Biological Psychology 92 (2013) 541–548

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Biological Psychology
journal homepage: www.elsevier.com/locate/biopsycho

Emotion regulation in psychopathy

Helen Casey, Robert D. Rogers, Tom Burns, Jenny Yiend ∗,1
Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford OX3 7JX, UK

a r t i c l e i n f o a b s t r a c t

Article history: Emotion processing is known to be impaired in psychopathy, but less is known about the cognitive
Received 14 August 2011 mechanisms that drive this. Our study examined experiencing and suppression of emotion processing
Accepted 28 June 2012 in psychopathy. Participants, violent offenders with varying levels of psychopathy, viewed positive and
Available online 16 October 2012
negative images under conditions of passive viewing, experiencing and suppressing. Higher scoring psy-
chopathics were more cardiovascularly responsive when processing negative information than positive,
Keywords:
possibly reflecting an anomalously rewarding aspect of processing normally unpleasant material. When
Emotion
required to experience emotional response, by ‘getting into the feeling’ of the emotion conveyed by a
Cognition
Emotion regulation
negative image, higher factor 1 psychopathic individuals showed reduced responsiveness, suggesting
Psychopathy that they were less able to do this. These data, together with the absence of corresponding differences in
Factor 1 psychopathy subjective self-report might be used to inform clinical strategies for normalising emotion processing in
Psychophysiology of emotion psychopathic offenders to improve treatment outcome, and reduce risk amongst this client group.
DSPD Crown Copyright © 2012 Published by Elsevier B.V. All rights reserved.

1. Introduction standard for psychopathy in research and clinical settings. The PCL-
R yields a total score, as well as subscores reflecting factor 1 and
In the first part of the 19th century Pinel described psychopathy factor 2. While factor scores are correlated, they are also disso-
as a manie sans délire, a disorder of affect and impulse that other- ciable (Verona et al., 2004). Cognitive affective deficits have been
wise seemed to spare intellectual functioning (Pinel, 1801, 1806). shown, as predicted, to be most strongly related to factor 1 psy-
Later Cleckley’s (1941) psychopath was identifiable by his ‘general chopathy. It is therefore important to consider them separately
poverty in major affective reactions’. More recently, Hare’s (1991, when examining emotion processing ability in psychopathy (Blair
2003) 2 factor model of psychopathy distinguished callous, unemo- et al., 2004; Verona et al., 2004). Estimates suggest that 20–30%
tional traits (factor 1) from antisocial acts and unstable/deviant of prison populations can be categorized as ‘psychopathic’ (Harpur
lifestyle (factor 2). Factor 2 psychopathy is characterised by affec- and Hare, 1994), while an additional unknown number of individ-
tive disturbances believed to originate in aversive psychosocial uals meet similar affective criteria, without coming to the attention
learning (Blair and Mitchell, 2009). Disturbances include poor of criminal justice systems (Hare et al., 1999).
behavioural controls and impulsivity. Factor 2 is also associated Emotion processing in psychopathy is an important area of
with anxiety (Blackburn, 2007). In contrast, factor 1 psychopa- study because the associated deficits are functionally linked to
thy is characterised by callous unemotional traits thought to be violent offending and can be a target for treatment. Importantly,
rooted in temperament (Blair and Mitchell, 2009) and highly her- factor 1 characteristics are thought to be more treatment resis-
itable (Viding et al., 2005). These traits include shallow affect and tant than those of factor 2 (Poythress et al., 2007). One of the most
a lack of empathy, guilt or remorse. Factor 1 is exemplified by consistent findings from a wide range of studies of incarcerated
conning, manipulative behaviour combined with superficial charm psychopathic individuals is that they fail to process, experience or
aimed at maximising personal gain or excitement. The Psychopathy appreciate the emotional significance of stimuli in the way that
Check List-Revised (PCL-R; Hare, 1991, 2003) is the measurement 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.,
∗ Corresponding author at: PO 63, Department of Psychosis Studies, Institute of 2007). Emotion processing in psychopathy has been studied in a
Psychiatry, King’s College London, London SE5 8AF, UK. Tel.: +44 020 7848 5119. variety of different ways, including the recognition of emotional
E-mail addresses: [email protected] (H. Casey), categories (see Kirsch and Becker, 2007; Willmott et al., 2009 for
[email protected] (R.D. Rogers), [email protected] (T. Burns),
reviews), the subjective experience of emotion (Kirsch and Becker,
[email protected] (J. Yiend).
1
Present address: Institute of Psychiatry, King’s College London, London SE5 8AF, 2007) and psychophysiological responses to emotional material
UK. (Arnett, 1997; Kirsch and Becker, 2007; Lorber, 2004). In the present

0301-0511/$ – see front matter Crown Copyright © 2012 Published by Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.biopsycho.2012.06.011
542 H. Casey et al. / Biological Psychology 92 (2013) 541–548

investigation we concentrated on the latter two, measuring both self-reported levels of anger following mood induction, although
the strength of subjective experience of, and cardiovascular respon- heart rate and blood pressure were reduced for those with ASPD. In
sivity to, emotional images. addition, post hoc analyses showed that those 6 participants who
The psychophysiological response to differences in emotional scored highly on factor 1 psychopathy were less physiologically
valence (and arousal) has been well documented in the healthy responsive (blood pressure decreased) to the anger induction.
population. Negative or unpleasant stimuli prompt heart rate More recent emotion regulation paradigms (cf. Ochsner et al.,
deceleration, increased electromyographic (EMG) activity (such as 2004; Gross, 2002; Dalgleish and Yiend, 2006; Yiend et al., 2008;
frowning), increased skin conductance (SC) and potentiation of Mathews et al., 2004) have not yet been used to investigate emotion
affective startle (see Kirsch and Becker, 2007 for a review). Con- processing in psychopathy. In particular enhancement and sup-
versely positive emotional material is generally associated with pression of emotional experience when viewing affective images
the reverse pattern (with the exception of SC). In contrast reduced has not, to our knowledge, been examined in psychopathy. In an
or deficient autonomic responsivity to emotional material is usu- fMRI study Ochsner et al. (2004) instructed participants to view
ally reported in psychopathic individuals (Arnett, 1997; Kirsch and affective pictures (negative and neutral) under three conditions
Becker, 2007; Lorber, 2004). In particular there are widely docu- (look, experience and suppress) and to rate the level of their emo-
mented deficits in fear conditioning suggesting that psychopathic tional experience (0 = weak to 7 = strong). Results indicated that
individuals are unable to learn a fear response in the way that self-report ratings were significantly higher for experience and
others do (Hare et al., 1978) and reduced or absent autonomic dif- significantly lower for suppress compared to base-line look when
ferentiation between fearful and neutral stimuli across a variety viewing negative images. In addition, experiencing increased acti-
of measures (e.g. Patrick et al., 1994; Levenston et al., 2000). In a vation of the left amygdala whilst suppression decreased amygdala
detailed review of autonomic responsivity in psychopathy, Arnett activation bilaterally. Deficits in amygdala activation are implicated
(1997) notes that studies involving SC show a fairly consistent in emotion processing deficits in psychopathy (Blair et al., 2005).
pattern of reduced electrodermal activity when psychopathic indi- We used an adaptation of the Ochsner design to examine emotion
viduals process punishment or fearful stimuli, although response regulation in psychopathy. We used an instructed encoding task
to positive material has been less well studied. In contrast the find- to manipulate the cognitive processing of emotional pictures in a
ings for cardiovascular (heart rate) response are less clear, with sample of violent offenders categorised according to their level of
some showing acceleration in response to aversive stimuli (e.g. psychopathy. If clinicians are to improve therapy outcome amongst
Hare and Craigen, 1974; Hare et al., 1978), while others suggest few psychopathic offenders, then evidence based knowledge about how
psychopathy related differences (e.g. Patrick et al., 1993; Lorber, these individuals process and regulate their emotional responses is
2004). vital. Our translational study (compare Yiend et al., 2011) aimed to
In contrast, self-report ratings of the emotional content of address this clinical need by investigating the basic mechanisms
stimuli have frequently failed to show corresponding differences, involved in regulating emotion processing.
with psychopathic individuals showing similar valence and arousal
ratings as do comparator groups. For example, Patrick et al. (1993)
and Carmen Pastor et al. (2003) found no significant group dif- 2. Method
ferences for subjective ratings of picture content. Both high and
2.1. Participants
low psychopathic individuals reported that they found emotional
pictures more arousing and more interesting than neutral ones. 95 male prisoners at the Dangerous and Severe Personality Disorder (DSPD) Unit,
A similar dissociation between psychophysiological response and ‘D Wing’ at HMP Whitemoor were approached over a fourteen-month recruitment
self-report ratings was reported by Verona et al. (2004) when exam- period between June 2009 and July 2010. Heart rate was chosen as the sole physio-
logical measure due to the pragmatic considerations of security restrictions around
ining evocative sounds taken from a standardized set (positive for
equipment and prisoner acceptability and consent rates. The political and clinical
example baby’s laugh; negative, for example baby’s cry; neutral, context of these specialist units is described in detail in Burns et al. (2011a), together
for example toothbrush). Factor 1 was associated with attenuated with characteristics of the UK DSPD population and how these compare to similar
SC for both valences of emotional sound, and factor 2 was related previous samples in the literature. Of these 70 (74%) consented to take part in the
to heart rate differences, but neither factor was related to affec- study. Seven participants subsequently refused to take part due to paranoid concerns
about the heart rate monitoring equipment. For the same reasons, one participant
tive ratings, which were in line with normative data for these agreed to complete only the self-report ratings. One participant was transferred
stimuli. Together these findings point to dissociations between from the prison before testing commenced. Consequently complete datasets were
physiological response and self-report related to affective stimuli available for 61 participants, with 62 sets of data available in the case of self-report
in psychopathy. ratings.
Although experimental investigation of emotion regulation is a
topic of considerable current interest (see Koole, 2009) its inves-
tigation in psychopathy has rarely been reported. Two studies 2.2. Materials
are of some relevance however. Steinberg and Schwartz (1976)
2.2.1. Individual difference measures
examined the extent to which psychopathic individuals could mod- Level of psychopathy was measured using the PCL-R (Hare, 1991, 2003), admin-
ify SC by using instructions alone and then using biofeedback istered by trained and experienced clinical and forensic psychologists who conduct
training. Controls but not psychopathic individuals could imple- inter-rater reliability checks as part of their routine duties. It consists of a semi-
structured interview used in conjunction with a collateral file search to give a score
ment instructions (requiring affective imagery) alone, whereas
on a scale of 0–40 (sum of 0–2 for each of 20 traits) with higher scores indicating
after biofeedback training both groups could influence their SC greater levels of psychopathy. In clinical settings a score of 30 is used as a diag-
responsivity. In contrast no heart rate differences were found nostic cut off. The Eysenck Personality Questionnaire (EPQ, Eysenck, 1975) was also
until after biofeedback training, when psychopathic individuals administered. This is a widely used 100 item self-report questionnaire examining
were unable to maintain the heart rate effects of the instructional extroversion/introversion and neuroticism/stability and including a lie scale.

manipulation. The authors concluded that while psychopathic indi-

viduals were able to regulate some physiological responses, other
autonomic differences were less susceptible to control. A second 2.2.2. Picture stimuli
12 positive and 12 negative stimuli were selected from the International Affec-
study of direct relevance is that of Lobbestael et al. (2009) who tive Picture System (IAPS; Lang et al., 1999) on the basis of their normative valence
examined the effect of anger induction in antisocial personality dis- and arousal ratings. Negative pictures included guns, scenes of attack and fire, while
order (ASPD) and psychopathy. They found no group differences in positive images (which were matched for arousal, see below) included sporting and
 H. Casey et al. / Biological Psychology 92 (2013) 541–548 543

relationship pictures. Almost all pictures involved people.2 For each valence (nega- Heart rate
tive and positive) pictures were divided into 3 matched sets of 4 pictures each. Sets 73
did not differ significantly on normative arousal ratings (positive M = 6.28, negative
M = 6.27), t(22) = .08, p > .05 but differed significantly on valence (positive M = 7.29, 72
negative M = 2.50), t(22) = 27.92, p < .01. Sets were assigned to the emotion regula-
tion task condition (Look, Experience, and Suppress: see below) in counterbalanced
71
order across participants, according to a Latin square design.

Mean Heart Rate /

beats per minute
70
2.2.3. Apparatus
Heart rate was measured by finger pulse amplitude (FPA) and recorded with 69 Posive pictures
a photoplesythmograph connected to a pulse oximeter and placed by a clip on Negave pictures
the second finger of the non-dominant hand. FPA was sampled at 1000 Hz using
68
a Cambridge Electronic Designs Micro 1401 data acquisition unit with Spike 2 ver-
sion 4 software. Stimuli were presented using Psychology Software Tools’ E-prime
version 1.1 which also recorded self-report response ratings indicating strength of 67
emotion experienced.
66
High Lower
2.3. Procedure
Psychopathy group
Assessment took place in a designated room on a quiet part of the prison wing.
Heart rate recording was commenced at the beginning of the session prior to the task Fig. 1. Psychopathy-related group differences in cardiovascular response.
starting and continued throughout the task. On screen task instructions indicated
participants would see a series of pictures, with each one preceded by one of the fol-
lowing words: ‘Look’, ‘Experience’ or, ‘Suppress’. Initial instructions explained that 3.2. Heart rate data
‘Look’ meant participants should ‘view the picture naturally’; ‘Experience’ meant
they should ‘get into the feeling of the picture by imagining themselves involved in Pulse oximeter heart rate data was first down-sampled using a
the scene shown’; ‘Suppress’ meant they should ‘view the picture with the detached
perspective of a photographer’ (cf. Yiend et al., 2008). On individual trials this
low pass differentiator filter to remove extraneous noise. Identifica-
instruction appeared for 2 s followed by the picture presented full screen in colour tion of individual HR events (beats) was based on semi-automated
for 10 s. Participants then rated the picture on a Likert scale according to ‘the strength detection of peak amplitudes in the resulting differential data.
of feeling experienced while viewing the picture’ (1 = weak to 7 = strong). Each trial User-adjustable interactive cursors provided instantaneous event
ended with a 4 s rest period. Participants were given three practice trials (look,
interval displays, which were adjusted by eye to allow optimum
experience, and suppress) to allow familiarisation with the task. The entire task
took approximately 30 min to complete. In line with site practice (where prisoner event detection on a participant by participant basis. Individual
earnings are capped at a very low level) participants were not paid for participation. recordings were further examined for spurious events (e.g. due to
In a separate task delivered after the main emotion regulation paradigm we movement artefacts), which were manually removed. Spike 2 auto-
obtained participant ratings of the affective content (as opposed to ‘strength of feel- matically generated an evenly sampled waveform from this final,
ing’) of the stimuli used. Pictures used in the present task were presented full screen
on computer and participants were asked to rate valence and arousal (i.e. valence:
clean datafile which was then used to calculate (in milliseconds)
1, unpleasant – 7, pleasant, and arousal: 1, calming – 7, energetic). The rating task beats per minute and inter beat interval by participant by condition
was self-paced. (each 10 s picture presentation).

3.3. Group comparison

3. Results
A 2 × 2 × 3 repeated measures ANOVA with Group (high
3.1. Participant characteristics and design of analyses psychopathic, lower psychopathic) × Picture (positive, nega-
tive) × Instruction (Look, Experience, Suppress) was performed,
Two type of analysis were used to investigate the relation- with EPQ neuroticism, EPQ Extraversion and Previous Convictions
ship between psychopathy and emotion regulation. First we used as covariates. There were no significant main effects, but a signifi-
a median split group comparison, based on the clinical threshold cant interaction of Group × Picture, F (1, 54) = 5.77, p = 0.02, partial
of 30 (high psychopathic group = PCL-R ≥ 30, lower psychopathic 2 = 0.1.3 This interaction was interpreted by examining the sim-
group = PCL-R < 30). We compared these groups using repeated ple main effects of Picture at each level of Group. This revealed
measures ANOVAs with within subjects factors of Picture Type that while the lower psychopathic group showed no difference in
(positive and negative) and Instruction (Look, Experience, Sup- heart rate response to different types of pictures, the high psy-
press) and between subjects factor Group (high psychopathic, chopathic group showed a significant increase in heart rate when
lower psychopathic). Second, in line with previous practice (e.g. viewing negative compared to positive pictures (t(28) = 2.6, p = 0.01,
Yiend et al., 2008; Mathews et al., 2004), we calculated indices d = 0.49; see Fig. 1). Analyses of the same design were conducted
of experiencing and suppressing of emotion and used regression upon measures of the inter-beat interval. A similar pattern of results
analyses to examine their relationship with individual difference emerged in which only high psychopathic scorers had significantly
measures, in particular psychopathy. shorter (853 vs. 875 ms) inter-beat intervals when viewing negative
Table 1 therefore presents the characteristics of the whole sam- than positive pictures (F(1, 54) = 5.83, p = 0.02, partial 2 = 0.1).
ple and each group separately. The two groups differed significantly
in factor 1, factor 2 and total psychopathy score (by design), and
3.4. Regression analysis
also on EPQ-neuroticism, with non-significant trends indicating
possible differences on EPQ-extraversion and the number of previ-
In order to examine emotion regulation across the whole sam-
ous convictions. The latter three variables were therefore used as
ple indices of experiencing and suppression were calculated in
covariates in all analyses reported below.
line with previous practice (e.g. Yiend et al., 2008; Mathews

2
A full list of IAPS picture stimuli used can be obtained from the corresponding 3
Partial 2 effect size conventions vary but one suggestion is as follows: .04 small;
author upon request. .25 medium; .64 large (Ferguson, 2009).
544 H. Casey et al. / Biological Psychology 92 (2013) 541–548

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
a
p values reflect significance of high and lower group comparisons using either independent t-tests or chi squared analyses, as appropriate.
b
Normative scores measured using either the Wechsler Adult Intelligence Scale or the WASI.
c
Numbers may vary on individual measures due to occasional missing data points.

et al., 2004). For this the ‘just look’ condition acted as a base- (>2) indicated significant multicollinearity among the predictors
line which was subtracted from the ‘experience’ and ‘suppress’ and values were therefore z transformed prior to entry into the
conditions respectively (Experience Index = Experience − Look; regression model, after which collinearity was acceptable (Cohen
Suppress Index = Suppress − Look). Thus a positive Experience et al., 2003). Stepwise linear regression was chosen because we had
Index reflected the extent of heart rate speeding produced by the no a priori reasons to expect that the confounding variables would
instruction to ‘get into the feeling of the picture’, and a nega- be related to regulation of emotion. Results of the regression are
tive Suppress Index reflected heart rate slowing when attempting presented in Table 2.
to view in a detached manner, relative to simply looking at the As shown in Table 2 psychopathy factor 1 score was the
pictures. Indices were calculated by type of picture (positive and strongest predictor of heart rate Experience Index for negative pic-
negative) for each dependent measure separately (heart rate and tures and the only one to meet entry criteria (p < .05) for the model.
inter-beat interval). This produced a well fitting model in which factor 1 significantly
Bivariate correlations between these psychophysiological predicted increased heart rate when experiencing negative pictures
indices and psychopathy scores were examined. This suggested (p = .001), accounting for just over a quarter (26%) of its variance.
a possible association between total psychopathy score and the As can be seen in Fig. 2, the model suggests that for every one point
heart rate Experience Index for negative pictures (r = −.29, p = .023) increase in factor 1 score, increased heart rate when experiencing
and between factor 1 psychopathy (i.e. the affective subscale) and negative pictures will be smaller by approximately half a beat per
the same index (r = −.31, p = .015). Psychopathy was significantly minute.
negatively correlated with number of years spent in full time
education (r = −.29, p = .023), EPQ-neuroticism (r = −.26, p = .035)
and positively associated with the measure of recidivism risk, Table 2
the HCR20 (r = .29, p = .04). Index scores were significantly posi- Linear regression to determine predictors of heart rate speeding when experiencing
tively associated with number of years spent in full time education negative pictures.
(r = .30, p = .029) and negatively associated with the HCR20 (r = −.37,
Predictor Cumulative R2 ˇ t p
p = .017). These variables were therefore entered as predictors
Psychopathy factor 1 .26* −.51 −3.53 .001
alongside psychopathy in the regression analysis.
Years in education .25 1.80 .08
The distribution of the dependent variable (Experience Index, HCR20 .24 −1.57 .13
negative pictures) was approximately normal. As stated above, sev- Psychopathy total −.20 −.78 .44
eral predictors were correlated, therefore tolerances and variance Psychopathy factor 2 −.10 −.65 .52
inflation values were examined to assess potential multicollinear- EPQ neuroticism .03 .19 .85

ity problems. Low tolerances (∼0) and high variance inflation values *
F(1, 35) = 12.42, p = 0.001.
 H. Casey et al. / Biological Psychology 92 (2013) 541–548 545

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 subjec-
tive 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 evi-
Fig. 2. The affective component of psychopathy is associated with reduced ability dence of psychopathy related psychophysiological differences, in
to experience negative emotion. 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,
3.5. Affective rating data
the affective component of psychopathy (factor 1) was associated
with specific deficits in the ability to experience negative emotion.
Self-reported ratings assessed the strength of feeling experi-
First the data suggest a dissociation between cardiovascular
enced on a 7 point Likert scale while viewing each picture, with
response and subjective experiencing of unpleasant stimuli in
higher values indicating stronger feeling. Average ratings were
psychopathy. The strength of feeling reported during picture view-
calculated for each participant separately according to condition
ing was not influenced by the emotion regulation procedure, nor
(Picture type × Instruction). Group comparisons and regression
showed any differences related to variation in psychopathy scores,
analysis controlled for confounding variables in the same manner
either in group comparison or dimensional analyses. While a sim-
as reported above.
ilar dissociation has been widely reported elsewhere (Carmen
Pastor et al., 2003; Levenston et al., 2000; Patrick et al., 1993;
3.6. Group comparison
Williamson et al., 1991; Verona et al., 2004), this has been in rela-
tion to ratings of the hedonic tone of the emotional information
A 2 × 2 × 3 repeated measures ANOVA with Group (high
itself (e.g. valence and arousal ratings of picture content). In con-
psychopathic, lower psychopathic) × Picture (positive, nega-
trast the current data reflected participants’ strength of feeling
tive) × Instruction (Look, Experience, Suppress) was performed,
during the task, in line with previous methods of investigating emo-
with EPQ neuroticism, EPQ Extraversion and Previous Convictions
tion regulation. That there were no such differences points to one
as covariates. There were no significant main effects or interactions.
of several possibilities. First, participants may simply have been
non-compliant, making no attempt to alter their emotional experi-
3.7. Regression analyses ence in line with instructions. However this is unlikely, given that
cardiovascular response was affected. Second, it is possible that
Indices of experiencing (Experience Index = Experience − Look) participants were ‘faking bad’ (i.e. reporting no subjective emo-
and suppressing (Suppress Index = Suppress − Look) were calcu- tional effects despite experiencing them). This potential confound
lated for rating data. Bivariate correlations between these rating is ever present (in one direction or another) when investigating this
indices and psychopathy scores were examined, but there were population. Most interesting however, is the possibility that partic-
no significant associations (all ps > .2). There were three other ipants’ genuine attempts to regulate emotion simply failed to elicit
significant correlations between indices and our other sample char- downstream subjective effects, despite their influencing underly-
acteristics. The Experience Index for negative picture ratings was ing physiological mechanisms. Instrumental violence is known to
significantly negatively correlated with age (r = −.31, p = .01) and be associated with self-reported lack of emotional experience dur-
time served in prison (r = −.25, p = .05), while the Experience Index ing an actual offense (Cornell et al., 1996; Williamson et al., 1987)
for positive picture ratings was significantly negatively correlated and the current investigation may be a useful laboratory analogue
with EPQ Lie score (r = −.26, p = .05). for investigating this further.
Our second main finding indicated faster cardiovascular
3.8. Participant ratings of valence and arousal responses at higher levels of psychopathy. Specifically, those with
psychopathy scores above the standard diagnostic threshold exhib-
Although our main interest in subjective self-report concerned ited raised heart rate when viewing negative compared to positive
the strength of feeling experienced across emotion regulation con- pictures, whereas those with lower psychopathy did not. This
ditions, we nevertheless also obtained participant ratings of the result may at first seem at odds with the wider literature in which
affective content of the stimuli used (i.e. ratings of valence, 1, reduced or deficient autonomic responsivity to emotional mate-
unpleasant – 7, pleasant, and arousal, 1, calming – 7, energetic). rial is reported in psychopathic individuals (Arnett, 1997; Kirsch
As expected, and as reported previously in this population, stimu- and Becker, 2007; Lorber, 2004). However, this is to deny the
lus content was judged by our participants in the same manner as complexity of the field, and in particular the specific findings for
546 H. Casey et al. / Biological Psychology 92 (2013) 541–548

cardiovascular measures. In his review of autonomic responsiv- The present study had a number of strengths, but also limita-
ity in psychopathic individuals, Arnett (1997) notes that while tions. Although none of the effects reported here were attributable
the findings involving heart rate measures are less robust than to any confounding characteristics that were measured, unmea-
other psychophysiological indices, the two best designed studies sured confounders cannot be ruled out. Practical constraints meant
show heart rate speeding and acceleration in response to aver- that it was only possible to use a 2 dimensional model of psy-
sive stimuli (e.g. Hare and Craigen, 1974; Hare, 1978b). The current chopathy (factor 1; factor 2). However more complex models of the
data are in line with this, but are the first to demonstrate a pattern construct are increasingly being favoured (e.g. Cooke et al., 2006,
of increased responsivity to negative material using an affective 2007) and it remains under debate which of these models provides
picture processing paradigm (cf. Patrick et al., 1993, 1994). the best fit. Similar practical constraints meant that only one physi-
How might we interpret this result? As Arnett argues, increased ological measure (heart rate) was taken. Future studies on emotion
heart rate does not necessarily imply a more fearful response, but regulation in psychopathy should consider using other measures
it does indicate a stronger cardiovascular output which requires of autonomic responsivity in addition to heart rate. In particular
explanation, especially in the light of contrasting electrodermal Polyvagal Theory, which refers to the parasympathetic regulation of
data in which psychopathic individuals show attenuated responses cardiac activity, may be a useful framework for understanding emo-
to emotional information (e.g. Lorber, 2004; Dvorak-Bertsch and tional regulation in psychopathy in the future (cf. Beauchaine et al.,
Rubinstein, 2009; Patrick et al., 1993). The best account to date 2007). It has been used as a framework to investigate emotion reg-
remains that of Hare (1978a), although this is not without critics ulation problems in conduct disordered children (Beauchaine et al.,
(Siddle and Trasler, 1981; Fowles and Missel, 1994). Hare sug- 2007; Hastings et al., 2008) and has been shown to predict spon-
gests a gating hypothesis in which heart rate is used to tag and taneous regulation of negative emotional expression in healthy
subsequently filter out negative cues, while electrodermal attenu- adults (Pu et al., 2009). This would require measuring respiratory
ation reflects the extent to which this gating has been successfully sinus arrhythmia (the natural variation in heart rate occurring dur-
achieved. However, an alternative explanation of our finding sug- ing the breathing cycle) in psychopathy during emotion regulation
gests itself. In our sample the more callous and unemotional the tasks of the sort used here and would be one useful way to validate
participant, the more responsive was his cardiovascular system and extend the present work.
when processing negative compared to positive information. In A further limitation of our data was the absence of a truly low
the wider literature heart rate acceleration is the usual response psychopathic comparator group. Due to the population from which
to processing pleasant visual stimuli (e.g. Lang et al., 1999). This our sample was taken (incarcerated male offenders from the UK
raises the possibility that the response of high factor 1 psychopathic DSPD service) the entire sample scored in the upper ranges of the
individual to negative images may reflect a rewarding emotional PCL-R. It is therefore possible that the effects reported here apply
response to material that would normally be experienced neg- only to those upper ranges of the psychopathy distribution. In addi-
atively (Kirsch and Becker, 2007). Thus psychopathic individuals tion, our design did not include a neutral picture viewing condition,
may process the emotions that victims are most likely to express meaning that conclusions must necessarily be limited to differences
as rewarding and this may contribute to explaining their crimes in valence alone. This does not therefore permit conclusions about
(compare Marshall et al., 1995). general emotional responsivity in psychopathy, which may have
Our third and arguably most interesting finding was that been either attenuated or enhanced.
dimensional analyses revealed a specific relationship between We now turn to a brief speculative discussion of the three
factor 1 (affective component) psychopathy scores and the expe- themes of this special issue. The first theme is the ‘Specificity
riencing of emotional responses to negative pictures. More of Emotional Attention Brain Mechanisms’, in particular, how
callous/unemotional individuals exhibited smaller increases in can emotional attention mechanisms be dissociated from sys-
heart rate when trying to ‘get into the feeling of’ negative pictures. tems involved in the control of non-emotional attention? We
This result suggests that the experiencing of negative emotion focus our discussion on the specification the concept of ‘control’.
is more impaired at higher levels of factor 1 psychopathy. High Although our data cannot speak directly to the involvement of neu-
factor 1 psychopathic individuals fail to experience the physi- ral substrates, the question of attentional control of information
ological signals that those lower on factor 1 experience when processing is clearly central to paradigms such as ours that purport
fully engaging in negative emotional processing. Again, it is pos- to investigate ‘emotion regulation’. Controlling attention to differ-
sible that high factor 1 psychopathic individuals merely appeared ent types of information is very obviously one way (but not the
unable to increase physiological response to negative material, only way) that participants may use to implement instructions to
but in fact were simply less compliant with instructions to do ‘experience’ or ‘suppress’ their emotion. We have argued elsewhere
so. However, the absence of a similar pattern in affective rating (Yiend et al., 2008; Mathews et al., 2004) that an important next
data renders this an unlikely explanation. If high factor 1 psycho- step is to investigate exactly how participants implement these
pathic individuals were less compliant in regulating their emotions instructions. Observed differences in participants’ ability to ‘con-
as instructed, one would expect this to be at least, if not more, trol’ their attention in the manner we ask may be due to different
apparent when directly asked to report how they were feeling abilities to implement one particular strategy/mechanism, but it
under different regulation conditions. That rating data showed no could also arise from differences in which strategies/mechanisms
differences in factor 1 psychopathy level mitigates against this are actually used. One might start by evidencing the strategies
explanation. Failure to experience emotional response to negative and mechanisms that are spontaneously employed when instruc-
material will inevitably lead to a relatively reduced appreciation tions such as ‘suppress’ and ‘experience’ are given (an approach we
and understanding of that negativity, which in turn could form have called ‘explicit or volitional control’, see Yiend et al., 2008).
the basis for the absence of empathy that characterises factor Subsequently, one might compare different experimental tasks, all
1 psychopathy. Despite lack of empathy being core to the con- designed to elicit attentional control in a tightly prescribed fash-
struct of psychopathy (especially factor 1) very little research ion, but which reflect different underlying mechanisms for doing
has directly examined the relationship (Kirsch and Becker, 2007). so (‘implicit control’; Yiend et al., 2008). In both approaches, biolog-
Objective measures of empathy are required and the ability to ically based measures such as psychophysiology and neuroimaging
‘get into the feeling’ of emotional information using paradigms can provide objective and sensitive measurement of variations
such as that reported here could provide one possible starting in the control of attention to stimuli differing in emotional
point. tone.
 H. Casey et al. / Biological Psychology 92 (2013) 541–548 547

The second theme is ‘Emotional Attention in Psychopathology’, influential, they do not currently recognise the component cog-
in particular how can findings inform intervention strategies for nitive processes (such as attention) that might be differentially
relevant pathologies? We focus our discussion on the implication involved and that have proven so important in other clinical disor-
of our emotion regulation data for the treatment of psychopathy. It ders.
is well documented that addressing deficits in emotion processing In conclusion, the current investigation of emotion regulation in
is important for a good therapy outcome (Pos et al., 2003; Whelton, psychopathy revealed an amplified cardiovascular response when
2004; Greenberg and Pascual Leone, 2006). Indeed, some of the processing negative compared to positive emotional images in high
latest treatments for psychopathy in the UK specifically target emo- psychopathic individuals. It is possible that this reflects an anoma-
tional regulation (Burns et al., 2011b; Murphy and McVey, 2010). lously rewarding aspect of normally unpleasant material in the case
Our data suggest that effective treatment for psychopathy may of high psychopathic individuals. In addition when attempting to
need to focus on reducing the dissociation between subjective and experience emotional response, by ‘getting into the feeling’ of the
physiological response that we report. One way to do this might emotion conveyed by the image, higher factor 1 psychopathic indi-
be to raise individuals’ awareness of their physiological responses viduals showed reduced responsiveness, suggesting that they were
to aversive information. Mindfulness approaches that use biofeed- less able to do this. Overall this suggests that while psychopathic
back exercises to enhance emotion regulation may be particularly individuals may be more cardiovascularly responsive to negatively
effective. In addition, incorporating experimental measures along- valenced material than positive, the subset who are higher on the
side more traditional assessments of therapeutic outcome would be factor 1 scale are less able to intentionally regulate this response.
one potential translational application of the paradigm described These results could be used to inform clinical strategies for target-
here. Our data further suggest that although both patient and clin- ing emotion regulation in psychopathic offenders. In this way our
ician may believe they are engaging with the emotions targeted study may help to inform and improve treatment outcome, thereby
by therapy, the higher the factor 1 score of the patient, the less reducing risk amongst this client group.
likely this is to be true. Investigating emotion regulation ability in
psychopathy may be essential not only for understanding its rela- Acknowledgements
tionship to violent offending, but also for the appropriate allocation
of scarce therapeutic resources. The authors are indebted to the H.J. Eysenck Memorial Fund,
The third theme of this special issue is the ‘Methodology of who supported this work through the award of the 9th annual
Emotional Attention’, in particular how the results from different scholarship made to Dr. Jenny Yiend. We gratefully acknowledge
research methodologies might be usefully combined to test mod- the Ministry of Justice and Department of Health whose funding
els of emotional attention. We focus our discussion on the benefits through the DSPD Programme provided a significant proportion
and challenges of integrating different methodologies and con- of the data reported here. We are deeply grateful to the staff and
sider applying this to two specific psychopathologies. Cross cutting patients at HMP Whitemoor without whose assistance this work
research, whether across methods or disciplines, is lauded by pol- would not have been possible, in particular Dr. Jacqui Saradjian
icy makers and funders alike because of its potential to improve and her clinical team. We gratefully acknowledge the Flemish Sci-
the validity and impact of the research output and generate high ence Foundation (FWO-Vlaanderen) whose Research Community
quality, innovative work. It is often hard to achieve though, due Grant to collaborators of Dr. Yiend at Gent University fostered the
to inherent differences in researchers’ theoretical priorities and preparation, presentation and discussion of these data. Particular
assumptions or empirical constraints. As previous reviews have thanks are due Jan de Houwer, Dirk Hermans, Ernst Koster and Rudi
demonstrated (Yiend et al., in press; Yiend, 2010) the investiga- de Raedt for their supportive collaboration. We thank Steve Clifford
tion of emotional attention is a classic case in point. Attention to for assistance with psychophysiological data analysis and Matthew
emotion in the general population and attention to emotion in Isard for assistance with preparation of the manuscript.
psychopathology have largely proceeded as independent fields of
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