Psychophysiological Effects of Downregulating Negative Emotions: Insights From a Meta-Analysis of Healthy Adults.

Assessing psychophysiological responses of emotion regulation is a cost-efficient way to quantify emotion regulation and to complement subjective report that may be biased. Previous studies have revealed inconsistent results complicating a sound interpretation of these findings. In the present study, we summarized the existing literature through a systematic search of articles. Meta-analyses were used to evaluate effect sizes of instructed downregulation strategies on common autonomic (electrodermal, respiratory, cardiovascular, and pupillometric) and electromyographic (corrugator activity, emotion-modulated startle) measures. Moderator analyses were conducted, with moderators including study design, emotion induction, control instruction and trial duration. We identified k = 78 studies each contributing multiple sub-samples and performed 23 meta-analyses for combinations of emotion regulation strategy and psychophysiological measure. Overall, results showed that effects of reappraisal and suppression on autonomic measures were highly inconsistent across studies with rather small mean effect sizes. Electromyography (startle and corrugator activity) showed medium effect sizes that were consistent across studies. Our findings highlight the diversity as well as the low level of standardization and comparability of research in this area. Significant moderation of effects by study design, trial duration, and control condition emphasizes the need for better standardization of methods. In addition, the small mean effect sizes resulting from our analyses on autonomic measures should be interpreted with caution. Findings corroborate the importance of multi-channel approaches.

Improved emotion regulation after neurofeedback: A single-arm trial in patients with borderline personality disorder.

Real-time functional magnetic resonance imaging (fMRI) neurofeedback training of amygdala hemodynamic activity directly targets a neurobiological mechanism, which contributes to emotion regulation problems in borderline personality disorder (BPD). However, it remains unknown which outcome measures can assess changes in emotion regulation and affective instability, associated with amygdala downregulation in a clinical trial. The current study directly addresses this question. Twenty-four female patients with a DSM-IV BPD diagnosis underwent four runs of amygdala neurofeedback. Before and after the training, as well as at a six-weeks follow-up assessment, participants completed measures of emotion dysregulation and affective instability at diverse levels of analysis (verbal report, clinical interview, ecological momentary assessment, emotion-modulated startle, heart rate variability, and fMRI). Participants were able to downregulate their amygdala blood oxygen-dependent (BOLD) response with neurofeedback. There was a decrease of BPD symptoms as assessed with the Zanarini rating scale for BPD (ZAN-BPD) and a decrease in emotion-modulated startle to negative pictures after training. Further explorative analyses suggest that patients indicated less affective instability, as seen by lower hour-to-hour variability in negative affect and inner tension in daily life. If replicated by an independent study, our results imply changes in emotion regulation and affective instability for several systems levels, including behavior and verbal report. Conclusions are limited due to the lack of a control group. A randomized controlled trial (RCT) will be needed to confirm effectiveness of the training.

The orbitofrontal cortex processes neurofeedback failure signals.

Receiving feedback from neural activity, dubbed neurofeedback, can reinforce brain self-regulation. In a real-time functional magnetic resonance imaging (fMRI) experiment, healthy participants received amygdala neurofeedback via a visual brain-computer interface. The brain response to signals of reward and failure was modeled. In contrast to previous analyses, we take into account feedback that immediately preceded these signals. That means we tested whether responses were modulated while participants observed sequent reward and failure signals. The orbitofrontal cortex (OFC) showed a negative Blood Oxygenation Level Dependent (BOLD) response to failure signals, when they were preceded by more failure signals. When failure signals were preceded by reward, in contrast, the response was less pronounced. The results suggest weighted processing of neurofeedback value in the OFC. Learning to self-regulate the brain with neurofeedback may involve similar neural networks as the learning of goal-directed action.

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

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

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

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

Alterations of amygdala-prefrontal connectivity with real-time fMRI neurofeedback in BPD patients.

With the use of real-time functional magnetic resonance imaging neurofeedback (NF), amygdala activitiy can be visualized in real time. In this study, continuous amygdala NF was provided to patients with borderline personality disorder (BPD) with the instruction to down-regulate. During four sessions of NF training, patients viewed aversive pictures and received feedback from a thermometer display, which showed the amygdala blood oxygenation level-dependent signal. Conditions of regulation and viewing without regulation were presented. Each session started with a resting-state scan and was followed by a transfer run without NF. Amygdala regulation, task-related and resting-state functional brain connectivity were analyzed. Self-ratings of dissociation and difficulty in emotion regulation were collected. BPD patients down-regulated right amygdala activation but there were no improvements over time. Task-related amygdala-ventromedial prefrontal cortex connectivity was altered across the four sessions, with an increased connectivity when regulating vs viewing pictures. Resting-state amygdala-lateral prefrontal cortex connectivity was altered and dissociation, as well as scores for 'lack of emotional awareness', decreased with training. Results demonstrated that amygdala NF may improve healthy brain connectivity, as well as emotion regulation. A randomized-controlled trial is needed to investigate whether amygdala NF is instrumental for improving neural regulation and emotion regulation in BPD patients.