It is what it is: A Comparative fMRI Study on the Regulation of Negative Emotions via Distraction, Reappraisal, and Acceptance

While the neural correlates of emotion regulation (ER) have frequently been investigated, only few studies have compared the neural correlates of several ER strategies against another. Here, we present fMRI data from 45 female participants who used distraction, reappraisal, and acceptance to downregulate emotions in a within-subject design. ER compared to the control condition of simply viewing negative stimuli showed activation in frontal and temporoparietal regions. Acceptance resulted in activation in frontal regions and precuneus, as well as reductions in occipital and temporal regions. Reappraisal showed prefrontal and temporal activation with suppression of the PCC and cuneus. Distraction was not associated with stronger activation, but relative deactivation of occipital areas. Direct comparisons between strategies revealed increased engagement of prefrontal and cingulate networks during acceptance and reappraisal compared to distraction, while distraction showed stronger recruitment of occipital and parietal regions. Acceptance differed from reappraisal with greater activation in the dmPFC and fusiform and lingual gyri. Our results indicate that distraction engages earlier in the emotion generating process than acceptance or reappraisal and mostly relies on regions involved in visual perception and attention. Acceptance and reappraisal resemble one another in the recruitment of areas related to cognitive control, however, acceptance also shows a unique activation in areas related to visual processing that are absent in reappraisal. These findings may inform clinical practice in the choice of ER strategies recommended for certain patient groups and speaks towards the theoretical debate on the contextualization of acceptance in the Process Model of Emotion Regulation.