A Framework to Test Emotion Regulation in the Lab and the Clinic

Emotion regulation is the process of influencing one’s emotional experiences, including how intense an emotion is, how long the emotion lasts, and even what emotion one is feeling (Gross & Thompson, 2007). Understanding how people regulate their emotions well is a key question of interest for both basic and applied psychology researchers. However, basic and applied researchers have developed relatively independent lines of research about emotion regulation, using distinct operationalizations, materials, and timescales. These somewhat distinct traditions can make it hard to translate findings between these domains. For example, it’s unclear how well teaching people to use cognitive reappraisal by asking them to think about situations differently and assessing how their degree of negative affect changes in response to seeing a novel image translates to teaching people in therapy to use reappraisal in response to real-life stressors over multiple therapy sessions to reduce depression. To facilitate translation between these areas, we developed a framework highlighting important domains in each area, with a sampling of the research to date in each domain.

Motivational Mechanisms

To use emotion regulation strategies, people must have some belief that they can use these strategies and these strategies may lead to emotional changes. This belief, referred to as self-efficacy, has been studied as a general construct since at least the 1970’s (Bandura, 1977). However, specific self-efficacy beliefs regarding emotion regulation have received relatively less attention. Improvements in self-efficacy in treatment have predicted improvements in panic symptoms in a trial of CBT (Gallagher et al., 2013). Understanding how to improve emotion regulation self-efficacy (through motivational enhancement, in-session practice, or symptom reduction) offers a translational bridge between basic and applied researchers.

Between-Situation Mechanisms

People regulate their emotions across different situations and within specific situations. We first review patterns of emotion regulation across different situations, or what we have called “between-situation mechanisms of emotion regulation.”

Increasing the Frequency of Adaptive Strategies

Because people with psychopathology tend to use adaptive strategies less frequently than those without psychopathology (e.g., Southward & Cheavens, 2020b), many treatments have been designed to teach people to use a wide array of strategies more frequently. Treatments that include explicit emotion regulation practice and implementation have been efficacious in improving a wide range of outcomes (e.g., Linehan et al., 2015). However, there are mixed findings regarding whether the frequency of strategy use mediates improvements in treatment (e.g., Webb et al., 2016; Wilks et al., 2016). Combining more fine-grained assessments (such as ecological momentary assessment [EMA] or daily diaries) with treatment studies may facilitate our understanding of the role of adaptive strategy frequency in treatment.

Increasing the Repertoire of Adaptive Strategies

People who have access to a larger repertoire of emotion regulation strategies tend to report better psychological health, but this relation is small (r = .12; Cheng et al., 2014). When distinguishing adaptive from maladaptive strategies, researchers have found stronger evidence that larger repertoires of adaptive strategies are related to better mental health and larger repertoires of maladaptive strategies are related to worse mental health (McMahon & Naragon-Gainey, 2019; Southward & Cheavens, 2020a). However, affective science researchers have shown that people use more strategies in response to more intense negative affect (Ford et al., 2019), a finding that has been replicated in treatment (Southward et al., 2021). It is also time-consuming to teach patients in therapy a large repertoire of strategies. Thus, it is important to understand whether larger repertoires buffer against experiencing negative affect or are better leveraged in response to negative affect and whether teaching a large repertoire of strategies is the most efficient way to reduce symptoms. 

Improving the Quality of Emotion Regulation

A more targeted approach way to reduce symptoms may be to help patients improve the quality of their emotion regulation strategies, or how well they use them, rather than how many strategies are used or how frequently they’re used. People with more severe psychopathology have demonstrated lower quality emotion regulation strategies (Southward & Cheavens, 2020b). Most of the treatment research on emotion regulation quality has focused on cognitive therapy for depression where higher quality strategies generally predict decreases in depressive symptoms (e.g., Strunk et al., 2014). Thus, there are many lines of inquiry open to affective science and intervention researchers to test what constitutes high quality strategies and whether capitalizing on patients’ strengths by improving the quality of their strategies (Cheavens et al., 2012), rather than teaching them new strategies, may lead to more efficient symptom change.

Reducing the Frequency of Maladaptive Emotion Regulation

In meta-analyses, maladaptive emotion regulation strategies tend to demonstrate stronger absolute associations with psychopathology than adaptive strategies (Aldao et al., 2010). We draw an analogy to physical regulation in that consuming a large meal will lead to weight gain more directly than exercise will contribute to weight loss. Thus, in a treatment context, it may be more important to help patients reduce their use of maladaptive strategies than to teach them many adaptive strategies. When directly compared, decreases in maladaptive strategy use have predicted symptom reductions more consistently than increases in adaptive strategy use (Conklin et al., 2015; Gibbons et al., 2009; Uliaszek et al., 2018). We encourage affective science and intervention researchers to (a) develop measures that do not conflate emotion regulation strategies (e.g., worry) with outcomes (e.g., generalized anxiety) and (b) to test whether targeting reductions in maladaptive strategies is more efficacious than teaching new adaptive strategies.

Within-Situation Mechanisms

In addition to using patterns of strategies across different situations, people often use multiple strategies to regulate their emotions in any given emotional situation (Heiy & Cheavens, 2014; Ford et al., 2019). To characterize these “within-situation mechanisms,” it’s important for researchers to conduct more nuanced analyses of the unfolding of these situations.

Increasing or Decreasing Within-Strategy Use

In two experimental studies, people who used more emotion regulation strategies in response to disgust (Aldao & Nolen-Hoeksema, 2013) or repeated negative feedback (Southward et al., 2018) reported more intense disgust, depressive symptoms, and borderline personality disorder features. However, across three EMA studies, using more adaptive strategies in the moment predicted reductions in negative affect, dysphoria, and anxiety whereas using more maladaptive strategies in the moment predicted increases in these outcomes (McMahon & Naragon-Gainey, 2019; Roesch et al., 2010; Southward & Cheavens, 2020a). Among patients in treatment who completed an EMA protocol, within-situation adaptive strategy use was unrelated to affective outcomes; only using fewer maladaptive strategies predicted improvements in affect. To resolve these mixed findings, we encourage researchers to experimentally manipulate the number of strategies participants use in specific situations. Recruiting participants with the full range of psychopathology will further help determine whether these effects vary by levels of clinical severity. 

Order and Timing of Strategy Use

If people do use multiple strategies in a situation, it’s important to know whether certain sequences of strategies are more efficacious than others. People tend to try avoiding, suppressing or ruminating first, followed by reappraisal, distraction, and problem-solving, and ending with acceptance (Guiller et al., 2019). Experimentally, switching from reappraisal to distraction may be more adaptive in response to more intense negative emotions (Birk & Bonanno, 2016), but switching from rumination or self-compassion to reappraisal may be effective in the moment (Peuters et al., 2019; Diedrich et al., 2016). In treatment, teaching patients emotion regulation strategies they are either skilled at (Sauer-Zavala et al., 2019) or that are related to many of their symptoms (Fisher et al., 2019) may lead to more rapid symptom reductions. Given the number of emotion regulation strategies, identifying optimal sequences can help researchers and therapists guide patients in how to prioritize their responses in the moment.

Timescale of Effects

As many of these results imply, researchers may consider the effects of emotion regulation at two general timescales: short-term (e.g., minutes to hours) or long-term (e.g., days to years). Emotion regulation strategies may be effective in the short-term or adaptive in the long-term. Of course, some strategies are effective and adaptive (e.g., acceptance), effective and maladaptive (e.g., distraction, self-injury, suppression), ineffective and adaptive (e.g., problem-solving), or ineffective and maladaptive (e.g., rumination). Considering the timescale of the effects of emotion regulation strategies, as well as the goals of the person using them, can help determine the optimal regulatory fit.

Contextual Factors

Finally, contextual factors may influence each of these domains (Aldao, 2013). These contextual factors may include basic biological processes (e.g., neural connectivity, respiratory sinus arrhythmia, or heart rate variability), developmental trajectories, environmental affordances, or personality dimensions, each of which has been shown to influence certain patterns of emotion regulation. It is important for researchers to test whether certain strategies or patterns of use have relatively broad effects across contexts or if they are moderated by contextual factors (e.g., Southward et al., 2019).

Concluding Remarks

We hope this framework can facilitate the translation of emotion regulation research between affective science and intervention researchers. Given the important role of emotion regulation in treatment and in our everyday lives, we are excited to set the stage for researchers to enhance our understanding of these processes and use that understanding to inform and optimize our psychotherapy treatments.

Target Article

Southward, M. W., Sauer-Zavala, S., & Cheavens, J. S. (2021). Specifying the mechanisms and targets of emotion regulation: A translational framework from affective science to psychological treatment. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000003

Discussion Questions

  1. In your experience, is it more effective to help patients reduce the frequency of their maladaptive strategies or increase the frequency of their adaptive strategies?
  2. Do larger repertoires of strategies lead people to “flail” for the right one or offer people many helpful options to manage difficult emotions?
  3. What might be an optimal sequence of emotion regulation strategies? Does that differ by person or disorder?

About the Authors

Matt Southward, PhD is a postdoc at the University of Kentucky. He is interested in mechanisms of change in treatment, and specifically the role of emotion regulation flexibility for people with mood, anxiety, and personality disorders. Dr. Southward is also the Social Media Coordinator for Division 12. He can be contacted by email at southward@uky.edu or on Twitter at @Matt_Southward_.

Shannon Sauer-Zavala, PhD is an assistant professor at the University of Kentucky and the founding Director of Clinical Services at the UK Clinic for Emotional Health. She is interested in exploring emotion-focused mechanisms that maintain psychological symptoms (particularly high-risk symptoms such as suicidal thoughts and behaviors) and using this information to develop more targeted, easily-disseminated intervention strategies. Dr. Sauer-Zavala can be contacted by email at ssz@uky.edu or on Twitter at @SauerZavala.

Jennifer Cheavens, PhD is a professor and Director of Clinical Training at The Ohio State University. She is interested in characterizing flexible emotion regulation patterns to inform the development and adaptation of treatments to enhance their efficacy and effectiveness, with an emphasis on treatments for people with mood and personality disorders. Dr. Cheavens can be contacted by email at cheavens.1@osu.edu.

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