Current Psychiatry Reports

, Volume 14, Issue 3, pp 182–187 | Cite as

Emotion Regulation and Anxiety Disorders

  • Josh M. CislerEmail author
  • Bunmi O. Olatunji


A growing body of research suggests that the construct of emotion regulation is important for understanding the onset, maintenance, and treatment of anxiety disorders. In this review, we provide a selective overview of this emerging field and highlight the major sources of evidence. First, evidence suggests that the construct of emotion regulation can be differentiated from the construct of emotion. Second, there is a large and consistent body of research demonstrating that emotion regulation strategies can modulate emotional responding, and this finding is observed in both behavioral and neuroimaging studies. Third, measures of emotion regulation explain incremental variance in measures of anxiety disorder symptoms not accounted for by measures of negative affect. Although the research implicating emotion regulation in the anxiety disorders is promising, future research will be necessary to further clarify causal mechanisms explaining how emotion regulation confers vulnerability for anxiety disorders and to improve the clarity and consistency of definitions of emotion regulation.


Emotion regulation Anxiety Fear Anxiety disorders Generalized anxiety disorder GAD Amygdala Prefrontal cortex Treatment Post-traumatic stress disorder PTSD 



Dr. Cisler has received grant support from the National Institute on Drug Abuse (nos. RO1DA019999, R21DA025243, and T32DA022981) and the National Center for Research Resources (no. UL1RR029884).


No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Cisler JM, Olatunji BO, Feldner MT, Forsyth JP. Emotion regulation and the anxiety disorders: an integrative review. J Psychopathol Behav Assess. Mar 2010;32(1):68–82. This article provides a comprehensive review of the concepts highlighted here. PubMedCrossRefGoogle Scholar
  2. 2.
    Barlow DH. Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. New York: Guilford Press; 2002.Google Scholar
  3. 3.
    Zinbarg RE. Concordance and synchrony in measures of anxiety and panic reconsidered: A hierarchical model of anxiety and panic. Behavior Therapy Spr. 1998;29(2):301–23.CrossRefGoogle Scholar
  4. 4.
    Davis M. Neural systems involved in fear and anxiety measured with fear-potentiated startle. Am Psychol. 2006;61(8):741–56.PubMedCrossRefGoogle Scholar
  5. 5.
    LeDoux JE. Emotion circuits in the brain. Annu Rev Neurosci. 2000;23:155–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Etkin A, Egner T, Peraza DM, Kandel ER, Hirsch J. Resolving emotional conflict: a role for the rostral anterior cingulate cortex in modulating activity in the amygdala. Neuron. 2006;51(6):871–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Bechara A, Damasio H, Damasio AR, Lee GP. Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. J Neurosci. 1999;19(13):5473–81.PubMedGoogle Scholar
  8. 8.
    Bechara A, Tranel D, Damasio H, Adolphs R, Rockland C, Damasio AR. Double dissociation of conditioning and declarative knowledge relative to the amygdala and hippocampus in humans. Science. 1995;269(5227):1115–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Anderson AK, Phelps EA. Lesions of the human amygdala impair enhanced perception of emotionally salient events. Nature. 2001;411(6835):305–9.PubMedCrossRefGoogle Scholar
  10. 10.
    van den Heuvel OA, Veltman DJ, Groenewegen HJ, et al. Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis. Arch Gen Psychiatry. 2005;62(8):922–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Zimmerman JM, Rabinak CA, McLachlan IG, Maren S. The central nucleus of the amygdala is essential for acquiring and expressing conditional fear after overtraining. Learn Mem. 2007;14(9):634–44.PubMedCrossRefGoogle Scholar
  12. 12.
    Walker DL, Davis M. Double dissociation between the involvement of the bed nucleus of the stria terminalis and the central nucleus of the amygdala in startle increases produced by conditioned versus unconditioned fear. J Neurosci. 1997;17(23):9375–83.PubMedGoogle Scholar
  13. 13.
    Lee JL, Dickinson A, Everitt BJ. Conditioned suppression and freezing as measures of aversive Pavlovian conditioning: effects of discrete amygdala lesions and overtraining. Behav Brain Res. 2005;159(2):221–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):281–91.PubMedCrossRefGoogle Scholar
  15. 15.
    Gross JJ, editor. Handbook of Emotion Regulation. New York, NY: Guilford Press; 2007.Google Scholar
  16. 16.
    Feldner MT, Zvolensky MJ, Eifert GH, Spira AP. Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge. Behav Res Ther. 2003;41(4):403–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Gross JJ. Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. J Pers Soc Psychol. 1998;74(1):224–37.PubMedCrossRefGoogle Scholar
  18. 18.
    Koole SL, Rothermund K. “I feel better but I don’t know why”: the psychology of implicit emotion regulation. Cogn Emot. 2011;25(3):389–99.PubMedCrossRefGoogle Scholar
  19. 19.
    • Gyurak A, Gross JJ, Etkin A. Explicit and implicit emotion regulation: a dual-process framework. Cognition Emotion. 2011;25(3):400–412. This article is a recent attempt to link implicit emotion with existing theoretical models of explicit emotion regulation. PubMedCrossRefGoogle Scholar
  20. 20.
    Ochsner KN, Gross JJ. Cognitive emotion regulation: insights from social cognitive and affective neuroscience. Curr Dir Psychol Sci. 2008;17(2):153–8.CrossRefGoogle Scholar
  21. 21.
    • Schiller D, Delgado MR. Overlapping neural systems mediating extinction, reversal and regulation of fear. Trends Cogn Sci. Jun 2010;14(6):268–276. This article provides a good discussion of overlapping neural mechanisms mediating the regulation of fear. PubMedCrossRefGoogle Scholar
  22. 22.
    Ghashghaei HT, Hilgetag CC, Barbas H. Sequence of information processing for emotions based on the anatomic dialogue between prefrontal cortex and amygdala. NeuroImage. 2007;34(3):905–23.PubMedCrossRefGoogle Scholar
  23. 23.
    • Diekhof EK, Geier K, Falkai P, Gruber O. Fear is only as deep as the mind allows: a coordinate-based meta-analysis of neuroimaging studies on the regulation of negative affect. Neuroimage. Sep 1 2011;58(1):275–285. This is a recent meta-analysis examining neural regions that mediate emotion regulation across different experimental tasks. PubMedCrossRefGoogle Scholar
  24. 24.
    Quirk GJ, Beer JS. Prefrontal involvement in the regulation of emotion: convergence of rat and human studies. Curr Opin Neurobiol. 2006;16(6):723–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Hofmann SG, Heering S, Sawyer AT, Asnaani A. How to handle anxiety: the effects of reappraisal, acceptance, and suppression strategies on anxious arousal. Behav Res Ther. 2009;47(5):389–94.PubMedCrossRefGoogle Scholar
  26. 26.
    Jackson DC, Malmstadt JR, Larson CL, Davidson RJ. Suppression and enhancement of emotional responses to unpleasant pictures. Psychophysiology. 2000;37(4):515–22.PubMedCrossRefGoogle Scholar
  27. 27.
    Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG. Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behav Res Ther. 2006;44(9):1251–63.PubMedCrossRefGoogle Scholar
  28. 28.
    Koster EHW, Fox E, MacLeod C. Introduction to the special section on cognitive bias modification in emotional disorders. J Abnorm Psychol. 2009;118(1):1–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Amir N, Beard C, Taylor CT, et al. Attention training in individuals with generalized social phobia: a randomized controlled trial. J Consult Clin Psych. 2009;77(5):961–73.CrossRefGoogle Scholar
  30. 30.
    MacLeod C, Rutherford E, Campbell L, Ebsworthy G, Holker L. Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. J Abnorm Psychol. 2002;111(1):107–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Banks SJ, Eddy KT, Angstadt M, Nathan PJ, Phan KL. Amygdala—frontal connectivity during emotion regulation. Soc Cogn Affect Neur. 2007;2(4):303–12.CrossRefGoogle Scholar
  32. 32.
    Urry HL, van Reekum CM, Johnstone T, et al. Amygdala and ventromedial prefrontal cortex are inversely coupled during regulation of negative affect and predict the diurnal pattern of cortisol secretion among older adults. J Neurosci. 2006;26(16):4415–25.PubMedCrossRefGoogle Scholar
  33. 33.
    Goldin PR, Mcrae K, Ramel W, Gross JJ. The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biol Psychiat. 2008;63(6):577–86.PubMedCrossRefGoogle Scholar
  34. 34.
    Delgado MR, Nearing KI, LeDoux JE, Phelps EA. Neural circuitry underlying the regulation of conditioned fear and its relation to extinction. Neuron. 2008;59(5):829–38.PubMedCrossRefGoogle Scholar
  35. 35.
    Botvinick MM, Braver TS, Barch DM, Carter CS, Cohen JD. Conflict monitoring and cognitive control. Psychol Rev. 2001;108(3):624–52.PubMedCrossRefGoogle Scholar
  36. 36.
    Egner T, Etkin A, Gale S, Hirsch J. Dissociable neural systems resolve conflict from emotional versus nonemotional distracters. Cereb Cortex. 2008;18(6):1475–84.PubMedCrossRefGoogle Scholar
  37. 37.
    • Etkin A, Schatzberg AF. Common abnormalities and disorder-specific compensation during implicit regulation of emotional processing in generalized anxiety and major depressive disorders. Am J Psychiat. Sep 2011;168(9):968–978. This was a recent neuroimaging study investigating common and unique implicit emotion regulation differences between depression and GAD. PubMedCrossRefGoogle Scholar
  38. 38.
    •• Etkin A, Prater KE, Hoeft F, Menon V, Schatzberg AF. Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder. Am J Psychiat. May 2010;167(5):545–554. This was a recent neuroimaging study demonstrating altered capacity for implicit emotion regulation in GAD. PubMedCrossRefGoogle Scholar
  39. 39.
    Mennin DS. Emotion regulation therapy for generalized anxiety disorder. Clin Psychol Psychot Jan-Feb. 2004;11(1):17–29.CrossRefGoogle Scholar
  40. 40.
    Mennin DS, Heimberg RG, Turk CL, Fresco DM. Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther. 2005;43(10):1281–310.PubMedCrossRefGoogle Scholar
  41. 41.
    Tull MT, Stipelman BA, Salters-Pedneault K, Gratz KL. An examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample. Journal of Anxiety Disorders. 2009;23(2):275–82.PubMedCrossRefGoogle Scholar
  42. 42.
    Tull MT, Rodman SA, Roemer L. An examination of the fear of bodily sensations and body hypervigilance as predictors of emotion regulation difficulties among individuals with a recent history of uncued panic attacks. Journal of Anxiety Disorders. 2008;22(4):750–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Tull MT, Roemer L. Emotion regulation difficulties associated with the experience of uncued panic attacks: evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy. 2007;38(4):378–91.PubMedCrossRefGoogle Scholar
  44. 44.
    Kashdan TB, Zvolensky MJ, McLeish AC. Anxiety sensitivity and affect regulatory strategies: individual and interactive risk factors for anxiety-related symptoms. Journal of Anxiety Disorders. 2008;22(3):429–40.PubMedCrossRefGoogle Scholar
  45. 45.
    Moore SA, Zoellner LA, Mollenholt N. Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behav Res Ther. 2008;46(9):993–1000.PubMedCrossRefGoogle Scholar
  46. 46.
    Tull MT, Barrett HM, McMillan ES, Roemer L. A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy. 2007;38(3):303–13.PubMedCrossRefGoogle Scholar
  47. 47.
    Cloitre M, Miranda R, Stovall-McClough KC, Han H. Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy Spr. 2005;36(2):119–24.CrossRefGoogle Scholar
  48. 48.
    Cloitre M, Stovall-McClough KC, Miranda R, Chemtob CM. Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder. J Consult Clin Psych. 2004;72(3):411–6.CrossRefGoogle Scholar
  49. 49.
    Staiger PK, Melville F, Hides L, Kambouropoulos N, Lubman DI. Can emotion-focused coping help explain the link between posttraumatic stress disorder severity and triggers for substance use in young adults? J Subst Abus Treat. 2009;36(2):220–6.CrossRefGoogle Scholar
  50. 50.
    • McLaughlin KA, Hatzenbuehler ML, Mennin DS, Nolen-Hoeksema S. Emotion dysregulation and adolescent psychopathology: a prospective study. Behaviour Research and Therapy. Sep 2011;49(9):544–554. This was a recent longitudinal study demonstrating that emotion regulation prospectively predicts increases in anxiety disorder symptoms. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Brain Imaging Research Center, Psychiatric Research InstituteUniversity of Arkansas for Medical SciencesLittle RockUSA

Personalised recommendations