How to Regulate Emotions

The crux of this article from the point of daily application is:

“ Emotional processing can also be modulated through deliberate and conscious application of top-down executive control over processing of an emotional stimulus”.

You can find how this is done:
1- One page outline made of quotations from the original article
2- 4 Pages of my notes made of quotations from the original article
3- Original article itself.

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Emotional processing in anterior cingulate and medial prefrontal cortex
Amit Etkin1,2, Tobias Egner3 and Raffael Kalisch4

In summary, the pattern of anatomical connectivity supports an important role for the sgACC, pgACC and adACC in interacting with the limbic system, including its effector regions, and for the adACC and pdACC in communicating with other dorsal and lateral frontal areas that are important for top-down forms of regulation [72].

Fear conditioning and extinction in humans

Thus, the dorsal ACC and mPFC seem to function generally in the appraisal and expression of fear or anxiety.

To elucidate how fear is regulated, we next discuss activations associated with extinction of learned fear. In extinction, the CS is repeatedly presented in the absence of reinforcement, leading to the formation of a CS(conditioned stimulus)–no US(unconditioned stimulus) association (or extinction memory) that competes with the original fear memory for control over behavior [28–30]. Hence, extinction induces conflicting appraisals of, and response tendencies to, the CS because it now signals both threat and safety, a situation that requires regulation, as outlined above.

Emotional conflict regulation
The circuitry we find to be specific for regulation of emotional conflict (ventral ACC and mPFC and amygdala) is very similar to that involved in extinction.

Top-down control of emotion
During emotional conflict regulation, emotional processing is spontaneously modulated in the absence of an explicit instruction to regulate emotion. Emotional processing can also be modulated through deliberate and conscious application of top-down executive control over processing of an
emotional stimulus. The best-studied strategy for the latter type of regulation is reappraisal, a cognitive technique whereby appraisal of a stimulus is modified to change its ability to elicit an emotional reaction [42]. Reappraisal involves both the initial emotional appraisal process and
the reappraisal process proper, whereby an additional positive appraisal is created that competes with the initial negative emotional appraisal.

These data suggest that controlled top-down regulation, like emotional conflict regulation, uses ventral ACC and mPFC areas to inhibit negative emotional processing in the amygdala, thus dampening task interference.

The ventral ACC and mPFC might thus perform a generic negative emotion inhibitory function that can be recruited by other regions (e.g. dorsal ACC and mPFC and lateral PFC) when there is a need to suppress limbic reactivity [10].

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Emotional processing in anterior cingulate and medial prefrontal cortex
Amit Etkin1,2, Tobias Egner3 and Raffael Kalisch4
1 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
2 Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC) at the Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
3 Department of Psychology & Neuroscience and Center for Cognitive Neuroscience, Duke University, Durham, NC, USA
4 Institute for Systems Neuroscience and NeuroImage Nord, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

Negative emotional stimuli activate a broad network of brain regions, including the medial prefrontal (mPFC) and anterior cingulate (ACC) cortices. An early influential view dichotomized these regions into dorsal–caudal cognitive and ventral–rostral affective subdivisions. In this review, we examine a wealth of recent research on negative emotions in animals and humans, using the example of fear or anxiety, and conclude that, contrary to the traditional dichotomy, both subdivisions make key
contributions to emotional processing. Specifically, dorsal– caudal regions of the ACC and mPFC are involved in appraisal and expression of negative emotion, whereas ventral–rostral portions of the ACC and mPFC have a regulatory role with respect to limbic regions involved in generating emotional responses. Moreover, this new framework is broadly consistent with emerging data on other negative and positive emotions.
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Glossary
Appraisal: evaluation of the meaning of an internal or external stimulus to the organism. Only stimuli that are appraised as motivationally significant will induce an emotional reaction, and the magnitude, duration and quality of the emotional reaction are a direct result of the appraisal process. Moreover,
appraisal can be automatic and focus on basic affective stimulus dimensions such as novelty, valence or value, or expectation discrepancy, or may be slower and sometimes even require controlled conscious processing, which permits a more sophisticated context-dependent analysis.

Fear conditioning: learning paradigm in which a previously neutral stimulus, termed the conditioned stimulus (CS), is temporally paired with a non-learned aversive stimulus, termed the unconditioned stimulus (US). After pairing, the CS predicts the US and hence elicits a conditioned response (CR). For example, pairing of a tone with a foot shock results in elicitation of fear behavior during
subsequent responses to a non-paired tone.

Extinction: learning process created by repeatedly presenting a CS without pairing with an US (i.e. teaching the animal that the CS no longer predicts the US) after fear conditioning has been established. This results in formation of an extinction memory, which inhibits expression of, but does not erase, the original fear memory.

Reappraisal: specific method for explicit emotion regulation whereby a conscious deliberate effort is engaged to alter the meaning (appraisal) of an emotional stimulus. For example, a picture of a woman crying can be reappraised from a negative meaning to a positive one by favoring an
interpretation that she is crying tears of joy.

Regulation: general process by which conflicting appraisals and response tendencies are arbitrated between to allow selection of a course of action. Typically, regulation is thought to have an element of inhibition and/or enhancement for managing competing appraisals and response tendencies.
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Box 1. Anatomy of the ACC and mPFC
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In summary, the pattern of anatomical connectivity supports an important role for the sgACC, pgACC and adACC in interacting with the limbic system, including its effector regions, and for the adACC and pdACC in communicating with other dorsal and lateral frontal areas that are important for top-down forms of regulation [72].
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Fear conditioning and extinction in humans
The paradigms used in the acquisition and extinction of learned fear are particularly valuable for isolating the neural substrates of fear processing because the anticipatory fear or anxiety triggered by the previously neutral conditioned stimulus (CS) can be dissociated from the reaction to the aversive unconditioned stimulus (US) per se. This is not possible in studies that, for example, use
aversive images to evoke emotional responses. Furthermore, comparison between fear conditioning and fear extinction facilitates an initial coarse distinction between regions associated with either the appraisal of fear-relevant stimuli and generation of fear responses (fear conditioning), for the inhibitory regulation of these processes (extinction).
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sympathetic nervous system activity correlates positively primarily with dorsal ACC and mPFC regions and negatively primarily with ventral ACC and mPFC regions, which supports a role for the dorsal ACC and mPFC in fear expression (c).
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These processes are intermixed with, and supported by, learning processes, namely, acquisition, consolidation and storage of a fear memory (CS–US association), and retrieval of the fear memory on subsequent CS presentations.
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Thus, the dorsal ACC and mPFC seem to function generally in the appraisal and expression of fear or anxiety.
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To elucidate how fear is regulated, we next discuss activations associated with extinction of learned fear. In extinction, the CS is repeatedly presented in the absence of reinforcement, leading to the formation of a CS–no US association (or extinction memory) that competes with the original fear memory for control over behavior [28–30]. Hence, extinction induces conflicting appraisals of, and response tendencies to, the CS because it now signals both threat and safety, a situation that requires regulation, as outlined above.
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Emotional conflict regulation
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The circuitry we find to be specific for regulation of emotional conflict (ventral ACC and mPFC and amygdala) is very similar to that involved in extinction. ... Much like the relationship between improved emotional conflict regulation and decreased conflict evaluation-related activation in the dorsal ACC and mPFC, more successful extinction is associated with decreased CS-driven activation in the dorsal ACC and mPFC of humans and rodents [40,41]. Thus, the most parsimonious explanation for these data is that emotional conflict evaluation-related functions involve overlapping neural mechanisms with appraisal and expression of fear, and that regulation of emotional conflict also involves circuitry that overlaps with fear extinction.
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Top-down control of emotion
During emotional conflict regulation, emotional processing is spontaneously modulated in the absence of an explicit instruction to regulate emotion. Emotional processing can also be modulated through deliberate and conscious application of top-down executive control over processing of an
emotional stimulus. The best-studied strategy for the latter type of regulation is reappraisal, a cognitive technique whereby appraisal of a stimulus is modified to change its ability to elicit an emotional reaction [42]. Reappraisal involves both the initial emotional appraisal process and
the reappraisal process proper, whereby an additional positive appraisal is created that competes with the initial negative emotional appraisal. Thus, we would expect reappraisal to involve the dorsal ACC and mPFC regions that we observed to be important for emotional conflict detection (Figure 2a). Consistent with this prediction, a meta-analysis found that reappraisal was reliably associated with activation in the dorsal ACC and mPFC (Figure 2b) [43].

This reappraisal meta-analysis, interestingly, did not implicate a consistent role for the ventral ACC and mPFC [43], which suggests that reappraisal does not primarily work by suppressing the processing of an undesired emotional stimulus. Nevertheless, activity in the ventral ACC and mPFC in some instances is negatively correlated with activity in the amygdala in paradigms in which reappraisal resulted in downregulation of amygdalar activity in response to negative pictures [44,45]. ...
These data suggest that controlled top-down regulation, like emotional conflict regulation, uses ventral ACC and mPFC areas to inhibit negative emotional processing in the amygdala, thus dampening task interference. The ventral ACC and mPFC might thus perform a generic negative emotion inhibitory function that can be recruited by other regions (e.g. dorsal ACC and mPFC and lateral PFC) when there is a need to suppress limbic reactivity [10]. This would be a prime example of parsimonious use of a basic emotional circuitry, conserved between rodents and humans (Box 2), for the purpose of higher-level cognitive functions possible only in humans.
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Amygdala–ACC and –mPFC functional connectivity
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In addition, during regulation tasks, connectivity was restricted to the ventral ACC and mPFC and was primarily negative (Figure 2d). These data thus lend further support to our proposal of a dorso–ventral separation in terms of negative emotion generation (appraisal and expression) and inhibition (regulation).
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Integration with other perspectives on ACC and mPFC function and other emotions
Although less developed than the literature on fear and anxiety, studies on other emotions are broadly consistent with our formulation of ACC and mPFC function. On the negative emotion appraisal and expression side, direct experience of pain, or empathy for others experiencing
pain, activates the dorsal ACC and mPFC [49], and lesions of the dACC also serve as treatment for chronic pain [50]. Similarly, increased sensitivity to a range of negative emotions is associated with greater engagement of the dorsal ACC and mPFC, including disgust [51] and rejection [52], and transcranial-magnetic-stimulation-induced disruption of the dmPFC interferes with anger processing [53]. Uncertainty or ambiguity, which can induce anxiety and relates to emotional conflict, leads to activation in the dACC and dmPFC [54].
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Positive emotion, which can serve to regulate and diminish negative emotion, has been associated in a metaanalysis with activation in the sgACC, vmPFC and pgACC [58]. Extinction of appetitive learning activates the vmPFC [59], much as extinction of learned fear does. The evaluation of positive stimuli and reward is more complicated. For instance, Rushworth and co-workers proposed that the processes carried out by the adACC are mirrored by similar contributions to reinforcement-guided decision-making from the orbitofrontal cortex, with the distinction that the adACC is concerned with computing reinforcement value of actions whereas the orbitofrontal cortex is concerned with gauging the reinforcement values of stimuli [60].

Taken together, these data broadly support our dorsal–ventral distinction along appraisal–expression versus regulation lines, with respect specifically to negative emotion.
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