Frontiers in Psychology 03/2017 Vol. 8 Article 220

Question 1

emotional regulation

Answer 1

The conscious and non-conscious strategies we use to
increase, maintain or decrease one or more components of an emotional response (Gross, 2001), including implicit, non-conscious, and automatic processes, as well as explicit , voluntary and conscious mental processes (Gyurak et al., 2011).

Question 2

Brain areas involved in emotional reactivity

Answer 2

Subcortical regions like the amygdala, periaqueductal gray, ventral striatum (VS), anterior insula (AI), and dorsal-anterior cingulate cortex (dACC) are involved in
emotional reactivity, as emotion generation regions leading changes in arousal and valence regarding the
triggering stimuli.

Question 3

Brain areas involved in explicit emotional regulation

Answer 3

Cortical regions such as the dorso-lateral prefrontral cortex (dLPFC), the ventro-lateral prefrontral cortex (vLPFC), the pre-supplementary and supplementary
 motor cortex (pre-SMA and SMA) and parietal cortex. These regions conform to the so-called central executive network (CEN), usually involved in top-down
emotion regulation, but also in attention and voluntary cognitive control.

Question 4

Brain areas involved in implicit emotional regulation

Answer 4

The ventral-anterior cingulate cortex (v
ACC) and the ventro-medial prefrontal cortex (vMPFC), the outside of awareness processing of emotion, but also in encoding subjective value of the stimuli or condition experienced by the subject (Frank et al., 2014; Kohn et al., 2014; Etkin et al., 2015).

Question 5

Mindfulness

Answer 5

non-elaborative, non-judgemental, present-centered awareness

Question 6

Mindfulness Based Interventions (MBIs)

Answer 6

Lead to better emotional regulations (a key problem in multiple mental disorders) and decreased neuroticism and rumination.

MBSR, MBCT, ACT (acceptance and commitment therapy), DBT, and MBRP (M-B Recovery and Prevention)

Question 7

Detachment, distraction and expressive suppression affect which brain regions…

Answer 7

Dörfel et al. found that detachment, distraction (two forms of reappraisal), and expressive suppression
increase brain activation in the same regions of the right fronto-parietal network, reducing activation
of the left amygdala. This suggests a common underlying neural process for these strategies, but somewhat contrary to theoretical predictions, since
expressive suppression as a less adaptive strategy might have a different neural correlate from reappraisal strategies.

only reinterpretation induced a different activation pattern, recruiting the left vLPFC and orbitofrontal gyrus, but not decreasing amygdala activation
(Dörfel et al., 2014).

Question 8

Areas down regulated during explicit emotional regulation on neuroimaging (meta-analysis)

Answer 8

Recently, a meta-analysis of 48 studies of cognitive reappraisal emotion regulation neuroim
aging studies concluded that this strategy particularly activates the bilateral dLPFC, vLPFC, dMPFC, posterior parietal cortex, and left-middle temporal gyrus, and deactivates the amygdala bilaterally. Clearly involving the explicit emotion regulation network. Unexpectedly, no other regions related to emotion reactivity decreased their activation level during reappraisal
down regulation (Buhle et al., 2014).

Question 9

Does top-down emotional control explain it all?

Answer 9

No. In particular, in two studies, applying cognitive reappraisal to emotions generated via implicit
stimulation resulted in a paradoxical increased activation of the amygdala (Herwig et al., 2010; McRae et al., 2012). In Herwig et al.’s study, the usage of emotional body-awareness strategy decreased amygdala activation compared to reappraisal strategy
(Herwig et al., 2010).

Question 10

Structural changes on MRI with MBIs and long-term mindfulness meditation practice

Answer 10

Cross-sectional design studies comparing healthy
controls with expert meditators (EMs) from different meditation traditions have demonstrated structural MRI changes in: the hippocampus (Hölzel et al., 2008; Luders et al., 2009; Kang et al., 2013); right anterior insula (AI; Lazar et al., 2005; Hölzel et al.,
2008); orbitofrontal cortex (OFC; Hölzel et al., 2008; Luders et al., 2009; Kang et al., 2013); anterior cingulate cortex (ACC; Grant et al., 2013
); left temporal pole (TP; Hölzel et al., 2008; Luders
et al., 2009; Kang et al., 2013); left frontal gyrus (Vestergaard-Poulsen et al., 2009; Kang et al., 2013); right frontal sulcus ( Lazar et al., 2005); corpus callosum (Luders et al., 2012; Kang et al., 2013); and regions in the brainstem (Vestergaard-Poulsen et al., 2009).

Question 11

Effects of MBI on aging

Answer 11

A study using machine learning structural pattern recognition analysis estimated that brains of meditators
were 7.5 years younger than matched control subjects (Luders et al., 2016)

Question 12

Another argument against cognitive reappraisal being the mechanism of action of MBIs

Answer 12

Covering a wide range of brain regions,
according to recent reviews and meta-analysis of neural bases of emotion regulation (Frank et al., 2014; Kohn et al., 2014; Etkin et al., 2015), would partially overlap with emotion reactivity (AI, ACC), and with implicit emotion regulation regions (OFC and vMPFC), and very loosely with explicit emotion regulation
(medial PFC, but not lateral PFC regions) systems. From this, if mindfulness meditation would involve cognitive reappraisal, or top-down emotion regulation strategies, one would expect changes in lateral PFC morphometry.

Question 13

Yet another argument against top-down control being the mechanism of action of MBIs

Answer 13

8-week MBI (MBSR) might induce neuroplastic changes in key areas for emotional reactivity (amygdala, insula), body awareness or interoception/exteroception (insula, somatosensory cortex), self-consciousness (posterior cingulate cortex, pons), mood , and arousal regulation (brainstem regions—locus coeruleus, and raphe nuclei), perspective taking (TPJ) and memory systems (hippocampus, cerebellum). Interestingly, none of these studies suggest changes in PFC areas or regions involved in the top-down emotion regulation system are suggested as a means of action.

Question 14

Effects of dispositional mindfulness seen on rs-fMRI (resting state)

Answer 14

Using resting -state functional connectivity (rs-fMRI) analysis, the authors found a relationship between higher dispositional mindfulness and Guendelman et al. Mindfulness and Emotion Regulation decreased connectivity within the midline regions, including
the PCC and MPFC (Way et al., 2010). Importantly, the
midline regions like the MPRC, PCC, precuneus, ACC, and parietal cortex are part of the so-called default mode network (DMN; Raichle and Snyder, 2007), which has been related to mind-wandering (task-unrelated thought) and self-referential processing (Qin and and Northoff, 2011).

Question 15

Effects of MBIs on pain processing

Answer 15

Zeidan et al. performed a longitudinal uncontrolled study with 4-day MBI training, using Artetial Spin Labeling (ASL), a technique for estimating cerebral blood flow with MRI across time points. After the intervention, during a breathing meditation task, the authors found decreased perfusion of the MPFC and PCC (DMN), and a major activation of the AI, ACC, pre-SMA, OFC, VS, SSC, and posterior insula (PI). During a pain induction paradigm, minor activation of the contra-lateral SSC and increased activation in the ACC, AI, PI, and fronto-parietal operculum were reported. It is worthy of note that participants reported a significant decrease in pain intensity and unpleasantness (Zeidan et al., 2011). [More support for bottom-up hypothesis]

Question 16

Bottom-up control of emotional reactivity hypothesis of function of MBIs

Answer 16

Multiple studies highlight emotion reactivity (AI, ACC, VS) and implicit emotion regulation (OFC, vMPFC) systems as the main emotion regulation targets of MBIs, again notably without any major involvement of PFC-related systems (top-down emotion regulation). There are studies that support a role for top-down control, but it does not seem the only mechanism (and top-down control is found in other modalities, like CBT)

Question 17

Changes in brain in experiences meditators during active meditation (fMRI)

Answer 17

Taylor et al. compared Western EMs with novel meditators using emotional pictures during fMRI, and observed a decrease in activation levels of the PCC and MPFC (DMN) during active meditation in EMs.

Question 18

Changes in brain in EMs compared to active controls (fMRI)

Answer 18

Lutz et al. used an annoying auditory task during fMRI,
comparing Tibetan monks and controls during active compassion meditation. They found increased activity in the AI and ACC, which were proportional to first-person experience of compassion intensity (Lutz et al., 2008a). Using the same experimental task, but during focused-attention meditation, researchers also found a direct relationship between meditation expertise (total hours of practice) and amygdala
deactivation (Brefczynski-Lewis et al., 2007).

Question 19

Unique pain control in experienced meditators

Answer 19

Grant et al. also compared EMs with controls during a pain induction task in fMRI. EMs showed decreased activation of the PFC, amygdala and hippocampus, and increased activity in the AI, ACC, and thalamus. Interestingly, the decreased functional connectivity
between PFC and AI and ACC predicted lower pain in EMs (Grant et al., 2011). In a similar study, EMs showed lower baseline activation in the AI, ACC, and amygdala, and during pain induction higher activation of AI and ACC regions than controls (Lutz A. et al., 2013). These studies indicate that EMs specifically increases activation of subcortical emotion generation regions, related to affective processing of pain, and deactivates
top-down mechanisms, evidencing a unique emotion regulation bottom-up mechanism

Question 20

Behavioral modulation in experienced meditators

Answer 20

studies show that during socially induced negative emotions, EMs showed stronger modulation of their interactive behavior (less punishment, accepting more unfair offers) and greater emotion regulation, which was mediated via increased activation of interoception and exteroception brain regions, modulating emotion generation regions

Question 21

Longitudinal studies have yielded mixed results regarding the involvement of different emotion regulation systems (top-down vs. bottom-up).

Answer 21

Studies with healthy populations using
self-experiential focus recruit emotion-generation (AI, s
g-ACC) and body-awareness (AI, SSC) systems. Well-designed RCTs with active control groups have mostly (but not exclusively) demonstrated changes in emotion generation (amygdala, AI, ACC) and implicit emotion regulation systems (v-MPFC, OFC), while being effective in regulating negative emotions.

Question 22

Effects of long term meditation

Answer 22

In line with Chiesa et al. (2013), studies with EMs show a clearer engagement pattern of bottom-up systems, suggesting that these types of strategies are developed through long-term meditation training

Question 23

Explicit point of MBIs (therapeutically speaking)

Answer 23

MBIs explicitly involve the engagement of bottom-up
mindfulness emotion regulation strategies, using the
sensory and interoceptive components of emotions as targets and vehicles for emotion regulation (according to embodied emotion regulation account).

From a clinical psychotherapeutic perspective, MBIs are used to guide the patient/client into the application of different top-down and bottom-up mindfulness based strategies. In the case of bottom-up strategies, the clinician encourages the participants to focus
on the “bodily” components of different emotional state, always conveying the attitudinal stance of acceptance and openness. In this way, discouraging the intend to control and subjugate negative emotional states, but more importantly, discouraging the use of maladaptive top-down emotion regulation strategies
like avoidance, rumination, and suppression among others

There is a constant incentive to shift from a
self-narrative perspective (ruminative), based on past or future stories, to a self-experiential present-centered perspective, so the experience of emotion is decoupled from maladaptive evaluative cognitions

Question 24

Psychotherapeutic interventions vs. MBIs

Answer 24

One main difference between psychotherapeutic interventions like psychoanalysis and CBT, and MBIs, is that the former aim to change the content of
emotional states (self-narratives and cognitions), while MBIs focus on changing the relationship (and not the content) with the emotional (painful) states (Chambers et al., 2009); changing the perspective from which it is experienced, encouraging acceptance and curiosity about the experience itself (self-experiential focus)

Question 25

MBIs from a emotional learning perspective

Answer 25

From an emotional learning perspective, this process can be seen as an exercise of exposure (to certain emotions or experiences), extinction of maladaptive cognitions or reactive responses, and reconsolidation
as a new relationship pattern regarding own experiences or daily life problems (Hölzel et al., 2011a).