Discrete emotional episodes – belonging to established categories such as fear, anger and joy – both regulate and dysregulate cognition and behavior. They also need to be regulated themselves, and the term “emotion regulation” usually refers specifically to this latter process.

Although there are different definitions of emotion regulation, it is generally taken to encompass a range of strategies, such as changing our situation, shifting attention, re-evaluating things, and modifying expressions of emotion. It is also said to include both conscious and nonconscious strategies, as well as different and sometimes conflicting goals and motives¹.

In line with this, emotion dysregulation could be regarded as a matter of whether an emotion occurs at all, whether it is situationally appropriate, and whether its intensity is proportionate to an eliciting stimulus. It might concern a single occurrence of emotion, a type of emotion and/or emotionally relevant situation, or wider-ranging sets of emotional dispositions.

Conceived of in such ways, emotion regulation and dysregulation are certainly of interest to psychiatry. However, it is important not to think of them in ways that are too atomistic and individualistic. A broader, more integrated approach is required if we are to appreciate a distinctive kind of dysregulation often associated with psychiatric diagnoses.

I suggest that we distinguish three regulatory challenges: a) everyday emotion regulation; b) regulating emotional responses when our lives lack structure; and c) regulating temporally extended patterns of emotions that contribute to how we respond and adapt to losses of structure.

The appropriateness of our emotional responses to everyday situations depends in part on the idiosyncratic organization of our lives. Whether and how something matters to us reflects what we already care about or value – an established network of relationships, projects, commitments, pastimes, and treasured possessions. Whether or not our anger, fear, joy or relief is situationally appropriate, and also proportionate in its intensity and duration, depends on whether and how it relates to this backdrop of cares and concerns.

So, we could think of emotion regulation in terms of ensuring that our various emotions track how events and situations matter to us in relation to the dynamic structures of our lives, enabling us to respond in appropriate and effective ways. It is arguable that, in mundane situations, separate regulatory processes are seldom required for this. Instead, our emotions “auto-regulate”, by initiating behaviors that alter emotion-eliciting stimuli or our relationships with them². In any case, whatever we are doing here is altogether different from the task of regulating emotion when our lives lack organization, as in circumstances of upheaval.

Consider, for instance, the variety of circumstances associated with “grief” or “loss”: a significant bereavement; the breakup of an interpersonal relationship; forced migration; the sudden and unexpected end of a career; the destruction of one's home; or the diagnosis of serious illness. These and other life events can undermine the cares and concerns relative to which mundane emotional experiences once arose and made sense to ourselves and others. Hence we can no longer draw upon regulatory resources that presuppose this orienting life structure.

There is also a third regulatory challenge to be discerned. Certain patterns of emotions contribute to how we respond and adapt to significant changes in the organization of our lives. Some of these are more plausibly construed as integrated, temporally extended processes than as sequences of disparate emotional episodes. This applies to the grief we experience over the death of another person, which involves – amongst other things – comprehending, responding to, and adapting to what has happened and what is now the case, often over a lengthy period of time³.

How do we regulate such emotions while engaging with losses of regulatory structure? In considering this question, we should turn our attention to processes that are distributed between individuals and their social environments, rather than limiting ourselves to the capacities of individuals. It is plausible to maintain that we utilize external “scaffolding” even to regulate certain everyday emotions⁴. However, there is a distinction to be drawn between mundane and exceptional forms of scaffolding. The organization of our lives depends in many ways upon habitually established interactions with social environments – our home, our workplace, our family and friends. Emotional responses to upheaval engage with losses of this structure, where what is lost includes emotional scaffolding that was once taken for granted. So, the need for emotion regulation is especially apparent here, as is the lack of regulatory resources. There is thus a need for exceptional forms of regulation, involving exceptional forms of scaffolding. I want to suggest that this type of regulatory challenge is – or at least should be – of particular interest to psychiatry.

Much of the emotional scaffolding that we rely upon in both mundane and exceptional circumstances is interpersonal or social in nature. Regulatory processes draw upon – and may even be partly constituted by – relations with specific individuals, families, other people in general, and larger social and cultural environments. For example, it has been suggested that there are close links between emotion regulation and attachment⁵. When deprived of our more usual regulatory resources, we can still turn to other people in order to interpret, evaluate and alter our emotions, including those emotions that contribute to negotiating upheaval and reorienting ourselves.

Hence, an especially profound form of dysregulation would be one involving a pervasive loss or absence of life structure, combined with lack of access to interpersonal and social scaffolding – one is lost and alone. This is consistent with a number of psychiatric conditions, including post-traumatic stress disorder and some forms of depression. One might feel cut off from others, or unable to trust anyone anymore. There might be feelings of shame, guilt, fear or inadequacy. But underlying this variety is the common theme of feeling unable to experience and relate to others in precisely those ways that might otherwise mitigate emotional turmoil and distress.

Deprivation of certain kinds of interpersonal possibilities not only contributes to experiences of being lost or alone. It can further amount to a sense of inescapability or irrevocability. For example, first-person accounts of trauma often refer to a pervasive loss of the capacity for interpersonal trust, something that might otherwise have sustained the appreciation that there remain significant possibilities beyond one's current situation⁶. Being estranged from others without any prospect of positive change is also a prominent and consistent theme in first-person accounts of depression. There is no way of escaping from your prison or pit because what is altogether absent from your experiential world is the prospect of anyone ever throwing you a rope^{7, 8}. The sense of irrevocability, and with it the loss of a capacity for hope, is inseparable from one's being alone, cut off from others, estranged, or abandoned.

This form of experience can be characterized in terms of losing access to regulatory processes that might otherwise have aided in navigating loss and disorientation. Diagnoses of depression are often associated with a “felt unavailability of others as potential external co-regulators”⁹. However, the sense that nobody could intervene in ways that might have opened up new and significant life possibilities is not limited to depression. Experiences of disorientation, inescapability, disconnection, absence, lack, loss and emptiness that involve diminished access to interpersonal scaffolding are diagnostically non-specific.

What is therefore required is an overarching perspective on emotion regulation that emphasizes the relationships between emotions and the ever-changing organization of human lives, in conjunction with the importantly different ways in which mundane and exceptional forms of emotion regulation are reliant upon interpersonal and social processes.

离散的情绪事件（属于恐惧、愤怒和喜悦等既定类别）既能调节认知和行为，也能失调。它们也需要自我调节，“情绪调节”一词通常特指后一个过程。

尽管情绪调节有不同的定义，但通常被认为涵盖一系列策略，例如改变我们的处境、转移注意力、重新评估事物以及改变情绪的表达。据说它还包括有意识和无意识的策略，以及不同的、有时甚至是相互冲突的目标和动机¹ 。

与此相一致，情绪失调可以被视为情绪是否发生、情绪是否在情境上适当以及情绪的强度是否与引发刺激成比例的问题。它可能涉及一次情绪的发生、一种情绪和/或情绪相关的情况，或更广泛的情绪倾向。

从这种角度来看，情绪调节和失调肯定引起精神病学的兴趣。然而，重要的是不要以过于原子主义和个人主义的方式来思考它们。如果我们想要认识到通常与精神病诊断相关的一种独特的失调现象，就需要更广泛、更综合的方法。

我建议我们区分三个监管挑战：a）日常情绪调节； b）当我们的生活缺乏结构时调节情绪反应； c）调节情绪的暂时延伸模式，有助于我们如何应对和适应结构的丧失。

我们对日常情况的情绪反应是否恰当，部分取决于我们生活的特殊组织。某件事对我们是否重要以及如何重要反映了我们已经关心或重视的东西——一个由关系、项目、承诺、消遣和珍贵财产组成的既定网络。我们的愤怒、恐惧、喜悦或宽慰是否在具体情况下适当，以及其强度和持续时间是否相称，取决于它是否以及如何与这种关心和担忧的背景相关。

因此，我们可以将情绪调节视为确保我们的各种情绪跟踪事件和情况对我们生活的动态结构的影响，使我们能够以适当和有效的方式做出反应。有争议的是，在平常情况下，很少需要单独的监管流程。相反，我们的情绪通过发起改变情绪引发刺激或我们与它们的关系的行为来“自动调节” ² 。无论如何，我们在这里所做的一切与当我们的生活缺乏组织时（例如在动荡的情况下）调节情绪的任务完全不同。

例如，考虑与“悲伤”或“损失”相关的各种情况：重大的丧亲之痛；人际关系的破裂；强迫迁移；职业生涯突然且意外的结束；家园被毁；或严重疾病的诊断。这些和其他生活事件可能会破坏与我们自己和他人曾经产生并有意义的世俗情感体验相关的关心和担忧。因此，我们不能再利用以这种定向生命结构为前提的监管资源。

还有第三个监管挑战需要识别。某些情绪模式有助于我们如何应对和适应生活组织中的重大变化。其中一些更合理地被解释为整合的、时间上延伸的过程，而不是不同的情感事件的序列。这适用于我们因另一个人的死亡而经历的悲伤，其中包括理解、回应和适应已经发生的事情和现在的情况，通常需要很长一段时间³ 。

在监管结构丧失的情况下，我们如何调节这种情绪？在考虑这个问题时，我们应该把注意力转向分配在个人及其社会环境之间的过程，而不是将我们自己局限于个人的能力。可以说，我们甚至利用外部“脚手架”来调节某些日常情绪⁴ 。然而，普通脚手架和特殊形式的脚手架之间是有区别的。我们的生活组织在很多方面取决于与社会环境（我们的家庭、工作场所、家人和朋友）习惯性建立的互动。对剧变的情绪反应与这种结构的丧失有关，其中失去的包括曾经被视为理所当然的情绪脚手架。因此，情绪调节的必要性在这里尤为明显，监管资源的缺乏也是如此。因此，需要特殊形式的监管，包括特殊形式的脚手架。我想建议的是，精神病学对这种类型的监管挑战特别感兴趣，或者至少应该特别感兴趣。

我们在平凡和特殊情况下所依赖的大部分情感支架本质上都是人际或社会性的。监管过程借鉴——甚至可能部分由——与特定个人、家庭、一般其他人以及更大的社会和文化环境的关系构成。例如，有人认为情绪调节和依恋之间存在密切联系⁵ 。当我们被剥夺了更常见的监管资源时，我们仍然可以求助于其他人来解释、评估和改变我们的情绪，包括那些有助于谈判剧变和重新定位自己的情绪。

因此，一种特别严重的失调形式是一种普遍丧失或缺乏生活结构，加上缺乏人际和社会支架的机会——一个人迷失和孤独。这与许多精神疾病一致，包括创伤后应激障碍和某些形式的抑郁症。一个人可能会感到与他人隔绝，或者无法再信任任何人。可能会有羞耻、内疚、恐惧或无能为力的感觉。但这种多样性背后的共同主题是，感觉无法以原本可以减轻情绪混乱和痛苦的方式体验和与他人建立联系。

剥夺某些人际交往的可能性不仅会导致迷失或孤独的经历。它可以进一步等同于一种不可避免或不可撤销的感觉。例如，对创伤的第一人称描述通常指的是人际信任能力的普遍丧失，否则这种信任能力可能会维持人们对超越当前状况的重大可能性的认识⁶ 。在抑郁症的第一人称描述中，与他人疏远而没有任何积极改变的前景也是一个突出且一致的主题。没有办法逃离你的监狱或深渊，因为你的体验世界中完全不存在任何人向你扔绳子的前景^{7, 8} 。不可挽回的感觉，以及随之而来的希望能力的丧失，与一个人的孤独、与他人隔绝、疏远或被遗弃是分不开的。

这种经历的特点是无法进入监管流程，否则这些流程可能有助于应对损失和迷失方向。抑郁症的诊断通常与“感觉其他人无法作为潜在的外部共同调节者” ⁹相关。然而，没有人能够以可能开辟新的、重要的生活可能性的方式进行干预的感觉并不仅限于抑郁症。迷失方向、无法逃避、脱节、缺席、匮乏、失落和空虚等涉及人际支架接触机会减少的经历在诊断上是非特异性的。

因此，我们需要对情绪调节有一个总体的视角，强调情绪与不断变化的人类生活组织之间的关系，以及平凡和特殊形式的情绪调节依赖于人际和社会过程的重要不同方式。 。