Alessandro Grecucci

By Alessandro Grecucci, Daniele Chiffi, Ferdinando Di Marzio, Remo Job and Jon Frederickson

Although anxiety is not necessarily a pathological phenomenon, it can become dysregulated, causing suffering. Indeed, emotion dysregulation lies at the core of many psychopathologies. Thus, anxiety regulation is central to all effective psychological treatment. The predominant perspective on emotion regulation and dysregulation is appraisal theory, which proposes that the cognitive appraisal of an event generates an emotional response. According to Gross’s process model, any emotion can become dysregulated when the patient lacks or fails to use an appropriate regulatory strategy. Therefore, the clinician must teach the patient better regulatory strategies. The perspective we put forward departs from Gross’s model based on appraisal theory. The experiential-dynamic emotion-regulation model, EDER, grounded in affective neuroscience and modern psychodynamic psychotherapy proposes that (1) emotions precede cognition (temporal and neuroanatomical primacy), (2) emotions are not inherently dysregulated (they have specific properties of time and strength proportional to the quality of the stimulus), and (3) dysregulation derives from the combination of emotions plus conditioned anxiety, or from secondary-defensive affects, both leading to dysregulated-affective states (DASs). To regulate DAS, the clinician must regulate the dysregulating anxiety or restructure the defenses, which create defensive affects, and then help the client to fully express the underlying emotions that elicit anxiety and defenses. In this chapter, we specifically focus on dysregulated anxiety, its neural bases, and how to regulate it according to the EDER model. First, we present hypotheses and data to show the neural bases of anxiety. Then, specific strategies and techniques to regulate anxiety are explained and clinical excerpts illustrate their application.

Part of the book: New Developments in Anxiety Disorders