Motivation and emotion/Book/2019/Cognitive reappraisal of emotion

Overview
Maya is a 16 year old girl who is currently in high school. She has been diagnosed with Generalised Anxiety Disorder and sees a psychologist regularly. She finds that various situations provoke an increased level of anxiety and panic, including receiving grades back on assignments, being given constructive feedback at school or at her weekend job, and also situations where she finds herself in larger groups of people. This is affecting her ability to function effectively at school and work and she is working with her psychologist to improve her anxiety in these situations.
 * Case study



Many people have found themselves in a situation where their emotions have gotten the better of them. They may have experienced a strong feeling of anger in a frustrating situation, but wished they had refrained from saying something that ended up making the situation worse. Our emotions have an important role, to influence our actions when something important to us may be under threat (Gross, 2002), like if we stumble across a poisonous snake, for instance. However, sometimes our emotions can get out of hand and may not be appropriate for the situation we are in (Gross, 2002). This is when we may want to exercise control over our emotions and influence them in a particular way (see Figure 1). We can do this through the use of emotion regulation. Effective emotion regulation techniques such as cognitive reappraisal of emotion can allow us to better understand our emotions and why they occur, giving us the power to influence them in a way that results in a higher overall life satisfaction (King & deal Rossa, 2019).

This chapter explores cognitive reappraisal of emotion, an emotion regulation strategy, and how it can be used to improve emotion regulation. Cognitive reappraisal will be defined, and key theories will be identified and discussed. Emotion regulation is discussed in relation to cognitive reappraisal, including an overview of other emotion regulation strategies. This chapter also gives an explanation about how cognitive reappraisal can be used to regulate emotions. Strategies for implementing cognitive reappraisal for individuals will be looked at and also how it might be applied in a therapeutic setting. Finally, strengths and limitations of cognitive reappraisal of emotion are discussed. Throughout this chapter the fictional case study of Maya will be referred to as an example of a real-world application for cognitive reappraisal of emotion. Quizzes are also included throughout the text as an opportunity to test one's understanding of some of the key concepts.

Focus questions:


 * 1) How can cognitive reappraisal of emotion improve an individual's control over their emotions?
 * 2) How can cognitive reappraisal of emotion be used by individuals?
 * 3) What are the limitations of cognitive reappraisal of emotion?

Cognitive reappraisal of emotion


Cognitive reappraisal of emotion is an emotion regulation strategy. It involves cognitive manipulation and restructuring in an event where an undesirable emotional reaction is expected, with the primary goal being to reduce an aversive emotional outcome or, in some cases, increase a desirable emotional outcome (Buhle et al., 2003; Gross, 1998; McRae, 2016). In other words, it is a process by which people try to change their emotions by changing the way they think about whatever it is that is causing the emotion.

The overall brain structures associated with cognitive reappraisal of emotion are the frontal and parietal regions (Buhle et al., 2013; Erk et al., 2010). Activation in these structures influences the regulation of emotional responses in the amygdala (Buhle et al., 2013; Erk et al., 2010). During cognitive reappraisal, increased activation can be seen in the frontal and parietal areas (Erk et al., 2010). Reduced activity in the amygdala can be observed during emotion regulation when using a cognitive modifying process such as cognitive reappraisal (Buhle et al., 2013).

The main process behind cognitive reappraisal is the cognitive reinterpretation of events that influences an emotional reaction in a preferable way (Gross, 2002). An individual may employ cognitive reappraisal of emotion when telling themselves that the hurtful comment they received from a co-worker wasn't meant to be hurtful, and perhaps their co-worker didn't realise the comment might be taken the wrong way. Think of cognitive reappraisal as rewriting the narrative about a particular event to allow yourself to interpret the event differently, and thus achieving a different emotional response (McRae, Jacobs, Jay, John & Gross, 2011). This process does not always have to be innately positive. It can involve reappraising an event from really bad to simply average, for example, one might start with the thought 'I have my job, it's the worst', and reappraise the situation with the thought 'I can get through this job, it will be ok' (McRae, 2011).

In order for changing one's thoughts to be effective in regulating emotions, it needs to be implemented before or at the start of an emotion developing (McRae et al., 2011). The idea is to change the meaning of an event to influence how you react to it, so it has little effect if attempted once an emotional response is fully developed (Gross, 1998). Although cognitive reappraisal of emotion is most commonly associated and used to down-regulate negative emotions, it can also be used to up-regulate positive emotions (McRae, 2011).

Emotion regulation
Emotions are a psychological state that arise instinctively, with associated physiological changes and they are often not consciously manipulated (Gross, 1998). The conscious experience of these emotions is called affect (Gross, 1998). Emotion regulation is defined as any act that aims to change or manipulate an emotional reaction in response to a stimuli (Haga, Kraft & Corby, 2009). This can mean reducing negative emotions or increasing positive emotions. Emotion regulation can also occur both consciously and unconsciously, and strategies implemented can be both adaptive and maladaptive, depending on the strategy and how it is used (Gross, 2002).

Process model of emotion regulation
The process model of emotion regulation, also referred to as the modal model of emotion regulation, aims to explain how different types of emotion regulation strategies fit into the timeline of an emotional reaction development (Gross, 1998; Gross 2002). The two main categories of emotion regulation strategies are antecedent- and response-focused strategies (Gross, 1998; Gross 2002). Antecedent-focused strategies mean the strategy is implemented before or at the beginning of an emotional reaction, fitting them into the start of the timeline (Gross, 1998; Gross, 2002). Response-focused emotion regulation strategies typically incorporate strategies used during an emotional reaction or after an emotional reaction, fitting them in at the end of the emotional development timeline (Gross, 1998; Gross, 2002).

There are five main types of emotion regulation strategies focused on within the process model of emotion regulation:


 * 1) Situation selection, e.g., choosing not to attend a music festival due to a dislike for large crowds.
 * 2) Situation modification, e.g., changing the subject of conversation to avoid talking about something.
 * 3) Attentional deployment, e.g., redirecting one's attention away from an uncomfortable conversation and focusing on the view from the window.
 * 4) Cognitive change, e.g., cognitive reappraisal of emotion.
 * 5) Response-focused emotion regulation, e.g., expressive suppression (Gross 1998; McRae, 2016).



These five categories follow this order on the emotional response development timeline, the first four falling under the category of antecedent-focused strategies, and the latter falling under response-focused strategies (Gross, 1998; McRae, 2016). Cognitive reappraisal of emotion is part of the cognitive change category and is the last on this list to be considered an antecedent-focused strategy (Gross, 1998; McRae, 2016). Cognitive reappraisal of emotion is most commonly compared to expressive suppression, an emotion regulation technique that falls into the response-focused category of emotion regulation (Gross, 2002). Expressive suppression involves trying to reduce the visible expressions of a particular emotional reaction (McRae, 2016). Many people automatically turn to this method of emotion regulation, especially if they have not been taught any specific techniques (McRae, 2016). There are problems with this method however, as it often involves an emotion that has already started exhibiting physiological expressions, and this makes suppressing it very difficult (Gross & John, 2003). In fact, more often than not, expressive suppression results in an increase in physiological expressions of an emotion and an overall heightened emotional experience, essentially backfiring on the individual (Gross & John, 2003). When compared to cognitive reappraisal of emotion, expressive suppression is usually considered to be more maladaptive and has less long-term effects on one's ability to regulate emotions effectively in the future (Gross & John, 2003). Cognitive reappraisal of emotion is considered to be more effective overall and has better long-term influences on emotion regulation ability, making the process easier as time goes on (Westermann, Rief & Lincoln, 2012).

Maya has tried to regulate her emotions when she feels an increase in anxiety before by attempting to push the emotion down and not let it show in her face and in her body. This is how she responded in class when she received a bad grade on an assignment and felt very upset and anxious about the bad grade. Maya wanted to avoid her classmates and teacher noticing her emotional reaction to the grade. Eventually she was unable to suppress the emotion any longer and ended up crying and walking out of the class. She discussed it later with her psychologist.
 * Case study

Maya's psychologist explained to her that how she attempted to regulate her anxiety was called expressive suppression and it is not always a very effective method to use. The psychologist suggests instead a cognitive restructuring technique called cognitive reappraisal of emotion. Maya works with the psychologist in session to change how she thinks about her assignment grades and practices challenging her view that receiving a low grade is a very bad thing. Maya's psychologist explains to her that she needs to practice this technique in order for it to be effective, and asks her to practice before her next class when she will receive a grade back. Maya is to restructure her thoughts surrounding receiving a grade back before she actually receives the grade, before she is walking into the class, and as she is waiting for the grade to be handed back.

The thoughts she used to have regarding receiving a bad grade were 'I am a failure', and 'I will never get good marks and get into uni'. Maya decides to challenge these thoughts with 'One low grade is ok, I can do better next time', and 'there are lots of ways to get into uni if I don't get really high marks'.

Quiz 1
{Which emotion regulation category is a response-focused strategy, according to the process model of emotion regulation? - Situation modification - Situation selection - Cognitive reappraisal + Expressive suppression - Attentional deployment
 * type=""}

How does cognitive reappraisal of emotion improve emotion regulation?
Cognitive reappraisal is considered to be an effective strategy for regulating emotions (McRae et al., 2011; Gross, 1998). This is because cognitive reappraisal aims to intervene before the emotional reaction starts, or has barely begun, and because of this an individual is able to reinterpret the situation and thus avoid a negative emotional reaction in the first place (Amstadter, 2007). It also provides individuals with a long-term solution for regulating their emotions, as they can choose to interpret events in a particular way (Amstadter, 2007). It also allows an individual to participate in events without having to modify the situation, divert their attention away or even avoid the event or situation altogether (Gross, 2002). It is also more effective than expressive suppression as it generally does not make the emotion worse if implemented properly (Gross, 2002).

For psychological disorders
Cognitive reappraisal of emotions is a useful tool that can be used in the treatment of psychological disorders, such as anxiety, depression (McRae et al., 2011). It can provide a helpful way for sufferers to challenge their negative thoughts and appraisals about a situation that often manifest as part of their disorder (Zilverstand Parvaz & Goldstein, 2016). Cognitive reappraisal teaches them how to restructure these negative appraisals and replace them with more helpful and adaptive ones (McRae 2016). This is also helpful in the long-term as individuals learn how to do this process and it positively affects their ability to regulate emotions in the future (Gross, 1998). These benefits are not observed for many other emotion regulation techniques such as avoiding situations in order to avoid high levels of anxiety (McRae, 2016). Through the use of cognitive reappraisal an individual can reappraise the situation in a way that means they are able to engage with it rather than avoid it entirely and simply miss out (McRae, 2016).

A study conducted by Kudinova, James and Gibb (2018) demonstrates the positive effects of cognitive reappraisal for children with a genetic predisposition to depression. The researchers compared children who did and did not use cognitive reappraisal of emotion in their everyday lives, and followed up several years later to see if the children had or had not developed a diagnosable depressive illness (Kudinova et al., 2018). The researchers found that those children who naturally used cognitive reappraisal techniques were less likely to develop depression and had higher levels of positive affect when compared to the children did not use cognitive reappraisal (Kudinova et al., 2018). This study supports the idea that children with a genetic predisposition to psychological disorders could benefit from early intervention involving cognitive reappraisal (Kudinova et al., 2018).

For healthy individuals
Cognitive reappraisal of emotion is also a very useful technique for healthy individuals to enhance their emotion regulation strategies in order to facilitate self-development (Westermann et al., 2012)). One study suggests that through the use of cognitive reappraisal, individuals can experience higher levels of positive affect when compared to those individuals who do not utilise cognitive reappraisal (Westermann et al., 2012). Those who do not use cognitive reappraisal were found to have higher levels of negative affect overall. Cognitive reappraisal also contributes to an individuals sense of overall life satisfaction and optimal well-being (King & deal Rossa, 2019). Overall, there is sufficient scientific evidence and research to suggest there is a benefit of incorporating cognitive reappraisal into everyday life for healthy individuals.

Quiz 2
{What is one way cognitive reappraisal of emotion improves emotion regulation? + It allows an individual to engage in events they would have avoided otherwise. - It involves cognitive processes. - Cognitive reappraisal is often used as part of Cognitive Behavioural Therapy (CBT).
 * type=""}

Maya has been practicing the new technique of emotion regulation, called cognitive reappraisal, that her psychologist taught her in their last session. She is finding it is helping her to stay calm in the lead up to receiving assignment grades back. Maya still feels some anxiety in these situations but has noticed a significant decrease in the intensity of the emotion. She is finding it easier to attend classes and focus on the assignment feedback the teacher gives. Maya is considering implementing this strategy into other situations where she feels heightened anxiety and is excited to tell her psychologist of the success she has had using cognitive reappraisal.
 * Case study

For healthy individuals
Cognitive reappraisal of emotion is a very beneficial strategy for healthy individuals to implement into their everyday lives (King & dela Rossa, 2019). This strategy is most definitely not reserved purely for the treatment of psychological disorders and can be utilised by anyone to improve their ability to effectively regulate their emotions in their daily lives (Gross & John, 2003).

The basic steps for implementation are:


 * 1) Identify the target situation or event that elicits an unwanted emotional reaction (Gross, 1998; McRae, 2016).
 * 2) Identify the desired outcome, e.g., what emotional reaction would be most preferable (Gross, 1998; McRae, 2016).
 * 3) Think ahead of time what thoughts need to be restructured and changed and come up with several alternative thoughts and interpretations for the situation (Gross, 1998; McRae, 2016).
 * 4) Be prepared for the next occurrence of the event, and use the new interpretation of the event before and during it (Gross, 1998; McRae, 2016).
 * 5) Reflect on the process. What worked and what did not? Think about how it could be done better next time and come up with some new interpretations (Gross, 1998; McRae, 2016).
 * 6) Practice is essential in order to master this technique!

In therapy
A psychologist or counsellor may decide to incorporate cognitive reappraisal into an individual's therapy sessions. This would most likely be as part of a Cognitive Behavioural Therapy (CBT) program that is individualised for each client (McRae, 2016). A psychologist will educate their client on the technique and how it works, as well as providing an explanation of how to implement it (McRae, 2016). They will then work with their client to identify key areas that cognitive reappraisal could be useful for (e.g., in clients with anxiety) (McRae, 2016). During sessions both psychologist and client will work together to restructure the thoughts and interpretations associated with the event the client has identified (Gross, 2002). The client will be encouraged to practice going through the alternative thoughts and interpretations during session when the psychologist is there to help them (Gross, 2002). Between sessions, the client will be asked to practice using cognitive reappraisal and in the next session the success or shortcomings of their experiences will be discussed and worked on (McRae, 2016). The psychologist may prescribe homework tasks, either in the form of mental practice or physical worksheets to help the client implement cognitive reappraisal and experience the most benefit possible (McRae, 2016). A psychologist will most likely use this technique in conjunction with many other CBT techniques.

Maya's psychologist suggests the use of cognitive reappraisal of emotion to complement her CBT therapy for her anxiety. During session Maya is asked to identify situations where she experiences high anxiety to target with cognitive reappraisal, with the aim to teach Maya how to regulate her emotions in the identified situations. During sessions, Maya and her psychologist work together to restructure thoughts and interpretations of the events Maya has identified. Her psychologist often gives her worksheets to fill out with a flowchart of the steps in cognitive reappraisal as a tool for Maya to practice implementing the technique before attempting it in real-life. Each session they discuss together how Maya went with using cognitive reappraisal during the week and make plans and adjustments for using it next time.
 * Case study

Quiz 3
{What is the third step in implementing cognitive reappraisal of emotion for individuals? - Reflect on the process.. - Identify the desired outcome. - Be prepared for the next occurrence of the event. + Think ahead of time what thoughts need to be restructured and changed. - Identify the target situation or event. - Practice is key.
 * type=""}

Limitations of cognitive reappraisal of emotion


Several criticisms for cognitive reappraisal of emotion exist. The biggest criticism is the difficulty of implementing this strategy for people suffering from severe psychological disorders, as their cognitive capacity to engage in cognitive manipulation tasks is vastly limited (Westermann et al., 2012). It appears that the very nature of many psychological disorders and the reduced cognitive functioning that accompanies them affects an individual's ability to effectively implement cognitive reappraisal, as the cognitive restructuring can be very challenging for someone experiencing intense negative or intrusive thoughts (Westermann et al., 2012). Furthermore, observations of the brain structures associated with emotion regulation show a reduced level of activation when attempting to cognitively reappraise something (Buhle et al., 2013). This can be overcome however, with the help of a psychologist and regular therapy that addresses the psychological disorder, and the psychologist can incorporate cognitive reappraisal once the individual has a better cognitive ability to implement the technique (Westermann et al., 2012). It can also be beneficial to incorporate other emotion regulation strategies and coping mechanisms, such as mindfulness, into an individual's therapy (Westermann et al., 2012).

Another big limitation of cognitive reappraisal is the potential for it to be maladaptive (Westermann et al., 2012). This is most likely to occur unconsciously in an individual who has a tendency to overthink things and jump to conclusions. It involves the reversal of the cognitive reappraisal technique, whereby an event is reappraised in a more catastrophic way than before (Westermann et al., 2012). Examples of this include thoughts such as 'my boss doesn't like me' and escalating thoughts that follow on from this such as 'I know my boss hates be because of the look she gave me'. This results in the reappraisal of an event that is maladaptive and increases emotional distress (Westermann et al., 2012). This can be improved with the help of a psychologist or by the individual if they become self-aware of the process and educate themselves on how to use cognitive reappraisal of emotion in an effective manner (McRae, 2016). However, this maladaptive process of cognitive reappraisal is most commonly observed in psychological disorders such as anxiety or depression, so professional help is highly recommended (Westermann et al., 2012). An individual can be taught how to use the technique in a more positive and adaptive way (Westermann et al., 2012).

Conclusion
Cognitive reappraisal of emotion is an emotion regulation strategy involving cognitive manipulation to change the way an event is perceived, in order to change the emotional outcome. This process involves coming up with new interpretations of the event that make an individual feel more positive and emotionally in control. The process model of emotion regulation theory explains that cognitive reappraisal of emotion is an antecedent-focused strategy that is implemented either before or at the initial onset of an aversive emotional response. This strategy, when used effectively, can improve an individual's capacity to regulate their emotions and also has beneficial long-term effects on overall well-being. Cognitive reappraisal can be implemented by an individual or as part of a therapy program administered by a psychologist. The limitations of cognitive reappraisal include the potential for the technique to be maladaptive in individuals with a tendency to overthink situations, and individuals suffering from a psychological disorder may have difficulty using this technique due to the intrusive thoughts associated with their disorders.