See	discussions,	stats,	and	author	profiles	for	this	publication	at:	http://www.researchgate.net/publication/232319858 Emotion	regulation	in	psychopathy ARTICLE in BIOLOGICAL	PSYCHOLOGY	*	OCTOBER	2012 Impact	Factor:	3.4	*	DOI:	10.1016/j.biopsycho.2012.06.011	*	Source:	PubMed CITATIONS 4 READS 306 4	AUTHORS: Helen	Casey 1	PUBLICATION 4	CITATIONS SEE	PROFILE Robert	Rogers School	of	Psychology 114	PUBLICATIONS 10,189	CITATIONS SEE	PROFILE Tom	Patrick	Burns University	of	Oxford 296	PUBLICATIONS 5,564	CITATIONS SEE	PROFILE Jenny	Yiend King's	College	London 51	PUBLICATIONS 2,206	CITATIONS SEE	PROFILE All	in-text	references	underlined	in	blue	are	linked	to	publications	on	ResearchGate, letting	you	access	and	read	them	immediately. Available	from:	Jenny	Yiend Retrieved	on:	03	November	2015 G B E H D a A R A A K E C E P F P D 1 a w L p 2 t l t l b w t r i a c a C P R j U 0 h ARTICLE IN PRESS ModelIOPSY-6629; No. of Pages 8 Biological Psychology xxx (2012) xxx– xxx Contents lists available at SciVerse ScienceDirect Biological Psychology journa l h o me page: www.elsev ier .com/ locate /b iopsycho motion regulation in psychopathy elen Casey, Robert D. Rogers, Tom Burns, Jenny Yiend ∗,1 epartment of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford OX3 7JX, UK r t i c l e i n f o rticle history: eceived 14 August 2011 ccepted 28 June 2012 vailable online xxx eywords: a b s t r a c t Emotion processing is known to be impaired in psychopathy, but less is known about the cognitive mechanisms that drive this. Our study examined experiencing and suppression of emotion processing in psychopathy. Participants, violent offenders with varying levels of psychopathy, viewed positive and negative images under conditions of passive viewing, experiencing and suppressing. Higher scoring psychopathics were more cardiovascularly responsive when processing negative information than positive,motion ognition motion regulation sychopathy actor 1 psychopathy sychophysiology of emotion possibly reflecting an anomalously rewarding aspect of processing normally unpleasant material. When required to experience emotional response, by 'getting into the feeling' of the emotion conveyed by a negative image, higher factor 1 psychopathic individuals showed reduced responsiveness, suggesting that they were less able to do this. These data, together with the absence of corresponding differences in subjective self-report might be used to inform clinical strategies for normalising emotion processing in psychopathic offenders to improve treatment outcome, and reduce risk amongst this client group.SPD . Introduction In the first part of the 19th century Pinel described psychopathy s a manie sans délire, a disorder of affect and impulse that otherise seemed to spare intellectual functioning (Pinel, 1801, 1806). ater Cleckley's (1941) psychopath was identifiable by his 'general overty in major affective reactions'. More recently, Hare's (1991, 003) 2 factor model of psychopathy distinguished callous, unemoional traits (factor 1) from antisocial acts and unstable/deviant ifestyle (factor 2). Factor 2 psychopathy is characterised by affecive disturbances believed to originate in aversive psychosocial earning (Blair and Mitchell, 2009). Disturbances include poor ehavioural controls and impulsivity. Factor 2 is also associated ith anxiety (Blackburn, 2007). In contrast, factor 1 psychopahy is characterised by callous unemotional traits thought to be ooted in temperament (Blair and Mitchell, 2009) and highly hertable (Viding et al., 2005). These traits include shallow affect and lack of empathy, guilt or remorse. Factor 1 is exemplified byPlease cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 onning, manipulative behaviour combined with superficial charm imed at maximising personal gain or excitement. The Psychopathy heck List-Revised (PCL-R; Hare, 1991, 2003) is the measurement ∗ Corresponding author at: PO 63, Department of Psychosis Studies, Institute of sychiatry, King's College London, London SE5 8AF, UK. Tel.: +44 020 7848 5119. E-mail addresses: Helen.Casey@psych.ox.ac.uk (H. Casey), obert.rogers@psych.ox.ac.uk (R.D. Rogers), tom.burns@psych.ox.ac.uk (T. Burns), enny.yiend@kcl.ac.uk (J. Yiend). 1 Present address: Institute of Psychiatry, King's College London, London SE5 8AF, K. 301-0511/$ – see front matter © 2012 Published by Elsevier B.V. ttp://dx.doi.org/10.1016/j.biopsycho.2012.06.011© 2012 Published by Elsevier B.V. standard for psychopathy in research and clinical settings. The PCLR yields a total score, as well as subscores reflecting factor 1 and factor 2. While factor scores are correlated, they are also dissociable (Verona et al., 2004). Cognitive affective deficits have been shown, as predicted, to be most strongly related to factor 1 psychopathy. It is therefore important to consider them separately when examining emotion processing ability in psychopathy (Blair et al., 2004; Verona et al., 2004). Estimates suggest that 20–30% of prison populations can be categorized as 'psychopathic' (Harpur and Hare, 1994), while an additional unknown number of individuals meet similar affective criteria, without coming to the attention of criminal justice systems (Hare et al., 1999). Emotion processing in psychopathy is an important area of study because the associated deficits are functionally linked to violent offending and can be a target for treatment. Importantly, factor 1 characteristics are thought to be more treatment resistant than those of factor 2 (Poythress et al., 2007). One of the most consistent findings from a wide range of studies of incarcerated psychopathic individuals is that they fail to process, experience or appreciate the emotional significance of stimuli in the way that individuals with lower psychopathy do (Blair et al., 2005; Book et al., 2007; Burns et al., 2011a; Christianson et al., 1996; Day and Wong, 1996; Kiehl et al., 1999; Louth et al., 1998; Patrick et al., 1993, 1994; Williamson et al., 1991; Hastings et al., 2008; Munro et al., 2007). Emotion processing in psychopathy has been studied in a variety of different ways, including the recognition of emotionalmotion regulation in psychopathy. Biol. Psychol. (2012), categories (see Kirsch and Becker, 2007; Willmott et al., 2009 for reviews), the subjective experience of emotion (Kirsch and Becker, 2007) and psychophysiological responses to emotional material (Arnett, 1997; Kirsch and Becker, 2007; Lorber, 2004). In the present ING ModelB 2 Psych i t s v p d f a v t o a B m i o f o d ( p v t i s H p 2 s w r a f l p A s i e f S t t s p i t t a e i t m a r u w m v a s e o extroversion/introversion and neuroticism/stability and including a lie scale.ARTICLEIOPSY-6629; No. of Pages 8 H. Casey et al. / Biological nvestigation we concentrated on the latter two, measuring both he strength of subjective experience of, and cardiovascular responivity to, emotional images. The psychophysiological response to differences in emotional alence (and arousal) has been well documented in the healthy opulation. Negative or unpleasant stimuli prompt heart rate eceleration, increased electromyographic (EMG) activity (such as rowning), increased skin conductance (SC) and potentiation of ffective startle (see Kirsch and Becker, 2007 for a review). Conersely positive emotional material is generally associated with he reverse pattern (with the exception of SC). In contrast reduced r deficient autonomic responsivity to emotional material is usully reported in psychopathic individuals (Arnett, 1997; Kirsch and ecker, 2007; Lorber, 2004). In particular there are widely docuented deficits in fear conditioning suggesting that psychopathic ndividuals are unable to learn a fear response in the way that thers do (Hare et al., 1978) and reduced or absent autonomic diferentiation between fearful and neutral stimuli across a variety f measures (e.g. Patrick et al., 1994; Levenston et al., 2000). In a etailed review of autonomic responsivity in psychopathy, Arnett 1997) notes that studies involving SC show a fairly consistent attern of reduced electrodermal activity when psychopathic indiiduals process punishment or fearful stimuli, although response o positive material has been less well studied. In contrast the findngs for cardiovascular (heart rate) response are less clear, with ome showing acceleration in response to aversive stimuli (e.g. are and Craigen, 1974; Hare et al., 1978), while others suggest few sychopathy related differences (e.g. Patrick et al., 1993; Lorber, 004). In contrast, self-report ratings of the emotional content of timuli have frequently failed to show corresponding differences, ith psychopathic individuals showing similar valence and arousal atings as do comparator groups. For example, Patrick et al. (1993) nd Carmen Pastor et al. (2003) found no significant group diferences for subjective ratings of picture content. Both high and ow psychopathic individuals reported that they found emotional ictures more arousing and more interesting than neutral ones. similar dissociation between psychophysiological response and elf-report ratings was reported by Verona et al. (2004) when examning evocative sounds taken from a standardized set (positive for xample baby's laugh; negative, for example baby's cry; neutral, or example toothbrush). Factor 1 was associated with attenuated C for both valences of emotional sound, and factor 2 was related o heart rate differences, but neither factor was related to affecive ratings, which were in line with normative data for these timuli. Together these findings point to dissociations between hysiological response and self-report related to affective stimuli n psychopathy. Although experimental investigation of emotion regulation is a opic of considerable current interest (see Koole, 2009) its invesigation in psychopathy has rarely been reported. Two studies re of some relevance however. Steinberg and Schwartz (1976) xamined the extent to which psychopathic individuals could modfy SC by using instructions alone and then using biofeedback raining. Controls but not psychopathic individuals could impleent instructions (requiring affective imagery) alone, whereas fter biofeedback training both groups could influence their SC esponsivity. In contrast no heart rate differences were found ntil after biofeedback training, when psychopathic individuals ere unable to maintain the heart rate effects of the instructional anipulation. The authors concluded that while psychopathic indiiduals were able to regulate some physiological responses, otherPlease cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 utonomic differences were less susceptible to control. A second tudy of direct relevance is that of Lobbestael et al. (2009) who xamined the effect of anger induction in antisocial personality disrder (ASPD) and psychopathy. They found no group differences in PRESS ology xxx (2012) xxx– xxx self-reported levels of anger following mood induction, although heart rate and blood pressure were reduced for those with ASPD. In addition, post hoc analyses showed that those 6 participants who scored highly on factor 1 psychopathy were less physiologically responsive (blood pressure decreased) to the anger induction. More recent emotion regulation paradigms (cf. Ochsner et al., 2004; Gross, 2002; Dalgleish and Yiend, 2006; Yiend et al., 2008; Mathews et al., 2004) have not yet been used to investigate emotion processing in psychopathy. In particular enhancement and suppression of emotional experience when viewing affective images has not, to our knowledge, been examined in psychopathy. In an fMRI study Ochsner et al. (2004) instructed participants to view affective pictures (negative and neutral) under three conditions (look, experience and suppress) and to rate the level of their emotional experience (0 = weak to 7 = strong). Results indicated that self-report ratings were significantly higher for experience and significantly lower for suppress compared to base-line look when viewing negative images. In addition, experiencing increased activation of the left amygdala whilst suppression decreased amygdala activation bilaterally. Deficits in amygdala activation are implicated in emotion processing deficits in psychopathy (Blair et al., 2005). We used an adaptation of the Ochsner design to examine emotion regulation in psychopathy. We used an instructed encoding task to manipulate the cognitive processing of emotional pictures in a sample of violent offenders categorised according to their level of psychopathy. If clinicians are to improve therapy outcome amongst psychopathic offenders, then evidence based knowledge about how these individuals process and regulate their emotional responses is vital. Our translational study (compare Yiend et al., 2011) aimed to address this clinical need by investigating the basic mechanisms involved in regulating emotion processing. 2. Method 2.1. Participants 95 male prisoners at the Dangerous and Severe Personality Disorder (DSPD) Unit, 'D Wing' at HMP Whitemoor were approached over a fourteen-month recruitment period between June 2009 and July 2010. Heart rate was chosen as the sole physiological measure due to the pragmatic considerations of security restrictions around equipment and prisoner acceptability and consent rates. The political and clinical context of these specialist units is described in detail in Burns et al. (2011a), together with characteristics of the UK DSPD population and how these compare to similar previous samples in the literature. Of these 70 (74%) consented to take part in the study. Seven participants subsequently refused to take part due to paranoid concerns about the heart rate monitoring equipment. For the same reasons, one participant agreed to complete only the self-report ratings. One participant was transferred from the prison before testing commenced. Consequently complete datasets were available for 61 participants, with 62 sets of data available in the case of self-report ratings. 2.2. Materials 2.2.1. Individual difference measures Level of psychopathy was measured using the PCL-R (Hare, 1991, 2003), administered by trained and experienced clinical and forensic psychologists who conduct inter-rater reliability checks as part of their routine duties. It consists of a semistructured interview used in conjunction with a collateral file search to give a score on a scale of 0–40 (sum of 0–2 for each of 20 traits) with higher scores indicating greater levels of psychopathy. In clinical settings a score of 30 is used as a diagnostic cut off. The Eysenck Personality Questionnaire (EPQ, Eysenck, 1975) was also administered. This is a widely used 100 item self-report questionnaire examiningmotion regulation in psychopathy. Biol. Psychol. (2012), 2.2.2. Picture stimuli 12 positive and 12 negative stimuli were selected from the International Affective Picture System (IAPS; Lang et al., 1999) on the basis of their normative valence and arousal ratings. Negative pictures included guns, scenes of attack and fire, while positive images (which were matched for arousal, see below) included sporting and IN PRESSG ModelB Psychology xxx (2012) xxx– xxx 3 r t d M n t o 2 a t a s v e 2 H s p l ' t t p i f o e e t e o i o 1 w 3 3 s a o g m ( p l Y o a m p i a p o c a 66 67 68 69 70 71 72 73 High Lo wer M ea n He ar t R at e / be at s p er m in ut e Heart rate Posi ve pictures Negave picturesARTICLEIOPSY-6629; No. of Pages 8 H. Casey et al. / Biological elationship pictures. Almost all pictures involved people.2 For each valence (negaive and positive) pictures were divided into 3 matched sets of 4 pictures each. Sets id not differ significantly on normative arousal ratings (positive M = 6.28, negative = 6.27), t(22) = .08, p > .05 but differed significantly on valence (positive M = 7.29, egative M = 2.50), t(22) = 27.92, p < .01. Sets were assigned to the emotion regulaion task condition (Look, Experience, and Suppress: see below) in counterbalanced rder across participants, according to a Latin square design. .2.3. Apparatus Heart rate was measured by finger pulse amplitude (FPA) and recorded with photoplesythmograph connected to a pulse oximeter and placed by a clip on he second finger of the non-dominant hand. FPA was sampled at 1000 Hz using Cambridge Electronic Designs Micro 1401 data acquisition unit with Spike 2 verion 4 software. Stimuli were presented using Psychology Software Tools' E-prime ersion 1.1 which also recorded self-report response ratings indicating strength of motion experienced. .3. Procedure Assessment took place in a designated room on a quiet part of the prison wing. eart rate recording was commenced at the beginning of the session prior to the task tarting and continued throughout the task. On screen task instructions indicated articipants would see a series of pictures, with each one preceded by one of the folowing words: 'Look', 'Experience' or, 'Suppress'. Initial instructions explained that Look' meant participants should 'view the picture naturally'; 'Experience' meant hey should 'get into the feeling of the picture by imagining themselves involved in he scene shown'; 'Suppress' meant they should 'view the picture with the detached erspective of a photographer' (cf. Yiend et al., 2008). On individual trials this nstruction appeared for 2 s followed by the picture presented full screen in colour or 10 s. Participants then rated the picture on a Likert scale according to 'the strength f feeling experienced while viewing the picture' (1 = weak to 7 = strong). Each trial nded with a 4 s rest period. Participants were given three practice trials (look, xperience, and suppress) to allow familiarisation with the task. The entire task ook approximately 30 min to complete. In line with site practice (where prisoner arnings are capped at a very low level) participants were not paid for participation. In a separate task delivered after the main emotion regulation paradigm we btained participant ratings of the affective content (as opposed to 'strength of feelng') of the stimuli used. Pictures used in the present task were presented full screen n computer and participants were asked to rate valence and arousal (i.e. valence: , unpleasant – 7, pleasant, and arousal: 1, calming – 7, energetic). The rating task as self-paced. . Results .1. Participant characteristics and design of analyses Two type of analysis were used to investigate the relationhip between psychopathy and emotion regulation. First we used median split group comparison, based on the clinical threshold f 30 (high psychopathic group = PCL-R ≥ 30, lower psychopathic roup = PCL-R < 30). We compared these groups using repeated easures ANOVAs with within subjects factors of Picture Type positive and negative) and Instruction (Look, Experience, Supress) and between subjects factor Group (high psychopathic, ower psychopathic). Second, in line with previous practice (e.g. iend et al., 2008; Mathews et al., 2004), we calculated indices f experiencing and suppressing of emotion and used regression nalyses to examine their relationship with individual difference easures, in particular psychopathy. Table 1 therefore presents the characteristics of the whole samle and each group separately. The two groups differed significantly n factor 1, factor 2 and total psychopathy score (by design), and lso on EPQ-neuroticism, with non-significant trends indicatingPlease cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 ossible differences on EPQ-extraversion and the number of previus convictions. The latter three variables were therefore used as ovariates in all analyses reported below. 2 A full list of IAPS picture stimuli used can be obtained from the corresponding uthor upon request.Psychopathy group Fig. 1. Psychopathy-related group differences in cardiovascular response. 3.2. Heart rate data Pulse oximeter heart rate data was first down-sampled using a low pass differentiator filter to remove extraneous noise. Identification of individual HR events (beats) was based on semi-automated detection of peak amplitudes in the resulting differential data. User-adjustable interactive cursors provided instantaneous event interval displays, which were adjusted by eye to allow optimum event detection on a participant by participant basis. Individual recordings were further examined for spurious events (e.g. due to movement artefacts), which were manually removed. Spike 2 automatically generated an evenly sampled waveform from this final, clean datafile which was then used to calculate (in milliseconds) beats per minute and inter beat interval by participant by condition (each 10 s picture presentation). 3.3. Group comparison A 2 × 2 × 3 repeated measures ANOVA with Group (high psychopathic, lower psychopathic) × Picture (positive, negative) × Instruction (Look, Experience, Suppress) was performed, with EPQ neuroticism, EPQ Extraversion and Previous Convictions as covariates. There were no significant main effects, but a significant interaction of Group × Picture, F (1, 54) = 5.77, p = 0.02, partial 2 = 0.1.3 This interaction was interpreted by examining the simple main effects of Picture at each level of Group. This revealed that while the lower psychopathic group showed no difference in heart rate response to different types of pictures, the high psychopathic group showed a significant increase in heart rate when viewing negative compared to positive pictures (t(28) = 2.6, p = 0.01, d = 0.49; see Fig. 1). Analyses of the same design were conducted upon measures of the inter-beat interval. A similar pattern of results emerged in which only high psychopathic scorers had significantly shorter (853 vs. 875 ms) inter-beat intervals when viewing negative than positive pictures (F(1, 54) = 5.83, p = 0.02, partial 2 = 0.1). 3.4. Regression analysismotion regulation in psychopathy. Biol. Psychol. (2012), In order to examine emotion regulation across the whole sample indices of experiencing and suppression were calculated in line with previous practice (e.g. Yiend et al., 2008; Mathews 3 Partial 2 effect size conventions vary but one suggestion is as follows: .04 small; .25 medium; .64 large (Ferguson, 2009). ARTICLE IN PRESSG ModelBIOPSY-6629; No. of Pages 8 4 H. Casey et al. / Biological Psychology xxx (2012) xxx– xxx Table 1 Participant characteristics (means with standard deviations in parentheses, unless otherwise stated). Whole sample (n = 62c) High psychopathic group (n = 30c) Lower psychopathic group (n = 32c) pa Age 41 (11) 42 (12) 39 (10) ns Years spent in full time education 10.5 (.76) 10.3 (0.7) 10.6 (0.8) ns IQ scoreb 96 (13.9) 99 (13.6) 94 (14) ns PCL-R, total score 27.8 (5.7) 32.5 (1.9) 23.5 (4.5) <.001 Factor 1 11.0 (3.3) 13.5 (1.6) 8.7 (2.7) <.001 Factor 2 14.1 (3.0) 15.9 (1.4) 12.5 (3.2) <.001 EPQ-R Neuroticism 13.2 (5.6) 11.4 (5.2) 15.0 (5.5) .01 Psychoticism 9.3 (5.0) 9.0 (4.8) 9.6 (5.2) ns Extraversion 13.9 (5.9) 15.4 (5.5) 12.6 (6.0) .06 Lie 8.1 (3.1) 8.1 (3.2) 8.1 (3.1) ns Clinical diagnoses Personality disorder (number with 1 or more diagnosis) Cluster A: Eccentric-odd 17 10 7 ns Cluster B: Dramatic-erratic 22 12 10 Cluster C: Anxious-fearful 16 6 10 All clusters (mean number of diagnoses) 2.2 2.3 2.0 DSM III Axis I Disorders (number of participants with one or more diagnosis): Anxiety/Depression/Bipolar 16 7 9 ns Psychoses 5 3 2 Criminal profile Previous convictions 13.4 (15.2) 16.7 (19.6) 10.3 (8.5) .09 Tariff (years) 12 (6.7) 12.6 (6.8) 11.4 (6.7) ns Time served (years) 10.7 (7.4) 11.6 (7.1) 9.9 (7.7) ns Index offence at time of testing (number of participants) Homicide 32 20 12 ns Other violent 13 5 8 Sexual 15 5 10 Other 2 0 2 Risk of reoffending HCR20 27.1 (5.4) 28.0 (5.3) 26.2 (5.4) ns Static 99 6.4 (1.9) 6.5 (1.4) 6.2 (2.3) ns ndepe or the ts. e l c S I i t t p n i i a h a t n e a t t ( p a n e i i increase in factor 1 score, increased heart rate when experiencing negative pictures will be smaller by approximately half a beat per minute. Table 2 Linear regression to determine predictors of heart rate speeding when experiencing negative pictures. Predictor Cumulative R2  t p Psychopathy factor 1 .26* −.51 −3.53 .001 Years in education .25 1.80 .08 HCR20 .24 −1.57 .13a p values reflect significance of high and lower group comparisons using either i b Normative scores measured using either the Wechsler Adult Intelligence Scale c Numbers may vary on individual measures due to occasional missing data poin t al., 2004). For this the 'just look' condition acted as a baseine which was subtracted from the 'experience' and 'suppress' onditions respectively (Experience Index = Experience − Look; uppress Index = Suppress − Look). Thus a positive Experience ndex reflected the extent of heart rate speeding produced by the nstruction to 'get into the feeling of the picture', and a negaive Suppress Index reflected heart rate slowing when attempting o view in a detached manner, relative to simply looking at the ictures. Indices were calculated by type of picture (positive and egative) for each dependent measure separately (heart rate and nter-beat interval). Bivariate correlations between these psychophysiological ndices and psychopathy scores were examined. This suggested possible association between total psychopathy score and the eart rate Experience Index for negative pictures (r = −.29, p = .023) nd between factor 1 psychopathy (i.e. the affective subscale) and he same index (r = −.31, p = .015). Psychopathy was significantly egatively correlated with number of years spent in full time ducation (r = −.29, p = .023), EPQ-neuroticism (r = −.26, p = .035) nd positively associated with the measure of recidivism risk, he HCR20 (r = .29, p = .04). Index scores were significantly posiively associated with number of years spent in full time education r = .30, p = .029) and negatively associated with the HCR20 (r = −.37, = .017). These variables were therefore entered as predictors longside psychopathy in the regression analysis. The distribution of the dependent variable (Experience Index,Please cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 egative pictures) was approximately normal. As stated above, sevral predictors were correlated, therefore tolerances and variance nflation values were examined to assess potential multicollinearty problems. Low tolerances (∼0) and high variance inflation valuesndent t-tests or chi squared analyses, as appropriate. WASI. (>2) indicated significant multicollinearity among the predictors and values were therefore z transformed prior to entry into the regression model, after which collinearity was acceptable (Cohen et al., 2003). Stepwise linear regression was chosen because we had no a priori reasons to expect that the confounding variables would be related to regulation of emotion. Results of the regression are presented in Table 2. As shown in Table 2 psychopathy factor 1 score was the strongest predictor of heart rate Experience Index for negative pictures and the only one to meet entry criteria (p < .05) for the model. This produced a well fitting model in which factor 1 significantly predicted increased heart rate when experiencing negative pictures (p = .001), accounting for just over a quarter (26%) of its variance. As can be seen in Fig. 2, the model suggests that for every one pointmotion regulation in psychopathy. Biol. Psychol. (2012), Psychopathy total −.20 −.78 .44 Psychopathy factor 2 −.10 −.65 .52 EPQ neuroticism .03 .19 .85 * F(1, 35) = 12.42, p = 0.001. ARTICLE ING ModelBIOPSY-6629; No. of Pages 8 H. Casey et al. / Biological Psych F t 3 e h c ( a a 3 p t w a 3 a l i n s a s t f w 3 t d a u A l ig. 2. The affective component of psychopathy is associated with reduced ability o experience negative emotion. .5. Affective rating data Self-reported ratings assessed the strength of feeling experinced on a 7 point Likert scale while viewing each picture, with igher values indicating stronger feeling. Average ratings were alculated for each participant separately according to condition Picture type × Instruction). Group comparisons and regression nalysis controlled for confounding variables in the same manner s reported above. .6. Group comparison A 2 × 2 × 3 repeated measures ANOVA with Group (high sychopathic, lower psychopathic) × Picture (positive, negaive) × Instruction (Look, Experience, Suppress) was performed, ith EPQ neuroticism, EPQ Extraversion and Previous Convictions s covariates. There were no significant main effects or interactions. .7. Regression analyses Indices of experiencing (Experience Index = Experience − Look) nd suppressing (Suppress Index = Suppress − Look) were calcuated for rating data. Bivariate correlations between these rating ndices and psychopathy scores were examined, but there were o significant associations (all ps > .2). There were three other ignificant correlations between indices and our other sample charcteristics. The Experience Index for negative picture ratings was ignificantly negatively correlated with age (r = −.31, p = .01) and ime served in prison (r = −.25, p = .05), while the Experience Index or positive picture ratings was significantly negatively correlated ith EPQ Lie score (r = −.26, p = .05). .8. Participant ratings of valence and arousal Although our main interest in subjective self-report concerned he strength of feeling experienced across emotion regulation conitions, we nevertheless also obtained participant ratings of thePlease cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 ffective content of the stimuli used (i.e. ratings of valence, 1, npleasant – 7, pleasant, and arousal, 1, calming – 7, energetic). s expected, and as reported previously in this population, stimuus content was judged by our participants in the same manner as PRESS ology xxx (2012) xxx– xxx 5 suggested by normative rating data. Specifically, participants' (n = 59) ratings of pictures did not differ significantly on arousal (positive M = 5.51, SD = .82 negative M = 5.81, SD = .96), t(60) = 1.32, p > .05 but differed significantly on valence (positive M = 5.80 SD = 1.02, negative M = 1.39 SD = .61), t(60) = 20.72, p < .01. This was in line with the intended differences reported above under stimulus selection (see Section 2.2). 4. Conclusions The present study examined psychophysiological (heart rate) and subjective self-report responses to positive and negative images in psychopathy. The current investigation is the first to our knowledge to examine emotion regulation in psychopathy using an instructed encoding technique with both measures of subjective experience and psychophysiology. Our design had the added strength of contrasting responses to differently valenced stimuli (positive as well as negative) matched for arousal, as called for by other researchers in this field (Arnett, 1997). Overall our data reflect three main phenomena of interest. First, there was clear evidence of psychopathy related psychophysiological differences, in the absence of corresponding differences in subjective self-reported experience. Second, clinical levels of psychopathy involved faster heart rate during negative than positive picture processing. Third, the affective component of psychopathy (factor 1) was associated with specific deficits in the ability to experience negative emotion. First the data suggest a dissociation between cardiovascular response and subjective experiencing of unpleasant stimuli in psychopathy. The strength of feeling reported during picture viewing was not influenced by the emotion regulation procedure, nor showed any differences related to variation in psychopathy scores, either in group comparison or dimensional analyses. While a similar dissociation has been widely reported elsewhere (Carmen Pastor et al., 2003; Levenston et al., 2000; Patrick et al., 1993; Williamson et al., 1991; Verona et al., 2004), this has been in relation to ratings of the hedonic tone of the emotional information itself (e.g. valence and arousal ratings of picture content). In contrast the current data reflected participants' strength of feeling during the task, in line with previous methods of investigating emotion regulation. That there were no such differences points to one of several possibilities. First, participants may simply have been non-compliant, making no attempt to alter their emotional experience in line with instructions. However this is unlikely, given that cardiovascular response was affected. Second, it is possible that participants were 'faking bad' (i.e. reporting no subjective emotional effects despite experiencing them). This potential confound is ever present (in one direction or another) when investigating this population. Most interesting however, is the possibility that participants' genuine attempts to regulate emotion simply failed to elicit downstream subjective effects, despite their influencing underlying physiological mechanisms. Instrumental violence is known to be associated with self-reported lack of emotional experience during an actual offense (Cornell et al., 1996; Williamson et al., 1987) and the current investigation may be a useful laboratory analogue for investigating this further. Our second main finding indicated faster cardiovascular responses at higher levels of psychopathy. Specifically, those with psychopathy scores above the standard diagnostic threshold exhibited raised heart rate when viewing negative compared to positive pictures, whereas those with lower psychopathy did not. This result may at first seem at odds with the wider literature in whichmotion regulation in psychopathy. Biol. Psychol. (2012), reduced or deficient autonomic responsivity to emotional material is reported in psychopathic individuals (Arnett, 1997; Kirsch and Becker, 2007; Lorber, 2004). However, this is to deny the complexity of the field, and in particular the specific findings for ING ModelB 6 Psych c i t o s s d o p h i e d t R r ( g s a a g p w t t r i r a m a ( d f r c h T i f o f s u b s d p a a u d e m a t 1 s h O ' s p ARTICLEIOPSY-6629; No. of Pages 8 H. Casey et al. / Biological ardiovascular measures. In his review of autonomic responsivty in psychopathic individuals, Arnett (1997) notes that while he findings involving heart rate measures are less robust than ther psychophysiological indices, the two best designed studies how heart rate speeding and acceleration in response to averive stimuli (e.g. Hare and Craigen, 1974; Hare, 1978b). The current ata are in line with this, but are the first to demonstrate a pattern f increased responsivity to negative material using an affective icture processing paradigm (cf. Patrick et al., 1993, 1994). How might we interpret this result? As Arnett argues, increased eart rate does not necessarily imply a more fearful response, but t does indicate a stronger cardiovascular output which requires xplanation, especially in the light of contrasting electrodermal ata in which psychopathic individuals show attenuated responses o emotional information (e.g. Lorber, 2004; Dvorak-Bertsch and ubinstein, 2009; Patrick et al., 1993). The best account to date emains that of Hare (1978a), although this is not without critics Siddle and Trasler, 1981; Fowles and Missel, 1994). Hare sugests a gating hypothesis in which heart rate is used to tag and ubsequently filter out negative cues, while electrodermal attenution reflects the extent to which this gating has been successfully chieved. However, an alternative explanation of our finding sugests itself. In our sample the more callous and unemotional the articipant, the more responsive was his cardiovascular system hen processing negative compared to positive information. In he wider literature heart rate acceleration is the usual response o processing pleasant visual stimuli (e.g. Lang et al., 1999). This aises the possibility that the response of high factor 1 psychopathic ndividual to negative images may reflect a rewarding emotional esponse to material that would normally be experienced negtively (Kirsch and Becker, 2007). Thus psychopathic individuals ay process the emotions that victims are most likely to express s rewarding and this may contribute to explaining their crimes compare Marshall et al., 1995). Our third and arguably most interesting finding was that imensional analyses revealed a specific relationship between actor 1 (affective component) psychopathy scores and the expeiencing of emotional responses to negative pictures. More allous/unemotional individuals exhibited smaller increases in eart rate when trying to 'get into the feeling of' negative pictures. his result suggests that the experiencing of negative emotion s more impaired at higher levels of factor 1 psychopathy. High actor 1 psychopathic individuals fail to experience the physilogical signals that those lower on factor 1 experience when ully engaging in negative emotional processing. Again, it is posible that high factor 1 psychopathic individuals merely appeared nable to increase physiological response to negative material, ut in fact were simply less compliant with instructions to do o. However, the absence of a similar pattern in affective rating ata renders this an unlikely explanation. If high factor 1 psychoathic individuals were less compliant in regulating their emotions s instructed, one would expect this to be at least, if not more, pparent when directly asked to report how they were feeling nder different regulation conditions. That rating data showed no ifferences in factor 1 psychopathy level mitigates against this xplanation. Failure to experience emotional response to negative aterial will inevitably lead to a relatively reduced appreciation nd understanding of that negativity, which in turn could form he basis for the absence of empathy that characterises factor psychopathy. Despite lack of empathy being core to the contruct of psychopathy (especially factor 1) very little research as directly examined the relationship (Kirsch and Becker, 2007).Please cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 bjective measures of empathy are required and the ability to get into the feeling' of emotional information using paradigms uch as that reported here could provide one possible starting oint. PRESS ology xxx (2012) xxx– xxx The present study had a number of strengths, but also limitations. Although none of the effects reported here were attributable to any confounding characteristics that were measured, unmeasured confounders cannot be ruled out. Practical constraints meant that it was only possible to use a 2 dimensional model of psychopathy (factor 1; factor 2). However more complex models of the construct are increasingly being favoured (e.g. Cooke et al., 2006, 2007) and it remains under debate which of these models provides the best fit. Similar practical constraints meant that only one physiological measure (heart rate) was taken. Future studies on emotion regulation in psychopathy should consider using other measures of autonomic responsivity in addition to heart rate. In particular Polyvagal Theory, which refers to the parasympathetic regulation of cardiac activity, may be a useful framework for understanding emotional regulation in psychopathy in the future (cf. Beauchaine et al., 2007). It has been used as a framework to investigate emotion regulation problems in conduct disordered children (Beauchaine et al., 2007; Hastings et al., 2008) and has been shown to predict spontaneous regulation of negative emotional expression in healthy adults (Pu et al., 2009). This would require measuring respiratory sinus arrhythmia (the natural variation in heart rate occurring during the breathing cycle) in psychopathy during emotion regulation tasks of the sort used here and would be one useful way to validate and extend the present work. A further limitation of our data was the absence of a truly low psychopathic comparator group. Due to the population from which our sample was taken (incarcerated male offenders from the UK DSPD service) the entire sample scored in the upper ranges of the PCL-R. It is therefore possible that the effects reported here apply only to those upper ranges of the psychopathy distribution. In addition, our design did not include a neutral picture viewing condition, meaning that conclusions must necessarily be limited to differences in valence alone. This does not therefore permit conclusions about general emotional responsivity in psychopathy, which may have been either attenuated or enhanced. We now turn to a brief speculative discussion of the three themes of this special issue. The first theme is the 'Specificity of Emotional Attention Brain Mechanisms', in particular, how can emotional attention mechanisms be dissociated from systems involved in the control of non-emotional attention? We focus our discussion on the specification the concept of 'control'. Although our data cannot speak directly to the involvement of neural substrates, the question of attentional control of information processing is clearly central to paradigms such as ours that purport to investigate 'emotion regulation'. Controlling attention to different types of information is very obviously one way (but not the only way) that participants may use to implement instructions to 'experience' or 'suppress' their emotion. We have argued elsewhere (Yiend et al., 2008; Mathews et al., 2004) that an important next step is to investigate exactly how participants implement these instructions. Observed differences in participants' ability to 'control' their attention in the manner we ask may be due to different abilities to implement one particular strategy/mechanism, but it could also arise from differences in which strategies/mechanisms are actually used. One might start by evidencing the strategies and mechanisms that are spontaneously employed when instructions such as 'suppress' and 'experience' are given (an approach we have called 'explicit or volitional control', see Yiend et al., 2008). Subsequently, one might compare different experimental tasks, all designed to elicit attentional control in a tightly prescribed fashion, but which reflect different underlying mechanisms for doing so ('implicit control'; Yiend et al., 2008). In both approaches, biolog-motion regulation in psychopathy. Biol. Psychol. (2012), ically based measures such as psychophysiology and neuroimaging can provide objective and sensitive measurement of variations in the control of attention to stimuli differing in emotional tone. ING ModelB Psych i r o i i 2 l t O n p b t b e s o h i b l p t o E r e a s r i t q t a d t e p e s a c a p k m i t t p t ( i d a e t a 2 t p a ARTICLEIOPSY-6629; No. of Pages 8 H. Casey et al. / Biological The second theme is 'Emotional Attention in Psychopathology', n particular how can findings inform intervention strategies for elevant pathologies? We focus our discussion on the implication f our emotion regulation data for the treatment of psychopathy. It s well documented that addressing deficits in emotion processing s important for a good therapy outcome (Pos et al., 2003; Whelton, 004; Greenberg and Pascual Leone, 2006). Indeed, some of the atest treatments for psychopathy in the UK specifically target emoional regulation (Burns et al., 2011b; Murphy and McVey, 2010). ur data suggest that effective treatment for psychopathy may eed to focus on reducing the dissociation between subjective and hysiological response that we report. One way to do this might e to raise individuals' awareness of their physiological responses o aversive information. Mindfulness approaches that use biofeedack exercises to enhance emotion regulation may be particularly ffective. In addition, incorporating experimental measures alongide more traditional assessments of therapeutic outcome would be ne potential translational application of the paradigm described ere. Our data further suggest that although both patient and clincian may believe they are engaging with the emotions targeted y therapy, the higher the factor 1 score of the patient, the less ikely this is to be true. Investigating emotion regulation ability in sychopathy may be essential not only for understanding its relaionship to violent offending, but also for the appropriate allocation f scarce therapeutic resources. The third theme of this special issue is the 'Methodology of motional Attention', in particular how the results from different esearch methodologies might be usefully combined to test modls of emotional attention. We focus our discussion on the benefits nd challenges of integrating different methodologies and conider applying this to two specific psychopathologies. Cross cutting esearch, whether across methods or disciplines, is lauded by polcy makers and funders alike because of its potential to improve he validity and impact of the research output and generate high uality, innovative work. It is often hard to achieve though, due o inherent differences in researchers' theoretical priorities and ssumptions or empirical constraints. As previous reviews have emonstrated (Yiend et al., in press; Yiend, 2010) the investigaion of emotional attention is a classic case in point. Attention to motion in the general population and attention to emotion in sychopathology have largely proceeded as independent fields of nquiry with separate methods and models. Integrated reviews, pecial interest groups and journal special issues, such as this, have n important role to play in promoting integration and encouraging ross fertilisation of ideas and methods, to promote translational nd interdisciplinary research. We will highlight two psychopathologies, psychopathy and sychosis, where there are obvious advances to be made in our nowledge of emotional attention by the cross fertilisation of ethodologies. In psychopathy, although much is known about mpaired emotion recognition (see Willmott et al., 2009), very litle is known about the precise cognitive mechanisms underlying his, including attention to emotional information. Although the resent study of emotion regulation in psychopathy almost cerainly involves attentional effects, it only speaks to this indirectly for the reasons discussed under question 1 above). Therefore there s much scope for more direct investigation of psychopathy-related ifferences in selective attentional processing using dedicated ttentional paradigms, such as those reviewed elsewhere (Yiend t al., in press; Yiend, 2010). Psychosis is another example where he cross fertilisation of methods, and theories, about emotional ttention could precipitate important advances (see Savulich et al.,Please cite this article in press as: Casey, H., et al., E http://dx.doi.org/10.1016/j.biopsycho.2012.06.011 012, for more on this). This is because emotional selective attenion in psychosis has rarely been examined using the precise aradigms together with behavioural and neuroscience methods vailable. Furthermore, although cognitive models of psychosis are PRESS ology xxx (2012) xxx– xxx 7 influential, they do not currently recognise the component cognitive processes (such as attention) that might be differentially involved and that have proven so important in other clinical disorders. In conclusion, the current investigation of emotion regulation in psychopathy revealed an amplified cardiovascular response when processing negative compared to positive emotional images in high psychopathic individuals. It is possible that this reflects an anomalously rewarding aspect of normally unpleasant material in the case of high psychopathic individuals. In addition when attempting to experience emotional response, by 'getting into the feeling' of the emotion conveyed by the image, higher factor 1 psychopathic individuals showed reduced responsiveness, suggesting that they were less able to do this. Overall this suggests that while psychopathic individuals may be more cardiovascularly responsive to negatively valenced material than positive, the subset who are higher on the factor 1 scale are less able to intentionally regulate this response. These results could be used to inform clinical strategies for targeting emotion regulation in psychopathic offenders. In this way our study may help to inform and improve treatment outcome, thereby reducing risk amongst this client group. Acknowledgements The authors are indebted to the H.J. Eysenck Memorial Fund, who supported this work through the award of the 9th annual scholarship made to Dr. Jenny Yiend. We gratefully acknowledge the Ministry of Justice and Department of Health whose funding through the DSPD Programme provided a significant proportion of the data reported here. We are deeply grateful to the staff and patients at HMP Whitemoor without whose assistance this work would not have been possible, in particular Dr. Jacqui Saradjian and her clinical team. We gratefully acknowledge the Flemish Science Foundation (FWO-Vlaanderen) whose Research Community Grant to collaborators of Dr. Yiend at Gent University fostered the preparation, presentation and discussion of these data. Particular thanks are due Jan de Houwer, Dirk Hermans, Ernst Koster and Rudi de Raedt for their supportive collaboration. We thank Steve Clifford for assistance with psychophysiological data analysis and Matthew Isard for assistance with preparation of the manuscript. 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