The neural bases of expressive suppression: A systematic review of functional neuroimaging studies

The interrelation of emotion regulation, anterior insula structure, and narcissistic traits

BACKGROUND

Emotion regulation deficits are prevalent in most psychiatric conditions; in particular in affective and personality disorders. The insula cortex is an intersection of emotion regulation, (expressive suppression vs. cognitive reappraisal), affective disorders, and traits predisposing dysfunctional personality. In this study, we tested the interrelation of emotion regulation strategies, brain structure, and narcissistic personality traits in a sub-clinical cohort.

METHODS

In a sample of 172 psychiatrically healthy individuals we obtained 3 T MRI to acquire high resolution T1 weighted images for analyses of voxel- and surface-based structural parameters (SPM12/CAT12) along with measures of dispositional use of emotion regulation (Emotion Regulation Questionnaire; ERQ) and narcissistic traits (Pathological Narcissism Inventory; PNI). We tested their interrelation using a GLM approach and mediation models.

RESULTS

ERQ mediated the negative association of right insula volume and PNI and the association of right insula gyrification and PNI. PNI mediated the association of bilateral insula volume and ERQ. Additionally, PNI sub-scales were positively associated with gyrification of bilateral anterior insulae, cortical thickness of left precuneus and negatively correlated with cortical thickness of the left inferior temporal gyrus.

LIMITATIONS

In contradistinction to preceding studies, no associations have been identified in prefrontal brain regions.

CONCLUSION

This is the first study that primarily tested meditated correlations of emotion regulation, brain structure, and narcissistic traits supporting the idea of the insula as a convergence structure for affective and personality disorders. Moreover, additional analyses indicate involvement of further brain regions such as precuneus and inferior temporal gyrus that have also been discussed in self-attributional processes.

Emotion regulation: The role of hypnotizability and interoception

Hypnotizability-related differences in interoception may be relevant to emotion regulation. The present study examined the relationships between hypnotizability, interoceptive sensibility (IS) and interoceptive accuracy (IA), and the use of cognitive reappraisal and expressive suppression. One hundred and two healthy volunteers, assessed for hypnotizability, completed questionnaires assessing absorption, state anxiety, IS and emotion regulation. A portion of them (N = 62) participated in the heartbeat counting task, measuring IA. IS was positively associated with hypnotizability and cognitive reappraisal and negatively associated with expressive suppression. IA was negatively associated with hypnotizability and cognitive reappraisal and showed no relationship with expressive suppression. Mediation analysis revealed that hypnotizability indirectly positively predicted cognitive reappraisal through both IS and IA. Participants with high and low hypnotizability were more likely to use expressive suppression than participants with medium hypnotizability. Results support the role of interoception and hypnotizability in emotion regulation and may guide new clinical approaches.

Expressive Suppression of Emotions in Bulimia Nervosa: An Electroencephalography Study

OBJECTIVE

Previous research has found dysfunctional emotion regulation in bulimia nervosa (BN), including self-reported greater habitual use of maladaptive strategies such as suppression than in healthy individuals. However, there is no evidence on the performance in the implementation of expressive suppression in BN. The aim of this study was to investigate brain activity (in terms of ERP) and self-reported ratings associated with expressive suppression of emotions elicited by positive and negative stimuli in women with BN.

METHOD

Event-related potentials (ERP) were recorded from 23 female individuals with BN and 26 matched healthy controls. Participants were shown emotional pictures under two conditions: using facial suppression or attentively viewing. High-density EEG was used to characterize the time course of emotion regulation.

RESULTS

ERP amplitudes varied significantly with valence, with positive (vs. neutral and negative) pictures eliciting larger ERP amplitudes. However, no significant differences in ERP were observed between the groups or conditions. The BN group reported lower self-efficacy in implementing suppression compared to the control group, the latter with a positive correlation between the perceived self-efficacy and the change in emotional arousal between conditions.

DISCUSSION

Our findings suggest that individuals with BN might have difficulties in monitoring the emotion regulation process compared to healthy individuals. This suggests that other processes (e.g., metacognitive difficulties, self-esteem) rather than a failure to implement suppression, might underlie these results. However, further research is needed to validate this interpretation. Implications and directions for future research are discussed.

Neural correlates and plasticity of explicit emotion regulation following the experience of trauma

Experiencing trauma or other adverse life events is highly prevalent and poses a significant risk for the development of mental disorders. Understanding the underlying mechanisms and neural processes involved in trauma processing is crucial for both prevention and targeting symptoms. Especially, difficulties in emotion regulation emerge as one key mechanism implicated in the development of conditions such as post-traumatic stress disorder (PTSD) following traumatic experiences. However, neural correlates of explicit emotion regulation among individuals who have undergone trauma have not received much attention. Understanding the neural basis of dysregulated emotion following trauma could reveal important details about how trauma interferes with emotional regulation systems, informing the development of more specific intervention approaches. Therefore, this mini review summarizes current research, and identifies relevant gaps in the literature and challenges for future studies. Specifically, it provides an overview of the neural dysregulation associated with explicit emotion regulation strategies such as reappraisal or suppression. Finally, it highlights promising findings from intervention studies targeting emotion regulation, such as trauma-focused exposure therapy and neurofeedback, indicating neural plasticity in individuals with traumatic experiences. Hereby, this review aims to bridge the gap between fundamental and intervention research and highlights future directions for translational research.

A Model for Emotional Intelligence in Biology Education Research

Informed by social science fields including psychology and public health, we propose a Model for Emotional Intelligence to advance biology education research in affective learning. The model offers a shared discourse for biology education researchers to develop and assess evidence-based strategies to perceive, use, understand, and manage emotions for students and instructors in life sciences classrooms. We begin by reviewing the connection between stress, emotional invalidation, Sense of Belonging, and Science Identity as it relates to emotions in undergraduate life sciences classrooms. Next, we highlight the impact that emotionally invalidating classroom environments have on science students' development of psychological distress, maladaptive coping, and high-risk behaviors. Assuming Emotional Intelligence can be taught and learned (i.e., the ability model of Emotional Intelligence), we develop a Model for Emotional Intelligence to advance biology education research in this arena. This essay aims to inform assessments of current and future interventions designed to counteract emotional invalidation and encourage the development of emotional management among students and instructors. In alignment with our collective effort to support student well-being in the life sciences, the study of Emotional Intelligence in undergraduate biology education has the potential to support student mental health as future scientists and health care practitioners.

The association between aspects of expressive suppression emotion regulation strategy and rumination traits: a network analysis approach

Expressive suppression is an abnormal emotion regulation strategy, and its relationship with rumination traits is unclear. In this study with 395 participants in China (33.9% female, Mean age = 21.22, SD = 2.11), we estimated the association between expressive suppression and rumination traits, using the Rumination Response Scale (RRS) and the Emotion Regulation Questionnaire (ERQ) respectively. Considering there may be complex correlations between different behavioral symptoms of expressive suppression ("Keeping emotions to myself", "Inhibiting positive emotion responses", "Controlling emotions by not expressing them", "Inhibiting negative emotion responses") and different subtypes of rumination traits, this study employed a symptom-based network analysis method to uncover the differential association between rumination traits and expressive suppression, and the key symptoms linking the two. The study found the S3 node (Controlling emotions by not expressing them) had significant positive correlations with symptom rumination, brooding, and reflective pondering. Among the network, the S3 node acts as a bridge between two variables. This suggests that interventions targeting the S3 symptom may improve rumination traits. The present study was a cross-sectional study with limitations in revealing the causal relationships between expression suppression and rumination traits. Future studies could employ longitudinal tracing methods to explore the relationship between them.

A Latent Profile Analysis of Emotion Regulation in Relation to Distress of Symptoms in Youth with Prodromal Psychotic Symptoms

(1) Background: Although abnormal emotion regulation is a key characteristic of youth with prodromal psychotic symptoms and is closely related to the degree of distress caused by these symptoms, research on the internal heterogeneity of emotion regulation within this clinically high-risk population has been insufficient. (2) Methods: The current study analyzed data from 394 college students with prodromal psychotic symptoms, using latent profile analysis (LPA) to identify emotion regulation profiles based on differences in expressive suppression and cognitive reappraisal. One-way ANOVA was employed to examine the relationship between the identified latent profiles and distress of symptoms. (3) Results: Three latent profiles were identified: "high cognitive reappraisal group" (n = 117, 29.70%), "moderate cognitive reappraisal group" (n = 233, 59.14%), and "low cognitive reappraisal group" (n = 44, 11.16%). Significant differences in distress of negative symptoms (F = 9.122, p < 0.05) and perceptual abnormalities (F = 3.103, p < 0.05) were observed across the latent profiles but not in unusual thought content and specific perceptual abnormalities (both p > 0.05). The "low cognitive reappraisal group" exhibited the most severe distress of symptoms, followed by the "moderate cognitive reappraisal group", while the "high cognitive reappraisal group" experienced the least distress. (4) Conclusions: The current study provides evidence for the heterogeneity of emotion regulation among youth with prodromal psychotic symptoms and reveals differences in distress of perceptual abnormalities and negative symptoms between the latent profiles of emotion regulation. These findings support the development of targeted psychological interventions to alleviate the distress of symptoms and improve quality of life.

Predictors of knowledge and knowledge gain after decision aid use among women with BRCA1/2 pathogenic variants

OBJECTIVE

To identify factors contributing to baseline knowledge in women with BRCA1/2 pathogenic variants (PVs) and knowledge gain after decision aid (DA) use.

METHODS

Women with PVs in BRCA1 or BRCA2 genes were randomly assigned to an intervention group (IG) receiving DAs or a control group (CG). Of the total sample, 417 completed the baseline survey and were included in this analysis. Two multiple regression analyses were conducted: baseline data on socio-demographic, medical, decision-related and psychological variables were used to identify predictors for (1) baseline knowledge within the total group and (2) knowledge gain within the IG after DA use three months post study inclusion.

RESULTS

At baseline, higher education status, no breast cancer history, and lower decisional conflict related to higher knowledge within the total group. After DA use within the IG, higher baseline scores for decisional conflict predicted higher knowledge gain, and higher baseline scores for depression and intrusion predicted lower knowledge gain.

CONCLUSIONS

This study identified predictors of baseline knowledge and knowledge gain after DA use in women with BRCA1/2 PVs.

PRACTICE IMPLICATIONS

Awareness of facilitating and hindering factors on these women's knowledge can improve understanding of their health literacy and enable further targeted support interventions.

Sensorimotor regulation of facial expression - An untouched frontier

Facial expression is a critical form of nonverbal social communication which promotes emotional exchange and affiliation among humans. Facial expressions are generated via precise contraction of the facial muscles, guided by sensory feedback. While the neural pathways underlying facial motor control are well characterized in humans and primates, it remains unknown how tactile and proprioceptive information reaches these pathways to guide facial muscle contraction. Thus, despite the importance of facial expressions for social functioning, little is known about how they are generated as a unique sensorimotor behavior. In this review, we highlight current knowledge about sensory feedback from the face and how it is distinct from other body regions. We describe connectivity between the facial sensory and motor brain systems, and call attention to the other brain systems which influence facial expression behavior, including vision, gustation, emotion, and interoception. Finally, we petition for more research on the sensory basis of facial expressions, asserting that incomplete understanding of sensorimotor mechanisms is a barrier to addressing atypical facial expressivity in clinical populations.

Does cognitive load influence expressive flexibility? Comparing civilian and veteran populations

Expressive flexibility (EF) is a component of emotion regulation flexibility repertoire that constitutes the ability to enhance or suppress the expression of emotion in accordance with a given situational context. Previous research has associated EF with healthy adjustment to adversity. This association has also been observed in combat veterans with elevated post-traumatic stress. EF and other elements of regulatory flexibility are believed to rely on functions of cognitive control, such as working memory. However, previous research has yet to investigate this link. Accordingly, we examined performance in veterans (N = 42) and non-veterans (N = 75) on an EF Task with and without the inclusion of a numerical cognitive load task. Results indicate an interaction between cognitive load and expressive condition. Specifically, suppression abilities were weaker in cognitive load conditions. These findings did not vary in veteran and non-veteran samples. These results add to a growing body of work indicating a relationship between cognitive control and regulatory flexibility, and suggest similar mechanisms between veteran and non-veteran populations.

Aerobic exercise promotes emotion regulation: a narrative review

Aerobic exercise improves the three stages of emotion regulation: perception, valuation and action. It reduces the perception of negative emotions, encourages individuals to reinterpret emotional situations in a positive or non-emotional manner, and enhances control over emotion expression behaviours. These effects are generated via increased prefrontal cortex activation, the strengthening of functional connections between the amygdala and several other brain regions, and the enhancement of the plasticity of key emotion regulation pathways and nodes, such as the uncinate fasciculus. The effect of aerobic exercise on emotion regulation is influenced by the exercise intensity and duration, and by individuals' exercise experience. Future research may explore the key neural basis of aerobic exercise's promotion of emotion regulation.

Cognitive Reappraisal and Expressive Suppression Evoke Distinct Neural Connections during Interpersonal Emotion Regulation

Interpersonal emotion regulation is the dynamic process where the regulator aims to change the target's emotional state, which is presumed to engage three neural systems: cognitive control (i.e., dorsal and ventral lateral PFC, etc.), empathy/social cognition (i.e., dorsal premotor regions, temporal-parietal junction, etc.), and affective response (i.e., insula, amygdala, etc.). This study aimed to identify the underlying neural correlate (especially the interpersonal one), of interpersonal emotion regulation based on two typical strategies (cognitive appraisal, expressive suppression). Thirty-four female dyads (friends) were randomly assigned into two strategy groups, with one assigned as the target and the other as the regulator to downregulate the target's negative emotions using two strategies. A functional near-infrared spectroscopy system was used to simultaneously measure participants' neural activity. Results showed that these two strategies could successfully downregulate the targets' negative emotions. Both strategies evoked intrapersonal and interpersonal neural couplings between the cognitive control, social cognition, and mirror neuron systems (e.g., PFC, temporal-parietal junction, premotor cortex, etc.), whereas cognitive reappraisal (vs expressive suppression) evoked a broader pattern. Further, cognitive reappraisal involved increased interpersonal brain synchronization between the prefrontal and temporal areas at the sharing stage, whereas expressive suppression evoked increased interpersonal brain synchronization associated with the PFC at the regulation stage. These findings indicate that intrapersonal and interpersonal neural couplings associated with regions within the abovementioned systems, possibly involving mental processes, such as cognitive control, mentalizing, and observing, underlie interpersonal emotion regulation based on cognitive reappraisal or expressive suppression.SIGNIFICANCE STATEMENT As significant as intrapersonal emotion regulation, interpersonal emotion regulation subserves parent-child, couple, and leader-follower relationships. Despite enormous growth in research on intrapersonal emotion regulation, the field lacks insight into the neural correlates underpinning interpersonal emotion regulation. This study aimed to probe the underlying neural correlates of interpersonal emotion regulation using a multibrain neuroimaging (i.e., hyperscanning) based on functional near-infrared spectroscopy. Results showed that both cognitive reappraisal and expressive suppression strategies successfully downregulated the target's negative emotions. More importantly, they evoked intrapersonal and interpersonal neural couplings associated with regions within the cognitive control, social cognition, and mirror neuron systems, possibly involving mental processes, such as cognitive control, mentalizing, and observing. These findings deepen our understanding of the neural correlates underpinning interpersonal emotion regulation.

Decoding reappraisal and suppression from neural circuits: A combined supervised and unsupervised machine learning approach

Emotion regulation is a core construct of mental health and deficits in emotion regulation abilities lead to psychological disorders. Reappraisal and suppression are two widely studied emotion regulation strategies but, possibly due to methodological limitations in previous studies, a consistent picture of the neural correlates related to the individual differences in their habitual use remains elusive. To address these issues, the present study applied a combination of unsupervised and supervised machine learning algorithms to the structural MRI scans of 128 individuals. First, unsupervised machine learning was used to separate the brain into naturally grouping grey matter circuits. Then, supervised machine learning was applied to predict individual differences in the use of different strategies of emotion regulation. Two predictive models, including structural brain features and psychological ones, were tested. Results showed that a temporo-parahippocampal-orbitofrontal network successfully predicted the individual differences in the use of reappraisal. Differently, insular and fronto-temporo-cerebellar networks successfully predicted suppression. In both predictive models, anxiety, the opposite strategy, and specific emotional intelligence factors played a role in predicting the use of reappraisal and suppression. This work provides new insights regarding the decoding of individual differences from structural features and other psychologically relevant variables while extending previous observations on the neural bases of emotion regulation strategies.

Neural correlations between cognitive deficits and emotion regulation strategies: understanding emotion dysregulation in depression from the perspective of cognitive control and cognitive biases

The link between cognitive function and emotion regulation may be helpful in better understanding the onset, maintenance, and treatment for depression. However, it remains unclear whether there are neural correlates between emotion dysregulation and cognitive deficits in depression. To address this question, we first review the neural representations of emotion dysregulation and cognitive deficits in depression (including deficits in cognitive control and cognitive biases). Based on the comparisons of neural representations of emotion dysregulation versus cognitive deficits, we propose an accessible and reasonable link between emotion dysregulation, cognitive control, and cognitive biases in depression. Specifically, cognitive control serves the whole process of emotion regulation, whereas cognitive biases are engaged in emotion regulation processes at different stages. Moreover, the abnormal implementation of different emotion regulation strategies in depression is consistently affected by cognitive control, which is involved in the dorsolateral, the dorsomedial prefrontal cortex, and the anterior cingulate cortex. Besides, the relationship between different emotion regulation strategies and cognitive biases in depression may be distinct: the orbitofrontal cortex contributes to the association between ineffective reappraisal and negative interpretation bias, while the subgenual prefrontal cortex and the posterior cingulate cortex underline the tendency of depressed individuals to ruminate and overly engage in self-referential bias. This review sheds light on the relationship between cognitive deficits and emotion dysregulation in depression and identifies directions in need of future attention.