121Emotional Regulation and Cognition

7/31/2019 121Emotional Regulation and Cognition

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The European Network for Traumatic StressTraining & Practice

www.tentsproject.eu


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Emotional regulation and cognition

Barbara JuenUniversity of InnsbruckAustrian Red Cross

IFRC Reference Centre for PS support


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Learning outcomes

1. To give participants some basic knowledge on emotionalregulation and the role of cognition

2. To enable participants to understand the link between affect and(dysfunctional) cognitions in trauma

3. To give participants an insight into the importance of preventingtrauma survivors from becoming overwhelmed whilst at the sametime enabling a feeling of control and opportunities forreinterpretation


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What is an emotion?

Emotion is defined as

a reaction to an emotion-specific elicitor which has agiven form (Ekman, 1984, Izard and Malatesta, 1987,Bnninger-Huber, 1996)

a psychological function (motivation and actionreadiness) in human action regulation (Campos et al,1989, Frijda, 1986, Scherer, 1993)


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Emotion as a self-regulating system

Recent theories define emotion as a functional

system which consists of different subsystemsworking together in a synchronised manner(Scherer, 2000)


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Sub-Systems of emotions(Scherer, 2000)

Appraisal System Motoric System

Body Regulation System

Feeling System


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What is emotion regulation? Emotion regulation means the intentional or non-

intentional influencing of emotions

In order to regulate emotions, different levels ofregulation as well as different forms of regulationstrategies may be used


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Levels of emotion regulation(Leventhal & Scherer, 1987)

Sensomotoric level (reflex)

Schematic level (appraisal)

Concept level (knowledge)


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Classification of regulation strategies

(Bridges & Grolnik, 1995)

Attention regulation (e.g. to divert oneself)

Self soothing strategies (e.g. to suck one'sthumb)

Interactive regulation (e.g. to seek comfort)

Symbolic resp. verbal strategies (e.g. to

reinterpret)


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Organic basis of the systems

(Damasio, 1994, Scherer, 2001) Appraisal System: cortex and subcortex

Motoric System: motoric cortex and somaticneurosystem

Body Regulation System: autonomous neuralsystem and subcortical structures responsible

for endocrinological functions Feeling System: cortex and subcortex


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Interaction of the sub-systems(Holodynski, 2006, Damasio, 1994)

Expression and body reactions elicit feelings

Body and expression sensations are necessaryindicators for feeling

The emotion eliciting cause is marked andcoloured by the body and expression sensation(somatic markers, Damasio, 1994)


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What if the relation between body sensation

and perceived cause is disturbed? Sometimes, the body and expression sensation

are present without a consciously perceived

cause (fear without perceiving an elicitor orwithout perceiving an appropriate elicitor)

Or the emotion eliciting cause is present without

the expected body and expression sensations (aloved one dies and we feel nothing)


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The disintegration of psychologicalprocesses in the case of trauma

In the case of trauma cognition, emotion,memory, action and perception may dissociate

For example a threat may be perceived withoutexperiencing an emotion (numbing) or withoutbeing able to react (freezing, stupor)


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Characteristics of trauma memory Mostly sensory impressions Experienced as if they where happening here and now Re-experience stays the same even if new information is

given Affect without recollection Some triggers without semantic relationship to trauma,

only temporarily associated


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The role of concept based emotionregulation in the course of trauma recovery

A trauma threatens a persons belief system (Janoff-Bulman, 1992) and thus initiates a process of meaningmaking.Tedeschi and Calhoun talk of a seismic event whichinitiates a process of rumination (Tedeschi & Calhoun,2004)

Some of the cognitions in the course of searching fornew meanings may be functional, some may bedysfunctional with regard to recovery


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Integration and processing

According to Horowitz (1997) persons remain in a stateof permanent arousal as long as the traumatic

experience is not fully processed

Memories of the event are at the same time warded offand relived obsessively until the processing comes to an

end, this oszillating process is seen as necessary fortrauma recovery


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Contextualisation

Trauma memory has to be contextualised (seefor example: Ehlers and Clark, 2003) whichmeans putting it into a chronological order,distinguishing between now and then andavoiding overgeneralization by going back to theevent and comparing subjective and objectivesituation aspects (Fischer and Riedesser, 1989)


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Appraisal and negative overgeneralization

Ehlers and Clark assume that, unlike individuals whorecover naturally, individuals with persistent PTSD areunable to see the trauma as a time-limited event thatdoes not have global negative implications for theirfuture.


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Appraisal and negative overgeneralization

Clients may overgeneralise

The event itself

Their reactions during the event

Their reactions after the event

Other persons reactions


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Overgeneralising one's own reactions

Appraisals of the way one felt or behaved during theevent also can have long-term threatening implications

Also the negative appraisal of the sequelae of thetraumatic event can produce a sense of threat.


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Negative appraisal of others reactions

Other people, including family and close friends, are

often uncertain about how they should respond to atrauma victim and may avoid talking about the event inorder not to distress the victim.


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Negative appraisals produce negativeemotions

These appraisals maintain PTSD by producing negative

emotions (such as anxiety, depression or anger) andbyencouraging individuals to engage in dysfunctionalcoping strategies that have the paradoxical effect ofenhancing PTSD symptoms (Ehlers and Clark, 2000).


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The link between positive emotions andrecovery

Experiencing positive emotions on the other hand seemsto have a positive effect on recovery after trauma. Thesepositive emotions may be pride, but also a feeling ofsolidarity and group cohesion as well as other positiveemotions (e.g. Yehuda, 2006, Vasques, Hervas, &Sales, 2006)


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How to use positive emotions ininterventions

Initiatives with the aim of channeling the diverse types of aid to the affectedpeople may promote growth, both of the individuals and of society as awhole.

Creating spacesin which to communicate emotions can have a beneficialeffect on positive adaptation to the effects of the trauma.

Assess and provide feedback about the learnings experiencedat theindividual and collective level to promote a more complete perspective ofthe situation.

Shared rituals and Symbolic elements(i.e., flags, monuments,demonstrations,) seem to be very important to the way in which thesekinds of events are processed.


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Early Interventions and their effects Single session debriefing has been one of the main

intervention strategies for a long time. It has been proved

to be not beneficial and sometimes may even causenegative effects (see for example Rose et al, 2007,Ehlers & Clark, 2003)

Repeated sessions of individual CBT or EMDR given to

persons at risk have been proved to be more successful(Ehlers & Clark, 2003)


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Oscillating between withdrawal andexposure

According to Horowitz (1997), after traumatic events orbereavement, people show a pattern of intermittent processing and

are continuously oscillating between phases ofwithdrawal/numbness/ avoidance and intrusion/processing of theevent.

Ehlers and Clark assume that this intermittent processing in smalldoses facilitates natural recovery and that very early exposure

instructions pushing people to talk and think about the trauma in itsaftermath may not be beneficial (Ehlers & Clark, 2003, p. 822)


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Discrimination between past and present

According to Ehlers and Clark (2003) a central elementof treatment is that the patient learns to discriminatebetter between the then (the trauma and the stimuli thataccompanied it) and the now (the present situation andthe triggers of memories that have similarities anddifferences to those present at the time of the event).

In imaginal reliving a time code is put into the memory,so that it can be experienced as a memory rather than

as something that is happening (again) in the present


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Going through the event in a chronologicalorder

Some patients may need active help in overcoming avoidance andmay not do self-exposure intensively and systematically enough.

In CBT patients go through the event in chronological order. On theirown, patients may instead go over isolated moments of the event.

In CBT the patient shall make progress in linking these moments inmemory with the final outcome of the situation or other momentsduring the event that disconfirmed the patients expectations at the

time (I though he would kill me linked to He let me go in the end;I thought I was paralyzed linked to I could walk) (Ehlers andClark, 2003)


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Reappraisal of problematic meanings

In the course of working through the experience it maybecome important to reappraise problematic meanings

(such as feeling responsible for an accident although itwas not their fault, thinking that they actually died duringthe event, thinking that the scars from an assault makethem look disfigured, or thinking that no one cared aboutthem when they waited for treatment in the hospital)(Ehlers and Clark, 2003)


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Comparing the objective and subjectivesituation

Fischer (1996) differentiates between objective andsubjective situation analysis

Objective situation analysis: what has happened in the givensituation, what possibilities for action have been present in thegiven situation?

Subjective situation analysis: what subjective meaning is givento the situation? Which of the given action possibilities havebeen actually perceived and realised by the person?


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Early rumination

At the beginning traumatized persons often ruminate about theevent, thinking about questions such as why the event happened tothem, how their life has been ruined by the event, how the eventcould have been prevented, or how they can punish the person who

caused the event

Several prospective longitudinal studies have found that suchrumination about a traumatic event is among the best predictors ofchronic PTSD (Ehlers et al 1998; Murray et al 2002).

Self-exposure instructions during this stage may run the risk ofincreasing rather than decreasing one of the maintainingmechanisms in persistent PTSD.


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The experience of positive change after

trauma

The appraisal of the traumatic events and itsconsequences as something not entirely negative, whichalso includes the subjective experience of positivechange in the domains of self, relationships and valuesis an important effect of trauma (Tedeschi & Callhoun,2004)


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The experience of effective emotional regulationas a prerequisite for recovery

Znoij (2006) found that persons who lost a child showed

an improvement in the regulation of stressful emotionscompared to controls

He assumed that due to the massive negative emotions

experienced by this group the cortical control for emotionregulation might be stimulated and the ability for emotionregulation be improved


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Resumee

Cognitions and the emotions that result from negative appraisal play a veryimportant role in enhancing symptoms after trauma

Experiencing emotions as overwhelming, without chronological order, andbeyond control of reflexive processing may lead to an increase in

dysfunctional coping strategies after trauma

Especially in the early stages after trauma it may be of crucial importanceto assist persons in protecting themselves from too much trauma exposureand arousal

The experience of effective emotion regulation and the appraisal that thetraumatic event does not only have negative outcomes are very importantfactors in recovery


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Resumee

Talking about the event

Be careful not to produce loss of control over

emotions Be careful about keeping the chronological order ofthe events

Help to reinterpret negative appraisals

Be careful about distinguishing past and present


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References (emotion)

Ekman, P. (1984) Expression and the Nature of Emotion, in: Scherer, K R, Ekman, P:(eds) Approaches to emotion . Erlbaum: Hillsdale, NJ, pp. 319-343

Izard, C E, Malatesta, C Z (1987) Perspectives on emotional developmentI:differential emotions theory of early emotional development. In: Osofsky, J D (ed)Handbook of Infant Development . Wiley, New York, pp 494-554

Bnninger-Huber, E, & Widmer, Ch (1996) A New Model of the Elicitation,Phenomenology, and Function of Emotions in Psychotherapy. Proceedings of the

IXth Conference of the International Society for Research on Emotions, (pp. 251-254), Toronto, August 13-17, 1996 Bridges, L J, Grolnik, W S (1995) The development of emotional self regulation in

infancy and early childhood. In: Eisenberg N (ed) Social development, Sage;Thousand Oaks, CA, pp 185-211

Campos, JJ, Campos, R G, , Barrett K C (1989) Emergent themes in the study ofemotional development and emotion regulation. Developmental Psychology, 25, pp.394-402

Damasio, A R (1994) Descartes error. Emotion, reason and the human brain. Avon,New York Fonagy, P., Gergely, G., Jurist, E. & Target, M. (2002). Affect regulation,

mentalization, and the development of the self. New York: Other Press


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References (emotion)

Frijda, N H (1986) The emotions. Cambridge University Press., New York Holodynski, M (2006) Emotionen, Entwicklung und Regulation, Springer, Heidelberg Leventhal, H, Scheer, KR (1987) the relationship of emotion to cognition : a functional

approach to a semantic controversy. Cognition and Emotion, 1, pp 3-28 Scherer, K R (1993) Studying the emotion antedecent appraisal process: an expert

system approach. Cognition and Emotion 7: pp 325-355 Scherer, K R (2000) Emotions as episodes of subsystem synchronisation driven by

nonlinear appraisal processes. In: Lewis, M, Granik,c, I (eds) Emotion, developmentand self organisation . Cambridge University Press, New York Scherer, K R (2001) Appraisal considered as a process of multilevel sequential

checking. In: Scherer, K R, Schorr A, Johnstone, T (eds) Appraisal process inemotion. Theory, methods, research. Oxford University Press, Cambridge

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121Emotional Regulation and Cognition

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