Reappraising negative emotions often a better mental health strategy than suppressing them

Emotions play an important role in the lives of humans, and influence our behavior, thoughts, decisions, and interactions. The ability to regulate emotions is essential to both mental and physical well-being. "Conversely, difficulties with emotion regulation have been postulated as a core mechanism underlying mood and anxiety disorders," according to the authors of a new study published in Biological Psychiatry.

Philippe R.Goldin and colleagues from Stanford University's Department of Psychology compared two specific regulation strategies - cognitive reappraisal and expressive suppression - in the context of negative emotions.

"Cognitive reappraisal is similar to one of the skills we teach in cognitive-behavioral therapy," Goldin said. "It's using thinking strategies to modulate emotional reactivity by changing the meaning of something." For example, if you were watching a doctor stitch up a wound in someone's arm, rather than just being horrified by all the blood, you might instead focus on the fact that the patient was being helped and would recover.

The other technique, expressive suppression, is a behavioral strategy that does not involve rethinking what you are experiencing. Instead, you simply suppress displaying any outward signs of what you are feeling; you grit your teeth and bear it.

People use both reappraisal and suppression to regulate emotions in everyday life. However, it has been suggested that reappraisal type cognitive regulation may be more effective because it impacts the emotion-generative process earlier than behavioral strategies.

To examine the differences in these processes, the researchers recruited healthy women volunteers who viewed short video clips of either neutral or negative (disgusting) images and were then instructed to implement the differing emotion regulation strategies. While doing so, the women provided emotion experience ratings and their facial expressions were videotaped. In addition, their brain activity was measured with functional magnetic resonance imaging, which allowed the authors to compare which areas of the brain were activated under each condition.

"In order to understand what happens when people control intense emotions in everyday life," said James Gross, associate professor of psychology and the paper's senior author. "We needed to induce potent emotions in the scanner so that we could see what parts of the brain are activated both by the emotion itself and by the efforts to regulate that emotion."

The researchers found that, while reappraisal reduced negative emotion experience and suppression reduced disgust facial expressions, they differed markedly in their impact on brain activity. Reappraisal resulted in rapid cognitive regulation-related prefrontal cortical activation and subsequent reduction of activation in two brain regions implicated in emotional experience, the amygdala and insula. In contrast, suppression resulted in a delayed component of prefrontal cortex activation related to volitional motor inhibition, but increased the activity of the amygdala and insula.

"These two forms of regulation work quite differently," Gross said. "Early forms of regulation, such as reappraisal, effectively shut down the emotion at relatively little cost." As for suppression, he said, "Although you can look cool as a cucumber, you actually get physiologically even more activated than you would have been if you had just let the emotion play itself out."

However, the researchers add that although rethinking the meaning of something is a better strategy in many situations, it is not always best.

"If a person is in an abusive relationship and uses reappraisal to justify the behavior of the person who is hurting him or her, that could lead them to stay in that dangerous situation far too long," Gross said. "

Similarly, suppression is often crucial in, for example, an interaction with an angry superior or boss at work. One simply doesn't have time to think or reappraise the situation differently and so one might, for the good of one's job, in that moment, choose to suppress so that the boss doesn't see what you really think of him or her."

Commenting on the findings John H. Krystal, MD, Editor of Biological Psychiatry said "These data support the belief that response suppression 'covers up' stress response, so that people who use this approach remain in a state of heightened vulnerability to negative emotion, while reappraisal may be a more successful coping strategy." Dr Goldin added, "This finding suggests that the efficacy of different emotion regulation strategies may be related to when they interrupt the emotion generative process. This sets the stage for understanding how to develop more effective forms of emotion regulation."

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Goldin PR, McRae K, Ramel W, Gross JJ. The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biol Psychiatry. 2008 Mar 15;63(6):577-86.   [Abstract]