Emotion Regulation in Current and Remitted Depression: A Systematic Review and Meta-Analysis

Abstract

Background: Major Depressive Disorder (MDD) is a highly prevalent, recurrent, and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD.Methods: Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD, and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties.Results: Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges' g = 1.3), rumination (g = 2.1), and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g = −1.0), problem solving (g = −1.0), and reappraisal (g = −0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g = 1.45), lower emotional awareness (g = −0.95), emotional clarity (g = −1.50) and emotional tolerance (g = −1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6), and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation.Conclusion: The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions.

Examining the Structure of Negative Affect Regulation and Its Association With Hedonic and Psychological Wellbeing

“…Forms of affect regulation were also related to well-being (Koval et al, 2014; Visted et al, 2018). Results confirm that withdrawal and social isolation, and suppression are associated with negative high self-reported affect over the past month, and to low psychological well-being.…”

A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single‐arm pilot study

“…A meta‐analysis of coping processes in breast cancer patients and other meta‐analyses in adults with cancer indicate consistent relations of avoidant coping with higher depression, whereas approach‐oriented coping processes predict more favorable outcomes . In addition, onset and maintenance of depressive disorders are also associated with lower emotional awareness . Nonjudgmental awareness of emotions that can be described and tolerated facilitates ER as it makes emotions more salient and available for reflection and response .…”

“…Taken collectively, coping and ER research suggests that strategies to decrease avoidance and to promote specific approach‐oriented strategies are promising targets for preventing depression . Preliminary evidence shows changes in ER and coping processes mediate the effects of psychotherapy for resolution of depression, but more rigorously designed studies are needed to establish causal priority . To our knowledge, these mediating targets have not been tested in preventive interventions.…”

“…21 In addition, onset and maintenance of depressive disorders are also associated with lower emotional awareness. 22 Nonjudgmental awareness of emotions that can be described and tolerated facilitates ER as it makes emotions more salient and available for reflection and response. 23,24 Taken collectively, coping and ER research suggests that strategies to decrease avoidance and to promote specific approach-oriented strategies are promising targets for preventing depression.…”

Is it worth turning a trigger into a joke? Humor as an emotion regulation strategy in remitted depression

“…By contrast, adaptive emotion regulation strategies are indicated to improve emotional responses to adversity and, thus, reduce the risk of depression onset (Compare, Zarbo, Shonin, Van Gordon, & Marconi, ). The existing literature demonstrates that such strategies as acceptance, reappraisal, self‐compassion, and distraction are particularly effective in both current and remitted depression (Joormann & Stanton, ; Visted, Vøllestad, Nielsen, & Schanche, ). The objective of the present study is to investigate one promising but thus far unexamined emotion regulation strategy in recurrent depression—humor.…”