner, R. B., 571, 587

Turza, A. C., 429

Tuschen-Caffier, B., 65, 83, 127,

418

Tversky, A., 136, 144

Twenge, J. M., 615, 621, 622

Tyler, E., 351

Tzur, G., 311

Uchida, Y., 289

Uchino, B. N., 204, 212, 227

Uher, R., 67

Uhlmann, C., 574

Ullsperger, M., 61

Underhill, L. G., 225

Underwood, B., 115

Ungerleider, L. G., 28

Updegraff, J. A., 398

Urgesi, C., 497

Urier, G., 575

Urry, H. L., 6, 13, 29, 33, 48, 52,

61, 128, 187, 210, 268, 287,

416, 420, 474

Ursache, A., 160, 164

Uutela, A., 601

Uyeji, L., 229

Vaillant, G., 367

Vainiger, D., 355

Vaitl, D., 81

Valiente, C., 160, 164, 168, 179

Van Bavel, J. J., 260, 261

Van Damme, S., 395

van den Bos, W., 94, 99

van den Hout, M., 395

van den Kommer, T., 195, 417

van den Wildenberg, W. P., 316

Van der Laan, L. N., 349

van der Molen, M. W., 316

van der Pligt, J., 354

Van Dillen, L. F., 61, 128, 132,

223, 347, 348, 349, 351, 352,

362

van Dulmen, M. M., 315

Van Gucht, D., 353

van Harreveld, F., 354

van IJzendoorn, M. H., 63, 229,

510

Van Knippenberg, A., 353, 618

654 Author Index

van Koningsbruggen, G. M.,

620

Van Lange, P. A., 223

van Oppen, P., 469

Van Overwalle, F., 452

Van Pelt, J., 188

Van Ree, J. M., 616

van Reekum, C. M., 29, 52, 61,

71, 263, 474

Van Rijsbergen, G. D., 529

van Steenbergen, H., 53

van Straten, A., 469

Van Strien, J. W., 46

van Veen, V., 35

Vansteenwegen, D., 353

Van’t Wout, M., 141, 142, 146,

148, 149, 150

VanYperen, N. W., 382

Vasan, R. S., 589

Vasey, M. W., 164, 516

Vaughan, J., 603

Veissier, I. I., 376

Veling, H., 353

Velten, E., 614

Verdejo-García, A., 431, 433

Verette, J., 243

Verhasselt, S., 500

Verheul, R., 494

Verhulst, F. C., 164

Vernon, M. L., 245

Veroff, J., 378

Versace, F., 52

Verschuere, B., 395, 522

Verstraeten, K., 164

Vervliet, B., 480

Viborg, G., 11

Vidmar, M., 166

Viergevera, M. A., 350

Vierthaler, J., 245

Vigil, S. A., 399

Villamil, E., 205, 210

Villarroel, N. A., 614

Vincenzo Piazza, P., 432

Vine, S. J., 223

Vinogradov, S., 86

Virmani, E. A., 180, 181

Visscher, B. R., 571, 575

Voegler-Lee, M., 166

Voelker, P. M., 167, 309, 312,

313

Vogelgesang, J., 195

Vohs, K. D., 116, 135, 230, 347,

348, 349, 350, 356, 618, 619,

620, 621, 623

Vokonas, P., 597

Volkow, N. D., 145, 230, 433,

434, 436, 437

Volokhov, R. N., 189, 354

von Cramon, D. Y., 27

Vrints, C. J., 571

Vuilleumier, P., 45, 47, 537

Vujanovic, A. A., 433

Wachs, T. D., 310

Wade, A. R., 449

Wadlinger, H. A., 511

Wadsworth, M. E., 159

Wager, T. D., 26, 27, 29, 30, 33,

36, 52, 62, 64, 83, 403, 452,

460, 496

Waggoner, A. S., 260

Wagner, A. D., 28, 33

Wagner, D. D., 119, 613, 614,

617, 619, 622

Wagner, G. G., 187, 192, 212,

214, 366

Wagner, J., 274

Walach, H., 548, 552

Waldinger, R. J., 191

Waldstein, S. R., 589

Walker, C. D., 498

Walker, D. L., 63

Walker, M. P., 492

Wall, S., 226, 237, 273, 277

Walle, E. A., 267

Wallentin, L., 589

Walter, H., 11, 58, 61, 65, 66,

82, 145, 432, 538, 574

Walters, E. E., 469, 530

Wang, G. J., 434

Wang, P. S., 413

Wang, R., 607

Wang, T. S., 119

Wang, X. T., 99

Wang, Y., 162

Wang, Z., 307

Wang Erber, M., 192

Warburton, W. A., 615

Ward, A. S., 353, 429, 617

Wardle, J., 116

Warlop, L., 99

Wasel, W., 255

Washburn, D. A., 315

Waters, E., 226, 237, 239, 273,

277

Waters, H. S., 239

Waters, S. F., 180, 181, 182, 183

Watkins, E. R., 127, 134, 415,

461, 470, 479, 558

Watkins, L. L., 601

Watson, D., 251, 461, 469, 484

Watson, J. C., 475

Wayment, H. A., 245

Weaver, I. C. G., 228, 229, 576

Webb, T. L., 10, 321, 341, 361,

367, 368

Weber, G., 514

Wechsler, R. L., 230

Weersing, V., 523

Wegner, D. M., 353, 378, 519,

537, 617, 618

Weierich, M. R., 209

Weimer, B. L., 183

Weinberg, A., 43, 44, 45, 46, 51,

53, 321, 337, 574

Weinberger, D. A., 367, 574

Weinberger, D. R., 67, 121, 537

Weiner, B., 382

Weiner, D. K., 556

Weintraub, J. K., 323, 330

Weisberg, R. B., 523

Weiss, A., 571

Weiss, F., 437

Weiss, N. H., 396, 399, 405

Weiss, S. T., 589

Weiss, T., 81

Weissman, R., 530, 539

Weissman, S., 530, 539

Weisz, J. R., 194, 285, 292, 380

Wells, A., 414, 415

Wells, T. T., 424, 474, 517

Welsh, R., 46

Wendelken, C., 229, 244

Wentzel, M., 165

Wenzlaff, R. M., 537

Werlinich, C. A., 383

Werner, K., 84, 400, 508, 529

Werner, K. H., 84, 400, 496,

508, 529

Werner-Seidler, A., 420

Wertheim, E. H., 113, 116

Wessa, M., 11, 65, 81, 314

Westbrook, C., 433, 434, 439

Westen, D., 8, 328

Westenberg, P., 188

Westlund, K. N., 26

Westlye, L. T., 204

Westphal, M., 128, 135, 368,

369, 398, 415, 533

Westra, H., 476

Wewerka, S., 188

Whalen, P. J., 96, 296

Author Index 655

Wheeler, L., 382

Whisman, M. A., 276

White, D., 450

White, J., 119, 510

White, L. K., 509, 521

White, T. L., 519

Whitley, B., 529, 531, 535

Whitmer, A. J., 127, 475

Whitney, G. A., 243

Whittington, E. J., 363

Wicker, B., 95

Wicklund, R. A., 377

Wiech, K., 28

Wiers, R. W., 351, 352, 353, 354,

523

Wiersema, J. R., 395

Wierzbicka, A., 284

Wieser, M. J., 31

Wilamowska, Z. A., 401

Wilbarger, J. L., 141, 349

Wildgruber, D., 207

Wile, D. B., 272, 279

Wilhelm, F. H., 4, 24, 76, 257,

276, 366, 368, 406, 420, 480,

600

Wilkinson, R. B., 245

Willer, R., 11, 341

Willhelm, F. H., 341

Williams, B. R., 161

Williams, C. J., 253

Williams, D. R., 586

Williams, H., 49, 129

Williams, J. B. W., 500

Williams, J. M. G., 424, 475,

498, 549, 559, 562

Williams, K. A., 556, 615

Williams, K. D., 230, 615, 622

Williams, L. E., 31, 288, 367

Williams, M. G., 509, 586

Williams, N. L., 242

Williams, P., 141

Williams, R., 422

Williams, R. M., 479

Williams, S. C. R., 66

Williamson, D. A., 497

Williamson, P. C., 460

Williford, A. P., 309

Willis, W. D., 26

Willmott, L., 599

Willner, P., 614, 623

Willoughby, M. T., 161, 166

Wilson, G., 483

Wilson, H. R., 208

Wilson, K. G., 378, 472, 474,

481, 482, 533

Wilson, M. N., 164

Wilson, M. R., 223

Wilson, S., 187

Wilson, T. D., 129, 130, 131,

254, 255, 256, 258, 350, 379,

380, 509

Wilson, W. H., 230

Wilson-Mendenhall, C. D., 14,

447, 448, 451, 453, 454, 458

Winecoff, A., 71

Winkielman, P., 141, 349

Winkler, I., 45

Winquist, J., 621

Wirth, R. J., 161

Wirtz, C., 535

Wisco, B. E., 127, 414, 470

Wise, R. A., 96, 145

Wise, S., 277

Witkiewitz, K., 432, 440, 561,

614

Witt, A. A., 548

Witt, W. P., 587

Wittenberg, L., 614

Wittman, M., 121

Wittstein, I. S., 588

Wohleb, E. S., 576

Woitach, M. J., 178

Wojnowicz, M. T., 259, 260

Wolf, O. T., 617

Wolfe, C. D., 316

Wolgast, M., 11, 398

Wolitzky-Taylor, K. B., 395

Woltering, S., 176

Wong, G., 419

Wong, L., 552

Wong, M. M., 496

Wood, C., 618

Wood, J. V., 363

Wood, P. K., 494

Wood, S., 46

Woody, S., 475, 484

Woolery, A., 589, 600

Woolley, A. W., 224

Worthington, E. L., Jr., 243

Wrase, J., 145

Wright, C. I., 63

Wrosch, C., 369

Wrzus, C., 187, 192, 212, 274

Wundt, W., 450

Wupperman, P., 529, 530, 531,

533, 535, 541

Wurm, L. H., 213

Wyatt, T., 181

Wyer, R. S., 367

Wynder, E. L., 432

Xiao, E., 146, 150

Xu, F., 454

Yamamura, N., 225

Yan, P., 436

Yang, E. V., 575

Yang, Y., 315

Yao, X., 9

Yap, M. B., 187, 188, 189, 191

Yarczower, M., 530

Yárnoz-Yaben, S., 243

Yeboah, J., 589

Yen, N. S., 46

Yen, Y., 118

Yeomans, J. S., 96

Yerkes, R. M., 270

Yeung, D., 286

Yeung, N., 103

Yi, R., 106

Yiend, J., 401

Yim, C. Y., 349

Yirmiya, N., 178

Yoo, S., 492

Yoon, J. E., 166

Young, L., 27

Young, R. D., 621

Young, R. M., 496

Younger, J., 227, 228

Youngstrom, E., 163

Youngstrom, E. A., 163

Yu, B. H., 416

Yuan, J. W., 275, 276, 278

Yurgelun-Todd, D., 189

Zack, J. A., 574

Zack, M. M., 205

Zacks, R. T., 422

Zadro, L., 615

Zahn-Waxler, C., 273, 294

Zajonc, R. B., 6, 140

Zaki, J., 27, 28

Zaldivar, F., 600

Zanakos, S., 378, 618

Zanarini, M. C., 495

Zangen, A., 355

Zanna, M. P., 252

Zayas, V., 240

656 Author Index

Zeidan, F., 551

Zeiss, A. R., 114, 616

Zeki, S., 226

Zelazo, P. D., 23, 252, 260, 261,

262

Zell, A. L., 321

Zeman, J., 181, 188, 189, 197,

604, 609

Zentner, M., 305

Zgierska, A., 439

Zhang, F., 242

Zhang, L., 111

Zhou, F., 589

Zhou, Q., 158, 160, 162, 166

Ziaie, H., 10, 309

Ziegenhain, U., 114

Zikopoulous, B., 459

Zilcha-Mano, S., 239

Zilles, K., 27

Zimmer-Gembeck, M. J., 194, 195

Zinser, M. C., 616

Znoj, H., 534, 535

Zoccola, P. M., 600

Zoellner, L. A., 11, 399, 405,

549

Zucker, R. A., 496

Zuckerman, M., 307

Zulfiqar, U., 204

Zvolensky, M. J., 401, 433, 533

Zysset, S., 27

657

Academic outcomes, 164–165,

431, 586

Acceptance

affect regulation training and,

536f, 537–538

anxiety disorders and, 397,

398, 403

ART model of adaptive affect

regulation and, 532f, 533

mindfulness training and,

554f, 555–556

Acceptance and commitment

therapy (ACT), 479, 481,

561

Acceptance-based interventions,

352, 378, 475

Adaptation

adaptive hopelessness, 532f

ART model of adaptive affect

regulation and, 532f

emotion regulation choice and,

129

normative emotional

functioning and, 472–473

overview, 195–197

self-awareness and, 385

Adjustment outcomes,

326–327

Adjustment problems, 163–164

Adolescence. See also

Developmental factors

attentional bias modification

approach and, 518–519

cardiovascular disease (CVD)

and, 606–607

development of emotional

regulation skills and,

189–192

emotion regulation strategies

and, 193–197

motivational processes and,

192–193

overview, 187–189, 197–198,

368

Adult attachment, 237, 240–247

Affect, 6, 305–306

Affect regulation training (ART).