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provided by Frontiers - Publisher Connector OPINION ARTICLE published: 10 January 2014 doi: 10.3389/fpsyg.2013.01019 Cognitive strategies to regulate —current evidence and future directions

Natali Moyal*, Avishai Henik and Gideon E. Anholt

Department of Psychology and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel *Correspondence: [email protected]

Edited by: Tom Johnstone, University of Reading, UK

Keywords: regulation, reappraisal, distraction, labeling, cognitive strategies

Emotions are important and basic in before the generation of the emotion. use reappraisal, they report less nega- human experience, and are comprised Distraction constitutes the deployment of tive compared with a control group of different components, such as sub- attention away from a negative aspect of (e.g., Ochsner et al., 2004; Sheppes and jective feelings, cognitive appraisal, a situation, to a neutral or positive aspect Meiran, 2007). This is in line with stud- physiological response and action ten- (Gross, 1998). Attention can be deployed ies that examined the neural basis of dencies (Kleinginna and Kleinginna, externally (e.g., focus on the shape of a cer- reappraisal and found increased activ- 1981). Emotions become dysfunctional tain stimulus) or internally (e.g., focus on ity in the medial, dorsolateral and ven- when they interfere with one’s ability to neutral or positive thoughts). Distraction trolateral PFC that was correlated with behave adaptively, and therefore successful was found to be an effective ER strategy decreased activity in the while emotion regulation (ER), when neces- in various studies (Nolen-Hoeksema et al., using reappraisal (Goldin et al., 2008; sary, is crucial for psychological health. 2008; McRae et al., 2009; Sheppes et al., McRae et al., 2009). McRae et al. (2009) Difficulties in adaptive ER are related 2011). Sheppes et al. (2011) found, for found that although distraction caused to different psychopathologies such as example, that people tend to choose dis- greater decrease in amygdala activation depression and disorders [for a traction when emotional stimuli are highly compared with reappraisal, reappraisal review see Aldao et al. (2010)]. A well- intense, and it was also found that distrac- was more effective in down-regulating known model that describes the process tion reduces negative affect in depressed the emotional experience as measured by of ER was suggested by Gross (1998). patients (Nolen-Hoeksema et al., 2008). self-reports. The model describes five processes of ER Moreover, in cognitive behavioral ther- that occur at different time points in the apy (CBT), patients learn how to dis- LABELING course of emotional processing and regu- tract themselves from negative situations Labeling is the linguistic processing of the lation. In this paper we focus on two ER that might cause dysphoria (Beck, 2011, emotions that arise in a certain situation strategies included in the process model of p. 213). These findings are in line with (Lieberman et al., 2007). Different stud- Gross—distraction and reappraisal—and data on brain activation during distrac- ies showed that labeling, much like reap- also on labeling, an ER strategy that is not tion that show increased activation in praisal and distraction, results in decreased part of Gross’ model. Reappraisal, distrac- the ventro-medial prefrontal cortex (PFC) activity in the amygdala and increased tion and labeling are cognitive strategies and decreased activation in the amygdala activity in prefrontal areas and Broca’s area used to regulate emotions [for a review (McRae et al., 2009; Kanske et al., 2011). (Hariri et al., 2000; Lieberman et al., 2007; on the reciprocal relationship between Torrisi et al., 2013; Tupak et al., 2014). emotion and cognition see Dolcos et al. REAPPRAISAL Hariri et al. (2000) showed that label- (2011)]. We start with definitions and Reappraisal is also an antecedent-focused ing of facial emotions involved increased findings regarding distraction, reappraisal strategy, but it is implemented later than activation in the right ventral PFC and and labeling. Subsequently, we present the distraction during the time course of ER decreased activation in the amygdala com- process model of Gross, with labeling as an (Gross, 1998). Reappraisal constitutes a pared with a control condition requiring additional form of ER. Finally, we suggest cognitive change of the meaning of an matching facial stimuli with respect to that labeling might mediate the effective- emotion eliciting situation, in order to emotional expressions. This finding sug- ness of reappraisal in clinical populations reduce negative feelings (Gross, 1998). gests that labeling has a unique contri- with deficits in emotion recognition and Reappraisal was found to be highly adap- bution to this pattern of brain activation ER, and discuss the clinical implications tive and people who tend to use this strat- since processing different characteristics of of this suggestion and future directions of egy show greater well-being and fewer the emotional stimuli (e.g., by matching research and conceptualization. symptoms of depression compared with a facial expression) is insufficient to regu- people who do not tend to use reap- late amygdala activation. Similarly, Taylor DISTRACTION praisal (Gross and John, 2003). In addi- et al. (2003) found that when partic- Distraction is an antecedent-focused strat- tion, different studies demonstrated that ipants rated their emotional experience egy of ER, meaning that it is implemented when participants are explicitly asked to while watching negative pictures there was

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decreased activation in the amygdala and TIME COURSE OF EMOTION bottom-up or top-down process—it might increased activation in the dorsal medial REGULATION be that Gross’ model may describe a PFC and the anterior cingulate sulcus. The process model of ER (Gross, 1998) spontaneous or bottom-up process, but These findings regarding the pattern of includes five processes of ER. The first top-down control may enable switch- activation in the brain during labeling process is situation selection—we choose ing strategies or changing the timing of were replicated in different studies (e.g., whether to approach or avoid a situation. strategy implementation. Nakamura et al., 1999; Narumoto et al., Next, there is situation modification— 2000; Gorno-Tempini et al., 2001)and changing the situation. Then there is atten- OUR SUGGESTION suggest that linguistic processing of emo- tional deployment—changing the focus of We suggest that an additional stage of tions (but not other, non-emotional prop- attention (e.g., distraction). The fourth ER should be included in Gross’ model erties of stimuli) regulates the activation ER process is cognitive change (e.g., (1998)—emotion recognition (e.g., label- in the amygdala. The influence of label- reappraisal)—changing the meaning of ing) (see Figure 1). Labeling itself is an ER ing on physiology was also demonstrated the situation. The last process is response strategy that helps to decrease emotional in a study by Tabibnia et al. (2008).In modulation—control over the emotional reactivity (Hariri et al., 2000; Lieberman this study, spider phobics were assigned response (i.e., behavioral, physiological, et al., 2007; Tabibnia et al., 2008; Kircanski to three groups: exposure only, expo- and experiential). In the time course of et al., 2012). It might be that similar to sure with a negative label, and exposure ER, consistent with Gross’ model (1998), distraction, labeling allows dealing with with a neutral label. Eight days after the distraction starts to attenuate late posi- highly intense emotional situations (e.g., exposure to spider pictures, skin con- tive potential (LPP) in the brain at early exposure to phobic stimuli; Tabibnia et al., ductance response (SCR) was measured processes, 300 ms after the stimulus onset. 2008; Kircanski et al., 2012), but unlike whilewatchingthepicturesfromtheini- Attenuation by reappraisal starts 1500 ms distraction, it also allows learning, since tial exposure. Participants from the expo- after the stimulus onset (Thiruchselvam the individual attends to the emotional sure with a negative label group showed et al., 2011), meaning that distraction stimulus. Successful reappraisal includes lower SCR (indicating decreased physio- reduces the emotional reactivity in the an underlying process of emotion recogni- logical arousal) compared with the other brain earlier than reappraisal. According to tion (that is part of the appraisal process). two groups. In addition, their SCR was Gross’ model, when a stimulus is presented Emotion recognition can be explicit (e.g., lower while watching new pictures of spi- we first appraise it (a process that starts labeling) or implicit (e.g., awareness of the ders compared with their SCR during 100 ms after the stimulus onset; see Brosch feeling). We suggest that healthy individ- their first exposure. In another study, spi- and Sander, 2013), and then implicitly uals succeed in reappraisal because they der phobics engaged in exposure to spi- decide whether to use distraction or reap- areabletorecognizetheiremotions.This ders while applying labeling, reappraisal, praisal. However, it is important to note assertion is based on findings with sub- or distraction, or by watching the spi- that ER is a continuous process, and dif- jects with alexithymia (difficulty to iden- ders (control group). It was found that ferent processes in the model can occur tify emotions and describe them; Aleman, when comparing the SCR immediately in parallel. We monitor our emotional 2005) who show a reduced tendency to after exposure to that of 1 week after response and can choose a preferable strat- use reappraisal compared with partici- the exposure, the labeling group showed egy to regulate emotions (consciously or pants who do not suffer from alexithymia the greatest reduction in SCR compared unconsciously), and can switch between (Swart et al., 2009). Other studies also with the other groups. On the other hand, strategies. One can think about ER as a found a relationship between difficulties in the groups did not differ in their self- reported levels (Kircanski et al., 2012). It is important to distinguish between appraisal and labeling. Labeling is dif- ferent from appraisal in the sense that appraisal is an automatic and general processing of various aspects of a situa- tion [e.g., novelty, relevance; for review see Ellsworth and Scherer (2003); Brosch and Sander (2013)], and it includes a basic evaluation of emotional aspects in order to execute an adaptive emo- tional response (e.g., action tendencies; Brosch, 2013). Labeling, on the other hand, relates specifically to the emotional aspect of the situation and involves an explicit verbal process of identifying and FIGURE 1 | A renewed model of the emotion regulation process, based on Gross’ model naming the emotion (Lieberman et al., (Gross, 1998; APA, adapted with permission). This model includes only antecedent-focused 2007). strategies and suggests that emotion recognition is part of emotion regulation processes.

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emotion recognition and ER in different are systematically taught to identify and Brosch, T., and Sander, D. (2013). Comment: the disorders (e.g., anorexia nervosa, Harrison label emotions, in order to improve their appraising brain: towards a neuro-cognitive model et al., 2009; bipolar disorder, Getz et al., reappraisal capability (Beck, 2011, p. 94). of appraisal processes in emotion. Emot. Rev. 5, 163–168. doi: 10.1177/1754073912468298 2003). We suggest that when reappraising, The use of labeling was also suggested Dolcos, F., Iordan, A. D., and Dolcos, S. (2011). we focus on the emotional situation and as one of the techniques that might help Neural correlates of emotion-cognition interac- automatically (and maybe even uncon- improve the outcomes of CBT for patients tions: a review of evidence from brain imaging sciously) appraise the situation, and rec- who suffer from obsessive-compulsive dis- investigations. J. Cogn. Psychol. 23, 669–694. doi: ognize the feeling that arises from this order (Abramowitz and Arch, 2013). We 10.1080/20445911.2011.594433 Ellsworth, P. C., and Scherer, K. R. (2003). “Appraisal situation and the action tendencies that suggest that when studying ER processes processes in emotion,” in Handbook of Affective evoked it. Only then we can interpret the in normal populations, emotion recogni- Sciences, eds R. J. Davidson, K. R. Scherer, and H. situation differently. Different emotions tion occurs automatically and improves H. Goldsmith (New York, NY: Oxford University elicit different action tendencies (e.g., fear the ability to successfully reappraise; and Press), 572–595. elicits the need to move away from the therefore, the importance of explicit label- Getz, G. E., Shear, P. K., and Strakowski, S. M. (2003). Facial affect recognition deficits in bipolar dis- danger), and in order to reappraise suc- ing was not evaluated properly. order. J. Int. Neuropsych. Soc. 9, 623–632. doi: cessfully, one has to modify this action 10.1017/S1355617703940021 tendency. In order to adaptively reap- FUTURE DIRECTIONS Goldin, P. R., McRae, K., Ramel, W., and Gross, praise a situation and down-regulate a Future studies regarding the effective- J. J. (2008). The neural bases of emotion reg- ness of reappraisal in clinical popula- ulation: reappraisal and suppression of nega- negative emotion, one has to attend to tive emotion. Biol. Psychiatry 63, 577–586. doi: one’s feelings and understand them, and tions should consider the role of labeling 10.1016/j.biopsych.2007.05.031 not only appraise the situation in a gen- in ER processes. It might be interest- Gorno-Tempini, M. L., Pradelli, S., Serafini, M., eral way. It might be that populations ing, for example, to study if labeling fol- Pagnoni, G., Baraldi, P., Porro, C., et al. (2001). with difficulties in reappraising situations lowed by reappraisal is more effective than Explicit and incidental facial expression process- each strategy alone in clinical populations, ing: an fMRI study. Neuroimage 14, 465–473. doi: can benefit from explicit labeling of the 10.1006/nimg.2001.0811 emotions that a situation is eliciting, and and even in non-clinical populations. It Gross, J. J. (1998). The emerging field of emotion reg- labeling can be used as a mediator for is also important to understand what ulation: an integrative review. Rev. Gen. Psychol. 2, successful reappraisal. Whereas distraction exactly should be labeled (e.g., the emo- 271–299. doi: 10.1037/1089-2680.2.3.271 impairs memory of the emotional situa- tion itself, the antecedent that caused the Gross, J. J., and John, O. P. (2003). Individual dif- emotion, etc.). To conclude, although the ferences in two emotion regulation processes: tion (Sheppes and Meiran, 2008), labeling implications for affect, relationships, and well- enables on the emotional situ- importance of emotion recognition, and being. J.Pers.Soc.Psychol.85, 348–362. doi: ation. Therefore, we suggest that label- specifically labeling, is common knowl- 10.1037/0022-3514.85.2.348 ing allows coding the characteristics of edge in practice, we suggest Hariri, A. R., Bookheimer, S. Y., and Mazziotta, J. C. (2000). Modulating emotional responses: effects the emotional situation and remembering that emotion recognition should also be included in the theoretical models of ER. of a neocortical network on the limbic system. the emotional experience, while reducing Neuroreport 11, 43–48. doi: 10.1097/00001756- its intensity. 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