C 8 Emotion Regulation

Ann. N.Y. Acad. Sci. ISSN 0077-8923

ANNALS OF THE NEW YORK ACADEMY OF SCIENCESIssue: The Year in Cognitive Neuroscience

Functional imaging studies of emotion regulation:a synthetic review and evolving model of the cognitivecontrol of emotionKevin N. Ochsner, Jennifer A. Silvers, and Jason T. BuhleDepartment of Psychology, Columbia University, New York, New York

Address for Correspondence: Kevin Ochsner, Department of Psychology, Columbia University, 369 Schermerhorn Hall, 1190Amsterdam Ave., New York, NY 10027. [email protected]

This paper reviews and synthesizes functional imaging research that over the past decade has begun to offer newinsights into the brain mechanisms underlying emotion regulation. Toward that end, the first section of the paperoutlines a model of the processes and neural systems involved in emotion generation and regulation. The secondsection surveys recent research supporting and elaborating the model, focusing primarily on studies of the mostcommonly investigated strategy, which is known as reappraisal. At its core, the model specifies how prefrontaland cingulate control systems modulate activity in perceptual, semantic, and affect systems as a function of onesregulatory goals, tactics, and the nature of the stimuli and emotions being regulated. This section also shows how themodel can be generalized to understand the brainmechanisms underlying other emotion regulation strategies as wellas a range of other allied phenomena. The third and last section considers directions for future research, includinghow basic models of emotion regulation can be translated to understand changes in emotion across the life span andin clinical disorders.

Keywords: amygdala; cognitive control; emotion; emotion regulation; prefrontal cortex

. . .Thy fate is the common fate of all,Into each life some rain must fall. . .

Henry Wadsworth LongfellowThe Rainy Day (1842)

. . .Every cloud, says the proverb, has a silverlining.

P. T. BarnumStruggles and Triumphs (1869)

It might be said that emotions are the weather ofour lives. Some days, we experience the blue skies ofhappiness and the sunshineof joy.Otherdays,we aredrenched by the rain clouds of sadness or buffetedby the hot winds of anger. How we respond adap-tively to our emotional weather patternsfindingthe silver lining in every dark cloudhas impor-tant consequences for our physical andmental well-being.17

Although we cannot control the weather outside,we are capable of using myriad emotion regulationstrategies to take control of our internal climates.8

Such strategies allow us to wholly or partially alterthe nature, magnitude, and duration of our emo-tional responses, including initiating new ones. Inrecent years, great strides have been taken in usingneuroscience techniques to understand the mecha-nisms underlying emotion regulation. In humans,this research has primarily used functional imagingto examine our ability to control affective responsesusing cognitive strategies. The overarching goals ofthis paper are to review the progress made by suchresearch, synthesize from it conclusions that suggestexpansion on and elaborations of a model of thecognitive control of emotion (MCCE), and showhow the model can make sense of a wide range ofemotion regulatory abilities and allied phenomena.Toward these ends, the remainder of the paper is

divided into three parts. In the first, we outline a ba-sicMCCEwhose core elements have been describedpreviously.9,10 In the second section, we review cur-rent imaging research suggesting ways in which themodel can evolve to integrate new findings on the

doi: 10.1111/j.1749-6632.2012.06751.xAnn. N.Y. Acad. Sci. 1251 (2012) E1E24 c 2012 New York Academy of Sciences. E1

Functional imaging studies of emotion regulation Ochsner et al.

Figure 1. A multilevel approach to building a model of emo-tion regulation. (A) In cognitive, affective, and social neuro-science research, we seek to describe phenomena in terms ofrelationships among three levels of analysis: experience andbehavior, psychological processes, and neural systems. Thebidirectional arrows between levels indicate that the relation-ships among them are bidirectional. (B) Throughmeasurementand/or experimental manipulation, neuroimaging research onemotion regulation can observe phenomena at the behaviorallevel and the neural level and use these observations to infer thenature of the intervening cognitive and/or affective processes.The direction of the arrows from the behavioral and neurallevels toward the process level indicates the direction of causalinference (i.e., we cant observe the operation of these processesdirectly, but infer theiroperationbasedonbehavioral andneuralobservations).

brain bases of emotion regulation as well as be ap-plied to account for other related phenomena, suchas affective learning, affect-based decision making,and affective expectancies. Throughout these firsttwo sections we focus primarily on one strategy inparticularknown as reappraisalbecause it hasreceived the bulk of empirical attention. In the thirdand last section, we summarize and consider direc-tions for future basic and translational research.

A model of the cognitive control of emotionAny model of emotion regulation (or any otherphenomenon) is predicated on assumptions abouthow different levels of analysis fit together. Our as-sumptions follow those now commonplace in cog-nitive, affective, and social neuroscience in whichresearchers seek to describe phenomena in termsof the relationships among three levels of analysis:behavior/experience, process, and neural systems(Refs. 1113; Fig. 1A). Neuroimaging research onemotion and its regulation can observe phenomenaat the behavioral level (e.g., measures of emotionalresponse and the specific regulatory strategies onemight employ) and the neural level (e.g., fMRImea-sures of brain activity) and use these observations toinfer the nature of the intervening cognitive and/oraffective processes (Fig. 1B).

With this in mind, our review of current researchwill sometimes be organized in terms of phenomenadescribed at the level of behavior, including regula-tory goals, tactics, and target stimuli. In other casesit will be organized in terms of issues concerning theneural-level pathways on which the field has begunto make progress. Taken together, the data reviewedin each section constrains and influences ourMCCE(see Fig. 2).To understand how emotion regulation works,

we must first have an idea of how emotions are gen-erated. As such, our model has two main partsdescriptions of the mechanisms supporting emo-tion generation on the one hand and the mecha-nisms supporting emotion regulation on the other.For the sake of simplicity, we present the psycho-logical and neural systems involved in the gener-ation and regulation of emotion as being distinct,yet it should be noted that there is evidence to sug-gest that the underlying psychological14 and neu-ral mechanisms15,16 are at least partially overlap-ping. Indeed, elsewhere we have noted that thedistinction between emotion generation and reg-ulation is blurry at best (e.g., Ref. 16), and whichterm one uses may reflect their usefulness for ad-dressing a particular question more than hard andfast differences in their mechanisms. Here, we treatthem separately to make points about the ways inwhich putative control and affect-triggering systemsinteract.

Mechanisms of emotion generationOur account of how emotions are generated is mul-tileveled12 in its description of both the processesand the neural systems that give rise to emotionalresponses.

Processes involved in generating emotionThe black time line at the bottomof Figure 2A showsa simple model of four steps involved in generatingemotional responses.17 In the first step, a stimu-lus is perceived in its current situational context.The stimulus could be an internal thought, feel-ing, or sensation, or any number of external cues,ranging from a facial expression or gesture to anaction or event. At the second stage, one attendsto some of these stimuli or their attributes. What-ever is in the focus of attention is passed alongto subsequent emotion generative stages, whereasignored or unattended stimuli may be either

E2 Ann. N.Y. Acad. Sci. 1251 (2012) E1E24 c 2012 New York Academy of Sciences.

Ochsner et al. Functional imaging studies of emotion regulation

Figure 2. A model of the cognitive control of emotion (MCCE). (A) Diagram of the processing steps involved in generating anemotion and the ways in which cognitive control processes (blue box) might be used to regulate them. As described in the text,the effects of different emotion regulation strategies (the red arrows descending from the cognitive control processes box) can beunderstood in terms of the stages of the emotion generation sequence that they influence. The pink box seen at the appraisal stageis meant to indicate that neural systems involved in generating emotion support this process. (B) Neural systems involved in usingcognitive strategies, such as reappraisal, to regulate emotion (left, blue boxes), systems involved in generating those responses (left,pink boxes), and systems with an undefined or intermediary role in reappraisal (left, yellow boxes).

excluded from these stages or receive diminishedsubsequent processing. The third stage involves ap-praising the significance of stimuli in terms of theirrelevance to ones current goals, wants, or needs.This is the stage focused on by appraisal theoriesof emotion, which describe the structure of dif-ferent appraisals that lead to positive versus neg-ative reactions in general and to specific types ofemotional responses in particular.18 Because thecurrent neuroscience literature suggests that theremay not be specific neural systems for different dis-crete emotions,19,20 for present purposes, we simplydistinguish between basic positive/appetitive ver-sus negative/aversive appraisals that have been re-liably associated with specific neural systems thatare described below. Finally, the fourth stage in-volves translating these appraisals into changes inexperience, emotion-expressive behavior, and au-tonomic physiology. Although these three indica-tors of emotional response do not always correlatewith one another for reasons that are not perfectlyunderstood,21 as noted below, emotion regulation

strategies can affect changes in some or all of them,depending on the strategy.

Neural systems involved in generatingemotionReviews and meta-analyses of functional imagingstudies19,20 indicate that a number of cortical andsubcortical brain systems may play key roles in theappraisal and/or response stages of emotion gener-ation. For present purposes, we focus on the fourthat have been most frequently discussed in studiesof reappraisal in particular, and emotion regulationstrategies more generally (see Fig. 2B; for examplesof other emotion systems that may bemodulated byemotion regulation, see Refs. 9 and 22).The first is the amygdala, which is involved in the

perception and encoding of stimuli relevant to cur-rent or chronic affective goals,23,24 ranging from re-wards or punishments to facial expressions of emo-tion to aversive or pleasant images and films.2527

Although the amygdala generally is sensitive todetecting and triggering responses to arousing

Ann. N.Y. Acad. Sci. 1251 (2012) E1E24 c 2012 New York Academy of Sciences. E3


stimuli,28 it exhibits a bias toward detecting cues sig-naling potential threats, like expressions of fear.2931

The second is the ventral striatum, which is in-volved in learning which cues (ranging from so-cial signals, like smiling faces, to actions, to ab-stract objects) predict rewarding or reinforcingoutcomes.3234

The third is the ventromedial prefrontal cortex(vmPFC), which integrates affective valuations ofspecific stimuli made by the amygdala and ventralstriatum with inputs from other regions, includingmedial temporal lobe systems that provide histor-ical information about prior encounters with thestimuli as well as inputs from brainstem motiva-tional and prefrontal control centers that provideinformation about current behavioral goals.3543 Assuch, vmPFC tracks the positive or negative valu-ation of stimuli in a context and goal-dependentmanner.41,4446 Examples of this include the findingthat vmPFC activity to an image of a healthy but nottasty food depends on whether one has the goal toeat healthily,47 and the findings that vmPFC lesionslead to context-inappropriate affective responses inboth humans and animals.39,48,49

The fourth brain system is the insula, which isthought to represent a viscerotopic map of ascend-ing viscerosensory inputs from the body50 and hasbeen implicated in negative affective experience ingeneral.51,52 There appears to be posterioranteriorfunctional gradient in the insula with posterior re-gions associated with primary representations ofsensations from the body and anterior regions asso-ciated with interoceptive awareness of the body andinmotivational and affective states, like disgust, thathave a strong visceral component.51,5356

Mechanisms of emotion regulationWith an understanding of how emotions are gener-ated in the first place, we can turn to an account ofthe processes and neural systems involved in regu-lating them.

Processes involved in emotion regulationAlthoughmanybehaviors can change our emotions,often these effects are unintended or incidental (e.g.,your mood improves because you happen to havelunch with a friend) and as such are not consideredto be examples of emotion regulation, per se. In-stead, emotion regulation entails the modificationof ongoingor the initiation of newemotional

responses through the active engagement of regu-latory processes. That said, we can further distin-guish between cases where emotion regulation isguided by regulatory goals that are implicit or out-side awareness (e.g., Ref. 57) as compared with ex-plicit and accessible to awareness. Although bothare interesting and important, no neuroscience re-search has addressed the former case and a greatdeal has addressed the latter case. Therefore, we fo-cus here on thedeliberate deployment of an emotionregulation strategy in the service of explicit goals tochange ones emotions. To understand how such ex-plicit emotion regulation strategies work, it is usefulto distinguish among five classes of strategies whoseeffects on emotion can be understood in terms ofthe stage of the emotion generation sequence onwhich they have an impact.58

It is important to note that the distinctions madebelow originally were based on behavioral analy-ses of the aspects of emotional responses targetedby different strategies.58 As such, this analysis wasagnostic to the specific nature of the regulatoryprocesses supporting each strategy, but tacitly as-sumed that all strategies drew upon some combi-nation of cognitive control processes (designatedby the blue box in Fig. 2A). In this regard, func-tional imaging has made a substantial contributionto our understanding of how emotion regulationworks because it provides insight into the natureof the control processes supporting emotion regu-lation that is not obtainable from behavioral dataalone.9

As illustrated by the top portion of Figure 2A,the first two strategies involve changing the natureof the stimulus inputs to the emotion generationcycle. In situation selection, you keep yourself awayfrom stimuli that elicit unwanted emotions and putyourself in the presence of stimuli that elicit desiredemotions. An example is staying away from a partywhere an old flame will be present if you dont wantto feel pangs of sadness for having been dumped byher. Situation modification is when you find yourselfin the presence of a stimulus that elicits an unwantedemotion and change something about the situationto alter its impact on you. In the old flame example,youmight leave a party at which she is unexpectedlypresent or leave the room in which she is havinga conversation. Although these two strategies areundoubtedly effective (e.g., Ref. 59), they can bedifficult to study neurally and have received little



attention in imaging or using other neurosciencetechniques (see below).The remaining three strategies are all amenable to,

andhave been studied, using imaging, albeit to vary-ing degrees. Attentional deployment controls whatstimuli are gated into, or out of, the emotion gen-eration process. The two most commonly studiedexemplars10 are selective attention, which involvesshifting the focus of attention toward or away fromstimuli or their attributes, and distraction, whichinvolves limiting attention to an external stimulusby focusing internally on information maintainedin working memory. These types of strategies differfrom situation selection in that they do not involvephysically altering ones proximity or relationshipto an emotional stimulus, but rather they manip-ulate attention so as to alter ones emotional re-sponse. Cognitive change involves changing the wayone appraises the meaning of a stimulus. It is oneof the most cognitively complex strategies insofaras it draws on any of a number of different highercognitive processes to support changes in stimulusmeaning, including language and memory, as wellprocesses that also support other strategies, such asattention and response selection. The most com-monly studied exemplar is reappraisal, which in-volves reinterpreting the meaning of a stimulus, in-cluding ones personal connection to it, to changeones emotional response. Finally, response modu-lation strategies target the systems for emotion-expressive behavior. The most commonly studiedexemplar is expressive suppression,60 which entailskeeping ones face still so that observers would notknow the emotion you are experiencing.A great deal of behavioral and psychophysiolog-

ical research has been devoted to comparing andcontrasting the behavioral consequences of deploy-ing each of these strategies. For example, its knownthat attentional deployment and reappraisal canhave downstream effects on various components ofan emotional response because they target the earlystages of the emotion generation sequence.6065 Bycontrast, expressive suppression has an impact ononly the behaviors it targets at the final responsestage of emotion generation;whenkeeping your facestill, emotional experiencemay subtly diminish,66,67

if at all, and your physiological arousal will increasefrom the effort.60 There is also evidence that strate-gies differ in their long-term effects. For example,reappraisal, but not distraction, has been shown to

have long-lasting effects on ones tendency to havean emotional response to a stimulus,65 presumablybecause only reappraisal involves an active changein how one represents the affective meaning of thatstimulus.

Neural systems involved in emotion regulationAs foreshadowed previously, the use of functionalimaging has provided insight into the nature of thecontrol systems that support regulatory strategiesas well as the affect systems that these strategiesmodulate to change an emotional response. Thissection discusses core conclusions that can be drawnfrom reappraisal studies and a model of emotionregulation that can be derived from it.

Reappraisal as a paradigm case. Reappraisal is anappropriate starting point for developing a MCCEfor three reasons. First, because reappraisal is amongthe most cognitively complex strategies, a model ofemotion regulation derived from reappraisal workmay be generally applicable to other strategies andphenomena that typically will be cognitively sim-pler. Second, the majority of studies to date havefocused on reappraisal because (i) it can be studiedeasily in an imaging environment and (ii) becauseit is the strategy referenced by countless aphorismsthat advise us, [to] look on the bright side. . ., [to]turn a sows ear into a silk purse. . ., When life givesyou lemons, make lemonade, and, [that] everydark cloud has a silver lining. Third, in contrastto other areas of emotion regulation research (re-viewed below) reappraisal studies tend to be moremethodologically and conceptually similar to oneanother and therefore provide a stronger base formechanistic inferences. With these considerationsin mind, we now describe five key insights into thebrain mechanisms supporting emotion regulationthat have been derived from studies of reappraisal.9

Basic control systemaffect system relationships.When the first fMRI studies of reappraisal were pub-lished approximately 10 years ago, there were noimaging studies of any form of emotion regulation.To develop hypotheses about how reappraisal mightwork, an analogy was drawn between the use of cog-nition to control emotion and the use of cognitionto control memory, attention, and other thoughtprocesses.43 The simple idea was that prefrontal andcingulate systems would support control processesthat modulate activity in posterior and subcortical



systems that generate emotional responses.10 Adecade and over 50 imaging studies later, this initialhypothesis has been strongly supported.Figure 2B schematically illustrates the brain sys-

tems shown by current research to be involved inthe cognitive control of emotion via reappraisal. Assuch, Figure 2B diagrams the core elements of theMCCE. Three types of neural systems are primarilyinvolved in generating and applying reappraisals.10

First, dorsolateral and posterior prefrontal cor-tex, along with inferior parietal regions gener-ally implicated in selective attention and workingmemory, may be used to direct attention toreappraisal-relevant stimulus features and hold inmind reappraisal goals as well as the content ofones reappraisal.6870 Second, dorsal regions ofthe anterior cingulate cortex implicated in perfor-mance monitoring may help track the extent towhich ones current reappraisals are changing emo-tional responses in the intended way.71 Third, re-gions of ventrolateral prefrontal cortex implicatedin selecting goal-appropriate (and inhibiting goal-inappropriate) responses and information from se-mantic memory may be used to deliberately se-lect a new stimulus-appropriate reappraisal in favorof ones initial prepotent appraisal of that stimu-lus.72,73 Finally, to the extent that ones reappraisalinvolves focusing on and interpreting or reinter-preting ones own emotional statesor those ofothersdorsomedial prefrontal regions implicatedin attributing mental states also may be active.74,75

With respect to the emotion-related regions thatare modulated by reappraisal, the four regions de-scribed earlier in the section on neural systemsfor emotion generation all have been implicatedalbeit to differing extents. Far and away, the mostcommonly modulated region is the amygdala, fol-lowed by the ventral striatum. The insula and thevmPFC are the least commonly modulated re-gions9,10 (although see the section on pathways be-low for a potential role of vmPFC in reappraisal asa modulator).Although we will discuss the significance of the

differential modulation of these regions in moredetail later (see later sections on valence speci-ficity and pathways), for now we can highlight theconsistency with which they have been observed.Figure 3 plots peak activation foci for 43 studies(see Table 1) of reappraisal in healthy individuals asa function of reappraisal goals (panel A), reappraisal

tactics (panel B), and the valence of the emotionbeing regulated (panel C). Ignoring these distinc-tions for a moment, one can see that the controlsystemaffect system relationships shown in Figure2B and described previously have been observed re-liably across numerous studies.

Moving beyond the basic modelWith the consistency of the core controlaffect sys-tem relationship as a foundation, we are now ina position to consider how this basic modelfirstproposed in 200243 and elaborated in 200510hasevolved. Belowwe discuss first new conclusions thatcan be drawn about themodel from recent studies ofreappraisal. In this section, we pay special attentionto two emerging features of the model: (i) the po-tential intermediary role of semantic/perceptual sys-tems in reappraisal, and (ii) pathways linking con-trol and affect systems. Next, we discuss the way inwhich the model can be applied to understandingregulatory strategies other than reappraisal aswell asvarious allied phenomena involving controlaffectsystem interactions.

Integrating new research on reappraisalRecent research provides new insight into the distri-butionof emotion regulationrelated activation focias a function of reappraisal goals (i.e., the outcomeone hopes to achieve by regulating, for example,increasing or decreasing an emotional experience),tactics (i.e., the specific subtype of reappraisal oneimplements), and the emotional valence of stim-uli (i.e., whether the stimulus evokes a positive ornegative emotional response). Here, we consider theimplications of this work for the evolving MCCE.

Goal specificityArguably, the most common goal when using reap-praisal is to decrease negative emotion, as when weattempt to make ourselves feel better about a dis-appointing paper rejection, an argument, and thelike. It is not surprising then that this goal has beenthe focus of the majority of reappraisal studies (seeTable 1). This is not the only goal that guides reap-praisal, however. In some cases, as when we worry,ruminate, ormake ourselvesmore anxious or fearfulby elaborating on themeaning of unpleasant events,we are using reappraisal in service of the goal to in-crease emotion. A small, but growing, number ofstudies have examined this reappraisal goal as well.



Figure 3. Plots of activation foci from the 43 studies of reappraisal described in the text and Table 1. (A) Plots of foci as afunction of the goals to decrease or increase emotion. (B) Plots of foci as a function of the specific reappraisal tactics usedeitherreinterpreting the meaning of events depicted in stimuli or actively changing ones psychological distance from them. (C) Plots offoci as a function of the valence of the stimuli eliciting the emotions that participants attempted to regulate. Blue boxes illustrateregions that are purported to support reappraisal (increase> look and decrease> look contrasts). Pink boxes illustrate regionsthat are purported to be modulated by reappraisal (look > decrease and increase > look contrasts; for clarity, only foci fallingwithin the boundaries of the amygdala and striatum are shown).

Figure 3A plots peak activation foci for reap-praisal studies of healthy individuals as a functionof decrease versus increase goals. Perusal of this fig-ure highlights three findings. First, whereas bothincrease and decrease goals recruit left prefrontalregions, decrease goals recruit right prefrontal re-gions to a much greater extent than do increasegoals. There are two interpretations of this finding.First, it may be attributable to the fact that decreas-ing an emotional response is more difficult than in-creasing one, and therefore may require additionalcognitive control resources.76 Second, decreasingbut not increasingan emotional response requiresinhibiting or limiting the expression of a prepotentappraisal of a stimulus (e.g., as negative) in favor ofselecting an alternative reappraisal (e.g., as neutralor evenpositive). Research shows that right dorsaland especially ventrolateralprefrontal cortex is in-volved in the selection and/or inhibition of variouskinds of responses.7780

Second, there is some evidence that increasegoals differentially involve anterior portions ofdorsomedial prefrontal cortex (dmPFC). Of the12 studies directly comparing increasing emotionwith a control condition in which participantsrespond naturally, six show increases in anteriordmPFC.16,76,8183 Of the six studies that did not,most showed activation in neighboring areas (suchas anterior cingulate cortex).62,8488 Given the roleof dmPFC in making judgments about mentalstates75,89,90 and that the majority of reappraisalstudies use photographs of people as stimuli (seeTable 1), it is likely that these regions supportattention to and elaboration of emotional states, in-tentions, and outcomes of the individuals depictedin these photos.Third, whereas increase and decrease goals both

seem to modulate the striatum (including both thecaudate and putamen), they may differ in the waythey modulate the amygdala. On the one hand,



Table 1.Neuroimaging studies of reappraisal in healthy individualsa

Design

Stimulus Timing of

Study Participants Goal Valence Tactic type reapp cue Amygdala

Beauregard et al.204 HYA Dec Pos Dist Videos Early NoDomes et al.81 HYA Both Neg Both Photos Late Yes

Eippert et al.84 HYA Both Neg Both Photos Late Yes

Erk et al.168 HC Dec Neg Dist Photos Early Yes

Goldin et al.66 HYA Dec Neg Reint Videos Early Yes

Harenski et al.205 HYA Dec Neg Both Photos Early Yes

Hayes et al.139 HYA Dec Neg Reint Photos Late Yes

Herwig et al.206 HYA Dec Both Reint Anticipate

photos

Early Yes

Hollmann et al.207 HYA Dec Pos (food) Reint Photos Early No

Ichikawa et al.82 HYA Both Neg

(errors)

Reint Task

errors

Early No

Kanske et al.127 HYA Dec Both Both Photos Late Yes

Kim et al.95 HYA Dec Both Reint Photos Early Inc pos

only

Kober et al.118 HYA

smokers

and non-

smokers

Dec Pos

(food/cigs)

Reint Photos Early Yes

Koenigsburg et al.199 HYA Dec Neg Dist Photos Early Yes

Krendl et al.208 HYA Dec Neg Unclear Photos Early Yes

Kross et al.112 HYA Dec Neg Reint Memories Late No

Lang et al.83 HC Both Neg Dist Scripts Early Inc only

Levesque et al.209 HYA Dec Neg Dist Videos Early NoMak et al.210 HYA Dec Both Unclear Photos Early NoMcRae et al.211 HYA Dec Neg Reint Photos Early Yes

McRae et al.61 HYA Dec Neg Reint Photos Early Yes

McRae et al.180 Healthy aged

1022

Dec Neg Reint Photos Early No

McRae et al.15 HYA Dec Neg Reint Photos of

faces

Early Yes

Modinos et al.212 HYA Dec Neg Reint Photos Late Yes

New et al.85 HC Both Neg Reint Photos Late Yes

Ochsner et al.43 HYA Dec Neg Reint Photos Late Yes

Ochsner et al.76 HYA Both Neg Both Photos Early Yes

Ochnser et al.16 HYA Inc Neg Both Photos Early Yes

Ohira et al.115 HYA Dec Both Unclear Photos Early YesOpitz et al.96 HYA and

HOA

Both Neg Reint Photos Late No

Phan et al.114 HYA Dec Neg Reint Photos Early YesPitskel et al.86 Healthy aged

717

Both Neg Reint Photos Early Yes

Continued



Table 1.Continued

Design

Stimulus Timing of

Study Participants Goal Valence Tactic type reapp cue Amygdala

Schardt et al.213 HYA Dec Neg Dist Photos Early Yes

Schulze et al.87 HC Both Neg Both Photos Late No

Staudinger et al.214 HYA Dec Pos Dist Reward Early NoStaudinger et al.215 HYA Dec Pos Dist Anticipate

reward

Early No

Urry et al.94 HOA Both Neg Reint Photos Late Inc only

Urry et al.216 HOA Both Neg Reint Photos Late Yes

van Reekum et al.88 HOA Both Neg Reint Photos Late Dec only

Vrticka et al.217 HYA Dec Both Reint Photos Early YesWager et al.117 HYA Dec Neg Reint Photos Early Yes

Walter et al.218 HYA Dec Neg Dist Photos Early Yes

Winecoff et al.195 HYA and

HOA

Dec Both Dist Photos Late Yes

aStudies are ordered first by year and second by alphabetical order.Only studies that reported contrasts (i.e., not only functional connectivity or correlational analyses) for psychologicallyhealthy individuals are included here. If a study included a patient sample but still reported results for its healthy adultcontrols separately, it was included.HYA, healthy young adults, typically 1830 yrs old; HOA, healthy older adult, typically aged 60 years or older; HC,healthy adult control participants matched to patients; For design, Goal, goal pursued by participants to increase ordecrease emotional responses; Valence, Positive or negatively valenced emotional stimuli; Tactic, type of reappraisalused, distancingor reinterpreting; StimType, stimulus type; Timingof reapp cue, timingof instruction cue to reappraiserelative to onset of stimulus, where early is just before simulus onset and late is a few seconds after stimulus onset;Amygdala, whether modulation of amygdala was reported.Note: All studies used event-related designs (different types of trials are presented in a randomized fashion so asto estimate responses on a trial-by-trial basis) except the nine studies designated by in the Timing of reapp cuecolumn, which indicates that they used a block design (trials are blocked by type, such that many of one type appearconsecutively). Also, for the stimulus-type column, photo stimuli were drawn from the international affective picturesystem111 unless otherwise specified. Goal: Dec, decrease; Inc, increase; Both, both increase and decrease conditionswere used; Valence: Neg, negative; Pos, positive; Both, both positive and negative stimuli were used; Strategy: Both,both distancing and reinterpreting were used (this only applies to Ref. 76), or participants were given the choice ofdistancing or reappraising; Dist, become more or less psychologically distant; Reint, cognitively reinterpret; Unclear,unclear as to what tactic was instructed.

decrease goals reliably modulate the amygdalasventral (corresponding to the basal and lateralamygdala nuclei) and dorsal portions (correspond-ing to the central nucleus) as well as the sublentic-ular extended amygdala (SLEA30,91,92) that lies be-tween the amygdala and the striatum. On the otherhand, increase goals may modulate only the dorsalamygdala/SLEA. One speculative interpretation ofthese data is that decrease goals influence percep-tual and semantic inputs to the amygdala, whichcome through the basolateral complex, whereas in-

crease goals influence the outputs of the amygdala,which flow from the central nucleus.43,76 This hy-pothesis would fit with anatomical data showingthat the basolateral complex has reciprocal con-nections with ventrolateral PFC as well as tempo-ral and parietal regions implicated in visuospatialand semantic representation, whereas the centralnucleus receives inputs from medial prefrontal re-gions and sends outputs to autonomic centers thatimplement various components of an emotionalresponse.93



The major caveat for all of these conclusions,however, is that very few studies have examinedincrease goals, and as a consequence, conclusionsabout the goal specificity of reappraisal-related acti-vations must be considered tentative. That beingsaid, the first study to directly compare increaseand decrease goals within subjects obtained ex-actly the results described previously76both in-creasing and decreasing negative affect recruited leftvlPFC and dlPFC and modulated the dorsal amyg-dala/SLEA (increasing affect increased amygdala ac-tivity, whereas decreasing negative affect decreasedactivity), yet it was also revealed that increasing neg-ative affect recruited the dmPFC to a greater degreethan did decreasing negative affect and decreasingnegative affect recruited right vlPFC andmodulatedventral amygdala to agreater extent thandid increas-ing negative affect. At least two-thirds of subsequentstudies comparing these goals have obtained resultsthat are generally consistent with them76,84,87,9496

(other findings also have been reported, includ-ing increase versus decrease differences only in theamygdala,81 striatal modulation,76,88,94 and greaterright PFC activation for increasing than decreas-ing84).

Tactic specificityIn the military, a distinction is commonly made be-tween strategy and tactics. Strategy is the overallmeans by which a goal (e.g., win the war) is to beachieved (e.g., divide and conquer). Tactics are thespecific ways in which strategies are implemented ina given circumstance (e.g., a quick infantry advance,an airstrike, etc.). In the same way, one can distin-guish between reappraisal as a strategy that involveschanging the meaning of a stimulus and the tacticsused to implement that strategy.97

Two different reappraisal tactics have been stud-ied with imaging.9,76 The first can be called reinter-pretation, which involves changing ones interpre-tation of the elements of the situation or stimulusthat elicits emotion. For example, if one is presentedwith a photo of a sick man in the hospital that elic-its feelings of sadness, one might reinterpret thisimage in a way that decreases emotion by think-ing about the mans hearty constitution and that hewill be healthy and well in the future. To increaseemotion, one might instead think about how theman is in a great deal of pain and may, in fact, getworse and even perish. The second can be called

distancing , which involves changing ones personalconnection to, or psychological distance from, thestimulus that elicits emotion. In the example of thephoto of the sick man, one might decrease emotionby viewing the image from the detached perspec-tive of an objective, third person observer and/orimagining that the pictured event took place a longtime ago or in a faraway location. One might in-crease emotion by instead imagining that one is ex-periencing pictured events in the present moment,from a first-person perspective, which enables youto smell, hear, and directly observe what is takingplace.As Table 1 shows, about twice as many studies

have examined reinterpretation as have examineddistancing, with a few allowing participants to en-gage in either tactic, and only a single study directlycomparing them.76 Figure 3B plots peak activationfoci for reappraisal studies of healthy individualsas a function of reinterpretation versus distancingtactics.This figure illustrates three conclusions that can

be drawn about reappraisal tactics. First, reinterpre-tation seems todifferentially call uponventral lateralprefrontal regions implicated in response selectionand inhibition.73,98,99 Presumably, this reflects thefact that reinterpretation requires that one mustlook up and select alternative meanings for stim-uli from semantic memory to a greater extent thandoes distancing. Second, distancing seems to recruitparietal regions implicated in spatial attention andrepresentation to a greater extent, including per-spective taking and the sense of agency.100103 Thismay reflect the fact that distancing involves chang-ing the conceptual and spatiotemporal perspectivefrom which stimuli are experienced. Third, in gen-eral, the regions involved in reinterpretation appearto be more strongly left lateralized in prefrontal andtemporal cortices, whereas regions involved in dis-tancing appear to be more strongly right lateral-ized in prefrontal cortex. These patterns may reflectthe differential dependence of reinterpretation anddistancing on linguistic and semantic processes asopposed to spatial and attentional processes, whichgenerally showa left versus right hemisphere patternof relative specialization.76,104

Here again, however, because comparativelyfewer studies have examined distancing, firmconclusions concerning the tactic specificityof reappraisal-related activations await further



research that directly test the conclusions drawnpreviously.

Valence specificityOn average, the impact of negative emotional ex-periences seems to be greater than the impact ofpositive emotional experiences, both in the shortand long term.105 Indeed, problems with regulat-ing negative emotion are more often a hallmark ofclinical disorders than are problems with regulatingpositive emotion.106 As such, it is not surprising thatTable 1 shows that the number of reappraisal studiesexamining negative emotion outnumber those ex-amining positive emotion more than three to one.That said, two conclusions can be drawn from

examining Figure 3C, which plots peak activationfoci for reappraisal studies of healthy individualsas a function of the negative versus positive va-lence of stimuli (and the emotions they presumablyelicit). First, whereas reappraisal of both negativeand positive stimuli depends upon left-hemisphereregions, reappraising negative stimuli depends onright hemisphere regions as well. These findingsmight reflect the fact that, to date, the majority ofstudies of negative emotion involve decrease goals.As noted earlier, decrease goals may require morecognitive resources than increase goals, includingplacing greater demands on selection/inhibitoryfunctions associated with right vlPFC.107109 Analternative explanation is that positive and neg-ative emotions generally involve approach versusavoidance motivations, which have been associ-ated with the left versus right prefrontal cortex.This interpretation seems less likely, however, giventhat this motivation-related prefrontal asymmetryis commonly observed in EEG110 but not in fMRIstudies.19

Second, its apparent that reappraising negativestimuli typically modulates activity in the amygdalaand less commonly activity in the striatum. By con-trast, thehandful of studies examining reappraisal ofpositive stimuli more commonly show modulationof the striatum, including the ventral portions asso-ciated with reward and reinforcement learning.33,34

These conclusions are again tentative, however,because so few studies have examined reappraisalof positive stimuli and, in general, studies of reap-praisal have focused overwhelmingly on decreaserather than increase goals. As a consequence, it isnot yet clear whether the patterns noted previously

are attributable to the pursuit of decrease versusincrease goals, the use of negative versus positivestimuli, or both.

Stimulus specificityTodate, 33 out of the 43 reappraisal studies shown inTable 1 have used photographic stimuli pulled fromthe International Affective Picture System (IAPS).These stimuli have been shown to reliably elicit ex-periential, physiological, and facial expressive com-ponents of an emotional response in a valence-specific manner.111 As such, they provide a straight-forward means of eliciting affective reactions in thescanner environment.That said, the emotions elicited by such stim-

uli may or may not generalize to other contexts.For example, IAPS photos are selected so as to benormatively positive or negative.111 Although thisis suitable for many experimental agendas, otherstimuli may be appropriate if one wants to exam-ine the ability to reappraise specific emotions, theemotions elicited by idiosyncratically self-relevantautobiographical experiences,112,113 and so on.With these considerations in mind, small num-

bers of studies have examined the ability to reap-praise the specific emotions elicited by sad, sex-ual, or disgusting videos, scripts that elicit partic-ular emotions, the recollection of autobiographicalmemories, anticipation of reward or shock, or thecommission of an error (see Table 1). Because so fewstudies have used each of these stimuli, it is not use-ful at present to plot activation foci for them or toattempt to draw conclusions about how they mightdiffer as a function of stimulus type. It remains forfuture research to directly address the question ofhow the nature of the stimulus per se, as opposed tothe kind of emotion elicited, influences the neuralsystems involved in reappraisal.

Pathways linking control and affectsystemsStudies of reappraisaland more generally studiesof any form of emotion regulationimplicitly orexplicitly assume that prefrontal regions modulateemotional responses via their impact on affect sys-tems like the amygdala and ventral striatum. Giventhe prevalence of this assumption, it is somewhatsurprising that it has seldom been put to a directtest. To be sure, a number of studies have showncorrelations between prefrontal and amygdala



Figure 4. Two kinds of mediation pathways involved in reappraisal. (A) and (B) show pathways identified in two studies of thedownregulation of negative emotion whereby dorsomedial or ventrolateral prefrontal regions diminish amygdala responses viatheir impact on ventromedial prefrontal cortex. These studies did not report weights for the mediation paths between regions ortest for full versus partial mediation. (C) and (D) show pathways identified in two studies of the downregulation of negative orpositive emotion whereby ventrolateral or dorsolateral prefrontal regions diminish self-reports of negative affect or craving viatheir impact on the amygdala or ventral striatum, respectively.

activity76,95,114 or correlations between some mea-sure of emotional response (typically self-report)and either prefrontal76,114,115 or amygdala activ-ity.76,94,116 Only four studies, however, have directlytested the mediation model implied by the hypoth-esis that control systems influence emotional re-sponse by influencing activity in affect systems (seeFig. 4).The first two studies to use mediation exam-

ined the use of reappraisal to diminish responses tonegative photos.94,116 Although both studies usedamygdala reactivity as their measure of emotionalresponse, neither reported a main effect of reap-praisal on diminishing amygdala activity.Motivatedby known connections between the amygdala andvmPFC, both studies looked for and found thatindividual differences in amygdala response werecorrelated inversely with responses of vmPFC. Me-diation analyses showed that vmPFC mediated a

relationship between either left dmPFC94 or leftvlPFC116 and the amygdala (Fig. 4A and B) suchthat activity in these prefrontal regions was posi-tively related with vmPFC activity, which, in turn,was negatively related to amygdala responses. Thereare, however, at least two qualifiers in interpret-ing these results. First, the study94 identifying theleft dmPFC region did so in an increase > attend(i.e., a no regulation baseline) > decrease contrast,meaning that it generally is less active when de-creasing negative emotion than when respondingnaturally in a baseline attend condition. This sug-gests that to the extent one shows less deactiva-tion when decreasing (relative to baseline), one willshow greater activity in vmPFC, and, in turn, lessamygdala response. It is not immediately clear howto interpret the reduced degree of dmPFC deacti-vation in this context. Second, the study116 iden-tifying the vlPFCvmPFCamygdala pathway



collapsed across activity in both amygdalae that wasextracted from structural ROIs. As such, it is notclear whether the prefrontal effects were strongerfor one amygdala or the other. That said, whentaken together, these two studies suggest that effec-tive reappraisal involves PFCvmPFCamygdalapathways.The second two studies used similar analytic ap-

proaches to study either the use of reappraisal todiminish responses to negative photos117 or forsmokers, the use of reappraisal to diminish crav-ing elicited by photographs of appetitive foodsor cigarettes.118 The study of negative emotion117

showed that right vlPFC activity predicted dropsin self-reported negative emotion, and that thisrelationship was independently mediated by sep-arate pathways through the amygdala and the ven-tral striatum (Fig. 4C). These two pathways weretaken to reflect the use of reappraisal to mini-mize negative appraisals and enhance positive reap-praisals, respectively (see also Table S1 from thatpaper, which shows left vlPFC involvement as well).The study of craving118 showed that left dlPFCactivity predicted drops in self-reported cravingvia modulation of activity in the ventral stria-tum (Fig. 4D). Together, these two studies suggestthat effective reappraisal involves a pathway linkingPFCsubcortexemotion change, with the spe-cific elements of the pathway depending on the na-ture of the stimulus and emotion involved.Why are there differences between the results of

these pairs of studies? On one hand, because differ-ent dependentmeasures of emotional responsewereused (amygdala response vs. self-reported emotion),its possible that different reappraisal pathways willemerge depending on the type of response. On theother hand, its also possible that differences inmethodology may lead participants to reappraisedifferently, and, in turn, recruit different pathwaysfor effective emotion regulation. Here, two differ-ences between the pairs of studies may be relevant.In the first pair of studies that identified the

vmPFC-mediated pathway, both had participantsthat were up to 40 years older than the average par-ticipants in studies of reappraisal in young adultsaged 6264 in one case94 and 1953 (average 33years) years in the other.116 Participants in the sec-ond pair of studies were younger, as is the norm, av-eraging 22.3117 and 26.8118 years, respectively. Givenfindings that older adults may be impaired in some

kinds of reappraisal; the lateral PFC thins, whereasvmPFC thickens with age;119 and that even whennot told to regulate, older adults can show greaterconnectivity between vmPFC and amygdala,120 it ispossible that the vmPFC plays a larger role in reap-praisal for older compared with younger adults.Second, the first pair of studies cued participants

to reappraise approximately 4 seconds into an ap-proximate 10-second presentation of an aversivephoto (a late cue), whereas the secondpair presentedthe cue to reappraise just before onset of aversivephotos (an early cue). The early cue method is in-tended to provide participants with an opportunityto first have a naturalistic emotional response to anaversive photo before they begin to regulate and hasbeen used in 14 studies (see Table 1). The late cuemethodmodels real-world situationswhere the goalto reappraise comes online just as one encounters anemotionally evocative stimulus and has been usedin 29 studies (see Table 1).Although the early cue method is analogous to

real-world situations where the goal to regulatecomes online only after one already is having anemotional response, there is a potential problemwith trying to model this in the lab. During the ini-tial free viewing of an aversive photo, participantsmay try out a few reappraisals just in case they areasked to subsequently reappraise on that trial. If thiswere the case, then we might expect one or both oftwo kinds of results.One possibility is that the ability to detect an

effect of reappraisal on amygdala responses wouldbe diminished for late cue studies, either becausethe amygdala responded early and then habituated,or because once participants were asked to reap-praise, the amygdalas response could have alreadydecreased because the participants had begun gen-erating/practicing potential reappraisals before theexplicit instruction cue appeared. Although neitherof the mediation studies in question showed whole-brain amygdala effects, and only one showed ef-fects using ROIs, weak effects of reappraisal on theamygdala are probably related to other factors (likeagesee above) given that roughly the same ratio(roughly 2/3 to 3/4) of studies using the late andearly cue methods show reappraisal-related amyg-dala modulation, especially for studies using photos(see Table 1).A second possibility is that the late versus early

timing of reappraisal cues changes the nature of



ones reappraisals, even if, on average, they havesimilar effects on amygdala responding. For exam-ple, in late cues studies, if participants have had achance to view stimuli for a few seconds and to thinkabout potential reappraisals before being explicitlytold to reappraise, then vmPFC recruitment couldreflect decision processes about which of a set ofprepared reappraisals they prefer and can best usefor the stimulus at hand (see also section ondecisionmaking below).To date, no imaging studies have com-

pared late and early cues. But one behavioral/psychophyiological study comparing these cuesfound that the effects of increase goals on somephysiologicalmeasures are greater for late than earlycues, but that the effects of decrease goals weresimilar for each cue type. Future work could fruit-fully illuminate these issues.All this said, it is of course possible that both kinds

of pathways are important and that a multistepvlPFCvmPFCamydala/striatumemotionresponse pathway may be observed in futurestudies. To date, however, no published studies haveexpressly tested for the existence of this complexpathway underlying reappraisal success.

The role of perceptual and semanticsystemsA related issue is whether and how reappraisal in-volves modulation not just of systems involved inaffective appraisal and response, but of systemsinvolved in representing the perceptual and se-mantic properties of stimuli as well. As shown inFigure 3, activation of a number of these systemsis often seen during reappraisal, including regionsalong the middle and superior temporal sulci in-volved in representing the visual properties of stim-uli, including nonverbal social cues to emotion likemovements of lips and eyes;121123 temporal polarregions implicated in representing episodic and se-mantic emotion knowledge;124 and regions near thetemporalparietal junction involved in representa-tions of beliefs, including false beliefs of the sortone generates when considering alternative reap-praisals of stimuli.125,126

These data raise at least three questions. First,there is the question of when activation of theseregions will be seen. Certainly, cognitive changestrategies like reappraisal may involve these regions,given that it involves an active reworking of the

meaning of a stimulus. Other strategies that do notfocus on meaning may not involve these regions,however. Consistent with this, two studies directlycomparing reappraisal and distraction found thatreappraisal differentially recruited all three of thetemporal regions listed above.61,127 Along theselines, it is also likely that these regions will be moreinvolved in regulating responses to visual stimuligiven the role of the temporal lobe in the ventralvisual stream for representing information aboutobject identity128130 (although this remains to betested directly). As noted previously, there is not yetenough work using different kinds of stimuli to saywhether reappraisal of stimuli in nonvisual modal-ities (e.g., somatosensory or auditory) may involvemodulation of corresponding modality-specific re-gions (e.g., somatosensory of auditory cortices).Second, if these regions are more active during

reappraisal, there is the question as to why this isthe case. Does greater activity here reflect increasedattention to perceptual and semantic aspects ofstimuli? Access to/retrieval of alternative views ofreappraised stimuli? The process of actively restruc-turing ones (visual) mental image of a stimulus?All three interpretations are possible and could betested in future work.Third, there is the question of whether these

temporal regions play a part in the regulationpathways described earlierplaying an interme-diary role, for examplebetween prefrontal con-trol systems and affective appraisal systems. Thispossibility was raised in early reappraisal studies(e.g., Ref. 43) where it was suggested that eventhough dorsolateral PFC regions do not have directconnections to subcortical regions like the amyg-dala, they may nevertheless modulate them viatheir impact on perceptual/semantic systems. Inline with this view, PFC could change ones men-tal representation of a stimuluss meaning fromthe top down, and that representation of the reap-praised stimulus would feed forward to the amyg-dala (and other structures that trigger affective re-sponses). Because the amygdala now sees thereappraised stimulus, its response changes. Al-though plausible, this hypothesis has yet to bedirectly tested.

SummaryExtant data from functional imaging studies ofreappraisal strongly support the MCCE depicted in



Figure 2B. Although many questions remain to beaddressed about how specific control systems mod-ulate specific affect systems as a function of reap-praisal goals and tactics or various aspects of stimuliand the emotions they elicit, a core controlaffectsystem dynamic is now well established.

Generalizability to other forms of regulationGiven the robustness of the MCCE (Fig. 2) inaccounting for reappraisal, the question naturallyarises as to whether this model can be generalizedto account for other types of emotion regulationstrategies.As noted previously, the majority of functional

imaging studies of emotion regulation have focusedon reappraisal. That said, the other fourmain classesof emotion regulation strategies diagrammed inFig-ure 2A have been targeted by imaging studies tovarying degrees. Here, we consider each in turn.

Situation selection and modificationThe two situation-focused strategies, situation se-lection and situationmodification, have received lit-tle attention thus far in human imaging research. Asnoted earlier, this is at least partially attributable tothe difficulty of devising appropriate lab paradigmsfor studying them. The lone human imaging studyof situation selection builds on the rodent literatureon avoidance conditioning. In a typical task, a ratlearns to perform an action that allows it to avoidpresentation of an aversive stimulus (e.g., Refs. 131and 132). In a human analogue of this procedure,Delgado et al. found that avoidance conditioning ac-tivates vlPFC and dlPFC control systems and mod-ulates the amygdala.133 These findings provide aninitial suggestion that situation selection may callsystems that maintain regulatory goals and selectcontext-appropriate avoidance responses.

Attentional deploymentBy contrast, studies of attentional deployment havebeen relatively common, second in number only tostudies of reappraisal. One set of these studies hasexamined the use of selective attention to shift visualspatial attention away from an affectively valencedstimulus or stimulus attribute and toward a neutralone. Another set of these studies has examined theuse of distraction to shift the focus of attention in-ward onto some internally maintained mental rep-resentation (e.g., a relevant working memory load,self generated stimulus-irrelevant thoughts, a pleas-

ant mental image, and so on). As has been reviewedin detail elsewhere,10,134 interpreting the findings ofboth of these kinds of studies is clouded by threeissues. First, almost all of the studies of selective at-tention, andmany studies of distraction, use stimulithat donot elicit strong emotional responses, such asfacial expressions of emotion. As such, these studiesare concernedwith the regulationof evaluative judg-ment or perception rather than affective respond-ing, per se. Second, when highly arousing and affect-inducing stimuli are employed, they most often arestimuli that cause physical pain. Although responsesto painful stimuli have a strong negatively valencedaffective component, this componentmay itself havea distinct neural signature because of its recruitmentof dedicated pain-specific neural pathways.135,136 Assuch, it is an empirical question whether the regu-lation of pain is similar to or different from theregulation of negative affective responses more gen-erally. Third, these studies are highly heterogenous,often employing very different stimuli and meth-ods of controlling the focus and level of attention,without a clear metric for assessing the extent towhich attention has or has not been paid to a givenaffective stimulus. Given these limitations, we referthe reader to other reviews of this literature,137,138

although noting that they are generally consistentwith the model depicted in Figure 2B, insofar asactivation of prefrontal systems and modulation ofaffect systems (like the amygdala) is often (but notalways) reported.

Response modulation. Finally, both behavioraland imaging studies of response modulation have fo-cused on expressive suppression,which is the abilityto hide behavioralmanifestations of emotion.60 Thetwo imaging studies of expressive suppression askedparticipants to suppress facial expressions of disgustelicited by a film clip.66,139 Both found that expres-sive suppression not only activated dorsolateral andventrolateral PFC regions associated withmaintain-ing goals, response selection, and inhibition,72,73,77

but also it increased activation of the insula, whichis involved in triggering affective responses. Amyg-dala findings were more mixed, however, with onestudy reporting increases66 and one decreases139

in activity during suppression. Increases in in-sula and amygdala fit with psychophysiologicalstudies, demonstrating that expressive suppression



boosts the autonomic component of emotionalresponding.60

In total, the available literature on emotion reg-ulation strategies other than reappraisal is in somecases limited and in other cases somewhat confus-ing, but in general supports the idea that all emotionregulation strategies involve interactions betweencognitive control and affect regions. Future neuro-maging research must apply the same rigorous andthorough approach to these other strategies that hasalready been applied to reappraisal.

Generalizability to other relatedphenomenaGiven the robustness of the MCCE (Fig. 2B) in ac-counting for multiple forms of regulation, a nat-ural next question is whether it can be generallyapplied to other allied phenomena, such as af-fective/emotional learning, decision making, andexpectancies. These phenomena are typicallyconsidered in separate literatures, but seemto involve related cognitiveaffective dynamics.Although space limitationsprohibit an in-depthdis-cussion, here, we briefly examine the broad applica-bility of the model in each of these three cases.

Affective/emotional learning. At the outset of thispaper we made a distinction between goal-directedforms of emotion regulation, which are the focusof this review, and other behaviors that may haveregulatory effects on emotion despite lacking a spe-cific goal to do so. There are a number of formsof affective or emotional learning that fit the lat-ter description. One of the most common exam-ples is extinction of a conditioned fear response.In the traditional fear conditioning paradigm,140

an animal learns that an ostensibly neutral stim-ulus, such as a light (known as the conditionedstimulus or CS), predicts the occurrence of an in-trinsically aversive stimulus, such as electric shock(known as the unconditioned stimulus or UCS).Over time, the repeated pairing of the light andshock lead the animal to respond to the light itselfwith an anticipatory fear response. Elegant animalstudies have shown that fear conditioning dependson communication between input and output nu-clei of the amygdala.140,141 Fear extinction involvesthe repeated presentation of the CS in the absenceof the UCS.142 Over time, the organism learns thatthe CS no longer predicts shock, ceases to have its

anticipatory fear response, and fear is said to be ex-tinguished. Importantly, extinction is known to in-volve the laying down of a new context-dependentmemory.143 In the current temporal context, the CSdoes not predict shock, whereas in the past temporalcontext it did. Rodent lesion studies have shown thatwhereas the initial acquisition of extinction requiresonly the amygdala, the ability to retain and expressmemory for extinction depends on vmPFC.142 Inkeeping with this finding, studies in humans haveshown thatboth themagnitudeof vmPFCactivationand vmPFC thickness predict the speed of extinc-tion.144146

In the present model, phenomena like extinction(or stimulusreward reversal learning, which alsodepends upon vmPFC147,148), are somewhat hybridphenomena. On the one hand, they can be viewedas an example of emotion generation, insofar as oneis learning to express a new emotional response toa given stimulus. On the other hand, they can beviewed as an implicit form of emotion regulationwhere one does not have an explicit goal to regulate,but the behaviors inwhichone engages directly, alterthe nature of ones emotional response.Beyond this, there are a number of ways in which

prefrontal control systems may have a regulatoryimpact on affective learning. For example, as notedearlier, in some cases reappraisal may involve in-teractions between PFC, vmPFC, and the amyg-dala, when reappraisal paradigms give participants achance to respond emotionally and potentially planreappraisals before deciding whether to implementthem. Interactions of this sort also have been ob-served in studies that use distraction to regulate aconditioned response.149,150 In these studies, one isinitially conditioned to expect either a painful shockor reward UCS following a visual CS (e.g., a yellowtriangle). Later, one regulates the conditioned re-sponse to the CS by thinking about a calm and neu-tral scene unrelated to either the CS or the UCS. Inboth cases, effective regulation involves activationof left dlPFC and modulation of both the amygdalaand/or ventral striatum and the vmPFC.

Affectivedecisionmaking. Affectivedecisionmak-ing involves choosing among several stimuli thatonemay purchase, consume, or own. In some cases,these choices are a simple matter of selecting theoption that has the greatest value. Imaging re-search suggests that activation in systems thought to



represent affect and value like the ventral striatum,insula, and vmPFC is sufficient to support and evenpredict such choices.151,152 But in other cases, thechoice options may be of similar value, or the rea-sons for valuing themmay conflictwithone another.In the model, such cases may draw on the controlsystems shown in Figure 2B to modulate the valuesassociated with choice options, essentially guiding atopdown revaluation of them to facilitate choice.Perhaps the simplest example of this is where the

act of choice itself arouses conflict as one decideswhich features of choice options they cant livewith-out and which features of choice options they mustforgo. Classically, this decision conflict is thought toarouse cognitive dissonance, which the act of choos-ing reduces by placing a higher value on chosenand a lesser value on unchosen stimuli.153 Imagingstudies show that these choice-induced changes invalue involve control systems like the anterior cingu-late cortex, which may signal the presence of choiceconflict andmotivate value change, and systems likethe ventral striatum, whichmay represent the reval-ued stimuli.153156

Another type of choice that commonly requiresthe use of control occurs when an individual mustdecide between options that fit short-term versuslong-term goals. This is the dilemma faced by adieter who must decide whether to eat a cupcakeor an apple. Consuming the cupcake satisfies theshort-term goal of hedonic pleasure, whereas eat-ing the apple satisfies the long-term goal of liv-ing a healthy lifestyle. A recent imaging study47

of this choice dilemma showed that food choicesreflecting a greater valuation of long-term healthover short-term tastiness involve the modulation ofvmPFC by dlPFC. This is consistent with the ideathat the cognitive control of choice involves interac-tions between systems for maintaining choice goals(e.g., dlPFC) and systems representing the value ofchoices with respect to those goals (e.g., vmPFC).This same logic applies to studies of intertem-

poral choice and delay of gratification,157 whereimaging158,159 and transcranial magnetic stimula-tion (TMS)160 studies suggest that lateral PFC con-trol systems can be used to effortfully represent thevalue of a larger delayed reward and guide selec-tion of it over a smaller but immediately availablereward.More generally, themodel can be applied to other

choices where control is needed to modulate the af-

fective valuations placed on choice options, rangingfrom risky decisionmaking161 to interpersonal con-texts in which one must decide whether to be fairtoward or punish others.162,163

Affective expectancies. In parallel to the growthand development of imaging research on emotionregulation, there has been a tremendous surge ofinterest in the brain mechanisms underlying the in-fluence of expectancies on behavior.164 In imaging,expectancies have been studied either by cueing par-ticipants that an upcoming stimulus will have par-ticular properties (e.g., that it will or will not bepainful, will be a neutral or aversive image, and soon) or by inducing beliefs about the effects of aplacebo drug on their experience (e.g., that an anal-gesic cream will reduce pain).In themodel, these phenomena all involve the use

of prefrontal control systems to set and maintain anexpectation,which, in turn, influences the responsesof affect generating systems. For example, imagingstudies show that expectancies and placebo beliefsabout pain activate lateral prefrontal/parietal con-trol systems and/or medial prefrontal systems164167

that may maintain expectations about upcomingevents. In turn, these systems may influence theway one attends to and appraises the meaning ofexpected stimuli, thereby increasing or decreasingactivity in affect systems to be consistent with thenature of ones expectations.

Summary and future directions for basicand translational researchThe overarching goal of this paper has been to re-view and synthesize current functional imaging re-search on emotion regulation. Toward that end, weoutlined a basic model of the processes and neuralsystems involved in emotion generation and emo-tion regulation and surveyed various domains ofresearch that support it. At its core, theMCCE spec-ifies how prefrontal and cingulate control systemsmodulate activity in affect systems as a function ofones regulatory goal, tactics, and the nature of thestimuli and emotions being regulated. Although themodel was built primarily from studies of one typeof cognitive change strategy known as reappraisal,it is generally applicable to understanding the brainmechanisms underlying the other emotion regula-tion strategies depicted in Figure 2A as well as arange of other allied phenomena.



That said, there is much work yet to be done. Atvarious points during the review weve highlightedthe limitations of current knowledge and the short-comings of current methodologies. Future work isneeded to clarify the mechanisms underlying all ofthe emotion regulation strategies discussed here aswell as the roles the brain systems supporting emo-tion regulation (Fig. 2B) play in affective learning,affective decision making, and affective expectan-cies. Progress is essential to refine our understand-ing of the distinctionsmade here, but also to addressnewquestions about howemotion regulationmech-anisms operate. For example, although it is certainlyimportant that regulation strategies have immediateeffects on emotional responses, it is also importantthat their effects be long lasting. Indeed, whetherregulatory effects last is critical both in everyday andclinical contexts inwhich one could repeatedly reen-counter an emotionally evocative stimulus (e.g., therisk of running into a girlfriend who dumped youbecause you work for the same company). To date,this issue has been addressed only twiceonce inan fMRI study168 reporting that the effects of reap-praisal on diminishing amygdala responses may en-dure for up to 40 minutes in healthy adults, but notthose with major depression, and once in an ERPstudy169 showing that the effects of reappraisal onarousal-related responses endure for up to 30 min-utes. Clearly, more work is needed here.In so doing, it will be important for this work

to increasingly make use of techniques other thanfunctional imaging (e.g., ERP,169177 TMS,160,178

and lesion methodologies179), as well as to in-tegrate insights gained from human studies withthe large body of literature on affective and reg-ulatory phenomena in nonhuman primates androdents.39,142,144 Progress on all of these fronts isabsolutely critical if we are to develop a model ofinteractions between control and affect systems thatcan make sense not just of emotion regulatory phe-nomena, but of all the other types of phenomenathat recruit these systems as well.Another important direction for future research

is the translation of basic research of emotion regu-lation to understanding the full range of normal toabnormal differences in emotional responding andregulatory ability. This is critical both for under-standing the mechanisms underlying this variabil-ity and for testing the boundaries of basic models ofemotion regulatory mechanisms.

One domain in which this will prove importantis understanding how and why our emotional livesevolve as we grow from childhood through adoles-cence into adulthood and old age. On one hand,there is growing evidence that childhood and ado-lescence are critical times for the development ofthe emotion regulatory abilities needed to adap-tively regulate affective impulses and the deleterioushealth behaviors (e.g., obesity, substance use) theycanpromote.A small but growingnumberof studieshave begun to address this issue by asking how theneuralmechanisms of reappraisal and emotional re-activity develop from adolescence into young adult-hood. Some early results suggest that reappraisalability increases linearly with age, whereas emo-tional reactivity remains relatively constant180,181

(but see Ref. 182). On the other hand, althoughphysical health and cognitive abilities tend todeclinewith age,183185 older adults report more emotionalstability and a greater ratio of positive to negativeexperiences in their daily life, with the extent of pos-itive emotion predicting longevity.186188 Althoughmany have hypothesized that this rosy glow of oldage is due in part to more effective emotion regula-tion, to date there is little evidence directly testingthis idea.187,189,190 One conundrum to resolve herewill be the apparent dependence of emotion regula-tion on the same kinds of prefrontal control systemsthat declinewith age. This raises the question of howregulatory abilities improve as theunderlyingneuralmachinery declines.191,192 Early results suggest thatit may depend on the strategies older adults deploy,with spared or greater regulatory ability shown forstrategies and tactics that fit with long-term goalsand have become habitual.9,96,190,193196

A second important goal for translational re-search will be to understand how potential dysfunc-tion in the mechanisms of emotion generation andregulation may underlie various forms of psychi-atric and substance use disorders (for a more indepth discussion, please see Ref. 197). This trans-lational direction is being pursued in studies ofreappraisal across various disorders, ranging fromdepression116,168,198 to borderline personality disor-der,83,87,199 social anxiety disorder,200,201 phobia,202

posttraumatic stress disorder,83,85 cocaine users,203

and smokers.118 These studies can be useful in twoways. First, theymay showdisorder-specificpatternsof altered function in control and affect systems.For example, current data suggest that depressed



individuals may show impaired recruitment ofvlPFC during reappraisal,116 suggestive of an im-pairment of topdown control, whereas border-line individuals may show heightened amygdalaresponses coupled with diminished cingulate re-sponses, suggestive of a failure to monitor para-doxical increases in affective responding when at-tempting to decrease emotion.199 Second, imagingmethods for studying emotion regulation may beused before and after treatment regimes as pre-dictors of and markers of improvement. Althoughsuch studies are only beginning to emerge, they holdgreat promise for understanding why some individ-uals improve andwhether different treatments (e.g.,drugs versus cognitive behavioral therapy) have dif-ferent mechanisms of action.In the long run, the hope is that integrating ba-

sic and translational perspectives will help specifywhich individuals are at greatest risk for maladap-tive health behaviors and emotional outcomes, atwhat ages this risk is greatest, and which regulatorymechanisms could be targeted in future interven-tions during particular points in the life course. Al-though realization of this dream is still a long wayaway, current research provides a strong foundationfor getting there.

AcknowledgmentsPreparation of this paper was supported by NIHGrants AG039279, MH076137, and DA022541awarded to Kevin N. Ochsner, as well as fellowshipF31MH094056 awarded to Jennifer A. Silvers.

Conflicts of interestThe authors declare no conflicts of interest.

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