Emerging Trends in The Social and Behavioral Sciences

Regulation of Emotions Under Stress

Item

Title

Regulation of Emotions Under Stress

Author

Shallcross, Amanda J.

Troy, Allison

Mauss, Iris B.

Research Area

Cognition and Emotions

Topic

Emotional Regulation

Abstract

Stressful life events (SLEs) are frequently associated with a range of deleterious mental and physical health outcomes. However, some individuals exhibit resilience, defined as maintained or even improved health in the wake of SLEs. How and why might this be the case? Given that SLEs give rise to negative emotions, which in turn contribute to mental and physical illness, promising answers to questions about resilience lie in research on people's ability to manage their emotions, or, emotion regulation. This essay focuses on emerging empirical evidence that suggests that two seemingly opposite emotion regulation strategies, cognitive reappraisal and emotional acceptance, are particularly effective for managing negative emotions, which, in turn, may confer resilience. By integrating theory with extant empirical evidence, we offer a model that aims to reconcile how these two strategies—one that involves minimizing emotions (cognitive reappraisal) and the other that involves engaging with emotions (emotional acceptance)—are each associated with resilience. Specifically, we propose that these strategies are not contradictory, but rather complementary. We additionally discuss broader implications for the links among stress, emotion regulation, and health, as well as key issues for future research at the intersection of social and clinical psychology, medicine, and public health.

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Identifier

etrds0036

extracted text

Regulation of Emotions Under Stress
AMANDA J. SHALLCROSS, ALLISON TROY, and IRIS B. MAUSS

Abstract
Stressful life events (SLEs) are frequently associated with a range of deleterious
mental and physical health outcomes. However, some individuals exhibit resilience,
defined as maintained or even improved health in the wake of SLEs. How and why
might this be the case? Given that SLEs give rise to negative emotions, which in turn
contribute to mental and physical illness, promising answers to questions about
resilience lie in research on people’s ability to manage their emotions, or, emotion
regulation. This essay focuses on emerging empirical evidence that suggests that
two seemingly opposite emotion regulation strategies, cognitive reappraisal and
emotional acceptance, are particularly effective for managing negative emotions,
which, in turn, may confer resilience. By integrating theory with extant empirical
evidence, we offer a model that aims to reconcile how these two strategies—one
that involves minimizing emotions (cognitive reappraisal) and the other that
involves engaging with emotions (emotional acceptance)—are each associated
with resilience. Specifically, we propose that these strategies are not contradictory,
but rather complementary. We additionally discuss broader implications for the
links among stress, emotion regulation, and health, as well as key issues for future
research at the intersection of social and clinical psychology, medicine, and public
health.

INTRODUCTION
Decades of research have shown that the experience of chronic or unusually
high levels of stress leads to deleterious mental and physical health outcomes (McEwen & Steller, 1993). Despite these well-known negative effects of
stress, some basic questions remain about the relationship between stress and
health. For example, how can we prevent or alleviate stress’ negative effects?
In addition, why do some people exhibit resilience, defined as maintained or
even improved health in the wake of stress?
Stress can be conceptualized as a number of different phenomena, including daily hassles, chronic stress, and stressful life events (SLEs), each of
which can affect health differently. We focus here on SLEs because: (i) they
are common; (ii) they can have detrimental effects on mental and physical
health; and (iii) they frequently have a distinct onset and duration (Kendler,
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Karkowski, & Prescott, 1999). SLEs are defined as unexpected, significant,
and negative events (Tennant, 2002). Given that SLEs give rise to an array
of negative emotional experiences, promising answers to questions about
resilience lie in research on how people manage their emotions, or, emotion
regulation. Although emotions can serve important functions such as facilitating interpersonal interactions and signaling need for action to be taken
(Keltner & Gross, 1999), excessive negative emotions, in particular, may
be implicated in many of the ill effects of SLEs (Feldman, Cohen, Lepore,
Matthews, Kamarck, & Marsland, 1999). Thus, there may be no greater need
for emotion regulation than in the face of SLEs when negative emotions
run high.
Broadly, the aim of this essay is to present a model whereby emotion regulation breaks the link between SLEs and negative outcomes by modulating
the experience of negative emotions, a key mechanism in the relationship
between SLEs and poor health outcomes. Specifically, this review will focus
on emerging empirical evidence that suggests that two seemingly opposite
emotion regulation strategies, cognitive reappraisal and emotional acceptance, are particularly effective for mitigating the negative effects of SLEs.
By integrating theory with extant empirical evidence, we offer a model that
aims to reconcile how these two strategies—one that involves minimizing
emotions (cognitive reappraisal), and the other that involves engaging with
emotions (emotional acceptance)—are both associated with resilience. We
additionally discuss broader implications for the links among stress, emotion regulation, and health, as well as key issues for future research at the
intersection of social and clinical psychology, medicine, and public health.
FOUNDATIONAL RESEARCH
STRESS
We are all bound to encounter SLEs over a lifetime—from major events such
as the death of a loved one or divorce to more minor events such as interpersonal conflicts. SLEs are not only ubiquitous and unpleasant; they also
cause a wide range of potentially debilitating mental and physical health outcomes including: anxiety (Finlay-Jones & Brown, 1981), depression (Kendler
et al., 1999), obesity (Torres & Nowson, 2007), hypertension (Spruill, 2010),
and infectious diseases (Leserman et al., 2000). Despite the alarming negative effects of SLEs, exposure to SLEs does not always lead to poor health
outcomes. In fact, recent evidence suggests that a considerable number of
individuals exhibit minimal (if any) disruption in normal functioning in the
face of SLEs (Bonanno, Brewin, Kaniasty, & La Greca, 2010), a phenomenon

Regulation of Emotions Under Stress

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that is referred to as resilience. Understanding the factors that govern individual variance in outcomes after exposure to SLEs is important for developing
interventions and prevention programs that foster resilience.
What factors, then, predict resilience? Several lines of research suggest that
the answer to this question lies in the fact that SLEs give rise to negative
emotions (Lazarus, 1999), which in turn contribute to mental and physical
illness (Kendler et al., 1999; Tosevski & Milovancevic, 2006). For this reason,
people’s ability to regulate emotions may be a critically important factor in
determining resilience. Below, we summarize relevant literatures to support
this thesis. We highlight two emotion regulation strategies, cognitive reappraisal and emotional acceptance, which hold particular promise for conferring resilience.
EMOTION REGULATION
Emotion regulation refers to “shaping which emotions one has, when one has
them, and how one experiences or expresses these emotions” (Gross, 2014,
p. 6). Thus, any strategy that involves the goal of modifying of one’s experience of emotion is considered emotion regulation.
Cognitive Reappraisal. Cognitive reappraisal, henceforth referred to as reappraisal, is defined as reframing an emotional event in order to modulate one’s
experience of negative or positive emotion (Gross, 1998). For example, in the
case of job loss, an individual may perceive the event as a threat to their
self-esteem and financial stability, or it could be perceived as an opportunity
to transition into a better position. Given that one’s subjective evaluation of
a stimulus (“appraisal”) is key to the generation of emotion (Lazarus & Folkman, 1984), reappraisal, which operates directly on appraisals, should play a
primary role in modifying negative emotions.
Several lines of evidence support that reappraisal can lead to the experience
of less negative emotion. First, cross-sectional studies have demonstrated
that individuals who report frequently using reappraisal tend to experience
less negative emotion (Gross and John, 2003). Second, support for the role of
reappraisal in the context of stress comes from laboratory studies that have
shown that individuals who report frequently using reappraisal experience
more positive and fewer negative emotions in response to a laboratory stress
induction (Mauss, Cook, Cheng, & Gross, 2007) and in response to daily
stressors (Folkman & Moskowitz, 2004; Shiota, 2006). Finally, experimental
studies demonstrate a causal link between reappraisal and decreased negative emotion. For example, studies that instruct individuals to use reappraisal
during laboratory stress contexts have shown that it leads to a more favorable

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

physiological response and less negative emotion than other experimental
groups (Gross, 1998; Ray, McRae, Ochsner, & Gross, 2010).
These studies suggest that reappraisal is associated with the experience
of less negative emotion. However, does reappraisal confer resilience (e.g.,
protect individuals from experiencing negative health outcomes) in the
wake of stress? Several lines of recent research suggest that it does. First,
cross-sectional and longitudinal studies have demonstrated a consistent
and robust correlation between self-reported use of reappraisal and better
psychological and physical health in highly stressed samples (Moskowitz,
Hult, Bussolari, & Acree, 2009; Pakenham, 2005). Causal evidence for the
role of reappraisal in resilience comes from a longitudinal and experimental
investigation by Carrico, Antoni, Weaver, Lechner, and Schneiderman
(2005). They found that a cognitive behavioral intervention (compared to a
control condition) decreased depressive symptoms in highly stressed males
with HIV, and that reappraisal was the active ingredient that led to these
salutary outcomes.
A recent study by Troy, Wilhelm, Shallcross, and Mauss (2010) builds on
these findings by addressing three key limitations of previous research. First,
the authors recruited individuals who had recently experienced a range of
SLEs (e.g., divorce and job loss), thus promoting understanding about how
reappraisal operates on heterogeneous SLEs (e.g., varied type and intensity).
Second, they used a novel laboratory to assess individuals’ ability to use reappraisal during a sad film clip, thus distinguishing the construct of ability to
use reappraisal from self-reported frequency of its use. Third, they measured
reappraisal ability using self-report assessments as well as objective physiological indices, which are not confounded by self-report biases. Results indicated that at high levels of stress, individuals who were high in reappraisal
ability (whether indexed by self-reports or physiological indices) exhibited
lower levels of depressive symptoms than individuals who were low in reappraisal ability. Essentially then, individuals who were high in reappraisal
ability were protected from experiencing depression in the wake of SLEs.
Taken together, these studies suggest that reappraisal confers benefits to
those who use it in the wake of SLEs. Specifically, reappraisal allows people
to modify their emotional responding (i.e., to experience attenuated negative
emotions and/or increased positive emotions), which is, in turn, associated
with resilience. The role of reappraisal in resilience is depicted in Pathway A
in the model in Figure 1.
Emotional Acceptance. Curiously, a parallel line of research suggests that a
different and seemingly opposite strategy known as emotional acceptance also
confers resilience. Acceptance, defined as attending to and nonjudgmentally

Regulation of Emotions Under Stress

Acceptance

Reappraisal

5

A

B

C

Resilience
to stressful
life events
(SLEs)

Acceptance + Reappraisal

Figure 1 Proposed model of resilience in the wake of stressful life events (SLEs).
Each of the pathways in the model is indicated by a letter (A–C). The links are
described in detail in the text.

engaging with negative emotions (Segal, Williams, & Teasdale, 2002), has
been shown in numerous studies to be inversely associated with the experience of negative emotions.
For example, correlational studies on young adults have shown that individuals high in self-reported trait acceptance experienced fewer symptoms
of physiological arousal and negative emotions during an acute state of stress
induced by a carbon dioxide (CO2 ) challenge (Feldner, Zvolensky, Eifert, &
Spira, 2003; Karekla, Forsyth, & Kelly, 2004) and after viewing a negative film
clip (Shallcross, Troy, Boland, & Mauss, 2010). In a heterogeneous community
sample, Shallcross, Ford, Floerke, and Mauss (2013) additionally found that
trait acceptance was correlated with decreased negative emotion, indexed
via trait measures, daily diary assessments, and experiential reactivity to a
laboratory stress induction.
Causal evidence supporting the correlational results above comes from two
experimental studies. For example, participants instructed to “experience
[their] feelings fully and to not try to control or change them in any way”
experienced fewer negative emotions after viewing an anxiety provoking
film (Campbell-Sills, Barlow, Brown, & Hofmann, 2006) and lower heart
rate after delivering an impromptu speech (Hofmann, Heering, Sawyer,
& Asnaani, 2009) compared to participants instructed to suppress their
feelings.
Despite this compelling evidence, the relationship between acceptance
and decreased negative emotion may appear puzzling at first glance: How
is a strategy that involves engaging with negative emotions associated with the
experience of less negative emotion? Acceptance is thought to decrease negative
affect via two related processes: (i) presenting opportunities to acknowledge
and understand negative emotions, which promotes self-compassion as
well as psychological and behavioral flexibility (Hayes & Wilson, 2003;
Kashdan, Barrios, Forsyth, & Steger, 2006) and (ii) reducing rumination
and meta-emotions, defined as emotional reactions to one’s own emotions

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

(Segal et al., 2002; Simons & Gaher, 2005). Although engaging with negative
emotions may increase one’s experience of these emotions in the initial
stages (Campbell-Sills et al., 2006; Hofmann et al., 2009), approaching negative emotions in a nonevaluative way may diffuse these emotions relatively
quickly (Campbell-Sills et al., 2006) via the mechanisms described above,
and ultimately lead to less “net” negative emotion (Segal et al., 2002).
Thus, acceptance appears to reduce individuals’ experience of negative
emotion. Does acceptance confer resilience? A longitudinal study by Shallcross and colleagues (2010) offers evidence in support of the notion that
acceptance may break the link between SLEs and negative outcomes. Results
from this study indicated that participants high in trait acceptance and who
had recently experienced an SLE were buffered from experiencing elevated
depressive symptoms at a 4-month follow up assessment.
Causal support for acceptance as a strategy that confers longer-term
resilience is evidenced by randomized controlled trials that assign participants with elevated psychopathology to interventions involving acceptance
(e.g., acceptance and commitment therapy and mindfulness-based cognitive
therapy). These studies suggest that acceptance-based interventions contribute to improvements in psychological health in individuals at greatest
risk for experiencing the deleterious effects of SLEs (Ma & Teasdale, 2004;
Twohig, Hayes, Plumb, Pruitt, Collins, Hazlett-Stevens, & Woidneck, 2010).
Overall, correlational, experimental, and intervention studies suggest a
robust—and perhaps causal—association between acceptance and reductions in negative emotions and point to acceptance as a strategy that confers
resilience in the wake of stress. The role of acceptance in resilience is depicted
in Pathway B in the model in Figure 1.
REAPPRAISAL AND ACCEPTANCE—CONTRADICTORY OR COMPLEMENTARY STRATEGIES?
The research on emotion regulation and resilience suggests that on the one
hand, reappraisal, a process that involves minimizing negative emotions is
related to resilience. On the other hand, acceptance, a process that involves
engaging with negative emotions, is related to resilience as well. How can
both be true? Several considerations support the idea that these strategies,
although seemingly opposites, can work in complement to one another.
More specifically, acceptance, when used before reappraisal, might facilitate reappraisal’s success. Acceptance involves two sub-processes, attention
to one’s present state and nonjudgment, each of which may facilitate successful reappraisal. First, attending to one’s present state leads to broadened
awareness of a wide range of stimuli (e.g., thoughts, feelings, and physical sensations). It may be easier for individuals to successfully reinterpret
their thoughts if they are first aware of what they are thinking and feeling.

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Thus, the heightened attention to one’s present experience that is inherent in
acceptance may help catalyze successful reappraisal. Second, nonjudgment is
characterized by appraising one’s emotions (including negative ones) as nonthreatening experiences that are passing events rather than reflections of permanent reality (Hayes & Wilson, 2003). This nonjudgmental appraisal, often
referred to as decentered or metacognitive, promotes three processes thought
to facilitate reappraisal (Garland, Gaylord, & Park, 2009; Malooly, Genet, &
Siemer, 2013): (i) the ability to disengage from negative thoughts and feelings; (ii) broadened attention to the event that led to the emotions; and (iii)
reinterpretation of the event.
Two models converge on the idea that acceptance, when utilized before
reappraisal, may enhance reappraisal’s success. First, Garland and colleagues’ mindful coping model (2009) suggests that mindfulness, which
is defined as nonjudgmental awareness of present moment experiences
and thus overlaps with acceptance (Hayes & Wilson, 2003) may catalyze
successful reappraisal. This model indicates that mindfulness may promote
decentering and cognitive flexibility, which, in turn, may help promote
reappraisal.
Second, Sheppes and Gross’ process-specific timing model (2011) suggests
that: (i) reappraisal can be difficult to achieve because it is associated with
a cognitive burden that may diminish its success when used in intensely
emotional situations and (ii) emotion regulatory processes that decrease
negative emotion, require minimal cognitive resources, and are used before
reappraisal may reduce this burden, thus enhancing reappraisal’s success
(Sheppes & Gross, 2011; Thiruchselvam, Blechert, Sheppes, Rydstrom, &
Gross, 2011) Acceptance, which reduces negative emotions (Shallcross et al.,
2010), has been shown to be unrelated to working memory in correlational
studies (Schloss and Haaga, 2011), and is associated with a lower cognitive
burden than reappraisal in experimental studies (Keng, Robins, Smoski,
Dagenbach, & Leary, 2013), may be the ideal emotion regulatory precursor
that can enhance the effects of reappraisal.
In sum, then, rather than being irreconcilable opposites, acceptance may be
a complementary strategy to reappraisal that when used before it may augment reappraisal’s success and lead to greater resilience than when either of
these strategies is used in isolation. This is illustrated in Figure 1 (Pathway
C) by the thickest directional arrow stemming from the combination of the
two strategies in Figure 1. Specifically, Pathway C proposes that the greatest
resilience is conferred when acceptance is used before reappraisal because
processes such as attention and nonjudgment, which are intrinsic to acceptance, may help facilitate successful reappraisal.
Empirical support for the idea that acceptance may facilitate reappraisal
comes from three lines of evidence from the literature on mindfulness. First,

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Troy, Shallcross, and Mauss (2013) found that individuals with a history
of mindfulness therapy demonstrated higher reappraisal ability in the
context of a laboratory reappraisal task, compared to individuals with a
history of Cognitive Behavioral Therapy and a no-therapy control group.
These results support that mindfulness treatments, in particular, may lay
the foundation for enhanced reappraisal ability. Second, Garland, Hanley,
Farb, and Froeliger (2013) found that: (i) individuals randomized to a brief
mindfulness meditation induction experienced greater state mindfulness
(assessed immediately after the induction) compared to a thought suppression and mind wandering condition and (ii) state mindfulness was
prospectively associated with increases in self-reported reappraisal 1 week
later. Finally, a neuroimaging study showed that self-reported dispositional
mindfulness was associated with activity in neural regions elicited during
a functional magnetic resonance imaging task whereby participants were
asked to reappraise negative stimuli (Modinos, Ormel, & Aleman, 2010).
This study suggests that individual differences in the tendency to be mindful
may help support cortical regions involved in reappraisal.
It is important to note that while mindfulness encompasses emotional
acceptance, it is not identical because it also operates on nonemotional
stimuli (e.g., awareness of the breath) and behavior (e.g., acting with awareness). Therefore, while this evidence is broadly consistent with the idea that
acceptance facilitates reappraisal, more research is needed that specifically
measures and manipulates acceptance and its effects on reappraisal.
Two important points should be noted about the model. First, we and others
conceptualize reappraisal and acceptance as distinct and independent strategies. Thus, although acceptance may facilitate successful reappraisal, reappraisal does not depend on acceptance and acceptance does not necessarily
lead to reappraisal. Second, it is possible that reappraisal, when used before
acceptance, may also confer greater resilience than when either strategy is
used in isolation. However, an explanation for how this may be the case is
less clear. The theoretical considerations and empirical evidence above favor
that acceptance may help lay the groundwork for successful reappraisal (thus
leading to greater resilience) rather than the other way around.
In sum, theoretical considerations and preliminary studies support the
model in Figure 1, which: (i) includes acceptance and reappraisal as central
emotion strategies that lead to resilience; (ii) accommodates findings from
the literature that indicate that each of these are separable strategies that
are beneficial in their own right (Pathways A and B); and (iii) reconciles
how reappraisal and acceptance, seemingly opposite strategies, may be
used synergistically to confer resilience (Pathway C). While the evidence in
support of Pathways A and B is relatively strong, evidence in support of
Pathway C is more tenuous.

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KEY ISSUES FOR FUTURE RESEARCH
In this entry, we have reviewed studies that suggest that reappraisal and
acceptance are effective emotion regulatory strategies that individuals can
rely on in the face of SLEs. We have additionally proposed a theoretically
and empirically supported model aimed at reconciling how these seemingly
opposite strategies both promote resilience, and how acceptance might
facilitate reappraisal. Although the extant literature and model we present
hold promise for understanding emotion regulation and resilience, work is
needed to: (i) develop the specific concepts articulated in this entry and (ii)
promote the translation of the proposed model into clinical medicine and
public health.
Two areas of investigation appear to be logical next steps toward advancing
the ideas discussed above. First, although Pathway C in the proposed model
has the potential for enhancing our understanding of how these two emotion
regulation strategies could be used synergistically to enhance resilience, this
pathway has not been empirically tested. Future investigations where reappraisal and acceptance are experimentally manipulated in the same study
would advance our understanding of how these strategies may interact with
one another in shaping risk and resilience.
Second, studies are needed that investigate contextual factors that might
influence the effects of reappraisal and acceptance, used in combination
or independently. For example, are there certain individual differences
or circumstances that affect for whom and when these strategies are
particularly effective? Several recent studies have begun to address this
important question of context. For example, some investigations indicate
that diagnosis of psychopathology (Arch & Ayers, 2013; Vilardaga, Hayes,
Atkins, Bresee, & Kambiz, 2013); the intensity of negative emotions (Aldao
& Nolen-Hoeksema, 2012; Sheppes & Gross, 2011); and types of stress (e.g.,
controllable vs uncontrollable) (Troy et al., 2013) moderate the effects of emotion regulation on outcomes (see Aldao, 2013 for review). In other words,
reappraisal and acceptance may not be universally adaptive; it may be the
context in which these strategies are used that predicts whether they lead
to resilience. Collectively, these studies support an initiative backed by The
National Institute of Mental Health, which calls for advancing personalized
medicine (PM). PM is an innovative approach to health care that aims to
identify the conditions under which behavioral health interventions are
most effective. Thus, basic science investigations that examine the contexts in
which emotion regulation strategies are effective, ineffective, or potentially
harmful are at the forefront of informing ways to maximize the effectiveness
of clinical interventions aimed at imparting emotion regulation skills.

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Finally, work is needed to integrate theoretical frameworks across relevant
fields to promote a translational and nonreductionist model of resilience. For
example, stress and coping researchers in the field of health psychology have
examined a number of constructs (e.g., emotion-focused coping) that overlap
with key concepts applied by emotion regulation researchers in the fields of
personality and social psychology (Folkman & Moskowitz, 2004). However,
owing, in part, to differences in methodological approaches and conceptualizations of stress and emotion (John & Eng, 2014), there has been surprisingly
little cross-talk between these fields. Bridging related but currently disparate
theoretical frameworks within and across the fields of psychology, medicine,
and public health will help synthesize converging perspectives, approaches,
and evidence supporting the link between stress and health.
We have attempted to integrate various theoretical frameworks from the
fields of social, cognitive, and clinical psychology to inform our model of
resilience. Broadly, this model could be used as a platform upon which three
different types of interdisciplinary collaborations may be launched, each of
which hold promise for translating basic science into effective clinical interventions. First, collaborations between social psychologists, who can test
active ingredients (e.g., emotion regulation), and clinical psychologists, who
can implement interventions and test reductions in psychopathology, would
be helpful to advance innovative interventions, with known mechanisms of
action, for stress-related mental and physical disorders.
Second, because standard of care protocols for physical disease infrequently include psychological treatments, research collaborations between
psychologists and health care practitioners may help promote the use
of emotion-regulation-based interventions for patients suffering from
stress-related conditions.
Finally, collaborations between psychologists and public health experts
who can facilitate population-level interventions aimed at improving
emotion regulation may help alleviate stress-related suffering on a wide
scale. Examples of such interventions may include: (i) harnessing smart
phone technologies (e.g., apps) to develop programs that promote basic
emotion regulation skills (e.g., awareness) by prompting users to identify
and label their emotional experiences throughout the day; (ii) large-scale
campaigns that promote stress education and behavioral modification, such
as relaxation techniques, to captive audiences (e.g., public transit users).
In sum, future investigations should focus on integrating converging theoretical frameworks that support a nonreductionist model of human functioning. This approach holds promise for translating basic science into clinical
and population-level interventions aimed at promoting resilience in the wake
of SLEs.

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an anger provocation. International Journal of Psychophysiology, 66(2), 116–124.
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Cognitive-Behavior Therapy, 29(1), 53–63. doi:10.1007/s10942-011-0127-3
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive
therapy for depression—A new approach to preventing relapse. New York, NY: Guilford
Press.
Shallcross, A. J., Ford, B. Q., Floerke, V. A., & Mauss, I. B. (2013). Getting better with
age: The relationship between age, acceptance, and negative affect. Journal of Personality and Social Psychology, 104(4), 734. doi:10.1037/a0034225
Shallcross, A. J., Troy, A. S., Boland, M., & Mauss, I. B. (2010). Let it be: Accepting
negative emotional experiences predicts decreased negative affect and depressive symptoms. Behaviour Research and Therapy, 48(9), 921–929. doi:10.1016/j.brat.
2010.05.025
Sheppes, G., & Gross, J. J. (2011). Is timing everything? Temporal considerations
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Spruill, T. M. (2010). Chronic psychosocial stress and hypertension. Current Hypertension Reports, 12(1), 10–16. doi:10.1007/s11906-009-0084-8
Tennant, C. (2002). Life events, stress and depression: A review of recent findings.
Australian and New Zealand Journal of Psychiatry, 36(2), 173–182. doi:10.1046/j.14401614.2002.01007.x

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Thiruchselvam, R., Blechert, J., Sheppes, G., Rydstrom, A., & Gross, J. J. (2011). The
temporal dynamics of emotion regulation: An EEG study of distraction and reappraisal. Biological Psychology, 87(1), 84–92. doi:10.1016/j.biopsycho.2011.02.009
Torres, S. J., & Nowson, C. A. (2007). Relationship between stress, eating behavior,
and obesity. Nutrition, 23(11), 887–894. doi:10.1016/j.nut.2007.08.008
Tosevski, D. L., & Milovancevic, M. P. (2006). Stressful life events and physical health.
Current Opinion in Psychiatry, 19(2), 184–189. doi:10.1097/01.yco.0000214346.
44625.57
Troy, A. S., Shallcross, A. J., & Mauss, I. B. (2013). A person-by-situation approach to
emotion regulation cognitive reappraisal can either help or hurt, depending on the
context. Psychological Science, 24(12), 2505–2514. doi:10.1177/0956797613496434
Troy, A. S., Wilhelm, F. H., Shallcross, A. J., & Mauss, I. B. (2010). Seeing the silver
lining: Cognitive reappraisal ability moderates the relationship between stress and
depressive symptoms. Emotion, 10(6), 783. doi:10.1037/a0020262
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., HazlettStevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for
obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5),
705. doi:10.1037/a0020508
Vilardaga, R., Hayes, S. C., Atkins, D. C., Bresee, C., & Kambiz, A. (2013). Comparing experiential acceptance and cognitive reappraisal as predictors of functional
outcome in individuals with serious mental illness. Behaviour Research and Therapy,
51(8), 425–433. doi:10.1016/j.brat.2013.04.003

FURTHER READING
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological
Science, 8(6), 591–612. doi:10.1177/1745691613504116
Garland, E. L., Gaylord, S. A., & Fredrickson, B. L. (2011). Positive reappraisal mediates the stress-reductive effects of mindfulness: An upward spiral process. Mindfulness, 2(1), 59–67. doi:10.1007/s12671-011-0043-8
Garnefski, N., & Kraaij, V. (2006). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific
samples. Personality and Individual Differences, 40(8), 1659–1669. doi:10.1016/j.paid.
2005.12.009
Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007). Automatic emotion regulation.
Social and Personality Psychology Compass, 1(1), 146–167. doi:10.1111/j.1751-9004.
2007.00005.x
Park, C. L., Folkman, S., & Bostrom, A. (2001). Appraisals of controllability and coping in caregivers and HIV + men: Testing the goodness-of-fit hypothesis. Journal of
Consulting and Clinical Psychology, 69(3), 481. doi:10.1037/0022-006X.69.3.481

Regulation of Emotions Under Stress

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AMANDA J. SHALLCROSS SHORT BIOGRAPHY
Amanda J. Shallcross is a board-certified naturopathic physician and
postdoctoral research fellow in the Department of Population Health at
New York University, School of Medicine. Her research focuses on translating basic affective and psychophysiological science into clinical behavioral
medicine and developing a scientific model for the use of mindfulness-based
interventions in treating mental and physical illness. She recently completed
a 3-year postdoctoral National Research Service Award from NIH, in which
she conducted a randomized controlled trial that examined the effects and
mechanisms of mindfulness-based cognitive therapy for depression. She
uses multiple methods in her research including laboratory tasks, experience
sampling, behavioral coding, and autonomic nervous system responding.
Webpage: http://pophealth.med.nyu.edu/divisions/chbc/faculty-staff/
trainees
ALLISON TROY SHORT BIOGRAPHY
Allison Troy is an Assistant Professor of Psychology at Franklin & Marshall College (F&M). She received her PhD in Affect/Social Psychology
from the University of Denver. Her research examines the role of emotion
regulation in response to stress. Her past work has focused specifically on
the relationship among cognitive reappraisal ability, stress, and resilience.
More recently she has become interested in examining how the effects of
cognitive reappraisal may vary depending the type of stressful context
one encounters (for example, controllable vs uncontrollable stressors). In
collaboration with Drs. Shallcross and Mauss, she is currently investigating
the interplay between cognitive reappraisal and acceptance in negative
emotional contexts. She teaches courses in personality and emotion at F&M.
Webpage: http://www.fandm.edu/allison-troy
IRIS B. MAUSS SHORT BIOGRAPHY
Iris B. Mauss is the Director of the Emotion & Emotion Regulation Lab at
Berkeley and an Associate Professor in the social and personality psychology area in the Department of Psychology at the University of California,
Berkeley. After completing her undergraduate degrees at the Universities of
Trier and Dusseldorf in Germany, she received her PhD from the Department of Psychology at Stanford University. Her research focuses on emotions
and emotion regulation, with an emphasis on their links to psychological
health. In her research, she uses measures of emotion experience, behavior,
and physiological responding, and combines laboratory, daily-diary, and longitudinal survey approaches.
Webpage: http://www.ocf.berkeley.edu/∼eerlab/

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Regulation of Emotions Under Stress
AMANDA J. SHALLCROSS, ALLISON TROY, and IRIS B. MAUSS

Abstract
Stressful life events (SLEs) are frequently associated with a range of deleterious
mental and physical health outcomes. However, some individuals exhibit resilience,
defined as maintained or even improved health in the wake of SLEs. How and why
might this be the case? Given that SLEs give rise to negative emotions, which in turn
contribute to mental and physical illness, promising answers to questions about
resilience lie in research on people’s ability to manage their emotions, or, emotion
regulation. This essay focuses on emerging empirical evidence that suggests that
two seemingly opposite emotion regulation strategies, cognitive reappraisal and
emotional acceptance, are particularly effective for managing negative emotions,
which, in turn, may confer resilience. By integrating theory with extant empirical
evidence, we offer a model that aims to reconcile how these two strategies—one
that involves minimizing emotions (cognitive reappraisal) and the other that
involves engaging with emotions (emotional acceptance)—are each associated
with resilience. Specifically, we propose that these strategies are not contradictory,
but rather complementary. We additionally discuss broader implications for the
links among stress, emotion regulation, and health, as well as key issues for future
research at the intersection of social and clinical psychology, medicine, and public
health.

INTRODUCTION
Decades of research have shown that the experience of chronic or unusually
high levels of stress leads to deleterious mental and physical health outcomes (McEwen & Steller, 1993). Despite these well-known negative effects of
stress, some basic questions remain about the relationship between stress and
health. For example, how can we prevent or alleviate stress’ negative effects?
In addition, why do some people exhibit resilience, defined as maintained or
even improved health in the wake of stress?
Stress can be conceptualized as a number of different phenomena, including daily hassles, chronic stress, and stressful life events (SLEs), each of
which can affect health differently. We focus here on SLEs because: (i) they
are common; (ii) they can have detrimental effects on mental and physical
health; and (iii) they frequently have a distinct onset and duration (Kendler,
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Karkowski, & Prescott, 1999). SLEs are defined as unexpected, significant,
and negative events (Tennant, 2002). Given that SLEs give rise to an array
of negative emotional experiences, promising answers to questions about
resilience lie in research on how people manage their emotions, or, emotion
regulation. Although emotions can serve important functions such as facilitating interpersonal interactions and signaling need for action to be taken
(Keltner & Gross, 1999), excessive negative emotions, in particular, may
be implicated in many of the ill effects of SLEs (Feldman, Cohen, Lepore,
Matthews, Kamarck, & Marsland, 1999). Thus, there may be no greater need
for emotion regulation than in the face of SLEs when negative emotions
run high.
Broadly, the aim of this essay is to present a model whereby emotion regulation breaks the link between SLEs and negative outcomes by modulating
the experience of negative emotions, a key mechanism in the relationship
between SLEs and poor health outcomes. Specifically, this review will focus
on emerging empirical evidence that suggests that two seemingly opposite
emotion regulation strategies, cognitive reappraisal and emotional acceptance, are particularly effective for mitigating the negative effects of SLEs.
By integrating theory with extant empirical evidence, we offer a model that
aims to reconcile how these two strategies—one that involves minimizing
emotions (cognitive reappraisal), and the other that involves engaging with
emotions (emotional acceptance)—are both associated with resilience. We
additionally discuss broader implications for the links among stress, emotion regulation, and health, as well as key issues for future research at the
intersection of social and clinical psychology, medicine, and public health.
FOUNDATIONAL RESEARCH
STRESS
We are all bound to encounter SLEs over a lifetime—from major events such
as the death of a loved one or divorce to more minor events such as interpersonal conflicts. SLEs are not only ubiquitous and unpleasant; they also
cause a wide range of potentially debilitating mental and physical health outcomes including: anxiety (Finlay-Jones & Brown, 1981), depression (Kendler
et al., 1999), obesity (Torres & Nowson, 2007), hypertension (Spruill, 2010),
and infectious diseases (Leserman et al., 2000). Despite the alarming negative effects of SLEs, exposure to SLEs does not always lead to poor health
outcomes. In fact, recent evidence suggests that a considerable number of
individuals exhibit minimal (if any) disruption in normal functioning in the
face of SLEs (Bonanno, Brewin, Kaniasty, & La Greca, 2010), a phenomenon

Regulation of Emotions Under Stress

3

that is referred to as resilience. Understanding the factors that govern individual variance in outcomes after exposure to SLEs is important for developing
interventions and prevention programs that foster resilience.
What factors, then, predict resilience? Several lines of research suggest that
the answer to this question lies in the fact that SLEs give rise to negative
emotions (Lazarus, 1999), which in turn contribute to mental and physical
illness (Kendler et al., 1999; Tosevski & Milovancevic, 2006). For this reason,
people’s ability to regulate emotions may be a critically important factor in
determining resilience. Below, we summarize relevant literatures to support
this thesis. We highlight two emotion regulation strategies, cognitive reappraisal and emotional acceptance, which hold particular promise for conferring resilience.
EMOTION REGULATION
Emotion regulation refers to “shaping which emotions one has, when one has
them, and how one experiences or expresses these emotions” (Gross, 2014,
p. 6). Thus, any strategy that involves the goal of modifying of one’s experience of emotion is considered emotion regulation.
Cognitive Reappraisal. Cognitive reappraisal, henceforth referred to as reappraisal, is defined as reframing an emotional event in order to modulate one’s
experience of negative or positive emotion (Gross, 1998). For example, in the
case of job loss, an individual may perceive the event as a threat to their
self-esteem and financial stability, or it could be perceived as an opportunity
to transition into a better position. Given that one’s subjective evaluation of
a stimulus (“appraisal”) is key to the generation of emotion (Lazarus & Folkman, 1984), reappraisal, which operates directly on appraisals, should play a
primary role in modifying negative emotions.
Several lines of evidence support that reappraisal can lead to the experience
of less negative emotion. First, cross-sectional studies have demonstrated
that individuals who report frequently using reappraisal tend to experience
less negative emotion (Gross and John, 2003). Second, support for the role of
reappraisal in the context of stress comes from laboratory studies that have
shown that individuals who report frequently using reappraisal experience
more positive and fewer negative emotions in response to a laboratory stress
induction (Mauss, Cook, Cheng, & Gross, 2007) and in response to daily
stressors (Folkman & Moskowitz, 2004; Shiota, 2006). Finally, experimental
studies demonstrate a causal link between reappraisal and decreased negative emotion. For example, studies that instruct individuals to use reappraisal
during laboratory stress contexts have shown that it leads to a more favorable

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physiological response and less negative emotion than other experimental
groups (Gross, 1998; Ray, McRae, Ochsner, & Gross, 2010).
These studies suggest that reappraisal is associated with the experience
of less negative emotion. However, does reappraisal confer resilience (e.g.,
protect individuals from experiencing negative health outcomes) in the
wake of stress? Several lines of recent research suggest that it does. First,
cross-sectional and longitudinal studies have demonstrated a consistent
and robust correlation between self-reported use of reappraisal and better
psychological and physical health in highly stressed samples (Moskowitz,
Hult, Bussolari, & Acree, 2009; Pakenham, 2005). Causal evidence for the
role of reappraisal in resilience comes from a longitudinal and experimental
investigation by Carrico, Antoni, Weaver, Lechner, and Schneiderman
(2005). They found that a cognitive behavioral intervention (compared to a
control condition) decreased depressive symptoms in highly stressed males
with HIV, and that reappraisal was the active ingredient that led to these
salutary outcomes.
A recent study by Troy, Wilhelm, Shallcross, and Mauss (2010) builds on
these findings by addressing three key limitations of previous research. First,
the authors recruited individuals who had recently experienced a range of
SLEs (e.g., divorce and job loss), thus promoting understanding about how
reappraisal operates on heterogeneous SLEs (e.g., varied type and intensity).
Second, they used a novel laboratory to assess individuals’ ability to use reappraisal during a sad film clip, thus distinguishing the construct of ability to
use reappraisal from self-reported frequency of its use. Third, they measured
reappraisal ability using self-report assessments as well as objective physiological indices, which are not confounded by self-report biases. Results indicated that at high levels of stress, individuals who were high in reappraisal
ability (whether indexed by self-reports or physiological indices) exhibited
lower levels of depressive symptoms than individuals who were low in reappraisal ability. Essentially then, individuals who were high in reappraisal
ability were protected from experiencing depression in the wake of SLEs.
Taken together, these studies suggest that reappraisal confers benefits to
those who use it in the wake of SLEs. Specifically, reappraisal allows people
to modify their emotional responding (i.e., to experience attenuated negative
emotions and/or increased positive emotions), which is, in turn, associated
with resilience. The role of reappraisal in resilience is depicted in Pathway A
in the model in Figure 1.
Emotional Acceptance. Curiously, a parallel line of research suggests that a
different and seemingly opposite strategy known as emotional acceptance also
confers resilience. Acceptance, defined as attending to and nonjudgmentally

Regulation of Emotions Under Stress

Acceptance

Reappraisal

5

A

B

C

Resilience
to stressful
life events
(SLEs)

Acceptance + Reappraisal

Figure 1 Proposed model of resilience in the wake of stressful life events (SLEs).
Each of the pathways in the model is indicated by a letter (A–C). The links are
described in detail in the text.

engaging with negative emotions (Segal, Williams, & Teasdale, 2002), has
been shown in numerous studies to be inversely associated with the experience of negative emotions.
For example, correlational studies on young adults have shown that individuals high in self-reported trait acceptance experienced fewer symptoms
of physiological arousal and negative emotions during an acute state of stress
induced by a carbon dioxide (CO2 ) challenge (Feldner, Zvolensky, Eifert, &
Spira, 2003; Karekla, Forsyth, & Kelly, 2004) and after viewing a negative film
clip (Shallcross, Troy, Boland, & Mauss, 2010). In a heterogeneous community
sample, Shallcross, Ford, Floerke, and Mauss (2013) additionally found that
trait acceptance was correlated with decreased negative emotion, indexed
via trait measures, daily diary assessments, and experiential reactivity to a
laboratory stress induction.
Causal evidence supporting the correlational results above comes from two
experimental studies. For example, participants instructed to “experience
[their] feelings fully and to not try to control or change them in any way”
experienced fewer negative emotions after viewing an anxiety provoking
film (Campbell-Sills, Barlow, Brown, & Hofmann, 2006) and lower heart
rate after delivering an impromptu speech (Hofmann, Heering, Sawyer,
& Asnaani, 2009) compared to participants instructed to suppress their
feelings.
Despite this compelling evidence, the relationship between acceptance
and decreased negative emotion may appear puzzling at first glance: How
is a strategy that involves engaging with negative emotions associated with the
experience of less negative emotion? Acceptance is thought to decrease negative
affect via two related processes: (i) presenting opportunities to acknowledge
and understand negative emotions, which promotes self-compassion as
well as psychological and behavioral flexibility (Hayes & Wilson, 2003;
Kashdan, Barrios, Forsyth, & Steger, 2006) and (ii) reducing rumination
and meta-emotions, defined as emotional reactions to one’s own emotions

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

(Segal et al., 2002; Simons & Gaher, 2005). Although engaging with negative
emotions may increase one’s experience of these emotions in the initial
stages (Campbell-Sills et al., 2006; Hofmann et al., 2009), approaching negative emotions in a nonevaluative way may diffuse these emotions relatively
quickly (Campbell-Sills et al., 2006) via the mechanisms described above,
and ultimately lead to less “net” negative emotion (Segal et al., 2002).
Thus, acceptance appears to reduce individuals’ experience of negative
emotion. Does acceptance confer resilience? A longitudinal study by Shallcross and colleagues (2010) offers evidence in support of the notion that
acceptance may break the link between SLEs and negative outcomes. Results
from this study indicated that participants high in trait acceptance and who
had recently experienced an SLE were buffered from experiencing elevated
depressive symptoms at a 4-month follow up assessment.
Causal support for acceptance as a strategy that confers longer-term
resilience is evidenced by randomized controlled trials that assign participants with elevated psychopathology to interventions involving acceptance
(e.g., acceptance and commitment therapy and mindfulness-based cognitive
therapy). These studies suggest that acceptance-based interventions contribute to improvements in psychological health in individuals at greatest
risk for experiencing the deleterious effects of SLEs (Ma & Teasdale, 2004;
Twohig, Hayes, Plumb, Pruitt, Collins, Hazlett-Stevens, & Woidneck, 2010).
Overall, correlational, experimental, and intervention studies suggest a
robust—and perhaps causal—association between acceptance and reductions in negative emotions and point to acceptance as a strategy that confers
resilience in the wake of stress. The role of acceptance in resilience is depicted
in Pathway B in the model in Figure 1.
REAPPRAISAL AND ACCEPTANCE—CONTRADICTORY OR COMPLEMENTARY STRATEGIES?
The research on emotion regulation and resilience suggests that on the one
hand, reappraisal, a process that involves minimizing negative emotions is
related to resilience. On the other hand, acceptance, a process that involves
engaging with negative emotions, is related to resilience as well. How can
both be true? Several considerations support the idea that these strategies,
although seemingly opposites, can work in complement to one another.
More specifically, acceptance, when used before reappraisal, might facilitate reappraisal’s success. Acceptance involves two sub-processes, attention
to one’s present state and nonjudgment, each of which may facilitate successful reappraisal. First, attending to one’s present state leads to broadened
awareness of a wide range of stimuli (e.g., thoughts, feelings, and physical sensations). It may be easier for individuals to successfully reinterpret
their thoughts if they are first aware of what they are thinking and feeling.

Regulation of Emotions Under Stress

7

Thus, the heightened attention to one’s present experience that is inherent in
acceptance may help catalyze successful reappraisal. Second, nonjudgment is
characterized by appraising one’s emotions (including negative ones) as nonthreatening experiences that are passing events rather than reflections of permanent reality (Hayes & Wilson, 2003). This nonjudgmental appraisal, often
referred to as decentered or metacognitive, promotes three processes thought
to facilitate reappraisal (Garland, Gaylord, & Park, 2009; Malooly, Genet, &
Siemer, 2013): (i) the ability to disengage from negative thoughts and feelings; (ii) broadened attention to the event that led to the emotions; and (iii)
reinterpretation of the event.
Two models converge on the idea that acceptance, when utilized before
reappraisal, may enhance reappraisal’s success. First, Garland and colleagues’ mindful coping model (2009) suggests that mindfulness, which
is defined as nonjudgmental awareness of present moment experiences
and thus overlaps with acceptance (Hayes & Wilson, 2003) may catalyze
successful reappraisal. This model indicates that mindfulness may promote
decentering and cognitive flexibility, which, in turn, may help promote
reappraisal.
Second, Sheppes and Gross’ process-specific timing model (2011) suggests
that: (i) reappraisal can be difficult to achieve because it is associated with
a cognitive burden that may diminish its success when used in intensely
emotional situations and (ii) emotion regulatory processes that decrease
negative emotion, require minimal cognitive resources, and are used before
reappraisal may reduce this burden, thus enhancing reappraisal’s success
(Sheppes & Gross, 2011; Thiruchselvam, Blechert, Sheppes, Rydstrom, &
Gross, 2011) Acceptance, which reduces negative emotions (Shallcross et al.,
2010), has been shown to be unrelated to working memory in correlational
studies (Schloss and Haaga, 2011), and is associated with a lower cognitive
burden than reappraisal in experimental studies (Keng, Robins, Smoski,
Dagenbach, & Leary, 2013), may be the ideal emotion regulatory precursor
that can enhance the effects of reappraisal.
In sum, then, rather than being irreconcilable opposites, acceptance may be
a complementary strategy to reappraisal that when used before it may augment reappraisal’s success and lead to greater resilience than when either of
these strategies is used in isolation. This is illustrated in Figure 1 (Pathway
C) by the thickest directional arrow stemming from the combination of the
two strategies in Figure 1. Specifically, Pathway C proposes that the greatest
resilience is conferred when acceptance is used before reappraisal because
processes such as attention and nonjudgment, which are intrinsic to acceptance, may help facilitate successful reappraisal.
Empirical support for the idea that acceptance may facilitate reappraisal
comes from three lines of evidence from the literature on mindfulness. First,

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Troy, Shallcross, and Mauss (2013) found that individuals with a history
of mindfulness therapy demonstrated higher reappraisal ability in the
context of a laboratory reappraisal task, compared to individuals with a
history of Cognitive Behavioral Therapy and a no-therapy control group.
These results support that mindfulness treatments, in particular, may lay
the foundation for enhanced reappraisal ability. Second, Garland, Hanley,
Farb, and Froeliger (2013) found that: (i) individuals randomized to a brief
mindfulness meditation induction experienced greater state mindfulness
(assessed immediately after the induction) compared to a thought suppression and mind wandering condition and (ii) state mindfulness was
prospectively associated with increases in self-reported reappraisal 1 week
later. Finally, a neuroimaging study showed that self-reported dispositional
mindfulness was associated with activity in neural regions elicited during
a functional magnetic resonance imaging task whereby participants were
asked to reappraise negative stimuli (Modinos, Ormel, & Aleman, 2010).
This study suggests that individual differences in the tendency to be mindful
may help support cortical regions involved in reappraisal.
It is important to note that while mindfulness encompasses emotional
acceptance, it is not identical because it also operates on nonemotional
stimuli (e.g., awareness of the breath) and behavior (e.g., acting with awareness). Therefore, while this evidence is broadly consistent with the idea that
acceptance facilitates reappraisal, more research is needed that specifically
measures and manipulates acceptance and its effects on reappraisal.
Two important points should be noted about the model. First, we and others
conceptualize reappraisal and acceptance as distinct and independent strategies. Thus, although acceptance may facilitate successful reappraisal, reappraisal does not depend on acceptance and acceptance does not necessarily
lead to reappraisal. Second, it is possible that reappraisal, when used before
acceptance, may also confer greater resilience than when either strategy is
used in isolation. However, an explanation for how this may be the case is
less clear. The theoretical considerations and empirical evidence above favor
that acceptance may help lay the groundwork for successful reappraisal (thus
leading to greater resilience) rather than the other way around.
In sum, theoretical considerations and preliminary studies support the
model in Figure 1, which: (i) includes acceptance and reappraisal as central
emotion strategies that lead to resilience; (ii) accommodates findings from
the literature that indicate that each of these are separable strategies that
are beneficial in their own right (Pathways A and B); and (iii) reconciles
how reappraisal and acceptance, seemingly opposite strategies, may be
used synergistically to confer resilience (Pathway C). While the evidence in
support of Pathways A and B is relatively strong, evidence in support of
Pathway C is more tenuous.

Regulation of Emotions Under Stress

9

KEY ISSUES FOR FUTURE RESEARCH
In this entry, we have reviewed studies that suggest that reappraisal and
acceptance are effective emotion regulatory strategies that individuals can
rely on in the face of SLEs. We have additionally proposed a theoretically
and empirically supported model aimed at reconciling how these seemingly
opposite strategies both promote resilience, and how acceptance might
facilitate reappraisal. Although the extant literature and model we present
hold promise for understanding emotion regulation and resilience, work is
needed to: (i) develop the specific concepts articulated in this entry and (ii)
promote the translation of the proposed model into clinical medicine and
public health.
Two areas of investigation appear to be logical next steps toward advancing
the ideas discussed above. First, although Pathway C in the proposed model
has the potential for enhancing our understanding of how these two emotion
regulation strategies could be used synergistically to enhance resilience, this
pathway has not been empirically tested. Future investigations where reappraisal and acceptance are experimentally manipulated in the same study
would advance our understanding of how these strategies may interact with
one another in shaping risk and resilience.
Second, studies are needed that investigate contextual factors that might
influence the effects of reappraisal and acceptance, used in combination
or independently. For example, are there certain individual differences
or circumstances that affect for whom and when these strategies are
particularly effective? Several recent studies have begun to address this
important question of context. For example, some investigations indicate
that diagnosis of psychopathology (Arch & Ayers, 2013; Vilardaga, Hayes,
Atkins, Bresee, & Kambiz, 2013); the intensity of negative emotions (Aldao
& Nolen-Hoeksema, 2012; Sheppes & Gross, 2011); and types of stress (e.g.,
controllable vs uncontrollable) (Troy et al., 2013) moderate the effects of emotion regulation on outcomes (see Aldao, 2013 for review). In other words,
reappraisal and acceptance may not be universally adaptive; it may be the
context in which these strategies are used that predicts whether they lead
to resilience. Collectively, these studies support an initiative backed by The
National Institute of Mental Health, which calls for advancing personalized
medicine (PM). PM is an innovative approach to health care that aims to
identify the conditions under which behavioral health interventions are
most effective. Thus, basic science investigations that examine the contexts in
which emotion regulation strategies are effective, ineffective, or potentially
harmful are at the forefront of informing ways to maximize the effectiveness
of clinical interventions aimed at imparting emotion regulation skills.

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Finally, work is needed to integrate theoretical frameworks across relevant
fields to promote a translational and nonreductionist model of resilience. For
example, stress and coping researchers in the field of health psychology have
examined a number of constructs (e.g., emotion-focused coping) that overlap
with key concepts applied by emotion regulation researchers in the fields of
personality and social psychology (Folkman & Moskowitz, 2004). However,
owing, in part, to differences in methodological approaches and conceptualizations of stress and emotion (John & Eng, 2014), there has been surprisingly
little cross-talk between these fields. Bridging related but currently disparate
theoretical frameworks within and across the fields of psychology, medicine,
and public health will help synthesize converging perspectives, approaches,
and evidence supporting the link between stress and health.
We have attempted to integrate various theoretical frameworks from the
fields of social, cognitive, and clinical psychology to inform our model of
resilience. Broadly, this model could be used as a platform upon which three
different types of interdisciplinary collaborations may be launched, each of
which hold promise for translating basic science into effective clinical interventions. First, collaborations between social psychologists, who can test
active ingredients (e.g., emotion regulation), and clinical psychologists, who
can implement interventions and test reductions in psychopathology, would
be helpful to advance innovative interventions, with known mechanisms of
action, for stress-related mental and physical disorders.
Second, because standard of care protocols for physical disease infrequently include psychological treatments, research collaborations between
psychologists and health care practitioners may help promote the use
of emotion-regulation-based interventions for patients suffering from
stress-related conditions.
Finally, collaborations between psychologists and public health experts
who can facilitate population-level interventions aimed at improving
emotion regulation may help alleviate stress-related suffering on a wide
scale. Examples of such interventions may include: (i) harnessing smart
phone technologies (e.g., apps) to develop programs that promote basic
emotion regulation skills (e.g., awareness) by prompting users to identify
and label their emotional experiences throughout the day; (ii) large-scale
campaigns that promote stress education and behavioral modification, such
as relaxation techniques, to captive audiences (e.g., public transit users).
In sum, future investigations should focus on integrating converging theoretical frameworks that support a nonreductionist model of human functioning. This approach holds promise for translating basic science into clinical
and population-level interventions aimed at promoting resilience in the wake
of SLEs.

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11

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FURTHER READING
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological
Science, 8(6), 591–612. doi:10.1177/1745691613504116
Garland, E. L., Gaylord, S. A., & Fredrickson, B. L. (2011). Positive reappraisal mediates the stress-reductive effects of mindfulness: An upward spiral process. Mindfulness, 2(1), 59–67. doi:10.1007/s12671-011-0043-8
Garnefski, N., & Kraaij, V. (2006). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific
samples. Personality and Individual Differences, 40(8), 1659–1669. doi:10.1016/j.paid.
2005.12.009
Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007). Automatic emotion regulation.
Social and Personality Psychology Compass, 1(1), 146–167. doi:10.1111/j.1751-9004.
2007.00005.x
Park, C. L., Folkman, S., & Bostrom, A. (2001). Appraisals of controllability and coping in caregivers and HIV + men: Testing the goodness-of-fit hypothesis. Journal of
Consulting and Clinical Psychology, 69(3), 481. doi:10.1037/0022-006X.69.3.481

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AMANDA J. SHALLCROSS SHORT BIOGRAPHY
Amanda J. Shallcross is a board-certified naturopathic physician and
postdoctoral research fellow in the Department of Population Health at
New York University, School of Medicine. Her research focuses on translating basic affective and psychophysiological science into clinical behavioral
medicine and developing a scientific model for the use of mindfulness-based
interventions in treating mental and physical illness. She recently completed
a 3-year postdoctoral National Research Service Award from NIH, in which
she conducted a randomized controlled trial that examined the effects and
mechanisms of mindfulness-based cognitive therapy for depression. She
uses multiple methods in her research including laboratory tasks, experience
sampling, behavioral coding, and autonomic nervous system responding.
Webpage: http://pophealth.med.nyu.edu/divisions/chbc/faculty-staff/
trainees
ALLISON TROY SHORT BIOGRAPHY
Allison Troy is an Assistant Professor of Psychology at Franklin & Marshall College (F&M). She received her PhD in Affect/Social Psychology
from the University of Denver. Her research examines the role of emotion
regulation in response to stress. Her past work has focused specifically on
the relationship among cognitive reappraisal ability, stress, and resilience.
More recently she has become interested in examining how the effects of
cognitive reappraisal may vary depending the type of stressful context
one encounters (for example, controllable vs uncontrollable stressors). In
collaboration with Drs. Shallcross and Mauss, she is currently investigating
the interplay between cognitive reappraisal and acceptance in negative
emotional contexts. She teaches courses in personality and emotion at F&M.
Webpage: http://www.fandm.edu/allison-troy
IRIS B. MAUSS SHORT BIOGRAPHY
Iris B. Mauss is the Director of the Emotion & Emotion Regulation Lab at
Berkeley and an Associate Professor in the social and personality psychology area in the Department of Psychology at the University of California,
Berkeley. After completing her undergraduate degrees at the Universities of
Trier and Dusseldorf in Germany, she received her PhD from the Department of Psychology at Stanford University. Her research focuses on emotions
and emotion regulation, with an emphasis on their links to psychological
health. In her research, she uses measures of emotion experience, behavior,
and physiological responding, and combines laboratory, daily-diary, and longitudinal survey approaches.
Webpage: http://www.ocf.berkeley.edu/∼eerlab/

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The Neurobiology and Physiology of Emotions: A Developmental Perspective (Psychology), Sarah S. Kahle and Paul D. Hastings
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Regulation of Emotions Under Stress
AMANDA J. SHALLCROSS, ALLISON TROY, and IRIS B. MAUSS

Abstract
Stressful life events (SLEs) are frequently associated with a range of deleterious
mental and physical health outcomes. However, some individuals exhibit resilience,
defined as maintained or even improved health in the wake of SLEs. How and why
might this be the case? Given that SLEs give rise to negative emotions, which in turn
contribute to mental and physical illness, promising answers to questions about
resilience lie in research on people’s ability to manage their emotions, or, emotion
regulation. This essay focuses on emerging empirical evidence that suggests that
two seemingly opposite emotion regulation strategies, cognitive reappraisal and
emotional acceptance, are particularly effective for managing negative emotions,
which, in turn, may confer resilience. By integrating theory with extant empirical
evidence, we offer a model that aims to reconcile how these two strategies—one
that involves minimizing emotions (cognitive reappraisal) and the other that
involves engaging with emotions (emotional acceptance)—are each associated
with resilience. Specifically, we propose that these strategies are not contradictory,
but rather complementary. We additionally discuss broader implications for the
links among stress, emotion regulation, and health, as well as key issues for future
research at the intersection of social and clinical psychology, medicine, and public
health.

INTRODUCTION
Decades of research have shown that the experience of chronic or unusually
high levels of stress leads to deleterious mental and physical health outcomes (McEwen & Steller, 1993). Despite these well-known negative effects of
stress, some basic questions remain about the relationship between stress and
health. For example, how can we prevent or alleviate stress’ negative effects?
In addition, why do some people exhibit resilience, defined as maintained or
even improved health in the wake of stress?
Stress can be conceptualized as a number of different phenomena, including daily hassles, chronic stress, and stressful life events (SLEs), each of
which can affect health differently. We focus here on SLEs because: (i) they
are common; (ii) they can have detrimental effects on mental and physical
health; and (iii) they frequently have a distinct onset and duration (Kendler,
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.

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Karkowski, & Prescott, 1999). SLEs are defined as unexpected, significant,
and negative events (Tennant, 2002). Given that SLEs give rise to an array
of negative emotional experiences, promising answers to questions about
resilience lie in research on how people manage their emotions, or, emotion
regulation. Although emotions can serve important functions such as facilitating interpersonal interactions and signaling need for action to be taken
(Keltner & Gross, 1999), excessive negative emotions, in particular, may
be implicated in many of the ill effects of SLEs (Feldman, Cohen, Lepore,
Matthews, Kamarck, & Marsland, 1999). Thus, there may be no greater need
for emotion regulation than in the face of SLEs when negative emotions
run high.
Broadly, the aim of this essay is to present a model whereby emotion regulation breaks the link between SLEs and negative outcomes by modulating
the experience of negative emotions, a key mechanism in the relationship
between SLEs and poor health outcomes. Specifically, this review will focus
on emerging empirical evidence that suggests that two seemingly opposite
emotion regulation strategies, cognitive reappraisal and emotional acceptance, are particularly effective for mitigating the negative effects of SLEs.
By integrating theory with extant empirical evidence, we offer a model that
aims to reconcile how these two strategies—one that involves minimizing
emotions (cognitive reappraisal), and the other that involves engaging with
emotions (emotional acceptance)—are both associated with resilience. We
additionally discuss broader implications for the links among stress, emotion regulation, and health, as well as key issues for future research at the
intersection of social and clinical psychology, medicine, and public health.
FOUNDATIONAL RESEARCH
STRESS
We are all bound to encounter SLEs over a lifetime—from major events such
as the death of a loved one or divorce to more minor events such as interpersonal conflicts. SLEs are not only ubiquitous and unpleasant; they also
cause a wide range of potentially debilitating mental and physical health outcomes including: anxiety (Finlay-Jones & Brown, 1981), depression (Kendler
et al., 1999), obesity (Torres & Nowson, 2007), hypertension (Spruill, 2010),
and infectious diseases (Leserman et al., 2000). Despite the alarming negative effects of SLEs, exposure to SLEs does not always lead to poor health
outcomes. In fact, recent evidence suggests that a considerable number of
individuals exhibit minimal (if any) disruption in normal functioning in the
face of SLEs (Bonanno, Brewin, Kaniasty, & La Greca, 2010), a phenomenon

Regulation of Emotions Under Stress

3

that is referred to as resilience. Understanding the factors that govern individual variance in outcomes after exposure to SLEs is important for developing
interventions and prevention programs that foster resilience.
What factors, then, predict resilience? Several lines of research suggest that
the answer to this question lies in the fact that SLEs give rise to negative
emotions (Lazarus, 1999), which in turn contribute to mental and physical
illness (Kendler et al., 1999; Tosevski & Milovancevic, 2006). For this reason,
people’s ability to regulate emotions may be a critically important factor in
determining resilience. Below, we summarize relevant literatures to support
this thesis. We highlight two emotion regulation strategies, cognitive reappraisal and emotional acceptance, which hold particular promise for conferring resilience.
EMOTION REGULATION
Emotion regulation refers to “shaping which emotions one has, when one has
them, and how one experiences or expresses these emotions” (Gross, 2014,
p. 6). Thus, any strategy that involves the goal of modifying of one’s experience of emotion is considered emotion regulation.
Cognitive Reappraisal. Cognitive reappraisal, henceforth referred to as reappraisal, is defined as reframing an emotional event in order to modulate one’s
experience of negative or positive emotion (Gross, 1998). For example, in the
case of job loss, an individual may perceive the event as a threat to their
self-esteem and financial stability, or it could be perceived as an opportunity
to transition into a better position. Given that one’s subjective evaluation of
a stimulus (“appraisal”) is key to the generation of emotion (Lazarus & Folkman, 1984), reappraisal, which operates directly on appraisals, should play a
primary role in modifying negative emotions.
Several lines of evidence support that reappraisal can lead to the experience
of less negative emotion. First, cross-sectional studies have demonstrated
that individuals who report frequently using reappraisal tend to experience
less negative emotion (Gross and John, 2003). Second, support for the role of
reappraisal in the context of stress comes from laboratory studies that have
shown that individuals who report frequently using reappraisal experience
more positive and fewer negative emotions in response to a laboratory stress
induction (Mauss, Cook, Cheng, & Gross, 2007) and in response to daily
stressors (Folkman & Moskowitz, 2004; Shiota, 2006). Finally, experimental
studies demonstrate a causal link between reappraisal and decreased negative emotion. For example, studies that instruct individuals to use reappraisal
during laboratory stress contexts have shown that it leads to a more favorable

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

physiological response and less negative emotion than other experimental
groups (Gross, 1998; Ray, McRae, Ochsner, & Gross, 2010).
These studies suggest that reappraisal is associated with the experience
of less negative emotion. However, does reappraisal confer resilience (e.g.,
protect individuals from experiencing negative health outcomes) in the
wake of stress? Several lines of recent research suggest that it does. First,
cross-sectional and longitudinal studies have demonstrated a consistent
and robust correlation between self-reported use of reappraisal and better
psychological and physical health in highly stressed samples (Moskowitz,
Hult, Bussolari, & Acree, 2009; Pakenham, 2005). Causal evidence for the
role of reappraisal in resilience comes from a longitudinal and experimental
investigation by Carrico, Antoni, Weaver, Lechner, and Schneiderman
(2005). They found that a cognitive behavioral intervention (compared to a
control condition) decreased depressive symptoms in highly stressed males
with HIV, and that reappraisal was the active ingredient that led to these
salutary outcomes.
A recent study by Troy, Wilhelm, Shallcross, and Mauss (2010) builds on
these findings by addressing three key limitations of previous research. First,
the authors recruited individuals who had recently experienced a range of
SLEs (e.g., divorce and job loss), thus promoting understanding about how
reappraisal operates on heterogeneous SLEs (e.g., varied type and intensity).
Second, they used a novel laboratory to assess individuals’ ability to use reappraisal during a sad film clip, thus distinguishing the construct of ability to
use reappraisal from self-reported frequency of its use. Third, they measured
reappraisal ability using self-report assessments as well as objective physiological indices, which are not confounded by self-report biases. Results indicated that at high levels of stress, individuals who were high in reappraisal
ability (whether indexed by self-reports or physiological indices) exhibited
lower levels of depressive symptoms than individuals who were low in reappraisal ability. Essentially then, individuals who were high in reappraisal
ability were protected from experiencing depression in the wake of SLEs.
Taken together, these studies suggest that reappraisal confers benefits to
those who use it in the wake of SLEs. Specifically, reappraisal allows people
to modify their emotional responding (i.e., to experience attenuated negative
emotions and/or increased positive emotions), which is, in turn, associated
with resilience. The role of reappraisal in resilience is depicted in Pathway A
in the model in Figure 1.
Emotional Acceptance. Curiously, a parallel line of research suggests that a
different and seemingly opposite strategy known as emotional acceptance also
confers resilience. Acceptance, defined as attending to and nonjudgmentally

Regulation of Emotions Under Stress

Acceptance

Reappraisal

5

A

B

C

Resilience
to stressful
life events
(SLEs)

Acceptance + Reappraisal

Figure 1 Proposed model of resilience in the wake of stressful life events (SLEs).
Each of the pathways in the model is indicated by a letter (A–C). The links are
described in detail in the text.

engaging with negative emotions (Segal, Williams, & Teasdale, 2002), has
been shown in numerous studies to be inversely associated with the experience of negative emotions.
For example, correlational studies on young adults have shown that individuals high in self-reported trait acceptance experienced fewer symptoms
of physiological arousal and negative emotions during an acute state of stress
induced by a carbon dioxide (CO2 ) challenge (Feldner, Zvolensky, Eifert, &
Spira, 2003; Karekla, Forsyth, & Kelly, 2004) and after viewing a negative film
clip (Shallcross, Troy, Boland, & Mauss, 2010). In a heterogeneous community
sample, Shallcross, Ford, Floerke, and Mauss (2013) additionally found that
trait acceptance was correlated with decreased negative emotion, indexed
via trait measures, daily diary assessments, and experiential reactivity to a
laboratory stress induction.
Causal evidence supporting the correlational results above comes from two
experimental studies. For example, participants instructed to “experience
[their] feelings fully and to not try to control or change them in any way”
experienced fewer negative emotions after viewing an anxiety provoking
film (Campbell-Sills, Barlow, Brown, & Hofmann, 2006) and lower heart
rate after delivering an impromptu speech (Hofmann, Heering, Sawyer,
& Asnaani, 2009) compared to participants instructed to suppress their
feelings.
Despite this compelling evidence, the relationship between acceptance
and decreased negative emotion may appear puzzling at first glance: How
is a strategy that involves engaging with negative emotions associated with the
experience of less negative emotion? Acceptance is thought to decrease negative
affect via two related processes: (i) presenting opportunities to acknowledge
and understand negative emotions, which promotes self-compassion as
well as psychological and behavioral flexibility (Hayes & Wilson, 2003;
Kashdan, Barrios, Forsyth, & Steger, 2006) and (ii) reducing rumination
and meta-emotions, defined as emotional reactions to one’s own emotions

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

(Segal et al., 2002; Simons & Gaher, 2005). Although engaging with negative
emotions may increase one’s experience of these emotions in the initial
stages (Campbell-Sills et al., 2006; Hofmann et al., 2009), approaching negative emotions in a nonevaluative way may diffuse these emotions relatively
quickly (Campbell-Sills et al., 2006) via the mechanisms described above,
and ultimately lead to less “net” negative emotion (Segal et al., 2002).
Thus, acceptance appears to reduce individuals’ experience of negative
emotion. Does acceptance confer resilience? A longitudinal study by Shallcross and colleagues (2010) offers evidence in support of the notion that
acceptance may break the link between SLEs and negative outcomes. Results
from this study indicated that participants high in trait acceptance and who
had recently experienced an SLE were buffered from experiencing elevated
depressive symptoms at a 4-month follow up assessment.
Causal support for acceptance as a strategy that confers longer-term
resilience is evidenced by randomized controlled trials that assign participants with elevated psychopathology to interventions involving acceptance
(e.g., acceptance and commitment therapy and mindfulness-based cognitive
therapy). These studies suggest that acceptance-based interventions contribute to improvements in psychological health in individuals at greatest
risk for experiencing the deleterious effects of SLEs (Ma & Teasdale, 2004;
Twohig, Hayes, Plumb, Pruitt, Collins, Hazlett-Stevens, & Woidneck, 2010).
Overall, correlational, experimental, and intervention studies suggest a
robust—and perhaps causal—association between acceptance and reductions in negative emotions and point to acceptance as a strategy that confers
resilience in the wake of stress. The role of acceptance in resilience is depicted
in Pathway B in the model in Figure 1.
REAPPRAISAL AND ACCEPTANCE—CONTRADICTORY OR COMPLEMENTARY STRATEGIES?
The research on emotion regulation and resilience suggests that on the one
hand, reappraisal, a process that involves minimizing negative emotions is
related to resilience. On the other hand, acceptance, a process that involves
engaging with negative emotions, is related to resilience as well. How can
both be true? Several considerations support the idea that these strategies,
although seemingly opposites, can work in complement to one another.
More specifically, acceptance, when used before reappraisal, might facilitate reappraisal’s success. Acceptance involves two sub-processes, attention
to one’s present state and nonjudgment, each of which may facilitate successful reappraisal. First, attending to one’s present state leads to broadened
awareness of a wide range of stimuli (e.g., thoughts, feelings, and physical sensations). It may be easier for individuals to successfully reinterpret
their thoughts if they are first aware of what they are thinking and feeling.

Regulation of Emotions Under Stress

7

Thus, the heightened attention to one’s present experience that is inherent in
acceptance may help catalyze successful reappraisal. Second, nonjudgment is
characterized by appraising one’s emotions (including negative ones) as nonthreatening experiences that are passing events rather than reflections of permanent reality (Hayes & Wilson, 2003). This nonjudgmental appraisal, often
referred to as decentered or metacognitive, promotes three processes thought
to facilitate reappraisal (Garland, Gaylord, & Park, 2009; Malooly, Genet, &
Siemer, 2013): (i) the ability to disengage from negative thoughts and feelings; (ii) broadened attention to the event that led to the emotions; and (iii)
reinterpretation of the event.
Two models converge on the idea that acceptance, when utilized before
reappraisal, may enhance reappraisal’s success. First, Garland and colleagues’ mindful coping model (2009) suggests that mindfulness, which
is defined as nonjudgmental awareness of present moment experiences
and thus overlaps with acceptance (Hayes & Wilson, 2003) may catalyze
successful reappraisal. This model indicates that mindfulness may promote
decentering and cognitive flexibility, which, in turn, may help promote
reappraisal.
Second, Sheppes and Gross’ process-specific timing model (2011) suggests
that: (i) reappraisal can be difficult to achieve because it is associated with
a cognitive burden that may diminish its success when used in intensely
emotional situations and (ii) emotion regulatory processes that decrease
negative emotion, require minimal cognitive resources, and are used before
reappraisal may reduce this burden, thus enhancing reappraisal’s success
(Sheppes & Gross, 2011; Thiruchselvam, Blechert, Sheppes, Rydstrom, &
Gross, 2011) Acceptance, which reduces negative emotions (Shallcross et al.,
2010), has been shown to be unrelated to working memory in correlational
studies (Schloss and Haaga, 2011), and is associated with a lower cognitive
burden than reappraisal in experimental studies (Keng, Robins, Smoski,
Dagenbach, & Leary, 2013), may be the ideal emotion regulatory precursor
that can enhance the effects of reappraisal.
In sum, then, rather than being irreconcilable opposites, acceptance may be
a complementary strategy to reappraisal that when used before it may augment reappraisal’s success and lead to greater resilience than when either of
these strategies is used in isolation. This is illustrated in Figure 1 (Pathway
C) by the thickest directional arrow stemming from the combination of the
two strategies in Figure 1. Specifically, Pathway C proposes that the greatest
resilience is conferred when acceptance is used before reappraisal because
processes such as attention and nonjudgment, which are intrinsic to acceptance, may help facilitate successful reappraisal.
Empirical support for the idea that acceptance may facilitate reappraisal
comes from three lines of evidence from the literature on mindfulness. First,

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Troy, Shallcross, and Mauss (2013) found that individuals with a history
of mindfulness therapy demonstrated higher reappraisal ability in the
context of a laboratory reappraisal task, compared to individuals with a
history of Cognitive Behavioral Therapy and a no-therapy control group.
These results support that mindfulness treatments, in particular, may lay
the foundation for enhanced reappraisal ability. Second, Garland, Hanley,
Farb, and Froeliger (2013) found that: (i) individuals randomized to a brief
mindfulness meditation induction experienced greater state mindfulness
(assessed immediately after the induction) compared to a thought suppression and mind wandering condition and (ii) state mindfulness was
prospectively associated with increases in self-reported reappraisal 1 week
later. Finally, a neuroimaging study showed that self-reported dispositional
mindfulness was associated with activity in neural regions elicited during
a functional magnetic resonance imaging task whereby participants were
asked to reappraise negative stimuli (Modinos, Ormel, & Aleman, 2010).
This study suggests that individual differences in the tendency to be mindful
may help support cortical regions involved in reappraisal.
It is important to note that while mindfulness encompasses emotional
acceptance, it is not identical because it also operates on nonemotional
stimuli (e.g., awareness of the breath) and behavior (e.g., acting with awareness). Therefore, while this evidence is broadly consistent with the idea that
acceptance facilitates reappraisal, more research is needed that specifically
measures and manipulates acceptance and its effects on reappraisal.
Two important points should be noted about the model. First, we and others
conceptualize reappraisal and acceptance as distinct and independent strategies. Thus, although acceptance may facilitate successful reappraisal, reappraisal does not depend on acceptance and acceptance does not necessarily
lead to reappraisal. Second, it is possible that reappraisal, when used before
acceptance, may also confer greater resilience than when either strategy is
used in isolation. However, an explanation for how this may be the case is
less clear. The theoretical considerations and empirical evidence above favor
that acceptance may help lay the groundwork for successful reappraisal (thus
leading to greater resilience) rather than the other way around.
In sum, theoretical considerations and preliminary studies support the
model in Figure 1, which: (i) includes acceptance and reappraisal as central
emotion strategies that lead to resilience; (ii) accommodates findings from
the literature that indicate that each of these are separable strategies that
are beneficial in their own right (Pathways A and B); and (iii) reconciles
how reappraisal and acceptance, seemingly opposite strategies, may be
used synergistically to confer resilience (Pathway C). While the evidence in
support of Pathways A and B is relatively strong, evidence in support of
Pathway C is more tenuous.

Regulation of Emotions Under Stress

9

KEY ISSUES FOR FUTURE RESEARCH
In this entry, we have reviewed studies that suggest that reappraisal and
acceptance are effective emotion regulatory strategies that individuals can
rely on in the face of SLEs. We have additionally proposed a theoretically
and empirically supported model aimed at reconciling how these seemingly
opposite strategies both promote resilience, and how acceptance might
facilitate reappraisal. Although the extant literature and model we present
hold promise for understanding emotion regulation and resilience, work is
needed to: (i) develop the specific concepts articulated in this entry and (ii)
promote the translation of the proposed model into clinical medicine and
public health.
Two areas of investigation appear to be logical next steps toward advancing
the ideas discussed above. First, although Pathway C in the proposed model
has the potential for enhancing our understanding of how these two emotion
regulation strategies could be used synergistically to enhance resilience, this
pathway has not been empirically tested. Future investigations where reappraisal and acceptance are experimentally manipulated in the same study
would advance our understanding of how these strategies may interact with
one another in shaping risk and resilience.
Second, studies are needed that investigate contextual factors that might
influence the effects of reappraisal and acceptance, used in combination
or independently. For example, are there certain individual differences
or circumstances that affect for whom and when these strategies are
particularly effective? Several recent studies have begun to address this
important question of context. For example, some investigations indicate
that diagnosis of psychopathology (Arch & Ayers, 2013; Vilardaga, Hayes,
Atkins, Bresee, & Kambiz, 2013); the intensity of negative emotions (Aldao
& Nolen-Hoeksema, 2012; Sheppes & Gross, 2011); and types of stress (e.g.,
controllable vs uncontrollable) (Troy et al., 2013) moderate the effects of emotion regulation on outcomes (see Aldao, 2013 for review). In other words,
reappraisal and acceptance may not be universally adaptive; it may be the
context in which these strategies are used that predicts whether they lead
to resilience. Collectively, these studies support an initiative backed by The
National Institute of Mental Health, which calls for advancing personalized
medicine (PM). PM is an innovative approach to health care that aims to
identify the conditions under which behavioral health interventions are
most effective. Thus, basic science investigations that examine the contexts in
which emotion regulation strategies are effective, ineffective, or potentially
harmful are at the forefront of informing ways to maximize the effectiveness
of clinical interventions aimed at imparting emotion regulation skills.

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Finally, work is needed to integrate theoretical frameworks across relevant
fields to promote a translational and nonreductionist model of resilience. For
example, stress and coping researchers in the field of health psychology have
examined a number of constructs (e.g., emotion-focused coping) that overlap
with key concepts applied by emotion regulation researchers in the fields of
personality and social psychology (Folkman & Moskowitz, 2004). However,
owing, in part, to differences in methodological approaches and conceptualizations of stress and emotion (John & Eng, 2014), there has been surprisingly
little cross-talk between these fields. Bridging related but currently disparate
theoretical frameworks within and across the fields of psychology, medicine,
and public health will help synthesize converging perspectives, approaches,
and evidence supporting the link between stress and health.
We have attempted to integrate various theoretical frameworks from the
fields of social, cognitive, and clinical psychology to inform our model of
resilience. Broadly, this model could be used as a platform upon which three
different types of interdisciplinary collaborations may be launched, each of
which hold promise for translating basic science into effective clinical interventions. First, collaborations between social psychologists, who can test
active ingredients (e.g., emotion regulation), and clinical psychologists, who
can implement interventions and test reductions in psychopathology, would
be helpful to advance innovative interventions, with known mechanisms of
action, for stress-related mental and physical disorders.
Second, because standard of care protocols for physical disease infrequently include psychological treatments, research collaborations between
psychologists and health care practitioners may help promote the use
of emotion-regulation-based interventions for patients suffering from
stress-related conditions.
Finally, collaborations between psychologists and public health experts
who can facilitate population-level interventions aimed at improving
emotion regulation may help alleviate stress-related suffering on a wide
scale. Examples of such interventions may include: (i) harnessing smart
phone technologies (e.g., apps) to develop programs that promote basic
emotion regulation skills (e.g., awareness) by prompting users to identify
and label their emotional experiences throughout the day; (ii) large-scale
campaigns that promote stress education and behavioral modification, such
as relaxation techniques, to captive audiences (e.g., public transit users).
In sum, future investigations should focus on integrating converging theoretical frameworks that support a nonreductionist model of human functioning. This approach holds promise for translating basic science into clinical
and population-level interventions aimed at promoting resilience in the wake
of SLEs.

Regulation of Emotions Under Stress

11

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Tennant, C. (2002). Life events, stress and depression: A review of recent findings.
Australian and New Zealand Journal of Psychiatry, 36(2), 173–182. doi:10.1046/j.14401614.2002.01007.x

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Thiruchselvam, R., Blechert, J., Sheppes, G., Rydstrom, A., & Gross, J. J. (2011). The
temporal dynamics of emotion regulation: An EEG study of distraction and reappraisal. Biological Psychology, 87(1), 84–92. doi:10.1016/j.biopsycho.2011.02.009
Torres, S. J., & Nowson, C. A. (2007). Relationship between stress, eating behavior,
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Tosevski, D. L., & Milovancevic, M. P. (2006). Stressful life events and physical health.
Current Opinion in Psychiatry, 19(2), 184–189. doi:10.1097/01.yco.0000214346.
44625.57
Troy, A. S., Shallcross, A. J., & Mauss, I. B. (2013). A person-by-situation approach to
emotion regulation cognitive reappraisal can either help or hurt, depending on the
context. Psychological Science, 24(12), 2505–2514. doi:10.1177/0956797613496434
Troy, A. S., Wilhelm, F. H., Shallcross, A. J., & Mauss, I. B. (2010). Seeing the silver
lining: Cognitive reappraisal ability moderates the relationship between stress and
depressive symptoms. Emotion, 10(6), 783. doi:10.1037/a0020262
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., HazlettStevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for
obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5),
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Vilardaga, R., Hayes, S. C., Atkins, D. C., Bresee, C., & Kambiz, A. (2013). Comparing experiential acceptance and cognitive reappraisal as predictors of functional
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FURTHER READING
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological
Science, 8(6), 591–612. doi:10.1177/1745691613504116
Garland, E. L., Gaylord, S. A., & Fredrickson, B. L. (2011). Positive reappraisal mediates the stress-reductive effects of mindfulness: An upward spiral process. Mindfulness, 2(1), 59–67. doi:10.1007/s12671-011-0043-8
Garnefski, N., & Kraaij, V. (2006). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific
samples. Personality and Individual Differences, 40(8), 1659–1669. doi:10.1016/j.paid.
2005.12.009
Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007). Automatic emotion regulation.
Social and Personality Psychology Compass, 1(1), 146–167. doi:10.1111/j.1751-9004.
2007.00005.x
Park, C. L., Folkman, S., & Bostrom, A. (2001). Appraisals of controllability and coping in caregivers and HIV + men: Testing the goodness-of-fit hypothesis. Journal of
Consulting and Clinical Psychology, 69(3), 481. doi:10.1037/0022-006X.69.3.481

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AMANDA J. SHALLCROSS SHORT BIOGRAPHY
Amanda J. Shallcross is a board-certified naturopathic physician and
postdoctoral research fellow in the Department of Population Health at
New York University, School of Medicine. Her research focuses on translating basic affective and psychophysiological science into clinical behavioral
medicine and developing a scientific model for the use of mindfulness-based
interventions in treating mental and physical illness. She recently completed
a 3-year postdoctoral National Research Service Award from NIH, in which
she conducted a randomized controlled trial that examined the effects and
mechanisms of mindfulness-based cognitive therapy for depression. She
uses multiple methods in her research including laboratory tasks, experience
sampling, behavioral coding, and autonomic nervous system responding.
Webpage: http://pophealth.med.nyu.edu/divisions/chbc/faculty-staff/
trainees
ALLISON TROY SHORT BIOGRAPHY
Allison Troy is an Assistant Professor of Psychology at Franklin & Marshall College (F&M). She received her PhD in Affect/Social Psychology
from the University of Denver. Her research examines the role of emotion
regulation in response to stress. Her past work has focused specifically on
the relationship among cognitive reappraisal ability, stress, and resilience.
More recently she has become interested in examining how the effects of
cognitive reappraisal may vary depending the type of stressful context
one encounters (for example, controllable vs uncontrollable stressors). In
collaboration with Drs. Shallcross and Mauss, she is currently investigating
the interplay between cognitive reappraisal and acceptance in negative
emotional contexts. She teaches courses in personality and emotion at F&M.
Webpage: http://www.fandm.edu/allison-troy
IRIS B. MAUSS SHORT BIOGRAPHY
Iris B. Mauss is the Director of the Emotion & Emotion Regulation Lab at
Berkeley and an Associate Professor in the social and personality psychology area in the Department of Psychology at the University of California,
Berkeley. After completing her undergraduate degrees at the Universities of
Trier and Dusseldorf in Germany, she received her PhD from the Department of Psychology at Stanford University. Her research focuses on emotions
and emotion regulation, with an emphasis on their links to psychological
health. In her research, she uses measures of emotion experience, behavior,
and physiological responding, and combines laboratory, daily-diary, and longitudinal survey approaches.
Webpage: http://www.ocf.berkeley.edu/∼eerlab/

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

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