Down-regulation Of Negative Emotions Research Articles

Functional MRI correlates of emotion regulation in major depressive disorder related to depressive disease load measured over nine years

Major Depressive Disorder (MDD) often is a recurrent and chronic disorder. We investigated the neurocognitive underpinnings of the incremental risk for poor disease course by exploring relations between enduring depression and brain functioning during regulation of negative and positive emotions using cognitive reappraisal.We used fMRI-data from the longitudinal Netherlands Study of Depression and Anxiety acquired during an emotion regulation task in 77 individuals with MDD. Task-related brain activity was related to disease load, calculated from presence and severity of depression in the preceding nine years. Additionally, we explored task related brain-connectivity. Brain functioning in individuals with MDD was further compared to 35 controls to explore overlap between load-effects and general effects related to MDD history/presence.Disease load was not associated with changes in affect or with brain activity, but with connectivity between areas essential for processing, integrating and regulating emotional information during downregulation of negative emotions. Results did not overlap with general MDD-effects. Instead, MDD was generally associated with lower parietal activity during downregulation of negative emotions. During upregulation of positive emotions, disease load was related to connectivity between limbic regions (although driven by symptomatic state), and connectivity between frontal, insular and thalamic regions was lower in MDD (vs controls).Results suggest that previous depressive load relates to brain connectivity in relevant networks during downregulation of negative emotions. These abnormalities do not overlap with disease-general abnormalities and could foster an incremental vulnerability to recurrence or chronicity of MDD. Therefore, optimizing emotion regulation is a promising therapeutic target for improving long-term MDD course.

Trait Acceptance Buffers Aggressive Tendency by the Regulation of Anger during Social Exclusion.

Social exclusion has led to increased negative emotions and aggressive behaviors, two outcomes that are correlated with each other. Thus, the down-regulation of negative emotions appears to play a crucial role in reducing the tendency for aggressive behavior. However, this assumption has not yet been tested. To this end, a total of 397 undergraduates reported their aggressive tendencies, state emotions and trait acceptance by completing corresponding questionnaires, and a recall paradigm was used to induce experiences of social exclusion. The results showed that in the context of social exclusion, (1) trait acceptance was negatively correlated with negative emotions and aggressive tendency but was positively correlated with positive emotions; (2) negative emotions, rather than positive emotions, were positively correlated with aggressive tendency; (3) increased trait acceptance buffered the experience of anger, which is, in turn, related to reduced aggressive tendency; (4) trait acceptance also downregulated the feeling of sadness, which is, however, related to increased aggression; (5) the mediator of sadness was smaller in effect size than that of anger. Taken together, these results suggest that negative emotions are associated with aggression in the context of social exclusion, and the habitual use of an acceptance strategy was conductive to decreasing aggressive tendencies by decreasing anger.

The Effect of Non-Invasive Brain Stimulation on the Downregulation of Negative Emotions: A Meta-Analysis.

(1) Background: Emotion regulation (ER) is regarded as a core treatment target for depression and other mental illnesses. In recent years, non-invasive brain stimulation (NIBS) has been extensively used as an intervention for mental illnesses, but there has been no systematic review conducted regarding its effect on emotion regulation. Therefore, we conducted a meta-analysis of the effectiveness of NIBS for emotion regulation; (2) Methods: Systematic searches were conducted in Embase, Web of Science, PubMed, and Cochrane Library. We analyzed the effects of NIBS on tasks assessing emotion regulation using a random-effects model, and further explored the moderating role of the following factors on transcranial direct current stimulation (tDCS) studies by conducting subgroup analyses and meta-regression: target electrode placement, return electrode placement, current intensity, target electrode size, and duration of intervention; (3) Results: A total of 17 studies were included. Our meta-analysis indicated a small but significant effect of NIBS on the downregulation of negative emotions. Separate analyses indicated that repetitive transcranial magnetic stimulation (rTMS) had a medium and significant effect on the downregulation of negative emotions, whereas tDCS had no significant effect. Subgroup analyses showed that the effect of tDCS was moderated by target and return electrode placemen; (4) Conclusions: These results indicate that NIBS had a positive effect on the downregulation of negative emotions. The stimulation protocols should be carefully considered and the underlying mechanisms should be further explored.

Working memory load reduces the electrocortical processing of positive pictures.

To date, the emotion regulation literature has focused primarily on the down-regulation of negative emotion, with far fewer studies interrogating the mechanisms at work in positive emotion regulation. This body of work has suggested that nonaffective mechanisms, such as cognitive load have a role to play in reducing emotional response. For example, the late positive potential (LPP), which tracks attention to salient stimuli, is reduced when task-irrelevant negative and neutral stimuli are presented under high compared with low working memory load. Using positive stimuli, working memory load has been shown to reduce the LPP elicited by positive words and faces but has not previously been shown to modulate the LPP elicited by positive scenes. Emotional scenes are the predominant type of stimuli used in the broader emotion regulation literature, are more arousing than faces, and have been shown to more strongly modulate the LPP. Here, 41 participants performed a working memory task interspersed with the presentation of positive and neutral scenes, while electroencephalography was recorded. Results showed that the LPP was increased for positive compared with neutral pictures and reduced on high-load compared to low-load trials. Working memory performance was worse on high-load compared with low-load trials, although it was not significantly correlated with the LPP, and picture type did not affect working memory performance. Results bridge to the willful emotion regulation literature to increase understanding of the mechanisms underlying positive emotion regulation, which has been relatively unexamined.

The Role of Emotional Memory in Reappraising Negative Self-referent Thoughts

Reappraisal is an emotion regulation strategy that has been linked to positive emotional and health outcomes. However, the basic cognitive mechanisms underlying the effectiveness of reappraisal remain understudied and not well understood. To address this limitation, the present study examined whether long-term memory processes, including emotional memory accessibility, memory bias, and overgeneral memory, are related to individual differences in reappraisal effectiveness. All participants (N = 101) completed a memory accessibility and sentence completion memory task to measure bias, specificity, and accessibility of emotional memories. Next, participants completed an emotion regulation task requesting them to either attend to or reappraise negative self-referent thoughts. The results of the linear regression models showed that memory bias, but not memory specificity or accessibility, accounted for a significant proportion of the variance in the effectiveness of reappraisal. Retrieval of more negative memories was related to lower reductions in negative mood. These findings suggest that emotional long-term memory processes, and particularly memory bias, may modulate downregulation of negative emotions when implementing reappraisal. These insights could be leveraged to guide psychological treatments using cognitive techniques that rely on successful reappraisal use.

The role of frontal-subcortical connectivity in the relation between coping styles and reactivity and downregulation of negative emotion

Coping styles (CS) reflect individuals' habitual use of strategies for coping with negative events in daily life. Although research into coping has not reached consistent agreement about classifying coping strategies as either inherently adaptive or maladaptive, the influence of maladaptive CS on mental health is noticeable. CS might also be related to emotion regulation and associated brain systems. Participants (N = 165) completed measurements of CS, trait emotions including trait anxiety, depressive symptoms and happiness and then performed an emotion regulation task, in conjunction with functional MRI. Individual differences in maladaptive CS use were associated with higher trait negative emotionality and higher state reactivity of negative emotion. Concurrent bilateral amygdala-right middle frontal gyrus (MFG) connectivity during passive negative stimulus processing mediated the relation between maladaptive CS and negative emotion ratings. Psychophysiological interaction analyses showed that maladaptive and adaptive CS were linked to patterns of frontal-subcortical connectivity during state emotion regulation. These results suggest that maladaptive CS might be related to negative emotion processing and weaker spontaneous regulation and indicate that maladaptive CS is a risk factor in individual mental health.

Distraction and expressive suppression strategies in down-regulation of high- and low-intensity positive emotions

Emotion intensity is important for emotional regulation process. The studies in this literature, however, have generally focused on the down-regulation of negative emotions. Few studies have examined the down-regulation of positive emotions. Distraction and expressive suppression belong to disengagement strategies, which direct coping efforts away from emotions. Participants are more likely to select distraction and expressive suppression when motivated to down-regulate their emotions. Therefore, this study aimed to assess the impact of emotional intensity on down-regulating positive emotions via distraction and expressive suppression. The event-related potentials (ERPs) of college students were recorded while they were instructed to down-regulate positive emotions using expressive suppression or distraction versus free viewing when exposed to high- and low-intensity pleasant stimuli. Subsequently, participants were instructed to rate their positive experience using a 9-point scale. Supporting our predictions, behavioral results showed that both strategies could dramatically reduce high-intensity positive experience relative to viewing, and distraction led to a larger reduction of high-intensity positive experience than expressive suppression. Both strategies could not decrease low-intensity positive experience relative to viewing. ERP results showed that distraction successfully attenuated the early (500–700 ms) and late (700–1500 ms) stage of late positive potential (LPP) in high-intensity, and in low-intensity it modulated the early (but not late) LPP relative to viewing. Unexpectedly, expressive suppression effectively attenuated the early and late LPP in high- and low-intensity relative to viewing. The findings suggest that expressive suppression and distraction can effectively down-regulate positive emotions; however, distraction is more susceptible to emotional intensity and time.

Structural brain correlates of irritability and aggression in early manifest Huntington's disease.

In Huntington's disease (HD), irritability and aggressive behavior represent highly prevalent and disabling neuropsychiatric symptoms. However, their structural brain correlates have not been extensively explored. Here, we rated the severity of irritability and aggression (IAs) using the Problem Behaviors Assessment for HD (PBA-s) in 31 early HD participants. The IAs score was computed as the mean severity score for the irritability plus the mean severity aggression PBA-s items. Seventeen patients were classified as IAs (IAs score > 2) and 14 as non-IAs. All participants had available T1-MRI data. A grey matter volume voxel-based morphometry group comparison was performed, using age, motor status, severity of other PBA-s items and disease burden as covariates. Aside from irritability, aggression and obsessive-compulsive behavior, both groups were comparable in terms of other clinical and sociodemographic variables. In the IAs group, a significant reduction of grey-matter volume (GMV) was found in the bilateral caudate, putamen and globus pallidus, left pulvinar nucleus, right superior temporal pole (BA 38), left mid temporal gyrus (BA 21), right inferior temporal gyrus (BA 20) and left medial OPFC (BA 11). Lower GMV in the left pulvinar nucleus was significantly associated with higher anxiety and lower GMV in the left medial OPFC was significantly associated with higher suicidality. In sum, IAs in HD is associated with structural brain damage in a set of key nodes involved in the expression and down-regulation of negative emotions.

Concurrent amygdalar and ventromedial prefrontal cortical responses during emotion processing: a meta-analysis of the effects of valence of emotion and passive exposure versus active regulation.

Anatomically interconnected, the ventromedial prefrontal cortex (vmPFC) and amygdala interact in emotion processing. However, no meta-analyses have focused on studies that reported concurrent vmPFC and amygdala activities. With activation likelihood estimation (ALE) we examined 100 experiments that reported concurrent vmPFC and amygdala activities, and distinguished responses to positive vs. negative emotions and to passive exposure to vs. active regulation of emotions. We also investigated whole-brain experiments for other regional activities. ALE and contrast analyses identified convergent anterior and posterior vmPFC response to passive positive and negative emotions, respectively, and a subregion in between to mixed emotions. A smaller area in the posterior ventral vmPFC is specifically involved in regulation of negative emotion. Whereas bilateral amygdala was involved during emotional exposure, only the left amygdala showed convergent activities during active regulation of negative emotions. Whole-brain analysis showed convergent activity in left ventral striatum for passive exposure to positive emotions and downregulation of negative emotions, and in the posterior cingulate cortex and ventral precuneus for passive exposure to negative emotions. These findings highlight contrasting, valence-specific subregional vmPFC as well as other regional responses during passive exposure to emotions. The findings also suggest that hyperactivation of the vmPFC is associated with diminished right amygdala activities during regulation of negative emotions. Together, the findings extend the literature by specifying the roles of subregional vmPFC and amygdala activities in emotion processing.

<p>Disorder-specific dysfunction in dorsal anterior cingulate cortex and parietal cortex during cognitive reappraisal in anxiety disorder [Letter]</p>

Dear editor Following our recently published article1 in Neuropsychiatric Disease and Treatment, many readers have commented that the effects of comorbid depression cannot be ruled out as a factor in our results, since anxiety disorders and major depression are heterogeneous disorders. We would like to respond to the points made. Impaired cognitive emotion regulation is commonly seen in many psychiatric disorders.2 A recent review concluded that individuals with depressive disorders consistently show decreased activation of the ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal.3 Moreover, enhanced activity of the amygdala, which is associated with hyperactive bottom-up emotion responses during downregulation of negative emotion, is a disorder-specific deficit in the recruitment of brain regions during cognitive reappraisal in depression disorder.3 Our meta-analysis was intended to provide a comprehensive description of the brain mechanisms underlying cognitive reappraisal deficits in anxiety disorder. We concluded that patients with anxiety disorder could not recruit the frontoparietal network, including dorsal anterior cingulate cortex (dACC), parietal cortex, dorsomedial prefrontal cortex and supplementary motor area, to down-regulate their emotion responses. Notably, we did not find that abnormalities of vlPFC, dlPFC or amygdala activity were involved in anxiety disorder, which suggests that the cognitive-appraisal-related impairments in emotion regulation that occur in anxiety disorders and major depression have different neural correlates. There are several explanations for our negative findings. First, although we included some patients with anxiety disorder accompanied by depression, they were eligible for inclusion in the meta-analysis as anxiety disorder was the primary diagnosis. Second, although some studies reported that patients with anxiety disorder showed diminished vlPFC and dlPFC activity during downregulation of negative emotion,1 the results are mixed. Our comprehensive meta-analysis was performed to provide a robust description of the neurobiological underpinnings of anxiety. Third, although patients with major depression consistently show enhanced amygdala activity during cognitive reappraisal,3 none of the eight studies included in the meta-analysis reported enhanced amygdala during cognitive reappraisal in anxiety disorders.1 Using a more stringent significance criterion (p<0.001), we found that during cognitive reappraisal patients with anxiety disorder showed decreased activity relative to healthy controls in the dACC (peak MNI: 4, 12, 42; p=~0; Z =−2.838; voxels =2129) and parietal cortex (peak MNI: −48, −28, 46; p=0.000002563; Z =−2.329; voxels =544); thus, the main findings remained largely unchanged. The dACC is involved in allocating control and attentional resources during cognitive reappraisal,4 whilst parietal cortex is mainly associated with selective attention and may be involved in holding reappraisals in mind.5 Our results indicate that, in anxiety disorder, diminished dACC and parietal cortex activity may impair the allocation of attention and control during cognitive reappraisal. It should be noted that none of the nine major depressive disorder studies we reviewed reported reduced dACC and parietal cortex during cognitive reappraisal.3 Importantly, patients with anxiety disorder, unlike those with major depression, did not show enhanced amygdala activity or reduced vlPFC and dlPFC activity during cognitive reappraisal. Conversely, patient with major depression did not show decreased activation of the dACC and parietal cortex, unlike those with anxiety disorder. We believe, therefore, that the effects of comorbid depression in anxiety disorder on cognitive reappraisal in our meta-analysis are negligible or non-existent. These findings offer insight into the neurobiology of emotion dysregulation in anxiety disorder. They provide robust evidence that frontoparietal network impairments play a key role in the pathogenesis of anxiety disorder. More specifically, it appears that dysfunctions of dACC and parietal cortex, which are involved in allocation of attention and control, are relatively specific to anxiety disorder, rather than depression.

A preliminary study of association between adolescent estradiol level and dorsolateral prefrontal cortex activity during emotion regulation

Non-human primate models have been useful in clarifying estradiol’s role in cognitive processing. These animal studies indicate estradiol impacts cognitive processes supported by regions within dorsolateral prefrontal cortex (DLPFC). Although human functional neuroimaging studies have begun to find similar relationships between estradiol in women for some forms of ‘cold’ cognitive control, to date no studies have examined the relationship between estradiol and DLPFC function in the context of active attempts to regulate one’s emotions. Here, we asked whether peripheral 17-beta estradiol levels in adolescent girls in different pubertal developmental stages (age = 14.9 years ± 1.74) were related to engagement of DLPFC regions during the use of a cognitive strategy for regulating emotion known as reappraisal using functional Magnetic Resonance Imaging. Findings indicated that higher estradiol levels predicted greater DLPFC activity during the down-regulation of negative emotion using reappraisal. This is the first report of an association between estradiol level and DLPFC activity during cognitive reappraisal of negative emotion. The study suggests a possibility that estradiol might positively contribute to regulatory function of a cortical system important for emotional experiences.

Restoring emotional stability: Cortisol effects on the neural network of cognitive emotion regulation

Effective emotion regulation in stressful contexts is a key feature of mental health. Acute stress, however, impairs prefrontal top-down control, probably leading to a decline of emotion regulatory capacities. By contrast, the delayed cortisol increase in response to a stressor or after a pharmacological manipulation has been linked to mood-protecting effects and emotion regulation success. In this functional magnetic resonance imaging study, healthy men and women received either 30 mg cortisol or placebo 90 min before they were exposed to an emotion regulation paradigm involving neutral and negative pictures. As expected, behavioural and brain imaging data indicated successful induction and downregulation of negative emotions via cognitive reappraisal and distraction. Cortisol enhanced regulatory activity in the ventrolateral prefrontal cortex when participants used distraction and reduced emotion-related activation in the amygdala when regulating emotions via cognitive reappraisal. Together, these findings provide first evidence for a delayed glucocorticoid-induced facilitation of cognitive emotion regulation processes that might be beneficial for restoring emotional stability in the aftermath of stressful events.

The intricate relationship between stress and sex - findings from the men stress 40+ study

Non-human primate models have been useful in clarifying estradiol’s role in cognitive processing. These animal studies indicate estradiol impacts cognitive processes supported by regions within dorsolateral prefrontal cortex (DLPFC). Although human functional neuroimaging studies have begun to find similar relationships between estradiol in women for some forms of ‘cold’ cognitive control, to date no studies have examined the relationship between estradiol and DLPFC function in the context of active attempts to regulate one’s emotions. Here, we asked whether peripheral 17-beta estradiol levels in adolescent girls in different pubertal developmental stages (age = 14.9 years ± 1.74) were related to engagement of DLPFC regions during the use of a cognitive strategy for regulating emotion known as reappraisal using functional Magnetic Resonance Imaging. Findings indicated that higher estradiol levels predicted greater DLPFC activity during the down-regulation of negative emotion using reappraisal. This is the first report of an association between estradiol level and DLPFC activity during cognitive reappraisal of negative emotion. The study suggests a possibility that estradiol might positively contribute to regulatory function of a cortical system important for emotional experiences.

Emotion-modulated startle reflex during reappraisal: Probe timing and behavioral correlates.

Down-regulation of negative emotions has been shown to reliably inhibit the emotion-modulated startle reflex, but it remains unclear whether the timing of the startle probe influences the quantification of emotion regulation with this measure. Moreover, it is not known whether the degree of startle inhibition corresponds to the subjective attenuation of negative emotions. Therefore, the two main goals of the study were, first, to systematically analyze the effect of probe time on startle inhibition and, second, to explore the association between subjectively perceived down-regulation of arousal and valence and the degree of startle inhibition. We presented negative and neutral pictures to N = 47 participants. Pictures were paired with the instruction to reappraise or to maintain the emotions elicited by these pictures. Probes were delivered at three different times during a 12.5-s regulation phase, and the startle response was measured with electromyography. Valence and arousal ratings were assessed after each trial. Results revealed no significant impact of probe time on startle inhibition during reappraisal. Startle inhibition and perceived down-regulation of arousal were significantly and positively correlated, whereas perceived down-regulation of valence was not. The results provide important implications for future studies in terms of startle probe timing and shed light onto the interpretation of startle inhibition as an indicator of subjective attenuation of negative emotions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Predicting Career Decision-Making Difficulties: The Role of Trait Emotional Intelligence, Positive and Negative Emotions.

The current study evaluated the relationship between positive and negative emotions, trait emotional intelligence (trait EI) and difficulties in career decision-making. We examined whether trait EI could predict career indecisiveness, a type of career decision-making difficulty, over and above the “Big Five” personality traits. We also examined the mechanism through which trait EI affected career indecisiveness by investigating the mediating role of positive and negative emotions. Survey data were collected from a sample of 600 undergraduate students in a university in southwest United States, who completed questionnaires measuring trait EI, positive emotions, negative emotions, personality traits, and career indecisiveness. Hierarchical multiple regression analyses indicated that trait EI accounted for a significant proportion of the variance in career indecisiveness that was not explained by the “Big Five” personality traits. The parallel mediation analysis revealed that positive and negative emotions partially mediated the relationship between trait EI and career indecisiveness. Using the framework of Fredrickson’s (2001) broaden and build theory of positive emotions, the study provides empirical evidence explaining the mechanism through which trait EI helps individuals cope better with challenging situations in life. Trait EI aids the elicitation of positive emotions and the down-regulation of negative emotions, which, in turn, broaden the range of thoughts and actions that come to mind, helping individuals function more effectively in the context of career decision-making. Implications for career counseling and opportunities for further research are discussed.

Neural correlates of reappraisal considering working memory capacity and cognitive flexibility.

Cognitive reappraisal of emotion is strongly related to long-term mental health. Therefore, the exploration of underlying cognitive and neural mechanisms has become an essential focus of research. Considering that reappraisal and executive functions rely on a similar brain network, the question arises whether behavioral differences in executive functions modulate neural activity during reappraisal. Using functional neuroimaging, the present study aimed to analyze the role of working memory capacity (WMC) and cognitive flexibility in brain activity during down-regulation of negative emotions by reappraisal in N = 20 healthy participants. Results suggests that WMC and cognitive flexibility were negatively correlated with prefrontal activity during reappraisal condition. Here, results also revealed a negative correlation between cognitive flexibility and amygdala activation. These findings provide first hints that (1) individuals with lower WMC and lower cognitive flexibility might need more higher-order cognitive neural resources in order to down-regulate negative emotions and (2) cognitive flexibility relates to emotional reactivity during reappraisal.

The roles of hedonic and eudaimonic motives in emotion regulation

The pursuit of hedonic and eudaimonic activities is related to well-being. The current study examined whether hedonic and eudaimonic motives are associated with the strategies people choose to regulate their positive and negative emotions, which, in turn, predict well-being. Participants completed measures assessing hedonic and eudaimonic motives, down-regulation of positive emotions and up-regulation of negative emotions, and well-being. Eudaimonic motives correlated positively with down-regulation of negative emotions whereas hedonic motives correlated positively, but weakly, with up-regulation of positive emotions. Both types of motives and emotion regulation were associated with well-being, but eudaimonic motives and down-regulation of negative emotions were more strongly predictive of well-being than hedonic motives and up-regulation of positive emotions were. In addition, these associations appeared to be driven by people's choices for dysfunctional, rather than functional, strategies. In sum, the findings suggest that hedonic and eudaimonic motives may support different pathways to well-being, with eudaimonic motives and down-regulation of negative emotions playing a stronger role in well-being.

“Tears of joy” & “smiles of joy” prompt distinct patterns of interpersonal emotion regulation

ABSTRACTClose relationship partners often respond to happiness expressed through smiles with capitalization, i.e. they join in attempting to up-regulate and prolong the individual’s positive emotion, and they often respond to crying with interpersonal down-regulation of negative emotions, attempting to dampen the negative emotions. We investigated how people responded when happiness was expressed through tears, an expression termed dimorphous. We hypothesised that the physical expression of crying would prompt interpersonal down-regulation of emotion when the onlooker perceived that the expresser was experiencing negative or positive emotions. When participants were asked how they would behave when faced with smiles of joy, we expected capitalization responses, and when faced with tears of joy, we expected down-regulation responses. In six experimental studies using video and photographic stimuli, we found support for our hypotheses. Throughout our investigations we test and discuss boundaries of and possible mechanisms for such responsiveness.

Trait and neurobiological underpinnings of negative emotion regulation in gambling disorder.

Gambling disorder is characterized by poor regulation of negative emotions and impulsive behaviours. This study aimed to (1) compare gambling disorder patients (GDPs) and healthy controls (HCs) in self-report and brain activation measures of emotion regulation; and (2) establish its relationship with negative emotion-driven impulsivity. Two cross-sectional case-control studies including GDPs and HCs. GDPs and HCs were recruited from specialized gambling clinics in Andalusia (Spain), where they were following out-patient treatment, and from the community, respectively. Study 1 included 41 GDPs and 45 HCs [All males; Mage =35.22, 33.22; standard deviation (SD)=11.16, 8.18; respectively]. Study 2 included 17 GDPs and 21 HCs (16/20 males; Mage =32.94, 31.00; SD=7.77, 4.60; respectively). In study 1, we compared both groups on suppression and re-appraisal emotion regulation strategies [Emotion Regulation Questionnaire (ERQ)]. In study 2, we compared GDPs with HCs on brain activation associated with down-regulation of negative emotions in a cognitive re-appraisal task, measured with functional magnetic resonance imaging (fMRI). In both studies, we correlated the measures of emotion regulation with mood-related impulsivity indicated by negative urgency (UPPS-P impulsive behaviour scale). GDPs relative to HCs showed higher levels of emotional suppression [F=4.525; P=0.036; means difference MHCs -MGDPs =-2.433, 95% confidence interval (CI)=-4.706, -0.159] and higher activation of the premotor cortex and middle frontal gyrus during negative emotion regulation in the fMRI task [P≤0.005, cluster size (CS)>50 voxels]. Negative urgency correlated positively with emotional suppression (r=0.399, 95% CI=0.104, 0.629, one-tailed P=0.005) and middle frontal gyrus activation during negative emotion regulation (P≤0.005, CS>50) in GDPs. Gambling disorder is associated with greater use of emotional suppression and stronger pre-motor cortex and middle frontal gyrus activation for regulating negative emotions, compared with healthy controls. Emotional suppression use and middle frontal gyrus activation during negative emotion regulation are linked with negative emotion-driven impulsivity in this disorder.

Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review

Reduced capacity to cognitively regulate emotional responses is a common impairment across major neuropsychiatric disorders. Brain systems supporting one such strategy, cognitive reappraisal of emotion, have been investigated extensively in the healthy population, a research focus that has led to influential meta-analyses and literature reviews. However, the emerging literature on neural substrates underlying cognitive reappraisal in clinical populations is yet to be systematically reviewed. Therefore, the goal of the current review was to summarize the literature on cognitive reappraisal and highlight common and distinct neural correlates of impaired emotion regulation in clinical populations. We performed a two-stage systematic literature search, selecting 32 studies on cognitive reappraisal in individuals with mood disorders (n=12), anxiety disorders (n=14), addiction (n=2), schizophrenia (n=2), and personality disorders (n=5). Comparing findings across these disorders allowed us to determine underlying mechanisms that were either disorder-specific or common across disorders. Results showed that across clinical populations, individuals consistently demonstrated reduced recruitment of the ventrolateral prefrontal cortex (vlPFC) and dorsolateral prefrontal cortex (dlPFC) during downregulation of negative emotion, indicating that there may be a core deficit in selection, manipulation and inhibition during reappraisal. Further, in individuals with mood disorders, amygdala responses were enhanced during downregulation of emotion, suggesting hyperactive bottom-up responses or reduced modulatory capacity. In individuals with anxiety disorders, however, emotion regulation revealed reduced activity in the dorsal anterior cingulate cortex (dACC) and inferior/superior parietal cortex, possibly indicating a deficit in allocation of attention. The reviewed studies thus provide evidence for both disorder-specific and common deficits across clinical populations. These findings highlight the role of distinct neural substrates as targets for developing/assessing novel therapeutic approaches that are geared towards cognitive regulation of emotion, as well as the importance of transdiagnostic research to identify both disorder specific and core mechanisms.