Emotional Regulation and Empirically Supported Psychological Therapies Confluences, Complementarities, and Diver

Translated from Análisis y Modificación de Conducta ISSN: 0211-7339
2022, Vol. 48, Nº 177, 3-40 http://dx.doi.org/10.33776/amc.v48i177.5467
Emotional regulation and empirically supported

psychological therapies: Confluences,
complementarities, and divergences*
Regulación emocional y terapias psicológicas

empíricamente apoyadas: Confluencias,
complementariedades y divergencias
Darío Augusto de los Santos

Universidad Adventista del Plata
E mail: augustodls@yahoo.es
*Article Translation Notes

The following article is a translation to the English language of the original work:
de los Santos, D. A. (2021) Regulación emocional y terapias psicológicas
empíricamente apoyadas: Confluencias, complementariedades y divergencias. Análisis y
Modificación de Conducta, 48 (177), 3-40 http://dx.doi.org/10.33776/amc.v48i177.5467
This translation has been made to share content between researchers. This has not
gone through an exhaustive process of correction or review. In case of doubt about any
phrase, term, or concept, consult the original version of the article. The original version of
the article in Spanish was published under a Creative Commons 4.0 license.
EMOTIONAL REGULATION AND EMPIRICALLY SUPPORTED PSYCHOLOGICAL THERAPIES… 3
Emotional regulation and empirically supported

psychological therapies: Confluences, complementarities,
and divergences
ABSTRACT RESUMEN
Taking as a reference the Extended Process Teniéndose como referencia el Modelo
Model of emotional regulation of Gross (2015a), Procesual Extendido de regulación emocional de
a brief review of various concepts and processes Gross (2015a) se realiza un breve relevamiento
coming from different areas of the basic and de diversos conceptos y procesos provenientes
applied research related to contextual and de distintos ámbitos de la investigación básica y
cognitive-behavioral therapies is carried out. aplicada vinculados con las terapias contextuales
This makes it possible to link different processes y cognitivo-conductuales. Esto permite vincular
of change with the components of the distintos procesos de cambio con los
regulation stages contemplated in the model. It componentes de las etapas de regulación
is proposed that in some of these change contempladas en el modelo. Se propone que en
processes the second order system would focus algunos de estos procesos de cambio el sistema
mainly on the components of the appraisal de segundo orden se enfocaría principalmente
system that give rise to the emotion (e. g., en los componentes del sistema de valoración
modification, distraction, or reappraisal of the que da lugar a la emoción (por ej. modificación,
situation), while in others it would have as the distracción o reevaluación de la situación),
main object their own processes, especially mientras que en otros tendría como objeto
those of the identification stage (e. g., principal sus propios procesos, especialmente
acceptance, attention, or reappraisal of the los de la etapa de identificación (por ej.
emotion), although not exclusively. The aceptación, atención o reevaluación de la
interventions of traditional cognitive-behavioral emoción), aunque no exclusivamente. Las
therapies seem to promote the use of strategies intervenciones de las terapias cognitivo-
aimed at producing changes, especially in the conductuales tradicionales parecen promover el
first-order evaluation system, while the most uso de estrategias orientadas a producir
recent contextual and cognitive-behavioral cambios sobre todo en el sistema de valoración
therapies focus much more on the processes of de primer orden, mientras que, las terapias
the identification stage of the second-order contextuales y cognitivo-conductuales más
system. These divergences are more clearly recientes se focalizan mucho más en los
appreciated when considering the prominent procesos de la etapa de identificación del
place occupied by acceptance, emotional sistema de segundo orden. Estas divergencias se
awareness and distancing/cognitive defusion in aprecian más claramente cuando se considera el
these last. lugar destacado que ocupa la aceptación, la
consciencia emocional y el
distanciamiento/defusión cognitiva en estas
KEYWORDS
últimas.
Emotion; Emotional regulation; Extended Process
Model; Empirically supported psychological
therapies. PALABRAS CLAVE
Emoción; Regulación emocional; Modelo
Procesual Extendido; Terapias psicológicas
empíricamente apoyadas.
Translated from AMC, 2022, Vol. 48, Nº 177, 3-40 http://dx.doi.org/10.33776/amc.v48i177.5467

Introduction trying to understand this diversity, without

Various investigations and theoretical underestimating it, despite discrepancies
models have associated effective with one's perspective (Pérez-Álvarez,
emotional regulation with better health 2019).
and greater affective, intellectual, and This dialogue between different
interpersonal well-being. On the contrary, approaches can be enriching. There are no
difficulties in emotional regulation have therapies that are completely original and,
been associated with the development and therefore, have not been influenced by
maintenance of most of the problems that other models. Along these lines, basic and
may require clinical attention applied researchers face the great
contemplated in various diagnostic challenge of explaining, organizing, and
categories (DSM) (e. g., Aldao et al., 2010; integrating the abundant available clinical
Essau et al. 2017; Hervás, 2011; John & evidence coherently and functionally to
Gross, 2004; Papa & Epstein, 2018; facilitate and optimize clinical work (Hayes
Sheppes et al., 2015; Sloan et al., 2017; et al., 2020).
Werner & Gross, 2010). To make a simple contribution in this
In accordance with this, several direction, in this article, based on Gross's
therapeutic approaches have explicitly (2015a) Extended Process Model of
incorporated the concept of emotional emotional regulation, a brief review of
regulation and/or included some type of various concepts and models from
intervention or training to optimize how different areas of the theoretical research
people manage or relate to their own and applied linked to evidence-based
emotions. (e. g., Barlow et al., 2015; therapies. Without failing to highlight the
Greenberg, 2017; Hayes et al., 2012; Leahy importance of the philosophical and
et al., 2011; Linehan, 2003; Mennin & conceptual differences between the
Fresco, 2009; Nezu et al., 2018; Segal et al., different approaches, the premise of
2008; Valdivia et al., 2010; Wells, 2000). various authors is also shared that, in the
However, even though various clinical field of evidence-based therapies,
intervention practices and models are sometimes there are philosophically
effective (Fonseca-Pedrero et al., 2021; different ways of approaching and
Pérez Álvarez, 2020), simultaneously conceptualizing similar events, in which
almost all research indicates that the the differences are sometimes more
incidence and prevalence of behavioral philosophical than empirical (Blackledge,
problems in mental health are increasing 2018; Hayes et al., 2011; Hayes &
worldwide (Hayes & Hofmann, 2021). Hofmann, 2018; Hofmann & Hayes, 2019a;
Faced with this plurality of possible Houwer et al., 2018).
evidence-based practices, two major Metaphorically, as represented in Figure
alternatives arise before researchers and 1, these philosophical positions, often
clinical psychologists. The first and irreconcilable with each other, guide and
simplest is to deny or underestimate the give meaning to the scientific activity that
proposals that do not coincide with the is carried out (Hayes et al., 2012; Hayes et
approach itself, reading only what is al., 1988; Hughes, 2018; Pepper, 1942;
produced in the field of reference itself. Pérez-Álvarez, 2019; Wilson et al., 2013).
The second involves knowing and then However, these assumptions are not

empirical but pre-analytical, and although model and its subsequent extension will
the approaches have different starting be presented. Following this, in three
points, they often intersect and deal with broad sections, the successive stages of
similar events (e.g., Blackledge, 2018; emotional regulation of this model will be
Hayes et al., 2012; Hayes & Hofmann, developed, linking these and their
2018; Hofmann & Hayes, 2019a; Houwer et components with various concepts and
al., 2018). typical interventions in the clinical field.
Finally, issues related to the maintenance,
change, and origin of emotional regulation
strategies will be briefly addressed,
followed by a final section where what has
been done is discussed and some possible
future lines of research are proposed. A
summary chart and other materials will be
included in the annex.
The approach to emotional regulation
previously requires an understanding of
emotions (Gross, 2014). According to Papa
& Epstein (2018), research on emotions
and their evidence-based clinical
approaches can be grouped into three
large groups according to the
philosophical positions to which they
adhere. From a constructivist perspective,
Figure 1 Starting points, confluences, emotions are considered to be socially
and divergences between evidence-based conditioned evaluations or meanings that
therapies are attributed to antecedent stimuli and
that are imposed on neurophysiologically
In the following pages, several of these based affective responses (Barrett, 2012).
meeting points will be highlighted while For their part, those who adhere to an
pointing out some of the most important evolutionary perspective and are more in
discrepancies. The survey of the various line with philosophical contextualism,
processes that can be linked to the consider that emotion are discrete action
management of emotions will not be tendencies inherited by natural selection,
exhaustive but will consider the abundant which allow people to adapt and respond
specific research on emotional regulation, quickly to antecedents (Keltner & Haidt,
together with some processes and 1999). A third alternative adopts an
approaches from traditional and current intermediate position and considers that
contextual and cognitive-behavioral human emotions are various states whose
therapies. To do this, following the emergence is mediated by the evaluation
sequence of cycles and stages processes of the typical situations of the
contemplated in the Extended Process species (Scherer, 2009; Hofmann, 2016).
Model, emotions and their emergence will Beyond the theoretical orientation,
be addressed first. Next, the original Gross regarding antecedent conditions, different

perspectives agree that emotions are This approach is based on the idea that
responses to psychologically relevant emotions develop over time, in cycles that
events (Frijda, 1986; Gross, 2014; Hofmann, involve transactions between people and
2016; Lazarus, 1991; Scherer, 2009). In turn, the situations in which they find
numerous investigations indicate that themselves. From this perspective, it is
emotions are multidimensional whole- considered that these cycles entail
body phenomena that involve semi- situation-attention-appraisal-response
coupled responses, including sequences that begin with a
physiological, expressive, cognitive, and psychologically relevant situation or event
motivational changes (eg, Cacioppo et al., (either external or internal), that attracts
2000; Fredrickson & Branigan, 2005; Gross, attention and is evaluated by people,
2014; Keltner & Haidt, 1999; Levenson, giving rise to different changes vaguely
2014; Papa & Epstein, 2018; Vuilleumier & coupled of experiential, behavioral, and
Huang, 2009; Susskind et al., 2008; Vytal & physiological responses.
Hamann, 2010) In turn, from this perspective, to
Often, but not always, these responses distinguish and organize the different
help cope with the situations that gave rise concepts related to emotions, it is
to the emotion (Levenson, 1999). The proposed to consider affect as a general
approach to the intrapersonal and term that includes affective states such as
interpersonal functions of emotions a) positive and negative emotions (e. g.,
(Hofmann, 2014; Levenson, 1999; Zaki & happiness and sadness), b) stress
Williams, 2013) allows for different levels responses, such as non-specific negative
of analysis, including the individual, dyadic, responses to prolonged and difficult to
group, and cultural levels (Keltner and cope with events, and c) moods, such as
Haidt, 1999). In this sense, it has been more extended, diffuse responses, with
proposed that emotions inform people greater impact on cognition and less
about events that need to be addressed impact on actions than the emotions (e. g.,
and/or modified while preparing them to irritability, depression and euphoria). This
respond to problems that arise in social differentiation allows, in turn, to include
interactions. (Keltner and Haidt, 1999; within the broader category of affective
Levenson et al., 1990). It has also been regulation concepts such as a) emotional
pointed out that emotions and their regulation (e. g. managing anger or
expression facilitate the coordination of increasing joy), b) coping (e. g., coping
social interactions while helping to form with a grieving process), and c) mood
groups, define roles and manage conflicts regulation (e. g., managing or improving
that arise within them, also intervening depressed mood) (Gross, 2014; 2015a).
and being affected by the processes of
learning of the norms, values, cultural Emotional regulation
identities and power relations prevailing in Gross (1998, 2014) previously defined
a society (Keltner & Haidt, 1999). emotional regulation as those processes
In the process model of Gross (1998, that determine what emotions are
2014), the common points of several of the experienced, when they are experienced,
mentioned approaches are considered how they are experienced, and/or how
based on the modal model of emotions. they are expressed. More recently, this

author has begun to define emotional instrumental considerations, even having

regulation as the activation of a goal to the goal of decreasing a positive emotion
influence the processes of generation and or increasing a negative emotion, as a
trajectory of emotion. (Gross et al., 2011; means, to achieve another non-emotional
Gross, 2015a, 2019). purpose. The latter would apply, for
From this approach, it is argued that the example, when someone tries to appear
regulation of emotions can produce empathic, moved, or worried about
variations in the latency, rise time, another person, when they want to
magnitude, duration, or compensation of influence others, or when they seek to
the emotional response (Gross, 1998, have a reflective, serene or prevented
2014). The processes involved are attitude to act more effectively in a given
considered within a continuum of situation.
possibilities that range from explicit, The different types of strategies that
conscious, effortful, and controlled people can use to regulate their emotions
regulation to implicit, unconscious, are grouped in the process model of Gross
effortless, and automatic regulation (1998, 2014) into five large families: 1)
(Gyurak & Etkin, 2014). situation selection, 2) situation
According to Gross (2015a), the process modification, 3) attention deployment, 4)
of emotional regulation can be intrinsic, cognitive change, and finally 5) response
when it comes to regulating one's own modulation. Below is a graph that presents
emotions, or extrinsic, when, for example, the process model of Gross (2014) with the
an adult tries to influence a child's five types of emotional regulation
emotions. In turn, emotional regulation strategies contemplated in this model.
can be motivated by hedonic These processes will be described in more
considerations when the goal is to increase detail in the section on ineffective emotion
positive emotions and/or decrease regulation strategies.
negative ones in the short term, or by
Figure 2 Emotion regulation strategies

Note. Chart translated to Spanish from Gross (2014)

Extended Process Model of Emotion In turn, in obvious parallelism with the

Regulation modal model of emotions, it is considered
Unlike the traditional process model of that these assessment systems involve
Gross (1998), which focuses mainly on cycles of W-P-V-A sequences, where W
emotional regulation strategies, other refers to the internal or external world of
more integrative proposals and some the person (situation), P to the perception
even closer to contextual therapies, have of this (attention), V to the valuations of
also taken into account the process that these perceptions (appraisal), and finally
takes place between the emergence of the A, to the component of action (response)
emotion and its regulation (eg Berking, that includes both mental and physical
2017; Gratz & Roemer, 2004; Hervás & actions. These cycles of W-P-V-A
Moral 2017; Mennin & Fresco, 2009). For sequences are used both to explain the
example, Gratz and Roemer (2004) have generation of emotion (first-order system)
addressed emotional regulation and the and the emotional regulation process
possible difficulties associated with it by (second-order system) that includes
considering 1) the level of emotional stages such as a) the identification of
awareness, 2) the clarity or understanding whether or not to regulate emotions, b)
of emotions, 3) the acceptance or the selection of the strategy to be used,
rejection of these, 4) possible emotional and c) the implementation of specific
interference or difficulties in maintaining regulation tactics, together with the
goal-directed behavior, 5) impulse control monitoring of each of these stages
difficulties, and finally, 6) limited access to (Eldesouky & Gross, 2019; Gross, 2015a).
emotional regulation strategies. That is to say that, in a first-order or
Although the traditional model of level of analysis, the person faces a
Gross (1998, 2014) was one of the most situation (W), it attracts her attention (P),
used, to also include the processes that evaluates it (V), and responds affectively
explain how emotional regulation to it (A). Then, in a second-order, an
strategies start or stop, more recently identification stage begins where this
Gross (2015a) proposed a complementary emotion, now as an element of the
approach to the which he named the person's internal world (W), is perceived
Extended Process Model. (P) and evaluated in contrast to the
What is new about the new model is emotional state he longs for (V). Being
that it includes a series of functionally able in this way, to give rise or not to a
coupled loops or cycles where different series of action impulses (A) with the goal
assessment systems interact. Since of regulating emotions and eventually to
emotion involves an appraisal, emotional other cycles of W-P-V-A sequences to
regulation involves the appraisal of an select regulation strategies and
appraisal. Thus, in this perspective, it is implement specific tactics that would help
considered that a first-order appraisal reduce the discrepancy between current
system generates emotion, giving rise to and desired emotion.
that a second-order system that may or The following section deals in more
may not regulate it (Eldesouky & Gross, detail with the processes that, in the
2019; Gross, 2015b). extended procedural model of Gross
(2015a), are part of the identification

stage, while the stages of selection and Emotional awareness (P)

implementation of specific regulation People differ in their level of emotional
strategies and tactics will be addressed. in awareness. Various theories and
later sections. approaches to emotional regulation
highlight the importance of being able to
Experiences and relationships with pay attention, recognize and observe
one's own emotions one's own emotions in their context
Both emotions and how people (Berking, 2017; Gratz & Roemer, 2004;
experience them and relate to them have Hervás & Moral 2017; Mennin & Fresco,
come to occupy a prominent place both in 2009) According to Gross (2014)
so-called third-generation therapies and emotional awareness may be a crucial
in theoretical research on different limiting factor for successful emotion
emotional processes. With different regulation (Füstös et al., 2013). In this
nuances and from different theoretical sense, different interventions based on
perspectives, the way in which people mindfulness have been shown to improve
experience their emotions affectively and emotional regulation (Goldin et al., 2021;
cognitively has been addressed, taking Roemer, Williston & Rollins, 2015)
into account aspects such as the level of As an intervention in different therapies
consciousness, feelings or reactions to where mindfulness occupies an important
emotions, evaluations, and beliefs about place, it is usually differentiated between
these, as well as the tendencies to act that two ways of acting concerning what is
they entail (e.g. Bailen et al., 2019; happening in the present. One is the
Bernstein et al., 2009; Greenberg, 2017; autopilot mode in which attention
Hayes et al., 2012; Leahy, 2019; Linehan, wanders from one issue to another. The
1993, 2003; Segal et al., 2008; Wells, 2019) other is a state of mindfulness, in which
According to the Extended Process people intentionally focus and maintain
Model, after emotions are produced, in a attention on what is happening in the
subsequent stage of identification, these present, including their emotional state
(W) are detected or addressed (P), they (Baer, 2018; Linehan, 2003; Segal et al.,
are evaluated (V) as candidates for 2008). For its part, Acceptance and
regulation, and as a result, is given or not Commitment Therapy (ACT) emphasizes
the action (A) with the goal of regulating contact with the present moment, which
them (Eldesouky & Gross, 2019; Gross, consists of focusing attention on the here
2015a). and now in a non-analytical and non-
Next, these components are addressed judgmental way, being fully aware of what
separately, mentioning, in turn, some is being done, living, feeling, and/or
related processes that have been experiencing. The opposite involves
conceptualized and proposed both in the getting stuck in conceptualizations of the
field of empirically supported therapies past or feared representations of the
and in other evidence-based theoretical future whereby contact with ongoing
approaches. experience is greatly diminished (Hayes et
al., 2012; Luoma et al., 2007).

Evaluation and appraisal of the and pleasant emotions good (Tamir &
emotions (V) Ford, 2012).
Various approaches to emotional Along these lines, various investigations
regulation have highlighted the support the idea that emotional beliefs
importance of being able to name, can have short- and long-term
differentiate and understand the emotions consequences, sometimes being
that are experienced (Berking, 2017; Gratz paradoxical or counterproductive for
& Roemer, 2004; Hervás & Moral 2017; emotional regulation (Ford & Mauss,
Mennin & Fresco, 2009). In turn, the 2014). For example, believing that
impact on emotional regulation that both emotions in general, positive and
negative and positive evaluations of negative, are bad predicts lower well-
emotions can have has also been being and worse psychological health. In
emphasized (Gross, 2015a; Hervás & turn, believing that negative emotions in
Moral, 2017; Linehan, 2003). particular are bad is related to greater
According to Gross (2015a), the negative emotional responses to stressful
assessment that people make of emotions events (Ford, Lam et al., 2018).
can give rise to difficulties or failures in On the other hand, people who believe
emotional regulation, such as, for that some emotions are relatively good
example, when a person with bipolar tend to seek out more activities that
disorder assigns a positive value to manic maintain or enhance those emotions
feelings and is carried away by his (Tamir & Ford, 2012; Wood et al., 2009).
impulses. Ford & Gross (2019) point out However, some experimental studies
that beliefs about emotions shape the found that overvaluing joy is associated
standards with which the current with lower feelings of happiness (Mauss et
experience is contrasted with the desired al., 2011).
one. On the other hand, with regard to
These beliefs can be global or beliefs about the controllability of
subordinate to specific characteristics of emotions, it has been found that people
emotions such as valence, intensity, who believe that they are uncontrollable
duration, their particular components, the experience more intense negative
context, and the goals pursued, among emotions and have worse psychological
other aspects (Ford & Gross, 2019). In health (Ford et al., 2018; Ford & Gross,
general terms, beliefs about emotions can 2019).
be grouped into two broad categories. On In the clinical field, both Emotional
the one hand, beliefs about the goodness Schema Therapy (EST) and Metacognitive
of emotions, that is, whether they are Therapy (MCT) have highlighted the
good or bad, and on the other, beliefs importance that personal beliefs and
about their controllability. (Ford & Gross, theories about thoughts and emotions
2019). Beliefs about the goodness of can have. In the EST, a series of emotional
emotions can refer to whether they are processing schemes are proposed that
desirable, or undesirable, useful, or contemplate the way in which people
useless, beneficial, or harmful. This evaluate their emotions according to their
distinction indicates that unpleasant validity, comprehensibility, moral value,
emotions are not always considered bad complexity, relationship with values,

controllability, numbness, durability, controlling them make up the verbal

consensus with others, rumination, and contexts that are on the basis of
expression among others. From this problematic control of behavior (for
perspective, it is considered that the example: "I am can only have a good life if
rejection and negative evaluation of I keep my emotions in check" "to move
emotions increases emotional sensitivity forward in life I have to get rid of this
and dysregulation. In other words, what emotion", "only if I strictly control my
people tell themselves about their thoughts will I be able to feel better and
emotions affects the way they experience control my life”, etc.) (Luciano, Martínez et
them (Leahy, 2012; 2019). For its part, in al., 2005; Wilson and Luciano, 2002).
the MCT, the concept of metacognitive According to these verbal contexts,
beliefs is proposed to refer to the valence people can act fused with their private
and the type of beliefs that people have events (cognitive fusion) so that behavior
regarding the uncontrollability, meaning, is excessively controlled by language and
importance, dangerousness, and cognitions, relegating direct
usefulness of their psychological circumstances to the background. Or they
processes, which can lead them to can distance themselves and deliteralize
experience its content as the "reality" their content (cognitive defusion)
(object mode), thus increasing the experiencing the private events only for
intensity of their emotional problems. Or, what they are: memories, thoughts,
on the contrary, they can help them emotions, sensations, etc. (Blackledge,
distance themselves and assume a 2018; Hayes et al., 2012; Wilson and
perspective that allows them to more Luciano, 2002).
flexibly regulate their psychological Both defusion strategies and traditional
processes (metacognitive mode) (Wells, cognitive restructuring assume that
2019). thoughts can hinder effective behavior
On the other hand, in Dialectical and promote problematic emotional
Behavioral Therapy (DBT) as part of reactions. However, while more traditional
emotional regulation training, people are cognitive perspectives aim to modify the
usually presented with a list of Myths content of thoughts, in both the ACT
about emotions, encouraging them to cognitive defusion strategies and the MCT
expand the list and refute them (Linehan, metacognitive awareness strategies, the
2003). From a strictly functional emphasis is especially on the way in which
perspective, it is considered that people people relate to their thoughts and other
can act under direct control of the current private events (Blackledge, 2018). In the
contingencies of their situation or MCT, the only content that aims to
governed by descriptions or verbal rules explore and intervene is that of
that predict different results for behaviors metacognitive beliefs (Salguero & Ramos-
(Skinner, 1969). In this line, in ACT it is Cejudo, 2019). On the other hand, unlike
argued that the literalness with which the therapies more akin to constructivism,
private events, evaluations, and the from a contextual approach is avoided to
reasons given about them are taken, reify the private events, avoiding giving
about their causal impact on behavior, the behaviors of thinking and feeling the
and consequently the actions aimed at entity of schemes or other denominations,

as if they were things static. At the same differentiation (eg Hayes & Hofmann,
time, the popular and deeply rooted idea 2021; Ong et al., 2019).
in traditional CBT that private events are On the other hand, from another
the mechanical and linear cause of public perspective, the concept of meta-
behavior is questioned. That is why the emotions has been proposed to refer to
aim is not to change the content of emotions whose object is other emotions
private events but rather their function considered primary. For example, the fear
(Hayes & Brownstein, 1986; Luciano & of anxiety in agoraphobia, or when a
Hayes, 2001). person feels guilty for being angry. In
these cases, a second unpleasant
Feelings or affective reactions to emotional response is added or combined
emotions (A) that arises from the rejection or
The non-acceptance or the negative unwillingness to experience the primary
emotional reaction towards one's own emotion. However, the so-called positive
emotion has also been considered an emotions can also be the object of
important aspect in various models of negative meta-emotions, such as when a
emotional regulation (Berking, 2017; Gratz person feels ashamed or guilty for
& Roemer, 2004; Hervás & Moral 2017; laughing or being happy in a situation
Mennin & Fresco, 2009). where another reaction is socially
In the clinical setting, the additional expected, such as at a funeral or in a
discomfort caused by the non-acceptance situation someone else's misfortune
of the emotion has been approached in (Bailen & Thompson, 2019; Norman &
various ways. For example, in ACT people Furnes, 2016). Among the so-called
are often asked to make a distinction negative meta-emotions, have been
between clean pain and dirty pain. Clean considered anger, sadness, guilt, shame,
pain is the normal, natural, healthy contempt, and anxiety for the primary
discomfort experienced in the face of real- emotions experienced, while interest and
life problems. For its part, dirty pain is the compassionate attention have been
discomfort that is added by the lack of studied among the positive ones
willingness to experience clean pain and (Mitmansgruber et al. al., 2009). In turn,
by the unnecessary struggle to control, some researchers such as Shaver et al.
eliminate or avoid it (Hayes et al., 2012). (2013) consider that concepts such as
Similarly, in DBT, people are often asked sensitivity to anxiety and rejection or non-
to differentiate between pain and acceptance of emotions also describe
suffering, the latter being the sum of the experiences or forms of meta-emotion. In
initial pain plus the discomfort that this line, within the general categories of
accompanies the rejection of the emotion affective sensitivity and (in)tolerance
and/or the situation that is being (Bernstein et al., 2009; Farris et al., 2016),
experienced (McKay et al., 2019). experiences of acceptance or rejection
Acceptance and other processes closely linked to discomfort could be included,
related to it, such as self-compassion or such as the: 1) (in)tolerance of negative
kindness towards oneself and tolerance emotional states, 2) (in)tolerance of
for discomfort are at the center of this uncertainty, 3) (in)tolerance of frustration,
4) (in)tolerance of emotional ambiguity,

and/or 5) (in)tolerance of unpleasant regulation difficulties linked to action

physical sensations or states (see e.g. impulses may be due in part to
Bernstein et al., 2009; Farris et al., 2016; psychological inertia, that is, the tendency
Leahy, 2019; Leyro et al., 2010; Linehan, to continue acting as previously done
1993, 2003; McEvoy et al. al., 2019; even when this is not the most adaptive
Rodriguez et al., 2017; Schmidt et al., (Gross, 2015a; Suri et al., 2015).
2006). The previously described concepts of
According to Ford & Gross (2019), cognitive fusion, acting on autopilot,
distressing meta-emotions could occur in object experience mode, and others such
the combination of the belief that as emotion-driven behavior (Barlow et al.,
emotions are bad together with the belief 2015) describe, from diverse clinical
that they cannot be changed. In approaches, how people relate to the
presenting the Extended Process Model, emotions and how this relates to their
Gross (2015a) does not specifically actions.
address meta-emotions or affective In this way, people can specify in
reactions to emotions. However, similar to actions the inclinations or tendencies that
the primary emotions that are included in emotions entail or continue advancing in
the response or action component (A) of the process of selection and
the first-order appraisal system, affective implementation of particular regulation
reactions to emotions can be viewed as strategies and tactics.
updates to the primary emotions (first- Based on what has been developed so
order system) or as additional reactions, far and in line with the Extended Process
that are part of the action components (A) Model of Gross (2015a), two levels or
in the different stages of emotional orders of analysis of emotional experience
regulation together with action impulses and its regulation can be identified. On
and the activation of regulation goals the one hand, there are the traditional
(second-order system). investigations on emotions that describe
the physiological, expressive, and
Impact on actions and activation of cognitive changes that they entail, which
the regulation goal (A) is associated with the first-order appraisal
Among the deficits in emotional system in the Gross model (2015a). And,
regulation, difficulties have been on the other hand, there are various
considered to control or refrain from proposals from different therapies with
impulsive behaviors and/or to be able to empirical support and lines of theoretical
focus on achieving the proposed goals research that emphasize not so much the
while experiencing high-intensity emotion itself, but how people experience
emotions (Gratz & Roemer, 2004; Berking, them and relate emotionally and
2017). As mentioned above, emotions not cognitively with them. This would
only imply sensations and/or feelings but correspond to the second-order valuation
also action tendencies or inclinations system of Gross (2015a) mainly to the
(Frijda, 1986) that may or may not be identification stage.
beneficial in coping with the situations However, although this differentiation
that gave rise to them (Levenson, 1999). between emotion and its regulation is
According to Gross (2015a), emotional useful both theoretically and applied, not

all researchers agree that this necessarily goal of using a particular strategy. If this
implies a temporal sequence of two goal is activated, the implementation
different responses. In a similar way to stage of specific regulation tactics will
what happens internally with the different take place with its new W-P-V-A cycles
components or dimensions of emotions, (Gross, 2015a).
not everyone agrees as to whether or in According to Gross (2015a), the
what cases the processes contemplated in difficulties associated with these stages
an order or level precede, arise together maybe because the person has few
with and/or subsequently those strategies in their repertoire, perhaps
contemplated in the other level. because they have excessive dependence
As Gross himself (2014) maintains, the or overvalue some of them (for example,
more the subject is investigated, the more avoidance in anxiety problems) and/or
difficult it becomes to make a clear because he momentarily fails to perceive
distinction between emotion and other alternatives. It is also highlighted
emotional regulation (eg, Gross et al., that people who believe that emotions
2011). Many situations seem to trigger can be changed tend to be more adept at
both emotion and its regulation (Campos regulating their emotions than those who
et al., 2004), and several of the brain see emotions as relatively immutable
systems involved in emotion are also (Mauss & Tamir, 2014). Another important
involved in its regulation (Ochsner et al., aspect is self-efficacy beliefs in emotional
2009). All this has led some authors to regulation, that is, to what extent people
consider that it is not possible or believe they are capable of using certain
necessary to establish a clear particular regulation strategies effectively.
differentiation between the two processes (Goldin et al., 2012; Gross, 2014).
(Kappas, 2011; Paz, 2019; Thompson, The extended model proposes five
2011). large families of emotional regulation
In addition to the processes considered strategies, already contemplated in the
so far, there are different strategies by previous model by Gross (1998), which act
which people can try to regulate their on the first-order evaluation system that
emotional states. The latter will be generates emotion. These families of
addressed in the following sections. strategies include selection and situation
modification (W), deployment of attention
Emotion regulation strategies (P), cognitive change (V), and response
According to the Extended Process modulation (A) (Gross, 2015a).
Model, the activation of the objective of Next, the five large families of
regulating emotions in the identification emotional regulation strategies proposed
stage, now as part of the person's internal by Gross (2015a) are described, also
world (W), triggers the selection stage highlighting how these can become
where it will be attended (P) and maladaptive. In turn, some alternative
evaluated (V) the convenience of the behaviors and therapeutic processes that
possible strategies taking into account the have stood out in the field of evidence-
context and the personal resources based therapies are mentioned. However,
available for it. The result of this stage the focus is more on describing
may or may not be the activation of the maladaptive and counterproductive

emotional regulation processes than on the second-order system, although not

highlighting possible clinical interventions. exclusively. In turn, the differences
The latter are mentioned mainly because regarding the acceptance of the
of their opposite or alternative emotional experience can also be seen
relationship to the problematic strategies. between the theoretical models more
As can be seen, within each family of focused on the control of emotions and
strategies, some are aimed at producing their expression (Catanzaro & Mearns,
changes in the W-P-V-A cycle of the first- 2011; Salovey et al., 1995) and other
order system in which the emotion arises, proposals that have argued that
while others could easily be linked to regulation is not necessarily equivalent to
modifications in the identification stage of emotional control (Berking, 2017; Gratz &
the second-order system. For example, Roemer, 2004; Hervás & Moral 2017;
the cognitive change family includes the Mennin & Fresco, 2009)
reappraisal of the situation that triggers
the emotion (V, first-order system), but Situation Selection (W)
also the reappraisal of one's own By strategically choosing the situations
emotions (V, second-order system). to which they will be exposed, people can
Similarly, people can focus or divert avoid danger and sorrow, while also being
attention from the situation (P, first-order able to reorient their lives in directions
system) and/or from the emotion itself (P, that make it more or less likely that they
second-order system). Finally, as a way of will or will not experience certain
managing emotions, people can try to emotions (Gross, 2014, 2015a). This can
directly modulate emotions (A, first-order lead them to make successful or favorable
system) or accept them and give place to changes in life (Heatherton and Nichols,
them without trying to modify them, so 1994), to increase activities that are
that they pass without worsening or pleasant and/or valuable for people
without meta-emotions arising (A, (Kanter et al., 2009), or to decrease
second-order system). Although these exposure to harmful or harmful situations
emotion management processes always risky, such as those linked to drug use
involve the second-order system, in some (Kober, 2014). However, it can be difficult
cases this focuses mainly on the first- for people to anticipate the emotions they
order system that gives rise to the will experience in a given situation. They
emotion, while in others it has itself as its may even overestimate the possible
main object, especially to the processes of intensity, duration, or emotional impact
the identification stage, although this may that situations will have (Wilson & Gilbert,
or may not indirectly affect the first-order 2013). In turn, situational selection can
system. In this sense, a large part of the become ineffective or even
interventions of traditional cognitive- counterproductive when it becomes a
behavioral therapies seems to promote persistent and/or indiscriminate avoidance
strategies aimed at producing changes in pattern that, although it may reduce
the first-order evaluation system, while short-term discomfort, impoverishes the
the most recent contextual and cognitive- quality of life and increases unpleasant
behavioral therapies focus much more on emotions in the longer term (Barlow,
the processes of the identification stage of 2000). As an alternative in the clinical field,

there are different therapeutic proposals turn, an impulsive or hasty approach to

aimed at people facing certain situations modifying a problematic situation can also
such as behavioral exposure and the aggravate the situation (Nezu et al., 2013).
activation (Kanter et al., 2009), the Exposure with response prevention, that
realization of actions opposed to the is, without control or safety behaviors, can
impulse (Linehan, 1993, 2003), the actions be a viable therapeutic alternative
committed to values (Hayes et al., 2012; oriented to the situation (Werner & Gross,
Wilson and Luciano, 2002) and positive 2010), as well as the other proposals
orientation towards problems together mentioned in the description of the
with the planned search for solutions previous point on the selection of
(Nezu et al., 2013), among others. situations.
Situation Modification (W) Attentional display (P)

Once exposed to a certain situation, Without modifying or leaving the
people may try to directly modify the situation, people can regulate their
circumstances or some aspects of it, thus emotions by redirecting their attention,
altering its emotional impact (Gross, either concentrating, distracting, or
2015a). In turn, since the expression of suppressing the focus of attention
emotions can influence or operate on regarding some specific aspects of the
other people (Keltner & Haidt, 1999), it is situation (Gross, 2014). Distraction can
possible to make instrumental use of this help delay gratification when it is
process to modify situations and social convenient (Peake et al., 2002). In turn,
interactions experienced as annoying or when the emotion has already begun or is
unpleasant. For example, letting others high in intensity, people tend to prefer
see the discomfort experienced to receive distraction to the use of other strategies
help or for them to make changes in their such as reappraisal, which, in real-time, in
behavior or the situation (Greenberg, the face of very intense emotions may be
2017; Hofmann, 2014). In particular, less effective (Sheppes & Gross, 2011;
problem-solving understood as the Sheppes & Meiran, 2007; Sheppes, 2014;
conscious performance of specific actions Sheppes et al., 2011). However, from the
aimed at changing a situation has been clinical field, it has been highlighted that
considered an effective emotional both dissociation and distraction when
regulation strategy linked to better mental they become generalized or become rigid
health (Aldao et al., 2010). However, not can prevent full exposure and habituation
all forms of situation modification are to the situation (Barlow et al., 2015) as
adaptive. From the clinical field, it has well as hinder the adequate resolution of
been highlighted that when the change problems. problems (Nezu et al., 2013).
that is introduced in the situation implies At the other extreme, rumination
a dependence or persistent use of control understood as the repetitive and passive
and safety behaviors, such as excessive concentration on emotions and their
preparation, resorting to people, or consequences has also been considered a
consuming certain substances, short-term counterproductive emotional regulation
relief can occur, but prevent the long-term strategy linked to poorer emotional health
benefits of a full exposure (Clark, 2001). In (Aldao et al., 2010). The MCT describes

different processes linked to the setting, different therapeutic proposals

modulation of attention that, even though promote particular uses of attention, such
they can become harmful, people can use as mindfulness training (Kabat-Zinn, 2003;
them claiming that, currently or in the Linehan, 1993, 2003; Segal et al., 2008),
past, they have helped them to anticipate strategies that favor the metacognitive
or be able to control the situation and/or mode (Wells, 2019) and cognitive defusion
relieve themselves of the negative (Hayes et al., 2012; Wilson and Luciano,
emotions they experience. These include 2002; Ruiz et al., 2018), among others.
maintaining inflexible and negative
attention and thoughts on a) future Cognitive change (V)
threats that are experienced as By deliberately modifying the way they
uncontrollable (worries), b) discovering evaluate and give meaning to a situation,
the possible causes or consequences of people can modulate their experiences,
their current emotional state (rumination), even going so far as to experience other
c) in the thoughts, emotions, and physical emotions (Gross, 2014). The most studied
sensations that are experienced at every cognitive change strategy is reappraisal,
moment (self-focusing), and d) in being which can be used to try to increase or
alert to the appearance of possible decrease both negative and positive
internal and external dangers (threat emotions (Ochsner & Gross, 2005). This
monitoring). In MCT, this inflexible pattern may involve changing the way people
of attention and negative thoughts is view the situation and/or how they assess
given the name of Cognitive Attentional their own ability to manage the challenges
Syndrome and is considered to be at the they face (Gross, 2015a).
base of a large part of the emotional Along these lines, various experimental
disorders and the ineffective emotional and correlation studies have linked
regulation strategies of avoidance and reappraisal with a decrease in negative
suppression, both cognitive and emotions (Gross, 1998; Ray et al., 2010;
emotional (Hjemdal et al., 2013; Salguero Szasz et al., 2011; Gross, 2015a). However,
& Ramos-Cejudo, 2019; Wells, 2000). For as mentioned above, people tend to opt
its part, from ACT has proposed that for reappraisal when the intensity of the
rumination and worry, sometimes emotion is lower, while they prefer
encompassed as repetitive negative distraction when the emotional intensity is
thoughts, are usually the initial high because at high-intensity levels
experiential avoidance strategies that are reappraisal may no longer be effective.
put into practice in the face of aversive (Sheppes & Gross, 2011; Sheppes &
private events and that, in the medium- Meiran, 2007; Sheppes, 2014; Sheppes et
long term, they maintain and amplify the al., 2011).
discomfort, thus giving rise to other more On the other hand, the benefits of
obvious forms of experiential avoidance, reappraisal appear to be moderated by
which close the cycle, such as substance context. A more positive, or optimistic
use, binge eating, self-harm, unproductive appraisal of a situation may be associated
distraction, etc. (Ruiz et al., 2016; Ruiz et with reduced distress, increased positive
al., 2018). As an alternative to harmful affect, and greater perseverance toward
attentional deployment, in the clinical goals. However, when it involves

neglecting valuable information or sensitivity and dysregulation (Leahy, 2012;

underestimating risks, it can lead to 2019) and/or precipitate secondary
unfavorable decision-making, emotions as a reaction to those initially
unpreparedness, or dangerous behavior, experienced (Greenberg, 2017; Mennin &
and in the long run, to disappointment or Farach, 2007). From this perspective, the
increased negative affect. (Weinstein, usefulness of reflecting on and redefining
1980; Shepperd et al., 2015). In this way, emotions and the possible needs,
reappraisal can become a motivations, goals, and/or values
counterproductive form of rationalization underlying the experiences and events
or emotional avoidance (Barlow et al., that evoke them has also been
2015), being less adaptive, especially when highlighted (Greenberg et al., 2015;
applied to stressful situations that can be Hervás & Morale, 2017).
changed (Troy et al., 2013) or when it As mentioned above, in the realm of
leads to assuming greater risks and have other evidence-based therapies such as
less sensitivity to potential losses (Panno ACT, prominence is also given to
et al., 2013). In addition to this, various understanding how cognitions or verbal
investigations have highlighted that trying behaviors are functionally related to
to suppress and/or excessively control emotions and actions. However, from this
thoughts can produce a paradoxical or perspective, the aim is not to modify the
counterproductive effect (Barraca, 2011). content of thoughts, but rather how
However, at the other extreme, both people relate to them since it is
from the clinical field and in various considered that private events are not the
investigations it has also indicated that mechanical and linear cause of public
abandoning oneself to rumination and behavior. (Hayes & Brownstein, 1986;
worry in a persistent search and review of Luciano & Hayes, 2001; Luciano, Martínez
the most critical aspects and meanings of et al., 2005). Interventions based on
the situation or emotion can also become cognitive defusion, and acceptance are
problematic (eg Aldao et al., 2010; Ruiz et essential in this approach (Blackledge,
al., 2018; Wells, 2019). 2018; Hayes et al., 2012; Wilson and
On the other hand, cognitive change Luciano, 2002).
emotional regulation strategies include On the other hand, in the most recent
not only the reappraisal of the situation CBT proposals, the use of reappraisal,
that gives rise to the emotion but also often accompanied by a decentering and
other strategies such as perspective- expansion of consciousness, does not
taking and reappraisal of the emotion focus so much on eliminating cognitive
itself (Webb et al., 2012). In this line, errors, as on increasing cognitive flexibility
various psychotherapeutic proposals aim and the usefulness of having various
to achieve a change in the way people cognitions available to guide action (e. g.
perceive and value their own emotions Barlow et al., 2015; Garland et al., 2017;
and psychological processes (Greenberg, Hayes & Hofmann, 2021).
2017; Leahy, 2019; Mennin & Farach,
2007; Wells, 2019) because they consider Response modulation (A)
that rejection and negative evaluation of People may try to modify the emotion
emotions can increase emotional or its expression by acting directly on it or

its experiential, behavioral, or As an alternative to dysfunctional

physiological components. Physical emotion modulation strategies, which are
exercise and deep breathing relaxation also response-oriented, there are, among
techniques can be used for this (Gross, others, the therapeutic strategies that
2015a). However, when this pattern promote acceptance of experience (Hayes
becomes generalized or rigid, both et al., 2012; Segal et al., 2008) and
suppressing emotional expression (Barlow discomfort tolerance (Linehan, 1993, 2003;
et al., 2004) as concentrating of the McKay et al., 2019).
emotion and releasing it impulsively or in However, from these perspectives,
inappropriate situations, can become acceptance does not imply resigning
problematic (Carver et al., 1989; Nezu et oneself, abandoning oneself to the
al., 2013). emotion, and acting fused or controlled
Expressive suppression is the most by the thoughts, inertia, or action
studied response modulation strategy tendencies linked to it. For example, in
(Gross, 2015a). Experimental and ACT, acceptance work entails developing a
correlational research suggests that willingness to give rise to private
suppression of emotions is paradoxically experiences, ceasing counterproductive
associated with fewer positive and more actions intended to change or suppress
negative emotions, poorer memory, and them, to engage in other actions
less close and positive relationships and consistent with values (Hayes et al., 2014).
social interactions (e.g., Chervonsky & The focus is on the regulation of behavior,
Hunt, 2017; Gross, 1998; Mauss et al., not on the modification of discomfort
2011; Ray et al., 2010; Richards & Gross, (Blackledge & Hayes, 2001). In this sense,
2006; Srivastava et al., 2009; Szasz et al., the impulsivity and/or the tendency to
2011; Gross, 2002, 2014) inaction that characterize certain
In turn, the persistent use of emotional behaviors can be understood as forms of
modulation strategies that involve harmful avoidance or non-acceptance of
or high-risk behaviors, such as self-harm, discomfort, insofar as they imply actions
suicidal acts, substance abuse, violent or that are carried out to alleviate or not
aggressive behavior, restriction or binge have unpleasant or unpleasant
eating food, unprotected sex, etc. is also experiences bothersome (e.g., Barlow et
dysfunctional (Linehan, 1993, 2003; Carver al., 2015; Hayes et al., 2014).
et al., 1989; Gross, 2015a). Below is a table that summarizes what
On the other hand, as noted above, it is addressed in this section regarding
must be taken into account that some of the possible emotional regulation
emotional regulation can not only have an strategies that can become problematic.
intrapersonal function, but also a However, it is pertinent to highlight that
communicative or interpersonal function these actions perform adaptive or
(Hofmann, 2014; Zaki & Williams, 2013). maladaptive functions depending on the
Therefore, it is possible to make context and inflexibility with which they
instrumental use of response modulation are carried out. In turn, beyond the fact
to modify situations and social that therapeutic proposals can be
interactions, which can sometimes also mentioned that promote alternative
become problematic (Greenberg, 2017). behaviors to the problematic ones, given

that emotional regulation is a continuous, components can have an indirect positive

dynamic, and diverse process (Gross, impact on the other elements or the
2014), effective intervention in any of its whole process.
Table 1
Problematic emotional regulation strategies
Extended Examples of therapeutic processes and alternatives

ER strategies that can become
Process to the behaviors to problematic ER strategies
problematic
Model proposed from different approaches*
Avoidance or escape from the - Committed action (ACT)
situation - Behavioral activation (BA)
- Exposure with response prevention (BT or CBT)
Control or safety behaviors - Interoceptive exposure (PU)
Situation
- Problem Solving Training (PST)
(W)
Instrumental use of the emotion - Opposite action (DBT)
- Interpersonal effectiveness (DBT)
- Awareness and reflection on needs and
Impulsive or unplanned approach
motivations linked to emotion (EFT)
Rumination, worry, self-targeting, - Contact with the present moment (ACT)
and/or threat monitoring - Cognitive defusion (ACT)
Attention - Mindfulness (MBCT) and other strategies that
(P) Distraction, dissociation, and/or favor the metacognitive attention mode (MCT)
suppression of the attention focus - Emotional exposure, behavioral experiments, and
reappraisal of metacognitive beliefs (MCT)
Reappraisal and persistent negative - Cognitive defusion (ACT)
thinking - Self as context (ACT)
Positive reappraisal with - Contact with the present moment (ACT)
Cognition underestimation of risks or - Mindfulness (MBCT) and other strategies that
(P) pertinent information favor the metacognitive attention mode (MCT)
Cognitive suppression - Emotional exposure, behavioral experiments, and
reappraisal of beliefs about emotions (MCT, PU,
Emotions negative evaluation and EST)
Expressive inhibition and - Acceptance (ACT)
suppression - Cognitive defusion (DBT)
Concentration and impulsive - Working with values (ACT)
release - Committed action (ACT)
Response Instrumental use of the emotional - Mindfulness (MBCT)
(A) expression - Distress tolerance and crisis management (DBT)
- Opposite action (DBT)
Harmful or high-risk behaviors (self- - Interpersonal effectiveness (DBT)
harm, suicidal behavior, - Awareness and reflection on needs and
problematic consumptions, etc.) motivations linked to emotion (EFT)
* ACT (Acceptance and Commitment Therapy), BA (Behavioral activation), BT (Behaviour Therapy), CBT
(Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), EST (Emotional Schema Therapy), EFT
(Emotion-Focused Therapy), MBCT (Mindfulness-Based Cognitive Therapy), MCT (Metacognitive
Therapy), PST (Problem Solving Therapy), PU (Unified Protocol for Transdiagnostic Treatment of
Emotional Disorders)

controllability of the emotions and the

Maintenance, change, and origin of instructions on what strategies to use,
the strategies among others (eg, Bariola et al., 2012;
According to the Extended Process Ford, Lam et al., 2018; Eisenberg et al.,
Model, if an emotion regulation tactic is 1998; Gunzenhauser et al., 2014; Karreman
successful in modifying the emotional and Vingerhoets, 2012)
state, it will continue to be used until the However, unlike studies that address
goal of regulating emotion is no longer general issues of emotions and the
active, either because it has been achieved possible difficulties in their regulation, in
or because another goal has displaced it. the clinical field the question about why
On the other hand, if the tactic is people maintain certain maladaptive and
unsuccessful because the emotion does even counterproductive behaviors is
not change or changes in the opposite usually addressed through a functional
direction, the person may select a new analysis of ideographic type that considers
strategy/tactic or stop and abandon the the particular antecedents and
entire process of emotion regulation. The consequences of these (e.g., Barlow et al.,
monitoring of the stages of identification, 2015; Dixon & Rehfeldt, 2018; Hofmann &
selection, and implementation of Hayes, 2019b; Törneke, 2021; Wilson &
emotional regulation and its results is Murrell, 2002).
considered fundamental in this aspect In this line, regarding meta-emotions, it
(Gross, 2015a, 2015b). has been argued that these, whether
In turn, this model also highlights the positive or negative, can act as
importance of considering that emotion reinforcements or punishments,
regulation often involves trade-offs respectively, predisposing people to seek
between hedonic and instrumental to experience certain emotions and try to
motives. In certain situations, some avoid others (Bailen & Thompson, 2019).
strategies that may bring short-term relief However, many of the examples in this
can come at a significant longer-term cost article on emotional regulation strategies
to other, non-emotional goals. In turn, that can become problematic can be
sometimes chronically pursuing certain considered as ineffective, maladaptive, or
types of emotional regulation goals can counterproductive attempts to control-
backfire. For example, some research avoidance the emotional, and/or
indicates that the constant search to feel interpersonal experience associated with
happy can make people feel less happy in discomfort, and/or the search for pleasant
the long run (Gruber et al., 2011; Mauss et emotions.
al., 2011; Eldesouky & Gross, 2019). In this sense, in the ambit of contextual
On the other hand, among the therapies, emotional regulation difficulties
historical antecedents that are considered have been linked to a lack of
to predispose people to the use of certain psychological flexibility. According to
forms of problematic emotional Valdivia et al. (2010) ACT explicitly seeks
regulation, different investigations have to undermine rigidly applied destructive
considered early life experiences, the style emotional regulation processes. To do
of attachment with the caregiver, the this, it aims to favor experiential
education received on the kindness and

acceptance and value-driven behavioral and preventing people from having

change (Blackledge & Hayes, 2001). satisfactory lives or according to their
Since its inception, ACT has argued that values (see e. g. Barlow et al., 2015;
a large part of people's problems revolves Luciano, 2016). For this reason, one of the
around the rejection or non-acceptance of fundamental tasks in therapies is to help
uncomfortable private experiences people discern the relationship that occurs
(Wilson & Luciano, 2002). Avoidance and between their actions and the
fusion with emotional states experienced consequences that follow, both in the
as annoying or problematic can provide short and long term (Törneke, 2021).
some relief and a sense of coherence in On the other hand, from a contextual
the short term, but paradoxically they can approach it has been highlighted that the
also intensify and make them chronic, functional interrelationships between
producing a subsequent loss concerning behaviors, their antecedents, and their
having a valued life direction. From this consequences do not have inherent or
perspective, it is considered that the immutable functions, but rather dynamic
element common to most of the problems and changing ones, because they are also
that require clinical attention consists of a in a dynamic relationship with other
destructive avoidance pattern that variables or historical and current
prevents people from having valuable or conditions (“third variables” by Skinner,
satisfactory lives, receiving this pattern the 1931, p. 452) by which they are affected or
name of Experiential Avoidance Disorder updated (Morris, 1992; Pérez-Álvarez,
(Luciano, 2016). 2014). In a broad sense, the context of
Along these lines, it can be considered behavior refers to both the historical and
that many of the maladaptive emotional situational sources that influence the
regulation behaviors are reinforced behavior of the organism, including
because people do what they consider biological, social, and cultural variables,
correct, thus experiencing a sense of developmental and learning history, and
coherence (positive reinforcement), the internal environment (e. g., cognitive,
because their discomfort is immediately affective) and the current external
reduced (negative reinforcement) ( see for environment of the organism (Hayes &
example Luciano, Gutiérrez et al., 2005; Hofmann, 2021; Hofmann et al., 2021;
Wells, 2000, 2019) and/or because by Villatte et al., 2015).
expressing the emotions and carrying out In this way, clinical history, possible
their action tendencies they manage to current medical problems, lifestyle,
modify situations or social interactions, including diet, physical activity, sleep, and
avoiding (negative reinforcement ) or other biologically relevant behaviors,
thereby achieving (positive reinforcement) together with biographical, socio-cultural,
certain social consequences (see e.g. and environmental aspects, can be of
Greenberg, 2017; Hofmann, 2014). great importance in understanding and
However, although these strategies may modifying how people manage their
be effective in the short term, when they emotions as well as for their overall
become a persistent and destructive mental health (e. g., Linehan, 1993, 2003;
pattern of avoidance, they can end up Firth et al., 2020; Hayes & Hofmann, 2021).
intensifying and making problems chronic,

Discussion and future research lines (2015a) these processes have been
Based on the Extended Process Model, addressed considering the interaction
this article has addressed how people between the W-P-V-A cycles of the first-
experience and relate to their own order system and the stages of
emotions, along with what has been identification, selection, and
sustained in this regard from different implementation of the cycles of the
basic and applied perspectives with second-order system, together with their
empirical support. monitoring.
On the one hand, emotions have been In turn, regarding these processes, in
described as responses to psychologically terms of the Extended Process Model, it
relevant events that entail physiological, has been pointed out that it is possible to
experiential, and behavioral changes. This maintain that in some cases the second-
has been addressed by various traditional order system would focus mainly on the
models on emotions and, particularly in first-order system that gives rise to
the proposal by Gross (2015a) as part of emotion, while in others would have their
the W-P-V-A cycles of the first-order processes as their main object, especially
system. those of the identification stage, although
On the other hand, emphasis has been not exclusively. Along these lines, it can be
placed on the ways in which people: 1) stated that a large part of the
direct attention and are more or less interventions of traditional cognitive-
aware of their emotions, 2) evaluate their behavioral therapies seems to promote
emotional responses, their implications the use of strategies aimed at producing
and whether or not to modify them, 3) changes, especially in the first-order
react or they are sensitive to their evaluation system, while more recent
emotional states, 4) they are interfered contextual and cognitive-behavioral
with or influenced by them, 5) they therapies, ones would focus much more
evaluate the convenience or not of the on the processes of the identification
different emotional regulation alternatives stage of the second-order system. These
and their own ability to use them, 6) they divergences are more clearly appreciated
act directly or indirectly to modify their when considering the prominent place
emotions, 7) they express their emotions occupied by acceptance, emotional
socially, influencing and being emotionally awareness, and distancing/defusion in the
influenced by others, 8) they produce or latter, as well as in the differences
favor with their regulation behaviors between perspectives focused on the
certain results in the short, medium and control or change of emotions, and those
long term, both at a personal and that they consider that the proper
interpersonal level; and, finally, the management of emotions does not
relevance of 9) historical and current necessarily imply their modification.
biological, social, cultural, environmental- On the other hand, although it has
ecological, developmental and learning been highlighted that the philosophical
variables, regarding the predisposition to and conceptual differences are not a
experience emotions and undertake minor issue, it started from the idea that it
regulation behaviors has been very briefly is possible to establish a critical but fruitful
mentioned. In the proposal by Groos dialogue between the different theoretical

and applied approaches based on with the other described regulation

evidence (see e. g. Hayes & Hofmann, processes, can acquire great relevance for
2018; Hofmann & Hayes, 2019). the functional analysis and the approach
Regardless of the paradigm to which it of the difficulties related to the
adheres, borrowing a metaphor used by management of emotions. For example,
Skinner (1976, p.30), it is considered that several of these processes could easily fit
this dialogue between perspectives the integration and investigation criteria
requires a kind of "bilingualism" or of the recent Hayes & Hofmann Extended
"polyglotism". Some "languages" can be Evolutionary Metamodel (see Hayes et al.,
mutually intelligible or, conversely, very 2020; Hayes & Hofmann, 2021; Hofmann
different from each other. Some terms can et al., 2021). This metamodel proposes a
be linked or even try to be explained or type of functional analysis based on
"translated" into equivalent terms from processes that aim to coherently organize
another model, although, inevitably, there mediators of therapeutic change with
are no exact equivalences, and this always empirical support from different sources.
entails a loss concerning the original For this, it contemplates three levels and
emphases and contexts. In this sense, six dimensions. At the psychological level,
rather than making "exact translations", it considers the dimensions: a) cognition,
this work aimed to link or articulate some b) affect, c) attention, d) self, e) motivation
processes of clinical relevance, making the and f) manifest behavior. These
points of coincidence, complementarity, dimensions can include concepts and
and difference clearer or more visible. components related to a) evaluation of
In this way, it has been pointed out the situation/appraisal of the
how theoretical models such as that of emotion/cognitive change, b) response to
Groos (2015a) can be enriched by the the situation/affective reaction to the
experience and empirically supported emotion/modulation of the response, c)
proposals from the clinical field. Strategies attention to situation/emotional
and processes of emotional regulation awareness/attentional display, d) self-
that have not been extensively studied, or efficacy to manage the situation/self-
even previously not considered, may be efficacy to regulate emotions/cognitive
the subject of new lines of research. In this change, e) action tendencies/hedonic and
sense, it is considered that it can be instrumental motivations/regulatory goals,
fruitful in future research to differentiate, f) situation responses/influences or
link, and continue to delve into both the interferences in the actions/strategies of
regulation strategies focused on the W-P- selection and modification of situations.
V-A cycles of the first-order system and Similarly, considering what has been
the emotion management processes developed in other sections, it can be
focused mainly on the components of the considered that the sociocultural and
system of second-level and how all this physiological levels of the Extended
happens in controlled contexts, in Evolutionary Metamodel are also widely
therapeutic spaces and people's daily considered in research on emotional
lives. regulation. An additional advantage is that
Regarding the clinical field, the stages in addition to including processes linked
of the Gross model (2015a), articulated to these levels and dimensions, the

Extended Processing Model allows emotions and the difficulties in their

hypothesizing and testing in clinical regulation treated in this work. Below this,
practice the possible relationship between a table with questions is also included,
its components in the different stages of which together with the scheme could
the emotion generation and regulation serve as an additional reference to
process (identification, selection, continue reflecting on the possible
implementation). exploration of emotional regulation
To conclude, it is mentioned that for difficulties in clinical interviews, in the
didactic purposes in the appendix a graph formulation of cases and in the selection
or diagram is included that synthesizes of assessment instruments, for clinical use
several of the processes related to and future research.

Appendix
Figure A1 Summary graph of possible emotional regulation difficulties

Table A1.
Questions to reflect on the possible theoretical and clinical exploration of emotional regulation
difficulties and their research
Questions
What happens before the emotions appear? What situations, experiences,
memories, thoughts, physical sensations, etc. evoke or trigger the emotional
response? Does the same thing happen in different places or at other times? In
what situations is the emotion more likely or intense? What situations does the
person identify as the worst in intensity and duration? Which ones do they identify
Antecedents or
as the best? What do they think made the difference between those situations?
triggering events
What other changes in situations might momentarily decrease or increase the
(W-P-V first-order
person's likelihood of experiencing those emotions? What situations, needs, wants,
system)
aversions, or cues, memories, or thoughts associated with them make them more
likely? With what fears, needs or values is the appearance of the emotion related?
In metaphorical terms, if emotion could speak to him, what do they imagine it
would say? What do they think emotion prepares or predisposes him for? What do
they think he is trying to protect him from? What goals or results does it reach?
Response
What emotions does the person experience? With what intensity, frequency,
(A of the first-order
duration, and variability do emotions occur? On a scale of 1 to 10, how intense or
system which then
how much discomfort do they think they cause them? How long do they usually
constitutes the
last? What physical sensations, memories, images, thoughts, judgments,
second-order W if
evaluations, etc. Are they part of the emotion? Where is his attention most
the emotion is a
focused when experiencing these emotions? What happens in his body or how do
candidate for
they express them when they appear?
regulation)
Emotions subject to identification (W): What emotions do they experience
without much hesitation and which ones are subject to monitoring and/or
evaluation as candidates for regulation?
Emotional awareness (P): How aware is the person of their emotions (somatic
sensations, thoughts, etc.) and their context while they are happening? Can he
clearly describe what he feels? How aware is he of the emotions he feels during
the interview?
Evaluations and appraisal (V): How do they evaluate them or what does the
Experience and person think about their emotions? In metaphorical terms, what does their “mind”
relationship with “tell” him about her emotions as they experience them? What does it mean for the
one's own person to have those emotions? What reasons or explanations do they give for
emotions what causes them? How much control do they think they have over her behavior?
(W-P-V-A second- Do they consider her emotions to be abnormal? Are they concerned about issues
order system associated with their supposed permanence, duration, dangerousness, validity,
identification stage) complexity, or their difficulty in controlling, understanding, anticipating, or
tolerating them, etc.? To what extent do they think they should or should control
them to achieve their goals or have a valuable life? Do they experience their
emotional states and the thought content behind them as the “reality”, taking
them literally and acting on base them? What impact do these emotional
experiences have on the way they conceptualize or think about themselves? Do
they use phrases such as “I am”, “I feel” or “I have” to refer to her emotions? Is it
sometimes able to distance itself from these and see them as something transitory
not inherent to itself?

Feelings or affective reactions to emotions (A): What does the person feel or
how does the person react to their emotional states? How sensitive or unwilling
are they to experience her emotions? Do they experience emotions as intolerable?
Is difficulty tolerating distress primarily associated with a low tolerance for
negative emotions, feelings of uncertainty and lack of control, feelings of
frustration, ambiguity, and/or unpleasant physical sensations? Which of these
aspects related to discomfort makes them experience them as more difficult to
tolerate? Does this reaction further intensify their discomfort? What new emotions
arise as a reaction to the initial emotions?
Impact and/or interference in the actions (A): Do the emotional experiences
and how the person reacts to them interfere, hinder, or interrupt the actions that
they would like or would be more convenient for them to carry out? Do they
predispose them to act in ways that are unproductive or that they later regret? Do
they lead to the search for control-avoidance of the emotional experience
associated with discomfort and/or of the intensification of pleasant emotions?
What do they think the person, would do and now does not do if they did not
have those emotions?
Selection and
What set of emotional regulation alternatives does the person consider? Do they
implementation
have a reduced repertoire of regulatory strategies and tactics? What do they think
of strategies and
or how do they evaluate the convenience of using them? Do they consider
tactics (W-P-V-A
themself capable of implementing them successfully? Are they particularly
second-order
dependent or inflexible about using certain specific strategies or tactics?
system)
General: What emotions and in what contexts are most frequently regulated?
What does the person do to try to regulate or control them? How often? How
much time a day do they spend on it?
Situation (W): Do they avoid or try to modify certain situations so as not to
experience emotions? Do they use checks or security behaviors? Do they act
impulsively to quickly change circumstances and stop feeling emotions? Do they
turn to other people to deal with situations and thus experience emotions less
Control-avoidance
intensely? Do they use the expression of their emotions to influence others and
strategies that can
thus avoid or modify situations and social interactions that they experience as
become
annoying or undesirable?
ineffective or
Attention (P): Do they try to redirect their attention by distracting themselves
counterproductive
from or suppressing focus on specific aspects of the situation and/or emotional
(W-P-V-A of the
experience? Do they engage in harmful or unproductive distracting activities to
first-order and the
avoid or achieve certain emotional states? How often do they try to manage
identification stage,
emotion by focusing their attention and thoughts on anticipating future events,
that are the object
understanding the causes and consequences of emotions, or monitoring potential
of selection and
dangers that they think they may cause them? To what extent do they feel that
implementation of
they lose control of these processes? Do they tend to pay close attention or be
regulation
alert to how they feel? How much time a day do they spend checking their
strategies)
emotions or the thoughts associated with them?
Cognition(V): When they feel upset, do they try to reevaluate the situation to
modify their emotions? Do they fight or try to suppress certain thoughts? Do they
try to positively reassess the situation, but underestimate risks and/or important
information? Do they tend to look for negative aspects and critical meanings of
the situation to avoid, prepare for, and/or not be disappointed for possible
inconveniences?

Response Modulation (A): Do they try to suppress the expression of the

emotions? Do they tend to focus on the emotion and release it impulsively or in
inappropriate situations? Do they engage in harmful or high-risk behaviors to
regulate their emotions? Do they use the expression of their emotions to achieve
certain benefits or secondary results?
Short term: What happens after the emotion appears? What do they achieve or
avoid by responding to or managing emotion in this way? How do they feel when
it ends? Do they maintain that way of trying to regulate their emotions because
they think they are doing the right thing? Do they see their discomfort
immediately reduced when they use these strategies? Do they claim that these
actions help or prepare them to better prevent or cope with certain future
Impact or
situations? Are they able to modify situations or social interactions with the way
consequences
they regulate and express their emotions? How do other people react when they
(Hedonic or
experience the emotion? How might other people be contributing to maintaining
instrumental type
ineffective or counterproductive regulatory strategies?
results with their
Medium and long term: What impact do the regulation strategies used have on
new W-P-V-A
the person's life? Do they intensify and chronicle their emotional difficulties? Do
cycles of first and
they bring them new problems? Do they negatively impact there in life goals, their
second-order)
health, or the duration and/or quality of their interpersonal relationships? In what
way do these regulation strategies prevent them from having a more satisfying life
or according to the values? What did they stop doing that they used to do before
the emotional problem? What would they do if they didn't have this problem?
How do they imagine a day in the life would be if the problem disappeared or did
not interfere with achieving their goals?
Development and learning history, biographical aspects, and sociocultural
variables: What is the history of the problem? Have they received psychological
or psychiatric care in the past for this or any other problem? What biographical
aspects are relevant to understanding the way they relate to the emotions? At
what other times have they felt or acted similarly? How did they manage emotions
in those situations? Which strategies worked for them, and which didn't? In which
areas of life do avoidance or control-seeking strategies work for them and allow
them to solve problems appropriately? How much does this influence their trying
to handle emotions in the same way? How are emotions understood, valued, and
approached in the particular family and socio-cultural context of the person? How
could this be influencing the way they try to regulate them?
Historical and
History and current biological situation: Are there issues related to the person's
current conditions
lifestyle, alimentation, rest, or health status that are relevant? Could there be
medical problems associated with the emotional regulation difficulties that
negatively influence their emotional state or cognitive abilities? Could solving or
alleviating discomfort related to a medical problem have a positive impact on
emotional regulation? Has the person been evaluated by a doctor or other health
professional? Is it necessary to make a referral or an inter-consultation?
Environmental or ecological conditions: What places or physical environments
increase the possibility that the person will have difficulties regulating their
emotions? What characteristics do these places have? Are there risk conditions or
environmental factors that may negatively influence their physical or emotional
well-being?

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Translated from Análisis y Modificación de Conducta ISSN: 0211-7339

2022, Vol. 48, Nº 177, 3-40 http://dx.doi.org/10.33776/amc.v48i177.5467

Emotional regulation and empirically supported

Regulación emocional y terapias psicológicas

Darío Augusto de los Santos

*Article Translation Notes

Emotional regulation and empirically supported

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Introduction trying to understand this diversity, without

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author has begun to define emotional instrumental considerations, even having

Figure 2 Emotion regulation strategies

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Extended Process Model of Emotion In turn, in obvious parallelism with the

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stage, while the stages of selection and Emotional awareness (P)

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controllability, numbness, durability, controlling them make up the verbal

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and/or 5) (in)tolerance of unpleasant regulation difficulties linked to action

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emotional regulation processes than on the second-order system, although not

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there are different therapeutic proposals turn, an impulsive or hasty approach to

Situation Modification (W) Attentional display (P)

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different processes linked to the setting, different therapeutic proposals

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neglecting valuable information or sensitivity and dysregulation (Leahy, 2012;

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its experiential, behavioral, or As an alternative to dysfunctional

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that emotional regulation is a continuous, components can have an indirect positive

Extended Examples of therapeutic processes and alternatives

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controllability of the emotions and the

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acceptance and value-driven behavioral and preventing people from having

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and applied approaches based on with the other described regulation

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Extended Processing Model allows emotions and the difficulties in their

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Figure A1 Summary graph of possible emotional regulation difficulties

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Response Modulation (A): Do they try to suppress the expression of the

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References eliminación de pensamientos intrusos.

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https://psycnet.apa.org/doi/10.1111/j.1 emotion. Psychological inquiry, 9(4),

Translated from AMC, 2022, Vol. 48, Nº 177, 3-40 http://dx.doi.org/10.33776/amc.v48i177.5467

Montoya, I. (2021). Tratamientos https://dx.doi.org/10.1080%2F0269993

Translated from AMC, 2022, Vol. 48, Nº 177, 3-40 http://dx.doi.org/10.33776/amc.v48i177.5467

Gratz, K. L., & Roemer, L. (2004). Psychological inquiry, 26(1), 1-26.