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Mindful Emotion Regulation

Introduction

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Mindful emotion regulation is considered as a special strategy for regulating emotions, which is a process of enhancing the awareness of subtle changes in initial signals of affective states and acceptance of the emotions with non-judgmental and open attitude.[1] Unlike traditional emotion regulation strategies (e.g. reappraisal and emotional suppression), which may result in both positive and negative effects, mindful emotion regulation is believed to be one of the most effective therapies that is increasingly being adopted to treat an array of psychological disorders.[2][3][4][5][6][7][8]

Mindfulness

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Origin & Development in Western Psychology

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The concept of mindfulness originates from traditional Buddhist philosophy.[9] The term “mindfulness” derives from Pāli word Sati, which can be found in Buddhist scriptures such as the Abhidamma[10] and the Visuddhimagga. [11] The original meaning of Sati is remembering, awareness and attention [12][9], which indicate a psychological state of a lucid awareness of what is occurring. Through openly repeated and intensive observations, practitioners (of Sati) are able to achieve the results in thinking steadily without drifting.[9] Moreover, the process of objectifying someone’s own ongoing interactions with thoughts, senses and affections also facilitates a practitioner to understand the intrinsic quality and character of the wholeness.[9][13] As a result, it is generally believed that Sati can change a practitioner’s cognitive and emotion states. [14] Since a sustained emotional balance can result in a calm and contented state, Sati can be applied to reduce both human physical and psychological sufferings.[15][9]

The term Mindfulness-based Stress Reduction (MBSR) was first pioneered by Kabat-Zinn [16][17] in late 1970s. Kabat-Zinn defines mindfulness as “paying attention in a particular way, on purpose, in the present moment, and non-judgmentally”.[18] More recently, mindfulness is commonly accepted in Western psychology as a state of “presence of mind” that practitioners are clearly aware of the inner and outer worlds, such as sensations, emotions, thoughts, actions or surroundings of present moment.[19]

Benefits from Mindfulness & Clinical Applications

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Nowadays, various interventions incorporated with mindfulness practice, such as MBSR, Dialectical Behavior Therapy (DBT)[20], Acceptance and Commitment Therapy (ACT) [21], and Mindfulness-based Cognitive Therapy (MBCT)[22], have been widely adopted as supplemental treatments for many physical and psychological disorders in medical and mental health settings.[16][23] The evidence of the benefits of these interventions is widely established. For example, research shows that Mindfulness-based Intervention (MBIs) can relieve psychological symptoms in cancer patients such as mood and anxiety disorders, stress, several types of chronic pains, sleeping disorders.[24]

Linehan (1993) suggests that Mindfulness can be regarded as a skill that can be trained by practice. Mindfulness training can take in the form of regular practice of meditation, which would improve practitioners' awareness, insight, wisdom and compassion.[25][26] For example, MBSR and MBCT training contains an 8-week-group-lesson, which requires 45 minutes daily meditation exercise as well as the individual practice at home.[27] As far as DBT and ACT are concerned, mindfulness-related skills can be developed through relatively multi shorter exercises without meditation.[26]

Emotion Regulation

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Definition and Strategies

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Emotion regulation has been playing an important role in psychology as its dysfunction is considered as a core cause of emotional disorders.[28] Moreover, emotion regulation may also influence much on other important social aspects such as social interaction and academic achievement.[29] There are two classic types of emotion regulation strategies that are often examined regarding mental health and social life including expressive suppression and cognitive reappraisal.[30][31] Expressive suppression is believed to cause more maladaptive effects including increased distance between individuals or “stonewalling” [32][33], impaired cognitive processes, (i.e. recalling information related to social situations) and an increase in sympathetic activation and cardiovascular activity endangering physical health.[34] Cognitive reappraisal, on the other hand, has more adaptive effects.[34] A decrease in extreme reaction or intense negative emotion (e.g. anger or anxiety) without elevated physiological responses is an example.[32] However, applying cognitive reappraisal frequently in daily life may potentially produce distortions or denial.[32] Each strategy has its own merits and drawbacks. Overall, studies state that mindfulness improves emotion regulation through developing metacognition awareness and interception.[31]

Mechanism of Mindful Emotion Regulation

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Psychological Mechanism

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Even though mindful emotion regulation has been attracting much attention but its mechanism still remains unclear.[35]

As a psychological construct characterized by intentionally dealing with current experience in both surroundings and inner settings (e.g. thoughts, emotions, and body sensations) with the attitude of non-judgment and acceptance [26][36][37][13], mindfulness has attention control in center mechanism, which is similar to emotion regulation. During mindfulness practice, paying attention to feelings, thoughts, or whatever is coming and leaving the mind or happening around allows individuals to be aware of emotions as well as emotive stimuli. This sustained attention keeps individuals staying in touch with the environment and quickly picking up signals which can evoke emotions as well as initial sensations. Therefore, by improving interception, mindfulness helps individuals regulate their emotions, before which actually occurs and controls subjects.[35]

Moreover, while cognitive reappraisal strategy involving shifting focus or withdrawing from emotive stimuli that may cause avoidance is considered to have negative effects, mindful emotion regulation seems to be one of the most positive strategies to regulate emotions because mindfulness is opposite of avoidance.[38]Additionally, mindfulness suggests accepting the objects as they are without judgment or reaction and allowing events to come and leave without raising any question. As a result, individuals are able to view emotions they experience objectively, stay separated from these mental events and not get involved in them, which leads to an increase in naturally emotional expression and a decrease in emotion suppression.[38][6]

Mindful emotion regulation is also not a kind of positive cognition reappraisal. The underlying reason is that during mindfulness practice, objects are perceived as they are while the nature of cognitive reappraisal is reinterpretation and reassessment, which potentially lead to denial and distortion. Mindful emotion regulation, therefore, should be treated as a separate and unique emotion regulation strategy.[35]

Neurobiological Mechanism

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Research in neurobiology and neuropsychology suggests that mindfulness is associated with changes in brain function, structures and neuroplasticity, which could lead to the improvement of the levels of attention, memory and executive functions.[39] More specifically, the changes in brain include grey matter volume, cortical thickness and regions (e.g. prefrontal cortex, anterior cingulate cortex and limbic system).[40]

The comparison of collected functional magnetic resonance imaging (fMRI) data from a sample of practitioners with basic mindfulness training (i.e. with no prior experience, having 1 week training before study) and a group of practitioners with more experience (i.e. more than 1000 hour training) shows that functional connectivity influences in default mode network (DMN) regions.[41] Relatively deactivated DMN regions (i.e. medial prefrontal and posterior cingulate cortices) were found in practitioners with more experience, which involve self-referential processing and emotional appraisal. In addition, the more experienced practitioners tend to have stronger connectivity between certain DMN regions, such as the dorsomedial prefrontal cortex (DMPFC), right inferior parietal lobule, posterior cingulate, dorsal anterior cingulate, and dorsolateral prefrontal cortices, which involve self-monitoring and cognitive control. These findings indicate that differences in DMN possibly lead to strengthened present-moment awareness.[42][41][43] Experienced practitioners seem to turn off some areas of brain when meditating. Even they are not meditating, the areas associated with wandering thoughts, anxiety and some psychiatric disorders such as schizophrenia are also turned off.[42]

Research also shows that after taking MBSR, cortical thickness increases in some regions of practitioners’ brain.[44] As far as experienced practitioners are concerned, a greater cortical thickness presents in the anterior regions (including the medial prefrontal cortex, superior frontal cortex, temporal pole, the middle and interior temporal cortices, and temporal parietal junction).[45][43] On the other hand, the posterior regions of the brain (including the postcentral cortex, inferior parietal cortex, middle occipital cortex and posterior cingulate cortex) show the reduction in cortical thickness.[43] Compared to the control group, experienced practitioners show different structures in both gray matter and white matter of brain .[43][40] The greater areas are associated with self-awareness, compassion, and the shrinking areas are related to stress.[46]

For mindfulness practice beginners, the common induction is to focus on physical sensations, especially breathing. Evidence from fMRI shows that, after the novice complete a brief task of mindful attention, focused breathing recruits an attention network including parietal and prefrontal structures.[47] Moreover, research suggests that few hours of training can also induce changes in brain structures and neuroplasticity.[48][43]

Farb et al. (2012)[49] examine MBSR graduates who have trained with intensive and explicit emphasis on body awareness, such as body posture, breathing, ambient tactile and temperature sensations. The study reports that taking mindfulness training contributes to greater interceptive attention (IA) related activity in anterior dysgranular insula regions, and decreased recruitment of the dorsomedial prefrontal cortex (DMPFC) etc. The results suggest that the mindfulness training benefits interception-awareness of the body’s internal and visceral states, such as respiration and heart rate, which is consistent with the idea that mindfulness can lower the blood pressure and boost the immune system.

Brain regions responsible for emotion regulation are related to PFC including dorsal and ventral system and ACC. The dorsal system is responsible for executive control (e.g. selective attention and working memory)[50], in which dorsolateral and medial PFC analyze information related to motivation from ventro-network to orient attention and memory as well as plan actions.[50][48] Ventral regions are related to response inhibition encompassing limbic, brainstem, amygdala, orbitofrontal structure of PFC is associated with modulate emotion-generative process (e.g. detecting emotional arousal).[50][48] More specifically, this network is sensitive to information related to motivation and automatic evaluation. ACC involves monitor control process, executive attention and playing the role as a bridge between functions of the ventral and dorsal networks, which leads to interaction between emotion and cognition.[50]

According to the correspondence between psychological mechanism of mindfulness and emotion regulation along with neurobiological bases of the two constructs, it is evident that mindfulness could be a positive strategy of emotion regulation. However, this relationship demands further research/evidence.[35]

Research Methods

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To study the mindful emotion regulation, behavioral and neuropsychological, first of all, empirical literature needs to be presented to support the efficacy of mindfulness. Some related measurements have been developed to assess the relationship between mindfulness training and its beneficial effects. Studies in behavioral research suggest that self-report questionnaires are used the most, which empirically examine the nature of mindfulness and its correlations with other psychological constructs. Studies also often combine questionnaires of mindfulness and emotion regulation together to find out their relationships. These questionnaires include The Mindful Attention Awareness Scale (MAAS), The Freiburg Mindfulness Inventory (FMI), The Kentucky Inventory of Mindfulness Skills (KIMS), The Cognitive and Affective Mindfulness Scale (CAMS) and The Mindfulness Questionnaire (MQ).

Another questionnaire worth mentioning is the Five Facet Mindfulness Questionnaire, which was developed by employing psychometric approach to combine four questionnaires abovementioned with MAAS, then being analyzed into five facets of mindfulness, namely observing, describing, acting with awareness, non-judging and non-reacting.[26] This questionnaire later was applied and adapted in many studies on mindfulness in both clinical and non-clinical settings. Despite of the fact that such questionnaire is well-structured and predicts more different aspects in behavior, emotion or personality, it is still one type of behavior measurement. Attention, emotion regulation, and acceptance processes may be too subtle and covert to be observed directly through behaviors or self-evaluated easily using these behavior measurements.[50]

There are also other methods that are used to capture neural processes and interaction between mindfulness and emotion regulation [51][52][53], which include event-related potential (ERP) or neuroimaging technique (fMRI).[54][51][55] Generally speaking, these research methods focus on the effects of mindfulness on specific brain regions by examining psychological processes underlying mindfulness and emotion regulation (e.g. attention, emotion, and executive function). As far as ERPs research is concerned, valuable components to track attention regulation, response inhibition and conflict monitoring in challenging situations are N2, P3, Error-related negativity (ERN) and late positive potential (LLP).[50][56] Lewis (2006)Cite error: A <ref> tag is missing the closing </ref> (see the help page). states that N2 and P3 are consistently related to inhibiting response in Go/No-go task. The amplitude and latency of both N2 and P3 amplitudes and latency are negatively related to brain maturity with age.[50] Study of Lewis et al.[53][52]using the combination of ERPs and observations in construct situations (flexibility in parent-children interactions) demonstrate that no-go N2/P3 amplitudes are larger than go N2/P3 amplitudes following emotion induction that is related to inhibitory control. There is also a decrease in P3 with age (5-16 years old sample). These results also prove the feasibility of these components of emotion regulation research. Moreover, Teper and Inzlicht (2013)[57] show that ERN component in Stroop task is larger in amplitude in participants with a higher level of acceptance and less errors, while LPP component is lower in more mindful individuals than those less mindful when confronting high arousal unpleasant stimuli.[58]

References

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