Accepted Manuscript

Title: Mindfulness and Emotion Regulation

Author: Lizabeth Roemer Sarah Krill Williston Laura Grace

Rollins

PII: S2352-250X(15)00097-4
DOI: http://dx.doi.org/doi:10.1016/j.copsyc.2015.02.006
Reference: COPSYC 77

To appear in:

Received date: 28-1-2015

Revised date: 8-2-2015
Accepted date: 10-2-2015

Please cite this article as: L. Roemer, S.K. Williston, L.G. Rollins, Mindfulness and
Emotion Regulation, COPSYC (2015), http://dx.doi.org/10.1016/j.copsyc.2015.02.006

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RUNNING HEAD: Mindfulness and Emotion Regulation

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Mindfulness and Emotion Regulation

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Lizabeth Roemer1, Sarah Krill Williston1, Laura Grace Rollins1
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University of Massachusetts Boston

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Corresponding author: Lizabeth Roemer, PhD. Dept of Psychology University of
Massachusetts Boston, 100 Morrissey Blvd, Boston MA 02125 617 287-6358.
Lizabeth.roemer@umb.edu
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Mindfulness and Emotion Regulation

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Highlights

Self-reported mindfulness is associated with enhanced emotional recovery.

Mindfulness manipulations lead to reduced negative emotional responses.

Mindfulness manipulations lead to enhanced positive emotional responses.

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Mindfulness manipulations may reduce behavioral avoidance.

Mindfulness-based treatments lead to decreases in emotion regulation difficulties.

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Abstract

One proposed pathway for the documented psychological effects of mindfulness

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(cultivating awareness and acceptance of the present moment) has been through its

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facilitation of adaptive emotion regulation. Although conceptual overlap between the
two constructs complicates interpretation of correlational findings, an emerging body of

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laboratory, experimental, and treatment outcome studies provides preliminary support of
proposed conceptual models. These findings indicate that the practice of mindfulness is
associated with healthy emotion regulation (e.g., reduced intensity of distress, enhanced

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emotional recovery, reduced negative self-referential processing, and/or enhanced ability
to engage in goal-directed behaviors) and may play a causal role in these effects. More
experimental and longitudinal research is needed to determine the exact nature, temporal

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unfolding, and causality of these associations.
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Mindfulness and Emotion Regulation

Introduction

Mindfulness, a psychological construct drawn from Buddhist traditions, has been

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defined in secular contexts as “paying attention, on purpose, in the present moment, non-

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judgmentally [1].” It is most often conceptualized as containing at least two elements,
awareness of the present moment and the quality of that awareness (accepting, kind,

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nonjudgmental, curious; e.g., [2], while the currently most commonly used self-report
measure assesses five dimensions (observing, describing, acting with awareness,
nonjudgment, and nonreactivity; [3]. Mindfulness is used to refer to a dispositional

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quality that varies among individuals, brief practices that may elicit this quality or way of
responding, as well as treatment programs or lifelong practices that promote this
dispositional quality. One proposed pathway for the documented psychological effects of

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mindfulness has been through its facilitation of adaptive emotion regulation (ER) [4]. An
in-depth review of the conceptual and methodological complexities in the relations
among these two psychologically important constructs is beyond current space
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constraints (see [5,6**,7**] for in depth reviews), however we will highlight central
considerations and findings in this important area of study.

ER refers to the “process by which individuals influence which emotions they

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have, when they have them, and how they experience and express [them]” [8, pp. 275]
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with an emphasis on modulation rather than elimination of emotional responses and

adaptive behavioral responses to the environment [9,10]. The process model of ER [8]
highlights that emotions can be regulated at multiple stages from situation selection and
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modification, to attention to specific aspects of the situation, to reappraisal of a context

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(or emotional response); [11], to attempts to modify emotional responses (facial

expressions, physiological, experiential, and/or behavioral). While extensive research has
examined specific ER strategies (most often cognitive reappraisal and expressive
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suppression, see [11,12] for reviews), researchers have emphasized the importance of
better understanding the ongoing process of ER [13], context-dependence in the
effectiveness of strategies [9], and regulatory flexibility [14], as well as the specific
processes of ER among individuals who present with clinical disorders [15].

Conceptual links between mindfulness and ER

A host of researchers have proposed conceptual links between mindfulness

practices and adaptive ER. By promoting enhanced and expanded attention and
awareness in the present moment, mindfulness may improve individuals’ ability to attend
to specific aspects of a situation (e.g., expanding beyond a narrow focus on threat; [16*,
17]), as well as aspects of their own experience (e.g., body awareness, [18*]), and

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therefore improve their detection of the need to implement (or adjust) regulation
strategies [19]. This expanded awareness may also enhance inhibitory learning [20], so
that a previously feared stimulus becomes associated with (predictive of) absence of
threat, countering previous associations of threat and resulting in decreased anxious
responding. Further, the quality of this awareness (nonjudgmental, curious,
compassionate) may alter individuals’ way of relating to their own internal experiences

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(thoughts, feelings, sensations, memories) in ways that impact regulation. This

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“reperceiving” [21], decentering [22], or acceptance [19] may directly reduce the
intensity of emotional responses [7**], increase affect tolerance [23] and reduce negative

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valuation of emotional responses [7**]. It may also function as exposure (i.e., inhibitory
learning; [24, 18*, 20]) so that new, nonthreatening associations with internal experiences
are learned that counteract previous learned threatening associations. It may also increase

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positive reappraisal of situations [25] and reduce the automatic self-referential processing
(e.g., worry, rumination, self-criticism) that often perpetuates emotional distress,
particularly among individuals with emotional disorders [23,26]. This quality of

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awareness may also facilitate the flexible use of strategies to regulate emotions [7**]
and/or enhance individuals’ ability to engage in actions that matter to them (and refrain
from impulsive actions) even while experiencing intense emotions (e.g., [10]), an
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understudied type of response-focused regulation.

Many authors note that mindfulness may affect ER differently at different stages
of practice. For instance, Hayes and Feldman [27] suggest that mindfulness may initially
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reduce distress, while it may also subsequently, after practice, enhance an open
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experiencing of emotions (i.e., exposure to emotions), which promotes new emotional

learning and reestablishes adaptive ER among those presenting with emotional disorders.
Differences related to length of practice may explain some apparent contrasts in the
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literature: Chambers et al. [5] distinguish mindfulness from cognitive regulation, stating
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that mindfulness does not involve endorsing alternative cognitive beliefs, but instead
relating differently to beliefs as a whole. Teper and colleagues [19] and others make
similar distinctions. On the other hand, Webb and colleagues [11] categorize mindfulness
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as a reappraisal strategy, suggesting that mindfulness (and acceptance) involves a

reappraisal of an emotional response, and Garland et al. [25] suggest mindfulness
involves positive reappraisal of contexts. These differing models may be explained by
differences in the impact of mindfulness when initially learned (when it may be more of a
top-down, cognitive, regulatory process), and after extensive practice (for instance among
experienced meditators, see [6**, 18*] for reviews), when it may instead lead to a
different way of initially responding to emotions and beliefs. Chiesa and colleagues
(6**) provide an in-depth review of research to date (some of which is also reviewed
here), concluding that when initially practiced, mindfulness may lead to recruitment of
prefrontal cortex areas that modulate activation in limbic areas (indicating top-down,
regulatory processing), while cross-sectional studies of experienced meditators find

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evidence of reduced activation in limbic areas in the absence of corresponding activation

in the prefrontal cortex (indicating bottom-up processing, or reduced reactivity). They
note, however, that both top-down and bottom-up processes may also operate
concurrently among some individuals (and vary based on context) and that more research
is needed to examine the time course of development of these processes. Distinct
mindfulness practices may also differ in whether they enhance top-down regulatory

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strategies (including, but perhaps not limited to, reappraisal), or target reactivity more

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directly (6**, 18*).

Correlational studies of self-report measures

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Empirical investigation of the relations between mindfulness and emotion

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regulation is complicated by varied conceptual and operational definitions of both. One
point of confusion is whether mindfulness and ER are distinct or overlapping constructs,
or whether mindfulness is an example of an ER strategy. This has led to measurement

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challenges in correlational studies of self-report measures as some multi-dimensional
measures of mindfulness include aspects of ER (e.g., nonreactivity to internal
experiences, [3]), while some multi-dimensional measures of ER incorporate factors that
could be considered facets of mindfulness (e.g., nonacceptance (inversely) in the
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difficulties in emotion regulation scale; [10], see [28] for in depth discussion).
Nonetheless, correlational studies in undergraduate, healthy adult, and treatment-seeking
samples consistently find associations among both unidimensional (awareness only) and
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multidimensional measures of mindfulness and measures of ER (e.g., [29, 30]), including

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a unique relationship beyond shared variance with anxiety sensitivity, distress tolerance,
and negative affect [31]. Studies also find that various measures of ER explain
associations between mindfulness and psychological outcomes (e.g., [32]) and also
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mindfulness and difficulties in ER explain both unique and overlapping variance in

psychological symptoms (e.g., generalized anxiety disorder, [33]). In an experience
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sampling study, a multidimensional measure of mindfulness was positively correlated

with emotion differentiation and negatively correlated with emotional lability in a sample
of undergraduate students; and emotion differentiation explained the shared variance
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between mindfulness and emotional lability [34]. Adams and colleagues [35] similarly
found that dispositional mindfulness (unidimensional – awareness) was significantly
correlated with reduced emotional volatility in a sample of African American individuals
during a smoking cessation program.

To address potential overlap in measures of mindfulness and ER, Coffey et al.

[28] conducted a series of exploratory and confirmatory factor analyses of the subscales
of commonly used multi-dimensional measures of each construct in an undergrad sample,
revealing a four factor model of awareness, acceptance, clarity, and negative ER, with
each factor including subscales from both the mindfulness and ER measures. A path
analysis indicated that awareness and acceptance (both established components of

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mindfulness) each directly and independently predicted both clarity and negative ER, and
clarity also predicted negative ER. A follow-up study revealed that acceptance was the
strongest predictor of both positive and negative psychological outcomes and that
negative ER was strongly associated with both acceptance and psychological outcomes.
These studies and others like them indicate strong relations between self-reported
mindfulness and ER, and begin to suggest that acceptance may be strongly associated

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with both healthy regulation and psychological well-being, and that clarity may also be

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an important correlate of mindfulness that promotes healthy emotion regulation.
However, the cross-sectional nature of these findings precludes drawing conclusions

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regarding causality or temporal precedence.

Correlational studies using non self-report indicators of ER

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Many studies have also examined whether measures of dispositional mindfulness
(assessed by unidimensional (awareness only) or multidimensional measures of

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mindfulness, or by meditation history) are correlated with non-self-report indicators of
emotional responding and regulation. These studies indicate that dispositional
mindfulness is associated with reduced emotional intensity and enhanced emotional
recovery. Specifically, both a unidimensional and a multidimensional measure of
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mindfulness were significantly correlated with lower late positive potential (LPP) of the
event-related brain potential, a neural marker of emotional arousal, and this association
remained after controlling for self-reported attentional control [36*]. Similarly,
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individuals who scored higher on a unidimensional measure of mindfulness showed

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reduced cortisol response to a social stress task, and more rapid recovery after the task,
even after controlling for reports of fear of negative evaluation [37]. Bullis and
colleagues [38] found that only one aspect of mindfulness, the ability to describe
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observed experiences (which loaded on the clarity factor in [28]) uniquely predicted
faster heart rate recovery after exposure to hyperventilation (a laboratory stressor),
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beyond shared variance with measures of anxiety, anxiety sensitivity, and distress
tolerance. Arch and Craske [39] found that a unidimensional (awareness) measure of
mindfulness was uniquely associated with reduced self-reported distress following a
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hyperventilation task, as well as increased duration of exposure (i.e., reduced behavioral

avoidance) to the hyperventilation task among both healthy and clinically anxious
participants, after controlling for shared variance with measures of anxiety and anxiety-
sensitivity. Ortner and colleagues [40] examined correlates of an emotion interference
task that assesses the degree to which emotional images slow reaction times to a neutral
task, providing a potential analogue of engaging in goal-driven behavior in the face of
emotional arousal. They found that duration (in months) of mindfulness practice and self-
reported state mindfulness were both associated with reduced emotional interference for
both positive and negative images, while dispositional mindfulness was not correlated
with emotional interference. Finally, studies have shown that dispositional mindfulness is

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associated with neurological indicators of effective regulation when using other ER

strategies, such as affect labeling [41] and reappraisal [42]. Although these studies are all
correlational, the inclusion of statistical controls for psychological distress, attention, and
anxiety sensitivity strengthens conclusions regarding specific associations between
reports of mindfulness and these behavioral outcomes (reduced emotional arousal, more
rapid physiological recovery, reduced emotional interference, and enhanced neurological

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regulation in response to regulatory instructions). However, it remains to be seen whether

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similar relations emerge in clinical or more diverse samples.

Experimental studies

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Because mindfulness is thought to be a skill that requires repeated practice,

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particularly for it to become automatic in emotional contexts, experimental studies of
brief interventions may not capture the impact of repeated practice. These studies also
use manipulations that vary from focused breathing [43] to mindfulness (awareness and

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acceptance) of emotions [44] to a self-focus on emotions or feelings versus thoughts and
cognitive reflection [45]. Studies have also examined manipulations that emphasize
acceptance, a component of mindfulness, although these are often in contrast to
suppression or reappraisal conditions, making interpretation of differences between
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conditions problematic. Here we focus only on studies in which a short-term mindfulness
manipulation is compared to a control condition (e.g., unfocused attention or a distraction
task). These experimental studies have revealed that a mindfulness manipulation is
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associated with more positive self-reported emotional response to neutral slides [43],
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more sustained self-reported positive responding to a positive film clip [44], reduced
immediate self-reported negative emotional response to an affectively mixed film clip
[44], reduced negative mood [46] and reduced amygdala activation in response to
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positive and negative slides compared to baseline (in meditation naïve participants, [47])
and in comparison to a “think” condition [45]. Some evidence has also emerged that brief
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mindfulness may reduce behavioral avoidance: participants who engaged in focused

breathing reported greater willingness to view affectively negative slides than those in a
control condition [43]. Taken together, these studies indicate that brief mindfulness
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manipulations in meditation naïve participants may reduce negative emotional responses

and increase positive emotional responses, as well as reduce behavioral avoidance.
However, more research is needed to determine the specificity of these responses, as they
may be similar to the effects of relaxation.

Treatment studies

Numerous studies have demonstrated that mindfulness-based interventions, such

as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive
Therapy (MBCT) lead to self-reported decreases in ER difficulties [49], as do
interventions that incorporate mindfulness [e.g., 50, 51]. Mindfulness training also leads

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to greater decreases in reports of distraction and rumination than a relaxation treatment

[52]. Laboratory findings confirm these self-reports and expand on the nature of these
changes. Clients with depression treated with MBCT demonstrated more rapid recovery
after a laboratory social stressor and less stress sensitization than a control group [53].
Clients with social anxiety disorder treated with MBSR demonstrated reduced amygdala
responding in response to negative self-beliefs when engaged in focused breathing, as

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well as increased activation in areas associated with attention deployment, which may

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indicate approach versus avoidance [54]. Individuals who received MBSR demonstrated
reduced activation of self-referential and language processing areas of the brain and

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increased activation of areas related to awareness of body sensation compared to controls
when viewing sad images [48]. Interestingly, Taylor et al. [47] found a deactivation of
medial prefrontal and posterior cingulate cortices among experienced meditators in

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response to a mindfulness induction (in contrast to novice meditators described above).
Finally, when participants received a 7-week mindfulness training versus relaxation
training they demonstrated less emotional interference in the task described above [40].

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Taken together, these findings suggest that mindfulness-based interventions may reduce
emotional reactivity, along with negative self-referential processing that interferes with
healthy regulation, while also increasing the ability to engage in tasks despite emotional
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arousal.

Conclusions
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Correlational, experimental, and treatment studies converge to suggest that the

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practice of mindfulness (cultivating awareness and acceptance of the present moment) is

associated with healthy ER (e.g., reduced intensity of distress, enhanced emotional
recovery, reduced negative self-referential processing, and/or enhanced ability to engage
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in goal-directed behaviors) and may play a causal role in these effects, although more
experimental research is needed to determine this. Future studies should examine the
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temporal process of these strategies to examine whether mindfulness or awareness

precedes these outcomes, and should also include more rigorous control conditions (such
as relaxation; [52, 40]) to determine the specificity of the effects of mindfulness. More
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experimental and treatment studies that examine the impact of mindfulness on emotional
recovery (e.g., [53] emotional interference [40]) or ability to engage in meaningful
behaviors or refrain from impulsive behaviors (e.g., a mindful eating manipulation
enhanced delay food discounting in individuals with high body fat; [55]) will enhance our
understanding how mindfulness enhances adaptive regulation relative to the individual’s
environment. Similarly, studies are needed that examine the proposed mindfulness-based
enhancement of inhibitory learning (e.g., [18]). More attention to these processes among
individuals with clinical disorders (e.g., [54]) is also needed, as are studies in racial and
ethnic minority samples to examine potential contextual and cultural factors in these
interrelationships [56]. Mindfulness, with its emphasis on flexible attention and

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nonreactivity may be particularly helpful in promoting flexible, context-dependent ER; as

methods to examine these important aspects of ER are developed, this will be an
important direction for mindfulness and ER research. Similarly, developments in the
assessment of reactivity to emotional responses (e.g., negative valuation, self-criticism,
and judgment) will be important additions to this work. Finally, mindfulness practices
vary in their emphasis on breath awareness versus awareness of other internal

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experiences such as thoughts or feelings versus cultivation of self-compassion or

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lovingkindness (these studies were not reviewed here); research is needed to determine
whether these have differential effects, and whether these effects are moderated by

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context, individual goals, or individual levels of distress.

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*Brown KW, Goodman RJ, & Inzlicht M: Dispositional mindfulness and the
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attenuation of neural responses to emotional stimuli. Social Cognitive and

Affective Neuroscience 2013, doi:10.1093/scan/nss004, 8(1), 93-99.
ce

This study of undergraduate students found that higher reports of mindfulness

(awareness) were associated with reduced emotional arousal (measured by late positive
Ac

potential (LPP) of the event-related brain potential) in response to high arousal negative
and positive images, even after controlling for attentional control, indicating that
mindfulness may modulate neural responses.

Brown KW, Weinstein N, & Creswell JD: Trait mindfulness modulates

neuroendocrine and affective responses to social evaluative threat.
Psychoneuroendocrinology 2012, doi:10.1016/j.psyneuen.2012.04.003, 37(12),
2037-2041.

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* Bullis JR, Bøe H, Asnaani A, & Hofmann SG: The benefits of being mindful:
Trait mindfulness predicts less stress reactivity to suppression. J Behav Ther
Exp Psychiatry 2014, doi:10.1016/j.jbtep.2013.07.006, 45(1), 57-66.

This study of racially diverse healthy male adults found that self-reports of the
“describe” dimension of mindfulness were uniquely predictive of faster heart rate
recovery after exposure to hyperventilation in a laboratory setting, while self-

t
ip
reported “awareness” (attention to the present moment) predicted reduced
subjective distress.

cr
Arch J & Craske M: Laboratory stressors in clinically anxious and non-
anxious individuals: The moderating role of mindfulness. Behav Res Ther

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2010, doi:10.1016/j.brat.2010.02.005, 48(6), 495-505.

19. Ortner C, Kilner S, Zelazo P: Mindfulness meditation and reduced emotional

interference on a cognitive task. Motiv Emotion 2007, 31(4):271-283.

an
Creswell JD, Way BM, Eisenberger NI, & Lieberman MD: Neural correlates of
dispositional mindfulness during affect labeling. Psychosom Med 2007,
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doi:10.1097/PSY.0b013e3180f6171f, 69(6), 560-565.

20. Modinos G, Ormel J & Aleman A: Individual differences in dispositional mindfulness

and brain activity involved in reappraisal of emotion. Social Cognitive and Affective
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Neuroscience 2010, doi:10.1093/scan/nsq006, 5(4), 369-377.

te

Arch J & Craske M: Mechanisms of mindfulness: Emotion regulation

following a focused breathing induction. Behav Res Ther
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2006, doi:10.1016/j.brat.2005.12.007, 44(12), 1849-1858.

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Erisman SM, Roemer L: A preliminary investigation of the effects of

experimentally induced mindfulness on emotional responding to film clips.
Emotion 2010, doi:10.1037/a0017162, 10(1), 72-82.
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Herwig U, Kaffenberger T, Jäncke L & Brühl AB: Self-related awareness and

emotion regulation. Neuroimage 2010, doi:10.1016/j.neuroimage.2009.12.089,
50(2), 734-741.

Broderick PC: Mindfulness and coping with dysphoric mood: Contrasts with
rumination and distraction. Cognitive Therapy And Research
2005, doi:10.1007/s10608-005-3888-0, 29(5), 501-510.

21. Taylor V, Grant J, Daneault V, Scavone G, Breton E, Roffe-Vidal S, Courtemanche J,

Lavarenne A, Beauregard M: Impact of mindfulness on the neural responses to emotional

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pictures in experienced and beginner meditators. Neuroimage 2011, doi:

10.1016/j.neuroimage.2011.06.001, 57(4):1524-1533.

Farb NS, Anderson AK, Mayberg H, Bean J, McKeon D, & Segal ZV: Minding
one’s emotions: Mindfulness training alters the neural expression of sadness.
Emotion 2010, doi:10.1037/a0017151, 10(1), 25.

t
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22. Robins C, Keng S, Ekblad A, Brantley J: Effects of mindfulness-based stress reduction on
emotional experience and expression: a randomized controlled trial. J Clin Psychol,
2012, 68(1):117-131.

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23. Treanor M, Erisman S, Salters-Pedneault K, Roemer L, Orsillo S: An acceptance-based
behavioral therapy for GAD: Effects on outcomes from three theoretical models.
Depress and Anxiety 2011, 28:127-136.

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24. Kumar S, Feldman G, & Hayes A: Changes in mindfulness and emotion regulation in an
exposure-based cognitive therapy for depression. Cognitive Therapy and Research 2008,
doi:10.1007/s10608-008-9190-1, 32(6), 734-744.

an
Jain S, Shapiro SL, Swanick S, Roesch SC, Mills PJ, Bell I, & Schwartz GE: A
randomized controlled trial of mindfulness meditation versus relaxation
training: Effects on distress, positive states of mind, rumination, and
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distraction. Ann Behav Med 2007, doi:10.1207/s15324796abm3301_2, 33(1), 11-
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*Britton WB, Shahar B, Szepsenwol O, & Jacobs WJ: Mindfulness-based

cognitive therapy improves emotional reactivity to social stress: results from
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a randomized controlled trial. Behavior Therapy 2012, 43(2), 365-380.

This study found that individuals in partial or full remission from unipolar depression
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who received Mindfulness-Based Cognitive Therapy demonstrated significantly

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improved recovery in self-reported anxiety following a social stressor compared to those

in a wait list control condition.

Goldin PR, Gross JJ: Effects of mindfulness-based stress reduction (MBSR) on

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emotion regulation in social anxiety disorder. Emotion 2010,

doi:10.1037/a0018441, 10(1), 83-91.

Hendrickson KL, Rasmussen EB: Effects of mindful eating training on delay

and probability discounting for food and money in obese and healthy-weight
individuals. Behav Res Ther 2013, doi:10.1016/j.brat.2013.04.002, 51(7), 399-
409.

25. Matsumoto D, Yoo SH, & Nakagawa S: Culture, emotion regulation, and adjustment. J
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