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Different theoretical models have been used to understand and treat psychopathology. This article organizes these different models into two categories: affect regulation and affect reconsolidation. Affect regulation focuses on the management of emotion and related symptoms, whereas affect reconsolidation attempts to change underlying emotions. Historically, and often still today a classification can be made between theoretical models of psychotherapy as having either affect regulation or an affect reconsolidation approach in response to emotion in psychotherapy. Distinctions between affect regulation and affect reconsolidation therapeutic interventions are explored, with an emphasis on grounding these two approaches in affective neuroscience. The article demonstrates how affect regulation and affect reconsolidation are most effective when used together in the comprehensive treatment of many psychological disorders. Research indicates that emotion should be activated and regulated to reach a moderate level of arousal in creating the optimal conditions for affect reconsolidation to occur. Additionally, understanding how the principles of affect regulation and affect reconsolidation complement each other is essential in integrating psychotherapy and advancing our understanding of what a transtheoretical model of treatment might look like.

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Journal of Psychotherapy Integration

Affect Regulation and Affect Reconsolidation as

Organizing Principles in Psychotherapy

Francis L. Stevens

Online First Publication, October 4, 2018. http://dx.doi.org/10.1037/int0000130

CITATION

Stevens, F. L. (2018, October 4). Affect Regulation and Affect Reconsolidation as Organizing

Principles in Psychotherapy. Journal of Psychotherapy Integration. Advance online publication.

http://dx.doi.org/10.1037/int0000130

Affect Regulation and Affect Reconsolidation as Organizing

Principles in Psychotherapy

Francis L. Stevens

Reliant Medical Group, Worcester, Massachusetts

Different theoretical models have been used to understand and treat psychopathology.

This article organizes these different models into two categories: affect regulation and

affect reconsolidation. Affect regulation focuses on the management of emotion and

related symptoms, whereas affect reconsolidation attempts to change underlying emo-

tions. Historically, and often still today a classification can be made between theoretical

models of psychotherapy as having either affect regulation or an affect reconsolidation

approach in response to emotion in psychotherapy. Distinctions between affect regu-

lation and affect reconsolidation therapeutic interventions are explored, with an em-

phasis on grounding these two approaches in affective neuroscience. The article

demonstrates how affect regulation and affect reconsolidation are most effective when

used together in the comprehensive treatment of many psychological disorders. Re-

search indicates that emotion should be activated and regulated to reach a moderate

level of arousal in creating the optimal conditions for affect reconsolidation to occur.

Additionally, understanding how the principles of affect regulation and affect recon-

solidation complement each other is essential in integrating psychotherapy and advanc-

ing our understanding of what a transtheoretical model of treatment might look like.

Keywords: affect regulation, affect reconsolidation, salience network, affective neuro-

science, psychotherapy integration

Throughout the history of clinical psychol-

ogy, different theoretical models have been de-

veloped and various approaches have been

taken to understand psychopathology and guide

treatment. Early psychoanalysis centered on ac-

cessing the unconscious. This was followed by

a focus on behavior in understanding psychopa-

thology in the absence of mental processes, and

later an emphasis was placed on cognition in

determining feelings and behaviors. Histori-

cally, emotion has often been ignored in the

etiology of psychopathology because of its ab-

stract nature (Mennin & Farach, 2007). Yet

recently, emotion has become better defined and

more empirically supported (Gross & Jazaieri,

2014) as the field of affective science has

emerged. Affective science places importance

on emotion in diagnosis and treatment, and of-

fers a way to integrate the field of clinical psy-

chology (Gross, 1998; Tracy, Klonsky, &

Proudfit, 2014). Affective science has therefore

offered the field of clinical psychology a way to

assimilate and synthesize the previous frag-

mented camps of clinical psychology (Rotten-

berg & Johnson, 2007; Sloan et al., 2017). In

this article, affect regulation and affect recon-

solidation, tenets of affective science, are pro-

posed as organizing principles for psychother-

apy treatment in the field of clinical psychology.

Affect regulation, also referred to as emotion

regulation, is the ability to effectively manage

and tolerate emotions (Aldao, Nolen-Hoek-

sema, & Schweizer, 2010; Gross, 1998). Affect

regulation involves coping with negative emo-

tion without engaging in destructive or self-

defeating behaviors (Ochsner & Gross, 2005;

Schore, 2016). However, affect regulation may

also include managing positive emotions, as in

the case of a manic episode or the use of sub-

Correspondence concerning this article should be ad-

dressed to Francis L. Stevens, Department of Behavioral

Medicine, Reliant Medical Group, 425 Lake Avenue North,

Worcester, MA 01605. E-mail: fstevens377@gmail.com

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Journal of Psychotherapy Integration

© 2018 American Psychological Association 2018, Vol. 1, No. 999, 000

1053-0479/18/$12.00 http://dx.doi.org/10.1037/int0000130

1

stances as a way to enhance a positive state of

affect (Cooper, Frone, Russell, & Mudar, 1995).

Affect reconsolidation or emotion reconsolida-

tion, originally referred to as memory reconsoli-

dation, was a phenomenon first studied in the

rodent population, in which if a memory be-

came reactivated, it also became labile and thus

subject to change (for review, see Nader &

Hardt, 2009). Further research has indicated that

this phenomenon also occurs in humans and can

be applied to changing emotional memories

(Schiller & Phelps, 2011; Schwabe, Nader, &

Pruessner, 2014). Although accessing and re-

processing emotional memories from the past

was previously identified in clinical psychol-

ogy, and referred to as catharsis oracorrective

emotional experience (Alexander & French,

1946; Bridges, 2006), only recently has clinical

psychology been able to understand the neuro-

science behind this phenomenon. The rest of

this article will outline how affect regulation

and affect reconsolidation can be used as orga-

nizing principles to better conceptualize and

unify psychotherapy interventions based in af-

fective neuroscience.

For most individuals, emotions are typically

ephemeral states brief in duration (Verduyn &

Lavrijsen, 2015), and although they can be un-

comfortable at times, for the most part, individ-

uals are able to effectively recognize and man-

age their emotions. Yet for those struggling

with mental health concerns, emotions can often

be overly negative in nature, continuous, and

often unmanageable (Rottenberg & Johnson,

2007). Disrupted states of emotion are consis-

tently observed in psychiatric diagnoses (Berk-

ing & Wupperman, 2012; Werner & Gross,

2010). Many individuals with mental health dis-

orders show an increased sensitivity to negative

affect (Daros, Uliaszek, & Ruocco, 2014).

These individuals are hypersensitive to cues of

negative feelings and are quicker to recognize

negative emotions (Bourke, Douglas, & Porter,

2010). They become hypersensitive to the in-

duction of negative stimuli such as rejection

(Cardi, Di Matteo, Corfield, & Treasure, 2013),

sadness cues (Gotlib, Krasnoperova, Yue, &

Joormann, 2004), or fear stimuli (Bar-Haim,

Lamy, Pergamin, Bakermans-Kranenburg, &

van IJzendoorn, 2007). This article proposes

that emotional difficulties are present in, and

central to, most psychological disorders (Gross

& Jazaieri, 2014).

Unifying Therapy

Proponents of different therapeutic modali-

ties have advocated for different approaches to

handling emotion in psychotherapy. Histori-

cally, for example, cognitive approaches fo-

cused on decreasing emotion, whereas experi-

ential and psychodynamic approaches focused

on increasing emotion (Mennin & Farach, 2007;

Wiser & Goldfried, 1993). Often in research

studies, cognitive– behavioral therapy (CBT)

and psychodynamic therapy are pitted against

one another in a comparison of outcomes, pre-

sumably to help clinicians identify the best

treatment approach (Driessen et al., 2017;

Leichsenring et al., 2009; Shedler, 2010). This

dichotomy between treatments could be seen as

having either an affect regulation or affect re-

consolidation approach to psychotherapy. Un-

derstanding how these differing approaches use

affect regulation or affect reconsolidation in

treatment may help in developing more inte-

grated approaches to psychotherapy.

Affect regulation involves managing emo-

tions to prevent further upsetting states of neg-

ative affect and is especially important in pre-

venting harmful behaviors, such as substance

abuse or suicide, that result from negative states

of affect. Traditional cognitive therapy regu-

lates negative affect by changing one's

thoughts. Changing negative cognitions to more

positive thoughts helps to prevent the reinforce-

ment of negative ideas about the self, thus ter-

minating a continual cascade of negative feel-

ings (Beck, Liese, & Najavits, 2005). Other

models of affect regulation include dialectic

behavioral therapy, which emphasizes mindful-

ness and the use of coping strategies to manage

overwhelming emotions (Robins, Ivanoff, &

Linehan, 2001). Affect regulation involves

learning how to control upsetting feelings and

manage thinking to prevent escalating states of

negative affect. The focus of these affect regu-

lation techniques involves mitigating excessive

unpleasant states of affect.

Affect reconsolidation exists as a way to

change emotion to prevent future experiences of

continued negative affect. Traditional behav-

ioral therapy offers an example of affect recon-

solidation as a therapeutic approach. Behavioral

therapy exposes the individual to the feared

stimulus as part of a reconditioning process.

This process aims to eliminate the feared re-

2 STEVENS

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sponse through reexposure to the stimulus in the

absence of the fear response, often referred to as

extinction. Some debate exists in the distinction

between extinction and memory reconsolida-

tion; however, each has different mechanistic

properties (Duvarci, Mamou, & Nader, 2006).

In the psychology literature, extinction gener-

ally refers to the elimination of a conditioned

fear, through exposure to the feared stimulus,

whereas affect (memory) reconsolidation in-

volves a single instance in which the memory is

reactivated and the emotional response to the

stimulus changes. Welling (2012) identified

three major differences between exposure

through extinction and memory reconsolida-

tion: First, memory reconsolidation is used for

all negative emotions, not solely fear; second,

the coactivated state in memory reconsolidation

could involve various positive emotions, not

just relaxation; and third, in memory reconsoli-

dation, the negative stimuli is often internal and

overly present, whereas in exposure, the fear

stimuli is external and is often avoided.

Psychodynamic models of therapy typically

tend to focus less on affect regulation strategies

and more on recollection of past events. Tradi-

tionally, psychodynamic treatment attributed in-

sight as the mechanism for change, yet more

recent dynamic models focus on the reconsoli-

dation of affect as the major mechanism of

change (Fosha, 2005). These approaches at-

tempt to activate stored emotion-laden memo-

ries for reconsolidation of that emotion. More

recent therapeutic approaches, such as emotion-

focused therapy (EFT) or accelerated experien-

tial-dynamic therapy (AEDP), also focus on ac-

tivating and reconsolidating emotion (Fosha,

2002; Greenberg, 2004), and these approaches

have been increasingly recognized in the liter-

ature (Lane, Ryan, Nadel, & Greenberg, 2015).

Similar to behavioral methods, these therapies

both involve exposure to difficult emotions. Yet

with behavioral therapy, the emotion is acti-

vated via an in vivo stimulus, whereas in EFT or

AEDP, the emotion is internal and can often

involve an emotional recollection of a previ-

ously repressed or denied emotion. Other mo-

dalities of therapy have taken different ap-

proaches to psychotherapy, such as a focus on

the therapeutic relationship in interpersonal

therapy or on the body in somatic therapy, but

these therapies, too, and most all other thera-

pies, generally involve activation and/or abate-

ment of emotion.

This article highlights one clear dilemma

among therapeutic approaches: Should psycho-

therapy focus on activation or abatement of

emotion? Focusing on past emotional events

will likely increase emotion, whereas a focus on

thoughts can refocus the client away from past

negative feelings (Wiser & Goldfried, 1993).

Therefore, the question becomes whether the

role of the therapist is one of heightening feel-

ings or mitigating feelings? Increasing feelings

is necessary for affect reconsolidation, whereas

affect regulation focuses on mitigating feelings.

This assumption—that therapy should primarily

focus treatment around either increasing or mit-

igating feelings— creates a false dichotomy and

has left clinical psychology as a fractured sci-

ence, which further contributes to skepticism

because of the lack of a consistent theoretical

basis for psychotherapy. Single-sided treatment

approaches focusing only on one side of this

dichotomy are incomplete. Solely employing

affect regulation strategies is a symptom-based

model of treatment with no acknowledgment of

the potential cause of such negative emotions.

However, solely focusing on increasing the

level of emotion, important for affect reconsoli-

dation, provides the client with no skills to

manage overwhelming states of emotion and

could potentially lead the client to feel retrau-

matized or overpowered by negative emotions.

This could result in an early termination of

treatment and tarnish the efficacy of psychother-

apy. Moreover, if a client feels they will not be

able to control their response to an arousing

state of affect, they will avoid the emotion,

often through a variety of defense mechanisms,

further preventing any future opportunity for

affect reconsolidation.

Recently, memory reconsolidation has been

proposed as the mechanism of change in psy-

chotherapy (Ecker, Ticic, & Hulley, 2012; Lane

et al., 2015; Welling, 2012). Memory reconsoli-

dation is referred to in this article as affect

reconsolidation. This distinction is made be-

cause affect reconsolidation is not a change in

the content of the memory but a change in the

emotional valence and intensity associated with

the memory. The same memory exists, but after

affect reconsolidation, the emotion of the mem-

ory changes, a recollection of the trauma event

will have the same content, but the feelings

3AFFECT REGULATION AND RECONSOLIDATION

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around that content will be very different. This

article is in agreement—with Lane et al.

(2015)—that memory reconsolidation is the

mechanism of change in psychotherapy, yet fur-

ther proposes that the ability to effectively reg-

ulate affect is a necessary condition for the

secondary process of affect reconsolidation to

occur. Some authors even suggest that affect

regulation is the main component of change in

psychotherapy (Moyal, Cohen, Henik, & An-

holt, 2015). An increasingly amount of empiri-

cal support has demonstrated that a moderate

level of emotional arousal is most effective for

therapeutic change (Carryer & Greenberg,

2010; Corrigan, Fisher, & Nutt, 2011). Thus,

both affect regulation and affect reconsolidation

are equally important components of therapeu-

tic change. Affect regulation is necessary to

titrate emotion to an optimal level of moderate

arousal, whereas affect reconsolidation is im-

portant in transforming the baseline emotional

response once the emotion is activated.

The two mechanisms of affect regulation and

reconsolidation show different neural activation

responses in the brain (Frank et al., 2014;

Ochsner & Gross, 2005). Affect regulation in-

volves the use of higher cortical areas such as

the dorsal lateral prefrontal cortex and ventral

lateral prefrontal cortex, and reduction of

amygdala activation is seen after the regulation

of affect (Buhle et al., 2014). Kohn et al. (2014)

proposed that during affect regulation, the ven-

tral lateral prefrontal cortex engages in cogni-

tive appraisal, which then, through the dorsal

anterior cingulate cortex (ACC; also referred to

anterior mid-cingulate cortex), tempers emo-

tion in subcortical areas such as the amygdala

(Frank et al., 2014; Kim & Hamann, 2007).

Affect reconsolidation, operationalized as ex-

tinction or memory reconsolidation, appears to

involve lower cortical areas, primarily the ven-

tral medial prefrontal cortex and amygdala, and

also the dorsal ACC and hippocampus, to a

lesser extent (Milad & Quirk, 2012). Evidence

suggest that following reconsolidation circuitry

may be altered between ventral medial prefron-

tal cortex and amygdala (Schiller, Kanen, Le-

Doux, Monfils, & Phelps, 2013). Comparison

studies between the up- and downregulation of

emotion have found distinctive neural correlates

for each process (Frank et al., 2014; Ochsner et

al., 2004), distinguishing separate systems for

affect regulation and affect reconsolidation. Af-

fect regulation as a construct has often been

operationalized using the Difficulties in Emo-

tion Regulation Scale (Gratz & Roemer, 2004).

Other measures have been used to measure af-

fect regulation, and all show a relationship be-

tween poor emotion regulation and psychopa-

thology (Aldao et al., 2010). The process of

affect reconsolidation has been measured in the

laboratory setting through changing emotional

memories, and this process can be affected by

stress (Schwabe & Wolf, 2010). Affect recon-

solidation has shown promise as a therapeutic

tool in changing emotional memory (Beckers &

Kindt, 2017). Both affect regulation and affect

reconsolidation have been shown to be positive

contributors to therapeutic change (Linehan et

al., 2006; Schiller et al., 2010) using different

clinical interventions as previously outlined.

Recent approaches, such as the unified pro-

tocol (Barlow et al., 2010; Wilamowska et al.,

2010) and affect phobia therapy (McCullough

& Andrews, 2001), have also begun adding

interventions to increase affect in conjunction

with the more traditional affect regulation strat-

egies with interventions in evoking affect, rep-

resenting a positive step toward integrating psy-

chotherapy. CBT can also utilize affect

regulation and affect reconsolidation methods

(Samoilov & Goldfried, 2000); however, this

approach often insufficient when the feared

emotion is an internalized feeling (Westen,

2000), and emphasizes extinction over affect

reconsolidation. Although these therapies repre-

sent an important step, more can be done to in

creating consistent therapeutic principles. Ther-

apeutic approaches that focus solely on one side

of this dichotomy are based on a false supposi-

tion, because one cannot regulate affect without

first having affect. Furthermore, it is unlikely

that one can one reconsolidate affect if the af-

fect cannot be regulated to a tolerable level of

arousal (Alberini & Ledoux, 2013). Therefore.

placing a more equal emphasis on affect regu-

lation and affect reconsolidation can enhance

the process of psychotherapy.

Affect Regulation

Mindfulness has recently become popular as

an affect regulation skill (Shapiro & Carlson,

2017). This involves a deautomatization of pre-

vious actions, in which the individual is able to

separate their emotional experience from their

4 STEVENS

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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

actions (Kang, Gruber, & Gray, 2013). The

ability to be mindful has been shown to directly

help individuals in regulating their emotions

(Arch & Craske, 2006; Jimenez, Niles, & Park,

2010). Through mindfulness, the individual

learns to experience their feelings without au-

tomatically reacting. The individual is then able

to consider alternative strategies for managing

the emotion and possibly implement healthier

behavior. Research shows that regulation of af-

fect involves the use of top-down control

through the orbitofrontal, anterior cingulate,

and prefrontal cortexes to mitigate feelings (Et-

kin, Egner, & Kalisch, 2011; Ochsner & Gross,

2005). These neocortical regions may help in

allowing individuals to consider and implement

alternative actions when feeling emotionally

overwhelmed.

Cognitive therapy acts in a similar way, slow-

ing down the brain to reevaluate thoughts,

which helps to realign one's beliefs on a more

realistic level. Cognitive therapy utilizes in-

creased awareness to engage in conscious re-

flection of thought to evaluate a belief before

moving into action. It helps individuals ques-

tion their assumptions about the world before

believing the worst. Cognitive therapy does not

examine the affect from which the thought is

derived. It examines the individual thoughts in

response to their affect, encouraging individ-

uals to rethink things in a more realistic man-

ner (Beck, 2010). This, in turn, helps individ-

uals see the world in a potentially more

realistic light, which will enable them to ef-

fectively change their behavior and further

prevent thoughts that enable negative states of

affect. Cognitive therapy, in the pure sense, is

not an intervention to change basic affect;

rather, the goal is regulating affect through

managing thinking and behavior in response

to emotion (Kazdin, 2007). Research also ex-

ists to suggest that affect regulation can be an

implicit process as well (Braunstein, Gross, &

Ochsner, 2017). For example, a therapist may

simultaneously experience a client's emotion

as the client is feeling the emotion, during

which the therapist can model regulating this

emotion, thus providing an implicit model

through which the client can regulate their

emotion (Gyurak, Gross, & Etkin, 2011). All

of this happens without words and is similar

to the reflective functioning processes of reg-

ulating emotion that occurs between a care-

giver and their child (Fonagy & Target, 1997;

Schore, 2016; Siegel, 2012). However, to

change the basic affect, an intervention to

address the emotion(s), and not just the re-

sulting symptoms of the emotion(s), is need-

ed. Affect reconsolidation is such an interven-

tion.

Affect Reconsolidation: Moving Toward

Primary Affect

Greenberg and Pascual-Leone (2006) theo-

rized a distinction between primary emotions

and secondary emotions. Primary emotions

occur during the initial response to an event,

whereas secondary emotion(s) are pathologi-

cal reactions to the avoidance of primary

emotions (Greenberg & Safran, 1989). The

continual avoidance of a primary emotion re-

sults in a secondary emotion that exists indef-

initely, and this can be considered a state of

psychopathology. Greenberg and Pascual-

Leone suggested that one must first explore

secondary emotions and then progress to ad-

dressing primary emotions. For example, one

might feel continually hopeless after the death

of their spouse. The secondary emotion of

hopelessness exists as a result of the avoid-

ance of the primary emotion of sadness that

resulted from the death. The widower may

avoid their sadness, perhaps because they feel

unable to cope with grief or are afraid to

acknowledge the death and the resulting

changes. This causes a perpetual state of suf-

fering in which the individual will always feel

hopeless if they are unable to access their

sadness and grief. The hopelessness is the

resulting feeling of the ongoing avoidance of

the sadness. Essentially, the widower lives in

denial and in a continuous state of suffering.

Ostensibly, no one would knowingly choose

to suffer, but the suffering results because the

individual avoids the painful primary emo-

tion. Clients may be unaware of these primary

emotions or be actively defending themselves

against experiencing these primary emotions,

afraid they will be unable to cope with the

feelings once activated. The client may fear

that they will not be able to regulate this

primary emotion effectively and will act out

in harmful ways, such as through substance

use or self-harm. In some cases, clients may

fear falling deeper into a depression or psy-

5AFFECT REGULATION AND RECONSOLIDATION

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chotic state. Lastly, the client may fear shame

or judgment of the self that comes from hav-

ing certain feelings. These fears are not un-

grounded, and the client must learn the affect

regulation skills referred to above prior to

accessing these challenging feelings. Fosha

(2005) recommended starting with the most

apparent feelings and talking about these feel-

ings in order to eventually understand deeper

feelings, moving the client to increasingly

core levels of affect. Slowly accessing feel-

ings and regulating them accordingly will

give the client confidence that they can con-

tinue to experience intense feelings and effec-

tively cope with these feelings as they arise.

As the client gains confidence in their ability

to feel more and trusts the therapist to help

regulate and support them, the client will

move closer to the primary emotions to then

reconsolidate the affect. In achieving this pro-

cess, the client develops a trust in the thera-

pist to help regulate their affect as the emo-

tions arise. In this sense, it can be understood

why outcome studies of psychotherapy show

that a strong therapeutic relationship is highly

correlated with successful treatment (Flück-

iger, Del Re, Wampold, Symonds, & Horvath,

2012; Horvath, Del Re, Flückiger, & Sy-

monds, 2011; Krupnick et al., 1996).

In order for clients to access such primary

emotions for affect reconsolidation, both the

therapist and client must engage in an increas-

ing conscious reflection of emotion to help

move the client closer to the primary affect

(Lane et al., 2015). The process of deepening

emotion is facilitated by the therapist's reflec-

tion of the client's emotion. This reflection

heightens the emotion and may engage mirror

neurons (de Vignemont & Singer, 2006). The

emotion becomes more conscious and intensi-

fies when another individual reflects the emo-

tion back to the person (Hatfield, Cacioppo, &

Rapson, 1994; Lundqvist & Dimberg, 1995).

This is exemplified in the classical Rogerian

paraphrasing intervention, "It seems your say-

ing/feeling." This reflection of the client's feel-

ing back to the client intensifies the feeling

within the client and heightens the emotional

experience. This entire process can also happen

on a nonverbal level in the therapeutic process,

as the client expresses a feeling and the therapist

reflects that feeling back in a facial expression.

The client experiences the feeling and being

felt. The therapist, in developing a relationship

with the client, attunes to the client's nonverbal

expression, which, in turn, deepens the level of

affect in the therapy session.

Affect Reconsolidation: Reactivation

Reactivation of emotion is likely to be incon-

sistent across client type, and research suggests

that one's attachment style (Stevens, 2017) and

personality (Dimaggio & Lysaker, 2018) affects

one's ability to recognize emotions. Therapists'

emotional attunement and nonjudgmental ac-

ceptance of their clients' emotions will help

enable the client to express deeper levels of

emotion. However, this is often a challenging

process, as some clients may struggle to recog-

nize their feelings or engage in psychological

defenses so as not to experience such uncom-

fortable emotions. Here, the aforementioned af-

fect regulation strategies will be necessary to

employ so that the client can gain confidence in

coping with his or her emotions. Together, the

therapist and client will focus attention on rec-

ognizing and reactivating emotional experi-

ences. This will involve an awareness of emo-

tion. Some authors consider emotional

awareness as its own separate mechanism of

change (Greenberg & Pascual-Leone, 2006).

This article includes emotional awareness as

part of the affect regulation and affect recon-

solidation processes and not as a separate mech-

anism of change, because emotional awareness

does not specifically change affect. Consider an

individual with posttraumatic stress disorder

(PTSD) who continually is aware of their emo-

tions through trauma flashbacks or nightmares;

solely increasing emotional awareness here

would not lead to therapeutic change. Yet emo-

tional awareness is still an important first step

for affect regulation and reconsolidation to be-

gin. Multiple studies have implicated the ACC

and the insula that compromise the salient net-

work as important brain areas involved in the

awareness of emotion (Craig, 2009; Gu, Hof,

Friston, & Fan, 2013; Ibañez, Gleichgerrcht, &

Manes, 2010; Medford & Critchley, 2010;

Menon & Uddin, 2010). Research indicates that

feeling states first arise in the insula and are then

increasingly organized in the ACC as the feel-

ing progresses to an increasingly conscious state

(Medford & Critchley, 2010). As awareness of

the feeling increases, the ACC, along with other

6 STEVENS

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neocortical brain regions, can act together in

regulating the emotion to achieve a moderate

level of arousal (Etkin et al., 2011; Goldin,

McRae, Ramel, & Gross, 2008; Ochsner &

Gross, 2005). The ACC primarily selects where

to direct attention (Compton, 2003; Elliott &

Dolan, 1998; Lane, Fink, Chau, & Dolan, 1997)

and may have the capacity to direct attention in

downregulating emotion or in upregulating

emotion for reconsolidation. Some research

suggests that the ACC acts as a choice point for

the suppression or conscious awareness of emo-

tion (Anderson et al., 2004; Stevens, 2016).

Given that the brain has the capacity to divert

attention when faced with difficult emotion,

highlights the importance of regulating affect

prior to affect reconsolidation, for if the client is

not confident in their ability to cope with the

upsetting emotion(s) that is often activated in

order for affect reconsolidation to occur, they

may redirect their attention elsewhere. As in the

previous example of the death of a spouse, the

widower must first cope with the feelings of

hopelessness to then access the feeling of

deeper sadness. If they feel that they cannot

cope with the emotion, they may suppress or

deny the sadness.

Attention selection and affect regulation may

work together in managing the secondary emo-

tions before accessing and reconsolidating the

primary emotions. Recent research suggests that

selective attention and affect regulation may be

related processes. Malinowski (2013) suggested

that improved Stroop performance among med-

itators is due to their increased ability to regu-

late affect (the Stroop task is a selective atten-

tion task, in which the participant is asked to

read color words that appear in colors incongru-

ent with the name of the color). Further, Mali-

nowski cited evidence that emotional regulation

and response inhibition are simultaneously im-

proved through mindfulness training (Sahdra et

al., 2011). More specifically, Teper and Inzlicht

(2013) found that emotional acceptance medi-

ates the relationship between meditation and

Stroop performance. Shifting attention toward

the emotion that was previously ignored creates

deautomatization (Kang et al., 2013), in which

the direct link between emotion and action is

severed. This involves the ability to mindfully

step back, accept the emotion instead of auto-

matically acting to control it, and then engage in

a different response selection. Deautomatization

is important in both affect regulation and affect

reconsolidation and has been offered as a gen-

eral therapy change principle (Hoffart & Hof-

fart, 2014). One must be able to simultaneously

regulate affect for a different response selection,

while also staying with uncomfortable emotions

in order to reconsolidate the emotion. In the

case of the widower, at this point, the widower

attends to and copes with hopelessness, allow-

ing further access to the feelings of sadness.

This is not easy because, often when experienc-

ing a difficult emotion, our instinct is to avoid

the emotion. Selectively attending to negative

emotions may initially be counterintuitive and

difficult for clients to understand. Why would a

client want to experience such negative affect if

they do not understand the positive benefits of

affect reconsolidation?

Affect Reconsolidation: Transformation

Research demonstrates that one must experi-

ence an emotion in order to reconsolidate the

emotion (Gorman & Roose, 2011; Schiller et

al., 2010; Shallcross, Troy, Boland, & Mauss,

2010); hence, the individual must consciously

experience the negative affect in order to recon-

solidate it. As Pascual-Leone and Greenberg

(2007) demonstrated in their research, if the

affect is truly to be reconsolidated, the "only

way out is through." The negative memory or

experience is retrieved and felt, and then a new

feeling emerges, in which the memory content

does not change but the emotion memory is

rewritten. In the previous example, the widower

experiences the sadness of the spouse's death

and a new feeling of acceptance, perhaps even a

feeling of gratitude for the relationship, replaces

the sadness. The content of memory surround-

ing the actual death does not change, just the

emotional meaning of the event. This may be

easier to conceptualize with positive memories.

Suppose you win an award—in the days after,

you may experience a positive feeling of pride

every time you recall that memory. Then over

time, you notice that the memory no longer

brings the same emotional valence with it, as it

has been reconsolidated. You may still feel

some pride for having won the award, but the

feeling of pride is diminished compared with

the initial reexperiencing of that pride. We still

have the memory, but the emotional valence

that comes with the memory slowly erodes

7AFFECT REGULATION AND RECONSOLIDATION

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through affect reconsolidation. If the memory

was infrequently or never recollected, than

when it is recollected, it will have a high level

of emotional intensity. Even though the mem-

ory is from an event that took place years ago,

it creates a strong affect response because it was

never reconsolidated. In this scenario, you have

won an award and felt pride, but never recol-

lected the memory, perhaps because you be-

came distracted with other life events. If you

then recollect the memory, you will experience

a surprising level of pride. However, this is less

frequent with positive memories because our

brain naturally wants to recollect positive mem-

ories/feelings, as it makes us feel good. We are

more likely to repress negative memories, and

we find ourselves surprised by our sadness

when recollecting a sad memory. For example,

when driving and hearing a particular song

linked to a distressing event, inevitably we are

stuck feeling sad.

Once previous feelings are reactivated, re-

consolidation can occur; this is a delicate pro-

cess, as the client needs to experience enough of

the emotion for reconsolidation, but too much

can overwhelm or retraumatize the client, which

is why a moderate level of arousal is most

effective for therapeutic change (Carryer &

Greenberg, 2010; Corrigan et al., 2011). Again,

it is important to be titrating affect throughout

the reconsolidation process to prevent the client

from becoming inundated with feelings. At a

moderate level, affect can be reconsolidated

through replacing the previous experience with

another experience. For example, if a client has

carried around the experience of feeling un-

loved, in this moment, they would feel loved.

Schiller et al. (2010) illustrated how a new

experience is important when the emotional

memory is reactivated for affect reconsolidation

to occur. They conditioned subjects to have an

adverse reaction to a neutral stimulus, by pair-

ing an electric shock with yellow or blue

squares. Their research found that in order to

reconsolidate memory, extinction training has

to take place within a window of time wherein

the adverse stimulus is reactivated. If the train-

ing takes place outside this window when the

adverse stimulus is not reactivated, then recon-

solidation does not occur. This supports previ-

ous clinical evidence (Bridges, 2006) as to why

emotion has to be reactivated in order for affect

reconsolidation to occur. It is not enough for the

therapist to provide clients with a new experi-

ence; this new experience must take place when

the old emotional memory is activated in order

for affect reconsolidation to occur.

The nature of the new experience will vary

depending upon the client's needs. In the Schil-

ler et al. (2010) study, in order to extinguish

their fear, the subject needed to experience that

same blue or yellow square that produced the

fear (reactivation) in a context in which no

adverse shock was given (i.e., a new experi-

ence). Providing this new experience is an es-

sential part of the reconsolidation process—

without it, one may just reinforce the previous,

old emotional memory (Sevenster, Beckers, &

Kindt, 2012). A similar paradigm is used in

exposure therapy for phobias, in which a fear

stimulus is experienced in a safe context. The

fear response is reactivated while the individual

is in a safe emotional context, which provides a

new emotional experience, thus reconsolidating

the affect and ameliorating the phobia. The pro-

cess becomes more nebulous when the feared

emotion is not readily activated by an external

stimulus. For example, an individual with

PTSD may not have any clear external cues that

will activate their trauma, yet the affect recon-

solidation process works the same once the in-

ternal emotional memories are accessible.

Transforming fear into safety might be the pro-

totypical example of affect reconsolidation.

Transforming shame into acceptance, or hate

into compassion, could be more challenging,

and little research exists on how the therapist

facilitates this transformational process.

Integrating Psychotherapy

A major difference among the various ap-

proaches to psychotherapy rests in whether

emotion should be activated or reduced. As

evidenced above, combining the principles of

affect regulation and affect reconsolidation of-

fers a more holistic treatment approach that

recognizes clients' varying needs and abilities

for accessing and regulating their emotion. Af-

fect regulation strategies are often first needed

to de-escalate negative emotions and prevent

further negative actions. Second, strategies to

increase emotions should be used that deepen

affect, helping the client to regulate more diffi-

cult levels of emotion and to eventually achieve

a moderate level of emotional arousal. Finally,

8 STEVENS

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in that moderate state of arousal, a new experi-

ence should be offered through which affect

reconsolidation can occur, transforming the

negative emotion into a positive emotion.

However, the organizing principles of affect

regulation and reconsolidation presented here

do not attempt to identify which emotional reg-

ulation strategies are best to employ across dis-

orders, client type, therapeutic style, and so

forth, nor what therapeutic conditions are best

for the reconsolidation of emotion or what pos-

itive emotion should be offered in transforming

the negative emotion. The field of psychother-

apeutic research will continue to identify the

best-practice standards among the large variety

of conditions that exist. Moreover, these princi-

ples do not offer a set timeline for therapy, the

client's incoming coping skills, or affect toler-

ance, and the rate at which the client can man-

age increasingly difficult levels of emotions will

greatly determine their ability for reconsolida-

tion. What these two organizing principles do

offer is a way for clinicians to think about

emotion in psychotherapy and to help clinicians

decide when it may be best to up- or downregu-

late emotion. Some clients may become easily

overwhelmed by their emotions and need more

focus on affect regulation, whereas other clients

may be more disconnected from their emotional

experience and need help accessing emotion for

affect reconsolidation. Identifying affect regu-

lation and affect reconsolidation as organizing

principles in psychotherapy can help to move

the field closer to a unified approach, integrating

the science and practice of psychotherapy.

References

Alberini, C. M., & Ledoux, J. E. (2013). Memory

reconsolidation. Current Biology, 23, R746–R750.

http://dx.doi.org/10.1016/j.cub.2013.06.046

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S.

(2010). Emotion-regulation strategies across psy-

chopathology: A meta-analytic review. Clinical

Psychology Review, 30, 217–237. http://dx.doi

.org/10.1016/j.cpr.2009.11.004

Alexander, F., & French, T. M. (1946). Psychoana-

lytic therapy: Principles and application. New

York, NY: Ronald Press.

Anderson, M. C., Ochsner, K. N., Kuhl, B., Cooper, J.,

Robertson, E., Gabrieli, S. W.,...Gabrieli, J. D.

(2004). Neural systems underlying the suppression of

unwanted memories. Science, 303, 232–235. http://

dx.doi.org/10.1126/science.1089504

Arch, J. J., & Craske, M. G. (2006). Mechanisms of

mindfulness: Emotion regulation following a fo-

cused breathing induction. Behaviour Research

and Therapy, 44, 1849–1858. http://dx.doi.org/10

.1016/j.brat.2005.12.007

Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-

Kranenburg, M. J., & van IJzendoorn, M. H.

(2007). Threat-related attentional bias in anxious

and nonanxious individuals: A meta-analytic

study. Psychological Bulletin, 133, 1–24. http://dx

.doi.org/10.1037/0033-2909.133.1.1

Barlow, D. H., Farchione, T. J., Fairholme, C. P.,

Ellard, K. K., Boisseau, C. L., Allen, L. B., &

Ehrenreich May, J. T. (2010). Unified protocol for

transdiagnostic treatment of emotional disorders:

Therapist guide. New York, NY: Oxford Univer-

sity Press. http://dx.doi.org/10.1093/med:psych/

9780199772667.001.0001

Beck, J. S. (2010). Cognitive therapy. In I. B. Weiner

& W. E. Craighead (Eds.), Corsini Encyclopedia

of Psychology (pp. 1–3). Hoboken, NJ: John Wi-

ley. http://dx.doi.org/10.1002/9780470479216

.corpsy0198

Beck, J. S., Liese, B. S., & Najavits, L. M. (2005).

Cognitive therapy. In R. J. Frances, S. I. Miller, &

A. H. Mack (Eds.), Clinical textbook of addictive

disorders (3rd ed., pp. 473–501). New York, NY:

Guilford Press.

Beckers, T., & Kindt, M. (2017). Memory reconsoli-

dation interference as an emerging treatment for

emotional disorders: Strengths, limitations, chal-

lenges, and opportunities. Annual Review of Clin-

ical Psychology, 13, 99–121. http://dx.doi.org/10

.1146/annurev-clinpsy-032816-045209

Berking, M., & Wupperman, P. (2012). Emotion

regulation and mental health: Recent findings, cur-

rent challenges, and future directions. Current

Opinion in Psychiatry, 25, 128–134. http://dx.doi

.org/10.1097/YCO.0b013e3283503669

Bourke, C., Douglas, K., & Porter, R. (2010). Pro-

cessing of facial emotion expression in major de-

pression: A review. Australian and New Zealand

Journal of Psychiatry, 44, 681– 696. http://dx.doi

.org/10.3109/00048674.2010.496359

Braunstein, L. M., Gross, J. J., & Ochsner, K. N.

(2017). Explicit and implicit emotion regulation: A

multi-level framework. Social Cognitive and Af-

fective Neuroscience, 12, 1545–1557. http://dx.doi

.org/10.1093/scan/nsx096

Bridges, M. R. (2006). Activating the corrective

emotional experience. Journal of Clinical Psychol-

ogy, 62, 551–568. http://dx.doi.org/10.1002/jclp

.20248

Buhle, J. T., Silvers, J. A., Wager, T. D., Lopez, R.,

Onyemekwu, C., Kober, H.,...Ochsner, K. N.

(2014). Cognitive reappraisal of emotion: A meta-

analysis of human neuroimaging studies. Cerebral

9AFFECT REGULATION AND RECONSOLIDATION

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Cortex, 24, 2981–2990. http://dx.doi.org/10.1093/

cercor/bht154

Cardi, V., Di Matteo, R., Corfield, F., & Treasure, J.

(2013). Social reward and rejection sensitivity in

eating disorders: An investigation of attentional

bias and early experiences. The World Journal of

Biological Psychiatry, 14, 622– 633. http://dx.doi

.org/10.3109/15622975.2012.665479

Carryer, J. R., & Greenberg, L. S. (2010). Optimal

levels of emotional arousal in experiential therapy

of depression. Journal of Consulting and Clinical

Psychology, 78, 190–199. http://dx.doi.org/10

.1037/a0018401

Compton, R. J. (2003). The interface between emo-

tion and attention: A review of evidence from

psychology and neuroscience. Behavioral and

Cognitive Neuroscience Reviews, 2, 115–129.

http://dx.doi.org/10.1177/1534582303002002003

Cooper, M. L., Frone, M. R., Russell, M., & Mudar,

P. (1995). Drinking to regulate positive and nega-

tive emotions: A motivational model of alcohol

use. Journal of Personality and Social Psychology,

69, 990–1005. http://dx.doi.org/10.1037/0022-

3514.69.5.990

Corrigan, F. M., Fisher, J. J., & Nutt, D. J. (2011).

Autonomic dysregulation and the window of tol-

erance model of the effects of complex emotional

trauma. Journal of Psychopharmacology, 25, 17–

25. http://dx.doi.org/10.1177/0269881109354930

Craig, A. D. (2009). How do you feel—now? The

anterior insula and human awareness. Nature Re-

views Neuroscience, 10, 59–70. http://dx.doi.org/

10.1038/nrn2555

Daros, A. R., Uliaszek, A. A., & Ruocco, A. C.

(2014). Perceptual biases in facial emotion recog-

nition in borderline personality disorder. Person-

ality Disorders: Theory, Research, and Treatment,

5, 79– 87. http://dx.doi.org/10.1037/per0000056

de Vignemont, F., & Singer, T. (2006). The empathic

brain: How, when and why? Trends in Cognitive

Sciences, 10, 435– 441. http://dx.doi.org/10.1016/j

.tics.2006.08.008

Dimaggio, G., & Lysaker, P. H. (2018). A pragmatic

view of disturbed self-reflection in personality dis-

orders: Implications for psychotherapy. Journal of

Personality Disorders, 32, 311–328. http://dx.doi

.org/10.1521/pedi.2018.32.3.311

Driessen, E., Van, H. L., Peen, J., Don, F. J., Twisk,

J. W. R., Cuijpers, P., & Dekker, J. J. M. (2017).

Cognitive-behavioral versus psychodynamic ther-

apy for major depression: Secondary outcomes of

a randomized clinical trial. Journal of Consulting

and Clinical Psychology, 85, 653– 663. http://dx

.doi.org/10.1037/ccp0000207

Duvarci, S., Mamou, C. B., & Nader, K. (2006).

Extinction is not a sufficient condition to prevent

fear memories from undergoing reconsolidation in

the basolateral amygdala. European Journal of

Neuroscience, 24, 249–260. http://dx.doi.org/10

.1111/j.1460-9568.2006.04907.x

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking

the emotional brain: Eliminating symptoms at

their roots using memory reconsolidation. New

York, NY: Routledge.

Elliott, R., & Dolan, R. J. (1998). Activation of

different anterior cingulate foci in association with

hypothesis testing and response selection. Neuro-

Image, 8, 17–29. http://dx.doi.org/10.1006/nimg

.1998.0344

Etkin, A., Egner, T., & Kalisch, R. (2011). Emotional

processing in anterior cingulate and medial pre-

frontal cortex. Trends in Cognitive Sciences, 15,

85–93. http://dx.doi.org/10.1016/j.tics.2010.11

.004

Flückiger, C., Del Re, A. C., Wampold, B. E., Sy-

monds, D., & Horvath, A. O. (2012). How central

is the alliance in psychotherapy? A multilevel lon-

gitudinal meta-analysis. Journal of Counseling

Psychology, 59, 10–17. http://dx.doi.org/10.1037/

a0025749

Fonagy, P., & Target, M. (1997). Attachment and

reflective function: Their role in self-organization.

Development and Psychopathology, 9, 679–700.

http://dx.doi.org/10.1017/S0954579497001399

Fosha, D. (2002). The activation of affective change

processes in AEDP. In J. J. Magnavita (Ed.), Com-

prehensive handbook of psychotherapy. Vol. 1:

Psychodynamic and object relations psychothera-

pies (pp. 309–344), New York, NY: Wiley. http://

dx.doi.org/10.1037/e318152004-008

Fosha, D. (2005). Emotion, true self, true other, core

state: Toward a clinical theory of affective change

process. Psychoanalytic Review, 92, 513–551.

http://dx.doi.org/10.1521/prev.2005.92.4.513

Frank, D. W., Dewitt, M., Hudgens-Haney, M.,

Schaeffer, D. J., Ball, B. H., Schwarz, N. F.,...

Sabatinelli, D. (2014). Emotion regulation: Quan-

titative meta-analysis of functional activation and

deactivation. Neuroscience and Biobehavioral Re-

views, 45, 202–211. http://dx.doi.org/10.1016/j

.neubiorev.2014.06.010

Goldin, P. R., McRae, K., Ramel, W., & Gross, J. J.

(2008). The neural bases of emotion regulation:

Reappraisal and suppression of negative emotion.

Biological Psychiatry, 63, 577–586. http://dx.doi

.org/10.1016/j.biopsych.2007.05.031

Gorman, J. M., & Roose, S. P. (2011). The neurobi-

ology of fear memory reconsolidation and psycho-

analytic theory. Journal of the American Psycho-

analytic Association, 59, 1201–1220. http://dx.doi

.org/10.1177/0003065111427724

Gotlib, I. H., Krasnoperova, E., Yue, D. N., & Joor-

mann, J. (2004). Attentional biases for negative

interpersonal stimuli in clinical depression. Jour-

nal of Abnormal Psychology, 113, 127–135. http://

dx.doi.org/10.1037/0021-843X.113.1.121

10 STEVENS

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Gratz, K. L., & Roemer, L. (2004). Multidimensional

assessment of emotion regulation and dysregula-

tion: Development, factor structure, and initial val-

idation of the difficulties in emotion regulation

scale. Journal of Psychopathology and Behavioral

Assessment, 26, 41–54. http://dx.doi.org/10.1023/

B:JOBA.0000007455.08539.94

Greenberg, L. S. (2004). Emotion–focused therapy.

Clinical Psychology & Psychotherapy: An Inter-

national Journal of Theory & Practice, 11, 3–16.

Greenberg, L. S., & Pascual-Leone, A. (2006). Emo-

tion in psychotherapy: A practice-friendly research

review. Journal of Clinical Psychology, 62, 611–

630. http://dx.doi.org/10.1002/jclp.20252

Greenberg, L. S., & Safran, J. D. (1989). Emotion in

psychotherapy. American Psychologist, 44, 19–29.

http://dx.doi.org/10.1037/0003-066X.44.1.19

Gross, J. J. (1998). The emerging field of emotion

regulation: An integrative review. Review of Gen-

eral Psychology, 2, 271–299. http://dx.doi.org/10

.1037/1089-2680.2.3.271

Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion

regulation, and psychopathology: An affective sci-

ence perspective. Clinical Psychological Science, 2,

387– 401. http://dx.doi.org/10.1177/216770261

4536164

Gu, X., Hof, P. R., Friston, K. J., & Fan, J. (2013).

Anterior insular cortex and emotional awareness.

The Journal of Comparative Neurology, 521,

3371–3388. http://dx.doi.org/10.1002/cne.23368

Gyurak, A., Gross, J. J., & Etkin, A. (2011). Explicit

and implicit emotion regulation: A dual-process

framework. Cognition and Emotion, 25, 400– 412.

http://dx.doi.org/10.1080/02699931.2010.544160

Hatfield, E., Cacioppo, J. T., & Rapson, R. L. (1994).

Emotional contagion. Cambridge, UK: Cambridge

University Press.

Hoffart, A., & Hoffart, A. R. (2014). Psychotherapy

integration through general therapy change princi-

ples: Missing the core of psychotherapy? Journal

of Psychotherapy Integration, 24, 263–274. http://

dx.doi.org/10.1037/a0038135

Horvath, A. O., Del Re, A. C., Flückiger, C., &

Symonds, D. (2011). Alliance in individual psy-

chotherapy. Psychotherapy, 48, 9–16. http://dx.doi

.org/10.1037/a0022186

Ibañez, A., Gleichgerrcht, E., & Manes, F. (2010).

Clinical effects of insular damage in humans.

Brain Structure & Function, 214, 397– 410. http://

dx.doi.org/10.1007/s00429-010-0256-y

Jimenez, S. S., Niles, B. L., & Park, C. L. (2010). A

mindfulness model of affect regulation and depres-

sive symptoms: Positive emotions, mood regula-

tion expectancies, and self-acceptance as regula-

tory mechanisms. Personality and Individual

Differences, 49, 645– 650. http://dx.doi.org/10

.1016/j.paid.2010.05.041

Kang, Y., Gruber, J., & Gray, J. R. (2013). Mindfulness

and de-automatization. Emotion Review, 5, 192–201.

http://dx.doi.org/10.1177/1754073912451629

Kazdin, A. E. (2007). Mediators and mechanisms of

change in psychotherapy research. Annual Review

of Clinical Psychology, 3, 1–27. http://dx.doi.org/

10.1146/annurev.clinpsy.3.022806.091432

Kim, S. H., & Hamann, S. (2007). Neural correlates

of positive and negative emotion regulation. Jour-

nal of Cognitive Neuroscience, 19, 776–798.

http://dx.doi.org/10.1162/jocn.2007.19.5.776

Kohn, N., Eickhoff, S. B., Scheller, M., Laird, A. R.,

Fox, P. T., & Habel, U. (2014). Neural network of

cognitive emotion regulation—An ALE meta-

analysis and MACM analysis. NeuroImage, 87,

345–355. http://dx.doi.org/10.1016/j.neuroimage

.2013.11.001

Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer,

J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996).

The role of the therapeutic alliance in psychother-

apy and pharmacotherapy outcome: Findings in

the National Institute of Mental Health Treatment

of Depression Collaborative Research Program.

Journal of Consulting and Clinical Psychology,

64, 532–539. http://dx.doi.org/10.1037/0022-006X

.64.3.532

Lane, R. D., Fink, G. R., Chau, P. M. L., & Dolan,

R. J. (1997). Neural activation during selective

attention to subjective emotional responses. Neu-

roreport: An International Journal for the Rapid

Communication of Research in Neuroscience, 8,

3969–3972. http://dx.doi.org/10.1097/00001756-

199712220-00024

Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L.

(2015). Memory reconsolidation, emotional

arousal, and the process of change in psychother-

apy: New insights from brain science. Behavioral

and Brain Sciences, 38, e1. http://dx.doi.org/10

.1017/S0140525X14000041

Leichsenring, F., Salzer, S., Jaeger, U., Kächele, H.,

Kreische, R., Leweke, F.,...Leibing, E. (2009).

Short-term psychodynamic psychotherapy and

cognitive-behavioral therapy in generalized anxi-

ety disorder: A randomized, controlled trial. The

American Journal of Psychiatry, 166, 875– 881.

http://dx.doi.org/10.1176/appi.ajp.2009.09030441

Linehan, M. M., Comtois, K. A., Murray, A. M.,

Brown, M. Z., Gallop, R. J., Heard, H. L.,...

Lindenboim, N. (2006). Two-year randomized

controlled trial and follow-up of dialectical behav-

ior therapy vs therapy by experts for suicidal be-

haviors and borderline personality disorder. Ar-

chives of General Psychiatry, 63, 757–766. http://

dx.doi.org/10.1001/archpsyc.63.7.757

Lundqvist, L.-O., & Dimberg, U. (1995). Facial ex-

pressions are contagious. Journal of Psychophysi-

ology, 9, 203–211.

11AFFECT REGULATION AND RECONSOLIDATION

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Malinowski, P. (2013). Neural mechanisms of atten-

tional control in mindfulness meditation. Frontiers

in Neuroscience, 7, 8. http://dx.doi.org/10.3389/

fnins.2013.00008

McCullough, L., & Andrews, S. (2001). Assimilative

integration: Short term dynamic psychotherapy for

treating affectphobias. Clinical Psychology: sci-

ence and practice, 8, 82–97.

Medford, N., & Critchley, H. D. (2010). Conjoint

activity of anterior insular and anterior cingulate

cortex: Awareness and response. Brain Structure

& Function, 214, 535–549. http://dx.doi.org/10

.1007/s00429-010-0265-x

Mennin, D., & Farach, F. (2007). Emotion and evolving

treatments for adult psychopathology. Clinical Psy-

chology: Science and Practice, 14, 329–352. http://

dx.doi.org/10.1111/j.1468-2850.2007.00094.x

Menon, V., & Uddin, L. Q. (2010). Saliency, switch-

ing, attention and control: A network model of

insula function. Brain Structure & Function, 214,

655– 667. http://dx.doi.org/10.1007/s00429-010-

0262-0

Milad, M. R., & Quirk, G. J. (2012). Fear extinction

as a model for translational neuroscience: Ten

years of progress. Annual Review of Psychology,

63, 129–151. http://dx.doi.org/10.1146/annurev

.psych.121208.131631

Moyal, N., Cohen, N., Henik, A., & Anholt, G. E.

(2015). Emotion regulation as a main mechanism

of change in psychotherapy. Behavioral and Brain

Sciences, 38, e18. http://dx.doi.org/10.1017/

S0140525X14000259

Nader, K., & Hardt, O. (2009). A single standard for

memory: The case for reconsolidation. Nature Re-

views Neuroscience, 10, 224–234. http://dx.doi

.org/10.1038/nrn2590

Ochsner, K. N., & Gross, J. J. (2005). The cognitive

control of emotion. Trends in Cognitive Sciences,

9, 242–249. http://dx.doi.org/10.1016/j.tics.2005

.03.010

Ochsner, K. N., Ray, R. D., Cooper, J. C., Robertson,

E. R., Chopra, S., Gabrieli, J. D., & Gross, J. J.

(2004). For better or for worse: Neural systems

supporting the cognitive down- and up-regulation

of negative emotion. NeuroImage, 23, 483– 499.

http://dx.doi.org/10.1016/j.neuroimage.2004.06

.030

Pascual-Leone, A., & Greenberg, L. S. (2007). Emo-

tional processing in experiential therapy: Why "the

only way out is through." Journal of Consulting

and Clinical Psychology, 75, 875– 887. http://dx

.doi.org/10.1037/0022-006X.75.6.875

Robins, C. J., Ivanoff, A. M., & Linehan, M. M.

(2001). Dialectical behavior therapy. In W. J.

Livesley (Ed.), Handbook of personality disor-

ders: Theory, research, and treatment (pp. 437–

459). New York, NY: Guilford Press.

Rottenberg, J. E., & Johnson, S. L. (2007). Emotion

and psychopathology: Bridging affective and clin-

ical science. Washington, DC: American Psycho-

logical Association. http://dx.doi.org/10.1037/

11562-000

Sahdra, B. K., MacLean, K. A., Ferrer, E., Shaver,

P. R., Rosenberg, E. L., Jacobs, T. L.,...Saron,

C. D. (2011). Enhanced response inhibition during

intensive meditation training predicts improve-

ments in self-reported adaptive socioemotional

functioning. Emotion, 11, 299–312. http://dx.doi

.org/10.1037/a0022764

Samoilov, A., & Goldfried, M. R. (2000). Role of

emotion in cognitive-behavior therapy. Clinical

Psychology: Science and Practice, 7, 373–385.

http://dx.doi.org/10.1093/clipsy.7.4.373

Schiller, D., Kanen, J. W., LeDoux, J. E., Monfils,

M. H., & Phelps, E. A. (2013). Extinction during

reconsolidation of threat memory diminishes pre-

frontal cortex involvement. Proceedings of the Na-

tional Academy of Sciences of the United States of

America, 110, 20040–20045. http://dx.doi.org/10

.1073/pnas.1320322110

Schiller, D., Monfils, M. H., Raio, C. M., Johnson,

D. C., Ledoux, J. E., & Phelps, E. A. (2010).

Preventing the return of fear in humans using

reconsolidation update mechanisms. Nature, 463,

49–53. http://dx.doi.org/10.1038/nature08637

Schiller, D., & Phelps, E. A. (2011). Does reconsoli-

dation occur in humans? Frontiers in Behavioral

Neuroscience, 5, 24. http://dx.doi.org/10.3389/

fnbeh.2011.00024

Schore, A. N. (2016). Affect regulation and the origin

of the self: The neurobiology of emotional devel-

opment. New York, NY: Routledge.

Schwabe, L., Nader, K., & Pruessner, J. C. (2014).

Reconsolidation of human memory: Brain mecha-

nisms and clinical relevance. Biological Psychia-

try, 76, 274–280. http://dx.doi.org/10.1016/j

.biopsych.2014.03.008

Schwabe, L., & Wolf, O. T. (2010). Stress impairs

the reconsolidation of autobiographical memories.

Neurobiology of Learning and Memory, 94, 153–

157. http://dx.doi.org/10.1016/j.nlm.2010.05.001

Sevenster, D., Beckers, T., & Kindt, M. (2012). Re-

trieval per se is not sufficient to trigger reconsoli-

dation of human fear memory. Neurobiology of

Learning and Memory, 97, 338–345. http://dx.doi

.org/10.1016/j.nlm.2012.01.009

Shallcross, A. J., Troy, A. S., Boland, M., & Mauss,

I. B. (2010). Let it be: Accepting negative emo-

tional experiences predicts decreased negative af-

fect and depressive symptoms. Behaviour Re-

search and Therapy, 48, 921–929. http://dx.doi

.org/10.1016/j.brat.2010.05.025

Shapiro, S. L., & Carlson, L. E. (2017). The art and

science of mindfulness: Integrating mindfulness

into psychology and the helping professions (2nd

12 STEVENS

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ed.). Washington, DC: American Psychological As-

sociation. http://dx.doi.org/10.1037/0000022-000

Shedler, J. (2010). The efficacy of psychodynamic

psychotherapy. American Psychologist, 65, 98–

109. http://dx.doi.org/10.1037/a0018378

Siegel, D. J. (2012). The developing mind: How

relationships and the brain interact to shape who

we are. New York, NY: Guilford Press.

Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred,

H., & Staiger, P. K. (2017). Emotion regulation as

a transdiagnostic treatment construct across anxi-

ety, depression, substance, eating and borderline

personality disorders: A systematic review. Clini-

cal Psychology Review, 57, 141–163. http://dx.doi

.org/10.1016/j.cpr.2017.09.002

Stevens, F. L. (2016). The anterior cingulate cortex in

psychopathology and psychotherapy: Effects on

awareness and repression of affect. Neuropsycho-

analysis, 18, 53– 68. http://dx.doi.org/10.1080/

15294145.2016.1149777

Stevens, F. L. (2017). Authenticity: A mediator in the

relationship between attachment style and affec-

tive functioning. Counselling Psychology Quar-

terly, 30, 392– 414. http://dx.doi.org/10.1080/

09515070.2016.1176010

Teper, R., & Inzlicht, M. (2013). Meditation, mind-

fulness and executive control: The importance of

emotional acceptance and brain-based perfor-

mance monitoring. Social Cognitive and Affective

Neuroscience, 8, 85–92. http://dx.doi.org/10.1093/

scan/nss045

Tracy, J. L., Klonsky, E. D., & Proudfit, G. H.

(2014). How affective science can inform clinical

science: An introduction to the special series on

emotions and psychopathology. Clinical Psycho-

logical Science, 2, 371–386. http://dx.doi.org/10

.1177/2167702614537627

Verduyn, P., & Lavrijsen, S. (2015). Which emotions

last longest and why: The role of event importance

and rumination. Motivation and Emotion, 39, 119–

127. http://dx.doi.org/10.1007/s11031-014-9445-y

Welling, H. (2012). Transformative emotional se-

quence: Towards a common principle of change.

Journal of Psychotherapy Integration, 22, 109–

136. http://dx.doi.org/10.1037/a0027786

Werner, K., & Gross, J. J. (2010). Emotion regulation

and psychopathology: A conceptual framework. In

A. M. Kring & D. M. Sloan (Eds.), Emotion reg-

ulation and psychopathology: A transdiagnostic

approach to etiology and treatment (pp. 13–37).

New York, NY: Guilford Press.

Westen, D. (2000). Commentary: Implicit and Emo-

tional Processes in Cognitive Behavioral Therapy.

Clinical Psychology: Science and Practice, 7,

386–390.

Wilamowska, Z. A., Thompson-Hollands, J.,

Fairholme, C. P., Ellard, K. K., Farchione, T. J., &

Barlow, D. H. (2010). Conceptual background,

development, and preliminary data from the uni-

fied protocol for transdiagnostic treatment of emo-

tional disorders. Depression and Anxiety, 27, 882–

890. http://dx.doi.org/10.1002/da.20735

Wiser, S., & Goldfried, M. R. (1993). Comparative

study of emotional experiencing in psychodynamic-

interpersonal and cognitive-behavioral therapies.

Journal of Consulting and Clinical Psychology, 61,

892– 895. http://dx.doi.org/10.1037/0022-006X.61.5

.892

Received February 14, 2018

Revision received June 8, 2018

Accepted June 18, 2018 䡲

13AFFECT REGULATION AND RECONSOLIDATION

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... Many studies have demonstrated the MR process with target learnings that involve no emotion, such as memory of a spatial arrangement of emotionally neutral objects, procedural memory of finger movements, or declarative/episodic memory of meaningless syllables. These research facts also mean that the MR mechanism is misrepresented by accounts that depict it as an inherently emotional or affective process (e.g., Lane et al. 2015;Stevens 2019;Welling 2012). ...

• Bruce Ecker
• Sara K. Bridges

Memory reconsolidation research by neuroscientists has demonstrated the erasure of emotional learnings. This article reviews these historic findings and how they translate directly into therapeutic application to provide the clinical field with an empirically confirmed process of transformational change. Psychotherapists' early use of this new, transtheoretical knowledge indicates a strong potential for significant advances in both the effectiveness of psychotherapy and the unification of its many diverse systems. The erasure process consists of the creation of certain critical experiences required by the brain, and it neither dictates nor limits the experiential methods that therapists can use to facilitate the needed experiences. This article explains memory reconsolidation, delineates the empirically confirmed process, illustrates it in a case example of long-term depression, indicates the evidence supporting the hypothesis that this process is responsible for transformational change in any therapy sessions, describes the differing mechanisms underlying transformational change versus incremental change, and reports extensive clinical evidence that the basis and cause of most of the problems and symptoms presented by therapy clients are emotional learnings, that is, emotionally laden mental models, or schemas, in semantic memory.

... rekonsolidace paměti doložený neurovědou teprve nedávno (Beckers, Kindt, 2017;Lane et al., 2015). Stevens (2019) ve svém článku ukazuje, jak se vědomá regulace emocí a korektivní zkušenosti mohou v psychoterapii doplňovat, a navrhuje obě tyto možnosti práce s emocemi v psychoterapii integrovat. ...

• Jan Benda

Background. Frequent comorbidity of mental disorders together with the latest findings in neurobiology have been drawing attention of health professionals over the past years to so-called transdiagnostic factors, including, but not limited to difficulties in emotion regulation and self-compassion. It seems that these factors play a significant role in the etiology of many mental disorders as well as in the maintenance of mental health and well-being. Objectives. The aim of this thesis was to theoretically discuss and scientifically verify the expected relationship between parental emotional warmth in childhood, self-compassion and emotion regulation. Sample and procedure. 440 adult respondents (141 men and 299 women) completed the questionnaire "My Memories of Upbringing"- Short Form (s-EMBU), the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF-CZ) and the Self-Compassion Scale (SCS-CZ) together with several demographic questions in an online survey. Statistical analysis. Descriptive statistics and the Pearson's correlation coefficients were calculated using IBM SPSS Statistics-23 software. The effect of gender and education on key variables was tested using two-way multivariate analysis of variance (MANOVA). Gender differences in correlations were compared using Fisher's r-to-z transformation. We also performed mediation analysis according to Baron and Kenny's procedure. Results. The results revealed significant correlations between the observed variables and showed that self-compassion was a significant mediator of the relationship between parental emotional warmth in childhood and difficulties in emotion regulation. The correlations of parental emotional warmth in childhood with self-compassion as well as with difficulties in emotion regulation were significantly higher in men than in women. Study limitations. This study relied exclusively on self-report measures. Respondents evaluated their parents' warmth only retrospectively.

• Paola Miano
• Gaia Di Salvo
• Massimo Lavaggi

Seeking help and assistance can prove to be a frustrating experience for intersex individuals: physicians and psychologists can be misinformed about variations of sex characteristics (VSC) and their practice may have a detrimental effect on the physical and psychological wellbeing of individuals with VSC. This paper focuses on how previous negative experiences, such as early genital cosmetic surgery and unaware clinical management, could negatively affect psychotherapeutic relationships. Its principal aims are to: 1) identify which elements in clinical management of VSC may cause difficulties in building a therapeutic alliance and 2) identify which elements may promote the construction and reinforcement of the therapeutic alliance, even when a patient's trust has been damaged by previous negative experiences. In order to explore the psychotherapeutic process with specific regard to the building of the therapeutic alliance, we report a case study whose subject is a 32-year-old man who sought legal advice for his sex reassignment process and began a brief supportive psychotherapeutic treatment. Roberto, the subject of this study, was born with VSC, was assigned the female gender and underwent genital surgery at birth. In his early childhood, he developed a male gender identity. Whenever Roberto reflected on the genital surgery that he had undergone at birth, anger and frustration pervaded his psychotherapy sessions and made it difficult to build a therapeutic alliance. However, it was possible to support Roberto in redirecting these negative affects, helping him to process them, build a therapeutic alliance, and benefit from a positive and trusting therapeutic relationship.

• Ruth Metten

Dieses Kapitel klärt die Frage, ob bei Gedächtnis-Updates, die Erinnerungen an Erfahrungen überschreiben, in der Tat das Wissen darum verloren geht, was ursprünglich geschah.

• Laura Martin Braunstein
• James J Gross
• Kevin N Ochsner

The ability to adaptively regulate emotion is essential for mental and physical well-being. How should we organize the myriad ways people attempt to regulate their emotions? We explore the utility of a framework that distinguishes among four fundamental classes of emotion regulation strategies. The framework describes each strategy class in terms their behavioral characteristics, underlying psychological processes, and supporting neural systems. A key feature of this multi-level framework is its conceptualization of the psychological processes in terms of two orthogonal dimensions that describe (1) the nature of the emotion regulation goal (ranging from to implicit to explicit) and (2) the nature of the emotion change process (ranging from more automatic to more controlled). After describing the core elements of the framework, we use it to review human and animal research on the neural bases of emotion regulation and to suggest key directions for future research on emotion regulation.

Experimental research on emotional memory reconsolidation interference, or the induction of amnesia for previously established emotional memory, has a long tradition, but the potential of that research for the development of novel interventions to treat psychological disorders has been recognized only recently. Here we provide an overview of basic research and clinical studies on emotional memory reconsolidation interference. We point out specific advantages of interventions based on memory reconsolidation interference over traditional treatment for emotional disorders. We also explain how findings from basic research suggest limitations and challenges to clinical translation that may help to understand why clinical trials have met with mixed success so far and how their success can be increased. In closing, we preview new intervention approaches beyond the induction of amnesia that the phenomenon of memory reconsolidation may afford for alleviating the burden imposed by emotional memories, and we comment on theoretical controversies regarding the nature of memory reconsolidation.

• Francis Leroy Stevens

The awareness of emotion and its subsequent regulation is an essential part of psychopathology and psychotherapy. A body of evidence indicates that the anterior cingulate cortex (ACC) plays a key role in accessing and regulating emotion and thus participates both in the conscious awareness and the repression of emotion. Research is examined drawing a distinction between psychopathologies with excessive affect, which exhibit hyperactivity in ACC, and psychopathologies with flat affect, which exhibit a hypoactivity in the rostral ACC. This distinction may support therapeutic interventions that target the up- or down-regulation of emotion dependent on clinical disorder. Specific focus is made to psychoanalytic therapy, being built upon the tenet of accessing repressed emotions, for which the ACC appears functionally significant. The research reviewed provides insight into how the ACC may be a primary region in the suppression and repression of emotion. Suggestions for how the ACC may be activated in different types of psychotherapy are also made.

This online therapist guide is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which capitalizes on the contributions made by cognitive-behavioral theorists by distilling and incorporating the common principles of CBT present in all evidenced based protocols for specific emotional disorders, as well as drawing on the field of emotion science for insights into deficits in emotion regulation. It covers the seven modules of UP, and focuses on four core strategies to help patients: becoming mindfully aware of emotional experience; reappraising rigid emotion laden attributions; identifying and preventing behavioral and emotional avoidance; and facilitating exposure to both interoceptive and situational cues associated with emotional experiences.

Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity.

A large body of research has implicated difficulties in emotion regulation as central to the development and maintenance of psychopathology. Emotion regulation has therefore been proposed as a transdiagnostic construct or an underlying mechanism in psychopathology. The transdiagnostic role of emotion regulation has yet to be systematically examined within the psychological treatment outcome literature. It can be proposed that if emotion regulation is indeed a transdiagnostic construct central to the maintenance of psychopathology, then changes in emotion regulation difficulties will occur after effective treatment and this will occur for different disorders. We conducted a systematic review, identifying 67 studies that measured changes in both emotion regulation and symptoms of psychopathology following a psychological intervention for anxiety, depression, substance use, eating pathology or borderline personality disorder. Results demonstrated that regardless of the intervention or disorder, both maladaptive emotion regulation strategy use and overall emotion dysregulation were found to significantly decrease following treatment in all but two studies. Parallel decreases were also found in symptoms of anxiety, depression, substance use, eating pathology and borderline personality disorder. These results contribute to the growing body of evidence supporting the conceptualization of emotion regulation as a transdiagnostic construct. The present study discusses the important implications of these findings for the development of unified treatments that target emotion regulation for individuals who present with multiple disorders.

• Francis Leroy Stevens

Attachment has been show to exhibit a strong effect on emotional well-being throughout an individual's lifetime. This study examined individuals' authenticity as a potential mediating variable in the relationship between insecure attachment and affective functioning. Authenticity was examined from multiple perspectives to better define its role as a mediating variable. Results showed that avoidant attachment is a predictor of affective functioning, and that authenticity acts as a mediating variable in this relationship. Anxious attachment showed no direct relationship with affective functioning, yet evidence was found for an indirect pathway from anxious attachment through authenticity on affective functioning. The differing results by attachment style support Mikulincer, Shaver, and Pereg's theory suggesting a two-part model of emotional response style, wherein individuals with avoidant attachment deactivate emotion and individuals with anxious attachment show hyper-activation when coping with emotion. The study examines the construct of authenticity and its importance in affective functioning. Implications for therapists working with clients are made that highlight the importance of authentic relationships in therapy and life.

Source: https://www.researchgate.net/publication/328087359_Affect_Regulation_and_Affect_Reconsolidation_as_Organizing_Principles_in_Psychotherapy

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