Emotion Regulation as a Pathway Connecting Early Life Adversity and Inflammation in Adulthood: a Conceptual Framework

Abstract

Chronic inflammation is implicated in a variety of diseases (e.g., cardiovascular disease and cancer). Much evidence suggests that early life adversity (ELA), such as maltreatment or neglect, can increase risk for inflammation in adulthood. ELA may program proinflammatory activity via its effects on brain areas involved in emotion regulation. Of multiple emotion regulation strategies, some are considered maladaptive (e.g., expressive suppression), while others are generally adaptive (e.g., cognitive reappraisal). We propose a conceptual framework for how emotion regulation tendencies may affect vulnerability or resilience to inflammation in adults who experienced adversity in childhood and/or adolescence. In support of this framework, we summarize evidence for the relationships between emotion dysregulation and higher inflammation (i.e., vulnerability), as well as between cognitive reappraisal and lower inflammation (i.e., resilience), in healthy adults with a history of ELA. Plausible neurobiological, physiological, psychosocial, and ELA-specific factors, as well as interventions, contributing to these associations are discussed. Strengths and limitations of the extant research, in addition to ideas for future directions, are presented.

Keywords: Cognitive reappraisal; Early life adversity; Emotion regulation; Inflammation; Resilience; Vulnerability.

Fig. 1

Model of emotion regulation tendencies as potential drivers of vulnerability or resilience to inflammation in adults with a history of early life adversity (ELA). Our conceptual framework proposes that emotion dysregulation can mediate connections between ELA and higher inflammation (i.e., vulnerability). Emotion dysregulation could also exacerbate associations between ELA and inflammation. In contrast, adaptive emotion regulation strategies such as cognitive reappraisal use may buffer connections between ELA and inflammation (i.e., resilience). Cognitive reappraisal use may also predict lower inflammation. Factors that may affect these pathways of vulnerability or resilience can be neurobiological, physiological, psychosocial, and/or ELA-specific