This article is for use only of students enrolled in GPS 520: Advanced Social Psychology for purposes associated with this course and may not be retained or further disseminated.

Dale, K. L., & Baumeister, R. F. (200 

SELF-REGULATION AND

PSYCHOPATHOLOGY

KAREN L. DALE AND ROY F BAUMEISTER

The term self-regulation refers to people’s efforts to alter their own responses, such as overriding behavioral impulses, resisting temptation, controlling their thoughts, and altering (or artificially prolonging) their emotions. During the 1980s, social psychologists belatedly awoke to the importance of self-regulation for understanding human functioning. By ne­cessity, clinical psychologists had gained some appreciation of self-regulation earlier (e.g., Kanfer & Karoly, 1972), but the full import of self-regulation for clinical phenomena could not be grasped until basic research estab­lished the major outlines of how it worked. Hence, it is only now that the implications of self-regulation for psychopathology can begin to be ex­plained. In this chapter, we apply current self-regulation theory to clinical patterns and psychopathology.

The potential applications of self-regulation theory are extensive. In a review of the research literature on self-regulation failure, Baumeister, Heatherton, and Tice (1994) concluded that the majority of contemporary social and personal problems afflicting Western society contained some significant element of self-regulation failure. These include alcohol and drug abuse, violence, teen pregnancy, school failure, addiction, unsafe sex, gambling, debt and overuse of credit cards, eating problems, failure to save money, child abuse, spouse abuse, elder abuse, divorce, and widespread deficiencies in exercise and physical fitness. If these problems of normal and supposedly healthy people involve deficiencies in self-regulation, it to self-regulation issues. Indeed, insofar as patterns of psychopathology reflect excesses or more extreme versions of the same problems that suppos­edly normal and healthy people suffer, one should expect self-regulation problems to prove central to many mental, emotional, and behavioral pathologies.

SELF-REGULATION THEORY: BACKGROUND

The concept of self-regulation is closely related to the colloquial term self-control, and here we use the two terms interchangeably. Self-regulation involves altering one’s own responses. Thus, a given stimulus might elicit one typical or automatic reaction, but the person can respond differently by virtue of self-regulation. Dieting is a good example. A hungry person would respond to the presence of delicious food by eating it, but self-regulation allows the person to override that response and refrain from eating.

Self-regulation theory has its roots in the study of delay of gratifica­tion (e.g., Mischel, 1974). The standard paradigm for studying delay of gratification was to offer a child the choice between an immediate but small reward and a larger but delayed one. Optimal, rational choice would entail taking the larger reward, but this required the child to resist the impulse and temptation to take the immediate gratification. The capacity to delay gratification is essential to civilized life, and predictably recent evidence suggests that children who have a higher ability to delay gratifi­cation at age 4 grow up to be more successful both socially and academi­cally (Mischel, Shoda, & Peake, 1988; Shoda, Mischel, & Peake, 1990).

Preparation of this chapter was facilitated by Research Grant MH-57039 from the National Institutes of Health.       

An important advance in self-regulation theory was provided by using the concept of feedback loops to construct a system framework (Carver & Scheier, 1981; see also Powers, 1973). Using the analogy of a thermostat, these theorists explained self-regulation in terms of comparing the self’s current status with a standard or goal and if the self fell short, making some change (as a thermostat turns on the furnace) to bring it up to the desired state. The acronym TOTE (i.e., test, operate, test, exit) was used to de­scribe this sequence: One compares oneself with a standard (e.g., measures one’s weight), operates to reduce discrepancies (i.e., undertakes a diet), and compares again, until the discrepancy is resolved and the self has matched the standard, whereon one exits the sequence.

Another decisive advance for self-regulation theory was the distinc­tion between automatic and controlled processes (e.g., Bargh, 1982). Au­tomatic processes are efficient and require few resources but are relatively rigid and inflexible. Controlled processes are inefficient and expensive (in terms of psychological resources) but are highly flexible. Pure automatic responses may be relatively immune to control, but there are many re­sponses that proceed automatically unless they are overridden by a con­trolled process. Controlled processes are thus central to self-regulation. The inefficiency and resource requirements of controlled processes mean that only a small proportion of behavior can be regulated effectively. However, the flexibility of controlled processes entails that self-regulation is central to the diversity and adaptive variety of human behavior.

SELF-REGULATION FAILURE AND PROCESSES

On the basis of Carver and Scheier’s (1981) analysis of the feedback loop, we can specify three main requirements of successful self-regulation: standards, monitoring, and strength. A deficiency in any of them can con­tribute to self-regulation failure (Baumeister et al., 1994). The first is hav­ing standards, which are norms, goals, ideals, or other values. These are cognitive representations of the way one ought ideally to be. If standards are lacking or are in conflict, self-regulation lacks direction and by defi­nition cannot succeed.

The second requirement is monitoring. Carver and Scheier (1981) explained self-awareness as being essential to self-regulation because the person must attend to the self to ascertain how the self compares with the standard. More generally, people cannot alter their own behavior without being aware of it, and states that reduce self-awareness (e.g., alcohol in­toxication; see Hull, 1981) tend to promote self-regulation failure. In con­trast, elaborate and specific monitoring of target behaviors (e.g., weighing oneself and keeping track of caloric intake) is an important contributor to successful self-regulation.

The third ingredient is the application of a resource for altering the self. After all, self-regulation would hardly succeed without the capacity to override one’s responses, even if one held clear standards and monitored the target behavior carefully. This corresponds to the “operate” phase in the TOTE model. Carver and Scheier (1981) did not clearly spell out how these operations occur, but the nature of these operations has been the focus of some recent efforts, including in our own laboratory. Because this work is relatively new, we summarize it briefly here.

We conclude that self-regulation operates like a muscle, in which strength or energy is used to override responses and alter behavior. In this analysis (Baumeister & Heatherton, 1996; Baumeister et al., 1994), the impulse contains some degree of strength; so for the person to resist that impulse, he or she must exert a greater amount of strength against it. There are individual and situational differences in self-regulatory strength, and so success at self-regulation will vary.

Evidence for the strength model of self-regulation has been found in studies of ego depletion. The strength model predicts that after an act of self-control, the resource will be temporarily depleted (akin to a muscle being tired after exertion) and subsequent efforts at self-control will be less successful. Contrary predictions can be made on the basis of other possible models of self-regulation. For example, if self-regulation operates like a cognitive schema, then an initial act of self-regulation would prime the schema and facilitate subsequent self-regulation. Alternatively, if self-regulation were primarily a skill, then there should be little or no change in consecutive acts of self-regulation, insofar as skill remains largely con­stant from one trial to the next (although over many acts it should improve through learning).

To test this model, Muraven, Tice, and Baumeister (1998) confronted people with two consecutive but seemingly unrelated demands for self-regulation. In a series of studies, they found that the effectiveness of self-regulation was diminished on the second task. In one study, for example, people first strove to regulate their thoughts (by suppressing thoughts about a white bear—a procedure borrowed from Wegner, Schneider, Carter, & White, 1987) and were then instructed to refrain from laughing or smiling in response to a humorous video. The thought suppression exercise im­paired their ability to stifle their amusement. In another study, an initial act of controlling their emotional distress in response to an upsetting video reduced their performance on a physical endurance task.

Thus, the results of these studies indicate that initial acts of self-regulation consumed an important resource that was then unavailable to help them regulate their behavior on a subsequent task. The capacity for self-regulation appears to involve a common resource that is easily de­pleted. Like a muscle that becomes tired and loses its ability to perform, self-regulation can accomplish only a limited amount without having some time to recover.

Subsequent work suggests that the resource or strength involved in self-regulation is also used for other functions of the self. Baumeister, Brats­lavsky, Muraven, and Tice (1998) concluded that all active responses by the self draw on that same volitional resource—hence, the choice of the term ego depletion rather than the narrower self-regulatory depletion. Using a procedure borrowed from cognitive dissonance research (Linder, Cooper, & Jones, 1967), they demonstrated that making a choice to perform a counterattitudinal behavior (specifically, a speech favoring a large tuition increase, which most tuition-paying students would oppose) depleted the resource and led to subsequent decrements in self-regulation. People who performed the same counterattitudinal behavior without free choice did not show the decrement. Moreover, people who chose to perform a pro-attitudinal behavior did show the drop in subsequent self-control. These findings indicate that it is the act of choice, not the behavior in question, that depleted the self and impaired subsequent self-regulation. In another study, Baumeister et al. linked self-regulatory exertion to greater passivity in choice behavior, suggesting that active responses draw on the same vo­litional resource required for self-regulation.

SELF-REGULATION THEORY: ADDITIONAL ASPECTS

Self-regulation failure can be divided into two types: underregulation and misregulation (Baumeister et al., 1994; Carver & Scheier, 1981). Un­derregulation is a failure to control one’s behavior, and it is the more prevalent and important pattern of failure. Misregulation involves success­fully altering one’s responses but in a way that fails to bring about the desired result. An example of underregulation is the dieter who gives in to temptation and eats the forbidden, fattening food. An example of misreg­ulation is the depressed person who consumes alcohol to cheer up but ends up feeling even worse.

Lack of strength is a common cause of underregulation, but the evi­dence is far from clear as to whether people are overwhelmed by powerful, uncontrollable impulses or instead simply neglect to use the strength they have. Baumeister et al. (1994; also see Baumeister & Heatherton, 1996, and commentaries in that issue) proposed a mitigated acquiescence model, by which people allow themselves to fail at self-regulation, although they do so under circumstances that allow them to think that self-regulation would be nearly impossible. They may feel overwhelmed for a moment to the point at which they cannot maintain self-control, but once they relax the self-control, they not only fail to restore it but also may even actively participate in thwarting it. For example, an abstaining drinker may feel overwhelmed by stress or emotion so that he or she is unable to avoid all drinking and therefore may break down and have one drink. At that point, however, he or she neglects to reinstate the abstinence and may even actively participate in obtaining and consuming more alcohol.

In any case, it is clear that success at self-regulation depends on both the strength of the impulse and the strength of the self-regulatory efforts that oppose it, and variations in either can tip the balance and affect the outcome. Stress and emotional upset are important causes of self-regulatory failure (Baumeister et al., 1994). Muraven and Baumeister (1997) ex­plained these effects in terms of ego depletion. Stress makes demands on the self for active responses, and emotional distress consumes resources, when people try to avoid acting out negative or harmful impulses and try to extricate themselves from their distressed state. These are relevant to the present discussion because many forms of psychopathology involve stress or emotional upset, and so individuals may deplete their self-regulatory resources in that struggle. Hence, many of the side-effects or harmful consequences of mental illness could be mediated by ego depletion.

Many forms of self-regulation (including delay of gratification) in­volve a conflict between an immediate, short-term goal and a long-term one, and self-regulation succeeds when the person can resist the immediate impulse and pursue what is best in the long run. To accomplish this suc­cessfully, it is often necessary for the person to see beyond the immediate situation and its pressing stimuli. The capacity to do this has been termed transcendence. That is, the person must be mentally able to transcend the immediate situation and appreciate the long-term implications of the op­tions and behaviors that are presently on offer. Factors that immerse the person in the immediate situation may therefore weaken self-regulation and contribute to impulsive, potentially regrettable acts.

The role of attention in self-regulation has been broadly recognized by both psychological theorists (e.g., Carver & Scheier, 1981, who titled their book Attention and Self-Regulation) and laypeople (e.g., the dieter who posts a photo of a pig on the refrigerator). Baumeister et al. (1994) con­cluded that the farther some response sequence has progressed, the more difficult it is to stop. Therefore, attention, which marks the beginning of most response sequences, is often the most effective and easiest way to control problem behaviors. Loss of control over attention is associated with many patterns of self-regulation failure.

Once self-regulation begins to fail, multiple additional factors come into play that can cause it to snowball into a major binge or breakdown. Marlatt (1985) coined the term abstinence violation effects to describe the way that once an addict or alcoholic begins to use the forbidden substance, the psychological consequences of crossing the line encourage him or her to continue using it and indeed to escalate to a problematic binge. Ban­meister et al. (1994) used the more general term lapse-activated patterns to extend Marlatt’s observation to forms of self-regulation failure other than substance abuse. Lapse-activated patterns may include rationalizing the in­itial misdeed, discovering that the anticipated bad consequences fail to materialize, enjoying the pleasure of the indulgence, losing control over attention (especially if abstinence depended on keeping one’s attention off the forbidden stimulus), and cessing to monitor the target behavior.

The initial lapse of self-control is itself often trivial. For example, eating one cookie may technically violate one’s diet, but the net effect on one’s caloric intake is small. If the first cookie leads to a second and so on until the bag is empty, however, then the diet is thwarted. Thus, the factors that escalate a small lapse into a major binge are often important for un­derstanding self-regulation failure.

SUMMARY OF SELF-REGULATION THEORY

Self-regulation involves the control of one’s own behavior, normally by means of controlled (vs. automatic) processes and often accomplished by overriding a normal, habitual, or impulsive response. It typically in­volves a feedback loop in which the person compares the self against stan­dards, operates to bring the self closer to these standards, and then com­pares again, until the goal is reached. The operate phase of self-regulation involves changing the self.

Underregulation, a form of self-regulation failure, can occur because standards are lacking or contradictory, because the person fails to monitor, or because the person cannot accomplish the desired change. Misregulation can occur when the person alters the self in nonoptimal ways.

Our work emphasizes that changing the self involves the use of a limited resource akin to strength. Strength is built up through exercise but temporarily depleted by exertion. Competing demands (e.g., emotional dis­tress) and stresses thus impair the capacity to regulate a given behavior.

SELF-REGULATION, PSYCHOPATHOLOGY, AND TREATMENT

Besides being essential for optimal functioning, the capacity for self-regulation is an important component of adaptive functioning. Clinical and social psychologists alike have long recognized this importance (albeit sometimes implicitly). For instance, Maddux and Lewis (1995) referred to psychological dysfunction as “ineffective or maladaptive self-regulation in pursuit of goals” (p. 39). Self-regulation failures are symptomatic of psy­chopathology and are often listed among the diagnostic criteria for mental disorders. For example, criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. LDSM-IVI; American Psychiatric Association LAPAI, 1994) were recently modified to include difficulties controlling worry as a criterion for generalized anxiety disorder (Clark, Smith, Neigh­bors, Skerlec, & Randall, 1994). In addition to being symptomatic of “gen­eral” psychological dysfunction, the central role of regulatory failure has also been implied in a wide variety of specific psychological problems rang­ing from childhood disinhibition disorders to the paraphilias (see, e.g., DeWaele, 1996; Levine, Risen, & Althof, 1990; Newman & Wallace, 1993; Stein & Hollander, 1993; Strauman, 1995).

Successful treatment of psychopathology requires the ability to self-regulate. Indeed, much of the literature on regulatory failures and clinical psychology focuses on treatment implications. Gruber (1987) found that children with developmental disorders are deficient in their capacities for self-regulation, which reduces their ability to benefit from therapy. Sea­baugh and Schumaker (1994) found that self-regulation training increased lesson completion in students with and without learning disabilities. A recent modification to behavioral couples therapy emphasized the change from partner- to self-defined behavioral change goals as an important factor in marital therapy (Halford, Sanders, & Behrens, 1994). The abilities to set goals and monitor progress toward one’s goals—requirements of self-regulation—are important components of successful therapy.

The processes outlined in our model can be applied to psychopa­thology to elucidate the treatment implications of self-regulation failure. In the remainder of this section, we discuss the implications of emotion regulation for treatment in general. Specific disorders are discussed in the following sections.

Poor control over emotional experiences and expression is a central characteristic of many psychopathologies. Gross and Munoz (1995) sug­gested that “emotion regulation is an essential feature of mental health” (p. 151). They noted that successful emotion regulation helps to sustain attention in the workplace, is essential to healthy relationships requiring emotional reciprocity, and is an important component of feeling a sense of comfort within oneself. Unsuccessful emotion regulation can result in the development of problems such as mood disorders, substance use disorders, poor school performance, marital distress, and dysfunctional parenting (Gross & Munoz, 1995). The implications of unsuccessful attempts to es­cape a negative mood state are discussed in the section on mood disorders.

The capacity to generate, express, and sustain emotions also has im­plications for psychopathology. Indeed, allowing oneself to experience and express negative emotions may be a focus of treatment. Cole, Michel, and Teti (1994) noted that research is needed on how the amplification of emotions supports or interferes with behavior in specific contexts. Research based on the strength model of ego depletion may address this issue. Ac­cording to the strength model, attempting to alter one’s emotional re­sponses could deplete regulatory resources and interfere with subsequent behaviors. Muraven et al. (1998) found that both the amplification and suppression of emotional responses require exertion and can decrease reg­ulatory strength in subsequent tasks. Participants who altered their emo­tional responses to an upsetting movie exhibited poorer self-regulation on a subsequent physical stamina task. Furthermore, this effect was not attrib­utable to the emotional state per Se. Likewise, consistent with the strength model of ego depletion, suppressing emotional responses, whether happy or sad, resulted in lower performance on a cognitive task, Baumeister et al. (1998) found. Thus, although suppression of emotions (e.g., experiencing denial to survive an incest experience) can serve adaptive functions (Cole et al., 1994), suppression can have some harmful effects. Further research is needed to identify the conditions under which amplification or suppres­sion of emotional responses is adaptive.

Our model suggests that attempting to regulate one’s emotions will drain an already seemingly limited supply of resources and perhaps make regulatory failure in other spheres more likely. Recommendations for treat­ment based on such a model could perhaps include focusing on a limited number of changes at once. For instance, starting a new diet to boost one’s confidence when depressed may be unwise. Attempting to regulate the depressed mood may deplete resources and increase the likelihood that the attempt to diet will fail. This failure may in term perpetuate the depressed mood and so on. Relevant treatment issues are noted later in the discussion of separate disorders.

ATTENTION DEFICIT HYPERACTIVITY DISORDER

One of the most fascinating areas of research integrating social and clinical perspectives on self-regulation is attention deficit hyperactivity dis­order (ADHD). The primary symptoms of ADHD are impulsiveness, hy­peractivity, and poor sustained attention (Barkley, 1997). Barkley reviewed the literature on neuropsychological functioning in those with ADHD and presented a model suggesting that deficiencies in behavioral inhibition are central to ADHD. Consideration of Barkley’s model and the evidence he presented highlights the applicability of our model to ADHD. For example, consistent with our model, central factors in Barkley’s model include con­flict over immediate and delayed consequences, an inability to engage in successful goal-directed behavior, deficiencies in controlled processing, and deleterious effects of a drain on regulatory resources.

Barkley’s (1997) review of the literature on ADHD showed extensive evidence of regulatory failure in those with ADHD. According to l3arkley, these failures may arise from the toll that poor behavioral inhibition takes on self-regulation. The term behavioral inhibition refers to three processes: the inhibition of a response that will yield immediate reinforcement, the stopping of an ongoing response (to delay the decision to respond), and interference control. According to Barkley’s model, behavioral inhibition is central to the successful functioning of working memory; internalization of speech; behavioral analysis and synthesis; and self-regulation of moti­vation, affect, and arousal. Each of these abilities affords control of goal-directed behavior. In children with ADHD, development of these abilities is impaired. That is, inhibitory deficits disrupt the successful execution of goal-directed behavior by its influence on the executive functions of the self, including self-regulation.

The need for successful behavioral inhibition may be strongest when there is a conflict between the immediate and distal consequences of an act. Given this conflict, inhibition permits a delay in the decision to re­spond, a delay that is necessary to determine one’s further actions and monitor one’s progress. Inhibition enables one to interrupt his or her on­going behavior, to assess the situation, and to reengage in that behavior. This is consistent with our model of regulatory failure. To reiterate, the abilities to transcend the immediate situation and monitor progress toward one’s future goals are essential components of effective self-regulation. Con­ceptualized in terms of Carver and Scheier’s (1981) feedback loop, inhi­bition enables one to act in ways to reduce discrepancies between one s current standards and actual events.

Children with ADHD experience deficits in this necessary disengage­ment and reengagement. Schachar, Tannock, Marriott, and Logan (1995) examined response inhibition and response reengagement in boys with per­vasive ADHD, boys with situational ADHD, and control boys and found that deficits were greatest in those with pervasive ADHD. Barkley’s (1997) model illustrates how such deficits may arise. For instance, according to the model, children with ADHD should be largely influenced by the im­mediate context and be less able to recall information that may aid in planning for the future (and thus engaging in the appropriate behavioral responses). Indeed, children with ADHD exhibit poor performance on tasks that might reflect such a capacity for forethought and planning ahead, such as the Wisconsin Card Sorting Task.’ Also important for the formu­lation of plans is the internalization of speech. This enables one to con­struct an organized method of behavioral change, which is necessary for effective self-regulation.

Consequently, tasks involving temporal delays and requiring inhibi­tion should produce performance deficits in those with ADHD (e.g., Barkley, 1997). Poorer task performance may be attributed to boredom, distractibility, or lowered persistence. The deleterious effects of boredom and distractibility implicate the role of poor attention control in ADHD, which is also consistent with our model.

Barber, Milich, and Welsh (1996) noted the poorer effort exhibited by children with ADHD on repetitive tasks. Research showing performance deficits on controlled processing tasks across children with ADHD and control participants fails to show such differences in performance on au­tomatic processing tasks (Borcherding et al., 1988). To reiterate, controlled processes are those that are central to self-regulation. Thus, the performance deficits exhibited by children with ADHD are found only on tasks requiring self-regulation. That is, relative to other children, children with ADHD exhibit deficits in self-regulation.

Other indications of regulatory failure are evident, such as problems deferring gratification and poor regulation of inappropriate verbal responses (Barkley, 1997). Children with ADHD are at risk for additional problems indicative of regulatory failure, such as impulse control disorders (Specker, Carlson, Christenson, & Marcotte, 1995). The depletion of regulatory strength could contribute to these additional problems. Furthermore, our model has implications for treating ADHD. Attempts to treat ADHD by instructing children to exert greater efforts at self-control could temporarily deplete resources and exacerbate immediate behavioral problems. Treat­ment programs that emphasize long-term outcomes and that educate par­ents and children about possible temporary “setbacks” could be beneficial. Research currently being conducted in our laboratory is examining the application of the strength model of ego depletion to children.

MOOD DISORDERS

Regulatory failure is both symptomatic and causal of the mood dis­orders. Symptoms of regulatory failure that are associated with the mood disorders are briefly described within the context of defining mood disor­ders. After this, we discuss the causal role of self-regulation failure.

The mood disorders section in the DSM-IV includes several condi­tions encompassing depressive disorders, bipolar disorders, and others. The predominant feature in all disorders is a disturbance in mood. That is, the individual experiences a particular emotional state such as a sad mood (in a major depressive episode) or an elevated, expansive, or irritable mood (in a manic episode). Although there are several diagnoses within the mood disorders, that section is largely restricted to a discussion of the disorders involving an unpleasant emotional state such as major depression. However, a brief description of the symptoms of manic episodes highlights the relevance of our model to other mood disorders.

¹Balkley reviewed studies on participants’ performance on the Wisconsin Card Sorting Test, concluding that those with attention deficit exhibit poorer performance.

Manic Episodes

Symptoms of manic episodes include distractibility; flight of ideas; increased goal-directed activity; and an abnormal and persistently elevated, expansive, or irritable mood (APA, 1994). Many of the components of regulatory failure outlined in our model are evident. For instance, the term distractibility refers to poor attention control. Increases in goal-directed be­haviors are evident, but these behaviors are often self-defeating. That is, misregulation is evident in that individuals are able to alter their responses, but they do so in ways that yield negative outcomes. The combination of symptoms present in mania presents an interesting challenge for self-regulation theory. In mania, acts of volition are strengthened in some aspects (e.g., goal-directed activity) but are weakened in others (e.g., poor attention control). This is consistent with the strength model of ego de­pletion in that exertion of regulatory effort in one sphere has deleterious effects on another sphere.

Major Depressive Episodes

Many indications of self-regulation failure outlined in our model are also evident in major depressive episodes. Symptoms include poor attention control, underregulation of emotional states, and misregulation of emo­tional states. For example, a failure to control one’s anger—an example of underregulatton—can occur (APA, 1994). Misregulation is also evident. For instance, the inability to regulate one’s depressed state often arises from the use of inappropriate or ineffective strategies. A discussion of the eti­ology of depression highlights how regulatory failure occurs in depression.

Strauman (1995) suggested that depression-related symptoms and emotions develop when events occur that are incongruent with self-standards. As noted, the monitoring and altering of one’s behavior to re­duce discrepancies between self-standards and one’s current situation are important components of self-regulation. Pyszczynsksi and Greenberg’s (1987) theory of depression described how these discrepancies can lead to depression. They proposed that a depressive self-focusing style is a mala­daptive response to the inability to reduce discrepancies between actual and ideal standards. High levels of self-focus and negative affect produce a negative self-image and help maintain the depression.²

Although self-awareness in general is essential for effective monitor­ing, the failure to direct attention away from a negative focus on the self can lead to depressive episodes. Ruminating on the depressed state inter­feres with active problem solving and the execution of behaviors that bring pleasure and thus could lift one’s mood. Furthermore, focusing on bad moods can result in risky behaviors that have negative outcomes that may perpetuate the bad mood (Baumeister et al., 1994). Thus, ruminating on the depressed state can be maladaptive in that attention may be drawn away from positive distractors that may lift one’s mood. Furthermore, in­effective attempts at emotion regulation may deplete regulatory resources that could be used for more effective coping strategies.

Evidence for an attentional bias toward negative information in gen­eral in depression is mixed.³ McCabe and Gotlib (1995) studied attentional deployment in individuals with and without clinical depression.

²Specifically, Pyszczynski and Greenberg (1986) noted that self-focus among depressed people increases after failures and decreases after success.

³In an earlier review, Dalgleish and Watts (1990) found this bias to be weaker than that found in the anxiety disorders.

They found that rather than showing an attentional bias toward negative information, participants with depression failed to demonstrate the positive bias exhibited by those without depression. Mathews, Ridgeway, and William­son (1996) studied attentional deployment in participants with depression and anxiety and found that depressed participants (but not anxious partic­ipants) selectively attended to socially threatening words more so than neutral words. This is consistent with the hypothesis that depression in­volves a negative attentional focus on the self.

The negative attentional focus exhibited by individuals with depres­sion can maintain and exacerbate the depression. Treatment for depression should focus on achieving attentional control of negative thoughts. How­ever, simply trying to focus on external factors or trying to think of positive thoughts may not be successful. Wegner (1994) described how attempts at mental control can produce a resurgence of the very thoughts one is trying to control. Furthermore, people are less able to suppress thoughts when they are under stress or fatigued. This is consistent with the idea of ego depletion outlined earlier. When there are competing demands on re­sources, attempts at thought suppression may fail.

Wenzlaff, Wegner, and Roper (1988) examined the strategies of thought suppression in individuals with depression. Participants attempted to control their negative thoughts by focusing on unpleasant distractors. This pattern was found despite acknowledgment from participants that the use of positive distractors could aid the suppression of negative thoughts. These attempts represent misregulation in that depressed individuals use strategies that eventually backfire. These strategies can contribute to the maintenance of depression. Wenzlaff, Wegner, and Klein (1991) found that thought suppression attempts can produce a reinstatement of the prior mood state. They assessed participants’ moods after the expression of thoughts that they had either previously expressed or suppressed. Those who had tried to suppress thoughts later experienced the same mood state that existed during this suppression period. Suppressing negative thoughts while one is depressed might seem to be an effective way of regulating one’s mood, but this can produce a subsequent exacerbation of the de­pressed affect when this thought returns. Thus, a negative cycle may ensue that maintains the depression.

However, distraction can be an effective way of controlling a negative mood. To work, the distractor chosen must be positive and engrossing (Nolen-Hoeksema, 1993). Thus, finding positive distractors that are easily accessible could be an important component of therapy for depression. Wenzlaff et al. (1991) suggested that the use of positive distractors could be increased when these were made easily accessible to participants. Un­fortunately, when one is depressed, it may be more difficult to conjure up positive distractors. Boden and Baumeister (1997) examined the use of distractors as a mood regulation strategy among repressors (i.e., those who habitually defend themselves against negative emotional stimuli) and non­repressors. Boden and Baumeister demonstrated that among nonrepressors, experiencing negative affect can inhibit the accessibility of positive affec­tive memories. Repressors, however, showed the opposite effect. Repressors coped by accessing pleasant thoughts. This research alluded to the possible automaticity of such an attentional control strategy—an important avenue for future research.

Achieving attentional control is important for reducing the symptoms of depression. Pyszczynski, Holt, and Greenberg (1987) found that inducing participants to focus their attention externally attenuated depressive indi­viduals’ pessimistic tendencies. That is, self—focused depressed participants were more pessimistic than control individuals, but externally focused de­pressed participants were not. Nix, Watson, Pyszczynski, and Greenberg (1995) manipulated the focus of attention in participants with and without depression and assessed their mood. They found that external focus reduced anxiety. Lowering the self-focus of depressed people reduced their depres­sive affect.

In summary, discrepancies between one’s current situation and self-standards can contribute to the development of depression. Becoming im­mersed in one’s mood and a negative self-focus can prevent the use of effective coping strategies, thus maintaining and exacerbating the depres­sion.

OBSESSIVECOMPULSIVE DISORDER

The predominant features of obsessive-compulsive disorder (OCD) are obsessions, compulsions, or both (APA, 1994). Obsessions are thoughts that are experienced as intrusive and senseless. These thoughts cause marked anxiety (APA, 1987, 1994). Compulsions are behaviors that are similar to obsessions in that the individual, although wishing to control them, cannot stop performing the behaviors. Compulsions represent an attempt to neutralize the anxiety caused by the obsessive thoughts. For example, an individual may be obsessed with thoughts of contamination. He or she may engage in repeated handwashing to ward off the anxiety associated with these thoughts.

The central self-regulatory deficit in OCD is one of self-stopping; that is, people are unable to stop themselves from having the forbidden thought or behavioral impulse (see Rachman & Hodgson, 1980; Reed, 1985). Sev­eral aspects of our theory can explain why individuals with OCD are unable to stop thinking obsessive thoughts or stop performing compulsive behaviors. Ineffective thought suppression attempts and lack of regulatory strength are particularly relevant.

When one wishes to control an intrusive thought, perhaps the most obvious solution is to suppress that thought. However, Wegner et al. (1987) found that attempted suppression of thoughts can result in a rebound effect. Wegner et al. asked participants to suppress thoughts of a white bear and found that after attempted suppression, participants experienced more thoughts of a white bear.

Trinder and Salkovskis (1994) examined the effects of the long-term suppression of negative intrusive thoughts in an experiment designed to maximize the similarity of participants’ experiences to those of obsessional patients. As Wegner did, they found that participants who tried to suppress their thoughts experienced more thoughts. Participants also found those thoughts to be more uncomfortable than did participants who did not sup­press their thoughts. Trinder and Salkovskis suggested that suppression may be important in the development and maintenance of anxiety disorders such as posttraumatic stress disorder and OCD.

Wegner (1994; see also Smart & Wegner, 1996) developed the ironic process theory to explain the failure of thought suppression attempts. Weg­net et al. proposed that successful self-regulation involves monitoring and operating processes. When attempting to regulate one’s thoughts, an au­tomatic monitoring process searches for signs of the thoughts and a con­trolled operating process overrides the thoughts. However, the operating process fails when one is tired. Thus, attention is directed to the unwanted thoughts, but the individual lacks the resources to override these thoughts. Specifically, the individual may lack regulatory strength.

Likewise, self-report data from compulsive patients suggest that rather than being at the mercy of some allegedly irresistible impulse of over­whelming strength, these individuals report that they lack the strength to override their compulsions. In other words, they acquiesce in relinquishing control (Reed, 1985).

Subsequent work on self-regulation has further elucidated this process. When resources are low, self-regulation may become more difficult. In­deed, OCD often begins under times of low resources, such as during stress­ful periods (Baumeister et al., 1994). Furthermore, the anxiety experienced by individuals with OCD can create a cognitive load that makes self-regulation more difficult. Attempts to regulate the negative affective state are a further drain on regulatory resources. That is, attempts to cope with OCD may render the individual unable to invoke the processes needed to control intrusive thoughts or compulsions. This inability may result in neg­ative affect.

Indeed, OCD may be associated with depression and other anxiety disorders (APA, 1994). Our model can be applied to explain this relation­ship. As noted, poor resources result in regulatory failure. People with OCD who fail to control thoughts or compulsions may experience this failure as a threat to the self. Sommer and Baumeister (1996) found that vulnera­bility to ego threat is increased under conditions of ego depletion. Partic­ipants who were given a thought suppression task and exposed to an ego threat reported lower subsequent self-esteem scores than those who were not depleted by the thought suppression tasks. That is, when depleted, one is less able to invoke the resources needed to defend the self. Thus, the relationship between OCD and depression may be mediated by the harmful effect that ego depletion has on the ability to defend against ego threats.

Further evidence of lack of regulatory strength in individuals with OCD is provided by data on performance. According to the strength model of depletion, trying to suppress intrusive thoughts should produce regula­tory failure in other spheres, such as performance and persistence. Consis­tent with this, Cooper (1996) found poor task performance to be one of the most frequently reported behavior problems associated with OCD. Likewise, in a study conducted in Spain examining the clinical records of children and adolescents with OCD, Toro, Cervera, Osejo, and Salamero (1992) found that poor school performance was a common feature.

Obsessive -compulsive behaviors in nonclinical populations are as­sociated with poorer performance on some tasks requiring mental flexibility, such as the Wisconsin Card Sorting Test (Goodwin & Sher, 1992). Similar cognitive impairments were found in an Israeli sample exhibiting obsessive-compulsive symptoms (Zohar, LaBuda, & Moschel-Ravid, 1995). Participants with obsessive -compulsive symptoms exhibited mental rigidity that impaired performance on the Wisconsin Card Sorting Test. In the study by Goodwin and Sher, poorer performance could not be completely explained by affective variables. Thus, another explanation is needed to explain the results. It is possible that the poorer performance can be at­tributed to the effects of ego depletion. Both studies show that the im­pairment was not in the ability to maintain a set but in the ability to shift from an established set. Thus, it appears that once a behavioral set (e.g., repeated checking) is established, checkers adopt the passive response of maintaining that behavioral set and they can do this effectively. The deficits occur when active responding is needed. Recent research (Bau­meister et al., 1998) indicates that ego depletion causes people to shift toward more passive responses because the active ones would consume more of the same resource that is already depleted. Attempting to control obsessions (from which compulsive behaviors arise) is such a condition. Hence, it seems plausible that some of the deficits associated with OCD may be attributable to chronic depletion, insofar as the person is frequently expending his or her ego resources in attempting to control the unwanted thought or impulse.

It is also possible that those with OCD are more susceptible than those in nonclinical populations to the effects of ego depletion. This sus­ceptibility is perhaps evident in the nature of the symptoms experienced by OCD sufferers. Stein and Hollander (1993) found that there is a subset of people with OCD who have poor impulse control. These individuals also have learning problems and low frustration tolerance. Stein and Hollander suggested that the overlap of impulsive and compulsive symptoms in OCD is indicative of general regulatory failure.

EATING DISORDERS

Self-regulation theory provides a particularly interesting framework for examining the eating disorders anorexia nervosa and bulimia nervosa. Furthermore, research on the eating disorders offers valuable insights into the nature of self-regulation. In particular, the different manifestations of regulatory failure in the same class of clinical disorders may be particularly informative.

The central features of anorexia are a refusal to maintain a normal body weight, fear of gaining weight, and disturbed perceptions of one’s body. The central features of bulimia are recurrent binge eating and en­gaging in inappropriate compensatory behaviors to prevent weight gain (APA, 1994). Both disorders are characterized by a “distorted attitude to­ward weight, eating and fatness” (Hsu, 1990, p. 1). This attitude is man­ifested in repeated ongoing attempts to regulate food intake. Thus, self-regulation is an essential component of even the most simplistic analysis of the eating disorders. A more complex analysis of the eating disorders elucidates the nature of the regulatory failure that occurs in them.

Several aspects of regulatory failure relevant to our model can be identified. Conflicting standards (e.g., healthy vs. tasty foods) and inappro­priate standards (e.g., an unattainable body weight) set the stage for reg­ulatory failure. The individual faced with the tempting foods yet desiring a thin body has to monitor his or her food intake to reconcile this conflict.

Bulimia

In bulimia, this process fails and the individual eats excessively. This failure may begin with a small lapse in one’s diet such as eating an extra cookie and may escalate into a binge. The binge eating represents a lapse-activated pattern, described in the introduction. As noted, these patterns include loss of attentional control and cessation of monitoring.

Heatherton and Baumeister (1991) proposed a model outlining how this occurs. They suggested that falling short of one’s standards elicits neg­ative emotional responses and aversive self-awareness. To escape these neg­ative responses, the individual directs attention away from meaningful thought (and toward the food and eating). Attention is drawn to the im­mediate stimuli and away from self-awareness. As noted, self-awareness is an important component of monitoring. If the individual escapes from the self-awareness, monitoring is impaired.⁴

Indeed, research shows that eating behavior can be influenced by experimentally manipulating the levels of self-awareness. Specifically, dis­inhibited eating occurs in conditions of low but not high self-awareness (Heatherton, Polivy, Herman, & Baumeister, 1993). Lowered self-awareness and a subsequent reduction in monitoring can also explain the relationship between alcohol and binge eating. Alcohol reduces self-awareness and thus the ability to monitor eating behavior. The prevalence of substance abuse in approximately one third of people with bulimia (APA, 1994) may be partially explained by this link. Furthermore, the narrow attentional focus on the immediate stimuli immerses bulimic individuals in the binge and contributes to their inability to consider the long-term implications of the binge. As noted, this failure to transcend the immediate situation weakens self-regulation.

⁴In bulimia, purging occurs as a means of coping with the negative emotions that emerge after the binge. Poor emotion regulation is discussed elsewhere in this chapter.

While immersed in the binge, bulimic individuals experience a lack of control, as if they cannot stop the binge. However, bulimic individuals are able to stop eating during the binge. For instance, bingeing may stop when another individual enters the room (APA, 1994). This is consistent with the concept of mitigated acquiescence proposed by Baumeister et al. (1994). The eating is not uncontrollable but involves a failure by bulimic individuals to exert enough control to stop the binge.

Anorexia

Our model of self-regulation failure is also applicable to anorexia. Although anorexic individuals often monitor their food intake excessively and succeed in regulating food intake, this control over eating is an ex­ample of misregulation. Control is exerted but in a way that yields negative outcomes. Continuing progress toward one’s goals is rarely perceived be-cause anorexic individuals’ (inappropriate) standards are revised upward when success is met (e.g., the desired weight continues to be lowered). As conceptualized in terms of the feedback loop described in the introduction, anorexic individuals proceed through the comparison of the self with the standards phase, act to reduce discrepancies, but do not exit the loop be­cause standards are never reached.

Loss of attentional control is relevant to anorexia. The cognitions of individuals with anorexia may become entirely focused on weight and food as they become immersed in the goal of losing weight. Indeed, Bruch (1973; see also Vandereycken & Meerman, 1984) noted that self-starvation results in “narrowed consciousness.”

People with anorexia exhibit excessive control over eating. However, as noted, this is an example of misregulation. Regulatory failure in other spheres is also noted. There is often a loss of control over thoughts and fears of weight gain. Herman and Polivy (1993) found that chronic dieters and binge eaters were often preoccupied with thoughts of food and had difficulties suppressing those thoughts.

Ego depletion is also relevant to anorexia. The onset of anorexia often occurs after a stressful life event (APA, 1994). As noted, coping with stress or emotional stressors can tax regulatory resources and contribute to reg­ulatory failures.

Ego Depletion and the Eating Disorders

The strength component of our model may be particularly relevant to eating disorders. To reiterate, attempts at self-regulation in one sphere may produce regulatory failures in other spheres. Resisting the temptation to eat a tempting food should produce deficits in persistence and perfor­mance, Indeed, Baumeister et al. (1998) found that participants who re­sisted eating cookies quit sooner on a cognitive task than did participants who did not have to resist eating cookies. This research was conducted with nonclinical populations, suggesting that the effects were caused by the exertion of regulatory effort than by other factors specific to the eating disorders. Furthermore, dieting and dietary restraint have been found to be related to deficits in cognitive performance (Green & Rogers, I995~ Green, Rogers, Elliman, & Gatenby, 1994; Rogers & Green, 1993).

Thus, attempts at resisting food produce a breakdown in subsequent self-control. This is consistent with recent research on the strength model of ego depletion. The distinctions between dieting, anorexia, and bulimia provide valuable insights into the nature of ego depletion and strength. Perhaps the most central factor distinguishing these related disorders is the difference in the nature of the misregulation evidenced by those who are affected by the disorders. Individuals with anorexia succeed in their at­tempts at self-starvation; people with bulimia frequently fail and engage in recurrent bingeing, which is accompanied by self-induced purging.

These apparent differences in regulatory strength are evident in other spheres, such as impulsivity and substance use. Self-report data suggest that individuals with bulimia are more impulsive than those with anorexia (Cas­per, Hedeker, & McClough, 1992; Fahy & Eisler, 1993; Pryor & Wieder­man, 1996; Steiger, Puentes-Neuman, & Leung, 1991). Furthermore, bu­limic individuals are more likely than anorexic individuals to engage in substance abuse (Wiederman & Pryor, 1996). Indeed, substance abuse or dependence occurs in approximately one third of bulimic individuals (APA, 1994). Holderness, Brooks-Gunn, and Warren (1994) reviewed the literature on eating disorders and substance abuse and found that substance abuse is more strongly associated with bulimia than with anorexia. This co-occurrence of bulimia and substance abuse may be partially explained by ego depletion. For instance, Bulik et al. (1992) analyzed the temporal patterns of substance use among bulimic, anorexic, and control participants and found that not only were bulimic behaviors and substance use related but that these behaviors were also more prevalent in the evening hours. This is consistent with our strength model of ego depletion. According to the model, regulatory failures are more likely to occur when one is tired and lacking in resources such as during the evening.
             Other regulatory failures are evident in people with bulimia. For example, bulimic individuals often engage in risky sexual behavior. Irving, McClusky-Fawcett, and Thissen (1990) found that participants at a high risk for bulimia engaged in riskier contraceptive behavior than those at a lower risk for bulimia. Furthermore, bulimic individuals were more sexually
active than controls (Coovert, Kinder, & Thompson, 1989) and less sexually inhibited than anorexic individuals (Haimes & Katz, 1988). These findings suggest that relative to other populations, bulimic individuals are more likely to engage in risky sexual behavior. This risky behavior may result from an inability to transcend the immediate situation and to consider the consequences of sexual intercourse without protection. Failure to consider the consequences of one’s actions is also apparent in the increased incidence of stealing among bulimic individuals. McElroy, Hudson, Pope, and Keck (1991) noted that kleptomania is associated with the eating disorders. Consistent with this research, more than 42% of the bulimic participants studied reported stealing, Rowston and Lacey (1992) found. They concluded that stealing marked a greater severity in bulimia. Likewise, Christenson and Mitchell (1991) studied impulse control behaviors among bulimic and control individuals and found that bulimic individuals showed a greater trend toward compulsive stealing than did controls. In summary, these findings suggest that bulimic individuals exhibit regulatory failure in several spheres.           
             However, those with anorexia also exhibit self-regulation failure, such as failure to control a preoccupation with food and striving for inappropriate goals, such as attaining an unhealthy body weight. They are unable to engage in appropriate goal-directed behavior. However, the manifestations of regulatory failure differ across those with anorexia and bulimia. Further examination of these differences and similarities between anorexia and bulimia may prove useful in elucidating the role of self-regulation in the eating disorders. Muraven, Baumeistër, and Tice (in press) proposed that repetitive exertions of regulatory strength may increase this strength over time. Anorexic individuals are often high achieving and perfectionistic. With a history of exerting considerable regulatory effort, perhaps regulatory strength develops in the way a dedicated athlete would develop muscle. In contrast, like athletes who do not succeed in pushing themselves to lift heavier and heavier weights and thus build muscle, perhaps bulimic individuals, succumbing to that initial morsel of food, have not yet exerted enough regulatory effort to build and develop strength over time. Factors contributing to these individual differences in regulatory success remain an important avenue for future research.

SUBSTANCE-RELATED DISORDERS

Regulatory failure is an essential component of substance-related dis­orders. Substance-related disorders include substance dependence and sub­stance abuse (APA, 1994). Central to both disorders is continued substance use despite associated impairments in functioning. Several components of regulatory failure are relevant.

Different factors contributing to the escalation of substance use can be identified. Substance use may begin because it is reinforcing, bringing pleasure and perhaps reducing emotional suffering. The importance of the motivated need to reduce suffering implies that the adaptive regulation of negative affect states may reduce this motivation. Likewise, an ability to experience positive emotions is necessary if one is to avoid making “un­healthy” attempts to feel positive. The self-medicating effects of substance use have been well documented (e.g., Krueger, 1981; Pervin, 1988). John­son and Gurin (1994) obtained interview data from more than 1,000 par­ticipants and found that expectancies moderated the relationship between negative affect and drinking. Co-occurrence was more likely when partic­ipants expected that alcohol would improve their mood. Consistent with current knowledge on the executive function, it appears that people ac­tively choose to participate in self-defeating behavior to obtain immediate rewards. Currently our laboratory is examining the negative implications of such attempts to “feel better” on other areas of self-regulation.

One method of coping with negative emotions is to direct attention away from those emotions, perhaps toward lower level actions such as drinking. Like the bulimic individual who binges to escape from the aversiveness, the alcoholic individual may become immersed in drinking as a form of escape. Steele and Josephs (1990), however, found that alcohol is effective as an escape only when used in conjunction with a distraction. This is consistent with recent research that has demonstrated the impor­tance of positive distractors for effective coping (see, e.g., Boden & Bau­meister, 1997). Nevertheless, immersion in alcohol or drugs does promise the appeal of experiencing positive emotions and warding off negative emo­tions. Such immediate pleasures can contribute to the escalation of the drinking binge through the resultant narrow attentional focus and impair­ment of cognitive resources associated with drinking (Baumeister et al., 1994). This attentional focus contributes to the inability of alcoholic individuals to recognize the long-term consequences of their actions. In other words, they are unable to transcend the immediate situation and so regu­latory failure ensues.

Substance abusers may completely break down and fail to resist temp­tation once they have started to use the substance. The likelihood of this giving in may be increased by attempts at restraint. Collins (1993) noted the increased attention in the literature to the role of attempts at restraint as a risk factor for substance abuse. The link between restraint and abuse can be explained by our model. An alcoholic individual attempting to refrain from drinking may be particularly attuned to drinking cues in the environment. However, when the person is stressed or depleted, the self-regulatory strength required to overcome these cues may be lacking and this attempt may fail.

The treatment implications of such a process are evident. Marlatt (1996) postulated a harm reduction model that acknowledges that al­though abstinence may he an ideal outcome of treatment programs, alter­native goals may be more feasible. Such treatment implications are con­sistent with our data, which show that the self’s regulatory resource is limited and that regulatory breakdowns occur readily and easily as a result (Muraven et al., 1998).

Treatment models that advocate complete abstinence may be based on the assumption that once the recovering substance abuser partakes in substance use, control failure has already occurred (Baumeister et al., 1994). Whether the initial lapse escalates into a binge is partially deter­mined by interpretations of this lapse. If the alcoholic individual perceives that he or she is helpless in the face of this initial lapse, the binge may escalate.

The conceptualization of urges (e.g., to drink) as irresistible or beyond the individual’s control has received considerable attention in the literature (e.g., Peele, 1989). According to the disease model of substance abuse, addiction is a disease affecting emotional and cognitive functioning (Stu­art, 1995). Helplessness in the face of such a disease is implied by advocates of this model who suggest that the substance abuser is a “victim” whose recovery can be facilitated by a shift in treatment away from attempts to correct a weak character (Miller, 1991). Alternative views of alcoholism view substance abuse as a form of self-medication, motivated by the need to reduce emotional suffering (Goldsmith, 1993). This model implies that the substance abuser thus has some choice in exercising a lack of control. As noted, Baumeister and colleagues (Baumeister & Heatherton, 1996; Baumeister et al., 1994) concluded that self-control failure involves miti­gated acquiescence. That is, rather than falling victim to irresistible impulses beyond his or her control, the substance abuser chooses at some point to relinquish control.

CONCLUSION

Self-regulation failures are central to many psychopathologies. Our discussion of specific childhood disorders, mood disorders, anxiety disorders, eating disorders, and substance use disorders has highlighted the applica­bility of a model of regulatory failure to psychopathology. These pathologies often arise from or are mediated by the use of ineffective, inappropriate strategies for reaching one’s goals or for coping (e.g., with emotional dis­tress). Conflicting standards and poor monitoring of behavior contribute to this misregulation. Furthermore, focusing and narrowing of attention on the immediate situation decreases the ability to monitor behavior effec­tively, increasing the likelihood that regulatory failure will occur. Our model also describes how this initial lapse may escalate into further regu­latory failure, such as a drinking binge.

Perhaps one of the most promising applications of our model to clin­ical psychology arises from the concept of self-regulatory strength. Recent work suggests that self-regulation and other acts of volition all draw on a common, limited resource. In psychopathology, the constant struggle to manage one’s emotional distress, control one’s attention, and restrain un­acceptable impulses may keep this resource constantly drained, which can contribute to some of the side-effects of the pathology. Conversely, stressful situations or heavy interpersonal demands may deplete the resource in the first place and make the person more vulnerable to the self-regulatory fail­ures that form the essence of the psychopathology (e.g., eating disorders). If chronic ego depletion does indeed turn out to be a central factor in psychopathology, as seems plausible on the basis of the evidence we have reviewed, it may become possible to refine treatment strategies to benefit from this new understanding.