Emotion regulation in somatic symptom and related disorders: a dynamical and interpersonal approach
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Abstract
Somatic symptom and related disorders (SSD) are one of the most prevalent conditions in health care. Patients with SSD suffer significantly from one or multiple bodily symptoms and associated psychological problems, such as excessive thoughts, feelings, and behaviors related to the symptoms. SSD can lead to high disability in patients, seriously limit their quality of life and social functioning.
Several studies have documented emotional processes and regulation as crucial factors contributing to the development, maintenance, and worsening of somatic symptoms. However, before we can understand emotion regulation, we should first know what is it that is being regulated. Although contemporary emotion research has embraced a dynamic and embodied perspective stressing emotions' social nature (Butler, 2015; Kuppens & Verduyn, 2015; Lewis, 2005; Scherer, 2009), research on SSD has failed to integrate such developments into its field. This limitation poses a gap in understanding the biopsychosocial mechanisms of the relationship between emotions and SSD.
This dissertation aims to investigate emotional processing and regulation in SSD with a contemporary framework of emotions that understands emotions as a continuously changing process (i.e., a dynamic system) consisting of subsystems, such as subjective affect, body/physiology, and appraisals. Furthermore, this work addresses the social nature of emotions by examining socio-emotional mechanisms occurring in SSD patients' interpersonal interactions. In total three studies were conducted for this research.
The first study systematically reviewed earlier empirical research to investigate Emotion Regulation (ER) processes that characterize SSD. We organized findings based on the targets/components of the regulation (i.e., attention, body, knowledge). The review of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The overview of the findings indicates that patients show a reduced engagement with the cognitive content of emotions while their bodily ER processes seem to depict an over-reactive pattern. Similarly, patients tend to encounter difficulties flexibly disengaging their (spontaneous) attention from emotional material. The review also detected a scarcity of experimental and interpersonal studies in research on ER in SSD.
The second study attempted to develop a methodology to assess embodied and interpersonal emotional processes in couples with an SSD patient and healthy couples. This case study showed the utility of the experimental manipulation and method that successfully created variations in the couples' physiological processes and subjective affect.
Drawing on the methodology of the case study, the third study investigated whether interpersonal emotion dynamics between interacting partners, namely physiological coherence, differ between couples with an SSD patient partner and healthy couples across various emotional conditions. Results showed that emotional conditions and having a partner with an SSD significantly affected physiological coherence between partners. From baseline to anger condition, physiological coherence between patients with SSD and their partners significantly increased while it decreased between the healthy partners. Interdependence between partners' subjective affect, as measured by correlations across groups, followed a comparable pattern to the physiological coherence in healthy and SSD patient-couples. Inability to reduce emotional interdependence in the domains of sympathetic activity and subjective affect during a mutual conflict observed in SSD patient-couples appears to capture emotion co-dysregulation.
These data provide empirical evidence for a disturbance in ER processes in SSD at intra- and inter-personal levels. Investigating the dynamic interaction of several ER modalities concurrently at individual and social levels promises insights for better understanding the ER mechanisms in SSD. The research results represent a further step towards developing a holistic treatment approach for SSD that integrates emotional interventions, framing them as embodied and social.