Which of the following are cognitive strategies that children might use to control their emotions?

Cognitive Change

This emotion regulation strategy involves using cognitive skills (e.g., perspective-taking, challenging interpretations, reframing the meaning of situations) to modify the meaning of a stimulus or situation that gives rise to emotional reactivity. Cognitive reappraisal, a primary form of cognitive change, entails using cognitive and linguistic processes to reframe or reinterpret the meaning of a stimulus or situation in order to up- or down-regulate the emotions. Reappraisal can modify emotional reactions to stressful, anxiety-provoking situations and can lead to psychological flexibility and emotional well-being (Gross & Thompson, 2007). Difficulty reappraising emotions is considered a core mechanism in individuals with anxiety and mood disorders (Campbell-Sills & Barlow, 2007).

Using a variety of methods, research studies have demonstrated that, compared to healthy controls, individuals with SAD are less successful using reappraisal to reduce anxiety responses. Behavioral studies have observed that compared to controls, individuals with SAD report lesser “reappraisal self-efficacy” when challenged to give a speech or recall autobiographical social anxiety situations (Werner et al., 2011). Neuroimaging studies have found that, compared with healthy controls, individuals with SAD generate lesser brain responses in cognitive control (DLPFC and DMPFC) and attention (medial precuneus, posterior cingulate, and bilateral dorsal parietal cortex) brain networks during reappraisal of harsh facial expressions (Goldin, Manber, Hakimi, Canli, & Gross, 2009), as well as temporally delayed prefrontal cortex activation (DMPFC, bilateral DLPFC, and bilateral VLPFC) and less PFC-amygdala inverse functional connectivity when reappraising self-generated negative self-beliefs (Goldin, Manber-Ball, et al., 2009). Thus, lesser and slower recruitment of cognitive control networks in SAD is related to less successful cognitive down-regulation of limbic responses. This reflects how heightened levels of anxiety can inhibit recruitment of PFC in the context of anxiety-inducing stimuli.

Regulating Emotions in Social Contexts

Many emotion regulation strategies occur in the context of interpersonal relationships. Social relationships are strongly tied to physical health and emotional well-being (e.g., Rook et al., 2007). Although social relationships can be a source of joy and contentment, they also can be a source of distress. The most common daily stressors are interpersonal in nature (Almeida, 2005). Interpersonal stressors elicit high levels of emotional distress (e.g., Birditt et al., 2005), and they are strongly related to both emotional and physical well-being (e.g., Newsom et al., 2008).

Socioemotional selectivity theory posits that older adults place greater emphasis and importance on the emotions derived from social relationships than do younger adults (Carstensen, 2006; Carstensen et al., 1999). Older adults have smaller social networks than do younger adults, and researchers believe this decrease reflects active efforts on the part of older adults to remove social partners from whom they derive few emotional benefits (Lang, 2001; Lang & Carstensen, 2002). This decrease of more peripheral partners begins in middle-age, with declines beginning across the third and fourth decade of life (Carstensen, 1992). In contrast to the number of peripheral, less important social partners, the number of close friends and family members is similar across age groups (Lang, 2001). In addition, people report increasing emotional satisfaction with close friends and family members over time (Carstensen, 1992). When reporting the emotions experienced with family members across the course of the week, for instance, older adults report higher levels of positive emotions than do younger adults (Charles & Piazza, 2007).

Even when people experience tense interpersonal exchanges, older adults engage in behaviors that decrease the escalation of these situations to a greater extent than do younger adults (Blanchard-Fields, 2007). For example, younger adults are more likely to respond by engaging in an argument or confronting a person who is the source of the contention, whereas older adults are more likely to report that they disengage from these situations or that they wait until the situation has passed (Blanchard-Fields et al., 2007; Charles et al., 2001). More passive behaviors also appear to confer greater emotion regulation advantages with age. A study examining emotional reactivity in response to two types of interpersonal stressors – one where people engaged in an argument and another where people could have argued but decided to let the situation pass – revealed that older adults are less reactive to the avoided argument than the actual argument (Charles et al., 2009). When comparing across age, older age is related to less reactivity to the avoided argument, but younger, middle, and older adults are similarly reactive to the actual argument.

Evidence suggesting that older adults create more benign outcomes in otherwise tense situations is also found in studies of married couples (Carstensen et al., 1995; Seider et al., 2009; Story et al., 2007). In these studies, older and middle-aged couples are asked to discuss an area of contention in their relationship. Researchers then analyze age differences in expressive behaviors, comments, and physiological reactivity during these exchanges. Results indicate that older and middle-aged couples differ in how they express themselves to their spouses during these conflicts; specifically, older adults use more relationship “we” words, whereas middle-aged couples make more “I” comments (Seider et al., 2009). Researchers interpret the use of “we” as symptomatic of older adults adopting a more communal, relationship orientation than middle-aged adults, which is perhaps why greater use of “we” as opposed to “I” is associated with more positive emotions and less physiological arousal during these arguments. Older adults also express less negative affect and more affection than do middle-aged spouses even after controlling for levels of marital satisfaction (Carstensen et al., 1995). Thus, the actual arguments of older couples appear to be less negative than those of middle-aged couples.

2.4 Cognitive change

The emotion regulation strategy of cognitive change refers to how interpretations or evaluations of emotional events are reframed to change emotional responses (Gross, 1998). The most commonly reported class of cognitive change is reappraisal, a strategy observed to be effective by many (Goldin et al., 2008; Gross, 2001) and has been associated with overall positive social and emotional wellbeing (Gross and John, 2003). Cognitive reappraisal is typically studied in lab settings by presenting participants with emotional material, varying in modality and complexity, and providing instructions to reinterpret the emotional stimuli. Many of these studies require participants to reevaluate negative content while additionally presenting neutral content as a control and for the purposes of reducing desensitization to the negative material.

Two different types of reappraisal, detached and positive reappraisal, have been widely studied in emotion regulation research (John and Gross, 2004; Ochsner and Gross, 2008; Opitz et al., 2012; Schmeichel et al., 2008; Shiota and Levenson, 2009). Detached reappraisal entails removing oneself from the emotional context presented and reframing the presented stimuli to reduce its potency. Positive reappraisal involves the continued engagement with emotional content while attempting to reinterpret the presented material in a more positive way.

Similar to the success of other regulation strategies, cognitive control is implicated in the success of cognitive reappraisal (Ochsner and Gross, 2008; Opitz et al., 2012). The success of detached and positive reappraisal in older adulthood has been shown to vary; positive reappraisal is more commonly successful for older adults than detached reappraisal (John and Gross, 2004; Shiota and Levenson, 2009). Differences observed in the successes of these reappraisal types have been argued to relate to the specific sub-processes of cognitive control they call upon (e.g., mental set shifting, information updating and monitoring, and inhibition of prepotent responses; McRae et al., 2012). Results from several previous studies corroborate the finding that detached reappraisal calls on cognitive control processes more so than does positive reappraisal (Opitz et al., 2012; Schmeichel et al., 2008; Shiota and Levenson, 2009). Positive reappraisal may enlist less cognitive control than detached reappraisal as individuals remain focused on the emotional event while reinterpreting the content to be more positive, whereas detached reappraisal necessitates a degree of separation from the emotional event, which may be more effortful. One recent study investigating the requisite cognitive control older adults use during detached and positive reappraisal shows detached reappraisal calls for greater cognitive control than positive reappraisal, specifically involving the sub-process of mental set shifting (Liang et al., 2017).

Although reappraisal has been shown to be an effective strategy for some, age may play an important role in the determination of the strategy's success due to the requisite level of cognitive control. Individuals with greater capacities in working memory and the cognitive control sub-process of mental set shifting have shown greater success in implementing strategies of reappraisal (Schmeichel et al., 2008). These capacities have been observed to decline with age (Craik and Salthouse, 2011), directing research to investigate potential age differences.

Models of emotion and cognition in aging (e.g., SOC-ER, SAVI) that posit the importance of recognizing available cognitive resources would predict older adults might not prefer to implement cognitive change due to this strategy's demand on cognitive resources. However, by comparison to young adults, evidence suggests older adults are more likely to report engaging in cognitive reappraisal strategies when confronted with distressing emotional content (John and Gross, 2004). Findings from previous research demonstrate that reappraisal may not be a generally effective strategy for older adults to reduce negative affect (Opitz et al., 2012; Urry and Gross, 2010). The apparent contradiction between self-reported preference for implementing cognitive reappraisal and the lab-based success of this strategy may derive from older adults relying on the use of regulation strategies that were previously successful earlier in life and are less successful with age due to declining cognitive resources. It may also result from differences in method (self-report vs lab paradigm). Another explanation could be that variations in choice and preference vary on an intraindividual level as opposed to between age-groups, where situational factors and the particular resources available at a given time may also impact how cognitive change is used (Hess, 2014).

Memory Reconsolidation

Cognitive emotion regulation strategies can help us to change our choices through altering emotional reactions, but they rely on a proposed circuitry that requires the prefrontal cortex to inhibit responses in other brain regions (Ochsner and Gross, 2005). This has certain advantages and disadvantages. One advantage is that these strategies can be flexibly applied when needed. A disadvantage, however, is that these strategies do not result in lasting changes in emotion; when a learned emotional response is consistently maladaptive, such as in addiction, a more long-lasting solution would be more suitable. In addition, it may be harder to utilize such strategies under stress, when PFC function may be compromised. Because of these issues, at times it would be ideal to have a technique that can more persistently reduce learned emotional reactions and associated choices. A promising new line of research suggests targeting memory reconsolidation may lead to a more lasting change in emotion.

When memories are initially learned, there is a period of time after acquisition called consolidation, during which the synaptic changes that instantiate the memory occur. Prior to the completion of consolidation, the memory is fragile or labile and can be disrupted. For many years it was thought that once a memory was fully consolidated it was permanently stable. However, over the last decade or so, an emerging body of research has suggested that every time a memory is retrieved it once again becomes labile and requires an additional storage process to regain stability, called reconsolidation. This additional period of fragility presents a second opportunity to disrupt or alter the memory by altering its re-storage or reconsolidation.

The best evidence for reconsolidation to date comes from studies of Pavlovian fear conditioning in which a neutral cue acquires aversive properties by virtue of simple pairing with an aversive event. A large body of research has shown that these simple associative fear memories are stored in the lateral amygdala (LeDoux, 2000). In a test of reconsolidation, Nader and colleagues (2000) taught a rat to fear a neutral tone and waited a day for this fear memory to be fully consolidated. They then presented the tone, reminding the rat of the fear memory and triggering memory reconsolidation. They subsequently injected a drug in the lateral amygdala that blocks protein synthesis, which is necessary for the synaptic processes required for memory stabilization. A day later, the tone was presented again and the rat showed no evidence of the fear memory; disrupting synaptic processes even after the memory had been initially consolidated disrupted the memory. These results thus provided convincing evidence that by targeting reconsolidation it is possible to disrupt fear memories. Additional research has also shown that targeting reconsolidation can disrupt simple Pavlovian appetitive associations (Lee and Everitt, 2008a), as well as Pavlovian-instrumental transfer (Lee and Everitt, 2008b), suggesting that the learned reinforcing properties of these appetitive stimuli are diminished with this technique.

Over the last decade, a large body of research targeting reconsolidation to change the learned affective qualities of stimuli has emerged in studies with non-human animals, but research in humans has been relatively sparse. One reason is that the drugs commonly used to block reconsolidation in non-human animals are not safe for human use, and the drugs that could be used in humans have had limited success (see Schiller and Phelps, 2011, for a review). An alternative approach has been to take advantage of the adaptive function of reconsolidation, which is to allow memory to be dynamic. Reconsolidating a memory every time it is retrieved both strengthens old memories and also updates old memories with new information available at the time of retrieval. This updating function suggests that it might be possible to introduce new information about the affective qualities of the conditioned stimulus during reconsolidation and change its emotional properties (Monfils et al., 2009).

In a test of this in humans, Schiller and colleagues (2010) taught participants to fear a neutral colored square by repeatedly pairing its presentation with a mild shock. After a day of memory consolidation, half the participants were reminded of the colored square, triggering the reconsolidation process. All the participants then underwent standard extinction training in which the colored square was presented repeatedly without shock. Extinction training provides evidence that the previously feared stimulus is now safe. Standard extinction training is known to result in a second “safe” memory, which can compete for expression with the original fear memory. Because of this, fears often return after standard extinction training when the primary fearful memory begins to reassert itself. Consistent with this, in the Schiller et al. (2010) study, the participants who underwent standard extinction training showed evidence of fear recovery a day later. In contrast, participants who underwent extinction after reconsolidation was triggered showed no evidence of fear recovery a day later, and at a follow-up test a year later. By precisely timing extinction training to occur during the reconsolidation process, it is possible that the original fear memory was updated with the new “safe” information, thus persistently changing this learned fear association and reducing its aversive properties.

To date, the vast majority of research on reconsolidation has examined simple learning paradigms and has not extended findings to the impact of changing affective memories on choices (see Lee and Everitt, 2008b, for an exception). One domain marked by maladaptive decision making where this type of lasting emotion reduction technique might be useful is addiction. Drug addiction is often considered a disorder of memory. Some environmental cues are so strongly associated with a drug, that the addict goes into an intense craving state when encountering these cues (consider, for example, the smell of cigarette smoke for a nicotine-addicted individual). In order for an individual to decide not to use the drug in these situations, she or he has to regulate the craving response to reduce the associated approach tendency. If these associative memories can be persistently changed, it should thus become easier to make healthy decisions. A recent study found that, in both rats and humans, triggering the reconsolidation process prior to exposure therapy – a clinical procedure based on extinction – helped reduce subsequent craving in heroin addicts when they were exposed to cues associated with the drug, more than standard exposure therapy alone (Xue et al., 2012). This powerful finding shows that targeting reconsolidation may be a promising strategy for preventing addicts from relapsing in the long-term. It may also be possible to use these techniques in any other situations where our learned emotional responses result in maladaptive or unintentional poor choices (e.g., Kubota et al., 2012).

Cultural differences in emotion processes and mental health

One emotion regulation strategy is the suppression of feelings. Studies showed that suppression is more common in Asian cultures than US culture (Kim & Sasaki, 2014; Matsumoto, Yoo, & Nakagawa, 2008). In US culture, expression of emotion is encouraged more strongly. For instance, Americans report experiencing more positive emotions than negative emotions, but this pattern is atypical for Asians. Thus cultures moderate the processes of emotion regulation and the way people feel in response to environment and experience (Kim & Sasaki, 2014). If cultures shape emotion regulation, we should expect these cultural differences also influence related neural activity. One study examined brain mechanisms of disgust suppression in Americans. Although participants reported experiencing reduced negative effects, greater emotion-related responses in the insula and amygdala were detected, suggesting self-report and brain response were discordant (Goldin, McRae, Ramel, & Gross, 2008). A similar study on Japanese did not find increased activation in the insula or amygdala during emotion suppression (Ohira, Nomura, Ichikawa, Isowa, & Iidaka, 2006). Although these studies did not directly compare different cultural groups, the divergent findings within each culture are meaningful. Of note is that cultures not only affect emotion processes, but also work together with genes to moderate emotional experience, well-being, and health (Tompson et al., 2018), see Chapter 4, Genetic association with meditation learning and practice (outcomes) for details.

Emotion processes and regulation are directly related to mental health and disorders, so we expect there are cultural differences in the experience of symptoms and mental disorders. Our experience is associated with attention and interoception that are shaped by cultures. Attentional bias refers to the tendency of our perception to be affected by our recurring thoughts and may explain our failure to consider alternatives, which is also influenced by culture. For example, smokers often have attentional bias for smoking-related cues. Sleep-related attentional bias plays an important role in the development and maintenance of insomnia (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007; Harris et al., 2015). Attentional bias is also involved in the exacerbation and maintenance of chronic pain (Rusu, Gajsar, Schlüter, & Bremer, 2019) and is associated with symptoms of disorders such as anxiety, depression, and posttraumatic stress disorder (PTSD) (Browning, Holmes, & Harmer, 2010). In a cross-cultural study of attentional bias in chronic fatigue syndrome, compared to controls, Dutch and British chronic fatigue patients showed a significant attentional bias for illness-related words and were significantly more likely to interpret ambiguous information in a somatic way (Hughes, Hirsch, Nikolaus, Chalder, Knoop, & Moss-Morris, 2018).

A review article examined cross-cultural differences in interoception and the role of culturally bound epistemologies and contemplative practices. The review summarized that people from Western and Eastern cultures exhibit differential levels of interoceptive accuracy and somatic awareness, and show different culturally bound psychopathologies, including somatization, body dysmorphia, pain sensitivity, and eating and mood disorders (Di Lernia, Serino, & Riva, 2016; Ma-Kellams, 2014). One explanation is that culture influences the attention allocation and subsequent cognitive, affective, and social processes. Therefore people in different cultures pay attention differently to the same thing in the same context, which may lead to different mental processes and interpretation of mental health and experience of symptoms and mental disorders (Boduroglu, Shah, & Nisbett, 2009). In summary, these results suggest that culture as a set of social behavior and norms can shape experiences of symptoms and disorders, including attitudes, mindsets, beliefs, and expression of symptoms and diseases, as well as treatment-seeking (Chase, Sapkota, Crafa, & Kirmayer, 2018).

Given that our social cognitive and affective processes are associated with how we believe and perceive mental health, and how we feel, interpret, and experience symptoms and cope with disorders, these research findings provide evidence that culture shapes our belief and attitude toward mental health, influence our feelings and experience of symptoms and mental disorders, and treatment preferences (Jimenez, Bartels, Cardenas, & Alegría, 2013; Jimenez, Bartels, Cardenas, Dhaliwal, & Alegría, 2012; Kramer, Kwong, Lee, & Chung, 2002). For instance, Asian patients tend to report somatic symptoms first and then later describe emotional afflictions, indicating that people selectively present symptoms in a “culturally appropriate” way that won’t reflect badly on them (US Department of Health and Human Services, 2001). In Western culture, we are socially asked how we feel and name our emotional states from an early age. Yet this is not the case everywhere such as in some Eastern and African cultures. In reality, whether we describe emotional or physical symptoms depends on our cultural beliefs and norms. Without considering these cultural differences, physicians may misunderstand and misinterpret the symptoms and make an incorrect diagnosis. Patients are often not aware of the cultural influences and only express “culturally appropriate” symptoms, which may mislead the diagnosis (Chase et al., 2018; Jimenez et al., 2013; Kohrt & Harper, 2008; Kramer et al., 2002). Moreover, some Asian patients prefer avoidance of upsetting thoughts with regard to personal problems rather than explicitly expressing their distress. Compared to white Americans, African Americans are more likely to handle personal problems and distress on their own or turn to their spirituality for support. Moreover, cultural factors often determine how much support we have from our families and communities in seeking help, where people from an Eastern collectivism culture versus Western individualism culture behave very differently (Hunt et al., 2013; Jimenez et al., 2013; U.S. Department of Health and Human Services, 2001). Therefore some symptoms and mental disorders may be more prevalent in certain cultures, but it should be noted that this is largely determined by whether that particular symptom(s) or disorder(s) is rooted more in genetic or social factors. For example, the prevalence of schizophrenia is consistent throughout the world cross-culturally, but pain, anxiety, depression, PTSD, and suicide rates are more attributed to cultural factors (Chiao, Li, Turner, Lee-Tauler, & Pringle, 2017; US Department of Health and Human Services, 2001). It should be noted that the elements of “self” (i.e., a set of beliefs, attitudes, thoughts, values, and emotions) in different cultures are central to the understanding of the conceptions of mental health, psychological well-being, and subsequent stigma as well as treatment-seeking (Kohrt & Harper, 2008; Liddell & Jobson, 2016), which are also significantly impacted by cultures (see Section “Cultural differences in social behavior and self-related processes”).

Rumination

Rumination is an emotion regulation strategy that involves repetitive thoughts on the experience of emotional distress (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Both reappraisal and rumination are emotion regulation strategies that involve cognitive elaboration. However, whereas cognitive reappraisal reinterprets a negative emotional event, rumination keeps people in a loop of repetitive thought about the event. Consequently, cognitive reappraisal often leads to less negative affect (Webb et al., 2012), whereas rumination leads to more negative affect (Segerstrom, Tsao, Alden, & Craske, 2000). People who are more religious are less likely to engage in rumination (Vishkin, Ben-Nun Bloom, et al., 2019), possibly because rumination and cognitive reappraisal recruit the same neural systems, including the left amygdala and the left ventrolateral prefrontal cortex, though for different purposes (Ray et al., 2005). Consequently, engaging in cognitive reappraisal may come at the expense of engaging in rumination. Specifically, once such systems have been recruited to engage in cognitive reappraisal among people who are more religious, they may be less available for engaging in rumination. A negative attitude toward rumination is reflected in some religious dictates. For example, the exhortation to turn the other cheek (Matthew 5:39), rather than dwelling on who has wronged us and how we have been wronged, is a call to let go of an emotional event, rather than ruminating over it. The diminished tendency among people who are more religious to engage in rumination may help them avoid the intensification and maintenance of fear of death, allowing it to subside.

Emotion regulation

Emotion regulation is the application of strategies that increase, maintain, or decrease the intensity, duration, and/or quality of an emotion (Gyurak et al., 2011). Emotions serve to motivate behavior and being able to regulate your emotions is advantageous because it allows you to engage in behaviors that may not provide an immediate reward. Being able to regulate your emotional reaction to an event also allows you to manipulate the likelihood of you engaging in behaviors associated with that emotion. For example, downregulating the emotion of anger to decrease its intensity makes you less likely to engage in behaviors associated with anger, such as fighting or aggression. Research on the neural mechanisms involved in emotion regulation has focused primarily on attempts to downregulate negatively valenced emotions. To date, emotion regulation strategies have been largely grouped into three different classes: (1) attentional control, (2) cognitive reappraisal, and (3) response modulation (Webb et al., 2012). Surprisingly, researchers have had little success in reliably differentiating which brain structures are specifically implicated with each strategy (Giuliani et al., 2011; Kühn et al., 2011). There seems to be much overlap in the neural resources recruited by these varied strategies.

Emotion regulation strategies and PTSD

Much of the research on emotion regulation strategies in PTSD is cross-sectional in nature, relying heavily on self-report measures of emotion regulation strategy use. Not surprisingly, research in this area shows that individuals with PTSD tend to rely on putatively maladaptive emotion regulation strategies. A recent metaanalysis by Seligowski et al. (2015) examined associations between PTSD and various measures of emotion regulation across 57 studies of college student, community, military, clinical, and substance-dependent samples. Results from this metaanalysis support the hypothesis that PTSD is associated with a greater reliance on putatively maladaptive emotion regulation strategies. Specifically the authors found the largest effects for the specific emotion regulation strategies of rumination, thought suppression, and experiential avoidance. Medium-sized effects were found for expressive suppression and worry. Of note, significant effects were not found for putatively adaptive emotion regulation strategies (acceptance and reappraisal).

In one of the few laboratory-based studies in this area, Tull, Berghoff, Wheeless, Cohen, and Gratz (2018) examined the relation between PTSD symptom severity and the use of specific emotion regulation strategies following exposure to a trauma-related reminder. Specifically, substance-dependent patients exposed to a Criterion A traumatic event listened to a personalized trauma script and then reported on the specific emotion regulation strategies that they used during the script. Interestingly, PTSD symptom severity was positively associated with the use of more putatively adaptive (e.g., distraction) and maladaptive (e.g., emotional avoidance) emotion regulation strategies. In addition, the authors found evidence of indirect effects of PTSD symptom severity on negative affect and cortisol reactivity through both putatively adaptive and maladaptive emotion regulation strategies. These findings speak to the complexity of emotion regulation strategy use among individuals with PTSD. Specifically the findings suggest, that although substance-dependent patients experiencing PTSD symptoms may be more likely to rely on maladaptive emotion regulation strategies, they may also have access to more adaptive emotion regulation strategies as well. It is also possible that, as PTSD symptoms become more severe, individuals may employ a greater number of strategies (potentially insensitive to context) in an attempt to modulate emotional distress.

Research has also demonstrated that the use of particular emotion regulation strategies is prospectively associated with the development of PTSD symptoms. For example, within a sample of individuals who had experienced a motor vehicle accident, dissociation at the time of an accident and persistent dissociation 4 weeks following the accident significantly predicted the severity of PTSD symptoms at 6 months (Murray, Ehlers, & Mayou, 2002). Murray et al. (2002) also found that rumination soon after the accident and 4 weeks postaccident exhibited high-magnitude associations with PTSD symptom severity 6 months after the accident. In a study of undergraduate students exposed to a campus shooting, Kumpla, Orcutt, Bardeen, and Varkovitzky (2011) found that preevent experiential avoidance predicted peritraumatic dissociation and PTSD intrusion and dysphoria symptoms 1 month following the traumatic event. Moreover, peritraumatic dissociation was associated with more severe PTSD symptoms 1 month after the traumatic event and experiential avoidance 1 month after the event was associated with more severe PTSD hyperarousal and dysphoria symptoms 8 months after the traumatic event. Jenness et al. (2016) also found that the use of particular emotion regulation strategies pretraumatic exposure (rumination and low cognitive reappraisal) predicted the onset and severity of PTSD symptoms among adolescents exposed to a terrorist attack. Similarly, Fitzgerald et al. (2018) found that deficits in the ability to engage in cognitive reappraisal (a putatively adaptive emotion regulation strategy) were associated with more PTSD symptoms over the course of 1 year among OEF/OIF/OND combat-exposed veterans. In a recent study, Short, Boffa, Clancy, and Schmidt (2018) used an ecological momentary assessment design to examine prospective associations between the use of putatively maladaptive and adaptive emotion regulation strategies and PTSD symptoms in a sample of individuals with a diagnosis of PTSD recruited from the community and a university setting. Over the course of 8 days, the authors found that the use of putatively maladaptive emotion regulation strategies (e.g., thought suppression, rumination, engaging in impulsive behaviors, and avoidance) in response to a stressor prospectively predicted more severe PTSD symptoms later in the day. Putatively adaptive emotion regulation strategy use (cognitive reappraisal, acceptance, and problem solving) in response to a stressor, however, did not prospectively predict PTSD symptoms later in the day.

Finally, neuroimaging studies provide further evidence of deficits in employing emotion regulation strategies among individuals with PTSD. In general, these studies show that, in the context of provocation paradigms (e.g., exposure to trauma-related or other emotionally evocative cues), individuals with PTSD exhibit hyperactivation of the dorsomedial prefrontal cortex, anterior insula, and amygdala and hypoactivation of the dorsal anterior cingulate cortex—all areas implicated in the experience and regulation of emotion (Taylor & Liberzon, 2007). In addition, several studies have utilized a paradigm where individuals with PTSD are instructed to utilize the specific emotion regulation strategy of cognitive reappraisal when viewing emotionally evocative aversive images. These studies found that, relative to control groups, individuals with PTSD had less recruitment of the dorsolateral prefrontal cortex during cognitive reappraisal (New et al., 2009; Rabinak et al., 2014). Similar to Tull et al. (2018), these findings suggest that individuals with PTSD can employ putatively adaptive emotion regulation strategies (as the dorsolateral prefrontal cortex was activated); however, evidence that the dorsolateral prefrontal cortex was recruited to a lesser extent than individuals without PTSD indicates that they may be less effective in doing so relative to those without PTSD.

5.2.2 Indirect Emotion Regulation Strategies

However, the applicability of direct emotion regulation strategies in intractable conflict may be limited, because even if people are trained to use a regulation strategy, they will not do so unless they are motivated to change their negative emotions about the out-group—a condition that may often be absent in strong real-world conflicts (Halperin et al., 2014). In this case, an alternative, indirect strategy may be useful. This strategy involves focused interventions aimed at specific appraisals, predicted to change corresponding emotions. In one example of this approach, the emotion of hatred, and its associated appraisal that the out-group has unchangeable negative characteristics, was targeted by messages suggesting that groups in general are malleable and can change (Levy, Stroessner, & Dweck, 1998). Halperin, Russell, Trzesniewski, Gross, and Dweck (2011) showed experimentally that such messages did indeed change appraisals and increase support for political compromises as a road to peace. Other studies have successfully used similar approaches to increase group-based guilt, which can play an important role in reconciliation (Čehajić-Clancy, Effron, Halperin, Liberman, & Ross, 2011).

Metaanalytic studies of emotion regulation

Two metaanalyses have attempted to estimate the average effect of ER strategies on emotional experience and related outcomes. In the first one, Augustine and Hemenover (2009) used Parkinson and Totterdell’s (1999) taxonomy to classify different affect regulation strategies. This taxonomy was developed by asking participants to classify 162 strategies into meaningful strategies. The results of this metaanalysis revealed two principal types of strategies: behavior and cognitive strategies.

Aldao, Nolen-Hocksema, and Schweizer (2010) examined the effects of six ER strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) on psychopathology. Avoidance and rumination were found to be positively associated with psychopathological symptoms, whereas acceptance and problem solving were negatively associated. With regard to the strategies described by the process model of Gross (1998), suppression was found to be positively correlated with psychopathological symptoms, whereas reappraisal was negatively correlated. Webb, Miles, and Sheeran (2012) outlined a new taxonomy that delineates the relationship between ER processes and specific ER strategies (Table 11.1). Moreover, they illustrate a number of potential moderators of the relation between strategy use and emotional outcomes.

Table 11.1. A Taxonomy for Linking Emotion Regulation Processes With Specific Strategies and Strategy Subtypes

Source: Reprinted from Webb, T. L., Miles, E., & Sheeran, P. (2012). Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychological Bulletin, 138(4), 775–808, with permission. Copyright 2012 by the American Psychological Association.