Can words heal? Using affect labeling to reduce the effects of unpleasant cues on symptom reporting

How do "words poorly expressed emotion" affect mental health? The mediating role of affect labelling effect

Previous studies have found that people with high negative emotional granularity(NEG) tend to have better health levels. It is generally believed that this is due to the selection and application of explicit emotion regulation strategies that affect mental health. However, no research has yet examined a more fundamental process, the role of affect labelling, an implicit emotion regulation strategy. This study focuses on the aforementioned issues and uses the experience sampling method to categorise participants into groups with high and low NEG. Using an affect labelling paradigm with ERP(event-related potential) technology, the study measures the effects of affect labelling in participants. Furthermore, it assesses the mental health levels of the participants through questionnaires to explore whether the affect labelling effect serves as a mediator between NEG and mental health. The results show that: (1) The high-NEG group exhibited significantly lower LPP wave amplitudes under affect labelling compared to under non-affect labelling, whereas the low-NEG group did not show significant differences. The results indicate that only the high-NEG group can produce the affect labelling effect. (2) The affect labelling effect mediates the relationship between NEG and mental health, meaning that NEG predicts mental health through the affect labelling effect.

"And how did that make you feel?" - Repeated symptom queries enhance symptom reports elicited by negative affect

OBJECTIVE

Negative affect, alexithymia, and other predisposing traits (such as health anxiety) can influence an individual's symptom perception. In this study, we used the affective picture paradigm (APP, Bogaerts et al., 2010) to induce symptoms using affective picture stimuli. We aimed to cross-sectionally test the effect of high vs low-frequency symptom queries and analyze the time course of the APP, including interactions with health anxiety and somatic symptom distress.

METHODS

Participants (N = 124) completed a modified APP and filled out various questionnaires. In the APP, participants were randomized to either a highly-frequent-query condition (18 symptom checklists) or a less-frequent-query condition (6 checklists). Data were analyzed using ANOVAs, cross-lagged panel models, moderation models, and multilevel models.

RESULTS

Both groups had comparable symptom baseline values, but people in the highly frequent as opposed to less frequent condition reported significantly higher symptom levels once the experiment started (F (1,120) = 14.319, p < .001, η2=.107). Symptom levels stayed stable over the course of the experiment and were best predicted by symptom levels at earlier timepoints in the experiment (β = 0.43 and β = 0.68, both p < .001). Health anxiety levels significantly predicted symptom levels (F(1,121) = 10.054, p = .002, η2=.077) and moderated the relation between condition and symptom levels (F(2,121) = 16.253, p < .001, η2=.212).

CONCLUSION

In terms of the predictive processing model (e.g.,[1]), repeated symptom queries following negative affective cues may activate prior beliefs about symptoms, resulting in elevated levels of symptom reports in interaction with health anxiety.

Current and lasting effects of affect labeling on late positive potential (LPP) amplitudes elicited by negative events

INTRODUCTION

Labeling the emotional aspect of self-unrelated stimuli (i.e., affect labeling) is a crucial strategy for implicit emotion regulation. However, it is uncertain whether affect labeling influences event-related potential (ERP) responses (e.g., the late positive potential, LPP) to negative stimuli in comparison with control conditions in which attention is shifted to the emotional content of the stimuli (e.g., affect matching). Additionally, it is unknown whether affect labeling has a lasting effect on the processing of negative stimuli.

METHODS

Participants were required to label the emotion (negative or neutral) of target pictures with two words, to match the emotion with alternative pictures or to merely view the target pictures. Target pictures were presented again immediately after the regulation task. After all the target pictures had been labeled, matched and viewed, the pictures were re-exposed for the third time.

RESULTS

The results showed that negative pictures elicited larger late LPP responses during the affect labeling task than during other tasks. However, the LPP responses were smaller for negative pictures in the affect labeling condition than in the other conditions when target pictures were re-exposed immediately after the task. When target pictures were re-presented again long after the regulation tasks, the LPP responses were smaller for negative stimuli with a history of affect labeling than viewing, whereas this effect did not differ between the affect labeling and matching conditions.

CONCLUSION

The current findings suggest that affect labeling has current effects and, to some extent, has lasting effects on negative stimulus processing.

Physiological arousal guides situational appraisals and metacognitive recall for naturalistic experiences

As individuals navigate the world, they are bound to have emotionally intense experiences. These events not only influence momentary physiological and affective responses, but may also have a powerful impact on one's memory for their emotional experience. In this research, we used the naturalistic context of a haunted house to examine how physiological arousal is associated with metacognitive emotional memory (i.e., the extent to which an individual remembers having experienced a certain emotion). Participants first navigated the haunted house while heart rate and explicit situational appraisals were recorded, and then recalled specific events from the haunted house and the intensity of these affective events approximately one week later. We found that heart rate predicted both the intensity of reported scariness in the haunted house and meta-cognitive memory of affect during recall. Critically, we found evidence for malleability in metacognitive emotional memory based on how the event was initially labeled. Individuals tended to recall events that they explicitly labeled as fear-evoking as being more intense than they reported at the time of the event. We found the opposite relationship for events that they labeled as not fear-evoking. Taken together, this indicates that there are strong relationships between physiological arousal and emotional experiences in naturalistic contexts, but that affective labeling can modulate the relationship between these features when reflecting on the emotionality of that experience in memory.

Effects of a nonviolent communication-based anger management program on psychiatric inpatients

This quasi-experimental study aimed to determine the effects of a nonviolent communication-based anger management program on self-esteem, anger expression, and aggression in 44 psychiatric inpatients (experimental group: n = 21; control group: n = 24). The program consisted of six sessions of 60 min each, using a non-equivalent control group pretest-posttest design, and thereafter analyzing the intervention effects. Results showed statistically significant differences between the experimental and control groups in anger expression and anger suppression. There were positive, though not statistically significant, changes in self-esteem and aggression. The findings indicated a decreasing effect of anger expression and anger suppression.

Affect labelling increases the intensity of positive emotions

Although affect labelling has been widely reported to decrease negative emotions, it is less clear whether affect labelling also decreases positive emotions. In four studies, we explored how affect labelling (choosing the emotion that best corresponds with the image), content labelling (choosing the word that best corresponds with the content of the image), and simply viewing images influence positive and negative emotions. Labelling positive emotions led participants to report higher positive emotional intensity than did content labelling or just viewing the image (Study 1, N = 49), and this effect persisted regardless of whether they labelled emotions during or after the image (Study 2, N = 116), rated the intensity or positivity of their emotions (Study 3, N = 120), or rated their emotions after a delay or no delay (Study 4, N = 120). Surprisingly, we did not replicate the previous findings on affect labelling and negative emotion, instead showing that content labelling of negative emotional images tended to be the most consistent predictor of decreased negative emotions. Our results challenge the formulation that affect labelling leads to the automatic downregulation of emotions and instead suggest that it might be an effective mechanism in the upregulation of positive emotions.

Emotion Naming Impedes Both Cognitive Reappraisal and Mindful Acceptance Strategies of Emotion Regulation

Friends and therapists often encourage people in distress to say how they feel (i.e., name their emotions) with the hope that identifying their emotions will help them cope. Although lay and some psychological theories posit that emotion naming should facilitate subsequent emotion regulation, there is little research directly testing this question. Here, we report on two experimental studies that test how naming the emotions evoked by aversive images impacts subsequent regulation of those emotions. In study 1 (N = 80), participants were randomly assigned into one of four between-subjects conditions in which they either (i) passively observed aversive images, (ii) named the emotions that these images made them feel, (iii) regulated their emotions by reappraising the meaning of images, or (iv) both named and regulated their emotions. Analyses of self-reported negative affect revealed that emotion naming impeded emotion regulation via reappraisal. Participants who named their emotions before reappraising reported feeling worse than those who regulated without naming. Study 2 (N = 60) replicated these findings in a within-participants design, demonstrated that emotion naming also impeded regulation via mindful acceptance, and showed that observed effects were unrelated to a measure of social desirability, thereby mitigating the concern of experimenter demand. Together, these studies show that the impact of emotion naming on emotion regulation opposes common intuitions: instead of facilitating emotion regulation via reappraisal or acceptance, constructing an instance of a specific emotion category by giving it a name may "crystalize" one's affective experience and make it more resistant to modification.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-021-00036-y.

Different Dimensions of Affective Processing in Patients With Irritable Bowel Syndrome: A Multi-Center Cross-Sectional Study

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome (IBS) remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls (HCs). Additionally, we exploratively investigated the impact of IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS. Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire (MZQ) and four subscales of the Operationalized Psychodynamic Diagnosis-Structure Questionnaire (OPD-SQ). Linear regression analysis was used to investigate the influence of IBS symptom severity (IBS-Severity Scoring System, IBS-SSS), depression (Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder, GAD-7), and anxious and avoidant attachment styles (Experiences in Close Relationships Scale, ECR-RD12) on the different dimensions of affective processing in IBS. Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance (d = 0.849) and lowest for emotional experience (d = 0.222) and emotional awareness (d = 0.420). Moderate effect sizes were found for affect differentiation (d = 0.773), emotional communication (d = 0.665), and affect regulation (d = 0.552). Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment. Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions. Clinical Trial Registration: DRKS00011685.

Affective rating of audio and video clips using the EmojiGrid

Background: In this study we measured the affective appraisal of sounds and video clips using a newly developed graphical self-report tool: the EmojiGrid. The EmojiGrid is a square grid, labeled with emoji that express different degrees of valence and arousal. Users rate the valence and arousal of a given stimulus by simply clicking on the grid. Methods: In Experiment I, observers (N=150, 74 males, mean age=25.2±3.5) used the EmojiGrid to rate their affective appraisal of 77 validated sound clips from nine different semantic categories, covering a large area of the affective space. In Experiment II, observers (N=60, 32 males, mean age=24.5±3.3) used the EmojiGrid to rate their affective appraisal of 50 validated film fragments varying in positive and negative affect (20 positive, 20 negative, 10 neutral). Results: The results of this study show that for both sound and video, the agreement between the mean ratings obtained with the EmojiGrid and those obtained with an alternative and validated affective rating tool in previous studies in the literature, is excellent for valence and good for arousal. Our results also show the typical universal U-shaped relation between mean valence and arousal that is commonly observed for affective sensory stimuli, both for sound and video. Conclusions: We conclude that the EmojiGrid can be used as an affective self-report tool for the assessment of sound and video-evoked emotions.

Affective rating of audio and video clips using the EmojiGrid

Background: In this study we measured the affective appraisal of sounds and video clips using a newly developed graphical self-report tool: the EmojiGrid. The EmojiGrid is a square grid, labeled with emoji that express different degrees of valence and arousal. Users rate the valence and arousal of a given stimulus by simply clicking on the grid. Methods: In Experiment I, observers (N=150, 74 males, mean age=25.2±3.5) used the EmojiGrid to rate their affective appraisal of 77 validated sound clips from nine different semantic categories, covering a large area of the affective space. In Experiment II, observers (N=60, 32 males, mean age=24.5±3.3) used the EmojiGrid to rate their affective appraisal of 50 validated film fragments varying in positive and negative affect (20 positive, 20 negative, 10 neutral). Results: The results of this study show that for both sound and video, the agreement between the mean ratings obtained with the EmojiGrid and those obtained with an alternative and validated affective rating tool in previous studies in the literature, is excellent for valence and good for arousal. Our results also show the typical universal U-shaped relation between mean valence and arousal that is commonly observed for affective sensory stimuli, both for sound and video. Conclusions: We conclude that the EmojiGrid can be used as an affective self-report tool for the assessment of sound and video-evoked emotions.

Use your words: The role of emotion labeling in regulating emotion in borderline personality disorder

Borderline personality disorder (BPD) treatments emphasize emotion labeling to decrease negative emotion and facilitate emotion regulation. However, no studies have examined emotion labeling in BPD or its impact on intentional emotion regulation. The present study examined the impact of emotion labeling on emotion and intentional emotion regulation attempts across self-reported and physiological indices (i.e., skin conductance response [SCR], respiratory sinus arrhythmia [RSA]) in BPD and healthy control (HC) groups. Participants listened to emotionally-evocative scripts and were either instructed to type the emotions that they were experiencing (labeling) or the objects they could imagine seeing in the script (control) into a computer. Following this, they were instructed to use either mindfulness or cognitive reappraisal to decrease their emotion. Self-reported, RSA, and SCR indices of negative emotion were collected throughout and analyzed using generalized estimating equations. Findings indicated that the BPD group experienced higher RSA during emotion labeling compared to the control task, but the HC group did not. HCs reported lower negative emotion after emotion labeling when implementing both emotion regulation strategies compared to the control task, but the BPD group did not. These findings suggest that emotion labeling may activate emotion regulatory systems in BPD and can potentiate intentional emotion regulation in HCs.

Does repeatedly reporting positive or negative emotions in daily life have an impact on the level of emotional experiences and depressive symptoms over time?

The extent to which people are aware of their emotional experiences, label them and communicate them to the outside world are considered to impact emotional experience itself and potentially people’s depressive symptom levels. All of these aspects are important elements of one of the most common methods to study and measure emotions in the context of daily life, the so-called experience sampling method (ESM). A straightforward question that arises when using this method is whether participating in ESM may bring about changes in the momentary emotional self-reports of the people engaging in it, thereby effectively influencing that what it intends to measure; emotional experience over time, and whether this would relate to average levels of depressive symptoms. To examine these questions, we conducted a 7-day ESM study in which 90 participants were randomly assigned to repeatedly report either positive emotions only, negative emotions only or non-emotional internal states only, course using smartphones. Participants also completed pre-, post- and follow-up measurements of levels of depressive symptoms. Results showed no significant impact on self-reported momentary emotions, respective to their condition, over time nor on average levels of depressive symptoms across groups. These findings suggest that the repeated assessment of emotions in daily life, over the course of seven days, does not impact their emotional experience over time nor levels of depressive symptoms.

The minute-scale dynamics of online emotions reveal the effects of affect labeling

Putting one's feelings into words (also called affect labeling) can attenuate positive and negative emotions. Here, we track the evolution of specific emotions for 74,487 Twitter users by analysing the emotional content of their tweets before and after they explicitly report experiencing a positive or negative emotion. Our results describe the evolution of emotions and their expression at the temporal resolution of one minute. The expression of positive emotions is preceded by a short, steep increase in positive valence and followed by short decay to normal levels. Negative emotions, however, build up more slowly and are followed by a sharp reversal to previous levels, consistent with previous studies demonstrating the attenuating effects of affect labeling. We estimate that positive and negative emotions last approximately 1.25 and 1.5 h, respectively, from onset to evanescence. A separate analysis for male and female individuals suggests the potential for gender-specific differences in emotional dynamics.

Putting Feelings Into Words: Affect Labeling as Implicit Emotion Regulation

Putting feelings into words, or “affect labeling,” can attenuate our emotional experiences. However, unlike explicit emotion regulation techniques, affect labeling may not even feel like a regulatory process as it occurs. Nevertheless, research investigating affect labeling has found it produces a pattern of effects like those seen during explicit emotion regulation, suggesting affect labeling is a form of implicit emotion regulation. In this review, we will outline research on affect labeling, comparing it to reappraisal, a form of explicit emotion regulation, along four major domains of effects—experiential, autonomic, neural, and behavioral—that establish it as a form of implicit emotion regulation. This review will then speculate on possible mechanisms driving affect labeling effects and other remaining unanswered questions.

Second Language Use Facilitates Implicit Emotion Regulation via Content Labeling

Previous studies reported that negative stimuli induced less affect in bilinguals when stimuli were presented in bilinguals’ second, weaker language (L2) than when they were presented in their native language (L1). This effect of L2 use was attributed to increased emotional distance as well as to increased levels of cognitive control during L2 use. Here we investigated how explicit (cognitive reappraisal, i.e., reinterpreting the meaning of the emotional stimulus to alter its emotional impact) and implicit (content labeling, i.e., categorizing the content of the image; and emotion labeling, i.e., naming the emotion induced by the emotional stimulus) emotion regulation strategies are altered in an L2 (English) context in German native speakers with medium to high proficiency in their L2. While previous studies used linguistic stimuli, such as words, to induce affect, here we used images to test whether reduced affect could also be observed for non-linguistic stimuli when presented in an L2 context. We hypothesized that the previously implicated increase in emotional distance and cognitive control in an L2 would result in an L2 advantage in emotion regulation (i.e., leading to less negative emotions compared to an L1 context), by strengthening the effect of linguistic re-evaluation on the evoked emotions. Using a classic emotion regulation paradigm, we examined changes in subjective emotional state ratings during reappraisal, emotion labeling and content labeling in a L1 and L2 context. We found that the strength of evoked affective responses did not depend on the language context in which an image was presented. Crucially, content labeling in L2 was more effective than in L1, whereas emotion labeling did not differ between languages. Overall, evoked responses were regulated most effectively through explicit emotion regulation (reappraisal) in L1 and L2 context. These results demonstrate an L2 advantage effect for emotion regulation through content labeling and suggest that L2 context alters sub-processes implicated in content labeling but not emotion labeling.

Accuracy and bias in retrospective symptom reporting

PURPOSE OF REVIEW

Self-reported bodily symptoms are of primary importance in healthcare and in health-related research. Typically, they are assessed in clinical interviews or by means of traditional questionnaire formats that require the respondent to provide retrospective symptom estimates rated along intuitive frequency and/or intensity standards and aggregated across varying or unspecified time windows.

RECENT FINDINGS

Retrospective symptom assessments are often biased when compared to (averaged) momentary assessments of symptoms. A variety of factors and conditions have been identified to influence the amount of bias in symptom reporting. Recent research has focused on the underlying mechanisms for the discrepancy between memory and experience. It is suggested that different types of questions and formats assess different types of information, and each may be relevant for different purposes. Knowledge of these underlying mechanisms also provides a relevant framework to better understand individual differences in symptom reporting, including somatoform and somatic symptom disorder.

SUMMARY

Accuracy of self-reported bodily symptoms is important for the clinician and the researcher. Understanding the mechanisms underlying bias may provide an interesting window to understand how symptom episodes are processed, encoded, and consolidated in memory and may also provide clues to modify symptom experiences.

Healing Words: Using Affect Labeling to Reduce the Effects of Unpleasant Cues on Symptom Reporting in IBS Patients

PURPOSE

The present study aimed to induce elevated symptom reports through the presentation of unpleasant cues in patients with irritable bowel syndrome (IBS) and examine whether applying an emotion regulation technique (affect labeling) can reduce symptom reporting in patients.

METHODS

Patients diagnosed with IBS (N = 29) and healthy controls (N = 26) were presented with six picture series (three pleasant, three unpleasant) under three within-subject conditions: merely viewing, emotional labeling, or content (non-emotional) labeling. Each picture viewing trial was followed by affect ratings and a symptom checklist, consisting of general arousal and IBS-specific symptoms.

RESULTS

Viewing unpleasant pictures led to overall increased symptom reports, both for arousal and gastrointestinal symptoms, in both groups. Labeling the pictures did not reduce these effects significantly, although a trend toward less arousal symptoms after unpleasant cues emerged in the patient group only, especially during emotional labeling.

CONCLUSIONS

Current findings indicate that the mere presentation of unpleasant cues can induce elevated symptom reports in IBS patients. The results of the labeling manipulation provide modest support for the effectiveness of emotion regulation strategies in reversing these effects of unpleasant cues in patients suffering from functional syndromes. Methodological issues that may have confounded present results are discussed.

Interoception and the uneasiness of the mind: affect as perceptual style

Autonomous system models of interoception describe perception of bodily sensations as an active process in which the brain generates and tests hypotheses about the body on the basis of proximal information. This view of perception as inference allows a new perspective on the role of affect in perception. Affect and interoception are closely linked, but processes underlying this link are poorly understood. We suggest that a predictive coding perspective allows acknowledging affect as integral part of information processing. We outline how affect may intrinsically modify processes of interoception by acting as threshold mechanism in stimulus grouping and information compression. We outline how well-established methods, for example, from categorization research may allow quantifying this influence of affect on perception in empirical tests of predictive coding models. We discuss how this may enrich the study of the relationship between affect and interoception and may have important clinical relevance.