Emotion-regulation strategies across psychopathology: A meta-analytic review

https://doi.org/10.1016/j.cpr.2009.11.004Get rights and content

Abstract

We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety, depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that examined the relationships between dispositional emotion regulation and psychopathology. We focused on dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we examined the relationship between each regulatory strategy and psychopathology across the four disorders. We found a large effect size for rumination, medium to large for avoidance, problem solving, and suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory strategy and each of the four psychopathology groups. We found that internalizing disorders were more consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses showed that whether the sample came from a clinical or normative population significantly moderated the relationships. This finding underscores the importance of adopting a multi-sample approach to the study of psychopathology.

Section snippets

Models of emotion regulation

Emotion regulation has been conceptualized as processes through which individuals modulate their emotions consciously and nonconsciously (Bargh and Williams, 2007, Rottenberg and Gross, 2003) to appropriately respond to environmental demands (Campbell-Sills and Barlow, 2007, Cole et al., 2004, Gratz and Roemer, 2004, Gross, 1998, Gross and Munoz, 1995, Thompson, 1994). Individuals deploy regulatory strategies to modify the magnitude and/or type of their emotional experience or the

Measuring emotion regulation

Along with the increased interest in individual differences in emotion regulation in recent years, there has been a proliferation of self-report measures of emotion-regulation strategies (see Table 1). These measures have advantages and disadvantages. On the one hand, because self-report measures are easy and quick to administer, there is a sufficient body of research from which to draw data for this meta-analysis. In addition, self-report scales typically measure dispositional tendencies

Literature searches

We searched for studies that provided data on at least one of the disorders and one of the regulatory strategies of interest, regardless of whether the study of these constructs was a central focus of the study. We conducted systematic searches for articles published between 1985 and July 2008 using PsycInfo and Medline. We chose 1985 as a beginning point because, with the exception of some studies of problem solving and avoidance coping, there was little work on what is now referred to as

Regulation strategies across disorders

We calculated the random-effect model of the correlation coefficients for each regulatory strategy collapsed across the disorder clusters (see Table 3). As predicted, the following strategies were positively associated with psychopathology: avoidance (r = .38; k = 37; 95% CI = [.33; .44]) and suppression (r = .34; k = 51; 95% CI = [.28; .39]), both with magnitudes from medium to large, and rumination with a large magnitude (r = .49; k = 89; 95% CI = [.45; .52]). Conversely, the following strategies were

Review of longitudinal studies

As noted earlier, there was a great deal of heterogeneity in the designs of longitudinal studies examining the relationships between one of the emotion-regulation variables of interest and one of the outcome variables of interest. Further, with the exception of rumination, there was a small number of longitudinal studies of any of the other emotion-regulation variables. We included the baseline bivariate correlations between emotion-regulation variables and psychopathology variables from these

Discussion

In the present meta-analytic review, we evaluated the relationship between six widely studied emotion-regulation strategies and four psychopathology groups. Each emotion-regulation strategy was associated with overall psychopathology in the predicted direction: maladaptive strategies (i.e., rumination, avoidance, suppression) were associated with more psychopathology and adaptive strategies (i.e., acceptance, reappraisal, and problem solving) with less psychopathology. However, interesting

References (264)

  • B. Egloff et al.

    Interactive effects of state anxiety and trait anxiety on emotional Stroop interference

    Personality and Individual Differences

    (2001)
  • P.A. ⁎Engler et al.

    Predicting eating disorder group membership: An examination and extension of the sociocultural model

    Behavior Therapy

    (2006)
  • J.A.K. ⁎Erskine et al.

    The predictors of thought suppression in young and old adults: Effects of rumination, anxiety, and other variables

    Personality and Individual Differences

    (2007)
  • M.T. Feldner et al.

    Emotional avoidance: An experiential test of individual differences and response suppression using a biological challenge

    Behaviour Research and Therapy

    (2003)
  • H.C. Fox et al.

    Difficulties in emotion regulation and impulse control during cocaine abstinence

    Drug and Alcohol Dependence

    (2007)
  • D.M. ⁎Fresco et al.

    Initial properties of the experiences questionnaire: Validation of a self-report measure of decentering

    Behavior Therapy

    (2007)
  • C. Aldwin

    Stress, coping, and development

    (1994)
  • D.G. Altman et al.

    The cost of dichotomising continuous variables

    British Medical Journal

    (2006)
  • J. Arbuckle

    Amos user's guide

    (2007)
  • A.A. Augustine et al.

    On the relative effectiveness of affect regulation strategies: A meta-analysis

    Cognition and Emotion

    (2008)
  • R.A. Baer et al.

    Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills

    Assessment

    (2004)
  • T.B. Baker et al.

    Addiction motivation reformulated: An affective processing model of negative reinforcement

    Psychological Review

    (2004)
  • J.A. Bargh et al.

    On the nonconscious of emotion regulation

  • E.R. Barker et al.

    Exploring criterion confounding in the measurement of binge eating symptoms and negative affect

    Journal of Psychopathology and Behavioral Assessment

    (2009)
  • L.F. Barrett et al.

    Emotional intelligence: A process model of emotion representation and regulation

  • A.T. Beck

    Cognitive therapy and the emotional disorders

    (1976)
  • A.T. Beck et al.

    Cognitive therapy of depression

    (1979)
  • C.G. ⁎Beevers et al.

    Thought suppression and depression risk

    Cognition and Emotion

    (2004)
  • C.B. Begg et al.

    Operating characteristics of a rank correlation test for publication bias

    Biometrics

    (1994)
  • H. Berenbaum et al.

    A taxonomy of emotional disturbances

    Clinical Psychology: Science and Practice

    (2003)
  • M. Berking et al.

    Prospective effects of emotion-regulation skills on emotional adjustment

    Journal of Counseling Psychology

    (2008)
  • E.T. Berkman et al.

    Using neuroscience to broaden emotion regulation: Theoretical and methodological considerations

    Social and Personality Psychology Compass

    (2009)
  • A.G. Billings et al.

    The role of coping responses and social responses in attenuating the stress of life events

    Journal of Behavioral Medicine

    (1981)
  • S.R. Bishop et al.

    Mindfulness: A proposed operational definition

    Clinical Psychology: Science and Practice

    (2004)
  • A. Blalock et al.

    Interaction of cognitive avoidance coping and stress in predicting depression/anxiety

    Cognitive Therapy and Research

    (2000)
  • G.A. Bonanno

    Emotion self-regulation

  • G.A. Bonanno et al.

    The importance of being flexible: The ability to both enhance and suppress emotion expression predicts long-term adjustment

    Psychological Science

    (2004)
  • A. Borders et al.

    Alcohol-aggression expectancies and dispositional rumination moderate the effect of alcohol consumption on alcohol-related aggression and hostility

    Aggressive Behavior

    (2007)
  • M.A. Brackett et al.

    Measuring emotional intelligence as a mental ability with the Mayer–Salovey–Caruso Emotional Intelligence Test

  • K.T. Brady et al.

    Co-occurring mental and substance use disorders: The neurobiological effects of chronic stress

    American Journal of Psychiatry

    (2005)
  • F.C. Breslin et al.

    An information-processing analysis of mindfulness: Implications for relapse prevention in the treatment of substance abuse

    Clinical Psychology: Science and Practice

    (2002)
  • P.C. ⁎Britton

    The relation of coping strategies to alcohol consumption and alcohol-related consequences in a college sample

    Addiction Research & Theory

    (2004)
  • P.C. ⁎Broderick et al.

    A prospective study of rumination and depression in early adolescence

    Clinical Child Psychology and Psychiatry

    (2004)
  • J.W. ⁎Burns et al.

    Anger management style, blood pressure reactivity, and acute pain sensitivity: Evidence for “trait × situation” models

    Annals of Behavioral Medicine

    (2004)
  • R.A. ⁎Burwell et al.

    Subtypes of rumination in adolescence: Associations between brooding, reflection, depressive symptoms, and coping

    Clinical Child and Adolescent Psychology

    (2007)
  • L.D. ⁎Butler et al.

    Gender differences in responses to depressed mood in a college sample

    Sex Roles

    (1994)
  • S. Bydlowski et al.

    Emotional-processing deficits in eating disorders

    International Journal of Eating Disorders

    (2005)
  • C.A. ⁎Calmes et al.

    Repetitive thought and emotional distress: Rumination and worry as prospective predictors of depressive and anxious symptomatology

    Cognitive Therapy and Research

    (2007)
  • L. Campbell-Sills et al.

    Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders

  • J.J. Campos et al.

    On the nature of emotion regulation

    Child Development

    (2004)
  • Cited by (4053)

    View all citing articles on Scopus
    1

    Tel.: +1 203 432 7352.

    2

    Tel.: +44 1223 355294.

    View full text