Emotion dysregulation in psychopathology: cultural, cognitive and neurophysiological processes involved

Chairs:   Caterina Lombardo &  Cristiano Violani

Department of Psychology, Sapienza University of Rome, Italy

Abstract:

Emotion Regulation (ER) can be defined as the process by which individuals influence the
quality, intensity and course of their emotional experience (e.g. Gross, 1998). The use of functional
ER strategies like reappraisal have been proposed as protective factors (e.g. Aldao et al., 2010) or as
mechanisms of change in psychotherapy (Hofmann & Asmundson, 2008) while the use of
dysfunctional ER strategies (e.g. suppression, rumination) have been associated with several
psychopathological disorders (Mennin & Farach, 2007; Aldao et al., 2010). However it is still
unclear which are the way through which this influence is accomplished.
Within this framework, the symposium, starting from evidencing the association between
ER strategies and different psychopathological conditions, aims at highlighting the socio-cultural
(contribution from Arens et al.), cognitive (namely attentional bias in Lombardo’s et al., and
Rossignol’s et al. contributions), and neuropsychological (Rossignol’s and Baglioni’s contributions)
processes and consequences involved in the use of dysfunctional or functional strategies.

Talk 1:

Ethnic Variation in Emotion Regulation: Do Cultural Differences end where Psychopathology begins?

Elisabeth A. Arens, Nazli Balkir, & Sven Barnow
Department of Clinical Psychology and Psychotherapy, University of Heidelberg

Emotion regulation (ER) via cognitive reappraisal has been shown to be superior to the use of
expressive suppression regarding several aspects of mental well-being. However, a cultural
perspective suggests that the consequences of emotional suppression may be moderated by cultural
values. In order to examine whether this also applies to clinical samples, we investigated healthy
and depressed German women and healthy and depressed Turkish immigrants living in Germany.
Groups were compared in terms of frequency of ER strategies (cognitive reappraisal and expressive
suppression) and their consequences for different aspects of mental well-being. Healthy Turkish
immigrants exhibited a greater ER balance (frequent use of suppression plus frequent use of
reappraisal), which was associated with more positive outcomes of expressive suppression in
Turkish than in German women. None of these differences were found between patient samples,
both of which showed a greater use of emotional suppression than cognitive reappraisal. Results
suggest that cultural moderation of the consequences of emotional suppression is associated with a
greater ER balance in healthy Turkish individuals. Depressed Turkish patients may not profit from
suppression due to their more rigid use of suppression.

Talk 2:

Is the enhancement of attentional allocation in social anxiety specific to emotional stimuli? Evidences for a generalized disruption of perceptual processes.


Mandy Rossignol; Virginie Peschard; Pierre Philippot.
Institute of Psychological Sciences, Université Catholique de Louvain-La-Neuve.

The capacity to respond efficiently and accurately to emotions displayed on faces is necessary to
ensure smooth social interactions in everyday life. However, different psychological disorders are
characterized by important deficits in the recognition of emotional faces. In particular, individuals
with high social anxiety show enhanced automatic vigilance to faces, indexed by higher amplitudes
of early ERP components as the P1. However, P1 enhancements have been reported for negative
faces but also for happy and neutral faces. One may suggest that all categories of faces represent a
potential threat in social anxiety. Alternatively, another theory postulates a generalized
hypervigilance to visual stimuli in social anxiety, which would extent to other categories of stimuli,
even non-emotional. In that context, we conducted two studies assessing the specificity vs.
generalization of enhanced visual processing in social anxiety (SA). In a first study, an emotional
Stroop paradigm was proposed to SA participants who had to name the emotional expression
(anger, happiness, neutrality) of faces (explicit processing) or the color of a mask superimposed on
them (implicit processing). In a second study, SA participants were asked to detect targets
succeeding to emotional faces, human postures, or everyday-life objects. In both studies, SAD
demonstrated enlarged P100 for all visual stimulation, suggesting a generalization of the
phenomenon of increased visual processing in social anxiety. These results will be discussed within
the framework of the recent models of anxiety and the phenomenon of emotional regulation.

Talk 3:

Emotion dysregulation in eating disorders

Caterina Lombardo, Gemma Battagliese, Monica David, Cristiano Violani
Department of Psychology, Sapienza University of Rome

Several etiological models of eating disorders suggest that people vulnerable to these problems
often experience intense negative emotions and turn to food for up-regulating them (Polivy and
Herman, 2002; Macth, 2008). Actually several studies report lower emotional awareness and higher
difficulties in regulating emotions, presence of dysfunctional emotion regulation strategies like
suppression or experiential avoidance and lower use of adaptive strategies like re-appraisal and
problem solving (e.g. Harrison et al., 2009; Bekker & Spoor, 2008; Paxton and Diggens, 1997;
Schmidt & Treasure, 2006) in eating disorders.
Since people with AN show extreme personality features of emotional dysregulation and inhibition,
which includes social avoidance, anxiousness and affective liability (Holliday, Uher, Landau,
Collier, & Treasure, 2006), it could be hypothesized that the emotion dysregulation is the factor that
promote both the development and/or maintainance of eating disorders and the comorbidity with
other Axis I and Axis II disorders. Consistently with this interpretation, a recent meta-analysis
(Aldao et al., 2010) evidence that the severity of the disorder is greatly predicted by emotion
suppression.
Within this conceptual framework, two studies will be presented evidencing that: 1) both ED
patients and people high in eating restriction show higher use of expressive suppression than
healthy control groups; 2) emotion suppression predicts the co-occurrence of symptoms of ED and
symptoms of insomnia, depression, anxiety in nonclinical samples; 3) emotion suppression predicts
physiological (EMG over the corrugators and zygomatic muscles, HR and SCL) responses to
emotional stimuli related and not related to the main disorder complied. Based on these sets of data,
the role of emotion suppression and the clinical implications of this relationship will be discussed.

Talk 4:

Emotional dysregulation in insomnia: a possible mediating factor in the relationship between insomnia and depression.

C. Baglioni, K. Spiegelhalder, W. Regen, B. Feige, C. Nissen, D. Riemann
Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Freiburg,
Germany

In many patients with depression, symptoms of insomnia herald the onset of the disorder and may
persist into remission or recovery, even after adequate treatment. A meta-analysis of recent data has
shown that people with insomnia have a two-fold risk of developing depression, compared to good
sleepers. However, the psychophysiological mechanisms underlying this causal relationship are still
not well understood. Heightened emotionality has been proposed to be a possible mediating factor;
however there is a surprising lack of studies using physiological indices. In one study, we evaluated
brain reactivity to emotional stimuli in people with primary insomnia and in good sleepers.
Patients with primary insomnia (n=22) and healthy controls (n=40) were presented with different
blocks of neutral, negative, and sleep-related negative pictures during an fMRI task. Neutral and
negative pictures were taken from the International Affective Picture System (IAPS), while sleep-
related negative pictures were previously validated. Stimuli were matched for valence and arousal
levels. All participants previously underwent two consecutive nights of polysomnographic
recordings in order to exclude those with other sleep disorders. Preliminary results are consistent
with the hypothesis that people with insomnia present altered emotional responses in the amygdala
and other limbic areas to negative stimuli related and non-related to sleep as compared to good
sleepers. Clinical implications of the present findings, which need confirmation by further
investigation, suggest that adding an emotional regulation component to standard therapy for
insomnia might be effective to ameliorate sleep and to prevent the development of depression as a
public health priority.