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Psychiatry Res Neuroimaging. 2018 Jul 30;277:7-13. doi: 10.1016/j.pscychresns.2018.04.008. Epub 2018 May 9.

Emotion introspection and regulation in depression.

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Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zürich, Switzerland; Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany; Clinic for Psychiatry and Psychotherapy AR, Herisau, Switzerland. Electronic address:
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zürich, Switzerland.
Sanatorium Kilchberg/Zürich, Private Hospital of Psychiatry, Kilchberg, Switzerland; University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
Department of Neuropsychology, University of Zürich, Zürich, Switzerland.


Depressed patients suffer from an impairment to voluntarily influence and regulate their unpleasant emotional state. Strengthening the mental ability to interfere with dysfunctional emotion processing may be beneficial in treating depression. According to models of emotion processing this may be done by successful down-regulation of enhanced amygdala activity. We investigated short periods of intentional emotion-introspection compared with cognitive self-reflection as two domains of self-awareness in terms of effects on emotion regulation. Thirty depressed patients performed twelve second periods of emotion-introspection, self-reflection and a neutral condition during functional magnetic resonance imaging. We analyzed brain activation in the patients with depression by means of whole brain, region of interest and connectivity analyses. Amygdala activity decreased during emotion-introspection relative to self-reflection and to the neutral condition, whereby left amygdala was inversely activated relative to the left insula. Insula activity itself was correlated with medial and dorsolateral prefrontal cortex (PFC) activation. In conclusion, depressed patients are able to down-regulate amygdala activity by emotion-introspection. This may be interpreted as well-working emotion regulation supposedly induced by PFC connections mediated via insula. The finding supports the application of emotion-introspection, a mindfulness-related process, in a clinical setting as an element of psychotherapy to train and improve emotion regulation.


Amygdala; Cognitive control; Mindfulness; Psychotherapy; Self-awareness; fMRI

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