Anxiety disorders are complex mental health conditions characterized by excessive worry, intense fear, and deficits in emotion regulation. These negative emotions are disproportionate to any real or perceived threat, and often endure long after any actual danger has dissipated.
As researchers explore potential causes and treatment options for anxiety disorders, some turn their attention toward the relationship between fears, phobias, and a set of behaviors known collectively as emotion regulation skills.
What Is Emotion Regulation?
Emotion regulation refers to the ability to effectively manage responses to experiences that can trigger difficult feelings.
Or, as described in a March 2010 article in the Journal of Psychopathology and Behavioral Assessment: “A set of actions designed to influence which emotions we have, when we have them, and how we experience and express them.”
Most people employ emotion regulation strategies several times every day. The situations may be minor, such as when a vending machine eats your dollar and doesn’t give you your candy bar. Or they may be major, such as when you fail a class or don’t receive a promotion at work.
The key to healthy emotion regulation is realizing that you are in control of your emotions, not vice versa. This prevents you from responding impulsively or behaving in a way that can lead to additional damage in the future.
Effective Emotion Regulation Strategies
- Assessing the problem before responding
- Understanding what you can (and cannot) change
- Applying conflict-resolution and problem-solving techniques
- Employing stress-management skills to manage distress in a positive manner
- Practicing mindfulness, acceptance, and self-care
Maladaptive Emotion Regulation Strategies
- Lashing out with anger, aggressiveness, or violence
- Numbing your pain with alcohol or other drugs
- Engaging in self-harming behaviors to punish yourself for perceived flaws or failures
- Ignoring problems or avoiding situations that could be challenging
- Worrying, ruminating, or catastrophizing (magnifying the potential threat and imagining the worst possible outcomes)
It is not surprising that experts have noted a connection between emotion regulation and mental health concerns such as anxiety disorders. However, as is so often the case in psychological matters, identifying an association is much easier than establishing a definitive cause-effect relationships.
In other words, does effective emotion regulation lead to better mental health, or are people with good mental health better able to regulate their emotions?
As we will discuss in the next few sections, researchers are continuing to investigate the ways that fear, phobia, and brain functioning may influence a person’s capacity for effective emotion regulation.
Emotion Regulation and Anxiety Disorders
The March 2010 article that we referred to in the previous section included a review of prior research into the relationship between anxiety disorders and emotion regulation. Among the review team’s goals for their article was to discuss how differences in emotion regulation may explain variances in symptom intensity among people who have anxiety disorders.
The authors observed that symptoms of generalized anxiety disorder (GAD) are particularly affected by dysfunctional emotion regulation strategies.
“GAD is marked by experiencing emotions quickly, easily, and with high intensity,” they wrote. “This emotional reactivity makes emotions difficult to regulate and is further complicated by the difficulty with identifying and understanding emotions that characterizes those with GAD.”
More specifically, they reported that the following factors affect the individual experience with generalized anxiety disorder:
- Ability to accept emotions
- Access to effective regulation strategies
- Deficits in emotional clarity
- Ability to control impulsive behaviors when distressed
- Ability to engage in goal-directed behaviors when distressed
Emotion dysregulation, the review team wrote, is also associated with more severe symptoms of panic disorder and posttraumatic stress disorder (PTSD). In the case of PTSD, they wrote, poor emotion regulation may also complicate treatment and recovery efforts, possibly because individuals who cannot properly regulate their emotions have a higher likelihood of turning to substance abuse.
“Emotion regulation difficulties may also partially explain the high rates of PTSD among those seeking treatment for substance use disorders,” the review team wrote. “Indeed, emotion-focused coping has been found to mediate the relationship between PTSD symptom severity and negative situational drug use.”
Anxiety Disorders, Emotion Regulation and Common Phobias
In addition to generalized anxiety disorder and panic disorder, the anxiety disorders section of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) also includes several phobias.
In April 2023, the journal Scientific Reports published a study from Hungary that focused on healthy and maladaptive emotion regulation strategies as they relate to the three most common types of phobias:
- Social phobia (or social anxiety disorder)
- Specific phobia involving animals
- Specific phobia involving blood, injections, or injuries
The study involved 856 subjects aged 18-80, 86% of whom were female. Researcher assessed the subjects with the following tools:
- Social Phobia Scale (SPS)
- Social Interaction Anxiety Scale (SIAS)
- Snake Phobia Questionnaire (SNAQ)
- Spider Phobia Questionnaire (SPQ)
- Medical Fear Survey (MFS)
- Cognitive Emotion Regulation Questionnaire (CERQ).
After analyzing the results of these assessments, the Hungarian researchers concluded:
- Catastrophizing was the only maladaptive emotion regulation strategy that was connected to all three types of phobias.
- People with social anxiety (social phobia) and specific phobia involving animals were more likely to employ both healthy and maladaptive emotion regulation strategies.
- Among those who had social phobia or animal-related phobias, people with more severe symptoms were less likely to use healthy emotion regulation strategies.
- People with blood-injection-injury phobia primarily used maladaptive strategies.
- Blood-injection-injury phobia had the greatest association with general emotional dysregulation.
These results suggest that helping people develop (or abandon) specific types of emotion regulation strategies may be a beneficial approach to treating these common phobias. Here’s how they describe their results on catastrophizing and the impact of CBT:
“Catastrophizing seems to appear as a transdiagnostic process across all phobia subtypes. The first step of clinical treatments could be reducing the use of that strategy. Our results may also provide a framework for potential – most favorably cognitive-behavioral-based – interventions to avoid the formation of severe psychopathological consequences.”
Anxiety Disorders, Emotion Regulation, Fear, and the Brain
The Hungarian team reported that prior research efforts have linked different types of phobias with different areas of the brain. For example, they wrote, magnetic resonance scans suggest the following:
- Fear of snakes appears to relate to the limbic and paralimbic structures.
- Fear of spiders is linked to activity in the dorsal anterior cingulate and anterior insula.
- Fear of the dentist seems to activate the pre- and orbitofrontal areas.
- Social anxiety disorder (social phobia) involves several areas, including the amygdala, insula, hippocampus, and medial prefrontal cortex.
Potential neurological influences on fear and emotion regulation were also the focus of an August 2009 review in the journal Neuropsychopharmacology.
The authors of this review, Catherine A. Hartley and Elizabeth A. Phelps, set out to explore what they described as “the fundamental architecture underlying the regulation of fear.” To accomplish this, they focused on the following four ways to achieve this type of emotion regulation:
Extinction:
This strategy eliminates fear by helping a person understand that a certain stimulus is no longer a sign of potential danger.
Cognitive emotion regulation:
This approach employs a variety of strategies to help people adopt a more productive way of responding to fear.
Active coping:
This involves regulating fear by taking steps to avoid the stimulus that causes this negative emotion.
Reconsolidation:
This technique uses medication and/or therapy to disrupt the impact of fear-related memories.
The reviewers found that the four emotion regulation and fear-controlling techniques listed above trigger activity throughout a network of regions in the brain that includes:
Amygdala:
These small, almond-shaped regions in each of the brain’s two cerebral hemispheres play a role in fear and other emotions.
Hippocampus:
Also located in each hemisphere, the brain’s hippocampi play vital roles in the transference of information from short- to long-term memory.
Hypothalamus:
This area of the brain produces hormones that regulate mood, hunger, sex drive, and other characteristics.
Prefrontal cortex:
This area is responsible for complex cognitive activities, including making decisions and expressing one’s personality.
Striatum:
The striatum includes neurons that control features such as motivation, planning, reward, and reinforcement.
“An improved understanding of the neurocircuitry of normal emotion regulation sheds light on the potential mechanisms underlying psychiatric disorders,” Hartley and Phelps wrote, “and may aid in the development of more effective treatments for these conditions.”
Implications for Advances in Treatment
Identifying areas associated with various emotion regulation functions and strategies may, in time, lead to pharmacological interventions that could help people whose lives have been disrupted by overwhelming fear and worry as a result of phobias, other anxiety disorders, or other mental health concerns.
For example, Hartley and Phelps described a recent study on rats in which the injection of a protein synthesis inhibitor into the lateral nuclei (LA) of the amygdala blocked the development of conditioned fear. This blocking was effective even after the rats had demonstrated fully consolidated fear memories in response to a conditioned stimulus.
Mental health professionals are a long way from attempting such interventions with humans. However, current research into the neurobiology of fear and emotion regulation could someday lead to breakthrough treatments.
Gianna Melendez
Jodie Dahl, CpHT