On the Benefits and Costs of Extrinsic Emotion Regulation to the Provider: Toward a
Neurobehavioral Model
#Noga Cohen1 and #Reout Arbel2
1Department of Special Education and The Edmond J. Safra Brain Research Center for the
Study of Learning Disabilities, University of Haifa
2Department of Counseling and Human Development, University of Haifa
#Equal contribution
Corresponding authors:
Reout Arbel, PhD
Department of Counseling and Human Development, University of Haifa, 199 Abba Khoushy
Ave, Haifa, 3498838, Israel.
Email: [email protected] phone: +972-54-718-833
Noga Cohen, PhD
Department of Special Education and The Edmond J. Safra Brain Research Center for the
Study of Learning Disabilities, University of Haifa, 199 Abba Khoushy Ave, Haifa, 3498838,
Israel.
Email: [email protected] phone: +972-54-585-2486
On the benefits and costs of EER to the provider / 1 Abstract
Emotion regulation often takes place within interpersonal relationships. Prior research has focused mainly on the impact of extrinsic emotion regulation (EER) on the recipient. Yet EER may also have emotional and physical consequences for the provider. Understanding who benefits from helping others regulate their emotions and under what conditions is crucial in understanding the mechanisms that reinforce well-being and social ties. This conceptual review integrates existing literature into an interim working model of the benefits and costs of EER for the provider and of the underlying neural mechanisms. Inspired by a recent framework on the factors that underlie intrinsic emotion regulation, we suggest that the influence of EER on the provider depends on interactions among individual differences in salient psychological characteristics, situational factors and type of the emotion regulation strategy used. We further propose three pathways through which EER may influence the provider—stress regulation, reward and empathy—and connect each pathway to a distinct pattern of neural activation.
Keywords: Extrinsic emotion regulation; interpersonal; support; neuroimaging
On the benefits and costs of EER to the provider / 2 1 Introduction How would you react if one of your friends felt sad and frustrated after losing an important job opportunity? You would probably feel bad for this friend and want to help them feel better. In other words, out of empathic concerns for your friend you might extrinsically attempt to regulate their emotions. Such attempts to influence the emotions of another person emotion is termed extrinsic emotion regulation (EER) (Niven et al., 2012a; Nozaki &
Mikolajczak, 2019; Reeck et al., 2016; Williams et al., 2018; Zaki & Craig Williams, 2013). For example, you might help the friend look at this loss constructively or take the friend out for dinner in a good restaurant. Recent research suggests that EER may benefit not only the recipient
(your friend) but also the provider (you) (e.g., Mongrain et al., 2018; Niven et al., 2012). For example, you may feel proud of yourself or simply happier for being supportive. This favorable effect on you, the provider, is consistent with the notion that positive transactions with others is a way to recover and boost mental resources and reduce strain (Hobfoll, 1989).
Yet, helping your friend to feel better may also be exhaustive and deplete your mental resources (Baumeister et al., 1998; Martínez-Íñigo et al., 2013, 2015). In addition, thinking about your friend's failure or sharing your friend’s negative experience may upset or overwhelm you.
Understanding how and under what conditions providers benefit from EER is an important research direction for promoting social ties and human well-being. In this conceptual review we propose that the consequences of EER for the provider vary as a function of personal, situational and strategy-related factors (see Figure 1). This suggested person x situation x strategy working model of EER is based on a recent framework on the determinants of beneficial intrinsic emotion regulation (Doré et al., 2016). We provide empirical support for the person x situation x strategy model of EER based on pioneering studies on the consequences of EER for the provider (e.g.,
Doré et al., 2017; Marigold et al., 2014; Morelli et al., 2015). We also rely on work from other
On the benefits and costs of EER to the provider / 3 closely related constructs, including prosocial behavior (Qu et al., 2020), which refers to supportive acts that benefit others but are not directed specifically at changing the emotion of the support recipient (Eisenberg & Miller, 1987), support provision (Burr et al., 2018), which includes behaviors that are intended to help others to cope with stress (Cohen, 2004), and empathy (Hodges & Klein, 2001), which can be defined as the concern for others that instigates a need to provide support (Coke et al., 1978). EER is differentiated from these constructs mainly as it consists a deliberate goal to change the emotions of the other person (for a more elaborated discussion on the differences between EER and these other terms see Nozaki & Mikolajczak,
2020).
A number of recent studies suggest that EER is mediated by the activation of distinct neural networks that are involved in stress regulation (Hallam et al., 2014; Inagaki &
Eisenberger, 2012), reward (Hallam, 2014; Inagaki & Eisenberger, 2012) and empathy (Hallam,
2014). In this review, we attempt to link these previously identified networks to the determinants of both the benefits and the costs of EER for the provider. Therefore, the current paper goes beyond prior explanations (Inagaki, 2018a; Reeck et al., 2016) by offering a working model that delineates the neurobehavioral mechanisms involved in providing EER and its consequences for the provider.
The paper is organized as follows. Section 2 seeks to define EER (Section 2.1) and review evidence pointing to its underlying neural networks (Section 2.2). In Sections Error:
Reference source not found we review existing research on EER’s behavioral and physiological benefits (Section 3.1) and costs (Section 3.2) to the provider. Next, we unpack the different factors—person, situation, and strategy—that modulate EER effects (Section Error: Reference source not found). In Section 4 we discuss the importance of the our neurobehavioral model in
On the benefits and costs of EER to the provider / 4 explaining the influences of EER on the provider and discuss critical barriers in current work.
We conclude by offering directions for future research (Section 6). Table 1 summarizes the existing empirical research on the consequences of EER for the provider.
2 What is Extrinsic Emotion Regulation? Definition and Neural Mechanisms 2.1 Defining EER
EER is defined as an action performed with the goal of influencing another person’s emotion trajectory (Nozaki & Mikolajczak, 2020). EER is therefore an interpersonal construct that involves a recipient and a provider (Nozaki & Mikolajczak, 2020; Zaki & Craig Williams,
2013). Though EER is motivated by a desire to change the emotions of another person (Nozaki
& Mikolajczak, 2020), it may or may not involve explicit emotion modulation. As illustrated by
Gross’s seminal emotion regulation process model (McRae & Gross, 2020), EER may include efforts to help another person change a stressful situation or alternatively to deploy attention away from it. It may even entail explicit acts to change other people’s emotions, for example by helping them reappraise the event’s meaning.
EER is not limited to up-regulation of positive emotions or down-regulation of negative emotions. In fact, EER may also serve counter-hedonic motives in which the provider attempts to increase unpleasant emotions or decrease pleasurable emotions to help the recipient accomplish a goal (e.g., increasing anxiety to motivate someone to study harder for a test) (López-Pérez et al.,
2017; Zaki, 2020).
Most literature on EER derives from studies that focused on the provider’s prosocial motives (i.e., provider’s efforts to help the recipient). Nevertheless, EER may also be employed to worsen the other person's well-being (e.g., anti-social motives) or to benefit the provider (e.g., egocentric motives) (Nozaki & Mikolajczak, 2020). In contrast to empathic concerns or benevolent motives, egocentric/anti-social EER acts to weaken social ties and to reduce the
On the benefits and costs of EER to the provider / 5 welfare of others. Therefore, the consequences to the provider of egocentric/anti-social EER are likely to differ substantially from the consequences of prosocial EER. Egocentric/anti-social
EER is beyond the scope of this paper and is not discussed here.
2.2 The Neural Networks Underlying EER Implementation A recent model proposed by Reeck et al. (2016), postulates that EER is mediated by activation in brain regions associated with identification of the emotional reaction of the target
(the mentalizing network), evaluation of the target's need for regulation (including cognitive control and reward systems), and strategy selection and implementation (including systems implicated in selecting goal-relevant information and implementing regulatory goals). In line with this theoretical framework, empirical data indicate that EER indeed recruits three main brain networks: 1) The empathy network (e.g., medial prefrontal cortex), which presumably plays a role in identification of the emotional reaction of the target; 2) Reward-related regions
(e.g., ventral striatum), which may be related to the evaluation of the target’s need for regulation as well as its success or failure; and 3) Stress regulation (e.g., ventrolateral prefrontal cortex), which is hypothesized to play a role in strategy implementation (Hallam, 2014; Inagaki, 2018;
Inagaki & Eisenberger, 2012). In what follows, we present the empirical evidence for the involvement of these networks in EER.
2.1.1 EER is associated with activation in empathy-related brain regions In a recent study, Hallam et al. (2014) asked participants undergoing fMRI scanning to regulate their own emotions or the emotions of another person using either reappraisal (i.e., reinterpretation of the situation to reduce negative affect) or suppression (i.e., avoiding the display of negative emotions). Findings showed that that providing emotion regulation support to others is involved in increased activity in regions associated with empathy such as the left tempo-parietal junction (TPJ), the bilateral inferior temporal gyrus, the medial prefrontal cortex
On the benefits and costs of EER to the provider / 6 (mPFC) and the temporal pole.
Activation in empathy-related regions is important to the identification and understanding of the other person’s emotions, which are essential processes in EER (Reeck et al.,
2016). However, empathy may also be associated with difficulty to tolerate the suffering of the other person (i.e., empathic distress). Indeed, increased activation in empathy-related regions was found to be associated with heightened activation in brain areas responsible for processing threat or pain (e.g., amygdala; Singer & Klimecki, 2014; see also Ashar et al., 2017).
2.1.2 EER is associated with activation in reward-related brain regions Both Hallam et al. (2014) and Inagaki and Eisenberger (2012) found that EER is associated with increased activation in the striatum, which is thought to play a role in reward processes. Specifically, Hallam et al. (2014) found increased activation in the bilateral caudate (a region that is a part of the dorsal striatum) when participants were asked to regulate another person's emotions. Inagaki and Eisenberger examined the networks involved when female participants held their male partner's hand while the men experienced physical pain (electrical shock). They found this type of support to be associated with higher activation in the ventral striatum. These findings support the notion that helping another person may be rewarding (see also Sherman et al., 2018 on reward-related brain activity when marking 'Like' on social media). 2.2.3 EER is associated with activation in stress-regulation brain regions In addition, EER was found to be associated with greater activity in regions associated with stress regulation (Hallam et al., 2014; Inagaki and Eisenberger 2012). Specifically, in addition to regions implicated in intrinsic emotion regulation such as the inferior frontal gyrus
(IFG), providing support to others in Hallam et al (2014) study was also associated with higher activity of the pre-supplementary motor area (pSMA) and the left anterior cingulate cortex
(ACC). Inagaki and Eisenberger (2012) showed that compared to control conditions, EER
(holding the partner's arm) was associated with higher activation in the septal area (SA), a region commonly associated with parental care in animals (Inagaki, 2018b). Further, higher activation of this region during support-giving was linked to greater perceived effectiveness of the support, higher feeling of social connectedness and a reduction in amygdala activity. Together, these
On the benefits and costs of EER to the provider / 7 findings may imply that EER is associated with recruitment of cognitive control and care processes involved in stress regulation.
3 Benefits and Costs of EER for the Provider 3.1 EER benefits for the Provider's Well-being Data suggest that providing EER may improve the provider’s well-being in the short- term. For example, in a recent daily diary study Morelli et al. (2015) showed that providing emotional support such as being empathic or responsive to a same-sex friend improved the provider’s self-reported daily well-being including increased happiness and decreased distress.
This favorable effect carried over to the next day, albeit to a lesser extent. Note, however, that instrumental support (i.e., listening and providing tangible assistance) was beneficial to the provider only if the provider also gave emotional support, emphasizing the central role of emotional engagement during support provision (Morelli et al., 2015). Examining a longer timeframe, Mongrain et al. (2018) demonstrated that a three-week intervention that included performing acts of kindness led to a reduction in depression among individuals low on agreeableness (as further discussed in Section 4.1.1). In another study, staff members and prisoners at a high-security prison who attempted to improve the feelings of others reported more positive mood one month later (Niven, Totterdell, Holman, & Headley, 2012).
Regulation of other people’s emotions may also serve as an opportunity to practice and improve self-regulatory capacities. Recent studies on EER focused on the common emotion regulation strategy of reappraisal, which entails reinterpretation of a negative event in a way that reduces negative feelings (Gross & John, 2003). Using a web-based support-provision platform, two studies tested the effects of EER toward strangers on providers’ depression levels and habitual use of reappraisal (Doré et al., 2017; Morris et al., 2015). Helping others to reappraise
On the benefits and costs of EER to the provider / 8 stressful personal situations for three weeks increased the use of habitual reappraisal among the support providers. This increased reappraisal, in turn, mediated the effect of helping others on providers’ depression and preservative thinking (Morris, Schueller, & Picard, 2015). Further, individuals who extended more help to others exhibited a larger reduction in depression and preservative thinking (Doré et al., 2017). Nevertheless, Inagaki and Eisenberger (2016) found that EER (writing a supportive letter to a friend) was not associated with a reduction in reported negative affect for the support provider during and following a stressful task (the Trier Social
Stress Task; TSST). However, they did find association between EER and a reduction in physiological stress markers, including lower systolic blood pressure and alpha-amylase (but not cortisol level) shortly afterwards. Although still preliminary, these findings suggest that EER may reduce the physiological stress response, and particularly sympathetic-related arousal.
Indirect support for the beneficial effects of EER on the provider also comes from the literature on prosocial behavior. Among other favorable outcomes, helping others was found to be associated with lower mortality (Brown et al., 2003), better overall health (Piferi & Lawler,
2006), improved mood (Schacter & Margolin, 2018), reduced perceived stress (Raposa, Laws, &
Ansell, 2016), higher levels of happiness (Dunn et al., 2008) and an enhanced sense of personal worth (Klein, 2017). In line with these findings, studies on support provision (Creaven et al.,
2013; Nealey et al., 2002; Piferi & Lawler, 2006) demonstrated reduced cardiovascular reactivity
(systolic and diastolic blood pressure, heart rate) and ultimately reduced risk of cardiovascular disease among providers (Burr et al., 2018)(Burr et al., 2018). Together, these findings indicate that providing EER may mitigate stress and its concomitant physiological arousal (e.g., activity in the hypothalamic-pituitary-adrenal axis and the autonomic nervous system).
3.2 EER costs for the Provider's Well-being Handful of studies have considered the possible negative effects of EER for the provider
On the benefits and costs of EER to the provider / 9 (Martínez-Íñigo et al., 2013, 2015; Morelli et al., 2015). In a daily-diary study, Morelli et al.
(2015) found that listening to friends’ disclosures or providing tangible support to friends led to higher levels of depression. Martínez-Íñigo et al (2015) demonstrated that providing EER to a simulated patient (enacted by a professional actor) led to resource depletion (assessed by the amount of time spent trying to solve an unsolvable anagram) among healthcare workers’ (see also Martínez-Íñigo et al., 2013).
Studies on burden and emphatic fatigue may help in understanding the potential detrimental effects of EER. Specifically, professional caregivers are often required to be empathic to their patients over a prolonged period of time. Empathy, may impinge on the provider's cognitive and emotional resources to the extent of reducing emotional engagement and motivation to provide care (Hodges & Klein, 2001). Indeed, empathic or compassion fatigue was found to be associated with distinct neural patterns in empathy-related regions. For example, Tei et al. (2014) showed that reduction in empathy-related brain activity (e.g., IFG, TPJ) predicts burnout severity among medical professionals. Moreover, reduced activation in these brain regions was associated with stronger emotional dissonance and alexithymia scores (Tei et al.,
2014).
Further, the broader literature discussing the provision of support or care for others suggests that being exposed to another person’s distress, especially over an extensive period of time (years in some cases) may lead to continuous strain that can result in emotion-dysregulation psychopathologies such as anxiety and depression (e.g., Morris & Feldman, 1996; Ketheesan et al., 2020). In line with these findings, prolonged or highly intense EER may overload physiological stress systems. This overload may have hidden long-term costs, particularly cardiovascular problems (McEwen, 2000). Studies on populations such as health providers, who
On the benefits and costs of EER to the provider / 10 frequently witness the traumatic events of others and may therefore suffer from allostatic overload, show that prolonged periods of support provision may harm providers (see Russell &
Brickell, 2015).
At the neural level, chronic stress may lead to structural and functional changes in the brain (De Kloet et al., 2005). These changes may be associated with widespread cognitive functions such as memory, attention and decision-making (De Kloet et al., 2005). Indeed, work- related burnout was suggested to be associated with failure of adult hippocampal neurogenesis due to elevated stress levels (Eriksson & Wallin, 2004). In addition, intensive activation of emotion-related brain regions can impair the immune system, heightening sensitivity to infections, chronic illness and diseases (for review see Stebnicki, 2007).
4 What Factors Determine Benefits or Costs Associated with EER Implementation? The variability in EER’s effects on the provider suggests a need to specify potential influences of individual and situational determinants. In a recent conceptual framework, Doré et al. (2016) specify the determinants of beneficial intrinsic emotion regulation. Specifically, the authors propose that the success of intrinsic emotion regulation vary as a function of personal, situational and strategy-related factors. Drawing on this model, the following section discusses the role of individual (Section ), situational (Section 4.2) and strategic (Section Error: Reference source not found) factors in the consequences of EER for providers (see Figure 1).
4.1 Person-related factors
Several studies have examined individual differences in the consequences of EER on the provider. These studies focused on psychological symptoms and personality traits, given their robust influence on socio-emotional functioning.
On the benefits and costs of EER to the provider / 11 4.1.1 Person-related factors associated with benefits for EER providers Regarding the role of psychological symptoms, Morris et al. (2015) demonstrated that individuals with elevated depression symptoms showed a greater reduction in depressive symptoms and perseverative thinking following a three-week intervention that included EER.
Support for this finding also comes from studies on prosocial behaviors. A recent study of young adults found that daily prosocial acts contributed to increased life satisfaction on the same day, but only for those with low or average but not high satisfaction with their physical appearance
(Zuffianò et al., 2018). Furthermore, Schacter and Margolin (2018) demonstrated that adolescents who are more depressed exhibited an increase in positive mood following days on which they provided support for peers or dating partners.
Yet these studies do not explain why those who have more symptoms derive more benefits from providing EER. Results from a recent study suggest that prosocial behaviors have a stronger favorable effect on mood among individuals who are more depressed (Schacter &
Margolin, 2018). Thus, for these individuals helping others is a promising way to elevate mood and perhaps self-worth, which is typically lower among these individuals (Orth et al., 2016; Will et al., 2017). These favorable effects, in turn, are likely to be mediated by reward systems
(Dutcher et al., 2016).
Along this line, other studies that focused on personality traits also found that being low on favorable traits or high on unfavorable traits increases susceptibility to the benefits of providing EER. For example, Morris et al. (2015) found that after a three-week intervention, individuals who are low on trait reappraisal exhibited a larger decline in mood and perseverative thinking. Furthermore, individuals low on agreeableness reported a greater decrease in depressive symptoms following three weeks of training in providing acts of kindness to social others than did individuals high on agreeableness (Mongrain et al., 2018). A similar trend was
On the benefits and costs of EER to the provider / 12 found in a study on prosocial behaviors. Specifically, individuals high on neuroticism reported a stronger increase in positive mood on the day after they provided support to others (Snippe et al.,
2018). Extroversion, however, did not moderate the effects of prosocial behaviors in this study.
In addition, in an experience sampling study, individuals low on altruism reported greater improvement in mood after providing support in the workplace (Conway et al., 2009). Taken together, these results indicate that being low on a desirable trait or high on an undesirable trait increases the benefits gained from providing support.
Nevertheless, why lower levels of desirable traits or higher levels of undesirable ones enhance the benefits gained from EER is largely unknown. One way to think about this is that individuals who are low on agreeableness or altruism often form more conflictual and problematic relationships (Vater & Schröder-Abé, 2015). Thus, acts of support on their part are probably more noticeable and appreciated by others, leading to a reduction in negativity within their social connections and a stronger sense of social bonding (Garcia & Erlandsson, 2011;
Schimmack, 2003). This, in turn, may reinforce empathic concern in future encounters.
In addition to psychological characteristics, sex may be an additional moderator of the consequences of EER for the provider, given sex differences in the social regulation of stress
(Taylor, 2006) and emotion (Niven et al., 2011). Indeed, several studies on prosocial behaviors showed that sex moderates the effect of support provision on the provider. For example, in a longitudinal study, Väänänen et al. (2005) found that within intimate relationships, women benefit more from providing (compared to receiving) support, while men benefit more from receiving support. Nevertheless, the effect of sex has not yet been tested in relation to EER.
4.1.2 Person-related factors associated with costs for EER providers Individual characteristics may also buffer the detrimental effects of EER. To our knowledge, no data exists regarding the costs of EER. Several studies on caregivers (Adelman et
On the benefits and costs of EER to the provider / 13 al., 2014; Russell & Brickell, 2015), however, showed that those who are higher in emotional adjustment are less vulnerable to exhaustion following repeated and frequent care provision
(Zeidner et al., 2013). Perhaps people who experience difficulty in regulating their empathic response may be more prone to feelings of exhaustion and emotional disengagement after caring for others (Russell & Brickell, 2015). Furthermore, individuals who tend to experience intense emotions, especially negative emotions, are more susceptible to aversive emotional reactions such as anxiety upon recognizing another person in distress (Decety & Jackson, 2004).
4.2 Situational factors The literature on support provision (Inagaki & Orehek, 2017) suggests several situational factors that may determine the consequences of EER for providers. These include the identity of the receiver (Marigold et al., 2014), the perceived effectiveness of the support
(Inagaki & Orehek, 2017; Marigold et al., 2014), whether the receiver provides feedback
(Marigold et al., 2014), the extent to which the motivation to support is autonomous or controlled
(Weinstein & Ryan, 2010), and the duration and intensity of the support provision (Adelman et al., 2014).
4.2.1 Situational factors associated with benefits for EER providers In a two-experiment study, Iganaki and Ross (2018) addressed the important question of whether the benefit of providing support depends on the receiver’s identity. Relying on evolutionary notions of maternal care and theoretical accounts of charitable giving, the authors tested neural patterns of targeted (i.e., identifiable recipient) versus untargeted (i.e., giving to a group or a cause) monetary support. The results showed that providing targeted support for either a close other or a stranger resulted in a stronger sense of social bonding and greater perceived support effectiveness. Furthermore, giving targeted, but not untargeted, support was associated with decreased amygdala activation in response to negative faces in a follow-up task (Inagaki &
On the benefits and costs of EER to the provider / 14 Ross, 2018). These findings imply that situational factors mediate stress-related neural activity during support provision.
An additional study (Marigold et al., 2014; Experiment 5) showed that both recipient's identity and type of disclosure influence the benefits of EER for the provider. Specifically, those who provided support to recipients with high self-esteem reported more positive affect and higher relationship quality when the recipient shared failures compared to successes.
In addition, studies on prosocial behaviors found that whether the motivation to help is autonomous (i.e., driven by well-meaning internal motives) or controlled by extrinsic considerations (e.g., impression management) alters the effect of prosocial behaviors on the provider (Weinstein & Ryan, 2010). In a set of studies using diverse methodologies, the authors found that prosocial behaviors increased the provider’s daily well-being only when the prosocial acts were autonomous and not controlled.
4.2.2 Situational factors associated with costs for EER providers One study tested whether perceived effectiveness is related to EER’s potential costs to providers. Participants in this study were asked to write a supportive message to a friend in response to hypothetical scenarios. Afterwards, they were asked to imagine their friend providing them feedback on their support attempt. Half were asked to imagine feedback indicating that their support was well-received (success). The other half were instructed to imagine feedback indicating that their support attempt made their friend feel misunderstood (failure). Providers felt worse about themselves and about their interaction with the friend when they imagined providing unsuccessful emotional support than when they imagined their support was successful (Marigold et al., 2014; Experiment 6).
Furthermore, in another study (Marigold et al., 2014; Experiment 5) the support recipient’s identity also mediated the findings. Specifically, when providers supported a friend
On the benefits and costs of EER to the provider / 15 with low self-esteem who disclosed a failure, they reported a more negative interaction, lower positive mood, lower perceived regard, and lower ratings of the quality of their friendship than in the case of a friend with low self-esteem who disclosed a success. Those who helped a friend who disclosed a failure also showed signs of depletion. Helping a friend with high self-esteem was not associated with negative outcomes.
4.3 Strategy-related factors Various strategies can be used in extrinsic regulation of the emotions of others. Based on the process model of emotion (Gross, 1998), Reeck et al. (2016) proposed the following strategies in providing emotion regulation support: situation selection/modification, attentional deployment, cognitive change and response modulation. Situation selection includes an attempt to change the situation, such as being present with the other person during a stressful situation and providing support via hand-holding (Inagaki & Eisenberger, 2012). Attentional deployment, which entails shifting attention away from the emotion-eliciting situation/stimulus, has been mainly studied in the context of parent-child interactions (Shechner et al., 2017). Cognitive change refers to the attempt to change an emotional response by reinterpreting the meaning of the emotion-eliciting event. For example, in Morris et al. (2015) and Doré et al. (2017) participants provided reappraisal support to another person. Response modulation entails changing how emotions are expressed, for example by suppression of emotional reactions as in the fMRI study in Hallam et al. (2014).
4.3.1 Strategies associated with benefits for EER providers Only one study to date (Hallam et al., 2014) directly compared the effectiveness of two
EER strategies. Specifically, this study compared brain activity associated with support provision via a cognitive change strategy (reappraisal) to brain activity during response modulation
(suppression). Compared to suppression, reappraisal support was associated with increased
On the benefits and costs of EER to the provider / 16 activation in the rostral prefrontal cortex and in areas of the cingulate gyrus.
Studies on prosocial behaviors similarly suggest that the type of support given determines its consequences to the provider. For example, prosocial behaviors such as caregiving, volunteering and giving support were found to be associated with a lower risk of mortality in older adults (Qu et al., 2020), while giving money did not exhibit such an association.
4.3.2 Strategies associated with costs for EER providers To our knowledge no study to date has tested how the use of specific types of EER may burden the provider. Current conceptualizations of emotion regulation view adaptive regulation as the ability to flexibly adapt the use of different strategies, depending on situational demand
(Bonanno & Burton, 2013; Haines et al., 2016). Therefore, the discussion on the benefits and costs of different emotion regulation strategies should be contextualized within interactions with individual and situational factors (see Section Error: Reference source not found).
5 Person X Situation X Strategy Effects To advance our understanding and guide future research, here we illustrate the few interactive effects that have already received some indirect or preliminary support.
Findings imply that when considering personality traits, those that primarily direct social relationships (i.e., agreeableness, introversion, low self-esteem) may be related to EER’s benefits and costs, particularly in situations in which the EER involves interpersonal bonding and communication (Graziano & Tobin, 2009). Indeed, individuals who have difficulty forming and maintaining rewarding social ties (e.g., introverted, low on agreeableness; Noftle & Shaver,
2006) exhibit reduced brain activity in empathy-related regions (Haas et al., 2015). Therefore, when providing EER these individuals may be overwhelmed and emotionally flooded, especially in situations in which the target experiences intense emotions (e.g., helping someone who has
On the benefits and costs of EER to the provider / 17 just been involved in a car accident). Similarly, individuals who exhibit less activity in reward- related brain regions, such as individuals with attention deficit/hyperactive disorder (ADHD)
(Plichta & Scheres, 2014), may derive less benefit from EER situations that are subjectively less rewarding (e.g., low perceived effectiveness, no feedback, effortful, prolonged).
An example to these interactive effects can be found in Marigold et al (2014) and
Nozaki (2015) studies. Marigold et al. (2014) (Study 5) demonstrated an interaction between the recipient’s personality, the situation (recipient shared either a positive or a negative event) and the strategy used by the provider. The findings showed that when the support recipients shared a failure and had low self-esteem, the provider tended to validate the recipient’s negative emotions less, in turn causing the provider to feel disappointed and frustrated and to consider the EER attempt to be unsuccessful.
Nozaki (2015) showed that individuals who exhibit higher interpersonal emotional competence provided more help to an ostracized person, but only when the ostracized person did not express sadness (Nozaki, 2015). Although this study did not assess the benefits or harms of support provision for the provider, we can assume that the emotions expressed by the support recipient may also influence the outcomes for the provider, depending on the provider's personality traits.
Future research should examine more interactive effects concerning personality traits, as well as dimensions of clinical symptoms. It is plausible, for example, that EER will be especially rewarding for depressed individuals in situations in which they can actively help another person, thus alleviating feelings of despair and hopelessness and increasing self-worth
(Schacter & Margolin, 2018). Yet another person's situation that elicits self-focused concerns may be especially taxing for depressed individuals due to their tendency to ruminate and worry
On the benefits and costs of EER to the provider / 18 (Raes, 2012). Furthermore, based on prior work stemming from the intrinsic emotion regulation literature (Cohen & Ochsner, 2018) , EER is expected to be more beneficial when the strategy used for the support provision takes the form of cognitive change (reappraisal). This is in line with findings from intrinsic emotion regulation studies showing that reappraisal is associated with increased activation in reward-related brain regions (Buhle et al., 2014).
For anxious individuals, EER may be especially beneficial due to its stress-reducing effect. Similar to what is known for depressed individuals, this is likely to occur when the situation at hand is perceived as manageable and does not elicit self-related concerns. Yet compared to depressed individuals who gain more from reappraisal, anxious individuals may gain more from situation selection or attentional deployment because such strategies may directly deploy attention away from their own worries (Cohen & Ochsner, 2018). As anxious individuals are prone to detect threats and exhibit difficulties in disengaging from threat- provoking stimuli (Okon-Singer, 2018), helping others may serve as a constructive means to distract them from their own concerns.
A challenge for future research, therefore, would be to specify interaction effects between person, situation and strategy related factors that benefits and costs the provider, which echoes the move toward a more personalized account of the function emotion regulation (Aldao et al., 2015; Bonanno & Burton, 2013; Doré et al., 2016; Hofmann, 2014). As the starting point, future investigation can draw on findings from intrinsic emotion regulation. Of relevance, for example, are findings which showed that individuals select and use specific emotion regulation strategies in their daily lives as a function of their personality and of the situation’s emotional tone (Lennarz et al., 2019; Sheppes et al., 2014). In addition, providing EER inherently involves intrinsic regulation of the provider emotions (Zaki, 2020). Thus, a promising direction to explore
On the benefits and costs of EER to the provider / 19 is how intrinsic and extrinsic regulation of the other interact to influence the provider’s emotions.
Taking a step forwards, in many real-life situations individuals co-regulate each other emotions
(e.g., during an emotional-laden discussion). Although recent brain studies try to understand how humans interact during real-life situations (e.g., Wheatley et al., 2019), exploring the bi- directional effects during EER along with simultaneous intrinsic regulation requires sophisticated designs and is a challenge for future research.
6. Conclusion
The benefits and costs of providing EER are likely to depend on complex interactions between person, situation and strategy related factors. However, more empirical research is needed to identify the nature of these interactions and their underlying neural mechanisms. Based on the existing data, individuals’ symptoms (depression, anxiety) and personality traits
(agreeableness, self-esteem, neuroticism) should be taken into account as prominent person- related factors (e.g., (Doré et al., 2017; Marigold et al., 2014). The motivation underlying the provision of EER and the emotion of the target is likely to be key situational factors (Weinstein
& Ryan, 2010). Future research may be expanded also to the exploration of non-prosocial motivations such as harms of egocentric or anti-social agenda (see Zaki & Williams, 2013). In relation to the strategy used, attention should be given to specification of strategy-situation fit
(Sheppes et al., 2014).
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On the benefits and costs of EER to the provider / 31 Figure 1. Brain networks supporting explanatory mechanisms of the consequences of EER for the provider. Empathy-related regions are depicted in yellow; stress-related regions are depicted in blue; the reward region is depicted in red. Amy – amygdala; MPFC – middle prefrontal;
LPFC – lateral prefrontal; ACC – anterior cingulate cortex; TPJ – tempo-parietal junction; TP – temporal pole; VS - ventral striatum.
On the benefits and costs of EER to the provider / 32 Figure 2. Conceptual model of the three sources of inter- and intra-individual differences in the consequences of EER for the provider. The model proposes interactive effects among individual’s characteristics, situational factors and type of emotion regulation strategy used.
Factors tested in the literature are depicted in black: Psychological symptoms (Dore et al., 2017;
Morris et al., 2015); Personality traits (Morris et al., 2015; Mongrain et al., 2018); Receiver characteristics (Marigold et al., 2014); Feedback (Marigold et al., 2014). Those that are potentially relevant based on research on intrinsic emotion regulation or EER related constructs
(i.e., prosocial behaviors, support) are depicted in red. These factors are illustrative and not exhaustive.
On the benefits and costs of EER to the provider / 33