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Interviews with AA participants illustrate effect on emotion regulation

July 24, 2015
by Miranda D. Teel, MS, and Edward J. Cumella, PhD
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Emotion regulation (ER) refers to the manner in which individuals express, subjectively experience and manage their feelings. Successful ER entails the capacity to self-soothe and endure stressful emotional occurrences in addition to the physiological arousal accompanying emotions. ER skills are essential in social interactions, stress management, and many aspects of daily living. Researchers have noted that poor ER is related to impulsivity, difficulty delaying gratification, and affective lability (rapid changes in emotion). In the absence of ER skills, people often use substances to manage their emotions. Logically, then, people with substance use problems often have limited ER skills.

Those in recovery from substance abuse often need to develop healthy ER skills so they are not tempted to use substances again to manage emotions. Alcoholics Anonymous (AA) and similar 12-Step support groups are foundational in the treatment of substance abuse. Appropriately, many of AA’s fundamental concepts involve ER. For example, the notion that one’s life is out of control includes one’s emotions being unregulated. Because of the intimate link between cognition and emotion, AA’s challenges to the ways addicts conceptualize reality likely promote the development of ER skills.

Nevertheless, a scientific investigation of AA’s effects on ER skills has not been attempted, to our knowledge. As such, we conducted in-depth interviews with nine long-term participants in AA groups in North Carolina to examine how AA participation has affected their ER skills.

Focus of research

We analyzed and coded the information obtained through participant interviews into five core categories of ER skills: situation selection, situation modification, attentional deployment, cognitive change, and response modulation.

In situation selection, people make predictive judgments of their emotional reactions in specific situations and estimate the likely emotional consequences of their actions within these situations; they then choose or avoid a situation based on their assessment. In situation modification, people attempt directly to adjust a situation to avert its subsequent emotional impact. In attentional deployment, individuals use distraction to divert their attention from negative aspects of their experiences to positive ones. In cognitive change, individuals evaluate an upcoming situation by altering the way they think about the situation. Finally, in response modulation, people directly influence their physiological, experiential, or behavioral responses through such techniques as meditation, prayer and exercise.

These five ER skills can be summed up as avoidance, assertiveness, distraction, reappraisal and suppression. In addition to these five primary ER skills, other skills exist.

During interviews, we asked AA members how AA has affected their ability to handle a variety of situations and specific emotions, including anxiety, fear, depression, sadness, anger, resentment, guilt, shame, loneliness and boredom. The ER categories they reported using were extracted from interview transcripts and were aggregated to determine which ER skills are learned through AA participation.

Cognitive change most prominent

Participants described 128 discrete instances of using ER skills. First, we tabulated interview results separately for men and women, but found no differences in the ER skills learned or used based on gender. Both men and women indicated that AA participation has taught them cognitive change more than any other ER skill, with 34% of ER reports falling into this category. The 12 promises of AA speak to this notion: “Our whole attitude and outlook on life will change. … We will intuitively know how to handle situations which used to baffle us.”1 It appears that this promise is being fulfilled in AA participants’ experiences, since they often report using cognitive change to manage emotions.

Many respondents also spoke of their journey through the 12 Steps as a spiritual awakening, beginning with surrender to a Higher Power as described in AA’s 2nd Step. “Sanity” is an inherently cognitive concept, and participants often elucidated their spiritual renewal in cognitive terms. “Charlie,” for example, stated that entering AA was a fresh start mentally: “You have to get rid of old attitudes and perceptions about addiction and drinking. … AA helps the recovering addict by somewhat of a reconditioning and unlearning of bad mental habits...”

As such, it appears that the spiritual dimension of AA may be acting in support of the ER method of cognitive change. Other AA adages, such as “Live life on life’s terms” and “One day at a time,” further teach recovering addicts to focus cognitively on today, reducing stressors that may arise from thinking about the past or future.

Response modulation was the second most commonly learned skill in AA, mentioned 26% of the time. Thus, AA members relied collectively on cognitive change and/or response modulation 60% of the time to regulate emotions. Along with cognitive change, response modulation was also noted as the most frequent ER skill that AA members discussed with their sponsors. All respondents reported that conversations with their sponsors have affected how they handle their emotions, with two-thirds discussing response modulation with their sponsors. It appears that the sponsor's role may be critical in the acquisition and effective application of this particular ER technique.