Emotion Regulation Therapy: An Integrative Approach to Treatment-Resistant Anxiety Disorders

Cognitive-behavioral, psychodynamic, and experiential approaches have historically been characterized by differing definitions of emotions and beliefs concerning their role in psychopathological process and treatment. However, given recent advances in the basic psychological sciences of emotion and emotion regulation, theoretical orientations are converging on similar viewpoints as to the functional role of emotions in conceptualizing and treating of a variety of disorders. One such area where emotions and their regulation may play a significant role is in chronic, complex, and treatment-resistant forms of anxiety disorders such as generalized anxiety disorder (GAD). A review of the historical approaches to emotions in the major theoretical orientations is presented. Following this, a model of emotion disruption and dysregulation is presented as it relates to anxiety disorders and GAD, in particular. Finally, a new treatment for GAD, emotion regulation therapy, aimed at ameliorating dysfunctional affective processes, is described.     

情绪调节灵活性的研究进展

情绪调节是个体适应现实的主要方式之一。由于情境和策略均会影响情绪调节效果,近期研究不仅关注个体在特定情境下使用特定的情绪调节策略,而且更加关注个体在变化情境下灵活地使用不同的情绪调节策略,即强调情绪调节灵活性的作用。基于情绪调节灵活性是个体随着情境的改变而同步改变策略,本文提出了情境改变、策略改变以及情境和策略的同步改变三个要素,介绍了情绪调节灵活性的三水平模型和三成分模型,区分了情绪调节灵活性的三类研究范式,讨论了情绪调节灵活性及其适应性,并指出了未来值得关注的研究方向。     

The Development of Anxiety Disorders: Considering the Contributions of Attachment and Emotion Regulation

Anxiety disorders are among the most common psychiatric disorders in childhood. Nonetheless, theoretical knowledge of the development and maintenance of childhood anxiety disorders is still in its infancy. Recently, research has begun to investigate the influence of emotion regulation on anxiety disorders. Although a relation between anxiety disorders and emotion regulation difficulties has been demonstrated, little attention has been given to the question of why anxious individuals have difficulties regulating their emotions. The present review examines the evidence of the link between emotion regulation and anxiety. It also explores the unique contributions of attachment style and dysfunctional emotion regulation to the development of anxiety disorders.     

The Role of Emotion Regulation in the Treatment of Child Anxiety Disorders

In this review, we examine the role of emotion regulation in the treatment of children with anxiety disorders. Cognitive-behavioral therapy (CBT) has been shown to “work” for children with anxiety disorders and it has been categorized as an evidence-based treatment. However, most studies have shown that the treatment is effective for about 60–70% of children, leaving the remaining children symptomatic and oftentimes with persisting psychological disorders. Of importance, it has also been shown that many children with anxiety disorders demonstrate poor emotion regulation skills. Despite these findings, little attention has been directed toward incorporating emotion regulation strategies into these relatively effective cognitive-behavioral treatments. It is possible that CBT programs do not work as well for a portion of children because their emotion regulation deficits, if present, are not being targeted sufficiently. In this review, it is suggested that adding an emotion regulation component could increase treatment efficacy. In addition, strategies aimed at improving emotion regulation at the individual level and at the family level are introduced. Details of how improved emotion regulation skills could be beneficial in bringing about change are discussed. Finally, issues of measurement and the clinical implications for research and practice are considered.     

Assessing Emotion Regulation in Social Anxiety Disorder: The Emotion Regulation Interview

Social anxiety disorder (SAD) is thought to involve emotional hyper-reactivity and emotion dysregulation. However, the precise nature of the emotion dysregulation in SAD has not been well characterized. In the present study, the Emotion Regulation Interview (ERI) was developed to quantify the frequency and self-efficacy of five emotion regulation strategies specified by Gross’s (Review of General Psychology 2: 271–299, 1998) process model of emotion regulation. Forty-eight individuals with SAD and 33 healthy controls (HCs) were interviewed about responses during (a) a laboratory speech task and (b) two recent social anxiety-evoking situations. Individuals with SAD reported greater use of avoidance and expressive suppression than HCs, as well as lesser self-efficacy in implementing cognitive reappraisal and expressive suppression. These regulation deficits were not accounted for by differences in emotional reactivity. These findings highlight specific emotion regulation deficits in SAD, and support the idea that the Emotion Regulation Interview may be usefully applied to other clinical disorders.     

Comorbidity of Anxiety and Depression in Children and Adolescents: An Integrative Review

Much evidence exists documenting the comorbidity of anxiety and affective disorders in youth. Furthermore, comorbidity appears to have serious implications both in terms of severity of impairment and course of disorder. Despite this, little is known about the meaning behind the high rate of co-occurrence of anxiety and depression in children and adolescents. Several conditions exist that may give rise to comorbidity. Specifically, two disorders may be comorbid when there is a high rate of symptom overlap between the disorders, when one underlying construct is split into two separate disorders, when the disorders share common risk or etiological factors, or because one disorder causes or increases the risk of developing the second disorder. The present paper examines each of these explanations as they relate to the comorbidity of anxiety and depression in youth.     

Emotion Regulation and the Specific Associations with Health Anxiety

This study investigated two primary research aims surrounding health anxiety: (a) to examine what differences exist in emotion regulation strategies of health anxious and non-health anxious populations and (b) to investigate what emotion regulation strategies predict health anxiety, before and after controlling for trait cognitive and somatic anxiety. A total of 95 participants of the general population completed a series of online questionnaires. A single factor between groups MANOVA revealed that a health anxious group scored significantly higher in several emotion regulation strategies: distraction, external attribution, emotion expression and acting out; anxiety-related variables: trait cognitive and somatic anxiety; and beliefs about the negative consequences of becoming ill. Hierarchical regressions showed that several emotion regulation strategies were significantly associated with higher levels of health anxiety, before: distraction, external attribution, capitalising, positive reappraisal and emotional expression; and after: external attribution and capitalising, the control of trait anxiety. Overall, the results demonstrated that (a) emotional intelligence and behavioural attempts to understand emotional experiences may be associated with specific health anxiety symptomology, while a lack of effective cognitive strategies and worry may be responsible for the associated trait anxiety dimensions.     

用整合的观点看情绪

该文主要根据James R．Averill(1997)等人的观点，从整合的角度探讨了情绪问题，阐述了情绪分析的框架。此框架由6个情绪变量组成，分五个水平。在阐述了这五个水平及其关系之后，又从下向上论述了处于不同情绪组织水平上的成份反应、情绪状态、情绪症侯群和气质特征。     

Emotion Regulation Therapy for Generalized Anxiety Disorder

Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations, such as patients with generalized anxiety disorder, fails to evidence adequate treatment response. Emotion Regulation Therapy (ERT) integrates facets of traditional and contemporary CBTs, mindfulness, and emotion-focused interventions within a framework that reflects basic and translational findings in affect science. Specifically, ERT is a mechanism-targeted intervention focusing on patterns of motivational dysfunction while cultivating emotion regulation skills. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. This article provides an illustration of ERT through the case of “William.” In particular, this article includes a case-conceptualization of William from an ERT perspective while describing the flow and progression of the ERT treatment approach.     

Emotion Regulation Across the Life Span: An Integrative Perspective Emphasizing Self-Regulation,Positive Affect,and Dyadic Processes

In this commentary, we build upon the papers featured in this 2-part special issue to advance an integrative perspective on emotion regulation that emphasizes the developmentally specific goal-contexts of emotional phenomena. We highlight the importance of (1) multilevel longitudinal investigations of interactions among biological, affective, cognitive, and behavioral processes with respect to emotion regulation; (2) the integration of emotion-regulation processes with self-regulatory processes across the life course; (3) the dynamic relationship between positive and negative affect and their respective influence on regulatory processes; and (4) greater consideration of the dyadic context of emotion-regulation processes. From this perspective, the optimal developmental outcome with respect to emotion regulation is not affective homeostasis, but rather a dynamic flexibility in emotional experience, the ability to pursue and prioritize different goals, and the capacity to selectively and proactively mobilize emotions and cognitions in the service of context-specific and developmentally specific goals.     

Guilt and Guiltlessness: An Integrative Review

This paper reviews the relationship between guilt and prosocial behaviors, and integrates multiple antisocial phenomena with the construct of guiltlessness both at the interpersonal and intergroup level. Interpersonal guilt is basically prosocial and introspective. Collective guilt is the vicarious acceptance of misdeeds of the ingroup. Yet it is sometimes so painful and detrimental for the individual and the society to tolerate guilt that people do not feel guilty, especially when the possibility of reparation is low. We argue that guilt is the acceptance of the mildly undesirable self whereas guiltlessness is the rejection of unbearable mental distress of anticipatory guilt. Guiltlessness requires great efforts for defense and justification. Multiple strategies and justifications are sought to relieve guilt. Furthermore, guiltlessness is related to various personality and ideology variables and entails moral disengagement. Guiltlessness can be destructive because, for example, during times of large‐scale conflicts ordinary people who feel guiltless are inclined to become ruthless. Reciprocity morality, ostracism, deservingness, empathy, and self‐control are proposed as means of explaining the origins of guilt and their implications for guiltlessness.     

Relations of Tripartite Dimensions of Emotion to Childhood Anxiety and Mood Disorders

This study examined preliminary higher-order models relating tripartite dimensions of emotion to severity of anxiety and depressive disorders in 100 clinically referred children and adolescents. In light of the accumulating support for multifactor models of vulnerability and negative emotion in children, the present investigation was designed to establish preliminary estimates of the structure and magnitude of the relations of three emotion factors with dimensions of social anxiety, depression, panic, generalized anxiety, obsessions/compulsions, and separation anxiety. Results were consistent with structures that minimally specified two higher-order emotion factors, yet only some parameter estimates were consistent with theory regarding the tripartite model. Problems with the measurement of tripartite factors and possibilities for further research are outlined.     

积极情绪调节的ERP研究

利用ERP技术研究认知重评对积极情绪调节及后续认知任务的影响。先呈现积极图片,要求被试被动观看或认知重评。接着呈现情绪词,要求被试进行效价判断。结果显示,在情绪调节阶段,与被动观看或评价忽视相比,评价重视调节下的LPP更大。在词呈现阶段,被试的反应时受情绪调节的影响,表现为:评价忽视>评价重视>被动观看。在160-720ms期间,认知重评之后词汇所诱发的ERP与被动观看后词汇的ERP有显著差异,支持情绪调节损耗认知资源的观点。     

Longitudinal Links among Mother and Child Emotion Regulation,Maternal Emotion Socialization,and Child Anxiety

Research on Child and Adolescent Psychopathology - Models of transdiagnostic family emotion processes recognize parents’ emotion-related characteristics and behaviors as key contributors to...     

Patterns of Emotional Reactivity and Regulation in Children with Anxiety Disorders

Emotion dysregulation is believed to be a key factor in anxiety disorders. However, the empirical basis for this view is limited, particularly in children and adolescents. This study aimed to examine whether anxious children display negative emotional hyper-reactivity and deficits in emotion regulation, using a new task that presents ambiguous situations with potentially threatening meanings. Forty-nine children diagnosed with either generalized anxiety disorder, social anxiety, or separation anxiety disorder, were compared with 42 non-anxious controls. Relative to controls, anxious children demonstrated (a) greater intensity and frequency of negative emotional responses, (b) deficits in using reappraisal in negative emotional situations and corresponding deficits in reappraisal self-efficacy, and (c) greater reliance on emotion regulation strategies that increase the risk of functional impairment, intense negative emotion, and low emotion regulation self-efficacy. Implications for the assessment and treatment of childhood anxiety are discussed.     

The Effects of Anxiety and Depressive Symptoms on Daily Positive Emotion Regulation

Individuals with anxiety and depressive symptoms exhibit disturbances in positive emotion regulation, which may hinder full recovery. By comparison, individuals with strong beliefs regarding their capacity to “savor” or maintain positive emotions (i.e., savoring beliefs) display more adaptive positive emotion regulation. The present daily diary study explores three momentary processes involved in positive emotion regulation, namely positive emotion reactivity, regulatory goals, and regulatory effectiveness, and examines the comparative effects of baseline anxiety and depressive symptoms versus savoring beliefs on such processes in real-life contexts. A sample of 164 nonclinical undergraduates provided baseline measures of anxiety and depressive symptom severity and savoring beliefs prior to completing 14 daily assessments of positive emotions and emotion regulatory responses to daily positive events. Results indicated that higher baseline anxiety and depressive symptom severity were associated with decreased positive emotion reactivity and increased down-regulation of positive emotions; higher baseline savoring beliefs were associated with increased positive emotion reactivity, decreased down-regulation and increased up-regulation of positive emotions. Potential clinical implications are discussed.     

The Associations Among Parent Anxiety,Emotion Regulation,and Parenting Behaviors

Journal of Child and Family Studies - Parenting behaviors play an essential role in healthy youth development, and poor parenting behaviors place youth at risk of developing problem behaviors,...     

Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders

Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.     

On Targeting Emotion Regulation Deficits in Eating Disorders through Defense Analysis

ABSTRACT

Psychodynamic approaches to the treatment of individuals with eating disorders are underrepresented in research and in academia. This will increasingly deprive patients of a viable therapeutic alternate to the dominant behavioral family-based models. As psychodynamic approaches may have unique benefits, there is value in resolving this loss. Recent models of dynamic therapies for eating disorders within modern, empirically derived theory show promise for future psychodynamic viability. An attachment-focused approach targeting disordered attachment patterns that are common in individuals with eating disorders has recently been introduced. To complement this model, this article proposes an approach for individuals with eating disorders that is hypothesized to target emotion regulation deficits that are also commonly found in individuals with eating disorders. Observed parallels between the implicit branch of the emotion regulation system and that of contemporary constructs of defense mechanisms guide this proposal. Developmental considerations reveal important connections between this biologically based model and a two-person model based in attachment theory. In this way, this proposal offers a flexible psychodynamic approach that integrates with the existing literature. Further development of this approach could one day help patients to have a greater range of therapeutic options for recovery from eating disorders.