Introducing a new model of emotion dysregulation with implications for everyday use of music and music therapy

Abstract

Music has the power to modify feelings and evoke emotions. Thus, not surprisingly, emotion regulation is one of the primary goals of the everyday use of music. Music therapists often use the effects of music to address emotions and emotional problems in their musical work. Although an increasing number of publications address emotion regulation and the influence of music in terms of regulating emotions, the quantity of different approaches makes orientation difficult. This article aims to define the core features of emotion regulation and present an integrative model of emotion dysregulation, with a focus on how dysregulation evolves. This paper first discusses current definitions and concepts of emotion regulation from the fields of musicology and psychology. Next, focusing on dysregulation, the article introduces a new model of emotion dysregulation based on a review of relevant literature. This model views dysregulation as the consequence of chronic over- or underregulation or as the result of relying solely on harmful regulation strategies. Finally, the initial implications for everyday music and music therapy are addressed.

Keywords

emotion dysregulation emotion regulation mood management music music-related regulation music therapy

In everyday listening, music can modify our feelings and evoke emotions (e.g., Saarikallio, 2011; Van Goethem, 2010). Emotion regulation through listening to music is a primary goal of the everyday use of music (Schäfer, Sedlmeier, Städtler, & Huron, 2013; Van Goethem, 2010). Music therapists often use these effects of music by focusing on musical work with emotions (Thaut & Wheeler, 2010). To work with these regulatory effects as a therapist, it is crucial to be aware of the basic mechanisms of regulation, and especially the dysregulation of emotion. Although an increasing number of studies are addressing emotion regulation and music’s influence in terms of regulating emotions, the quantity of different definitions of emotion regulation often creates confusion about the use of terms in the field of emotion regulation.

For this reason, this article focuses first on the definition and clarification of terms associated with emotion and emotion regulation. This clarification is crucial for the subsequent presentation of a new theory-driven model of dysregulation focusing on preconditions in the development of emotion dysregulation. The final section discusses the implications for everyday music and music therapy.

Definition of emotion, mood and affect

In many theories about emotion regulation, terms such as affect, mood and emotion are used interchangeably (cf., Van Dijke, 2008). Some authors include stress and coping in their models of emotion regulation (e.g., Leipold & Loepthien, 2015; Rieffe, Terwogt, & Jellesma, 2008) or make specific assumptions about single factors, such as mood regulation (cf., Larsen, 2000). According to Cole and colleagues (Cole, Martin, & Dennis, 2004), some authors do not offer any definition at all. The initial section of this paper will define and discuss important terms and their usage.

First, we start with emotions. Emotions can be described as dynamic and fluid processes (Cole et al., 2004; Hoeksma, Oosterlaan, & Schipper, 2004). Emotions have multiple components and include changes in experience, behaviour and physiology (Gross, 2014). Emotions often have a causal incident and are elicited by specific events (Gross, 2015; Larsen, 2000). Therefore, they involve the appraisal and evaluation of situations and imply tendencies towards specific actions (Cole et al., 2004; Gross, 2015). Emotions are not linked to specific functions; rather, their functions always depend on the context (Tamir, 2011). Feelings are one component of emotion and are understood as the subjective experience of emotions (Mulligan & Scherer, 2012).

Moods are distinguished from emotions in that they are more diffuse and last longer than emotions. They have the tendency to influence cognition and to change subjective feelings. In contrast to emotions, moods have fewer behavioural response tendencies and are not elicited by specific events (Gross, 2014, 2015; Larsen, 2000). Taking into account the differences between mood and emotion, some authors assume a considerable overlap between these two regulatory processes (e.g., Gross, 2015). In addition to this overlap, this article proposes a concept of emotion regulation and dysregulation that integrates emotions and moods (cf., Saarikallio, 2011).

Affect has a wide range of meanings (for an overview, see e.g., Gross, 1998, 2014). This paper will refer to Gross’s definition of affect as a superordinate term for different affective states including moods, emotions and stress responses (Gross, 2014, 2015). Because we refrain from elaborating on coping models and stress responses in our approach to emotion regulation, we will use the term emotion regulation instead of affect regulation. The term emotion will be used as an umbrella term for both emotions and moods. In the next section, which was inspired by Tamir’s (2011) line of thought, the question regarding different goals for regulation will be answered, and different approaches to the core features of emotion regulation will be presented.

Why do people need to regulate their moods and emotions?

Izard and Kobak (1991) demonstrated that in earlier concepts of emotion regulation, the primary goal was to control emotions, particularly negative emotions. Bridges, Denham, and Ganiban (2004) note that empirical studies continue to focus on minimizing negative emotions. By contrast, most theoretical approaches to emotion regulation suggest a more expanded perspective of the goals of emotion regulation. In these concepts, the goal of emotion regulation is to modulate (i.e., minimize, maximize, mask or dissemble) the experience and expression of negative and positive emotions (cf., Bridges et al., 2004; Gross, 1998). Further goals of emotion regulation can include either maintaining an internal state, which is often used in context with positive moods, or creating new states (Van Goethem, 2010). The creation of new states may be distinguished from common emotion generation by its focus on regulation as a predominant goal. Larsen (2000) proposes the theory that people want to feel good in both the short and long term and that they use emotion regulation to reach this goal. By contrast, Campos and colleagues (Campos, Walle, Dahl, & Main, 2011) argue that feeling better is rarely the desired end state and propose instrumental goals rather than hedonistic goals. Sheppes et al. (2014) suggest that emotion regulation strategies strive to achieve two major motivational goals and that these goals differ in their time frame. Hedonic goals lead to more positive or less negative emotional states in the near or immediate term. Conversely, instrumental goals help to achieve long-term goals.

Even if we are unable to determine which particular overriding goal people want to achieve, that is, to feel good or to solve social conflicts and contradictory goals in the long term, we can assume that the primary goal of emotion regulation is to force the state of the emotional system towards a preferred direction (Hoeksma et al., 2004). However, the preferred direction can vary dramatically in different contexts and depends on the person’s history (Tamir, 2011).

Core features of emotion regulation

Emotion regulation is defined by a change in an emotional state (Cole et al., 2004; Hoeksma et al., 2004). In other words, emotion regulation “refers to the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions” (Gross, 2014, p. 6). These regulatory processes include physiological, behavioural and cognitive domains (Bridges et al., 2004). Emotion regulation may range from automatic and unconscious to controlled and conscious regulation processes (Gross, 1998, 2014; Sheppes et al., 2014). Emotion regulation is understood as a dynamic process that is embedded in the situational context (Gross, 1998, 2014; Hoeksma et al., 2004).

Emotion as regulated vs. emotion as regulating

Previous studies convey a broad understanding of emotion regulation phenomena. According to Cole et al. (2004), some authors include changes in emotions themselves (emotion as regulated) in the concept of emotion regulation, as well as the instrumental use of emotions to provoke changes in other domains (emotion as regulating). This paper follows Gross’s (2014) idea of emotion regulation, including only “emotion as regulated”.

Emotion generation vs. emotion regulation

In favour of a more simplistic model of emotion regulation, we consider a distinction between regulation and emotion generation (Cole et al., 2004; Gross, 1998, 2014). However, this distinction remains a subject of debate (Hoeksma et al., 2004; Kappas, 2011; Tamir, 2011), most likely due to difficulties in making this distinction in empirical research and the complexity of emotion processes in general.

Levels of emotion regulation

People use various strategies and tactics to regulate their emotions, and many authors attempt to identify ways to classify this large number (Gross, 2015). Unfortunately, there is a lack of conceptual clarity regarding the definition and use of the terms strategy, tactic and mechanisms. For a better understanding, this article refers to the Goals, Strategies, Tactics and Mechanisms (GSTM) model (Van Goethem, 2010). Although the model is more an analytic guide than a model of emotion regulation, it may help to define some core features of emotion regulation in this paper. The GSTM model includes four different levels of regulation as follows: goals, strategies, tactics and mechanisms. The first level of regulation – the goals of emotion regulation – has been described above.

The use of strategies can be found in the next level of the emotion regulation model. A regulation strategy is defined as the procedure chosen to achieve a specific goal; that is, a change in the emotional state, including emotions and moods. Strategies can be divided into different types as follows: cognitive strategies, behavioural strategies, avoidance vs. approach strategies and situation-directed vs. affect-directed strategies (Van Goethem, 2010). One can also distinguish between intrapersonal (Gross, 1998, 2014) and interpersonal (Zaki & Williams, 2013) strategies. Because emotion regulation is a dynamic process, individuals can regulate their emotions and apply regulation strategies at different points in time (Gross, 1998, 2014, 2015). The selection or modification of the situation is one approach that is frequently used to regulate emotional factors. Other strategies also exist for attentional deployment, such as distraction and focusing on specific elements, followed by strategies that include cognitive changes to alter the emotional significance of the situation (e.g., reappraisal). The last step in the time course of emotion regulation is called response modulation, which takes place after response tendencies have been initiated. Exemplary strategies at this stage include relaxation techniques, drugs, food and emotion suppression (Gross, 2014, 2015). Response modulation can also include interpersonal strategies, such as calling a friend to start venting about the day’s negative experiences (Zaki & Williams, 2013). This theoretical frame for emotion regulation strategies supports an improved understanding of emotion regulation. Unfortunately, this theoretical concept is not easily applicable to daily life for various reasons. For example, individuals can use more than one strategy at a time (Bridges et al., 2004; Gross, 2014). Both goals and strategies are context-specific and individual in their choice and effectiveness (Bridges et al., 2004; Campos et al., 2011; Gross, 2014; Sheppes et al., 2014).

Third, to implement specific strategies in a given situation (Gross, 2015; Van Goethem, 2010), tactics are used to operationalize strategies. Specific tactics can be used for different reasons. Additionally, tactics are used in daily life for goals other than emotion regulation (e.g., listening to music can help one to run faster in addition to making one feel better). Many studies have demonstrated the use of music in everyday life to actively regulate emotional factors (e.g., Saarikallio, 2011; Saarikallio & Erkkilä, 2007; Sloboda, O’Neill, & Ivaldi, 2001; Thoma, Ryf, Mohiyeddini, Ehlert, & Nater, 2012; Van Goethem, 2010), and it is one of the most common tactics that is useful for a wide range of strategies (Van Goethem, 2010). For example: listening to music can support relaxation (Schäfer et al., 2013; Van Goethem, 2010; Van Goethem & Sloboda, 2011) or may facilitate introspection about emotional material (Schäfer et al., 2013; Van Goethem, 2010). Music can help people vent frustrations or let off steam, and it may facilitate cognitive change (Schäfer et al., 2013). Attempts to demonstrate the accordance between music-based emotion regulation (music listening) and strategies from Gross’s (1998, 2014, 2015) process model have failed (Randall, Rickard, & Vella-Brodrick, 2014), perhaps because the listeners found it difficult to tell which strategy they intended to use. Other authors tried to find new strategies and functions (e.g., entertainment, discharge and solace) to explain how music regulates mood and emotions (Saarikallio & Erkkilä, 2007), which are better interpreted as mechanisms based on the GSTM model (see below).

According to the GSTM model, the fourth level refers to mechanisms, which are understood as underlying processes that help people to regulate their emotions (Van Goethem, 2010). Strategies and tactics of emotion regulation are based on underlying mechanisms. Various mechanisms may be involved in music listening. For example, musical parameters such as dynamics and tempo affect emotional states. Music may also evoke memories or the lyrics of a specific music piece may have an effect.

For an example of this model, after a hard day of work and a dispute with my boss, the goal of regulation is to enhance my mood and reduce my anger concerning my boss [level 1: goal]. I will utilize a specific strategy, perhaps from the family of response modulation, for example, relaxation [level 2: strategy]. I will choose music listening as the specific tactic [level 3: tactic] to operationalize my chosen strategy. The underlying mechanism will include evoking memories: I will remember my last holiday, during which I listened to a specific music piece every evening while sitting at the beach, and this may help me relax [level 4: mechanism]. At the same time, other possibilities for effective emotion regulation exist in this situation: the same piece of music may also help me forget the world around me [level 4: mechanism]. Therefore, listening to this music [level 3: tactic] may help me to distract myself [level 2: strategy] and may also lead to a reduction in my anger [level 1: goal].

Definition of emotion dysregulation

Today, it is widely accepted that emotion regulation has important consequences for health (Tamir, 2011). Successful emotion regulation processes can support mental health, whereas dysfunctional regulation constitutes an important risk factor for psychopathology (Gross, 1998; Larsen, 2000; Van Dijke, 2008).

According to the assumption that dysregulation is involved in the pathogenesis of a variety of disorders (Gross, 1998), the question of which regulation strategies are adaptive and which are maladaptive often arises (e.g., Hofmann, 2014; for anxiety disorders). For example, Aldao, Nolen-Hoeksema, and Schweizer (2010), attempt to evaluate the association among six different regulation strategies and four psychopathology groups (anxiety, depression, and eating and substance-related disorders). They examine three regulation strategies that are widely accepted as adaptive (reappraisal, problem-solving and acceptance) and three maladaptive strategies (suppression, avoidance and rumination). In their meta-analysis, they conclude that certain strategies (problem-solving, avoidance, rumination and suppression) may be more strongly associated with mental health than acceptance and reappraisal. Other approaches link certain maladaptive strategies with specific psychological problems and symptoms in children (e.g., Braet et al., 2014). In the context of music-related regulation, attempts have been made to classify adaptive and maladaptive music-related strategies (e.g., Leipold & Loepthien, 2015; Miranda & Claes, 2009; Saarikallio, McFerran, & Gold, 2015; Thomson, Reece, & Di Benedetto, 2014).

There are three critical issues to consider regarding the terms adaptive and maladaptive. First, we must distinguish between effectiveness and adaptiveness. Adaptiveness occurs when the achieved goal is appropriate for the specific situation and for a specific individual. Effectiveness occurs when the selected strategy results in the desired goal.

Second, the effectiveness and adaptiveness of strategies cannot be generalized because they depend on the specific situation. The effectiveness of a strategy greatly depends on the context and the situational demands (Bridges et al., 2004). In the context of music-related emotion regulation, Thoma et al. (2012) demonstrated that listeners choose specific pieces of music in accordance with individual preferences and situational demands. Thus, the assumption that specific strategies always work better than others is likely to be misleading (Gross, 2014). In addition, a behaviour that proves to be adaptive in one context may be maladaptive in another context (Bridges et al., 2004; Campos et al., 2011; Hofmann, 2014). Garrido and Schubert (2013) propose that sad music can be used both for adaptive and maladaptive regulation, for example.

Third, we must distinguish between adaptiveness in the short term and adaptiveness in the long term. For example, the avoidance of a situation may provide short-term relief, but it is likely to prove maladaptive in the long run because it perpetuates and increases anxiety. Impairments in overriding short-term goals to pursue long-term goals have been linked to various psychopathologies, including eating disorders and addictions (Sheppes et al., 2014) and are also discussed in the context of music-related emotion regulation (Randall et al., 2014). These assumptions about adaptiveness and effectiveness will be considered in the presentation of our model of dysregulation.

Before explaining the dysregulation model, one must distinguish between minor difficulties or failures in emotion regulation and dysregulation (i.e., choosing an ineffective strategy once results in a regulation failure; choosing ineffective strategies more often leads to dysregulation). Dysregulation is viewed as the consequence of chronic over- or underregulation or of solely relying on harmful regulation strategies. In successful emotion regulation, regulation failures are part of the learning process and enable flexibility in emotion regulation. Speaking of flexibility, emotion regulation failure describes a situation in which the person is not able to maintain regulation processes when needed or to switch or stop regulation processes if situational demands or goals change (Gross, 2015). In the longer term, this inflexibility results in underregulation (not maintaining) or overregulation (not stopping or not switching). Cole, Michel, and Teti (1994) assume that when it is associated with psychopathology, emotion dysregulation often involves the dominance or absence of a single emotion. This overregulation (absence) or underregulation (dominance) could reflect a state of dysregulation in the overall emotion system.

Kashdan and Rottenberg (2010) postulate that psychological flexibility, including emotion regulation, is a fundamental aspect of mental health. They propose that the ability to modulate behaviour as required by the situation is more effective than any particular regulatory strategy. This notion stands in contrast with the conventional belief that some regulatory strategies are always better than others (Hofmann, 2014; Kashdan & Rottenberg, 2010). The link between restriction in flexibility and psychopathology is also described in several studies. These authors presume that inflexibility results in regulatory strategies that are rigid and maladaptive and that dysregulation may thus arise from these strategies (Bridges et al., 2004; Sheppes et al., 2014). From this point of view, successful emotion regulation “is the result of flexibly choosing between regulation strategies to adapt to differing situational demands” (Sheppes et al., 2014, p. 164).

Model of emotion dysregulation

Assuming that inflexibility results in emotion dysregulation and given the distinction between adaptiveness and effectiveness, we now present our model of emotion dysregulation, illustrating different pathways leading to dysregulation. This model is deduced from theoretical literature and still has to be verified through empirical research (see Figure 1).

Figure 1.

Model of emotion dysregulation. This figure presents a model of emotion dysregulation and displays different pathways leading to dysregulation. The model takes a specific situation as a starting point, i.e., when an individual is challenged to pursue a regulation goal and to choose a specific strategy. The figure includes only levels one and two (goals and strategies) of the GSTM model (Van Goethem, 2010). Tactics and mechanisms are not included in this illustration of the dysregulation model.

The starting point of the model is a specific situation; that is, when an individual decides to pursue a regulation goal and chooses a strategy to achieve this goal. The individual’s decision is based on his/her emotional competence. Individual factors, which can be internal or external (Cicchetti, Ganiban, & Barnett, 1991), also have an impact on emotional competence. Internal factors may include intelligence (for an overview of emotional intelligence, see Van Heck & Den Oudsten, 2008) and temperament (Cole et al., 2004; Larsen, 2000), and external factors may include bonding in early childhood, individual experiences and exemplified emotion regulation (Cole et al., 2004; Saarni, 1999).

Based on Saarni’s (1999) definition, emotional competence includes different emotion-related skills and components that one individual needs to address the changing environment. The use of emotion regulation strategies may be one of these skills, but the effect of emotional competence may also be observed in one’s ability to regulate his/her emotions.

Emotional competence may include skills such as emotional awareness (Gratz & Roemer, 2004; Gross, 2014, 2015; Roberton, Daffern, & Bucks, 2012; Saarni, 1999), the ability to use the vocabulary of emotional terms (Saarni, 1999; Van Dijke, 2008), and the understanding of emotions and emotional responses (Gratz & Roemer, 2004; Mennin, Heimberg, Turk, & Fresco, 2005; Roberton et al., 2012). Emotional competence is crucial for successful emotion regulation, although a lack of emotional competence is not the same as dysregulation, as some authors suggest (Fossati, Gratz, Maffei, & Borroni, 2014; Gratz & Roemer, 2004). Rather, emotional competence can be understood as having an important influence on emotion dysregulation, both as a cause and a consequence of emotion dysregulation.

Following the model, the selected strategy can be either effective (in terms of attaining the goal) or ineffective (i.e., not attaining the goal). Although a person may attain the goal through a selected strategy (i.e., the strategy proves to be effective), the strategy may still be adaptive or maladaptive, depending on the specific context of the situation, normative conceptions and social standards. Effective but maladaptive strategies directly result in dysregulation (see below). Effective adaptive strategies only lead to dysregulation when they are overused. As a result, they become ineffective strategies or result in overregulation. Applying ineffective strategies repeatedly leads to underregulation.

Effective but maladaptive strategies

Effective but maladaptive strategies can be understood as maladaptive implementation of otherwise intact processes (Kring & Werner, 2004). They include harmful strategies (e.g., self-destructive behaviour, consuming drugs and impulsive behaviour) and strategies that are derived from inappropriate goals. An inappropriate goal could be choosing to maintain a mood, such as the manic feelings of a person with bipolar disorder (Gross, 2015). Emotion dysregulation in the form of effective but maladaptive strategies can be observed in various psychiatric disorders such as borderline personality disorder (e.g., Neacsiu, Bohus, & Linehan, 2014), substance use disorders and eating disorders (e.g., Haedt-Matt & Keel, 2011: purging as an effective but harmful strategy to reduce negative affects). The use of effective but maladaptive strategies may also be caused by difficulties in controlling impulses when negative emotions are experienced (Gratz & Roemer, 2004).

Effective adaptive strategies

In this model, two paths by which effective adaptive strategies can result in dysregulation are described as follows: (1) Overuse of these strategies may lead directly to overregulation. Overregulation occurs when an individual overuses strategies to stop or escape emotional experiences (Roberton et al., 2012) due to a fear of feeling or experiencing emotions (Van Dijke, 2008). People with overregulation are inhibited (Bridges et al., 2004) or numb and have a lack of emotional competence (e.g., difficulties in verbalizing and analysing emotions) (Van Dijke, 2008). (2) An overuse of effective adaptive strategies may turn effective strategies into ineffective strategies. The overuse of effective adaptive strategies, such as eating to reduce negative emotions or moods, may lead to overregulation when it becomes the only option to regulate one’s emotional processes, but it can also become an ineffective strategy. Moreover, it may lead to an increase of negative emotions because of the guilt and shame that arise from uncontrolled behaviour. For example, binge eating episodes increase negative emotions in people suffering from bulimia nervosa and binge eating disorder (Haedt-Matt & Keel, 2011). Another example of the trajectory from effective to ineffective strategies can be found in the context of the diagnosis of general anxiety disorder (GAD). Individuals suffering from GAD may over-engage in control mechanisms – such as avoidance and blunting – to decrease emotional experiences that result in overregulation (Mennin et al., 2005). However, these control efforts may lead to further levels of discomfort over time (Mennin et al., 2005) and turn effective strategies (using avoidance for short-term relief) into ineffective strategies in the long term, which leads to underregulation. Cole et al. (1994) have also demonstrated the close interaction between over- and underregulation.

Ineffective strategies

Ineffective strategies can be understood, consistent with the definition of dysregulation from Neacsiu et al. (2014), as the inability to change emotional states in a desired way, even when considerable efforts are made. Ineffective strategies may be chosen for different reasons. One reason is that the person has only a limited number of strategies in her repertoire and relies excessively on one regulation strategy (Gratz & Roemer, 2004; Gross, 2015). Another is that the person does not believe in the effectiveness of the selected strategy or has generally weak self-efficacy with respect to emotion regulation (Gross, 2014; Mennin et al., 2005). Third, the person may have deficiencies in emotional awareness (Fossati et al., 2014; Gratz & Roemer, 2004; Gross, 2015; Kring & Werner, 2004; Neacsiu et al., 2014; Roberton et al., 2012). Finally, the person may not be able to use effective strategies because of a gap between situational demands and personal competences; for example, in a traumatic situation.

Moreover, the approach to a problem results in ineffective strategies when the environment reacts inappropriately, such as when one chooses a response-dependent interpersonal strategy, but the other person does not respond as expected (Zaki & Williams, 2013). Finally, ineffective strategies may occur due to ineffective or inadequate tactics (Gross, 2015).

Regardless of the motivation, the overuse of ineffective strategies typically results in underregulation. This form of dysregulation can be described “as being overaroused and overwhelmed by emotions” (Van Dijke, 2008, p. 153). Consequently, the inability to sufficiently regulate emotional factors implies that the individual is unable to control his/her behaviour (Roberton et al., 2012). This may become apparent in his/her failure to inhibit impulsive behaviour (Roberton et al., 2012) or in (self-) destructive behaviour.

Research has indicated that ineffective emotion regulation contributes to the development of depression (e.g., Berking, Wirtz, Svaldi, & Hofmann, 2014). Kring and Werner (2004) hypothesize that people with depression have difficulties in all antecedent-focused strategies (such as situation selection, attention deployment and cognitive change). Underregulation may be linked to other diagnoses such as posttraumatic stress disorders and borderline personality disorder (e.g., Neacsiu et al., 2014), or in the context of childhood, the relatively new diagnosis of disruptive mood dysregulation disorder (Agarwal & Tiwari, 2013).

Limitations of the dysregulation model

Given that emotion regulation processes never occur in this simplified and one-dimensional way and that people typically pursue more than one goal or strategy at a time, we propose that processes of dysfunctional emotion regulation are reducible to the main pathways described in the dysregulation model. Each modification of the goals or strategies leads to a new process and another pathway, as presented in Figure 1.

In accordance with the associations between specific diagnoses and emotion dysregulation, another limitation may involve an uncertain correlation: Does emotion dysregulation occur because of other problems and symptoms within distinct disorders? Is emotion dysregulation a predictor of some disorders? Do emotion regulation and disorders influence each other reciprocally? Further research is needed in this area.

Implications for everyday use of music and music therapy

Given that music has the potential to promote emotion regulation during everyday listening (e.g., Saarikallio, 2011; Van Goethem, 2010), the use of music in therapy may be even more important in enhancing individuals’ regulation competence and in treating dysregulation.

In this paper, music therapy is understood as:

a reflexive process wherein the therapist helps the client to optimize the client’s health, using various facets of music experience and the relationships formed through them as the impetus for change. As defined here, music therapy is the professional practice component of the discipline, which informs and is informed by theory and research. (Bruscia, 2014, p. 36)

Music therapy methods include improvising, receptive music therapy/listening, recreating/performance, and composition/songwriting (Stegemann & Geretsegger, 2014). The aims of music therapy include the restoration, maintenance or enhancement of emotional, mental and physical health.

Because of the complexity of the effectiveness of music as a regulation tactic, due to individual differences in music-related emotion regulation (Saarikallio, 2011; Vink, 2001) and contextual factors, many approaches in music therapy have the advantage of using improvisational music (Gilboa, Bodner, & Amir, 2006; Pavlicevic, 2000), which is always unique and fits the specific context and situation. Improvisational music therapy (for an overview, see Bruscia, 1987) has an impact not only through the music but also through the safe relationship between the patient and therapist (Bruscia, 1987; Lipponen, 2013). Regulation within a therapeutic relationship can be understood as interpersonal emotion regulation. Music therapy can be used to treat dysregulation in different ways. Specifically, music can be used to increase emotional competence as a catalyst or as a means to facilitate regulation strategies and other therapeutic goals, as well as for affect attunement.

Emotional competence

A lack of emotional awareness may be a cause of emotion dysregulation, as indicated in the path with ineffective strategies (see Figure 1), but it may also be a consequence of dysregulation, as considered in people suffering from overregulation. Therefore, working towards better emotional awareness and general emotional competence is one of the goals of music therapy. Music may function as a stimulus for the experience of emotions (Solli, Rolvsjord, & Borg, 2013; Vink, 2001). Therefore, active (e.g., improvisational) and receptive (i.e., listening) music exercises may be used to facilitate the identification, expression and experience of emotions and can help individuals understand the emotional communication of others (Gilboa et al., 2006; Goldbeck & Ellerkamp, 2012; Thaut & Wheeler, 2010). The use of music may facilitate the introspection of emotional material (Schäfer et al., 2013; Van Goethem, 2010) or help to enable the awareness of suppressed feelings (Solli et al., 2013; Thaut & Wheeler, 2010), which is most important for people with overregulation. Saarikallio (2011) suggests that greater awareness “of one’s music-related emotional self-regulation may also be related to more active general focus on and awareness of emotional experiences in other areas of life as well” (p. 322).

Music as a catalyst

Music may function as a catalyst for the experience of emotions (Vink, 2001). Through improvisational work, one can explore emotional issues with patients and emotion-related themes can be employed (Wigram, 2004). Therefore, music may be applied in working with emotions such as aggression or anxiety, as well as moods. Emotions can be expressed, experienced and integrated (Frohne-Hagemann & Pleß-Adamczyk, 2005; Gilboa et al., 2006; Goldbeck & Ellerkamp, 2012; Solli et al., 2013). Music can help people vent frustrations or let off steam (Schäfer et al., 2013). This could mean that a patient, when indicated, can express and act out his/her anger and aggression on an instrument without using maladaptive strategies while his/her therapist provides structure and assists him/her (Schumacher, 2014).

Supporting regulation strategies through music

Another function of music in therapeutic contexts is the fostering of regulation strategies. For example: listening to and playing music can support relaxation (Frohne-Hagemann & Pleß-Adamczyk, 2005, Goldbeck & Ellerkamp, 2012; Schäfer et al., 2013; Thaut & Wheeler, 2010; Van Goethem, 2010; Van Goethem & Sloboda, 2011). Music can also help facilitate cognitive change (Schäfer et al., 2013; Thaut & Wheeler, 2010) or other regulation strategies (Van Goethem & Sloboda, 2011).

If underregulated, such as in the case of depression (i.e., not using effective strategies to achieve a desired mood state), music may be a suitable positive activity and can alter a listener’s mood (Schäfer et al., 2013; Thaut & Wheeler, 2010). Regarding another aspect of underregulation, music can help with learning new strategies for emotional regulation; for example, to focus on beating a drum may help people avoid becoming overwhelmed by emotions. If music leads to an undesirable emotional state, learning to stop the music in group therapy (in terms of situation modification) can help increase self-efficacy regarding a person’s ability to regulate emotions. Music can also be used by people suffering from underregulation and/or overregulation instead of using the maladaptive strategy of nonsuicidal self-injury (Plener, Sukale, Ludolph, & Stegemann, 2010).

Music-related regulation to facilitate other therapeutic goals

Music therapy can create or enhance a positive emotional context and facilitate social learning and the experience of social interaction (Thaut & Wheeler, 2010). In this context, music-related regulation serves other aims in music therapy. Relaxing through music may also enhance therapeutic changes or help exercise difficult tasks in therapy. A specific use of relaxation through music may occur in the context of preoperative preparation (e.g., Spintge, 2000) and pain reduction (Mitchell & MacDonald, 2006).

Affect attunement

Affect attunement is a very specific use of music in music therapy that refers to the sharing of internal feeling states between the patient and the therapist; for example, through joint improvisational music playing. In the process of attunement, the intersubjective exchange occurs in an amodal or cross-modal manner, that is, it involves a neurophysiological, kinaesthetic and emotional sensing of others, as well as an appropriate response (Giordanella Perilli, 2013). Affect attunement followed by verbal processing helps link the mind with the body and provides better emotion self-regulation (Trondalen & Skårderud, 2007). For example, traumatic events can be expressed through joint improvisational music playing and regulated through affect attunement (Frohne-Hagemann & Pleß-Adamczyk, 2005).

Conclusion

Why is it important for music therapists to understand the concepts of emotion regulation and dysregulation in the treatment of patients? First, in clinical work, music therapists are often confronted with indications and requests that are ambiguous, such as “This patient has emotional problems” or “This patient is unable to express his/her feelings”. Often, these requests are not linked to specific diagnoses. Therefore, it is crucial for music therapists to become familiar with the terms of emotion regulation and the mechanisms and conditions of emotion dysregulation. This knowledge may lead to more effective interventions and successful therapy.

Second, music can be both helpful and harmful to emotion regulation. It can be an effective or an ineffective tactic, depending on the situational context and the individual. For example, music can be overused, similar to taking drugs to escape one’s problems, or it can be used to encapsulate oneself. Music can induce very unpleasant emotions or can overwhelm people when it is linked to a traumatic situation. Therefore, the use of music-related regulation in therapy must be systematic, sensitive and dosed properly.

Third, as mentioned above, music’s effectiveness as an emotion regulation tool depends on the context and the individual; thus, listening to one specific piece of music can never be a remedy for all people to reach a specific goal. Therefore, the individual-oriented/person-centred approach of improvisational music therapy elucidates the potential for musical interventions tailored to emotion regulation.

Furthermore, there are different areas in which music can help people suffering from dysregulation. On the one hand, it can help people work on their emotional competence and may enhance their ability to regulate their emotions. On the other hand, music can help to install adaptive and effective strategies. Moreover, the alteration of moods through music may create a good working atmosphere, thus opening the field for other therapeutic interventions.

For future research, this proposed model of emotion dysregulation may initiate, encourage and foster interdisciplinary approaches to the research of music-related regulation and music therapy to promote the scientific exploration of the heart of music: emotion.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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