Anxiety Regulation: From Affective Neuroscience to Clinical Practice

Abstract

According to psychoanalysis, anxiety signals a threat whenever a forbidden feeling emerges. Anxiety triggers defenses and maladaptive behaviors, thus leading to clinical problems. For these reasons, anxiety regulation is a core aspect of psychodynamic-oriented treatments to help clients. In the present theoretical paper, we review and discuss anxiety generation and dysregulation, first from a neural point of view, presenting findings from neuroimaging and psychophysiological studies. The aim is to trace parallels with psychodynamic theories of anxiety. Then, we discuss the psychological mechanisms and neural bases of emotion regulation in the laboratory, and possible neurobiological mechanisms of anxiety regulation in psychotherapy. We describe two different approaches to emotion/anxiety regulation, one based on the standard cognitive model of emotion regulation, the other based on psychodynamic principles and affective neuroscience. We then illustrate in detail a dynamic experiential approach to regulation. This model claims that emotions arise before cognition and are not inherently dysregulated. Dysregulation emerges from co-occurrences of emotions and associated anxiety. Technical consequences of this model are discussed and include strategies to regulate anxiety.

Tune in to the right frequency: Theta changes when distancing from emotions elicited by unpleasant images and words

“…Following these results, we suggest to consider Distancing more similar to a mindful strategy rather than a form of reappraisal. This is in line with previous findings in the field of affective neuroscience (Grecucci, De Pisapia et al., 2015; Grecucci, Giorgetta et al, 2020; Grecucci, Messina et al, 2020; Grecucci, Sığırcı et al, 2020; but see also Messina et al., 2015, Webb et al., 2012, for a different perspective).…”

“…The importance of understanding how emotions are generated and regulated is widely recognized by both scholars and clinicians. Grounded in psychodynamic findings of defense mechanisms and anxiety regulation (Frederickson et al., 2018; Grecucci et al., 2017; Grecucci, Giorgetta et al., 2020; Grecucci, Sığırcı et al., 2020; Gross, 2014), the emergence of the science of emotion regulation (ER) (Gross, 2002, 2014) has offered an experimental approach to the study of how emotions are modulated in order for people to maintain a healthy functioning. Although a plethora of studies have already investigated the neural structures involved in ER while using functional magnetic resonance (e.g., Buhle et al., 2014; Grecucci et al., 2013a, 2013b; Kohn et al., 2014; Ochsner & Gross, 2005; Pappaianni et al., 2019), neurophysiological mechanisms underlining the application and the effect of regulation strategies on emotional content are still unclear.…”

“…Notably, the majority of these studies focused on the neurophysiological activity during time windows when the emotional stimuli are perceived and regulated (Effect of Regulation), and no one on the time window in which the strategy is revealed and participants prepare themselves to face the subsequent stimulus (Effect of Strategy, Grecucci, Giorgetta et al, 2020; Grecucci, Messina et al, 2020; Grecucci, Sığırcı et al, 2020). In the present study, we aim to explore changes in the brain oscillations evoked by the application of the strategy compared to the baseline “Attend” condition (Effect of Strategy), but also during the regulation of the emotions generated by negative versus neutral pictures (Effect of Regulation).…”

The Mediating Effects of Diabetes Distress, Anxiety, and Cognitive Fusion on the Association Between Neuroticism and Fear of Hypoglycemia in Patients With Type 2 Diabetes

“…This neuroticism-anxiety orientation is consistent with our results that neuroticism has a positive predictive effect on anxiety. Furthermore, increased anxiety can trigger defensive and maladaptive behaviors in patients, leading to clinical problems ( Grecucci et al, 2020 ). For example, patients with FoH tend to show avoidance behaviors, including cutting the dose of insulin, overeating, and reducing physical activity, etc.…”

Case Report: Individualization of Intensive Transactional Analysis Psychotherapy on the Basis of Ego Strength

“…Educational and social restrictions are examples of obstacles to the satisfaction of impulses. Against impulse and related anxiety, the person may unconsciously use defenses (Frederickson et al, 2018 ; Grecucci et al, 2020a , b ). Several defense mechanisms have been described in psychoanalysis, from forms of avoidance of disturbing thoughts or memories (e.g., denial or suppression) to severe distortions of reality (e.g., projections or delusions) (Vaillant, 1992 ).…”