Cognitive control of emotion

1. Cognitive control of emotion neurocoachsa.wordpress.com Translational Neuromodeling & Computational Neuroeconomics Seminar 13.12.2013 Daniel Renz

2. Examples A person with social anxiety clenches her hands to avoid shaking as she tries to answer a professor's question. A person with alcohol dependence drinks himself into oblivion following a bitter divorce. A person with obsessive-compulsive disorder feels intense anxiety and washes his hands until they bleed. A person with depression fights back tears during an unpleasant work meeting. What do those people have in common? bbc.co.uk medindia.net wikipedia.org pensionriskmatters.com

3. Examples A person with social anxiety clenches her hands to avoid shaking as she tries to answer a professor's question. A person with alcohol dependence drinks himself into oblivion following a bitter divorce. A person with obsessive-compulsive disorder feels intense anxiety and washes his hands until they bleed. A person with depression fights back tears during an unpleasant work meeting. What do those people have in common? experience of high levels of negative emotion trying to suppress this experience Suppression is one of many strategies. bbc.co.uk medindia.net wikipedia.org pensionriskmatters.com

4. Emotion regulation and psychopathology Problems with emotion (regulation) characterize more than 75% of the diagnostic categories of psychopathology in DSM-IV. The mood and anxiety disorders are even primarily defined on the basis of disturbed emotions (and their control). We use the process model of emotion regulation to organize research on strategies of emotion regulation. We then use this framework to examine diverse forms of psychopathology

5. Emotion regulation - Intro Emotions have been said to represent the “wisdom of the ages” (Lazarus, 1991). But even the wisest guides have their limits. Regulation of emotion necessary for successful adaptive behavior. It has been conceptualized as processes through which individuals modulate their emotions either consciously or unconsciously. Conscious emotion regulation allows us to interact with our complex environment in a goal-directed manner. Emotion regulation is maladaptive when it does not change the emotional response in the desired way or when the long-term costs outweigh the benefits of short-term emotional changes. If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment. Marcus Aurelius, last of the Five Good Emperors psychologicalscience.org

6. History of emotion regulation • Roots in psychoanalytic theorizing about the nature of psychological defenses (Psychodynamic study of defense - Breuer & Freud, 1895). Study of regulation of negative emotions using individual difference studies of so-called perceptual defenses. • Stress and coping tradition (Lazarus, 1966). Focus on management of situations that tax or exceed the individual's resources. • Developmental study of self-regulation with roots in socio-emotional development. For example, it was shown that children can obtain a preferred but delayed reward by imagining a kind of metal frame around an immediately available treat. • Contemporary research builds on these foundations using both behavioral and neuroscience methods to investigate cellular responses to stress or the neural systems involved in simple forms of affective learning. • Only very recently, rapid growth of imaging studies of regulatory phenomena in humans has allowed study of regulatory power of higher cognitive control processes on emotion. This 'hot' control of emotion draws on models of the 'cold' control of attention and memory.

7. Modal model of emotion • Emotion is a somewhat elusive, but we can describe a prototypical response. • triggered by a psychologically relevant situation (internal or external) • no emotion occurs without attention to situation. • situations are appraised for their bearing on one's currently active goals. • appraisal sets in motion an elaborated response across these systems: • experiential (“feeling”) • behavioral (e.g. smiling, eyes widening) • physiological (autonomic and neuroendocrine changes)

8. Modal model of emotion • Emotion is a somewhat elusive, but we can describe a prototypical response. • triggered by a psychologically relevant situation (internal or external) • no emotion occurs without attention to situation. • situations are appraised for their bearing on one's currently active goals. • appraisal sets in motion an elaborated response across these systems: • experiential (“feeling”) • behavioral (e.g. smiling, eyes widening) • physiological (autonomic and neuroendocrine changes) • A simple way to describe those core features is the “modal model” of emotion. Situation Attention Appraisal Response

9. Process model of emotion regulation Example: Before an exam... The night before, study with other nervous students or meet a friend for relaxed dinner (situation selection) When friend asks exam, you might choose not to talk about it (situation modification) When friend persists, count ceiling tiles (attentional deployment) You attach a meaning to the test “it's only a test” rather than seeing it as measuring your value as a human being (cognitive change) After having miserably, you hide your embarrassment (response modulation) Selection / Modification Deployment Cognitive Change Modulation Experiential Behavioral Physiological Situation Attention Appraisal Response

10. Process model of emotion regulation We will focus on down-regulation of negative emotion using strategies from the families of attentional deployment, cognitive change and response modulation. Selection / Modification Deployment Cognitive Change Modulation Experiential Behavioral Physiological Situation Attention Appraisal Response

11. Situation selection & modification Selection / Avoidance of situation based on prediction of emotional experience Depression: enjoyment of an event is consistently underestimated. Avoidant personality disorder: Maladaptive chronic use of avoidance. Situation modification OCD: person goes to germ-filled public restroom, but can use paper towels. SAD: Implementation of safety behaviors in SAD attributes non-occurance of feared results to safety behaviors (instead of the safety of the situation).

12. Attentional deployment • Redirection of attention within a given situation (Selection of “internal situation”). • Can modulate all behavioral and neural responses that are conscious. • Example strategies: selective attention, rumination, worry, distraction. • Mindfulness therapy: brings awareness into the present, by focusing attention non-evaluatively, non-personalized into the present moment.

13. Attentional deployment • Selective attention • Task: Judging either emotional or perceptual features of emotional stimuli. • Results: Discrepant results of amygdala modulation. Studies suggest both decreases in amygdala activation when attending emotional features as well as invariant amygdala activity. • Explanation: (a) Some judgments might impose greater attentional load, which limits processing of perceptual input and thus limits amygdala responses. (b) In some cases, participants might actively regulate their responses. • Attentional distraction • Task: Use distracting secondary task to limit attention to pain. • Results: Distraction diminishes the aversiveness of pain, reduces activity in (sub)cortical pain-related regions (midcingulate, insula, thalamus, periacqueductal gray) and activates regions related to cognitive control (OFC, ACC, medial and lateral PFC). • Summary • Context and mechanisms governing regulatory effect are not clear. Problems: Different stimulus types. Absence of behavioral and physiological measures of regulation.

14. Cognitive change • A situation gives only rise to emotions if judged as important to one's goals (appraisal). • Reappraisal • May change (1) appraisals related to the situation (toddler vs working person: references to self) and (2) appraisals related to one's emotional responses (according to beliefs about which emotions are ok - “I hate myself when I get anxious”) • Unwillingness to experience negative emotions and subsequent attempts to avoid feelings such as anxiety or depression maintains psychopathology through secondary responses: “recursive emotional response”, “dirty emotions” or natural negativity vs negative negativity (buddhism). • Decreases emotion experience and behavioral expression, and has no impact on memory. • First evidence that reappraisal-like processes could influence emotional responding was provided by Lazarus et al in 1966. Students were shown a filmed circumcision ritual, with and without an accompanying soundtrack that was designed to minimize emotional impact. Participants who heard the soundtrack had more pleasant mood ratings.

15. Cognitive change • Reappraisal of negative emotion activates dorsal ACC and PFC (selection and application of reappraisal strategies) and modulates activity in amygdala / insula in accordance with the goal of reappraisal. The precise areas in PFC change with the task.

16. Cognitive change • If participants believe that placebo blunts pain, then painful stimuli elicit less pain and produce decreased activation of amygdala and pain-related cingulate, insula and thalamus as well as increased activation of lateral and medial PFC related to cognitive control (including dorsal and right vlPFC). This is strikingly similar to what happens during reappraisal, suggesting that placebo effects are mediated by the active maintenance of beliefs about the compounds. • Studies of cognitive change have shown consistently that emotional appraisal systems can be modulated by PFC, OFC and cingulate control systems. Subcortical regions such as the amygdala are constantly implicated in the appraisal.

17. Cognitive change • Controlled regulation • So how do those control systems regulate appraisal system activation? • Patterns of functional specificity are being discovered: • Ventral PFC and OFC systems may evaluate the context-appropriate emotional value of stimuli and select actions on the basis of those evaluations. This might directly affect emotional associations through direct reciprocal connections with amygdala and Nacc. Through those connections the appraisal systems could also affect goal-directed behavior. • Dorsal PFC (which has few, if any, direct connections to appraisal systems) may be used to explicitly reason about how associations between stimuli and emotional responses can be changed. This may indirectly affect emotional associations by biasing processing in the ventral PFC or in perceptual / sensory memory systems.

18. Response modulation • Occurs after response tendencies have been initiated. Influences experiential, behavioral and physiological responding as directly as possible. • Expressive suppression (Inhibiting the outward signs of inner feelings) • Decreases subjective experience of positive emotion. Has no (or amplifying) effect on the subjective experience of negative emotion. (it is not clear why) • Produces deleterious biological and cognitive effects such as increased sympathetic nervous system activation and impaired memory. • Experiential avoidance/suppression • efforts to inhibit the emotion experience itself (unwillingness to accept one's authentic experience) • maintains many mood and anxiety disorders • Acceptance: Allowing the rise and passage of emotions without attempts to avoid or control them.

19. Cognitive change vs Response modulation: Affective consequences • Short film showed an arm amputation to elicit disgust. • Three groups of participants: reappraise (to not feel anything), suppress (hide emotions), and control. • Measurement of finger pulse amplitude as indication of sympathetic activation. • Both reappraisal and suppression decreased disgust-expressive behavior. • Only suppression additionally led to increased sympathetic system activation. • Only reappraisal decreased disgust experience. Gross2002

20. Cognitive change vs Response modulation: Affective consequences • Self-assessment using Emotion Regulation Questionnaire: • individuals who habitually suppress have lesser emotion-expressive behavior • they have comparable levels of negative emotion experience, but lesser positive emotion experience • reappraisal is associatedwith greater positive emotion experience / expression and lesser negative emotion experience / expression

21. Cognitive change vs Response modulation: Cognitive consequences • Suppression leads to impaired memory while reappraisal does not. Can this be explained by the constant cognitive required to suppress, leaving little resources for processing of events in order to commit to memory? • In one study, participants were shown a short film clip known to elicit negative emotion. Suppression led to decrements in objective memory and memory confidence rating in a surprise cued-recognition test afterwards. • In another study, participants viewed slides that either elicited high or low levels of negative emotion. Suppression participants performed worse on verbal memory test (indifferent of emotional content), but normally on the nonverbal memory test. This suggests that the cognitive costs of suppression are due to verbal demands of self-instructions issues during suppression.

22. Cognitive change vs Response modulation: Social consequences Requirement of monitoring facial expressions and vocal signals could make the individual less responsive to the emotional cues of their partner. So suppression should have negative social consequences in casual conversation, and reappraisal less so. Unacquainted pairs of women watched an upsetting film, and then discussed their reactions. One member of each dyad had been asked to either suppress, reappraise, or interact naturally with her conversation partner. Interacting with a partner who shows little positive emotion, and who is unresponsive to emotional cues, is more physiologically activating than interacting with a partner who shows greater positive emotion and responsiveness. Habitually, suppression is also associated with poorer social support. Individualswho tended to use reappraisal were more likely to be liked than individuals who tended to use suppression (questionnaire data). Gross2002

23. Neuroimaging results Regulation of negative affect involves the medial and lateral prefrontal and the parietal cortex. Appraisal involves subcortical areas, especially the amygdala. Regulatory influences on amygdala pgACC inhibits in the resolution of emotional conflicts OFC modulates in the reappraisal of contextual values lmPFC and dmPFC modulate in reducing negative emotion, possibly mediated by OFC / vmPFC. The main brain areas involved in cognitive emotion regulation (especially amygdala), appear to be dysfunctional in depression. Elevated baseline activity of the amygdala associated with symptom severity heightened amygdala responsivity to affective stimuli ineffective functioning of the dlPFC, which may result in a reduced regulatory influence on amygdala activation in response to an emotional challenge, which might be expressed phenomenologically as perseveration of negative affect and rumination.

24. Temporal dynamics of detachment in MDD Task: 120 pictures (60 negative, 60 neutral) were shown for 8s each. Instruction 'permit' or 'regulate' for 2s before. Instruction 'relax' for 20s afterwards. 15 min later, stimuli were presented again in a passive viewing task (each picture 1s). Both groups showed amygdala activation in response to negative pictures, which was significantly reduced during regulation. Ability to down-regulate negative emotions and corresponding amygdala activation were anti-correlated with HAM-D scores. Erk2010

25. Temporal dynamics of detachment in MDD Healthy controls showed right DLPFC and inferior parietal cortex (IPL) activation during regulation, which was diminished in patients. Healthy controls showed a sustained regulation effect in the amygdala after 15 min delay. Erk2010

26. Failure to regulate in MDD Task: 144 pictures (72 pleasant, 72 unpleasant) were shown for 10s each. After 4s, a signal was given to either enhance, suppress or continue. Pupil dilation as measure of autonomic arousal. In response to negative stimuli, healthy controls showed left-lateralized activation in PFC when downregulating and an inverse relationship between activation in left vlPFC and the amygdala, mediated by vmPFC. Increased effort as reflected in greater pupil dilation was associated with decreased activation in amygdala and insula (successful downregulation). Depressed individuals showed bilateral PFC activation and a (counterproductive) positive association between vmPFC and amygdala. Pupil dilation was strongly positively correlated with activation in amygdala and insula. This suggests that the effortful attempt to reappraise negative stimuli was ineffective or counterproductive in the depressed group. It seems that the role of vmPFC as an inhibitory link between left vlPFC and the amygdala is compromised in depression.

27. Failure to regulate in MDD

28. 5-HTTLPR polymorphism • 5-HTTLPR polymorphism of the human serotonin transporter (5-HTT)gene SLC6A4 has been shown to influence transcriptional activity of 5-HTT. Short allele carriers have altered amygdala reactivity and lack of prefrontal regulatory control. Specifically: • increased anxiety-related traits and elevated risk of depression • increased amygdala reactivity • Reduced structural covariance between pgACC and amygdala • reduced gray matter volume in ACC and. Rostral sgACC was the maximum reduction within the whole brain • reduction of functional connection between Amygdala and pgACC. This connectivity was predictive of a measure of anxious temperament based on the Tridimensional Personality Questionnaire. • Importantly, this study showed that: amygdala connections to vmPFC, which may also participate in regulating amygdala activity, if they exist at all, are sparse. Thus, the previously reported finding of increased functional connectivity in s allele carriers in this region is likely based on indirect anatomical interconnections.

29. 5-HTTLPR polymorphism Pezawas2005

30. Journal club…

31. JC: Individual differences Reciprocal PFC-amygdala relationship during successful reappraisal of negative emotion suggests that greater regulatory ability is correlated with better engagement of the PFC-amygdala circuit. Individual differences in the capacity to regulate my determine vulnerability in the face of adversity. One of the best validated measures of negative emotion is facial EMG over frowning muscles (cEMG). In other studies: Measure of regulatory success through self-reported negative affect or non-specific physiological arousal (pupil dilation, skin conductance). cEMG has been shown to reflect specifically negative effect, be modulated by regulatory activity and have a high test-retest reliability over a four-week interval. Which PFC areas critically impact regulatory success? vlPFC, vmPFC, dlPFC, dmPFC, OFC, ACC? Study investigated only males, as their emotion regulation over time is more stable. Regulation instructions: enhance, suppress or maintain. Participants were allowed to choose reappraisal strategies, but were instructed to avoid non-cognitive strategies such as breathing or gaze aversion.

32. Individual difference results (1) negative emotion was elicited by pictures as shown by greater cEMG activity nd higher amygdala activation for negative versus neutral images during maintain condition. cEMGand amygdala were modulated by regulation conditions. ability to down-regulate as measured by cEMG was predictive of amygdala BOLD about 1.3 years later (up-regulation not significant!).

33. Individual difference results (2) Functional connectivity was assessed using psychophysiological interaction method. Results: down-regulatory ability predictive of PFC-amygdala connectivity: cEMG difference score was regressed voxel-wise on function connectivity of amygdala. Greater capacity for down-regulation was associated with greater inverse functional coupling between amygdala and pgACC, OFC, dmPFC and dlPFC. OFC was not modulated by regulation instructions. Individuals who were worse at regulation showed more positive coupling.

34. Individual difference discussion trait-like ability to regulate negative emotion is associated with modulation of the amygdala activity and with amygdala-PFC function connectivity. individual-difference analysis revealed a new set of large clusters in PFC. OFC not statistically significant at the group-mean level. This suggests that OFC was recruited in individuals who where particularly successful in decreasing amygdala activities. Banks2007 showed effects in the opposite direction! In Banks2007, negative emotion was self-reported. Regulatory success was self-reported too, but not used in connectivity analysis. Did not find stable associations for up-regulation. Reasons: Men show lower cEMG activity to negative pictures compared to women (limited range). Studies have shown that regulation during picture viewing produces higher effects than regulation afterwards, and the stimuli were presented for a different time scale in fMRI. For the future: How is the CAUSAL connectivity?

37. Additional material...

38. Cognitive control center: PFC dlPFC is involved with "on-line" processing of information such as integrating different dimensions of cognition and behaviour (planning, working memory, abstract thinking, ...) OFC plays a key role in impulse control, maintenance of set, monitoring ongoing behaviour and socially appropriate behaviours ACC is involved in emotional drives, experience and integration (inhibition, motivation, decision-making,...)

39. Theories of PFC Dynamic Filtering Theory (Shimamura): PFC is presumed to act as a high-level filter that enhances goal-directed activations and inhibits irrelevant activations. This filter enables executive control at various levels of processing, including selecting, maintaining, updating, and rerouting activations. It has also been used to explain emotional regulation. The OFC is heavily connected to sensory and limbic areas and therefore may be responsible for filtering neural activity associated with emotional response. Integrative Theory of PFC function (Miller and Cohen): Cognitive control stems from the active maintenance of patterns of activity in the prefrontal cortex that represents goals and means to achieve them. They provide bias signals to other brain structures whose net effect is to guide the flow of activity along neural pathways that establish the proper mappings between inputs, internal states, and outputs needed to perform a given task. Miller showed that PFC neurons represent abstract rules such as "same vs. different", process the category or quantity of visual stimuli, or guide the allocation of attentional resources. PFC activity has also been shown to reflect the flexible remapping of stimulus-response associations.

40. Neural components of emotions Amygdala: Critical for detecting what parts of our surroundings have emotional significance. Generates bio-behavioral adjustments. Critical for the production of emotion, especially fear. Hypothalamus: Synthesizing and releasing neurotransmitters which can effect mood, reward and arousal. Anterior cingulate cortex: May be important for subjective emotional awareness, may play an important role in the initiation of motivated behavior. Basal ganglia: motivation. OFC: Decision-making and influence by emotion on that decision. PFC: Regulation of emotion and behavior by anticipating the consequences of our actions (goal-directed). Nucleus accumbens: Involved in the experience of goal-directed positive emotion. Insula: Bodily experience of emotion. Especially important for disgust.