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The role of emotion regulation in the characterization, development and treatment of psychopathology

  • Review Article
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From Nature Reviews Psychology

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Abstract

Aberrant emotional processes are evident in various mental disorders. This raises the question of whether specific difficulties in regulating emotions are a driving factor of psychopathology and thus a worthwhile transdiagnostic treatment target. In this Review, we provide an overview of theoretical models of emotion regulation, research on emotion regulation difficulties associated with various mental disorders, longitudinal studies that address the question of causality and clinical interventions. This synthesis suggests that psychopathology across a range of disorders is associated with an inflexible pattern of regulating emotions predominantly using avoidance, rumination and suppression strategies. This pattern of emotion regulation seems to be both a predictor and a consequence of psychopathology. However, most studies do not support the assumption that people with mental disorders have a basic deficit in effectively employing potentially helpful strategies, such as acceptance or reappraisal. A separate line of research has developed effective transdiagnostic interventions for emotion regulation, but whether these interventions produce better outcomes than pre-existing therapies remains an open question. Linking basic clinical and intervention research is likely to increase understanding of what can go wrong in emotion regulation and support development of more effective interventions.

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Fig. 1: The extended process model of emotion regulation28.
Fig. 2: The two-stage appraisal theory of emotion regulation.
Fig. 3: The Adaptive Coping with Emotions model.
Fig. 4: Methodological approaches to studying emotion regulation in psychopathology.
Fig. 5: Emotion regulation strategies in psychopathology according to questionnaire studies.

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Acknowledgements

The authors thank S. E. Morales Macias, S. C. Schilberz, E. Bektas and E. Wolfram for contributing to the literature reviews and M. Wittkamp for providing feedback on Fig. 3.

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Authors and Affiliations

  1. Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany

    Tania M. Lincoln

  2. Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany

    Lars Schulze & Babette Renneberg

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Contributions

All authors made a substantial contribution to reviewing the literature and to conceptualizing and writing the Review. T.M.L. drafted the synopsis. L.S. wrote the first draft of the sections on experimental paradigms, emotion regulation as a causal factor and Box 1. B.R. wrote the first draft of the section on clinical interventions and Box 2. T.M.L. wrote the first draft of the remaining sections. T.M.L. and L.S. oversaw the literature reviews. T.M.L. drafted Figs 1–3 and T.M.L. and L.S. created Figs 4 and 5. All authors contributed to the discussion and interpretation of the findings and to editing and revising the manuscript.

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Correspondence to Tania M. Lincoln.

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Nature Reviews Psychology thanks David Bearle and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Glossary

Granger causality

A probabilistic method to assess whether the time series of one variable is useful to predict another variable.

Habituation

The process of becoming used to emotions so that they are no longer perceived as unpleasant or threatening.

Cognitive restructuring

A cognitive behavoural therapy (CBT) technique in which patients identify negative beliefs, to dispute these beliefs, generate alternative ways of thinking and practise the new thoughts in daily life.

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Lincoln, T.M., Schulze, L. & Renneberg, B. The role of emotion regulation in the characterization, development and treatment of psychopathology. Nat Rev Psychol 1, 272–286 (2022). https://doi.org/10.1038/s44159-022-00040-4

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