Emotional Processing Theory Research Articles

Increased functional connectivity between brain regions involved in social cognition, emotion and affective-value in psychedelic states induced by N,N-Dimethyltryptamine (DMT)

The modulation of social cognition is suggested as a possible mechanism contributing to the potential clinical efficacy of psychedelics in disorders involving socio-emotional and reward processing deficits. Resting-state functional Magnetic Resonance Imaging (rs-fMRI) can be used to detect changes in brain connectivity during psychedelic-induced states. Thus, this pharmacoimaging study investigates the effects of N,N-Dimethyltryptamine (DMT) on functional connectivity in brain areas relevant to social cognition, using a within-subject design in eleven healthy experienced users. The study included both an active and a control condition, conducted at different time points. The active condition involved DMT inhalation, while the control condition did not. Seed-based connectivity was measured for the two core regions involved in theory of mind and emotional processing, respectively, the posterior supramarginal gyrus and the amygdala. DMT increased supramarginal gyrus connectivity with the precuneus, posterior cingulate gyrus, amygdala, and orbitofrontal cortex. Additionally, increased connectivity emerged between the amygdala and orbitofrontal cortex. These results demonstrate that DMT modulates brain connectivity in socio-emotional and affective-value circuits, advancing our understanding of the neural mechanisms underlying the psychedelic experience and its potential therapeutic action.

Opening the Black Box: The Underlying Working Mechanisms in Virtual-Reality Exposure Therapy for Anxiety Disorders

Although research on virtual-reality (VR) exposure therapy (VRET) in anxiety disorders has primarily focused on effectiveness and acceptability, the underlying working mechanisms have received scant attention. To fill this knowledge gap, we discuss potential theoretical underpinnings of VRET based on three dominant theoretical accounts on exposure: inhibitory-learning theory (expectancy violation), emotional-processing theory (habituation), and self-efficacy theory. Whereas theoretically speaking, habituation and self-efficacy seem plausible candidate mechanisms to explain the effects of VRET, the role of expectancy violation is less straightforward. Because of the simulated nature of VR, some feared outcomes cannot occur, and therefore, possibilities to violate expectancies about their occurrence may be compromised. Empirical evidence on the working mechanisms of VRET is scarce and has important limitations. Avenues for future research are provided. Insights into the mechanisms of VRET not only are of theoretical importance but also can provide theory-based directions to optimize the application of VRET.

Emotional Changes during Imagery Rescripting of Aversive Social Memories in Social Anxiety Disorder: A Randomized Controlled Trial

Introduction: Imagery rescripting (ImRs) is a psychotherapeutic intervention targeting aversive memories. During the three-phase intervention, patients reexperience their aversive memory (phase 1), observe the scene from their adult perspective, and intervene to help their former selves (phase 2), and reexperience it again with the positive changes (phase 3). Previous studies have rarely investigated emotional and regulatory processes taking place during the intervention. Objective: This randomized controlled trial investigated self-reported affective and physiological responses during ImRs. Methods: Seventy-seven patients with social anxiety disorder (SAD) were randomly assigned to a single session of ImRs or a control intervention (recall and discussion of the memory) targeting an aversive social memory. Heart rate (HR) and heart rate variability (HRV) were assessed during and post hoc ratings of positive and negative feelings after baseline and the intervention phases. Results: Relative to the control intervention, ImRs resulted in an initial increase in negative feelings from baseline to phase 1 and a following larger (phase 1 to phase 2) and more stable (phase 2 to phase 3) decrease in negative feelings/increase in positive feelings. On the physiological level, during ImRs compared to the control intervention, mean HR was significantly higher during phase 1 and HRV during phase 3, each compared to baseline. Conclusions: These results provide further information about the specific sequence of emotional responses on different response levels during ImRs, being consistent with known theories of emotional processing and supposed mechanisms of ImRs.

State of the Science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder.

Prolonged exposure therapy (PE) is a well-established first-line treatment for posttraumatic stress disorder (PTSD) that is based on emotional processing theory. PE has been rigorously evaluated and tested in a large number of clinical trials in many countries covering a wide range of trauma populations. In this review, we summarize the evidence base supporting the efficacy of PE across populations, including adults with sexual assault-related PTSD and mixed trauma-related PTSD, military populations, and adolescents. We highlight important strengths and gaps in the research on PE with individuals from marginalized communities. We discuss the efficacy of PE on associated psychopathology and in the presence of the most commonly comorbid conditions, either alone or integrated with other treatments. In addition, we provide an overview of research examining strategies to augment PE. Much of this work remains preliminary, but numerous trials have tested PE in combination with other psychological or pharmacological approaches, interventions to facilitate extinction learning, and behavioral approaches, in the hopes of further increasing the efficiency and efficacy of PE. There are now several trials testing PE in novel formats that may have advantages over standard in-person PE, such as lower dropout and increased scalability. We examine this recent work on new models of delivering PE, including massed treatment, telehealth, and brief adaptations for primary care, all of which have the potential to increase access to PE. Finally, we highlight several promising areas for future research.

Threat Appraisal, Emotional Contagion, and Fear of COVID-19: Revision of the Extended Parallel Process Model

Fear of COVID-19 has been understandably widespread, given continual exposure to dire information from pandemic media coverage and interpersonal communications. The present study addresses a limitation of the extended parallel process model in predicting fear of COVID-19 by inclusion of the concept of emotional contagion. The main gap in the literature is filled by the study’s distinctive contribution that broadens and upgrades the extended parallel process model. The model is extended by its integration with the theory of emotional processing. The study is based on a national panel of adults ( N = 206). The methods include path modeling by SmartPLS. In addition, multigroup analyses examine overall model differences between gender classifications. Findings and conclusions can be used to minimize excessive fear, and at the same time to promote confidence in following official public guidance and protective regulations to cope with the pandemic.

Examining emotional processing theory and predictors of outcome in prolonged exposure for PTSD

Prolonged exposure (PE) is an empirically supported treatment for posttraumatic stress disorder (PTSD). The current study examined multiple facilitators and indicators of emotional processing to identify key predictors of outcome in PE using observational coding methods. Participants were 42 adults with PTSD who received PE. Video recordings of sessions were coded to capture negative emotion activation, negative and positive trauma-related cognitions, and cognitive rigidity. Two variables emerged as predictors of PTSD symptom improvement assessed via self-report, but not clinical interview: a greater decrease in negative trauma-related cognitions and lower average cognitive rigidity. Peak emotion activation, reductions in negative emotions, and increases in positive cognitions did not predict PTSD improvement (self-report or clinical interview). Findings contribute to growing evidence highlighting the importance of cognitive change as part of emotional processing and as a key ingredient of PE, beyond activation and reduction in negative emotions. Implications for evaluating emotional processing theory and for clinical practice are discussed.

Exposure Therapy and Its Mechanisms.

Exposure therapy is the gold-standard treatment approach for pathological anxiety. This therapeutic approach builds on principles of extinction training from traditional fear conditioning and extinction protocols. In this chapter, we discuss principles of exposure therapy in the clinic and the laboratory experimental results that guide our decisions in the therapy. We discuss emotional processing theory and inhibitory learning principles, with a focus on expectation violation. We conclude with future research directions needed to improve exposure therapy outcomes among patients with anxiety-related disorders.

Awareness impairment in Alzheimer's disease and frontotemporal dementia: a systematic MRI review.

This review aims to define awareness impairment and related disturbances in neurodegenerative diseases, including Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) spectrum of disorders. An update of the available scientific literature on the use of magnetic resonance imaging (MRI) in the study of awareness in these disorders is also offered. MRI plays an important role in the characterization of neurodegenerative signatures and can increase our knowledge on brain structural and functional correlates of awareness. In the reviewing process, we established a-priori criteria and we searched the scientific literature for relevant articles on this topic. In summary, we selected 36 articles out of 1340 publications retrieved from PubMed. Based on this selection, this review discusses the multiple terms used to define different or overlapping aspects of awareness impairment, and specifically summarizes recent application of MRI for investigating anosognosia, social cognition, including theory of mind and emotional processing, free will, and autonoetic awareness alterations in different neurodegenerative disorders, with most of these studies focused on AD and FTLD. This systematic review highlights the importance of awareness impairment and related domains in neurodegenerative disorders, especially in AD and FTLD, and it outlines MRI structural and functional correlates in these populations.

Does emotional processing predict 18-month post-therapy outcomes in the experiential treatment of major depression?

Objective: This study tested whether emotion-focused therapy’s (EFT) emotion processing theory serves as a predictor of 18-month post-therapy outcomes for major depressive disorder (MDD), independent of experiential therapy received. Method: We examined sequences of emotion episodes using the THEME™ sequential analysis of emotional processing in 55 clients who provided 18-month post-therapy Beck Depression Inventory reports after receiving experiential treatment in the York I and II trials, either emotion-focused or client-centered therapy. Archival Classification of Affective Meaning States (CAMS) ratings of emotion episodes of clients’ working-phase sessions were analyzed using THEME™ sequential analyses of emotions coded during emotion episodes. Results: According to THEME™, poor outcome clients (Beck Depression Inventory at 18 months ≥ 10) expressed more emotion episode sequences containing secondary, or self-protective emotions, than good outcome clients. Good outcome clients expressed more emotion sequences with needs, hurt/grief, and assertive anger than poor outcome clients. Conclusions: EFT sequential emotional processing theory appears to offer good basic assumptions for experiential long-term therapy outcomes after receiving therapy for MDD. Generalization of the theory for other treatments is desired.

Characteristics of Posttraumatic Nightmares and Their Relationship to PTSD Severity Among Combat Veterans With PTSD and Hazardous Alcohol Use.

Although nightmares are known to predict the clinical course of posttraumatic stress disorder (PTSD), research on the relationship between specific nightmare characteristics and PTSD severity is sparse. This study conducted a secondary analysis to explore how five nightmare characteristics are cross-sectionally related to PTSD severity in 76 combat veterans with PTSD and at-risk alcohol use. Consistent with emotional processing theory, we hypothesized that more replicative, threatening, realistic, and easily recalled nightmares would be associated with more severe PTSD, whereas those with greater symbolism would predict lower PTSD severity. Nightmares narratives were audio-recorded and rated by multiple coders. Multiple analyses of variance explored the relationship between nightmare characteristics and PTSD clinical indicators. Most nightmares were realistic, easily recalled, and involved significant threat. Greater realism and replication were associated with greater PTSD severity. Realistic and replicative nightmares may be markers of more severe PTSD and may indicate that less emotional processing of the trauma has occurred.

Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy

BackgroundExposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Its mechanisms of action are rarely studied, but two major theories make distinct assumptions: while the emotional processing theory assumes that treatment effects are associated with habituation within and between exposure sessions, the inhibitory learning approach highlights the acquisition of additional associations, implying alternative mechanisms like expectancy violation. The present study aimed to investigate whether process variables derived from both theories predict short-term outcome.MethodIn a university outpatient unit, 110 patients (63 female) with OCD received manual-based cognitive-behavioral therapy with high standardization of the first two exposure sessions. Specifically, therapists repeated the first exposure session identically and assessed subjective units of distress as well as expectancy ratings in the course of exposure sessions. Based on these data, individual scores for habituation and distress-related expectancy violation were calculated and used for prediction of both percentage change on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and remission status after 20 therapy sessions.ResultsIn a multiple regression model for percentage change, within-session habituation during the first exposure was a significant predictor, while in a logistic regression predicting remission status, distress-related expectancy violation during the first exposure revealed significance. A path model further supported these findings.ConclusionsThe results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent.

Imaginal exposure processing during Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) therapy: Examination of linguistic markers of cohesiveness.

Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is an integrated, evidence-based treatment that results in significant reductions in posttraumatic stress disorder (PTSD) and substance use disorder (SUD) severity. Emotional processing theory suggests that successful prolonged exposure-based treatments should result in more cohesive trauma narratives due to better integration and organization of trauma memory into cognitive conceptualizations of fear. Therefore, we hypothesized that language used by patients would become more cohesive over time and increased language cohesion would be related to larger reductions in PTSD and SUD outcomes. Broadly, language cohesion refers to several linguistic devices that help establish and cohere meaning throughout spoken and written discourse (e.g., increased use of transition words like "and," "then," and "but"). This was the first known study to examine changes in language related to both PTSD and SUD severity during COPE treatment. The sample included 28 military veterans with current comorbid PTSD/SUD enrolled in a larger COPE study. A text analysis program, Coh-Metrix, was used to analyze language cohesiveness. No language cohesion variables significantly changed over time. Narrativity levels significantly moderated change in PTSD outcomes, =0.11. Adversative connectives significantly moderated change in SUD outcomes, = 0.26. The findings illuminate potential processes underlying successful COPE treatment. Less use of language conveying a narrative and more use of contrast-indicative words (e.g., but, whereas) was associated with larger reductions in PTSD and SUD outcomes during treatment. These results contribute to the extant literature on associations between trauma exposure, language, and emotional processing.

Processes of Change in Trauma-Focused Cognitive Behavioral Therapy for Youth: An Emotional Processing Theory Informed Approach.

This study examines processes of change in trauma-focused cognitive behavioral therapy (TF-CBT) delivered to a community sample of 81 youth. Emotional processing theory (EPT) is used as an organizational framework. EPT highlights activating and changing pathological trauma-related responses and increasing adaptive responses across cognitive, emotional, behavioral, and physiological domains. We coded sessions during the trauma processing phase of TF-CBT to examine the extent to which pathological and adaptive trauma-related responses were activated across domains. Higher scores indicate that more domains (0-4) were activated at a threshold of moderate to high intensity. Curvilinear change (inverted U, increase then decrease) in multimodal negative response scores across sessions predicted improvement in internalizing and PTSD symptoms at posttreatment. Linear increases in multimodal positive responses predicted improvement in externalizing symptoms. Findings suggest value in activating and changing both pathological and adaptive trauma responses across multiple domains and examining nonlinear patterns of change.

The Relationship Between Experiential Avoidance and Posttraumatic Stress Symptoms: A Moderated Mediation Model Involving Dissociation, Guilt, and Gender

ABSTRACT Experiential avoidance, dissociation, and guilt have been shown to be associated with trauma exposure and to play an important role in explaining the development and maintenance of posttraumatic stress symptoms. However, there is a lack of studies that simultaneously address the relationship between these variables, which has never been studied within the framework of emotional processing theory. Furthermore, gender differences in traumatic victimization, posttraumatic stress symptoms, experiential avoidance, dissociation, and guilt have also been reported. Therefore, this study had a double aim: a) to assess the mediating roles of dissociation and guilt in the relationship between experiential avoidance and posttraumatic stress symptoms; and b) to investigate whether gender moderates any such relationship. The final sample comprised 683 undergraduate students (150 men and 533 women) with a history of exposure to traumatic events and with posttraumatic stress symptoms. Mediation and moderated mediation analyses were conducted. Dissociation and guilt independently mediated the association between experiential avoidance and posttraumatic stress symptoms: however, this mediation effect was not moderated by gender. The findings suggest that interventions aimed at controlling psychological variables linked to PTSD (i.e. experiential avoidance, dissociation, and guilt) may be of help to both men and women.

The Mechanism and Intervention of Depression: Based on the Theory of Emotional Processing Epidemic and Its Influencing Factors

抑郁；情绪加工；认知理论；认知控制；心理干预

Spatially Filtered Emotional Faces Dominate during Binocular Rivalry.

The present investigation explores the role of bottom-up and top-down factors in the recognition of emotional facial expressions during binocular rivalry. We manipulated spatial frequencies (SF) and emotive features and asked subjects to indicate whether the emotional or the neutral expression was dominant during binocular rivalry. Controlling the bottom-up saliency with a computational model, physically comparable happy and fearful faces were presented dichoptically with neutral faces. The results showed the dominance of emotional faces over neutral ones. In particular, happy faces were reported more frequently as the first dominant percept even in the presence of coarse information (at a low SF level: 2–6 cycle/degree). Following current theories of emotion processing, the results provide further support for the influence of positive compared to negative meaning on binocular rivalry and, for the first time, showed that individuals perceive the affective quality of happiness even in the absence of details in the visual display. Furthermore, our findings represent an advance in knowledge regarding the association between the high- and low-level mechanisms behind binocular rivalry.

Posttraumatic Stress Disorder Symptom Cluster Structure in Prolonged Exposure Therapy and Virtual Reality Exposure.

The emotional processing theory of posttraumatic stress disorder (PTSD) posits that avoidance is central to PTSD development and maintenance. Prolonged exposure (PE) therapy, which clinically focuses on avoidance reduction, has strong empirical support as a PTSD treatment. Virtual reality exposure (VRE) has been utilized to accelerate avoidance reduction by increasing multisensory engagement. Although some exposure therapy studies have found associations between avoidance and PTSD symptoms, others have indicated that reexperiencing or hyperarousal symptoms drive symptom trajectories. Using a cross-lagged panel design, the present secondary data analysis examined temporal associations between clinician-assessed PTSD symptom clusters during treatment with PE, VRE, or a waitlist control condition. There were no significant differences between PE and VRE regarding symptom clusters at any assessment. Compared to the waitlist condition, individuals who received VRE or PE exhibited earlier reductions in avoidance/numbing symptoms, β = -.19, 95% CI [-.33, -.05], followed by reductions in hyperarousal symptoms, β = -.21, 95% CI [-.33, -.09]. Hyperarousal symptoms predicted changes in later avoidance/numbing and reexperiencing outcomes across treatment: pretreatment to midtreatment, β = .29, 95% CI [.17, .42]; midtreatment to posttreatment, β = .23, 95% CI [.07, .39]. Reexperiencing symptoms predicted changes in hyperarousal outcomes earlier in treatment, β = .22, 95% CI [.02, .37], whereas avoidance/numbing symptoms predicted changes in hyperarousal outcomes later in treatment, β = .18, 95% CI [.04, .32]. These findings support the efficacy of exposure therapy in addressing avoidance/numbing symptoms and highlight the potential importance of hyperarousal symptoms in relation to other symptom clusters.

Social cognition in first-episode schizophrenia/schizoaffective disorder patients.

People with schizophrenia have neurocognitive as well as social cognition deficits. Numerous studies have shown impairment in these domains in patients with chronic schizophrenia. However, these disturbances during the early phase of the disease have been less studied. The aim of the study is to explore the theory of mind (ToM) and emotional processing in first-episode patients, compared to healthy subjects. Forty patients with a first psychotic episode of less than 5 years' duration, and 40 healthy control subjects matched by age and years of schooling were assessed. The measures of social cognition included four stories of false belief, the Reading the Mind in the Eyes Test (RMET) and the Pictures Of Facial Affect (POFA) series. The patients with a first psychotic episode performed significantly worse in all tasks of social cognition, compared to the healthy controls. The second-order ToM was impaired whereas the first-order ToM was preserved in the patients. Happiness was the emotion most easily identified by both patients and controls. Fear was most difficult for the patients, while for the controls it was disgust. Deficits in ToM and emotional processing are present in patients with a first psychotic episode.

Negative Affect Mediates the Association between Posttraumatic Cognitions and Craving in Veterans with Posttraumatic Stress Disorder and Alcohol Use Disorder

Objective: The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common. Individuals with PTSD/AUD commonly drink to cope with PTSD symptoms, which maintains PTSD/AUD, and may result in increased craving for alcohol. Negative affect is implicated in negative reinforcement models of craving. Further, Emotional Processing Theory posits that posttraumatic cognitions lead to the experience of negative affect, which may result in increased craving in PTSD/AUD. The current study aims to advance the understanding of craving in PTSD/AUD by evaluating if specific posttraumatic cognitions (e.g., cognitions about the self, world, and self-blame) are associated with increased negative affect, and whether higher negative affect is associated with heightened craving. Methods: Three separate simple mediation models were utilized to test if negative affect mediated the relationship between each specific posttraumatic cognition type and craving among 136 treatment-seeking veterans with PTSD/AUD. Results: We found that negative affect mediated the association between all posttraumatic cognition types and craving. Specifically, viewing oneself as being unable to handle PTSD-related distress, viewing the world as very dangerous, and blaming oneself for one’s role in a traumatic event were all associated with increased negative affect, which was related to higher craving. Conclusions: Given that posttraumatic cognitions improve via trauma-focused treatment for PTSD, future work should evaluate whether improvements in posttraumatic cognitions via trauma-focused treatment lead to decreased negative affect and craving in PTSD/AUD.

Cognitive Flexibility Matters: The Role of Multilevel Positive Affect and Cognitive Flexibility in Shaping Victims’ Cooperative and Uncooperative Behavioral Responses to Trust Violations

Despite a significant growth in the scholarly literature in the area of trust violations and repair in the last decade, extant work has largely ignored the complex and socially competent responses of the victims of these violations. Our framework integrates insights from affective events theory, the broaden-and-build theory of positive emotions, and theories of cognitive processing to suggest that cognitive flexibility is central to understanding how individuals respond to trust violations. Rather than viewing victims solely as gatekeepers to trust repair, we examine how victims’ cognitive processes are influenced by the affective context of those violations, which can, in turn, produce a spectrum of nuanced behavioral responses. We refer to this spectrum as the “swollen middle,” the range of behavior that resides between the extremes of impulsive revenge and forgiveness-based, communal cooperation. By integrating psychological theories of emotion and cognitive processing, we seek to highlight the central role of cognitive flexibility in the range of cooperative responses to trust violations. More broadly, we seek to contribute to the emergence of a new paradigm for studying interpersonal trust at work—a paradigm that explores trust-violating events as situated affect-laden experiences that interact with relevant organizational and interpersonal factors to influence employee behavior and trust dynamics in organizations.