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Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by symptoms of inattentiveness and hyperactivity/impulsivity. Besides, increasing evidence points to ADHD patients showing emotional dysfunctions and concomitant problems in social life. However, systematic research on emotional dysfunctions in ADHD is still rare, and to date most studies lack conceptual differentiation between emotion processing and emotion regulation. The aim of this thesis was to systematically investigate emotion processing and emotion regulation in adult ADHD in a virtual reality paradigm implementing social interaction. Emotional reactions were assessed on experiential, physiological, and behavioral levels.
Experiment 1 was conducted to develop a virtual penalty kicking paradigm implying social feedback and to test it in a healthy sample. This paradigm should then be applied in ADHD patients later on. Pleasant and unpleasant trials in this paradigm consisted of hits respectively misses and subsequent feedback from a virtual coach. In neutral trials, participants were teleported to different spots of the virtual stadium. Results indicated increased positive affectivity (higher valence and arousal ratings, higher zygomaticus activations, and higher expression rates of positive emotional behavior) in response to pleasant compared to neutral trials. Reactions to unpleasant trials were contradictory, indicating increased levels of both positive and negative affectivity, compared to neutral trials. Unpleasant vs. neutral trials revealed lower valence ratings, higher arousal ratings, higher zygomaticus activations, slightly lower corrugator activations, and higher expression rates of both positive and negative emotional behavior. The intensity of emotional reactions correlated with experienced presence in the virtual reality.
To better understand the impact of hits or misses per se vs. hits or misses with coach feedback healthy participants’ emotional reactions, only 50% of all shots were followed by coach feedback in experiment 2. Neutral trials consisted of shots over the free soccer field which were followed by coach feedback in 50 % of all trials. Shots and feedback evoked more extreme valence and arousal ratings, higher zygomaticus activations, lower corrugator activations, and higher skin conductance responses than shots alone across emotional conditions. Again, results speak for the induction of positive emotions in pleasant trials whereas the induction of negative emotions in unpleasant trials seems ambiguous. Technical improvements of the virtual reality were reflected in higher presence ratings than in experiment 1.
Experiment 3 investigated emotional reactions of adult ADHD patients and healthy controls after emotion processing and response-focused emotion regulation. Participants successively
went through an ostensible online ball-tossing game (cyber ball) inducing negative emotions, and an adapted version of the virtual penalty kicking game. Throughout cyber ball, participants were included or ostracized by two other players in different experimental blocks. Participants were instructed to explicitly show, not regulate, or hide their emotions in different experimental blocks. Results provided some evidence for deficient processing of positive emotions in ADHD. Patients reported slightly lower positive affect than controls during cyber ball, gave lower valence ratings than controls in response to pleasant penalty kicking trials, and showed lower zygomaticus activations than controls especially during penalty kicking. Patients in comparison with controls showed slightly increased processing of unpleasant events during cyber ball (higher ratings of negative affect, especially in response to ostracism), but not during penalty kicking. Patients showed lower baseline skin conductance levels than controls, and impaired skin conductance modulations. Compared to controls, patients showed slight over-expression of positive as well as negative emotional behavior. Emotion regulation analyses revealed no major difficulties of ADHD vs. controls in altering their emotional reactions through deliberate response modulation. Moreover, patients reported to habitually apply adaptive emotion regulation strategies even more frequently than controls. The analyses of genetic high-risk vs. low-risk groups for ADHD across the whole sample revealed similar results as analyses for patients vs. controls for zygomaticus modulations during emotion processing, and for modulations of emotional reactions due to emotion regulation.
To sum up, the virtual penalty kicking paradigm proved to be successful for the induction of positive, but not negative emotions. The importance of presence in virtual reality for the intensity of induced emotions could be replicated. ADHD patients showed impaired processing of primarily positive emotions. Aberrations in negative emotional responding were less clear and need further investigation. Results point to adult ADHD in comparison to healthy controls suffering from baseline deficits in autonomic arousal and deficits in arousal modulation. Deficits of ADHD in the deliberate application of response-focused emotion regulation could not be found.
Pain conditions and chronic pain disorders are among the leading reasons for seeking medical help and immensely burden patients and the healthcare system. Therefore, research on the underlying mechanisms of pain processing and modulation is necessary and warranted. One crucial part of this pain research includes identifying resilience factors that protect from chronic pain development and enhance its treatment. The ability to use emotion regulation strategies has been suggested to serve as a resilience factor, facilitating pain regulation and management. Acceptance has been discussed as a promising pain regulation strategy, but results in this domain have been mixed so far. Moreover, the allocation of acceptance in Gross’s (1998) process model of emotion regulation has been under debate. Thus, comparing acceptance with the already established strategies of distraction and reappraisal could provide insights into underlying mechanisms. This dissertation project consisted of three successive experimental studies which aimed to investigate these strategies by applying different modalities of individually adjusted pain stimuli of varying durations. In the first study (N = 29), we introduced a within-subjects design where participants were asked to either accept (acceptance condition) or react to the short heat pain stimuli (10 s) without using any pain regulation strategies (control condition). In the second study (N = 36), we extended the design of study 1 by additionally applying brief, electrical pain stimuli (20 ms) and including the new experimental condition distraction, where participants should distract themselves from the pain experience by imagining a neutral situation. In the third study (N = 121), all three strategies, acceptance, distraction, and reappraisal were compared with each other and additionally with a neutral control condition in a mixed design. Participants were randomly assigned to one of three strategy groups, including a control condition and a strategy condition. All participants received short heat pain stimuli of 10 s, alternating with tonic heat pain stimuli of 3 minutes. In the reappraisal condition, participants were instructed to imagine the pain having a positive outcome or valence. The self-reported pain intensity, unpleasantness, and regulation ratings were measured in all studies. We further recorded the autonomic measures heart rate and skin conductance continuously and assessed the habitual emotion regulation styles and pain-related trait factors via questionnaires. Results revealed that the strategies acceptance, distraction, and reappraisal significantly reduced the self-reported electrical and heat pain stimulation with both durations compared to a neutral control condition. Additionally, regulatory efforts with acceptance in study 2 and with all strategies in study 3 were reflected by a decreased skin conductance level compared to the control condition. However, there were no significant differences between the strategies for any of the assessed variables. These findings implicate similar mechanisms underlying all three strategies, which led to the proposition of an extended process model of emotion regulation. We identified another sequence in the emotion-generative process and suggest that acceptance can flexibly affect at least four sequences in the process. Correlation analyses further indicated that the emotion regulation style did not affect regulatory success, suggesting that pain regulation strategies can be learned effectively irrespective of habitual tendencies. Moreover, we found indications that trait factors such as optimism and resilience facilitated pain regulation, especially with acceptance. Conclusively, we propose that acceptance could be flexibly used by adapting to different circumstances. The habitual use of acceptance could therefore be considered a resilience factor. Thus, acceptance appears to be a promising and versatile strategy to prevent the development of and improve the treatment of various chronic pain disorders. Future studies should further examine factors and circumstances that support effective pain regulation with acceptance.
Cognitive control is what makes goal-directed actions possible. Whenever the environment or our impulses strongly suggests a response that is incompatible with our goals, conflict arises. Such conflicts are believed to cause negative affect. Aversive consequences of conflict may be registered in a conflict monitoring module, which subsequently initiates attentional changes and action tendencies to reduce negative affect. This association suggests that behavioral adaptation might be a reflection of emotion regulation. The theoretical cornerstone of current research on emotion regulation is the process model of emotion regulation, which postulates the regulation strategies situation selection, situation modification, attentional deployment, cognitive change, and response modulation. Under the assumption that conflict adaptation and affect regulation share common mechanisms, I derived several predictions regarding cognitive control from the process model of emotion regulation and tested them in 11 experiments (N = 509). Participants engaged in situation selection towards conflict, but only when they were explicitly pointed to action-outcome contingencies (Experiments 1 to 3). I found support for a mechanism resembling situation modification, but no evidence for a role of affect (Experiments 4 to 10). Changing the evaluation of conflict had no impact on the extent of conflict adaptation (Experiment 11). Overall, there was evidence for an explicit aversiveness of cognitive conflict, but less evidence for implicit aversiveness, suggesting that conflict may trigger affect regulation processes, particularly when people explicitly have affect regulation goals in mind.
Regulating our immediate feelings, needs, and urges is a task that we are faced with every day in our lives. The effective regulation of our emotions enables us to adapt to society, to deal with our environment, and to achieve long‐term goals. Deficient emotion regulation, in contrast, is a common characteristic of many psychiatric and neurological conditions. Particularly anxiety disorders and subclinical states of increased anxiety are characterized by a range of behavioral, autonomic, and neural alterations impeding the efficient down‐regulation of acute fear. Established fear network models propose a downstream prefrontal‐amygdala circuit for the control of fear reactions but recent research has shown that there are a range of factors acting on this network. The specific prefrontal cortical networks involved in effective regulation and potential mediators and modulators are still a subject of ongoing research in both the animal and human model. The present research focused on the particular role of different prefrontal cortical regions during the processing of fear‐relevant stimuli in healthy subjects. It is based on four studies, three of them investigating a different potential modulator of prefrontal top‐down function and one directly challenging prefrontal regulatory processes. Summarizing the results of all four studies, it was shown that prefrontal functioning is linked to individual differences in state anxiety, autonomic flexibility, and genetic predisposition. The T risk allele of the neuropeptide S receptor gene, a recently suggested candidate gene for pathologically elevated anxiety, for instance, was associated with decreased prefrontal cortex activation to particularly fear‐relevant stimuli. Furthermore, the way of processing has been found to crucially determine if regulatory processes are engaged at all and it was shown that anxious individuals display generally reduced prefrontal activation but may engage in regulatory processes earlier than non‐anxious subjects. However, active manipulation of prefrontal functioning in healthy subjects did not lead to the typical behavioral and neural patterns observed in anxiety disorder patients suggesting that other subcortical or prefrontal structures can compensate for an activation loss in one specific region. Taken together, the current studies support prevailing theories of the central role of the prefrontal cortex for regulatory processes in response to fear‐eliciting stimuli but point out that there are a range of both individual differences and peculiarities in experimental design that impact on or may even mask potential effects in neuroimaging research on fear regulation.