The effects of stress hormones on cognitive emotion regulation: A systematic review and integrative model

The experience of stress and the need to regulate emotions are pervasive in everyday life. Emotion regulation (ER) is particularly required under stress to facilitate successful adaptation and recovery. Importantly, a growing body of work has identified stress and ER deficits as transdiagnostic risk factors for psychopathology. This highlights the relevance of understanding how stress impacts ER to elucidate individual vulnerability to mental disorders. Stress alters cognitive and emotional functioning via stress hormones secreted by the two major stress systems: sympathetic nervous system and hypothalamus-pituitary adrenocortical axis. This review aims to compile and synthesize empirical studies in humans investigating the effects of acute stress and stress hormones on ER. A systematic literature search yielded 14 relevant studies, 11 investigating acute stress effects and 3 examining the influence of pharmacological cortisol elevations on ER. The results of the stress studies are mixed revealing either impairing, beneficial or no effects at all. Cortisol administration mostly facilitated ER attempts. Notably, we detected timing differences in measuring ER performance relative to stress exposure that potentially reconcile divergent findings. Here, we propose the PRESSURE model (Predominant Stress System Underpins Regulation of Emotions) postulating that the direction and magnitude of stress effects on ER depends on the relative predominance of one stress system over the other. Additionally, sex-stress hormone interactions, stimulus intensity and ER strategy are discussed as possible moderators. Finally, we highlight limitations in current research and provide recommendations for future studies that will further advance our understanding of the intricate relationship between stress and ER.