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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
revie...
Contexts in source publication
Context 1
... total of 72 studies involving 91 trials were identified for inclusion in our review. A flow-diagram of the study extraction process is provided in Figure 1. Sixty-nine trials involved participants with MDD, and 22 trials involved participants recovered or remitted from MDD. ...
Context 2
... studies had investigated suppression, but for these, a large effect size was found. The large effect size for suppression supports earlier findings that the use of suppression is associated with increased rumination (Liverant et al., 2011). Moreover, our findings may serve to clarify the role of suppression in MDD, as previous reviews have reported inconsistent results ( Joormann and Stanton, 2016;Liu and Thompson, 2017). ...
Context 3
... results from the meta-analysis support the hypothesis that individuals with current MDD use more maladaptive emotion regulation strategies compared to healthy controls, as was evident by the large effect sizes obtained within all subcategories of maladaptive emotion regulation strategies. The very large effect size found for rumination supports previous findings (Joormann and Stanton, 2016;Liu and Thompson, 2017), showing that the tendency to dwell on the causes and implications of emotions and emotion eliciting events is a central feature of current MDD. It is also notable that a large effect size was found for avoidance, a strategy often associated with anxiety disorders, but increasingly also shown to be a feature of depression ( Brockmeyer et al., 2015). Fewer studies had investigated suppression, but for these, a large effect size was found. The large effect size for suppression supports earlier findings that the use of suppression is associated with increased rumination (Liverant et al., 2011). Moreover, our findings may serve to clarify the role of suppression in MDD, as previous reviews have reported inconsistent results ( Joormann and Stanton, 2016;Liu and Thompson, 2017). Taken together, our results indicate that MDD is associated with an inability to disengage from repetitive negative thinking, and attempts to avoid or control unwanted mental and emotional ...
Context 4
... total of 72 studies involving 91 trials were identified for inclusion in our review. A flow-diagram of the study extraction process is provided in Figure 1. Sixty-nine trials involved participants with MDD, and 22 trials involved participants recovered or remitted from MDD. The search in OVID and ISI Web of Science databases provided 17,325 records. After duplicates were removed, 8,225 records remained. Of these, 7,956 records were excluded after reviewing them according to inclusion and exclusion criteria. In addition, seven potentially eligible records were included from reference lists from former studies and reviews. As result, 276 full-text articles were reviewed in more detail by the first and second author. Of these, 59 articles (21%) were rated differently by the authors, and were discussed to reach agreement (in favor of the first author: 32; in favor of the second author : 27). As a result of the rating process, 204 studies were excluded with following reasons: language not mastered by the authors (n = 13), clinical group no MDD or history of MDD (n = 8), heterogeneous clinical population (n = 20), participant age under 18 years (n = 9), clinical or healthy control group not screened with diagnostic interview, or not reported applying such an interview (n = 95), participants screened partially with diagnostic interview involving only a few diagnostic modules (n = 12), control group not healthy (n = 5), no self- report measure of emotion regulation (n = 17), questionnaire not validated (n = 3), duplicate data (n = 5), experimental induction prior to assessment (n = 3), and corresponding author not returning data on enquiry (n = 14). References of all included studies can be found in Appendix A (Supplementary ...
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Objective:The purpose of this study was to examine obsessive and compulsive signs among patients with Restless Legs syndrome (RLS), to compare the results with healthy controls and to investigate clinic importance of those signs.Methods:Thirty nine patients with RLS and 40 age-, sex- and education- matched healthy controls were assessed in Bezmiale...
Citations
... Hence, the subjective experience of dreaming may mirror not only the wakeful emotional experiences but also the difficulties in emotional regulation strategies (Rufino et al., 2020;Wong & Yu, 2022). Consistently, depression is often associated with more emotional dysregulation, including higher levels of alexithymia (Honkalampi et al., 2020;Radetzki et al., 2021;Visted et al., 2018), and in depressive individuals, nightmares could also reflect failures in adaptive emotional strategies (Levin & Nielsen, 2007). ...
The gestational period is a sensitive time marked by significant changes that can affect women's sleep and dreaming processes, with an augmented frequency and recall of dreams suggesting that dreaming represents an adaptive mechanism of emotional regulation. This study investigates the relationship between pregnancy‐related variables, alexithymia, and depressive symptoms in influencing dream characteristics in women during the first trimester of pregnancy. A total of 118 pregnant women were recruited at the Obstetric Outpatient Service of an Italian University Hospital and completed the Mannheim Dream Questionnaire, the Toronto Alexithymia Scale‐20, and the Edinburgh Postnatal Depression Scale. Regression analysis, t ‐test, and moderation analysis were conducted through Jamovi. Dream recall frequency was predicted by age, parity, and depressive symptoms. Nightmare frequency and lucid dream frequency were significantly predicted by depressive symptoms, while nightmare distress was predicted by an unplanned pregnancy. Alexithymia was linked to higher nightmare frequency and nightmare distress. Moderation analysis revealed that the presence of depressive symptoms predicted increased nightmare frequency only in women with higher levels of alexithymia. These findings highlight the role of emotional regulation in dreaming during pregnancy, particularly among women exhibiting alexithymic traits and depressive symptoms. Nightmare frequency may serve as an indicator of impaired emotional regulation, emphasising the need for targeted interventions to enhance emotional coping strategies in this population. Future research should examine the content of nightmares to further understand their implications for maternal mental health.
... First, children acquire ER skills through observation of their parents. Past research indicates that individuals experiencing depression often struggle with effective ER and parental mentalizing (the ability to infer behaviour as an expression of mental states), and therefore might provide maladaptive models of emotional expression and regulation as well as impaired capacity to self-reflect to their children (Granat et al., 2017;Schultheis et al., 2019;Visted et al., 2018). As children learn to regulate their emotions by watching and imitating their parents, children with depressed parents might learn unhealthy ways to manage their emotions (Keleynikov et al., 2023;Silk et al., 2006;Wu et al., 2020). ...
Background
Parental depression has consistently been shown to impact child's emotion regulation (ER), with limited research on risk and protective factors, especially in preschoolers. Grounded in Morris and colleagues' model of emotion socialization, this study addresses this gap by examining the mediating and moderating roles of parental mentalizing (reflective functioning).
Aims
We aimed to explore whether pre‐mentalizing modes mediate the link between parental depressive symptoms and the child's ER tendencies and whether parental interest and curiosity and parental certainty about mental states can buffer this link.
Materials & Methods
The study sample included 732 parents (91% females) of children aged 3–7 years. To assess parental mentalizing, the Parental Reflective Functioning Questionnaire was used. Child ER skills were assessed with the Emotion Regulation Checklist, and depression was assessed with the Patient Health Questionnaire.
Results
Findings demonstrated a negative link between parental depressive symptoms and children's ER skills, mediated by heightened parental pre‐mentalizing modes. Contrary to expectations, parental interest and curiosity did not moderate this link, but parental certainty about mental states emerged as a protective factor, weakening the link between depressive symptoms and child ER skills.
Conclusion
The results contribute to the understanding of ER development, particularly in the context of parental depressive symptoms, emphasizing parental mentalizing as a pivotal factor within this intricate dynamic.
... 10 Indeed, patients with major depressive disorder (MDD) or eating disorders in a remission phase adopt better ER strategies or manifest lower levels of ED compared to people with current clinically significant symptoms. 11,12 Summations • Emotion dysregulation, a transdiagnostic construct, is present in bipolar disorder and is directly correlated to its psychopathology. • Depressive symptoms are moderately correlated to emotion dysregulation, and are related to all type of emotion regulation strategies considered. ...
... ED, as measured by the total score of the Difficulties in Emotion Regulation Scale (DERS), 6 was significantly related to depressive symptoms with moderate effect size and no heterogeneity, and to (hypo)manic symptoms with weak effect size and moderate heterogeneity. The correlation between overall ED and depressive symptoms is consistent with previous findings in samples with MDD 11 and across different diagnoses. 7 At the same time, to the best of our knowledge, this is the first meta-analytic evidence of association with (hypo)manic symptoms. ...
... One of the factors that plays a central role in MDD is repetitive negative thinking (RNT) [12], such as depressive rumination, which has been defined as the process of thinking perseveratively about one's feelings and problems and their possible causes and consequences [13]. Patients with current and remitted MDD ruminate more than healthy controls, and severity of rumination has been shown to be related to severity of depression [14,15]. ...
Background: Mindfulness-based cognitive therapy (MBCT) is effective in reducing depressive symptoms in patients with major depressive disorder (MDD). Understanding for whom and how MBCT works may allow for improvements in treatment allocation and effectiveness. In this study, our aim was to investigate depressive rumination, content-independent perseverative thinking, mindfulness skills, and self-compassion as potential moderators and mediators of MBCT.
Methods: In this non-randomized controlled trial, patients with persistent (n = 53) or recurrent MDD with (n = 31) or without (n = 51) a current depressive episode were assigned to an intervention (MBCT plus treatment as usual [TAU], n = 94) or control group (TAU only, n = 40) based on the time between the date of inclusion and the start of MBCT. Assessments were carried out before, halfway, and after 8 weeks of MBCT + TAU or TAU. Latent growth models were employed to examine moderation, while cross-lagged structural equation models were used to assess the mediating effects of several possible mediators of MBCT-induced change in depressive symptoms and overall functional impairment.
Results: MBCT + TAU was more effective in reducing depressive symptoms (and overall functional impairment than TAU with a medium [d = −0.54] and small [d = 0.44] effect size, respectively). Higher baseline levels of rumination and perseverative thinking and lower levels of self-compassion moderated the effect of MBCT on depressive symptoms and overall functional impairment. Task-based negative intrusive thoughts moderated the effects of MBCT on overall functional impairment. No mediators were established, particularly due to a lack of effect of MBCT on all assessed mediators at mid-treatment. For interpretative purposes, a sample split (based on Johnson–Newman values) showed moderate-to-large effects in depressive symptom reduction for those with high rumination, high perseverative thinking, and low self-compassion, while negative-to-small nonsignificant effects were found for the opposite traits.
Conclusion: In the future, MBCT allocation based on levels of rumination and self-compassion might lead to a more efficient reduction in depressive symptoms. Directions for mediation analysis within the context of MBCT for depression are discussed.
Preregistration: This study was initially preregistered in the Dutch National Trial Register (NL7842). However, due to the NTR no longer being available since June 2022, the trial was reregistered at ClinicalTrials.gov (NCT05802966, dd 09-Apr-2023). The statistical analysis plan was adjusted after the start of the trial but before the finalization of data collection (NCT05802966; ClinicalTrials.gov).
... It has been determined that patients with depression have difficulty regulating their emotions. The present study's findings based on emotion regulation difficulties are consistent with two previous research findings (Brockmeyer et al., 2012;Visted et al., 2018). Furthermore, it was shown that individuals scored higher on the goals and strategies subscale, which is one of the emotional regulation difficulties subscales. ...
... As the emotion regulation difficulties of depression patients decrease, they may use less maladaptive emotion regulation strategies that contribute to the persistence of their depressive symptoms. Additionally, depression patients may become more aware of their emotions, quickly distance themselves from unpleasant emotions, and easily adapt to stressful situations (Visted et al., 2018;Vaughan et al., 2019). This in turn increases the positive effect of mindfulness on psychological resilience. ...
This study aimed to determine the mediating role of emotion regulation difficulties in the correlation between mindfulness and psychological resilience. This study was conducted with a total of 119 patients diagnosed with major depression. Data were collected with Personal Information Form, Mindfulness Scale, Emotion Regulation Difficulties Scale, and Psychological Resilience Scale. The study participants reported moderate levels of mindfulness and emotion regulation difficulties, and above-average levels of psychological resilience. It was found that there was a moderately negative correlation between mindfulness and emotion regulation difficulties ( r = −0.553, p < 0.001), as well as between psychological resilience and emotion regulation difficulties ( r = −0.429, p < 0.001). A moderately positive correlation was determined between mindfulness and psychological resilience ( r = 0.344, p < 0.001). Emotion regulation difficulties fully mediated the correlation between mindfulness and psychological resilience. These findings will guide the development of interventions aimed at enhancing mindfulness, emotion regulation skills, and psychological resilience in depression treatment.
... As such, brooding rumination (vs. reflection) has shown stronger associations with poor mental health (Rickerby et al., 2022;Treynor et al., 2003a;Visted et al., 2018). Rumination predicts increased future symptoms in several disorders (for an overview, see Watkins & Roberts, 2020). ...
Background
Previous research has reported associations between various forms of repetitive negative thinking (RNT; e.g., rumination, worry, and the content-independent process of RNT) and the onset and maintenance of psychological disorders. Additionally, reductions in RNT are linked to improved treatment outcomes, primarily based on findings from randomized controlled trials. This study examined RNT in the context of outpatient cognitive behavioral therapy (CBT) in routine clinical care.
Methods
We investigated the predictive value of RNT in a sample of 506 patients from an outpatient clinic and postgraduate training center for CBT, all of whom received CBT for various mental health conditions. Of these, 256 (50.6%) presented with depressive disorder, and we repeated our analyses using only this subsample. We assessed content-independent RNT, brooding, and worrying at pre- and post-assessment. General psychopathology and depression were assessed at pre- and post-assessment as well as at 6- and 12-month follow-up.
Results
There were significant reductions in general psychopathology and depression between pre-assessment and all subsequent assessments. All forms of RNT showed significant reductions from pre- to post-assessment. These reductions predicted general psychopathology and depression at post-assessment. At follow-up, findings were mixed, with only some forms of RNT being significantly associated with treatment outcome.
Conclusions
Naturalistic CBT reduced general psychopathology and depression, as well as content-independent RNT, rumination, and worrying. Change in all forms of RNT predicted reductions in general psychopathology and depression at post-assessment. This study highlights the relevance of addressing different forms of RNT in therapeutic interventions.
... growing number of meta-analyses consistently demonstrate that in comparison to healthy controls less frequent use of adaptive ER strategies (e.g. acceptance, problem solving, reappraisal) and more frequent use of maladaptive strategies (e.g., avoidance, rumination, suppression), is evident in most psychopathologies (substance use 9,10 ; eating disorders 9,11 ; psychosis 12 , borderline personality disorder 13 , bipolar disorder 14 , PTSD 15 ), including depression and anxiety 9,[16][17][18][19][20] . Consequently, several authors have defined ER as a transdiagnostic process relevant for the development and/ or maintenance 8,[21][22][23] , as well as for the treatment 24,25 across mental disorders. ...
... In sum, converging evidence suggest that affective and anxiety disorders are associated with a range of ER difficulties 9,19,20,33 . However, as outlined above, studies so far do not allow for a differential understanding of the interrelationship between ER-dysfunction and symptomatology within the affective and anxiety disorders spectrum. ...
Here, we investigated the association of different emotion regulation (ER) indices with symptom severity across a large transdiagnostic sample of patients with emotional disorders (cross-sectional approach) and the predictive validity these ER indices have for the outcome of routine care CBT (longitudinal approach). We assessed the trait-like use of adaptive (reappraisal) and maladaptive (suppression, externalizing behaviors) ER strategies via questionnaire as well as the situational ability to regulate emotions with an experimental ER paradigm. Psychopathology was assessed dimensionally using the depression, anxiety, and stress scale. Cross-sectionally symptom severity was predicted by less trait-like use of adaptive and more trait-like use of maladaptive ER strategies, but no associations were found for situational ER ability. This association was more pronounced for depression and stress symptoms rather than anxiety symptoms. In a striking dissociation, the longitudinal analyses revealed the reverse picture: Better situational ER ability, but not trait-like use of ER strategies was associated with less symptom severity after the CBT treatment. Our data argues in favor of a distinction between trait-like and situational ER abilities in individuals with emotional disorders, highlighting challenges in applying adaptive ER strategies in daily life despite demonstrating intact ER skills in experimental settings. Our findings also inform transdiagnostic models of psychopathology and suggest that distress/depression rather than anxiety symptomatology to be driving forces for the occurrence of ER deficits across the depression/anxiety disorders spectrum.
... Such trauma can exceed cognitive resources and affect the development of adaptive strategies in the face of adversities, especially if their caregiver was unable to teach the child to regulate their emotions adequately. Studies have shown that childhood interpersonal trauma is associated with higher affective disturbances throughout more depressive symptoms (Li et al., 2020), as yielding this internalized difficulty may be indicative of impaired affect regulation Joormann & Gotlib, 2010;Visted et al., 2018). Studies have also denoted associations between childhood interpersonal trauma and the use of maladaptive tension-reducing activities (e.g., externalizing behaviors such as hurting oneself to deal with internal pain; Liu et al., 2018). ...
... In other words, women facing postpartum depression or anxiety use less strategies considered effective in downregulating negative emotions but use more strategies that might exacerbate or prolong their negative emotions. These findings are consistent with previous research in (non) perinatal samples [33,35,37,56,[65][66][67]. It is possible that women facing postpartum depression or anxiety use less acceptance, cognitive reappraisal, or problem solving because these strategies require more effort. ...
Background
Major depressive disorder and anxiety disorders are highly prevalent and comorbid during the perinatal period. Although research and clinicians agree that emotion regulation (ER) is an important transdiagnostic factor underlying both disorders in the general population, ER during the perinatal period has received less research attention. The aim of this systematic review was to assess the literature regarding the role of ten commonly studied ER strategies in the onset and maintenance of perinatal depression and anxiety in pregnant women and young mothers, using the Process Model of Gross (1998) as a theoretical framework.
Methods
We searched four electronic databases with variations of the following key words: women; emotion regulation (i.e., behavioral approach, behavioral avoidance, problem solving, support seeking, distraction, rumination, reappraisal, acceptance, expressive suppression, and expressive engagement); perinatal period; and psychopathology. The aim was to identify peer-reviewed, and quantitative studies published between January 1999 and January 2023. Six articles were selected for analysis.
Results
Similar ER strategies emerged as risk and protective factors in perinatal depression and anxiety. Overall, behavioral avoidance, distraction, rumination, and expressive engagement appeared as risk factors, while problem solving, emotional and instrumental support seeking, cognitive reappraisal, and acceptance, emerged as protective factors in the onset and maintenance of perinatal depression and anxiety. These findings align with previous research in perinatal community samples, as well as in non-perinatal clinical samples.
Conclusions
Our results support the role of ER as a transdiagnostic factor underlying both perinatal depression and anxiety. Clinicians are encouraged to implement ER strategies into the screening, prevention, and treatment of perinatal depression and anxiety. Further research is needed to strengthen these findings and to examine the role of emotion regulation during antenatal depression and anxiety more closely.
... To the best of our knowledge, the psychometric properties of the PERCI has not been examined in the Chinese context. Difficulties in emotion regulation have been found in patients with major depressive disorder (MDD) 8 and have been proposed to be a risk factor for the onset of depression. 33 Thus, we further examined the clinical utility of the Chinese PERCI in patients with MDD. ...
Background
Abnormalities of regulating positive and negative emotion have been documented in patients with mental disorders. Valid and reliable psychological instruments for measuring emotion regulation across different valences are needed. The Perth Emotion Regulation Competency Inventory (PERCI) is a 32-item self-report measure recently developed to compressively assess emotion regulation ability across both positive and negative valences.
Purpose
This study aimed to validate the Chinese PERCI in a large non-clinical sample and examine the clinical utility in patients with major depressive disorder (MDD).
Methods
The Chinese PERCI was administered to 1090 Chinese participants (mean age = 20.64 years, 773 females). The factor structure, internal consistency, test-retest reliability, convergent validity, concurrent validity, and predictive validity were examined. Moreover, a MDD group (n = 50) and a matched healthy control group (n = 50) were recruited. Group comparisons and the linear discriminant analysis were conducted to assess the clinical relevance of the PERCI.
Results
Confirmatory factor analysis supported the intended eight-factor structure of the PERCI in the Chinese population. The PERCI showed high internal consistency, test-retest reliability, as well as good convergent and concurrent validity. The MDD group had significantly higher PERCI scores than the healthy control group. Linear discriminant function comprised of the eight factors successfully distinguish patients with MDD from their matched controls.
Conclusion
The Chinese version of the PERCI is a valid and reliable instrument to compressively measure emotion regulation across positive and negative valences in the general Chinese population and patients with depression.
