Gross, James J. (red.), 2014-, Handbook of Emotion Regulation

Muscle and Breathing Relaxation Every skills building module starts with a short psychoeducation that explains how different areas of the brain may mutually activate each other, thus forming neuroaffective vicious cycles that can override processes responsible for down- regulating undesired affective states. For example, when the amygdala is activated by a situation that is interpreted as a potential threat, it initiates physiological changes such as an increase in muscle tension and an acceleration of breathing. Because such changes have occurred in the past when encountering threatening situations, the muscle tension and rapid breathing themselves may in turn have become danger signals to the amygdala (i.e., classical conditioning or the concept of somatic markers; Damasio, 2000). As a result, a vicious cycle may develop in which the activation of the amygdala causes increased muscle tension and rapid breathing, which in turn causes further activation of the amygdala and even more muscle tension and further rapid breathing (for details on how somatic processes are integrated into information processing relevant for emotion elicitation and maintenance, see Stemmler, 2004; Teasdale & Barnard, 1993). When participants realize that they are experiencing stress or negative affective states, they can break through these vicious cycles by consciously relaxing their muscles and purposefully calming their breathing. By engaging in these exercises, they can reduce activation of the sympathetic system, the limbic system, and the brainstem (Porges, 2007). After this vicious cycle has been introduced and discussed with participants, we introduce participants to progressive muscle relaxation techniques (Jacobson, 1964) combined with a simple exercise to calm breathing. Studies have consistently shown the effectiveness of muscle and breathing relaxation in the treatment of a variety of mental and physical disorders (e.g., Öst, 1987; Conrad & Roth, 2007). Additionally, with reduced limbic activity through breathing and muscle relaxation, a shift can occur that changes the focus from primarily amygdala- driven limbic- and brainstemfocused responses back to more prefrontal, cortical responses that are reflective rather than reactive (Arnsten, 2009). Thus, reducing psychophysiological arousal with the help of muscle and breathing relaxation facilitates the subsequent use of techniques requiring more cognitive resources. Nonjudgmental Awareness When the amygdala detects potential threats, it alerts the prefrontal cortex (PFC), which then focuses attention and conscious processing on threat-relevant stimuli (LeDoux, 2012). Such effortful processing aims to more validly evaluate potential threats and determine behavioral responses most likely to be effective. However, if this processing does not lead to a solution of the problem, an ongoing focus on aversive experiences may lead to an ongoing activation of the amygdala. This activation may cause the PFC to focus even more attention on the problem (Amaral, Price, Pitkänen, & Carmichael, 1992; Gray & McNaughton, 2000; Vuilleumier, Richardson, Armony, Driver, & Dolan, 2004), thus potentially resulting in a cyclical reaction of even more intense processing of problematic stimuli and further activation in the amygdala. In attempt to prevent such a negative cycle, some individuals try to rigidly suppress “negative” thinking (Ottenbreit & Dobson, 2004). However, this strategy is likely to have a paradoxical effect of increasing the intensity of negative thinking instead of reducing it (Wenzlaff & Wegner, 2000). Thus, instead of fighting negative thinking, we encourage participants simply to observe the situation and their affective states without interpreting, judging, or reacting. This kind of mindfulness-based affect labeling has been shown to disrupt amygdala activity (Lieberman et al., 2007) and to be effective as a reappraisal or distraction in the regulation of negative affect (Lieberman, Inagaki, Tabibnia, & Crockett, 2011). When applying this technique as ART Skill 3, participants start by switching from regulating their breathing to simply observing it. Then, they start focusing on their sensual experiences (sensations in the body, sounds, odors, and visual perceptions); their thoughts (“What is the next thought that comes to mind?”); and their current salient wishes, desires, and goals (“If everything was going exactly according to your wishes, where would you be now? What would you be doing now? Imagine this perfect scene. . . . Briefly name the wish or goal expressed in this image”). At the end of this sequence, participants are invited to be aware of their affective states without judging them. Instead, they are instructed to (1) find a matter-of-fact label for this emotion (e.g., anger), (2) rate its intensity on a scale from 1 to 10, and (3) identify where the emotion is felt in the body. Finally, participants are invited to check for additional feelings that might lie behind the most prominent one and repeat the same three-step process on them. This technique of becoming aware of one’s affective states in nonjudgmental ways aims to recruit cognitive resources to facilitate effective affect regulation (Gyurak & Etkin, this volume; Hariri, Mattay, Tessitore, Fera, & Weinberger, 2003). Evidence for the efficacy of nonjudgmental awareness includes studies on the effectiveness of mindfulness-based interventions (Farb et al., this volume).

Incidental Regulation through Language Goal-directed engagement of higher order cognitive processes, such as language, in emotional contexts can have “accidental” emotion regulatory consequences. In experimental paradigms, participants are instructed to label the emotion displayed on a face (e.g., indicate whether the face is angry or afraid), match the affect shown on the face to another face showing the same emotion, or match the gender of the face (Hariri, Bookheimer, & Mazziotta, 2000; Lieberman et al., 2007; Lieberman, Hariri, Jarcho, Eisenberger, & Bookheimer, 2005). There are important similarities between verbal labeling as done in this task and creation of a verbal narrative that is supposed to lessen emotional arousal seen in explicit regulatory tasks. Because of these parallels, the task fits our definition of emotion regulation, as it results in the regulation of emotional arousal in a goal-directed fashion. Semantically labeling emotional stimuli, or “putting feelings into words,” as these paradigms are typically described, versus matching the emotion on another face or labeling the gender has a marked explicit component, yet the regulation still happens in the absence of an explicit goal to do so. At the neural level, matching emotional expressions on faces with words that label affect results in lower amygdala activation, as compared to matching expressions to other expressions, matching the gender to gender labels, or simply viewing the face. Moreover, labeling the emotion of facial expressions or focusing on physical rather than emotional features of an emotionally evocative scene results in increased activation in the lateral and medial prefrontal cortices, despite the fact that emotion regulation in this paradigm is unintentional or implicit (Hariri et al., 2000; Lieberman et al., 2005). Importantly, Lieberman and colleagues (2007) documented that a vmPFC activation mediated the relationship between lateral PFC and decreased amygdala activity, suggesting that similar to implicit emotion regulation, it may be the medial PFC–amygdala pathway that plays a critical role in dampening emotional reactivity in these tasks (see Figure 5.1). Variants of the affect-labeling task have been used in pediatric anxiety and mood disorder populations with or at-risk for psychopathology (Beesdo et al., 2009; Monk et al., 2007; Taylor, Eisenberger, Saxbe, Lehman, & Lieberman, 2006). These studies show that among at-risk adolescents, focusing attention on the physical features of an emotional face (nose width) or labeling one’s subjective emotions while viewing an emotional face, normalized concomitant neural activation in the PFC and amygdala. Similarly, McClure and colleagues (2007) found that the performance of children with GAD did not differ from that of their healthy counterparts in rating physical features of negative emotional faces, and that they recruited the same amygdala, dACC, and vmPFC networks as their healthy adolescent counterparts. However, in another study, Taylor et al. (2006) found that children from high-stress family environments showed higher amygdala and dlPFC activation during an affect labeling of faces task than children from low-risk families, who showed lower amygdala activation during affect labeling. Low-risk children did not differ in dlPFC activation. Taken together, these result shows that disordered and atrisk children are capable of labeling as a form of regulation behaviorally, and they might do so largely through the normative circuitry.