Emotion regulation seems to lie at the heart of mental health and psych
opathology – e.g., maladaptive emotion regulation strategies like rumination, avoidance, and suppression appear to be commonly used by patients across several mental disorders. On the other hand, adaptive emotion regulation strategies like acceptance, cognitive reappraisal and problem-solving are central skills being taught and trained in modern Cognitive Behavioral Therapy (CBT) for various kinds of mental health problems. It stands to reason that emotion regulation has been conceptualized as an important transdiagnostic process (Cludius et al., 2020).
A well-known meta-analysis by Aldao et al. (2010) suggested that the six emotion regulation strategies just mentioned are indeed linked to several symptoms of psychopathology. However, the size of these relationships varied for different strategy-symptom combinations, and the effect size estimates in groups of children and adolescents aren’t clear after all (Compas et al., 2017; Schäfer et al., 2017). Many of these estimates also suffered from low numbers of studies included. Luckily, emotion regulation research has been blooming exponentially. We were thus able to identify 184 studies with 386 effect sizes to estimate the relationships between rumination, avoidance, suppression, acceptance, cognitive reappraisal, and problem-solving with symptoms of depression, anxiety, aggression, and addiction in children and adolescents in our meta-analysis.
Results indicate that rumination, avoidance, and acceptance show the largest effects across all symptoms. Suppression showed smaller but still significant effect sizes across all symptoms, while the effect sizes of cognitive reappraisal and problem-solving with symptoms were generally the smallest and in some cases non-significant.
The moderator analyses did not suggest that these mixed findings for cognitive reappraisal and problem-solving were due to age. Generally, the links to externalizing symptoms were smaller than those to internalizing symptoms. Maladaptive strategies showed generally larger effect sizes for symptoms than adaptive strategies. Overall, the findings suggest that all of the six strategies seem to play an important role in psychopathology in children and adolescents. The meta-analysis provides evidence that emotion regulation strategies and their underlying processes could be important transdiagnostic targets in psychotherapy for children and adolescents.
Target Article
Kraft, L., Ebner, C., Leo, K., & Lindenberg, K. (2023). Emotion regulation strategies and symptoms of depression, anxiety, aggression, and addiction in children and adolescents: A meta-analysis and systematic review. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000156
Discussion Questions
- What about the causal nature (and direction) of these correlation-based links?
- Why are the effect sizes of cognitive reappraisal and problem-solving, both of which are central to CBT, relatively small?
- How important are the roles of emotion regulation flexibility and polyregulation (and, in broader terms, “meta-emotion-regulation”) for successful emotion regulation?
- How can we teach children and adolescents a broad repertoire of adaptive emotion regulation strategies and meta-emotion-regulation skills effectively, so that they learn to implement adaptive strategies flexibly and fluently, depending on the context?
About the Authors
Lorenz Kraft is a Clinical Psychology PhD student at the Johannes Gutenberg University Mainz and in training for becoming a CBT psychotherapist for children and adolescents at Goethe University Frankfurt, Germany. His main research interests include emotion regulation and active inference. He can be contacted at lorenz.kraft@uni-mainz.de
Christian Ebner is a Clinical Psychology PhD student at Goethe University Frankfurt, Germany and in training for becoming a CBT psychotherapist for children and adolescents. His main research interests include gaming disorder, internet use disorder, and e-mental health applications.
Katharina Leo is a Clinical Psychology PhD student at Goethe University Frankfurt, Germany and a CBT psychotherapist for children and adolescents. Her main research interests include gaming disorder and internet use disorder.
Katajun Lindenberg is Professor of Child and Adolescent Psychotherapy at the Johannes Gutenberg University Mainz and a CBT psychotherapist for children and adolescents. Her main research interests include gaming disorder and internet use disorder.
References
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion regulation strategies across psychopathology: A meta-analysis. Clinical Psychology Review, 30, 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
Cludius, B., Mennin, D., & Ehring, T. (2020). Emotion regulation as a transdiagnostic process. Emotion, 20(1), 37–42. https://doi.org/10.1037/emo0000646
Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M. A., Dunbar, J. P., et al. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: a meta-analysis and narrative review. Psychol Bull., 143(9), 939–91. https://doi.org/10.1037/bul0000110
Schäfer, J. Ö., Naumann, E., Holmes, E. A., Tuschen-Caffier, B., & Samson, A. C. (2017). Emotion regulation strategies in depressive and anxiety symptoms in youth: A meta-analytic review. Journal of Youth and Adolescence, 46, 261-276. https://doi.org/10.1007/s10964-016-0585-0