The role of emotion and emotion regulation in social anxiety disorder

Current Psychiatry Reports

Volumn 17, Issue 1, 2015, Pages

  Jazaieri, Hooria ^a   Morrison, Amanda S ^b   Goldin, Philippe R ^c   Gross, James J ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b STANFORD UNIVERSITY   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Emotion; Emotion dysregulation; Emotion regulation; Process model; Social anxiety disorder (SAD)

Indexed keywords

ARTICLE; COGNITION; CONCEPTUAL FRAMEWORK; DISTRESS SYNDROME; EMOTION; EMOTIONALITY; HUMAN; MOOD; NEUROMODULATION; OBSERVATION; PROCESS MODEL; PSYCHOSOCIAL CARE; PSYCHOTHERAPY; SELF REPORT; SOCIAL PHOBIA; STRESS; ANXIETY DISORDERS; COGNITIVE THERAPY; CONTROL; MINDFULNESS; PROCEDURES; PSYCHOLOGY; SOCIAL BEHAVIOR;

ANXIETY DISORDERS; COGNITIVE THERAPY; EMOTIONS; HUMANS; INTERNAL-EXTERNAL CONTROL; MINDFULNESS; SOCIAL BEHAVIOR;

EID: 84912142900     PISSN: 15233812     EISSN: 15351645     Source Type: Journal    
DOI: 10.1007/s11920-014-0531-3     Document Type: Article

References (94)

1. Wittchen H-U, Fuetsch M, Sonntag H, Müller N, Liebowitz M. Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. Eur Psychiatry. 2000;15(1):46–58. doi:10.1016/S0924-9338(00)00211-X.
2. Alonso J, Angermeyer M, Bernert S, Bruffaerts R, Brugha T, Bryson H, et al. Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand. 2004;109(s420):38–46. doi:10.1111/j.1600-0047.2004.00329.x.
3. Kessler RC, Berglund PD, Demler O, Olga JR, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. doi:10.1001/archpsyc.62.6.593.
4. Cairney J, McCabe L, Veldhuizen S, Corna LM, Streiner D, Herrmann N. Epidemiology of social phobia in later life. Am J Geriatr Psychiatr. 2007;15(3):224–33. doi:10.1097/01.jgp.0000235702.77245.46.
5. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):629–40. doi:10.1001/archpsyc.62.6.629.
6. Grant BF, Hasin DS, Blanco C, Stinson FS, Chou SP, Goldstein RB, et al. The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66(11):1351–61. doi:10.4088/JCP.v66n1102.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
8. Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, editors. Social phobia: diagnosis, assessment, and treatment. New York: Guilford Press; 1995. p. 69–93.
9. Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther. 2007;36(4):195–209. doi:10.1037/a0018555.
10. Gross JJ. Emotion regulation: conceptual and empirical foundations. In: Gross JJ, editor. Handbook of emotion regulation. 2nd ed. New York: Guildford Press; 2014. This is a current and in depth overview of the field of emotion regulation covering both the conceptual and empirical foundations of the field.
11. Gross JJ, Thompson RA. Emotion regulation: conceptual foundations. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; 2007. p. 3–24.
12. Jazaieri H, Urry HL, Gross JJ. Affective disturbance and psychopathology: an emotion regulation perspective. J Exp Psychopathol. 2013;4(5):584–99. doi:10.5127/jep.030312.
13. Gross JJ. The emerging field of emotion regulation: an integrative review. Rev Gen Psychol. 1998;2(3):271–99. doi:10.1037//1089-2680.2.3.271.
14. Cole PM, Michel MK, Teti LO. The development of emotion regulation and dysregulation: a clinical perspective. Monogr Soc Res Child Dev. 1994;59(2/3):73–100. doi:10.2307/1166139.
15. Gross JJ. Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. J Pers Soc Psychol. 1998;74(1):224–37. doi:10.1037//0022-3514.74.1.224.
16. Aldao A, Nolen-Hoeksema S. When are adaptive strategies most predictive of psychopathology? J Abnorm Psychol. 2012;121(1):276–81. doi:10.1037/a0023598.
17. Webb TL, Miles E, Sheeran P. Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychol Bull. 2012;138(4):775–808. doi:10.1037/a0027600. This meta-analysis reviews the effectiveness of various emotion regulatory strategies across all domains of measurement - experiential, behavioral, and physiological. The authors also identify key moderators that contribute to emotion regulation strategy effectiveness.
18. Bonanno GA, Papa A, Lalande K, Westphal M, Coifman K. The importance of being flexible: the ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychol Sci. 2004;15(7):482–7. doi:10.1111/j.0956-7976.2004.00705.x.
19. Aldao A. The future of emotion regulation research: capturing context. Perspect Psychol Sci. 2013;8(2):155–72. doi:10.1177/1745691612459518. This review addresses the important issue of why context and flexibility matter when considering emotion regulation and provides suggestions for future research.
20. Rusch S, Westermann S, Lincoln TM. Specificity of emotion regulation deficits in social anxiety: an internet study. Psychol Psychother Theory Res Pract. 2012;85(3):268–77. doi:10.1111/j.2044-8341.2011.02029.x.
21. Brühl AB, Herwig U, Delsignore A, Jäncke L, Rufer M. General emotion processing in social anxiety disorder: neural issues of cognitive control. Psychiatry Res Neuroimaging. 2013;212(2):108–15. doi:10.1016/j.pscychresns.2012.05.006.
22. Anderson B, Goldin PR, Kurita K, Gross JJ. Self-representation in social anxiety disorder: linguistic analysis of autobiographical narratives. Behav Res Ther. 2008;46(10):1119–25. doi:10.1016/j.brat.2008.07.001.
23. Werner K, Goldin PR, Ball TM, Heimberg RG, Gross JJ. Assessing emotion regulation in social anxiety disorder: the emotion regulation interview. J Psychopathol Behav Assess. 2011;33(3):346–54. doi:10.1007/s10862-011-9225-x.
24. Kashdan TB, Steger MF. Expanding the topography of social anxiety: an experience-sampling assessment of positive emotions, positive events, and emotion suppression. Psychol Sci. 2006;17(2):120–8. doi:10.1111/j.1467-9280.2006.01674.x.
25. Hirsch CR, Meynen T, Clark DM. Negative self-imagery in social anxiety contaminates social interactions. Mem Spec Issue Mem Ment Imag Mem Psychopathol. 2004;12(4):496–506.
26. Moscovitch DA, Rowa K, Paulitzki JR, Ierullo MD, Chiang B, Antony MM, et al. Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder. Behav Res Ther. 2013;51(8):476–86. doi:10.1016/j.brat.2013.05.002.
27. Wells A, Clark DM, Salkovskis P, Ludgate J, Hackmann A, Gelder MG. Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behav Ther. 1995;26(1):153–61. doi:10.1016/S0005-7894(05)80088-7.
28. Alden LE, Bieling P. Interpersonal consequences of the pursuit of safety. Behav Res Ther. 1998;36(1):53–64. doi:10.1016/S0005-7967(97)00072-7.
29. Taylor CT, Alden LE. To see ourselves as others see us: an experimental integration of the intra and interpersonal consequences of self-protection in social anxiety disorder. J Abnorm Psychol. 2011;120(1):129–41. doi:10.1037/a0022127.
30. Morgan H, Raffle C. Does reducing safety behaviours improve treatment response in patients with social phobia? Aust N Z J Psychiatr. 1999;33(4):503–10.
31. Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg MJ, Van Ijzendoorn MH. Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull. 2007;133(1):1–24. doi:10.1037/0033-2909.133.1.1.
32. Morrison AS, Heimberg RG. Social anxiety and social anxiety disorder. Annu Rev Clin Psychol. 2013;9:249–74. doi:10.1146/annurev-clinpsy-050212-185631.
33. Button K, Lewis G, Penton-Voak I, Munafò M. Social anxiety is associated with general but not specific biases in emotion recognition. Psychiatry Res. 2013;210(1):199–207. doi:10.1016/j.psychres.2013.06.005.
34. Blair KS, Blair R. A cognitive neuroscience approach to generalized anxiety disorder and social phobia. Emot Rev. 2012;4(2):133–8. doi:10.1177/1754073911430251.
35. White LK, Helfinstein SM, Reeb-Sutherland BC, Degnan KA, Fox NA. Role of attention in the regulation of fear and anxiety. Dev Neurosci. 2009;31(4):309–17. doi:10.1159/000216542.
36. Amir N, Weber G, Beard C, Bomyea J, Taylor CT. The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals. J Abnorm Psychol. 2008;117(4):860–8. doi:10.1037/a0013445.
37. Heeren A, Reese HE, McNally RJ, Philippot P. Attention training toward and away from threat in social phobia: effects on subjective, behavioral, and physiological measures of anxiety. Behav Res Ther. 2012;50(1):30–9. doi:10.1016/j.brat.2011.10.005.
38. Heeren A, Lievens L, Philippot P. How does attention training work in social phobia: disengagement from threat or re-engagement to non-threat? J Anxiety Disord. 2011;25(8):1108–15. doi:10.1016/j.janxdis.2011.08.001.
39. Li S, Tan J, Qian M, Liu X. Continual training of attentional bias in social anxiety. Behav Res Ther. 2008;46(8):905–12. doi:10.1016/j.brat.2008.04.005.
40. Amir N, Beard C, Taylor CT, Klumpp H, Elias J, Burns M, et al. Attention training in individuals with generalized social phobia: a randomized controlled trial. J Consult Clin Psychol. 2009;77(5):961–73. doi:10.1037/a0016685.
41. Schmidt NB, Richey JA, Buckner JD, Timpano KR. Attention training for generalized social anxiety disorder. J Abnorm Psychol. 2009;118(1):5–14. doi:10.1037/a0013643.
42. Niles AN, Mesri B, Burklund LJ, Lieberman MD, Craske MG. Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia. Behav Res Ther. 2013;51(10):669–79. doi:10.1016/j.brat.2013.06.005.
43. Heimberg RG. Cognitive-behavioral therapy for social anxiety disorder: current status and future directions. Biol Psychiatry. 2002;51(1):101–8. doi:10.1016/S0006-3223(01)01183-0.
44. Campbell-Sills L, Barlow DH. Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; 2007. p. 542–59.
45. Goldin PR, Manber T, Hakimi S, Canli T, Gross JJ. Neural bases of social anxiety disorder: emotional reactivity and cognitive regulation during social and physical threat. Arch Gen Psychiatry. 2009;66(2):170–80. doi:10.1001/archgenpsychiatry.2008.525.
46. Goldin PR, Manber-Ball T, Werner K, Heimberg R, Gross JJ. Neural mechanisms of cognitive reappraisal of negative self-beliefs in social anxiety disorder. Biol Psychiatry. 2009;66(12):1091–9. doi:10.1016/j.biopsych.2009.07.014.
47. Goldin PR, Ziv M, Jazaieri H, Hahn K, Heimberg R, Gross JJ. Impact of cognitive-behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs. JAMA Psychiatry. 2013;70(10):1048–56. doi:10.1001/jamapsychiatry.2013.234.
48. Gaebler M, Daniels JK, Lamke J-P, Fydrich T, Walter H. Behavioural and neural correlates of self-focused emotion regulation in social anxiety disorder. J Psychiatry Neurosci. 2014;39(4):249–58. doi:10.1503/jpn.130080.
49. Voncken MJ, Dijk C, de Jong PJ, Roelofs J. Not self-focused attention but negative beliefs affect poor social performance in social anxiety: an investigation of pathways in the social anxiety–social rejection relationship. Behav Res Ther. 2010;48(10):984–91. doi:10.1016/j.brat.2010.06.004.
50. Farmer AS, Kashdan TB. Social anxiety and emotion regulation in daily life: spillover effects on positive and negative social events. Cogn Behav Ther. 2012;41(2):152–62. doi:10.1080/16506073.2012.666561. This study utilized a 2-week daily diary to examine emotions, social events, and emotion regulation in adults with SAD. Highlights the consequences of maladaptive use of emotion regulatory strategies in SAD.
51. Moscovitch DA, Gavric DL, Senn JM, Santesso DL, Miskovic V, Schmidt LA, et al. Changes in judgment biases and use of emotion regulation strategies during cognitive-behavioral therapy for social anxiety disorder: distinguishing treatment responders from nonresponders. Cogn Ther Res. 2012;36(4):261–71. doi:10.1007/s10608-011-9371-1. This study underscores the clinical importance of examining the habitual use of adaptive and maladaptive emotion regulations strategies in SAD and highlights the consequences for treatment.
52. Kashdan TB, Farmer AS, Adams LM, Ferssizidis P, McKnight PE, Nezlek JB. Distinguishing healthy adults from people with social anxiety disorder: evidence for the value of experiential avoidance and positive emotions in everyday social interactions. J Abnorm Psychol. 2013;122(3):645. doi:10.1037/a0032733.
53. Erwin BA, Heimberg RG, Schneier FR, Liebowitz MR. Anger experience and expression in social anxiety disorder: pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behav Ther. 2003;34(3):331–50. doi:10.1016/S0005-7894(03)80004-7.
54. Turk CL, Heimberg RG, Luterek JA, Mennin DS, Fresco DM. Emotion dysregulation in generalized anxiety disorder: a comparison with social anxiety disorder. Cogn Ther Res. 2005;29(1):89–106. doi:10.1007/s10608-005-1651-1.
55. Craske MG, Niles AN, Burklund LJ, Wolitzky-Taylor KB, Vilardaga JCP, Arch JJ, et al. Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. J Consult Clin Psychol. 2014. doi:10.1037/a0037212.
56. Wolitzky-Taylor KB, Arch JJ, Rosenfield D, Craske MG. Moderators and non-specific predictors of treatment outcome for anxiety disorders: a comparison of cognitive behavioral therapy to acceptance and commitment therapy. J Consult Clin Psychol. 2013;80(5):786–99. doi:10.1037/a0029418.
57. Greenberg LS, Safran JD. Emotion in psychotherapy: affect, cognition, and the process of change. New York: Guilford; 1987.
58. Samoilov A, Goldfried MR. Role of emotion in cognitive-behavior therapy. Clin Psychol Sci Pract. 2000;7(4):373–85. doi:10.1093/clipsy.7.4.373.
59. Linehan MM. DBT skills training manual. 2nd ed. New York: Guilford Press; 2014.
60. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford; 1993.
61. Greenberg LS. Emotion-focused therapy: coaching clients to work through their feelings. Washington, DC: American Psychological Association; 2002.
62. Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205–30. doi:10.1016/s0005-7894(04)80036-4.
63. Mennin DS. Emotion regulation therapy for generalized anxiety disorder. Clin Psychol Psychother. 2004;11(1):17–29. doi:10.1002/cpp.389.
64. Berking M. Training emotionaler kompetenzen. [Affect regulation training]. Heidelberg: Springer; 2007.
65. Berking M, Wupperman P, Reichardt A, Pejic T, Dippel A, Znjo H. Emotion-regulation skills as a treatment target in psychotherapy. Behav Res Ther. 2008;46(11):1230–7. doi:10.1016/j.brat.2008.08.005.
66. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
67. Beck AT, Emery G, Greenberg RL. Anxiety disorders and phobias: a cognitive perspective. New York: Basic Books; 1985.
68. Tobon JI, Ouimet AJ, Dozois DJ. Attentional bias in anxiety disorders following cognitive behavioral treatment. J Cogn Psychother. 2011;25(2):114–29. doi:10.1891/0889-8391.25.2.114.
69. Boden MT, John OP, Goldin PR, Werner K, Heimberg RG, Gross JJ. The role of maladaptive beliefs in cognitive-behavioral therapy: evidence from social anxiety disorder. Behav Res Ther. 2012;50(5):287–91. doi:10.1016/j.brat.2012.02.007.
70. Goldin PR, Ziv M, Jazaieri H, Werner K, Kraemer H, Heimberg RG, et al. Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder. J Consult Clin Psychol. 2012;80(6):1034–40. doi:10.1037/a0028555. Although prior studies have highlighted the importance of cognitive reappraisal, this study’s results suggest that cognitive reappraisal self-efficacy may in fact mediate the effects of CBT for SAD on social anxiety symptom severity.
71. Goldin PR, Jazaieri H, Ziv M, Kraemer H, Heimberg R, Gross JJ. Changes in positive self-views mediate the effects of cognitive-behavioral therapy for social anxiety disorder. Clin Psychol Sci. 2013;1(3):301–10. doi:10.1177/2167702613476867.
72. Goldin PR, Lee I, Ziv M, Jazaieri H, Heimberg RG, Gross JJ. Trajectories of change in emotion regulation and social anxiety during cognitive-behavioral therapy for social anxiety disorder. Behav Res Ther. 2014;56(5):7–15. doi:10.1016/j.brat.2014.02.005.
73. Klumpp H, Fitzgerald D, Angstadt M, Post D, Phan K. Neural response during attentional control and emotion processing predicts improvement after cognitive behavioral therapy in generalized social anxiety disorder. Psychol Med. 2014;1–13. doi:10.1017/S0033291714000567.
74. Aldao A, Jazaieri H, Goldin PR, Gross JJ. Adaptive and maladaptive emotion regulation strategies: interactive effects during CBT for social anxiety disorder. J Anxiety Disord. 2014;28(4):382–9. doi:10.1016/j.janxdis.2014.03.005.
75. Morgan JR, Price M, Schmertz SK, Johnson SB, Masuda A, Calamaras M, et al. Cognitive processes as mediators of the relation between mindfulness and change in social anxiety symptoms following cognitive behavioral treatment. Anxiety Stress Coping. 2014;27(3):288–302. doi:10.1080/10615806.2013.839988.
76. Shikatani B, Antony MM, Kuo JR, Cassin SE. The impact of cognitive restructuring and mindfulness strategies on postevent processing and affect in social anxiety disorder. J Anxiety Disord. 2014;28(6):570–9. doi:10.1016/j.janxdis.2014.05.012.
77. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte; 1990.
78. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–83. doi:10.1037/a0018555.
79. Segal ZV, Williams JMG, Teasdale J. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press; 2002.
80. Bishop SR. What do we really know about mindfulness-based stress reduction? Psychosom Med. 2002;64(1):71–83.
81. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57(1):35–43. doi:10.1016/S0022-3999(03)00573-7.
82. Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125–43.
83. Baer RA, Carmody J, Hunsinger M. Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program. J Clin Psychol. 2012;68(7):755–65. doi:10.1002/jclp.21865.
84. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–48. doi:10.1037/0022-3514.84.4.822.
85. Vøllestad J, Sivertsen B, Nielsen GH. Mindfulness-based stress reduction for patients with anxiety disorders: evaluation in a randomized controlled trial. Behav Res Ther. 2011;49(4):281–8. doi:10.1016/j.brat.2011.01.007.
86. Evans S, Ferrando S, Findler M, Stowell C, Smart C, Haglin D. Mindfulness-based cognitive therapy for generalized anxiety disorder. J Anxiety Disord. 2008;22(4):716–21. doi:10.1016/j.janxdis.2007.07.005.
87. Craigie MA, Rees CS, Marsh A. Mindfulness-based cognitive therapy for generalized anxiety disorder: a preliminary evaluation. Behav Cogn Psychother. 2008;36(5):553–68. doi:10.1017/s135246580800458x.
88. Kocovski NL, Fleming JE, Rector NA. Mindfulness and acceptance-based group therapy for social anxiety disorder: a pilot study. Cogn Behav Pract. 2009;16(3):276–89. doi:10.1016/j.cbpra.2008.12.004.
89. Bögels SM, Sijbers GFVM, Voncken M. Mindfulness and task concentration training for social phobia: a pilot study. J Cogn Psychother. 2006;20(1):33–44. doi:10.1891/jcop.20.1.33.
90. Jazaieri H, Goldin PR, Werner K, Ziv M, Gross JJ. A randomized trial of MBSR versus aerobic exercise for social anxiety disorder. J Clin Psychol. 2012;68(7):715–31. doi:10.1002/jclp.21863.
91. Koszycki D, Benger M, Shlik J, Bradwejn J. Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behav Res Ther. 2007;45(10):2518–26. doi:10.1016/j.brat.2007.04.011.
92. Goldin PR, Gross JJ. Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion. 2010;10(1):83–91. doi:10.1037/a0018441.
93. Goldin P, Ziv M, Jazaieri H, Hahn K, Gross JJ. MBSR vs aerobic exercise in social anxiety: fMRI of emotion regulation of negative self-belief. Soc Cogn Affect Neurosci. 2013;8(1):65–72. doi:10.1093/scan/nss054.
94. Goldin PR, Ziv M, Jazaieri H, Gross JJ. Randomized controlled trial of mindfulness-based stress reduction versus aerobic exercise: effects on the self-referential brain network in social anxiety disorder. Front Hum Neurosci. 2012;6:1–16. doi:10.3389/fnhum.2012.00295.