Understanding Emotion Inflexibility in Risk for Affective Disease: Integrating Current Research and Finding a Path Forward

Abstract

Emotion-related disorders (e.g., depression, anxiety, stress, eating, substance and some personality disorders) include some of the most common, burdensome, and costly diseases worldwide. Central to many, if not all of these disorders, may be patterns of rigid or inflexible emotion responses. Indeed, theorists point to emotion in-flexibility as a potential cause or maintaining factor in emotion-related diseases. Despite the increasing prominence of emotion inflexibility in theories of affective disease, a comprehensive review of the developing empirical literature has not yet been conducted. Accordingly, this review will examine the three dominant lines of inquiry assessing emotion flexibility. These include: (1) the capacity to use and vary deliberate emotion regulation strategies, (2) the context sensitivity of spontaneous emotional responses, and (3) flexibility in the appraisal of emotional events and experiences. Moreover, current evidence suggests that each of these three lines of research may converge to suggest the interplay of two key biological dimensions in emotion inflexibility, threat sensitivity, and cognitive control, known to be impaired in patients with affective disorders. In short, this developing body of work suggests a path by which future research could explicate and even exploit the ties between emotion inflexibility and affective disease, contributing to the development of improved models of risk, assessment, and intervention, with broad implications for psychological health.

Dissociating Profiles of Social Cognitive Disturbances Between Mixed Personality and Anxiety Disorder

“…When faced with challenging events, these individuals tend to display stronger state orientation -a regulatory mode characterized by indecision and hesitation that prevents change to mental and behavioral states (Kuhl, 2000). Dispositions toward state orientation in these clinical populations is unsurprising given the difficulties they exhibit in down-regulating negative and up-regulating positive emotions; poor regulatory control over one's emotional reactions has long been recognized as a reliable predictor of many psychiatric (affective) illnesses, and emotional inflexibility predicts pathology following stressful events (Coifman and Summers, 2019). Moreover, the results of the present study align closely with those of our previous investigation with an independent large-scale sample, which revealed an inflexible personality profile characterized by a strong tendency toward avoidant, borderline and depressive personality styles, and state-oriented regulation (Shaw et al, 2018).…”

Intrinsic activity temporal structure reactivity to behavioural state change is correlated with depressive symptoms

“…This implies that their brain will display lower neural state dynamics over time which may in turn lead to less flexibility in mental processing. Notably, inflexibility across a number of psychological domains is a common feature in those with depression and has been identified as a risk factor for developing such a condition (Coifman & Summers, 2019; Miranda et al., 2012; Stange et al., 2017). This highlights the relevance of investigating such functions and related brain features across a full range of depressive symptom levels in both patients and sub‐clinical individuals.…”

“…This may reflect an ability to move easily from a critical state, where there is the maximum potential to respond flexibly to changing demands, to a sub‐critical one where processing can be focussed on a single task (Beggs & Plenz, 2003; Irrmischer, Poil, et al, 2018). A reduction in such psychological flexibility is a commonly reported depressive symptom and is a risk factor for serious depressive episodes (Coifman & Summers, 2019; Miranda, Gallagher, Bauchner, Vaysman, & Marroquín, 2012; Stange, Alloy, & Fresco, 2017). It is not clear, however, if these psychological symptoms can be mapped to underlying dynamic states.…”

A continuum hypothesis of psychotomimetic rapid antidepressants

“…For example, in depression, one might expect negative events to be very likely to occur and positive events likely to be absent. When these expectations are overly precise, this could lead to a phenomenon of cognitive inflexibility, which is known to contribute to depression ( Coifman and Summers, 2019 ; Leahy et al, 2012 ).…”