Positive emotion regulation in emotional disorders: A theoretical review

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Abstract

Conceptualizations of emotion regulation have led to the identification of cognitive and behavioral regulatory abnormalities that contribute to the development and maintenance of emotional disorders. However, existing research on emotion regulation in anxiety and mood disorders has primarily focused on the regulation of negative emotions rather than positive emotions. Recent findings indicate that disturbances in positive emotion regulation occur across emotional disorders, and may be a generative target for treatment research. The aims of this paper are to: 1. Present a transdiagnostic model of positive emotion disturbances in emotional disorders; 2. Review evidence for disturbances in positive emotion regulation in emotional disorders across categories of emotion regulation; and 3. Propose treatment strategies that may address these disturbances.

Highlights

► Positive emotions are an under studied topic in research for emotional disorders. ► Disturbances in positive emotion regulation occur across anxiety and mood disorders. ► Treatment strategies may be adapted to target the regulation of positive emotions.

Introduction

Conceptualizations of emotion regulation, defined as how individuals influence the onset, course, and experience of their emotions, have proven useful for understanding emotional disorders such as anxiety, depression, and bipolar disorder. Individuals with these disorders tend to experience their negative emotions as overwhelming and uncontrollable, and often lack the skills necessary to manage and regulate these intense emotional experiences (Campbell-Sills et al., in press, Fairholme et al., 2010). Transdiagnostic deficits in the regulation of negative emotions have been well characterized in depression and anxiety (e.g., Aldao et al., 2010, Campbell-Sills et al., in press, Kring and Sloan, 2010, Mennin et al., 2005).

Several lines of evidence now indicate that positive emotion regulation is an important clinical issue in emotional disorders that has implications for both how we conceptualize the phenomenology of these related disorders, and how we approach their treatment. Results from a number of clinical studies suggest that disturbances in positive emotionality, including both excesses and deficiencies in positive emotions, convey vulnerability for emotional disorders (for review, see Brown and Barlow, 2009, Gruber, 2011). Positive emotion regulation deficits likely contribute to such disturbances in positive emotionality, and may function as risk or maintaining factors in the onset and course of these disorders. Thus, positive emotion regulation deficits appear to represent promising therapeutic targets for addressing positive emotionality and related domains of functioning in the treatment of emotional disorders. As correlates of positive emotionality, such as behavioral approach and anhedonia, have often proved resistant to improvement in treatment (see Brown, 2007, Dunlop and Nemeroff, 2007, Treadway and Zald, 2011), new treatment strategies for such problems are greatly needed.

Studies from a range of disciplines, including emotion and affective sciences and clinical, health, and positive psychologies, suggest that the biobehavioral features of positive emotions are distinct from those of negative emotions (Garland et al., 2010), and therefore merit separate attention. Further, in addition to being implicated in the symptomatologies of emotional disorders, positive emotionality appears to have beneficial, generalized effects on health and functioning (e.g., Dockray and Steptoe, 2010, Moskowitz et al., 2008, Tugade et al., 2004). Thus, optimizing positive emotional functioning in the treatment of emotional disorders promises to enhance long-term recovery and resilience in addition to promoting acute symptom reduction (Ehrenreich, Fairholme, Buzzella, Ellard, & Barlow, 2007).

The aims of this paper are to promote more generative research in this area by providing a theory-driven review of the emerging body of literature on disturbances in positive emotion regulation associated with emotional disorders. Gross (1998) process model of emotion regulation, which has proved a useful heuristic for guiding systematic research into deficits of negative emotion regulation (e.g., Kring & Sloan, 2010), is utilized to organize the review. Gross' model identifies five categories of emotion regulation each relevant to a specific phase of the emotion generation process. This structure maintains ecological validity with emotion processes and has the advantage of highlighting potential underlying regulatory mechanisms. We have elaborated upon this model to more specifically identify processes of positive emotion regulation and how they are dysregulated in emotional disorders (see Table 1). This review is organized into five sections: 1. background information on positive emotion and positive emotion regulation; 2. a review of assessment methods relevant to positive emotion regulation; 3. a discussion of processes of positive emotion regulation and evidence of related disturbances associated with emotional disorders within each category of emotion regulation; 4. proposed treatment strategies for positive emotion regulation disturbances; and 5. a summary and discussion of future directions.

Section snippets

Positive emotion

Positive emotions may be comprised of any number of discrete pleasant-valenced emotions, such as joy, pride, contentment, or love, or a more undifferentiated state of positivity. The term positive emotionality refers to a trait-like dimension of emotional temperament that represents an individual's tendency to experience positive emotions (Soskin, Carl, Alpert, & Fava, 2012). Several closely related constructs appear to reflect different facets of a dimension of positive emotionality; these

Assessment of positive emotion regulation

Although the number of assessment instruments relevant to positive emotion regulation is growing, existing measures are limited in their breadth and depth of coverage of positive emotion regulation processes (see Table 2). Measures of positive emotion regulation have predominantly focused on specific, isolated strategies of positive emotion regulation, and these tend to be relatively controlled cognitive response-focused strategies (e.g., savoring, dampening). There is a dearth of assessment

Processes of situation selection and situation modification

Situation selection refers to how people influence their emotional experiences by choosing which situations to enter (and which to avoid), whereas situation modification describes how people alter situations they have chosen to enter in order to change the emotional characteristics of the situations (Gross & Thompson, 2007). Situation selection and modification are discussed together in this paper because the processes they are comprised of largely overlap. People can choose to enter and modify

Evidence-based treatment strategies

Although clinical disturbances in the regulation of positive emotions have only recently been conceptualized as direct targets for psychological intervention, a number of existing empirically supported treatments contain components that appear relevant to such disturbances (Table 3).

Several evidence-based treatments for depression, including cognitive therapy (CT, Beck, Rush, Shaw, & Emery, 1979), behavioral activation (BA; Jacobson, Martell, & Dimidjian, 2001), and self-system therapy (SST;

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