Motivation and emotion/Book/2019/Affect regulation theory

Overview


Lyle is a 55-year-old man who had a history of marked fear, rage, alcoholism, has spent a long time being unemployed and has had multiple failed treatments(psychotherapy and medications). He is also diagnosed with ADHD, attachment disorder and met the criteria for antisocial personality disorder. From his assessment, it was shown he was over-aroused and having great difficulty regulating his emotions, particularly fear and rage. The case study follows the effects of the training on increasing his capacity for affect regulation, evolving sense of empathetic engagement with others and the key physical symptoms he reported. He trained over 87 neurofeedback sessions (approx 44 hours). Later on we will talk about the outcomes of this case study but before that we will take a further look at Affect regulation theory and it application.



The ability to regulate affect develops from early attachment relationships and is an ongoing process throughout all developmental stages. Affect regulation is ability to successfully regulate both pleasant and unpleasant emotions in everyday life (see figure 1.). Affect regulation can apply to any individual in any situation that occurs in everyday life. The ability to handle everyday stressors in everyday life and return back to homeostasis is a result of good affect regulation strategies. Those who have poor affect regulation strategies do not return back to homeostasis. The lack of ability to return to homeostasis after everyday stressors can result in psychological and physiological disorders. The purpose of this chapter is to help people understand what Affect regulation theory is and how it can be applied.




 * - What is Affect regulation theory?


 * - How is Affect regulation theory applied?

What is affect regulation theory?
Firstly, we must know what an emotion is, (happiness, sadness, guilt and disgust etc.). An emotion is a mental state that can rise automatically, which often coexists with distinct physiological changes. While affect is the conscious experience of emotions, which often guide our behaviour. They often direct us to what is right in a situation but not always for every individual. For certain individuals emotions can be overwhelming and lead to negative behaviours.

Affect regulation refers to a set of processes involved in either the modification or maintenance of affects (emotions, moods and stress responses) (Guiller & Dauvier, Pavani & Chakri & Congard, 2019). An individual uses strategies (methods used to achieve a goal) to change and maintain an affective state. The main goal of affect regulation is to improve and enhance positive affect and decrease negative affect. The emotions experienced by individuals are a consequence of a feedback process that runs automatically.

Two varieties of affect are in play automatic affect regulation and controlled affect regulation. Automatic affect regulation is at a nonconscious level without awareness, such as defence mechanisms spontaneously occurring (fight, flight and freeze). While controlled affect regulation is intentional regulation using strategies to influence mood and emotion.

Daniel Hill developed affect regulation theory, which is derived from Allan Schore's work (regulation theory) and also from Peter Fonagy and his collaborators' work (metallisation theory) (Hill, 2015). The theory is an integration of other various theories and studies such as attachment theory, developmental affective neurobiology, emotional studies, mother-infant studies, developmental psychoanalysis, and developmental social-cognitive neurobiology. Affect theory is an integration of psychology and biology (body and mind). The contributions of this theory strive to explain how early experiences alter later experiences in life and to recognise the underlying mechanisms, by which the brain arranges its neural activities in social interactions.



Affect regulation has been found to reside more in the right hemisphere (RH). In the case study it was shown that Lyle had poor affect regulation especially towards rage and fear, which is generated (primarily) by the amygdala in the right hemisphere (see figure 2.). The RH is the non-verbal side of the brain, while the language centres are in the left hemisphere (LH). From the assessment it is suggested that his fight-flight-freeze RH amygdala is hyperactive and could explain why it could not reach the LH (language). Fear is a core emotion in psychopathology, based on the case study neurofeedback has the potential to enhance affect regulation, particularly in this case the regulation of fear. Further it seems that certain neurofeedback processes can effect on the functioning of the RH and may strengthen the inhibitory (decrease) activity of the right pre-frontal cortex over the fight-flight-freeze process in the amygdala. However, the results from this case study would need to be further research as this is only one instance and not a large enough sample to come to conclusion for the entire population.

An important aspect of affect regulation is the adaptiveness or maladaptiveness of certain affect regulation strategies. Some strategies such as avoidance and rumination are positively linked to anxiety while other strategies such as reappraisal and problem solving are negatively linked to anxiety. Controlled regulation is used normally to improve an individual's emotions (upward regulation), however one can deliberately worsen affect (downward regulation) and actively try to maintain an unpleasant state.

The table below shows affect-regulation strategies that individuals implement, which can be adaptive or maladaptive (Parkison & Totterdell, 1999):

Quiz


{What is affect ?


 * type=""}

- is a mental state that can rise automatically, which often coexists with distinct physiological changes. - refers to a set of processes involved in either the modification or maintenance of affects (emotions, moods and stress responses) - the ability to handle everyday stressors and return back to homeostasis is a result of good affect regulation strategies. + is the conscious experience of emotions, which often guide our behaviour. }

Relevant theories and research
Below are a mix of theories and areas of research that demonstrate significant relevance towards affective regulation theory:

Emotion regulation theory
As previously talked about emotions guide behaviours, which is explained in Emotion regulation theory. Emotions can be experienced as positive or negative, fleeting or prolonged and can vary in intensity (weak or strong). The brain structures that have been identified as crucial to emotion and emotion regulation include the limbic system, amygdala and the hippocampus.

The quality of emotions make up the term, modal model of emotion which consists of four steps.

The following is an emotional response generation which happens in 4 steps (modal model of emotion):


 * 1) situation: psychological relevant situation has occurred, which can be external or internal
 * 2) attention: the situation attracts the individuals attention
 * 3) appraisal: can happen across a number of dimensions such as novelty of the situation, degree to which the situation attracted the individuals attention, the attractiveness or valence of a situation which can lead to avoidance or approach behaviours and finally the motivational applicability of the situation
 * 4) response: emotional feedback, which can cause change in the original situation

Following from a situation appraisal, an emotional response may be produced, which shows how emotions are constantly moderating the situation in which we find ourselves in, causing us to reassess and respond to a certain situation as it happens. Different strategies can take place along this model such as antecedent focused strategies, situation selection, situation modification, attentional deployment and cognitive change. In depression, it is shown that emotional regulation is dysfunctional. It is suggested that individuals vulnerable and not vulnerable to depression do not differ in their response to a negative event, but differ in their ability to recover from the resulting negative affect. Thus specific habitual emotional regulation strategies used by individuals can play an significant role in the onset and maintenance of depression.

Self-regulation theory
Self-regulation theory (self control), is the self-corrective alterations that are needed to stay on track for goal oriented behaviour (Vohs & Baumeister, 2016). The corrective alterations originate from within, with behaviour seen as a reflecting feedback control for these corrective alterations. This feedback loop involves evaluating the present condition and comparing it to the desired condition, which is the future goal. Research into self regulation theory and physical illness shows how patients cope with events that occur during a physical illness. Every patient has a unique experience and will decide how satisfied they are with the outcome of their health care. Health care providers such as nurses can influence the patients analysis of their approach to coping, but the patients conclusions and choices is what guides their behaviour. Patients are also expected to also play an active role in evaluating their care. The correct types of information to cope with health care events can be explained by this theory, as the correct type of information can benefit patients in the health care process. In this study the theory was relying on information processing explanations to explain behaviour.

The following four assumptions of information processing based on self-regulation theory for coping with a physical illness were made:


 * 1) People use their perceptions and interpretations of their experience to adjust their responses and behaviour
 * 2) Knowledge about concepts and information and how to use that knowledge is represented in cognitive networks called schemata
 * 3) The information in a schema is organised hierarchically
 * 4) A disparity between the individuals goal or expected outcome and what currently occurring motivates the person to take control of their situation to reduce the difference between the what is expected and what is actually occuring

This theory has heavy reliance on experimental research and has showed that when nurses are guided by this theory patients outcomes were immensely improved.

Quiz


{Which step is not in the modal model of emotion?}


 * type=""}

+ achievement - situation - apraisel - response

{Self-regulation theory (self control), is the self-corrective alterations that are needed to stay on track for goal orienting behaviour. + True - False
 * type=""}

How can affective regulation theory be applied?
Below shows the various ways that Affective regulation theory can be applied:

Communication


Complex emotional relationships can have a transference of affect as it is contagious, such as if one baby starts crying many babies will also start crying (Hill, 2015). Infants are born with affect however have little ability to regulate their own affect. Attachment early on from the caregiver is important as it is necessary for building good affect regulation (nurture and comfort). It is passed down from caregiver through emotional communication, as the baby communicates both negative emotional states and positive emotional states the caregiver will be able to regulate these emotions. Insecurely attached children can create affect regulation impairment and from this it can leave the child predisposed to an onset of an psychosomatic and psychiatric disorders.

Purpose of secure attachment during the critical period:


 * early attachment drives brain development (right hemisphere is shaped, which is critical for affect regulation as it is the "emotional side") (see Figure 6.)
 * survival function (capacity to communicate internal states to others and receive a response, social relations)
 * self-regulation
 * ability to auto-regulate emotional states
 * early trauma/dysregulation is imprinted intro the the early developing right brain resulting in affect dysregulation which underlie all psychiatric and psychological disorders
 * develop strategies for affect regulation and coping mechanisms for basic regulation and positive affect in the face of environmental stressors



Mental disorders
Mental disorders involve at least some kind of undesired affective state either as important part of the diagnostic criteria or as a likely sign of a cognitive or behavioural symptom. They also appear relevant to the development, maintenance and treatment of various forms of psychopathology which increasing research showing these deficits in ability to deal with difficult emotions. Affect dysregulation often results in negative behaviours such as binge eating, restrictive eating, alcohol or drug consumption or self-harming behaviour. These behaviours are seen as a way to avoid or decrease aversive affective states or repair a sense of control over one’s own feelings. We will now delve deeper into one mental disorder and take a look at how affect regulation is a maintenance mechanism for eating disorders.

Underlying mechanisms of eating disorders
Affect-regulation is maintained by the way our nervous system controls the arousal in response to stress or it can be the way individuals manage their energy (Lapides, 2010). Individuals that are prone to dysregulated states, often have an underlying unhealthy relationship to food. Eating disorders are said to be strategies to manage excessive disruptive arousal.Characteristics of eating disorders:


 * subset of externalising disorders
 * considered the most difficult to treat
 * highest mortality rate among mental disorders
 * primary cause failure of early attachment relationships to teach self-regulation
 * they rely on external regulators to self-regulate
 * overeating as a source of comfort
 * others turn away from food (avoidance behaviours)
 * Anorexia creates an avoidance state
 * Binging/purgings creates a dissociative (numbing) state
 * attachment dysregulation may contribute to maladaptive affect regulation strategies

We will take a further look further at one eating disorder anorexia nervosa and its relationship with affect regulation. In the following study, negative affect for individuals suffering with anorexia nervosa was found to increase dietary restriction, it also significantly increased after loss of control eating, weighing one's self and purging behaviours. Negative affect would decrease after behaviours such as drinking fluids (decrease appetite) and exercising (see Figure 4.). It have been shown that negative affect is a maintenance mechanism for some anorexia nervosa symptoms. In the efforts of the individual to escape negative affect they perform these behaviours that are overall harmful to themselves. It has shown that guilt is an important component of negative affect that can explain the increased negative affect in anorexia patients after they engage in these behaviours. Next we will look at how affect regulation is used in therapy and how to treat patients with dysfunctional affect regulation as seen in anorexia nervosa.

Therapy
Therapeutic interventions across a wide spread of psychopathologies share a common objective to develop and improve emotional auto-regulatory and interactive regulatory processes within clients. Current research has significant implications for treatment for many mental disorders such as anorexia nervosa. Treatment such as cognitive emotional behavioural therapy (CBT) allow for emotions to be the central focus of treatment, with the aim of treating patients with mental disorders such as eating disorders to understand the experience and expression of emotion so that they can identify and challenge their beliefs and attention, and successfully respond to their emotions adaptively.

One type of therapy psychodynamic psychotherapies helps clients to regulate affect, so they can maintain homeostasis. From one study it showed that psychodynamic therapy plays a important role in in children’s understanding of their mental and internal reality by providing a safe environment to experiment with different types of mental states and feelings, experience negative emotions from a representational distance, and try out coping strategies. Pretend play for children was used as learning task about mental reality and the development of mentalisation. Childs play with a therapist allows for the child to have their mental states recognised and affirmed, which is crucial for the child to be able to understand their own internal mental states and for their own capacity to affect regulate (experiences). Those who have behavioural problems gave issues with symbolic play organisation, particularly with their regulation of negative affect. The aim with psychodynamic therapy with those who have behavioural problems is to enhance their symbolic and mentalising capacities in play, which in turn enhances their affect regulation.

Well-being


Affect regulation is important for successfully interacting with one's environment and with the implementation of good affect regulation strategies overall well-being can increase (optimal functioning). Individual's usually strive to increase positive emotions while dampening negative emotions through regulations strategies. Controlling an individual's reaction to the environment is an adaptive process, as various events will call for an individuals to regulate their affect in order to have optimal functioning. Positive emotions increase the individuals abilities in both attention and cognition, which increases well-being.

The regulation of both positive and negative emotions contributes to overall life satisfaction. Positive emotions are not only beneficial for the present but increase the likelihood to be able to feel good in the future (upward spiral effect). Positive emotions unlike negative emotions, increase thought-action, which encourages individuals to discover novel ideas and actions (eg. joy creates an urge to explore and play). The differences in affect regulation strategies among individuals varies with the degree of their emotional health. Avoidance strategies should be reduced, while increasing engagement strategies will improve overall well-being. One positive event does not maintain overall well-being but an accumulation increases longevity of overall well-being. This shows that being in a positive mental state increases the chance of survival, as people who frequently experience positive emotions are to be more resilient to adverse situations and adapt better to stressful situations (stressors) (see Figure 5.).

Quiz


{Affect dysregulation often results in negative behaviours such as binge eating, restrictive eating, alcohol or drug consumption or self-harming behaviour. + True - False
 * type=""}
 * type=""}

{Which answers are TRUE about eating disorders? + They are considered the most difficult to treat - They use good affect regulation strategies + they rely on external regulators to self-regulate + They are a subset of externalising disorders
 * type="[]"}


 * type=""}

{Controlling an individual's reaction to the environment is an adaptive process, as various events will call for individuals to regulate their affect in order to have optimal functioning.

+ True -False
 * type=""}
 * type=""}


 * type=""}

{Therapeutic interventions across a wide spread of psychopathologies do not share a common objective to develop and improve emotional auto-regulatory and interactive regulatory processes within clients. - True + False
 * type=""}
 * type=""}


 * type=""}

{Early _____ is important, as it is necessary for building good affect regulation.


 * type=""}

+ attachment - talking - walking - dance


 * type=""}

 Lyle had 87 sessions (8 months) of training and psychotherapy, after these sessions, he was no longer driven by fear and describes himself as being calm. He has made a lot of progress in his behaviour also driving slowly and his stress levels significantly decreased. However, he is unemployed and still experiences fear and failure, but is hopeful to keep progressing further towards bettering himself.

Operant conditioning the brain waves through neurofeedback impacted arousal and affect regulation for Lyle. Initially, he did not want to engage in psychotherapy, but after 50 treatment sessions of training, he was fully engaged in psychotherapy. Operant conditioning of his brain waves provided him with the capacity to regulate his affect, which prior therapy and medications had not. The psychotherapy then offered him an additional chance to talk about what he was experiencing. The greatest success that came out of this process for him, was the achievement of moving into the interpersonal world through empathic engagement with himself and others. The results from this case study, have important outcomes for enhancing affect regulation in individuals who do not have the full capabilities of performing affect regulation. Research further would be needed to come to further conclusions as it was a case study.

Conclusion
Affect regulation is an important factor in maintaining overall mental and physical health. It develops from a young age through caretaker emotional guidance and is an ongoing process throughout the developmental stages. The theory strives to explain how early life experiences alter future experiences in life and to understand how these experiences shape neural activities in social interactions (nature vs nurture). Knowledge of this theory will help individuals understand themselves better, as it shows the strategies that individuals utilise  to regulate their affect. Improving an individual's affect regulation strategies has many benefits for the individual and the society as a whole.

Future research should focus on different mental disorders and how they differ with coping in regulation of their emotions, which will enable therapy to be modified to the individuals needs (flexibility in therapy). Increasing individuals affect regulation improves well-being for those suffering and healthy, which can impact on society as a whole. More research into affect regulation improving well-being should be followed up, as someone who can manage their daily lives in the face of unpredictable events is optimal. ART is a fairly new theory and needs more research as limited sources were found compared to other theories such as emotion regulation theory.