Emotion regulation in patients with obsessive-compulsive disorder

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Emotional experience is based upon the interplay between the instantaneous appraisal of salient stimuli, provided by limbic brain areas, on the one hand, and prefrontal control mechanisms to adequately regulate the initial emotional response, on the other hand. In psychiatric disorders that are characterized by emotional hyperarousal, an imbalance of these two processes has been assumed (Phillips et al., 2003b). Models of emotional (dys)regulation may contribute to a better understanding of pathological anxiety experienced by patients with obsessive compulsive disorder (OCD). Initial evidence suggests that OCD is characterized by emotion regulation difficulties as indicated by self-report measures (de la Cruz et al., 2013). Further, OCD appears to be linked to functional changes in brain areas implicated in emotion processing and emotion regulation (Milad & Rauch, 2012). Thus, neuroimaging findings have demonstrated increased activity in both limbic and frontal brain areas during symptom provocation in OCD (e.g., Simon et al., 2010), suggesting altered cortico-limbic interactions, when OCD-relevant stimuli are being processed. However, emotion regulation strategies have not yet been directly examined in OCD. Therefore, we investigated in a first study, whether arousal elicited by anxiety-provoking stimuli can be reduced by visual distraction in OCD. Compared to a self-referential task, an attenuated amygdala response to OCD-relevant stimuli was found for patients during a visual distraction task (Simon et al., submitted). Because OCD-related anxiety is strongly influenced by dysfunctional beliefs and cognitive errors (e.g., catastrophizing), we suppose that emotion regulation is impaired in OCD patients specifically when using cognitive emotion regulation strategies. Therefore, this project aims at investigating cognitive emotion regulation (cognitive distraction and cognitive reappraisal) in OCD by using event-related potentials (study I) and examining whether emotion regulation deficits can be compensated when emotion regulation is guided externally (study II).