Everyone notices negative thoughts, memories and feelings. It is normal to try to make sense of these experiences by giving them lots of attention. We can even find ourselves immersed in them, re-living things over and over in our minds. However, this often makes us feel worse. In fact, unhelpful self-reflection is a common aspect of conditions like anxiety and depression. We might therefore explore other, more helpful, ways of interacting with the difficult things that go on in our minds. But this raises the question: can we still experience our unpleasant feelings, thoughts and memories without becoming emotionally overwhelmed?

A helpful way to reflect on such psychological stressors is through a tactic called ‘distancing’ (* although it is sometimes referred to as ‘decentering’ ). Simply put, distancing involves taking a step back, mentally. It is a process of generating a new perspective in your mind from which unpleasant experiences can be viewed – often with a greater appreciation for how these experiences fit into the bigger picture. For example, if you feel hurt by criticism in a professional context, then you might imagine how a neutral third-party would have perceived the same situation. Stepping back like this might lessen the emotional intensity of the criticism while also creating a space to objectively reflect on what was said and why.

Distancing has long been recognised as a helpful part of emotional regulation as well as a key ingredient within psychological interventions for anxiety and depression. Indeed, the literature is rife with terms that describe an ability to adopt an objective self-perspective in response to emotional challenges. Distancing’s popularity likely stems from the fact it can be quickly applied to different types of psychological stressors that might exacerbate a range of mental health difficulties. Thus, this tactic has appealing qualities like versatility, accessibility and ubiquity.

Despite its popularity, few psychologists or neuroscientists have collated the evidence to determine just how helpful distancing is and why it works the way it does. This gap has been partially filled by two recent reviews. The first attempt was by Powers and LaBar (2019) – they focused on the brain science underpinning distancing. The second attempt was by our team at the Medical Research Council- Cognition and Brain Sciences Unit (University of Cambridge). We focused on the role of distancing in youth mental health and psychological interventions.

In this blog, I will develop a bigger picture of distancing; one that illustrates ‘if it works and how’. I will do this by reviewing the work of Power and LaBar while also contrasting their findings with ours.

Methods

Powers and LaBar provide a detailed summary of the state-of-the-art. Findings from different studies were pooled together based on the authors expert interpretation. Thus, their review of distancing did not rely on any statistical techniques but instead on their own subjective evaluation. This way a gathering evidence is called a ‘narrative synthesis’. These authors specifically describe the evidence across three sections that:

1. characterise the defining features of distancing,
2. identify the impact of distancing on emotional states, and
3. explore the brain structures and process that make-up distancing.

Our review followed a similar approach but with some exceptions. First, we reviewed studies based on a semi-structured search of the literature that gathered an array of different types of studies. This included laboratory-based experimental studies, questionnaire studies and clinical trials of popular psychological interventions. This way of gathering evidence might be classed as a form of  ‘scoping review’. Second, our review reflects on the role distancing and related tactics play in psychological interventions.

Results

Characterising distancing

Power and LaBar offered a framework that describes distancing. The central idea is that the psychological content of difficult thoughts and memories is housed in one’s mind. This could be, for example, a mental image of being embarrassed in a social context. This content can become closely associated with the mental image one has of their self. Distancing works by separating between these two mental images and this can be achieved in four ways:

1. Distance could be introduced spatially. This is done by imagining that the difficult mental content is far away (“imagine the embarrassing scene but from a distance “).
2. Distance could be introduced temporally. This is done by imagining that the difficult mental content is in the past or future (“imagine the embarrassing scene but as if 20 years have passed”).
3. Distance could be introduced objectively. This is done by imagining the event from the point of view of a neutral person (“imagine the embarrassing scene but as if you are that really relaxed person that you admire”).
4. Distance could be introduced hypothetically. This is done by imagining the event from the point of view of a neutral person (“imagine the embarrassing scene but accept that your mental representation may not be very precise”).

It was reasoned that generating these new perspectives creates opportunities for alternative, more adaptive emotional reactions.

A similar characterisation of distancing related tactics was identified in our review. We did this by gathering studies that used self-rated questionnaires of distancing* in every-day life. A number of these studies were found to have used statistical techniques that extract the core factors that constitute distancing (e.g. exploratory factor analysis).

Two key characteristics of distancing were evident:

• One was a voluntary ability to shift one’s mental perspective.
• The other was a reduction in the impact of psychological stressors emotions, decisions and sense of self.

The impact of distancing

In their review, Power and LaBar found evidence for the salutary effect of distancing by discussing laboratory based experimental research. These studies ask volunteers to self-report the intensity and quality of their emotions while viewing evocative images, like an upsetting film clip. This step is done twice for each person: Once with an instruction to view the images as normal and then again with an instruction to regulate feelings via tactics like distancing. Findings indicate that distancing reduces the self-rated intensity of negative emotional responses; moreover, distancing was reported to be the third most effective emotion regulation tactic (Cohen’s d = .45). Interestingly, the authors found mixed evidence for the impact of distancing tactics on physiological markers of emotion. This includes changes in the autonomic nervous system that can be detected using measures of skin conductance. However, the discussion was limited to individuals without any mental health difficulties.

We found similar findings in our review along with evidence for the spontaneous use of distancing related tactics from childhood onwards. We also identified studies suggesting that the ability to deploy distancing skills improves in communion with other executive cognitive skills. Importantly, we also examined the link between every-day use of distancing related skills and mental health outcomes like anxiety and depression severity. A consistent pattern was clear: every-day experiences with distancing related tactics are associated with reduced anxiety and depression symptoms. This implies an important link between distancing and mental well-being.

Distancing and the brain

A provisional model to explain the impact of distancing tactics on emotion was proposed by Powers and LaBar. This account lays out a sequence of cognitive activities that are putatively implemented by particular regions of the brain. They say distancing begins with ‘a regulatory goal’. A desired outcome is imagined; that is, a less intense negative emotional state. This goal and a plan to achieve it is formulated and maintained in working memory which is supported by the dorsolateral prefrontal cortex. Second, one begins to recognise the emotional challenge from which they want to distance themselves. This implies a process of affective self-reflection that is supported by the dorsomedial prefrontal cortex. Third. a complex process of self-projection begins wherein a person mentally simulates themselves in an alternative space. The building blocks for this step involves earlier memories and knowledge (supported by the medial temporal lobe) and an ability to manipulate self-relevant information (supported by the temporal parietal junction). Fourth, moment-to-moment changes in emotional state are monitored via the affective self-reflection process. This provides feedback as to whether the ultimate goal (lower negative emotion) has been achieved. Finally, a new emotional state is supported by the brain’s limbic region. This updated emotional state is a reaction to the re-imagined scenario that was brought on by a shifted perspective.

Psychological interventions

We explored the role distancing plays in extant psychological interventions for anxiety and depression. The main result was that an ability to apply distancing related skills gets stronger across many different treatment approaches. This effect is found in interventions that explicitly target the way individuals notice their thoughts and memories (acceptance and mindfulness-based therapies) and interventions that try to undermine their negative content (cognitive behavioural therapies). Importantly, some studies suggest that improving distancing skills occur before reductions in core symptoms of anxiety and depression. This could mean that distancing is a vital ingredient in psychological interventions. In addition, there is also evidence that boosting distancing skills can help prevent anxiety and depression from returning in future.

Conclusions

• Distancing is a versatile emotional regulation tactic that can help people navigate low-medium intensity emotional challenges.
• Distancing can dampen the negative emotional states brought on by everyday experiences like unpleasant feelings, thoughts or memories. Moreover, the ability to self-initiate this tactic may be a core ingredient in extant psychological interventions.
• An important next step is to better understand the cognitive and brain mechanisms that underpin distancing. It may be possible for us to leverage this knowledge to optimise the way distancing tactics are used in both psychological intervention and in every-day life.
• In fact, our team is exploring ways to strengthening self-distancing at an early age. It is hoped that this might reduce the negative impact of psychological stressors across the lifespan.

Strengths and limitations

There is little evidence to indicate whether interventions can be used to improve distancing at an early age. Bridging this gap could be instrumental in developing techniques that delay, or even prevent the onset of anxiety and depression. However, this also requires better tools and methods to investigate distancing in young people.

Implications for practice

The descriptive framework by Powers and LaBar nicely indicates very specific ways to introduce distancing into everyday life. After noticing negative thoughts or memories, individuals can try to shift their perspective in four ways. These are: spatially, temporally, objectively and hypothetically.

Our finding also suggests that an ability to deploy distancing skills may be an active ingredient in psychological interventions. It may be helpful to monitor the development of these skills using brief prompts. After reflecting on a psychological stressor from an objective perspective, distance could be gaged by asking “How far away did you feel from the situation?” or “When recalling the situation, did you feel very close to it or very far from it?”.

Statement of interest

*We chose to adopt the term decentering rather than distancing in our report. This is because the term decentering is more common within the mindfulness-based literature with which our team is interested. However, this blog was to focus on the work of LaBar and Power (2019). We therefore chose to adopt the phrase distancing and distancing related skills instead.

Dr. Marc Bennett report is titled: Decentering is a core component in the treatment and prevention of youth anxiety and depression: An insight report. This was work lead by Dr. Bennett along with Prof. Tamsin Ford and Prof. Tim Dalgleish. It was conducted as part of the Wellcome Trust Mental Health Priority Area special commissions on Active Ingredients in Youth Mental Health.

Links

Primary paper

Powers, J. P., & LaBar, K. S. (2019). Regulating emotion through distancing: A taxonomy, neurocognitive model, and supporting meta-analysis. Neuroscience & Biobehavioral Reviews, 96, 155-173. https://doi.org/10.1016/j.neubiorev.2018.04.023

https://wellcome.org/what-we-do/our-work/mental-health-transforming-research-and-treatments (for information on Bennett et al.’s report)

Other references

Bernstein, A., Hadash, Y., Lichtash, Y., Tanay, G., Shepherd, K., & Fresco, D. M. (2015). Decentering and related constructs: A critical review and metacognitive processes model. Perspectives on Psychological Science, 10(5), 599-617.

Photo credits

• Infographic designed by Dr. Kim Haesen at Droodle.be