Theory of emotional awareness and brain processing of emotion

Negative affect that is not experienced or expressed may be the most pathogenic response to environmental stress. The purpose of this paper is to provide a way of understanding this phenomenon from a psychological and physiological perspective. A cognitive–developmental model of emotional awareness is presented that holds that the ability to become consciously aware of one's own feelings is a cognitive skill that goes through a developmental process similar to that which Piaget described for other cognitive functions. The developmental process consists of the transition from unconscious (implicit) to conscious (explicit) processing, with explicit emotional processing having a modulatory effect on implicit processes. A parallel hierarchical model of the neural substrates of emotional experience is presented next supported by recent neuroimaging work. It is argued that the neural substrates of implicit and explicit emotional processes are distinct. The neural substrates of implicit aspects of emotion and three distinguishable aspects of explicit emotional processing are then presented: background feelings, focal attention to feelings and reflective awareness of feelings. The conscious awareness of affective states requires participation of structures that subserve attention and mental representation that are not unique to emotion. The domain-general (i.e. not specific to emotion) function of these structures may help to explain the vast individual differences that are observed clinically in the ability that people have to monitor and report their own emotions. Some of the implications of this psychobiological model for behavioral medicine research are discussed.