title: Neural correlates of emotion acceptance vs worry or suppression in generalized anxiety disorder.
abstract: Recent emotion dysregulation models of generalized anxiety disorder (GAD) propose chronic worry in GAD functions as a maladaptive attempt to regulate anxiety related to uncertain or unpredictable outcomes. Emotion acceptance is an adaptive emotion regulation strategy increasingly incorporated into newer cognitive behavioral therapy (CBT) approaches to GAD to counter chronic worry. The current study explores the mechanisms of emotion acceptance as an alternate emotion regulation strategy to worry or emotion suppression using functional magnetic resonance imaging. Twenty-one female participants diagnosed with GAD followed counterbalanced instructions to regulate responses to personally relevant worry statements by engaging in either emotion acceptance, worry or emotion suppression. Emotion acceptance resulted in lower ratings of distress than worry and was associated with increased dorsal anterior cingulate cortex (dACC) activation and increased ventrolateral prefrontal cortex (VLPFC)-amygdala functional connectivity. In contrast, worry showed significantly greater distress ratings than acceptance or suppression and was associated with increased precuneus, VLPFC, amygdala and hippocampal activation. Suppression did not significantly differ from acceptance in distress ratings or amygdala recruitment, but resulted in significantly greater insula and VLPFC activation and decreased VLPFC-amygdala functional connectivity. Emotion acceptance closely aligned with activation and connectivity patterns reported in studies of contextual extinction learning and mindful awareness.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Ellard
authors.affiliation: Department of Psychology, Boston University, Boston, MA, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Barlow
authors.affiliation: Department of Brain and Cognitive Sciences, The McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Whitfield-Gabrieli
authors.affiliation: Department of Brain and Cognitive Sciences, The McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: John D E
authors.initials: JDE
authors.lastname: Gabrieli
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000000981:diagnostic imaging* / Q000523:psychology*; D001921:Brain / Q000000981:diagnostic imaging; D001931:Brain Mapping; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004644:Emotions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009415:Nerve Net / Q000000981:diagnostic imaging; D011569:Psychiatric Status Rating Scales; D011999:Recruitment, Neurophysiological
keywords: emotion acceptance; emotion regulation; functional magnetic resonance imaging; generalized anxiety disorder; worry