Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study.

AIM: Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial. METHOD: Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period. RESULTS: Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated. CONCLUSION: This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.

Reduced emotion regulatory selection flexibility in post-traumatic stress disorder: converging performance-based evidence from two PTSD populations.

BACKGROUND: Contemporary views of emotion dysregulation in post-traumatic stress disorder (PTSD) highlight reduced ability to flexibly select regulatory strategies according to differing situational demands. However, empirical evidence of reduced regulatory selection flexibility in PTSD is lacking. Multiple studies show that healthy individuals demonstrate regulatory selection flexibility manifested in selecting attentional disengagement regulatory strategies (e.g. distraction) in high-intensity emotional contexts and selecting engagement meaning change strategies (e.g. reappraisal) in low-intensity contexts. Accordingly, we hypothesized that PTSD populations will show reduced regulatory selection flexibility manifested in diminished increase in distraction (over reappraisal) preference as intensity increases from low to high intensity. METHODS: Study 1 compared student participants with high (N = 22) post-traumatic symptoms (PTS, meeting the clinical cutoff for PTSD) and participants with low (N = 22) post-traumatic symptoms. Study 2 compared PTSD diagnosed women (N = 31) due to childhood sexual abuse and matched non-clinical women (N = 31). In both studies, participants completed a well-established regulatory selection flexibility performance-based paradigm that involves selecting between distraction and reappraisal to regulate negative emotional words of low and high intensity. RESULTS: Beyond demonstrating adequate psychometric properties, Study 1 confirmed that relative to the low PTS group, the high PTS group presented reduced regulatory selection flexibility (p = 0.01, ŋ²â‚š= 0.14). Study 2 critically extended findings of Study 1, in showing similar reduced regulatory selection flexibility in a diagnosed PTSD population, relative to a non-clinical population (p = 0.002, ŋ²â‚š= 0.114). CONCLUSIONS: Two studies provide converging evidence for reduced emotion regulatory selection flexibility in two PTSD populations.

Steady-state visual evoked potentials differentiate between internally and externally directed attention.

While attention to external visual stimuli has been extensively studied, attention directed internally towards mental contents (e.g., thoughts, memories) or bodily signals (e.g., breathing, heartbeat) has only recently become a subject of increased interest, due to its relation to interoception, contemplative practices and mental health. The present study aimed at expanding the methodological toolbox for studying internal attention, by examining for the first time whether the steady-state visual evoked potential (ssVEP), a well-established measure of attention, can differentiate between internally and externally directed attention. To this end, we designed a task in which flickering dots were used to generate ssVEPs, and instructed participants to count visual targets (external attention condition) or their heartbeats (internal attention condition). We compared the ssVEP responses between conditions, along with alpha-band activity and the heartbeat evoked potential (HEP) - two electrophysiological measures associated with internally directed attention. Consistent with our hypotheses, we found that both the magnitude and the phase synchronization of the ssVEP decreased when attention was directed internally, suggesting that ssVEP measures are able to differentiate between internal and external attention. Additionally, and in line with previous findings, we found larger suppression of parieto-occipital alpha-band activity and an increase of the HEP amplitude in the internal attention condition. Furthermore, we found a trade-off between changes in ssVEP response and changes in HEP and alpha-band activity: when shifting from internal to external attention, increase in ssVEP response was related to a decrease in parieto-occipital alpha-band activity and HEP amplitudes. These findings suggest that shifting between external and internal directed attention prompts a re-allocation of limited processing resources that are shared between external sensory and interoceptive processing.

The Effects of Mindfulness-Based Stress Reduction on the Association Between Autonomic Interoceptive Signals and Emotion Regulation Selection.

OBJECTIVE: The ability to select the most adaptive regulatory strategy as a function of the emotional context plays a pivotal role in psychological health. Recently, we showed that mindfulness-based interventions (MBIs) can improve the sensitivity of regulatory strategy selection to emotional intensity. However, the mechanisms underlying this improvement are unclear. In this study, we tested the hypothesis that MBIs support adaptive regulatory selection by increasing sensitivity to interoceptive signals associated with the emotional stimuli. METHODS: Participants (n = 84, mean [standard deviation {SD}] age = 30.9 [8.3] years; 54% women) were randomized to either a mindfulness-based stress reduction (MBSR) program or a wait-list control condition. Before and after the MBSR program, physiological measures for autonomic nervous system activity were obtained, and participants performed a task examining emotion regulation selections (reappraisal versus distraction) when confronted with low or high negative intensity images. They also completed a battery of mindfulness, interoception, and well-being self-report measures. A cross-classified model was used for the main analyses. RESULTS: The participants assigned to the MBSR were overall more likely to choose reappraisal than distraction (b = 0.26, posterior SD = 0.13, 95confidence interval = 0.02-0.52) after the program. Interoceptive signals in response to negative images were associated with subsequent regulatory selections (b = 0.02, posterior SD = 0.01, 95% confidence interval = 0.01-0.03) in the MBSR group. Specifically, lower cardiac reactivity was associated with the choice to reappraise, whereas higher cardiac reactivity was related to the choice to distract. Greater differences in cardiac reactivity between states that prompt reappraisal and states that prompt distraction were associated with higher well-being (Satisfaction With Life Scale, Pearson r (29) = 0.527, p = .003). CONCLUSIONS: Mindfulness seems to increase the sensitivity of regulatory selections to interoceptive signals, and this is associated with subjective well-being. This may be a central pathway through which MBIs exert their positive effects on mental health and resilience.

Mental Logout: Behavioral and Neural Correlates of Regulating Temptations to Use Social Media.

Individuals sometimes use social media instead of sleeping or while driving. This fact raises the crucial need for-and challenge of-successfully self-regulating potent social-media temptations. To date, however, empirical evidence showing whether social-media temptations can be self-regulated and how self-regulation can be achieved remains scarce. Accordingly, the present within-participants study (N = 30 adults) provided causal evidence for self-regulation of social-media content and identified a potential underlying neural mechanism. We tested the premise that successful self-regulation requires limiting the mental representation of temptations in working memory. Specifically, we showed that loading working memory with neutral contents via attentional distraction, relative to passively watching tempting social-media stimuli, resulted in reduced self-reported desire to use social media, reduced initial attention allocation toward social-media stimuli (reduced late-positive-potential amplitudes), and reduced online representation of social-media stimuli in working memory (reduced contralateral-delay-activity amplitudes). These results have important implications for successfully navigating a social-media-saturated environment.

Identifying the determinants of emotion regulation choice: a systematic review with meta-analysis.

Day-to-day life is inundated with attempts to control emotions and a wealth of research has examined what strategies people use and how effective these strategies are. However, until more recently, research has often neglected more basic questions such as whether and how people choose to regulate their emotions (i.e. emotion regulation choice). In an effort to identify what we know and what we need to know, we systematically reviewed studies that examined potential determinants of whether and how people choose to regulate their emotions. Eighteen determinants were identified across 219 studies and were categorised as being affective, cognitive, motivational, individual or social-cultural in nature. Where there were sufficient primary studies, meta-analysis was used to quantify the size of the associations between potential determinants and measures of whether and how people choose to regulate their emotions. Based on the findings, we propose that people's decisions about whether and how to regulate their emotions are determined by factors relating to the individual doing the regulating, the emotion that is being regulated, and both the immediate situation and the broader social context in which the regulation is taking place.

The neural bases of cognitive emotion regulation: The roles of strategy and intensity.

When confronted with unwanted negative emotions, individuals use a variety of cognitive strategies for regulating these emotions. The brain mechanisms underlying these emotion regulation strategies have not been fully characterized, and it is not yet clear whether these mechanisms vary as a function of emotion intensity. To address these issues, 30 community participants (17 females, 13 males, Mage = 24.3 years) completed a picture-viewing emotion regulation task with neutral viewing, reacting to negative stimuli, cognitive reappraisal, attentional deployment, and self-distancing conditions. Brain and behavioral data were simultaneously collected in a 3T GE MRI scanner. Findings indicated that prefrontal regions were engaged by all three regulation strategies, but reappraisal showed the least amount of increase in activity as a function of intensity. Overall, these results suggest that there are both brain and behavioral effects of intensity and that intensity is useful for probing strategy-specific effects and the relationships between the strategies. Furthermore, while these three strategies showed significant overlap, there also were specific strategy-intensity interactions, such as frontoparietal control regions being preferentially activated by reappraisal and self-distancing. Conversely, self-referential and attentional regions were preferentially recruited by self-distancing and distraction as intensity increased. Overall, these findings are consistent with the notion that there is a continuum of cognitive emotion regulation along which all three of these strategies lie.

The fit between emotion regulation choice and individual resources is associated with adaptive functioning among young children.

Being able to resist temptation at a young age is crucial for successful functioning yet it can be challenging. According to the Selection, Optimization, and Compensation with Emotion Regulation (SOC-ER) framework, one central element of successful functioning is selection which involves choosing among regulatory options whose resource requirements fits with the amount of available resources an individual possesses. Although conceptually important, direct empirical evidence is lacking. Accordingly, the present study utilised performance based measures to examine the interactive effect of regulatory selection to resist temptation, and individual differences in executive resources, on functioning in young children. Specifically, 39 first grade children that varied in executive resources (working memory capacity, WMC), selected between two major regulatory strategies (reappraisal and distraction) to resist temptation, that varied in their resource demands, and were evaluated on successful functioning (via questionnaires completed by parents, that assess daily-life behaviours requiring executive functioning). Supporting SOC-ER predictions, we found that among children with low (but not high) WMC, choosing the less effortful distraction regulatory strategy was associated with adaptive functioning. Additionally, regulatory choice preferences previously obtained with adults were extended to children. Broad implications are discussed.

The relation between emotion regulation choice and posttraumatic growth.

Previous research has examined emotion regulation (ER) and trauma in the context of psychopathology, yet little research has examined ER in posttraumatic growth (PTG), the experience of positive psychological change following a traumatic event. ER typically involves decreasing negative affect by engaging (e.g. reappraisal) or disengaging (e.g. distraction) with emotional content. To investigate how ER may support PTG, participants who experienced a traumatic event in the past 6 months completed a PTG questionnaire and an ER choice task in which they down regulated their negative emotion in response to negative pictures of varying intensity by choosing to distract or reappraise. Latent growth curve analyses revealed that an increase in reappraisal choice from low to high subjective stimulus intensity predicted higher PTG, suggesting that individuals who chose reappraisal more as intensity increased reported higher PTG. Findings suggest that reappraisal of negative stimuli following a traumatic event may be a key component of PTG.

For whom is social-network usage associated with anxiety? The moderating role of neural working-memory filtering of Facebook information.

Is Facebook usage bad for mental health? Existing studies provide mixed results, and direct evidence for neural underlying moderators is lacking. We suggest that being able to filter social-network information from accessing working memory is essential to preserve limited cognitive resources to pursue relevant goals. Accordingly, among individuals with impaired neural social-network filtering ability, enhanced social-network usage would be associated with negative mental health. Specifically, participants performed a novel electrophysiological paradigm that isolates neural Facebook filtering ability. Participants' actual Facebook behavior and anxious symptomatology were assessed. Confirming evidence showed that enhanced Facebook usage was associated with anxious symptoms among individuals with impaired neural Facebook filtering ability. Although less robust and tentative, additional suggestive evidence indicated that this specific Facebook filtering impairment was not better explained by a general filtering deficit. These results involving a neural social-network filtering moderator, may help understand for whom increased online social-network usage is associated with negative mental health.

The impact of empathy and reappraisal on emotional intensity recognition.

Empathy represents a fundamental ability that allows for the creation and cultivation of social bonds. As part of the empathic process, individuals use their own emotional state to interpret the content and intensity of other people's emotions. Therefore, the current study was designed to test two hypotheses: (1) empathy for the pain of another will result in biased emotional intensity judgment; and (2) changing one's emotion via emotion regulation will modulate these biased judgments. To test these hypotheses, in experiment one we used a modified version of a well-known task that triggers an empathic reaction We found that empathy resulted in biased emotional intensity judgment. To the best of our knowledge, this is the first demonstration of a bias in the recognition of emotional facial expressions as a function of empathy for pain. In experiment two, we replicated these findings in an independent sample, and further found that this biased emotional intensity judgment can be moderated via reappraisal. Taken together, our findings suggest that the novel task used here can be employed to further explore the relation between emotion regulation and empathy.

Emotion regulation choice: the role of environmental affordances.

Which emotion regulation strategy one uses in a given context can have profound affective, cognitive, and social consequences. It is therefore important to understand the determinants of emotion regulation choice. Many prior studies have examined person-specific, internal determinants of emotion regulation choice. Recently, it has become clear that external variables that are properties of the stimulus can also influence emotion regulation choice. In the present research, we consider whether reappraisal affordances, defined as the opportunities for re-interpretation of a stimulus that are inherent in that stimulus, can shape individuals' emotion regulation choices. We show that reappraisal affordances have stability across people and across time (Study 1), and are confounded with emotional intensity for a standardised set of picture stimuli (Study 2). Since emotional intensity has been shown to drive emotion regulation choice, we construct a context in which emotional intensity is separable from reappraisal affordances (Study 3) and use this context to show that reappraisal affordances powerfully influence emotion regulation choice even when emotional intensity and discrete emotions are taken into account (Study 4).

Emotion regulation choice in an evaluative context: the moderating role of self-esteem.

Evaluative contexts can be stressful, but relatively little is known about how different individuals who vary in responses to self-evaluation make emotion regulatory choices to cope in these situations. To address this gap, participants who vary in self-esteem gave an impromptu speech, rated how they perceived they had performed on multiple evaluative dimensions, and subsequently chose between disengaging attention from emotional processing (distraction) and engaging with emotional processing via changing its meaning (reappraisal), while waiting to receive feedback regarding these evaluative dimensions. According to our framework, distraction can offer stronger short-term relief than reappraisal, but, distraction is costly in the long run relative to reappraisal because it does not allow learning from evaluative feedback. We predicted and found that participants with lower (but not higher) self-esteem react defensively to threat of failure by seeking short-term relief via distraction over the long-term benefit of reappraisal, as perceived failure increases. Implications for the understanding of emotion regulation and self-esteem are discussed.

Emotion regulation and psychopathology.

Emotional problems figure prominently in many clinical conditions. Recent efforts to explain and treat these conditions have emphasized the role of emotion dysregulation. However, emotional problems are not always the result of emotion dysregulation, and even when emotional problems do arise from emotion dysregulation, it is necessary to specify precisely what type of emotion dysregulation might be operative. In this review, we present an extended process model of emotion regulation, and we use this model to describe key points at which emotion-regulation difficulties can lead to various forms of psychopathology. These difficulties are associated with (a) identification of the need to regulate emotions, (b) selection among available regulatory options, (c) implementation of a selected regulatory tactic, and (d) monitoring of implemented emotion regulation across time. Implications and future directions for basic research, assessment, and intervention are discussed.

Patient inertia and the status quo bias: when an inferior option is preferred.

Medical noncompliance is a major public-health problem. One potential source of this noncompliance is patient inertia. It has been hypothesized that one cause of patient inertia might be the status quo bias-which is the tendency to select the default choice among a set of options. To test this hypothesis, we created a laboratory analogue of the decision context that frequently occurs in situations involving patient inertia, and we examined whether participants would stay with a default option even when it was clearly inferior to other available options. Specifically, in Studies 1 and 2, participants were given the option to reduce their anxiety while waiting for an electric shock. When doing nothing was the status quo option, participants frequently did not select the option that would reduce their anxiety. In Study 3, we demonstrated a simple way to overcome status quo bias in a context relevant to patient inertia.

See what you think: reappraisal modulates behavioral and neural responses to social stimuli.

The social environment requires people to quickly form contextually appropriate social evaluations. Models of social cognition suggest that this ability depends on the interaction of automatic and controlled evaluative systems. However, controlled processes, such as reappraisal of an initial response, have rarely been studied in the context of social evaluation. In the two studies reported here, participants reappraised or simply observed angry or neutral faces. In Study 1, reappraisal modulated evaluations of angry faces on explicit as well as implicit behavioral levels. In Study 2, reappraisal altered both early and late phases of evaluative electrocortical processing. These studies suggest that controlled processes, such as reappraisal, can quickly and substantially modulate early evaluative processes in the context of biologically significant social stimuli.

Do people choose the same strategies to regulate other people's emotions as they choose to regulate their own?

How do people choose how to regulate others' emotional responses? We extended previous work on how the intensity of an emotional situation influences which strategies people choose to regulate their emotions (i.e., intrapersonal emotion regulation choice) to also consider the effect of intensity on which strategies people choose to regulate other people's emotions (i.e., interpersonal emotion regulation choice). Studies 1a and 1b found that the intensity of the emotional situation influenced whether participants chose distraction or reappraisal in both intrapersonal and interpersonal regulation contexts, but also that the effect of intensity differed between the contexts (participants choose reappraisal more frequently for others in intense situations than for themselves). However, this difference was stronger (or only found) when participants helped the other person to control their emotions first. Two further studies examined whether differences in perceived intensity (Study 2) and/or the anticipated effort or effectiveness of the strategies (Study 3) could explain the difference between intrapersonal and interpersonal contexts. Together, the findings suggest that the regulation strategies that people choose depend on the intensity of the emotional situation, the target of regulation, and whether people choose how to regulate their own emotions before choosing how to regulate another person's emotions, with preliminary evidence that differences between intrapersonal and interpersonal emotion regulation choice may be associated with differences in the anticipated effort and effectiveness of regulation between these contexts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neural Indices of Emotion Regulatory Implementation Correlate With Behavioral Regulatory Selection: Proof-of-Concept Investigation.

"Do what you do best" conveys an intuition about the association between ability and preference. In the field of emotion regulation, ability and preference are manifested in two central stages, namely, implementation and selection of regulatory strategies, which to date have been mainly studied separately. Accordingly, the present proof-of-concept study wished to provide preliminary evidence for an association between neural indices of implementation ability and behavioral selection preferences. In this pilot study, participants performed a classic neuroimaging regulatory implementation task that examined their ability (neurally reflected in the degree of amygdala modulation) to execute two central regulatory strategies, namely, attentional distraction and cognitive reappraisal while viewing negative images. Then participants performed a separate, classic behavioral selection task that examined their choice preferences for using distraction and reappraisal while viewing negative images. Confirming our conceptual framework, we found that exclusively for distraction, which has been associated with robust amygdala modulation, a decrease in amygdala activity during implementation (i.e., enhanced ability) was associated with enhanced preference to behaviorally select distraction [r(15) = -0.69, p = 0.004]. These preliminary findings link between two central emotion regulatory stages, suggesting a clue of the adaptive association between neural ability and behavioral preference for particular regulatory strategies.

Emotion-regulation choice.

Despite centuries of speculation about how to manage negative emotions, little is actually known about which emotion-regulation strategies people choose to use when confronted with negative situations of varying intensity. On the basis of a new process conception of emotion regulation, we hypothesized that in low-intensity negative situations, people would show a relative preference to choose to regulate emotions by engagement reappraisal, which allows emotional processing. However, we expected people in high-intensity negative situations to show a relative preference to choose to regulate emotions by disengagement distraction, which blocks emotional processing at an early stage before it gathers force. In three experiments, we created emotional contexts that varied in intensity, using either emotional pictures (Experiments 1 and 2) or unpredictable electric stimulation (Experiment 3). In response to these emotional contexts, participants chose between using either reappraisal or distraction as an emotion-regulation strategy. Results in all experiments supported our hypothesis. This pattern in the choice of emotion-regulation strategies has important implications for the understanding of healthy adaptation.

Is timing everything? Temporal considerations in emotion regulation.

It is often said that timing is everything. The process model of emotion regulation has taken this aphorism to heart, suggesting that down-regulating emotions before they are "up and running" is always easier than down-regulating emotions once they have gathered force (i.e., generic timing hypothesis). But does timing (i.e., emotion intensity) matter equally for all forms of regulation? In this article, the authors offer an alternative process-specific timing hypothesis, in which emotion-generative and emotion-regulatory processes compete at either earlier or later stages of information processing. Regulation strategies that target early processing stages require minimal effort. Therefore, their efficacy should be relatively unaffected by emotion intensity. By contrast, regulation strategies that target later processing stages require effort that is proportional to the intensity of the emotional response. Therefore, their efficacy should be determined by the relative strength of regulatory versus emotional processes. Implications of this revised conception are considered.