Determinism, “Freedom,” and Psychotherapy†

Objective: Childhood abuse is associated with a wide range of negative outcomes, including increased risk for development of emotion dysregulation and psychopathology, such as posttraumatic stress disorder (PTSD). The goal of the present study was to examine associations between child abuse, PTSD symptoms, and performance on an emotional conflict regulation task that assesses implicit emotion regulation abilities. Method: The sample consisted of 67 (94% African American) females recruited from a public, urban hospital. Childhood abuse was measured using the Childhood Trauma Questionnaire, and PTSD was measured using the modified PTSD Symptom Scale. Task accuracy and implicit emotion regulation were measured through an emotional conflict regulation behavioral task. Results: A multivariate analysis of covariance showed that exposure to moderate to severe childhood abuse was significantly related to worse emotional conflict regulation scores independent of current PTSD symptoms, depressive symptoms, and adult trauma exposure, suggesting a deficit in implicit emotion regulation. We also found an interaction between PTSD symptoms and abuse exposure in predicting accuracy on the behavioral task; high levels of PTSD symptoms were associated with poorer task accuracy among individuals who reported moderate to severe exposure to childhood abuse. However, no relationship between implicit emotion regulation abilities and overall PTSD symptom severity was found. Conclusions: This study provides preliminary evidence of an implicit emotion regulation deficit for individuals exposed to significant childhood abuse and further supports the growing evidence that addressing various aspects of emotion dysregulation, such as awareness of emotions and strategies to manage strong emotions, in the context of treatment would be valuable.     

Explicit semantic stimulus categorization interferes with implicit emotion processing

Previous functional magnetic resonance imaging and event-related brain potential studies revealed that performing a cognitive task may suppress the preferential processing of emotional stimuli. However, these studies utilized simple and artificial tasks (i.e. letter, shape or orientation discrimination tasks), unfamiliar to the participants. The present event-related potential study examined the emotion–attention interaction in the context of a comparably more natural scene categorization task. Deciding whether a natural scene contains an animal or not is a familiar and meaningful task to the participants and presumed to require little attentional resources. The task images were presented centrally and were overlaid upon emotional or neutral background pictures. Thus, implicit emotion and explicit semantic categorization may compete for processing resources in neural regions implicated in object recognition. Additionally, participants passively viewed the same stimulus materials without the demand to categorize task images. Significant interactions between task condition and emotional picture valence were observed for the occipital negativity and late positive potential. In the passive viewing condition, emotional background images elicited an increased occipital negativity followed by an increased late positive potential. In contrast, during the animal-/non-animal-categorization task, emotional modulation effects were replaced by strong target categorization effects. These results suggest that explicit semantic categorization interferes with implicit emotion processing when both processes compete for shared resources.     

Context-based interpersonal relationship modulates social comparison between outcomes: an event-related potential study

Social comparison is a common behavior that largely determines people’s experience of decision outcome. Previous research has showed that interpersonal relationship plays a pivotal role in social comparison. In the current study, we investigated whether the manipulation of context-based relationship would affect participants’ comparison of self-outcome and other-outcome. Participants first finished a trust game with likeable (dislikeable) partner and then they were involved in a gambling task and observed the outcomes for themselves and for partners. According to self-reports, participants were more satisfied with likeable partner’s gains than losses only when they received gains, but they were always more satisfied with dislikeable player’s losses compared to gains. Event-related potentials including the feedback-related negativity (FRN), P3 and late positive component (LPC) were sensitive to context-based relationship. Specifically, the prediction error signal (indexed by the FRN) was largest when participants received losses but dislikeable player received gains. Meanwhile, the P3 indicates that participants had stronger motivation to outperform dislikeable player. Finally, the LPC was larger when participants received the same outcomes with dislikeable players. In general, our results support the key point of the self-evaluation maintenance model that personal closeness modulates subjective sensitivity when drawing a comparison of one’s outcomes with other’s outcomes.     

Emotion-induced loss aversion and striatal-amygdala coupling in low-anxious individuals

Adapting behavior to changes in the environment is a crucial ability for survival but such adaptation varies widely across individuals. Here, we asked how humans alter their economic decision-making in response to emotional cues, and whether this is related to trait anxiety. Developing an emotional decision-making task for functional magnetic resonance imaging, in which gambling decisions were preceded by emotional and non-emotional primes, we assessed emotional influences on loss aversion, the tendency to overweigh potential monetary losses relative to gains. Our behavioral results revealed that only low-anxious individuals exhibited increased loss aversion under emotional conditions. This emotional modulation of decision-making was accompanied by a corresponding emotion-elicited increase in amygdala-striatal functional connectivity, which correlated with the behavioral effect across participants. Consistent with prior reports of ‘neural loss aversion’, both amygdala and ventral striatum tracked losses more strongly than gains, and amygdala loss aversion signals were exaggerated by emotion, suggesting a potential role for this structure in integrating value and emotion cues. Increased loss aversion and striatal-amygdala coupling induced by emotional cues may reflect the engagement of adaptive harm-avoidance mechanisms in low-anxious individuals, possibly promoting resilience to psychopathology.     

Evidence for an emotion maintenance deficit in schizophrenia

Research has indicated that people with schizophrenia have deficits in reward representation and goal-directed behavior, which may be related to the maintenance of emotional experiences. Using a laboratory-based study, we investigated whether people with schizophrenia were able to maintain an emotional experience when given explicit instructions to do so. Twenty-eight people with schizophrenia and 19 people without completed a behavioral task judging their emotional experience of pictures held over a three second delay. This emotion maintenance task was compared to a subsequent in-the-moment emotion experience rating of each picture. In addition, all participants completed an analogous brightness experience maintenance and rating task, and patients completed a standardized visual working memory task. Participants with schizophrenia showed normal in-the-moment emotion experience of the emotion pictures; however, they showed decreased performance on emotion maintenance (for both positive and negative emotion) compared to participants without schizophrenia, even after controlling for brightness maintenance. The emotion maintenance deficit was not associated with visual brightness performance nor with performance on the visual working memory task; however, negative emotion maintenance was associated with an interview-based rating of motivation. These findings suggest that some aspects of impaired emotion maintenance in schizophrenia may be related to deficits in motivated behavior.     

Emotion regulation reduces loss aversion and decreases amygdala responses to losses

Emotion regulation strategies can alter behavioral and physiological responses to emotional stimuli and the neural correlates of those responses in regions such as the amygdala or striatum. The current study investigates the brain systems engaged when using an emotion regulation technique during financial decisions. In decision making, regulating emotion with reappraisal-focused strategies that encourage taking a different perspective has been shown to reduce loss aversion as observed both in choices and in the relative arousal responses to actual loss and gain outcomes. In the current study, we find using fMRI that behavioral loss aversion correlates with amygdala activity in response to losses relative to gains. Success in regulating loss aversion also correlates with the reduction in amygdala responses to losses but not to gains. Furthermore, across both decisions and outcomes, we find the reappraisal strategy increases baseline activity in dorsolateral and ventromedial prefrontal cortex and the striatum. The similarity of the neural circuitry observed to that seen in emotion regulation, despite divergent tasks, serves as further evidence for a role of emotion in decision making, and for the power of reappraisal to change assessments of value and thereby choices.     

The associations of emotion regulation and dysregulation with the metabolic syndrome factor

OBJECTIVE: Emotion regulation has been associated with good, and dysregulation with poor subjective health; but it is unclear if emotion regulation is related to metabolic syndrome. METHODS: Associations between the metabolic syndrome factor (systolic and diastolic blood pressure, waist circumference, high-density lipoprotein, triglycerides, and glucose), emotion regulation (the strategies of repair and maintenance, self-perceived emotion regulation) and dysregulation (emotional ambivalence); and subjective health (self-rated health and psychosomatic symptoms) were studied using a structural equation modelling (SEM) approach. The participants (96 women, 85 men) were drawn from the Jyv?skyl? Longitudinal Study of Personality and Social Development (JYLS). RESULTS: High repair was associated directly to the low metabolic syndrome factor, while high maintenance, high self-perceived emotion regulation, and low emotional ambivalence were related indirectly to the low metabolic syndrome factor through good subjective health. CONCLUSIONS: Successful emotion regulation may have an association not only with the subjective experience of health, but also with physiological regulation systems, leading to a reduced risk for metabolic syndrome.     

Alexithymia influences brain activation during emotion perception but not regulation

Alexithymia is a psychological construct that can be divided into a cognitive and affective dimension. The cognitive dimension is characterized by difficulties in identifying, verbalizing and analysing feelings. The affective dimension comprises reduced levels of emotional experience and imagination. Alexithymia is widely regarded to arise from an impairment of emotion regulation. This is the first functional magnetic resonance imaging (fMRI) study to critically evaluate this by investigating the neural correlates of emotion regulation as a function of alexithymia levels. The aim of the current study was to investigate the neural correlates underlying the two alexithymia dimensions during emotion perception and emotion regulation. Using fMRI, we scanned 51 healthy subjects while viewing, reappraising or suppressing negative emotional pictures. The results support the idea that cognitive alexithymia, but not affective alexithymia, is associated with lower activation in emotional attention and recognition networks during emotion perception. However, in contrast with several theories, no alexithymia-related differences were found during emotion regulation (neither reappraisal nor suppression). These findings suggest that alexithymia may result from an early emotion processing deficit rather than compromised frontal circuits subserving higher-order emotion regulation processes.     

Contrasting roles for lateral and ventromedial prefrontal cortex in transient and dispositional affective experience

Prefrontal cortex (PFC) has been implicated in the experience and regulation of emotional states. Emotional experience is a complex construct, encompassing a range of more specific processes. This exploratory study aimed to delineate which (if any) aspects of emotional experience rely critically on either the ventromedial frontal (VMF) or lateral frontal (LF) lobes. The affective experience of individuals with damage to these regions was surveyed in detail using several measures and compared with that of control participants. Dependent measures included subjective and observer ratings of both dispositional affect and transient responses to laboratory mood inductions. VMF damage was associated with greater negative dispositional affect relative to controls and to individuals with LF damage; however, transient responses to emotional stimuli were largely normal. In contrast, LF damage was associated with an exaggerated subjective reactivity to sad emotional stimuli relative to control participants, but normal dispositional affect. Interestingly, neither form of PFC damage affected spontaneous emotion recovery following the mood inductions. These findings suggest a role for VMF in modulating dispositional negative affect; in contrast, LF areas appear to be critical in regulating transient emotional responses while emotional stimuli are present. This study also illustrates the dissociability of different aspects of emotional experience in patients with focal brain injury.     

Neural correlates of immediate and prolonged effects of cognitive reappraisal and distraction on emotional experience

Cognitive emotion regulation strategies are important components of cognitive-behavioral therapy (CBT). Additionally, up-regulation and difficulties in the down-regulation of negative feelings are associated with mental disorders. However, little is known about the lasting effects of cognitive emotion regulation strategies on emotional experience and associated neural activation. Therefore, this study investigated immediate and prolonged effects of emotion regulation using cognitive reappraisal and distraction on subjective report and its neural correlates. Twenty-seven healthy females took part in a 2-day functional magnetic resonance imaging study. They were instructed to either up-regulate or down-regulate their negative feelings using a situation-focused cognitive reappraisal strategy, to distract themselves by imagining a specific neutral situation, or to passively look at repeatedly presented aversive and neutral pictures. Re-exposure to the same stimuli without a regulation instruction was conducted one day later. Self-reported negative feelings and blood-oxygen-level-dependent responses served as main outcome variables. As expected, the results show successful immediate up- or down-regulation of negative feelings by cognitive reappraisal and down-regulation of negative feelings by distraction. Furthermore, these changes in negative feelings were correlated with amygdala activation. A lasting effect on emotional experience associated with stronger ventromedial prefrontal cortex activation was found for down-regulation of negative feelings via cognitive reappraisal. Compared to distraction, down-regulation via cognitive reappraisal led to reduced negative feelings and stronger dorso- and ventrolateral prefrontal cortex responses one day later. While cognitive reappraisal and distraction are both effective strategies during active regulation, only cognitive reappraisal had a lasting effect. These findings might have implications for CBT.     

Regulation of emotions during experimental stress in alexithymia

OBJECTIVE: The aim of this study was to examine whether deficits in emotion regulation manifest as a relative lack of congruence between subjective reports of emotion and autonomic activity when confronted with stressors. METHODS: A pool of 830 university students was screened using the Toronto Alexithymia Scale-Revised for deficits in emotion regulation associated with alexithymia. Those meeting a criterion floor cutoff and other inclusion criteria composed the experimental group and were matched on age, gender, and race to those in the control group. A final sample size of 94 students (47 in each group) was presented with experimental stressor tasks (the Stroop task and a conversation task) in counterbalanced order while autonomic activity data (heart rate and skin conductance) and subjective reports of negative affect were continuously collected during baseline, stressor exposure, and recovery periods. Data were analyzed to determine relative differences in congruence between the autonomic and subjective measures. RESULTS: Data suggested that participants high in emotion regulation deficits reported consistently higher subjective negative affect relative to those without such deficits throughout baseline, stressor exposure, and recovery periods. However, autonomic activity remained nearly identical in both groups across phases. Explicit tests of group differences in congruence between autonomic and subjective emotion measures also partly supported evidence of subjective hyperarousal. CONCLUSIONS: Deficits in emotion regulation, as evidenced in those with high levels of the alexithymic trait, appear to manifest as chronically elevated subjective negative affect relative to autonomic activity regardless of the level of environmental demands. Theoretical and clinical implications of these findings are discussed.     

Implicit emotion perception in schizophrenia

Explicit but not implicit facial emotion perception has been shown to be impaired in schizophrenia. In this study, we used newly developed technology in social neuroscience to examine implicit emotion processing. It has been shown that when people look at faces, they automatically infer social traits, and these trait judgments rely heavily on facial features and subtle emotion expressions even with neutral faces. Eighty-one individuals with schizophrenia or schizoaffective disorder and 62 control subjects completed a computer task with 30 well-characterized neutral faces. They rated each face on 10 trait judgments: attractive, mean, trustworthy, intelligent, dominant, fun, sociable, aggressive, emotionally stable and weird. The degree to which trait ratings were predicted by objectively-measured subtle emotion expressions served as a measure of implicit emotion processing. Explicit emotion recognition was also examined. Trait ratings were significantly predicted by subtle facial emotional expressions in controls and patients. However, impairment in the implicit emotion perception of fear, happiness, anger and surprise was found in patients. Moreover, these deficits were associated with poorer everyday problem-solving skills and were relatively independent of explicit emotion recognition. Implicit emotion processing is impaired in patients with schizophrenia or schizoaffective disorder. Deficits in implicit and explicit emotion perception independently contribute to the patients' poor daily life skills. More research is needed to fully understand the role of implicit and explicit processes in the functional deficits of patients, in order to develop targeted and useful remediation interventions.     

Subjective emotional experience at different stages of Parkinson's disease

Subjective emotional experience is thought to rely on a large cortical-subcortical network including orbitofrontal and cingulate frontostriatal circuits together with the mesolimbic dopaminergic system that modulates their activity. Parkinson's disease (PD) provides a model for exploring this issue. By using an original emotion induction procedure, the present study examined to what extent subjective experience of emotion of PD patients at different stages of the disease was modulated by emotion in the same way as healthy individuals. A battery of film excerpts was used to elicit different emotional feelings (happiness, anger, fear, sadness, disgust, and neutral) in 15 newly diagnosed PD patients, 18 patients with advanced PD and 15 matched controls. The newly diagnosed patients were examined in two conditions: "on" and "off" dopaminergic medication. Participants reported the intensity of their emotional feelings on a scale consisting of 10 emotional categories. Results indicated that PD patients at different stages of the disease did not significantly differ from the controls in the self-reported emotional experience to the presented film excerpts. Moreover, analyses conducted within the newly diagnosed PD group (on-dopa vs. off-dopa conditions) indicated that the patients' emotional reactivity to the presented film excerpts was not significantly modulated by dopaminergic medication. These results thus question the possible role of dopaminergic pathways in subjective emotional experience, at least in this sample and in the context of emotion induction.     

A systematic review of studies that used NIRS to measure neural activation during emotion processing in healthy individuals

Functional neuroimaging provides an avenue for earlier diagnosis and tailored treatment of psychological disorders characterised by emotional impairment. Near-infrared spectroscopy (NIRS) offers ecological advantages compared to other neuroimaging techniques and suitability of measuring regions involved in emotion functions. A systematic review was conducted to evaluate the capacity of NIRS to detect activation during emotion processing and to provide recommendations for future research. Following a comprehensive literature search, we reviewed 85 journal articles, which compared activation during emotional experience, regulation or perception with either a neutral condition or baseline period among healthy participants. The quantitative synthesis of outcomes was limited to thematical analysis, owing to the lack of standardisation between studies. Although most studies found increased prefrontal activity during emotional experience and regulation, the findings were more inconsistent for emotion perception. Some researchers reported increased activity during the task, some reported decreases, some no significant changes, and some reported mixed findings depending on the valence and region. We propose that variations in the cognitive task and stimuli, recruited sample, and measurement and analysis of data are the primary causes of inconsistency. Recommendations to improve consistency in future research by carefully considering the choice of population, cognitive task and analysis approach are provided.     

The role of the medial frontal cortex in the maintenance of emotional states

Evidence is accruing that people can maintain their emotional states, but how they do it and which brain regions are responsible still remains unclear. We examined whether people maintain emotional states ‘actively’, with explicit elaboration of the emotion, or ‘passively’, without elaboration. Twenty-four participants completed an emotion maintenance task in which they either maintained the emotional intensity from the first picture of a pair to compare to that of the second picture (‘maintain’ condition), or only rated their emotional response to the second picture (‘non-maintain’ condition). Supporting the ‘active’ maintenance hypothesis, when maintaining vs not maintaining emotion, participants exhibited increased height and width of activation in the dorsal medial frontal cortex (MFC) and lateral prefrontal cortex, regions associated with explicit emotion generation and manipulation of contents in working memory, respectively. Supporting the ‘passive’ maintenance hypothesis, however, when viewing negative emotional pictures (vs neutral pictures) that were not explicitly maintained, participants exhibited greater duration of activity in the rostral MFC, a region associated with implicit emotion generation. Supported by behavioral findings, this evidence that people maintain emotional states both naturally in the rMFC and strategically in the dMFC may be critical for understanding normal as well as disordered emotion regulation.     

Stop laughing! Humor perception with and without expressive suppression

The neurophysiological study of emotion regulation focused on the strategy of reappraisal-i.e., the cognitive reinterpretation of a stimulus. Reappraisal reduces emotional expression, the experience of both negative and positive feelings, and the amplitude of an event-related potential (ERP)-the late positive potential (LPP). In contrast, the strategy of expressive suppression (ES), being the inhibition of emotional expression, has been reported to reduce subjective feelings of positive, but not negative emotion, and has not yet been investigated with ERPs. We focused on the LPP to assess the correlates of ES in the context of humor perception. Twenty-two female participants rated sequences of humorous (H) and non-humorous (NH) pictures, while their zygomaticus muscle was recorded. A spontaneous (SP) condition, in which participants attended naturally to the pictures, resulted in higher ratings of funniness, increased smiling, and increased LPP amplitude for H compared to NH stimuli. An ES condition, in which participants suppressed their facial reactions, resulted in reduced smiling, without affecting subjective ratings. LPP amplitude did not differ between H and NH stimuli during ES, suggesting equal allocation of processing resources to both stimuli. These results suggest that, similarly to reappraisal, ES modifies the way the brain processes positive emotional stimuli.     

Stop laughing! Humor perception with and without expressive suppression

The neurophysiological study of emotion regulation focused on the strategy of reappraisal—i.e., the cognitive reinterpretation of a stimulus. Reappraisal reduces emotional expression, the experience of both negative and positive feelings, and the amplitude of an event-related potential (ERP)—the late positive potential (LPP). In contrast, the strategy of expressive suppression (ES), being the inhibition of emotional expression, has been reported to reduce subjective feelings of positive, but not negative emotion, and has not yet been investigated with ERPs. We focused on the LPP to assess the correlates of ES in the context of humor perception. Twenty-two female participants rated sequences of humorous (H) and non-humorous (NH) pictures, while their zygomaticus muscle was recorded. A spontaneous (SP) condition, in which participants attended naturally to the pictures, resulted in higher ratings of funniness, increased smiling, and increased LPP amplitude for H compared to NH stimuli. An ES condition, in which participants suppressed their facial reactions, resulted in reduced smiling, without affecting subjective ratings. LPP amplitude did not differ between H and NH stimuli during ES, suggesting equal allocation of processing resources to both stimuli. These results suggest that, similarly to reappraisal, ES modifies the way the brain processes positive emotional stimuli.     

Stability of emotional dysfunctions? A long-term fMRI study in first-episode schizophrenia

OBJECTIVE: Patients with schizophrenia are characterized by emotional symptoms such as flattened affect which are accompanied by cerebral dysfunctions. This study aimed at determining changes of mood-related neural correlates under standardized pharmacological therapy in first-episode schizophrenia. METHOD: Using fMRI in a longitudinal approach, 10 first-episode schizophrenia patients (6 males) and 10 healthy subjects (same education, gender and age) were investigated during sad and happy mood induction using facial expressions. Reassessments were carried out following 6 months of standardized antipsychotic treatment. Data analysis focussed on therapy-related changes in cerebral activation and on stable, therapy-independent group differences. RESULTS: According to self ratings, mood induction was successful in both groups and did not reveal time-dependent changes. Patients revealed stable hypoactivations in core brain regions of emotional processing like the anterior cingulate cortex, orbitofrontal and temporal areas as well as the hippocampus. Therapy-related signal increases in pre- and postcentral, inferior temporal and frontal areas were restricted to sadness. DISCUSSION: Stable dysfunctions which are unaffected by therapy and symptom improvement were found in cortico-limbic regions crucially involved in emotion processing. They presumably reflect patients' difficulties in emotion regulation and emotional memory processes. However, therapy-related activation changes were also observed and demonstrate efficacy of antipsychotic therapy on improving emotion functionality. They may represent an increased usage of autobiographic emotional memories and an improved strategy to experience an emotion by mirroring someone else's emotions.     

An investigation of the impact of facial affect recognition impairments in moderate to severe TBI on fatigue,depression, and quality of life

Individuals with moderate to severe traumatic brain injury (TBI) have been shown to experience significant problems in facial affect recognition (FAR). However, it is not known how these impairments relate to overall functioning and quality of life (QoL) following TBI. The aim of the current study was to test the hypothesis that worse performance on an FAR task would be associated with reduced QoL (related to social and emotional functioning), worse mood, and increased fatigue. Forty-seven individuals with TBI and 27 healthy controls (HCs) completed the facial emotion identification task (FEIT), as well as questionnaires assessing social and emotional QoL, mood, and fatigue. The TBI group performed significantly worse than HCs on the FEIT. A significant relationship between FAR and fatigue and QoL related to social and emotional functioning was documented, but in an unexpected direction: individuals who performed better on the FEIT reported poorer QoL and greater fatigue. Individuals who have better FAR may require increased effort to perform this task, and thus experience greater fatigue and poorer social and emotional QoL.