The “thinking threshold”: A therapeutic concept guided by emotion regulation flexibility.

Abstract

Cognitive reappraisal is an emotion regulation strategy with significant empirical support. However, it is also true that many people have difficultly using cognitive reappraisal-and any cognitive strategy that requires significant mental effort-while experiencing intense emotions.Per the tenants of emotion-regulation flexibility, we provide information on a therapeutic concept we call the "thinking threshold" which helps clients identify the level of emotional distress at which their thinking becomes impaired. When clients are above the "thinking threshold" they are guided to use behavioral and bodily-focused emotion regulation strategies, and to use cognitive reappraisal and problem solving when below the "thinking threshold." In this paper, we outline the rationale for considering emotion-regulation flexibility with clients, identify why level of emotional intensity is an important context to consider when helping clients identify effective emotion regulation strategies, and review research supporting the notion that effortful cognitive strategies are less effective at high levels of emotional distress. We also describe how we teach clients to use the "thinking threshold" concept and provide a brief case study demonstrating the utility of the concept with a client. Finally, we review ways in which the "thinking threshold" could be tailored and adapted alongside acceptance-based approaches, and we describe future directions for both empirical examination of the "thinking threshold" as well as expansion within clinical practice.

Reconceptualizing emotion regulation and coping strategy usage in eating disorders research: The utility of a regulatory flexibility framework

“…Future studies may investigate the effectiveness of modified treatments that incorporate interventions to directly target regulatory flexibility. For example, one intervention developed by Veilleux et al (2022) educates individuals about the differential effectiveness of regulatory strategies in high‐ versus low‐intensity emotional states (i.e., different emotional contexts), helps them to recognize when the intensity of their emotions has escalated enough to warrant a shift in strategy, and has them practice switching between strategies in accordance with changes in the intensity of their emotions. Single‐case experimental designs could be used to test the effectiveness of modified treatments in individuals with EDs, particularly those with elevated emotional dysregulation.…”

A Theory of Momentary Distress Tolerance: Toward Understanding Contextually Situated Choices to Engage With or Avoid Distress

“…From the standpoint of emotion-regulation research (Aldao et al, 2010; Naragon-Gainey et al, 2017), these skills employ distraction and intentional physiological downregulation of emotion, suggesting they are response-focused emotion-regulation strategies (Gross, 1998). It may be that these skills actually do teach people to remain engaged with their emotions in the moment by reducing distress to a more tolerable level (Veilleux, Hyde, et al, 2022). Alternatively, they may have a delayed effect on the later development of tolerance because they improve self-efficacy as people realize they can change the trajectory of their emotion.…”

“…Distress tolerance might operate similarly, where sometimes escape is the better and more effective option. For example, when distress is particularly intense and cognitive abilities are impaired, distraction (i.e., avoidance) may help create space so the emotion decreases to a more tolerable level (Veilleux, Hyde, et al, 2022). It is clear that avoidance strategies can be effective at reducing intense emotion in the moment, but when used habitually, they tend not to be adaptive (Southward et al, 2021).…”

“…For example, the MEAQ contains the items, “When I am hurting, I still do what needs to be done” and “When working on something important, I won’t quit even if things get difficult” (Gámez et al, 2011). Interestingly, scores on the MEAQ distress endurance subscale demonstrate fairly weak associations with a typical index of distress intolerance, r = –.34 (Veilleux, Warner, et al, 2022), suggesting that intolerance and endurance are not fully opposites. Future work can focus on developing additional measures of openness and willingness to experience distress, including by adopting willingness-to-pay measures (Lau et al, 2013), as well as assessing the subjective valuation of distress.…”

Asymmetric Activation of Frontal Brain Regions during Cognitive Reappraisal Generation—A Function of Implemented Reappraisal Strategy?

“…As a final perspective, problem-oriented reappraisal received the highest believability ratings, indicating that participants found this strategy to be the most relatable, functional, and typical for dealing with anger-eliciting events. Given that a multitude of previous studies emphasize the prominent effect of individuals' beliefs on their emotion regulation engagement and regulation effort [98,99], an interlink between greater beliefs and greater (implicit) reappraisal efforts may explain greater involvement of the right frontal cortex in problem-oriented reappraisal.…”