Amelia Aldao, PhDAndre J. Plate, BS
Department of Psychology, The Ohio State University
Emotion regulation is the process by which individuals modify the intensity and/or duration of their emotions in order to respond to the various challenges posed by the environment (e.g., Gross, 1998). This construct stems from the coping literature, specifically that of emotion-focused coping (Lazarus & Folkman, 1984). Since the publication of Gross’s process model of emotion regulation in 1998, there has been an exponential growth in the study of emotion regulation strategies in basic (Webb, Miles, & Sheeran, 2012) and clinical research (Aldao, Nolen-Hoeksema, & Schweizer, 2010). Two commonly discussed regulation strategies are cognitive reappraisal (i.e., reinterpreting thoughts or situations in order to change the intensity and/or duration of emotional experiences; see chapter 21) and acceptance (i.e., experiencing thoughts, emotions, and physiological sensations in the present moment and observing them in a nonjudgmental way; see chapter 24). Clients can sometimes encounter difficulties when seeking to implement these emotion regulation strategies in their everyday lives, however, in part because their effectiveness varies as a function of context (e.g., Aldao, 2013).
The idea that specifically changing the way we think can alter our emotional experiences was conceptualized by Aaron Beck in the early 1960s as he began to formalize his highly influential cognitive therapy for depression (A. T. Beck, 1964). Through cognitive restructuring and reappraisal, the client is encouraged to modify maladaptive thinking by critically evaluating the evidence for and against an automatic thought or overarching belief, and by generating cognitive alternatives. Studies have found that reappraisal increases from pre- to post-treatment (Mennin, Fresco, Ritter, & Heimberg, 2015), and that these changes mediate improvement following treatment (Goldin et al., 2012).
A growing number of practitioners and researchers have focused on the importance of accepting, rather than changing, difficult emotions, physical sensations, or other experiences. For example, acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is based on the idea that avoiding emotional experience tends to be toxic, especially when it becomes fixed across contexts (i.e., disconnected from long-term values), fostering a pattern of psychological inflexibility that may lead to the onset, maintenance, and/or exacerbation of psychopathology. For instance, a person who drinks alcohol after work every day may do so to reduce tension, to increase pleasurable feelings, or both. Regardless of context, this person may more readily engage in behavioral patterns (i.e., drinking) that conflict with his personal values (e.g., being emotionally available to his spouse and children). ACT and related therapies, such as dialectical behavior therapy (Linehan, 1993), teach acceptance skills that in this instance may help the client experience alcohol cravings with openness and curiosity, without having to act on them. Acceptance skills are readily increased from pre- to post-treatment, and these changes commonly mediate long-term clinical improvement (e.g., Gifford et al., 2011).
By teaching reappraisal and acceptance, a clinician might help a woman suffering from generalized anxiety disorder and depression increase her awareness of the presence and function of her distressing emotions and worries. Doing so might help her notice that her experience of anxiety is characterized by specific patterns of thinking (e.g., worrying), physiological sensations (e.g., muscle tension), and maladaptive behaviors (e.g., irritability, rigid avoidance of situations that elicit anxiety). By developing awareness and acceptance of emotional experiences, she might be better equipped to adopt flexible patterns of thinking later on in treatment. For example, she might come to view her worries as merely thoughts that she can detach from or feelings that are temporary and will pass with time. She might also nonjudgmentally acknowledge her muscle tension as a bodily sensation that is uncomfortable, yet not harmful. This, in turn, might reduce her avoidance, enhance her abilities to reappraise her maladaptive cognitions, and increase her engagement in long-term adaptive behaviors.
It is worth noting, however, that teaching these emotion regulation strategies to clients can be challenging. It is particularly common for clients to easily learn to implement reappraisal and/or acceptance within therapy sessions but then struggle when utilizing them in response to real-life stressors. In order to effectively teach clients to use emotion regulation strategies flexibly in their everyday lives—and, consequently, enhance the effectiveness of cognitive behavioral approaches—it becomes essential that we help clients generalize learning from the therapy room to the outside world. To that end, we turn to the latest work in the field of affective science, which has increasingly focused on the contextual factors that regulate the use and impact of emotion regulation strategies (e.g., Aldao, 2013; Aldao, Sheppes, & Gross, 2015; Kashdan & Rottenberg, 2010).
There are two main sources of contextual variability that might shed light on the general use of regulation strategies. First, each strategy (e.g., reappraisal, acceptance) can be implemented in different ways by employing a wide range of regulatory tactics, such as focusing on positive aspects of the situation, reconceptualizing future consequences, distancing from the situation, and even accepting aspects of the experience (McRae, Ciesielski, & Gross, 2012). We refer to this as regulatory drift. Second, a given strategy might have different functions in each context. We refer to this as multifinality.
Meta-analytic findings suggest that even small variations in how a strategy is implemented can have diverging consequences on affect (Webb et al., 2012). In this respect, Webb and colleagues identified three types of reappraisal commonly given as instructions in laboratory studies: (1) reappraising the emotional stimulus (e.g., reinterpreting a negative situation to view it more positively), (2) reappraising the emotional response (e.g., reframing an emotional reaction to minimize its negative consequences), and (3) adopting a different perspective (e.g., observing emotions and events from a third-person perspective or detaching from one’s thoughts through cognitive defusion). Each of these reappraisals produced differential effects on emotional arousal. For example, reappraising the emotional stimulus was more effective at reducing emotional outcomes than reappraising the emotional response.
Individuals who suffer from psychopathology tend to experience difficulty recognizing that different situations might call for different regulatory goals (e.g., Ehring & Quack, 2010). Clients tend to have difficulty identifying and labeling their emotions (e.g., Vine & Aldao, 2014), which may reduce their awareness of what emotions might need to be regulated in the first place. This may help explain why problems in emotional identification are associated with a variety of maladaptive behaviors, such as binge drinking, aggression, and self-injury (Kashdan, Barrett, & McKnight, 2015). Lastly, even when clients are aware of the goals of a situation and the emotions experienced there, they may still drift toward utilizing regulation strategies that provide quick and easy short-term relief, even if it comes at the expense of longer-term outcomes (e.g., Aldao et al., 2015; Barlow, 2002; Hayes, Luoma, Bond, Masuda, & Lillis, 2006). For example, a client with obsessive-compulsive disorder might learn to reappraise her contamination concerns about touching the subway handrails from “I touched something dirty. I’m going to contract a disease” to “I touched something dirty but the chances of me actually contracting a disease are very low.” Doing so would allow her to embrace uncertainty. However, when the subway train suddenly speeds up, throws her off balance, and she needs to grasp onto the railing so that she does not fall, she might drift toward using a more maladaptive form of reappraisal. She may respond to her obsessional thoughts by saying, “I touched something dirty and contaminated, but my friend is here, so as long as I ask for reassurance that I won’t contract a disease, then I will be safe.” This type of reappraisal might result in a similar reduction of anxiety in the short term as the first one, but over time it will result in the mistaken belief that the client needs to depend on a friend and engage in reassurance seeking (e.g., maladaptive safety behaviors) that may preclude opportunities for corrective learning (i.e., that touching the handrail does not mean she will contract an illness). It is worth noting, however, that the use of safety behaviors might not always be detrimental (e.g., Rachman, Radomsky, & Shafran, 2008), which suggests that conducting a careful functional analysis of their long-term consequences—and potential for interfering with values—is essential.
A given strategy has different functional relationships with emotional, cognitive, and behavioral outcomes in different contexts—what is called multifinality (Nolen-Hoeksema & Watkins, 2011). For example, social stressors may alter the link between stress and adaptive emotion regulation. This is not surprising given that a substantial amount of emotion regulation happens in relation to other people (e.g., Hofmann, 2014; Zaki & Williams, 2013). For example, in a recent study we found that the use of reappraisal by adolescents was associated with flexible physiological reactivity (i.e., vagal withdrawal) in response to stress only with high levels of interpersonal stressors (i.e., peer victimization). When interpersonal stressors were low, reappraisal was associated with maladaptive physiological responding (Christensen, Aldao, Sheridan, & McLaughlin, 2015). In another study, reappraisal was associated with reduced depression symptoms only when participants were experiencing uncontrollable stressors. If stressors were controllable, the use of reappraisal led to higher levels of depression (Troy, Shallcross, & Mauss, 2013).
In addition, there is evidence suggesting that the link between acceptance and mental health might be a function of context. Shallcross, Troy, Boland, and Mauss (2010) found that when community participants reported experiencing high levels of stress, their habitual use of acceptance was associated with marginally lower levels of depression symptoms four months later. For participants reporting low levels of stress, there was no association between acceptance and depression symptoms.
If the usefulness of a given strategy hinges on the particular context in which it is implemented (e.g., Aldao, 2013), it may be important to match strategies to a given type of situation (e.g., Cheng, Lau, & Chan, 2014). Clients might experience difficulties with this matching for a number of reasons. As we discussed above, it is possible that they might have a difficult time identifying the goals of a situation and/or the emotions they experience and, consequently, which regulation strategy to use. In addition, they might perseverate and use the same strategy across vastly different contexts. It is possible that clients might perseverate when selecting which strategies to use. In this respect, one recent study with a sample of firefighters found that lower levels of switching between strategies (reappraisal, distraction) as a function of various emotional intensities (low, high) was associated with a positive relationship between trauma exposure and PTSD symptoms. That is, in participants with low regulatory flexibility, the link between trauma and symptoms was strong. Conversely, in participants with greater regulatory flexibility, such a link was nonexistent (Levy-Gigi et al., 2016). Thus, these findings suggest that regulatory flexibility might be a critical factor underlying the relationship between exposure to trauma and experience of psychological symptoms.
Perhaps this low regulatory flexibility involving reappraisal might be the result of individuals having low confidence in their ability to effectively modify emotions. In this respect, a recent study found that in the context of a social stressor, healthy participants who were told that emotions were malleable were more likely to spontaneously use reappraisal than those who were told that emotions were not malleable (Kneeland, Nolen-Hoeksema, Dovidio, & Gruber, 2016).
It is also likely that clients might have inflexibility even when explicitly instructed to use different regulation strategies. In this respect, Bonanno and colleagues have shown that individuals with psychological disorders (e.g., trauma, complicated grief) have a difficult time following instructions to enhance or suppress their facial expressions in response to emotion-eliciting pictures (e.g., Bonanno, 2004; Gupta & Bonanno, 2010).
Clients might further have difficulty incorporating feedback about their utilization of regulation strategies. A recent study examined switching from reappraisal to distraction in response to viewing pictures that were emotionally evocative. It found that when participants were highly responsive to internal feedback (defined as high corrugator activity, which reflects frowning) while viewing the pictures in trials in which they ultimately switched strategies, more switching was associated with higher life satisfaction. Conversely, when participants were less responsive to internal feedback, more switching was linked to lower life satisfaction (Birk & Bonanno, 2016). In other words, switching that was based on internal feedback was linked with high life satisfaction, whereas switching that was loosely coupled with feedback (i.e., was haphazard) was associated with low life satisfaction. These findings underscore the importance of incorporating meaningful information about the environment and our reactions to it before making regulatory choices. Thus, psychopathology is linked to difficulties identifying and labeling emotional reactions (e.g., Vine & Aldao, 2014) and physical sensations (e.g., Olatunji & Wolitzky-Taylor, 2009).
Based on the affective science research reviewed above, in this section we provide a series of recommendations for helping clients enhance their regulatory flexibility and generalize what they learn in psychotherapy to their own lives outside the therapy room.
The first step is to track how varying emotions, thoughts, goals, and affective and behavioral outcomes characterize different situations. It is essential to help clients balance short- and long-term outcomes of emotion regulation. Otherwise, they might drift toward utilizing strategies that provide immediate relief but might interfere with their long-term functioning. To do this, it can be helpful to modify the “daily dysfunctional thought record” (A. T. Beck, 1979; J. S. Beck, 2011) and turn it into an “emotion regulation map”; this worksheet (provided at the end of the chapter) can help clients become more aware of their emotional reactions and subsequent consequences. We recommend starting with the following columns for this map: (1) situation description, (2) emotions experienced (both helpful and unhelpful) and their intensity, (3) regulation strategies used, (4) short-term outcomes of regulation, and (5) long-term outcomes of regulation. You can also use this emotion regulation map to set up exercises to help your clients flexibly regulate their emotions (see also Aldao et al., 2015). Here are a few flexibility techniques to develop this map.
Cognitive behavioral approaches teach clients to use strategies such as reappraisal and acceptance to manage their emotional experiences in more adaptive and functional ways. However, using these strategies flexibly in the real world can be quite difficult, and these difficulties might help account for the fact that cognitive behavioral therapy is not effective for everyone (Vittengl, Clark, Dunn, & Jarrett, 2007). In this chapter, we turned to the latest research on affective science for answers. This growing literature suggests that the difficulties our clients encounter generalizing emotion regulation knowledge from the clinic to their everyday lives might stem from the context-dependent nature of emotion regulation. By helping our clients to regulate their emotions more flexibly, therapists are targeting processes that should lead to greater success and to the enhanced efficacy of evidence-based therapy approaches.
Use this worksheet to keep track of your emotions in distressing situations, as well as the strategies that you used to manage your emotions. Refer back to this sheet to evaluate the short- and long-term consequences of using these emotion regulation strategies. Afterward, evaluate how effective each strategy was and adjust which strategies you will use in the future accordingly. Remember, it is important to try out and practice different strategies for different emotions that you experience. Doing so will improve your ability to manage a variety of emotions across many situations.
| 1. Situation Description | 2. Emotions Experienced and Their Intensity | 3. Regulation Strategies Used | 4. Short-Term Outcomes of Regulation | 5. Long-Term Outcomes of Regulation |
|---|---|---|---|---|
|
Be as specific as possible. What were you doing? What triggered your emotional reaction? When was it? Who were you with? Where were you? |
Describe the emotions that you experienced. Rate the intensity of each emotion (0–100). |
List which emotion regulation strategies you used. Be very detailed in how you used each specific strategy. |
What happened immediately after you used these strategies? How did your emotions change? Did they increase or decrease in intensity? How did your thoughts, physical sensations, and behaviors change? |
Did using these strategies help you achieve your long-term goals? How so? How might you manage your emotions differently in the future? |
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