Emotion Regulation Therapy: A Synthesis of Affective Neuroscience and Contemplative Practices to Target Mechanisms Underlying Anxious Depression

Despite the availability of efficacious treatments for emotional disorders, a sizable subgroup of patients fails to evidence adequate treatment response. This situation is especially true for patients with anxious depression (a combination of apprehensive anxiety and depression symptoms) who often feel their emotions very intensely resulting in trouble resolving the simultaneous motivational cues for avoiding threat and pursuing reward. These individuals also perseverate (i.e., worry, ruminate) in response to this emotionally and motivationally intense distress, which interferes with responding to, and learning from cues in the environment. Emotion Regulation Therapy (ERT) is a theoretically-derived, evidence based, treatment that integrates principles from cognitive behavioral treatments, Buddhist mental training exercises, and findings from affect science. ERT offers a blueprint for improving intervention by focusing on the motivational responses and corresponding regulatory characteristics of individuals with distress disorders by teaching clients skills of attention and metacognitive regulation so they can develop optimal behavioral repertoires associated with threat and reward learning. Findings demonstrate that ERT patients show significant decreases in symptoms, worry, rumination, as well as increases in life quality, mindfulness, and emotion regulation abilities. Further, preliminary findings indicate that improvements in behavioral (e.g., conflict monitoring, reactivity to emotional interference) and physiological (e.g., vagal tone) markers of emotion regulation are associated with short and long-term symptomatic and functional outcome. These findings highlight the importance of identifying and targeting candidate biobehavioral markers that are especially amenable to normalization with practices derived from Buddhist mental training exercises.