Three studies of emotion regulation

Raugh & Strauss (2023) published “Integrating Mindfulness into the Extended Process Model of Emotion Regulation: The dual-mode model of mindful emotion regulation” in Emotion.  Here’s the edited abstract:

Extensive research has been conducted regarding how people manage their emotions. Within this research, there has been growing attention toward the role of mindfulness in emotion regulation. While prior reviews have discussed mindfulness in the context of emotion regulation, they have not provided a thorough integration using the prevailing models of emotion regulation or mindfulness. The present review discusses the Extended Process Model of Emotion Regulation and Monitoring and Acceptance Theory of mindfulness in order to propose a novel integrated framework, the Dual-mode Model of Mindful Emotion Regulation (D-MER). This model proposes two “modes” of mindfulness: Implementation and facilitation. Implementation posits that mindfulness skills can be used as emotion regulation strategies through attentional deployment and cognitive change. Facilitation posits that mindfulness as a state or trait affects emotion generation and regulation through effects on cognitive processes and positive or negative valence systems. Further, the D-MER posits that mindfulness experience can improve the efficiency of mindfulness-based emotion regulation strategies (implementation) while effects of mindfulness on emotion regulation processes become increasingly trait-like and automatic over time (facilitation). Empirical and theoretical support for this model are discussed, specific hypotheses to guide further research are provided, and clinical implications are presented. Use of this model may identify mechanisms underlying the interaction between mindfulness and emotion regulation which can be used in ongoing affective and clinical research. 

I like the idea of introducing mindfulness to therapy and hope to see more research using this model. The next study sees specific value in assessing emotion regulation in treating Major Depressive Disorder (MDD). Bar-Sella et al. (2023) published “The Prognostic Role of Emotion Regulation Dynamics in the Treatment of Major Depressive Disorder” in Journal of Consulting and Clinical Psychology. Here are the edited abstract and impact statements:

The potential prognostic role of emotion regulation in the treatment of major depressive disorder (MDD) has been highlighted by transtheoretical literature and supported by promising empirical findings. The majority of the literature is based on self-report observations at a single snapshot, thus little is known about the prognostic value of moment-to-moment dynamic evolvement of emotion. The present study is the first to examine the prognostic value of both intra- and interpersonal, moment-to-moment emotion regulation dynamics, and the potential moderating effect of the type of treatment. To assess the prognostic value of emotion regulation dynamics, we focused on the first session, using 6,780 talk-turns within 52 patient–therapist dyads. Emotion regulation dynamics were measured using fundamental frequencies of the voice and were calculated using empirical Bayes residuals of the actor–partner interdependence model. Symptomatic change was measured using the Hamilton Rating Scale for Depression across 16 weeks of supportive treatment (ST) or supportive–expressive treatment (SET). Findings suggest that patients who show less regulated intrapersonal dynamics during the first session show less reduction of symptoms throughout treatment (β = .26, p = .019). Findings further suggest that this association is mitigated when these patients receive SET, as opposed to ST (β = .72, p = .020). The findings demonstrate the ability of first-session emotion regulation dynamics to serve as a prognostic variable. The findings further suggest that the adverse effect of emotion regulation dynamics on the patient’s prognosis can be mitigated by explicit work on changing maladaptive emotional patterns. 

This study is the first to demonstrate the role of first-session emotion regulation dynamics in predicting symptomatic change throughout treatment. The findings suggest that patients who show less regulated intrapersonal dynamics during the first session might benefit less from treatment. The findings further suggest that the adverse effect of emotion regulation dynamics on the patient’s prognosis can be mitigated by providing treatment that works explicitly on changing maladaptive emotional patterns. The findings may support identification of individuals with a risk of poorer prognosis based on their emotional dynamics, as early as the first session of treatment. The findings may further inform personalized treatment selection. 

I think this is an important article for therapists and complements the first one. Finally, we have a study of treatment-resistant depression. Heshmati, Wienicke & Driessen (2023) published “The Effects of Intensive Short-Term Dynamic Psychotherapy on Depressive Symptoms, Negative Affect, and Emotional Repression in Single Treatment-Resistant Depression: A randomized controlled trial” in Psychotherapy. The edited abstract and impact statement follow:

Intensive short-term dynamic psychotherapy (ISTDP) is theorized to reduce negative affect by challenging patients’ defense mechanisms so that they can experience and work through attachment-trauma-related emotions. While ISTDP has been shown to decrease depressive symptoms in single treatment-resistant depression (TRD), it has not been established whether negative affect and emotional repression are reduced, as theorized. Next to depressive symptoms, this retrospectively registered (https://osf.io/v46gy) randomized controlled trial, therefore, examined the effects of ISTDP on emotional repression and negative affect in adults with TRD. Eighty-six adults with major depressive disorder, who had not responded to at least one trial of antidepressants were randomized to 20 sessions of ISTDP (N = 43) or a waitlist control condition (N = 43). Mixed-effect models on the intention-to-treat sample showed that compared to the control condition, ISTDP resulted in significantly lower posttreatment levels of depressive symptoms (d = −1.73), emotional repression (d = −1.91), and negative affect (d = −1.45). Similarly, ISTDP resulted in significantly lower levels of depressive symptoms (d = −2.67), emotional repression (d = −2.69), and negative affect (d = −1.85) at the 3-month follow-up. These results support the evidence base of ISTDP by showing that it can decrease depressive symptoms, emotional repression, and negative affect in TRD. Future studies should assess whether these effects are specific to ISTDP.

Intensive short-term dynamic psychotherapy (ISTDP) has been shown to decrease depressive symptoms in individuals with treatment-resistant depression (TRD). Whether ISTDP also decreases negative affect and emotional repression in line with its theoretical background has not been studied yet. Therefore, this study investigated the effects of ISTDP on negative affect and emotional repression for individuals with TRD. Adults with TRD were randomly assigned to either receive ISTDP or to be placed on a waiting list. At the end of treatment and 3 months later, individuals treated with ISTDP showed greater decreases in experiencing negative feelings and in emotional repression than those who had been on the waiting list. ISTDP is more effective than the passage of time in reducing negative feelings and emotional repression in adults who previously did not benefit from antidepressant medication for their depressive episode. While these findings indicate ISTDP is a potentially promising treatment for TRD, further rigorous comparisons of ISTDP to other active treatments for TRD and research on it its proposed working mechanisms are needed. 

Taken together, these three articles suggest the value of mindfulness in emotion regulation, the power of assessing emotion regulation early in treatment, and addressing negative feelings and emotional repression in treatment-resistant depression.