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Cited by 136Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPersonality Disorders and Psychopathology

A meta-analysis of emotional regulation outcomes in psychological interventions for youth with depression and anxiety

Open access
Daros, Alexander R., Haefner, Sasha A., Asadi, Shayan, Kazi, Sharifa, Rodak, Terri, Quilty, Lena C.·2021·Nature Human Behaviour
DOI 10.1038/s41562-021-01191-9PMC PMC7611874
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Abstract

Difficulties in applying emotional regulation (ER) skills are associated with depression and anxiety symptoms, and are common targets of treatment. This meta-analysis examined whether improvements in ER skills were associated with psychological treatment outcomes for depression and/or anxiety in youth. A multivariate, random-effects meta-analysis was run using metafor in R. Inclusion criteria included studies that were randomized controlled trials (RCTs) of a psychological intervention for depression and/or anxiety in patients aged 14–24, were peer reviewed, were written in English, measured depression and/or anxiety symptoms as an outcome and measured ER as an outcome. Medline, Embase, APA PsycInfo, CINAHL and The Cochrane Library were searched up to 26 June 2020. Risk of bias (ROB) was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool. The meta-analysis includes 385 effect sizes from 90 RCTs with total N = 11,652. Psychological treatments significantly reduced depression, anxiety, emotion dysregulation (k = 13, Hedges’ g = 0.54, P < 0.001, 95% confidence interval (CI) = 0.30–0.78) and disengagement ER (k = 83, g = 0.24, 95% CI = 0.15–0.32, P < 0.001); engagement ER also increased (k = 82, g = 0.26, 95% CI = 0.15–0.32, P < 0.001). Improvements in depression and anxiety were positively associated with improved engagement ER skills, reduced emotion dysregulation and reduced disengagement ER skills. Sensitivity considered study selection and publication bias. Longer treatments, group formats and cognitive-behavioural orientations produced larger positive associations between improved ER skills and reduced symptoms. ER skill improvement is linked to depression and anxiety across a broad range of interventions for youth. Limitations of the current study include reliance on self-report measures, content overlap between variables and inability to test the directionality of associations. In this meta-analysis of 90 randomized controlled trials of youth psychological treatment, Daros et al. show that a reduction in depression and anxiety symptoms is associated with improvements in emotional regulation skills.

Integrity signals

Registry

Crossref · 10.1038/s41562-021-01191-9

Cites

88 of 88 references verified0 citation errors · 0 not checkable

Statistics

16 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 118 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Reductions in anxiety and depression symptoms during treatment were positively associated with increases in engagement ER skills.

    “significant reductions in anxiety and depression symptoms during treatment were positively associated with significant reductions in emotion dysregulation and disengagement ER skills, as well as significant increases in engagement ER skills.”
    Quote in the paperSubstantial claim
  • Findingown data

    In non-randomized studies, medium-to-large effects were found for reducing depression symptoms (k=55, g=0.61, p<.001, 95% CI=0.46-0.75).

    “results indicated medium-to-large main effects in reducing symptoms of depression (k=55, g=0.61, p<.001, 95% CI=0.46-0.75)”
    Quote in the paperSubstantial claim
  • Findingown data

    Psychological treatments tended to increase acceptance.

    “psychological treatments for depression and anxiety tended to increase acceptance and problem solving, but not cognitive reappraisal”
    Quote in the paperSubstantial claim
  • Findingown data

    In non-randomized studies, medium-to-large effects were found for reducing disengagement emotion regulation skills (k=33, g=0.56, p<.001, 95% CI=0.32-0.60).

    “disengagement ER skills (k=33, g=0.56, p<.001, 95% CI=0.32-0.60)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Psychological treatments yielded small increases in engagement emotion regulation skills (k=82, g=0.26, p<.001, 95% CI=0.15-0.32).

    “they also produced small effect size increases in engagement ER skills (k=82, g=0.26, p<.001, 95% CI=0.15-0.32)”
    Quote in the paperSubstantial claim
  • May combine two claims. 46
  • Classified as probably not a substantial claim. 62

  • May combine two claims.

    Findingown data

    The meta-analysis drew on 385 effect sizes from 90 randomized controlled trials, with a total sample of 11,652 participants.

    “The meta-analysis includes 385 effect sizes from 90 RCTs with total N=11,652.”
    • Also stated in: § Search Results and Characteristics of Selected Studies · plain
      “Data were extracted and primary analyses were conducted using 385 effect sizes from 88 included studies. Two of these studies contained secondary studies, for a total of 90 RCTs (N=11,652).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For depression outcomes, trim-and-fill estimated 13 missing studies, yielding an adjusted g=0.48 that favored larger intervention effects.

    “For depression outcome studies, 13 studies were estimated as missing to the right of the mean under random effects modeling, with an adjusted random-effects Hedges’ g=0.48, p<.001, 95% CI=0.38-0.58, again favoring larger intervention effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Decreases in avoidance were positively linked with reduced anxiety symptoms but negatively linked with reduced depression symptoms.

    “For avoidance, decreases were positively associated with reduced anxiety symptoms but negatively associated with reduced depression symptoms (the latter finding is opposite to expectations).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In half of the randomized controlled trials, the country's primary language was not English.

    “Half of these RCTs (50%) were from countries where English was not a primary language.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Egger's test was significant for anxiety outcome studies, indicating a skew toward underestimating positive intervention effects.

    “Egger’s test was significant for subgroupings of studies focused on outcomes for anxiety, t(65)=4.25, p<.001, and depression, t(78)=4.79, p<.001, due to a skew towards underestimating the magnitude of positive intervention findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Egger's test was significant for depression outcome studies, indicating a skew toward underestimating positive intervention effects.

    “Egger’s test was significant for subgroupings of studies focused on outcomes for anxiety, t(65)=4.25, p<.001, and depression, t(78)=4.79, p<.001, due to a skew towards underestimating the magnitude of positive intervention findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The youth advisory board highlighted that framing depression and anxiety as ER problems may reduce stigma.

    “Our youth advisory board highlighted the utility of framing depression and anxiety as problems with ER to reduce the stigma regarding the disorders”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Shorter treatments, blended/online formats, cognitive training, and Acceptance/ER-based interventions showed some negative correlations for both anxiety and depression, opposite to previous research.

    “Moreover, shorter treatments, blended/online formats, and cognitive training and Acceptance/ER-based interventions exhibited some negative correlations (opposite direction than expected) for both anxiety and depression compared to previous research.44–48”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [44] Sakiris, N. & Berle, D. A systematic review and meta-analysis of the unified protocol as a transdiagnostic emotion regulation based intervention. Clin. Psychol. Rev. 72, 101751 (2019). source

      Not checked in the free run.

    • cites [45] Forman, E. M. et al. Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy. Behav. Ther. 43, 341–354 (2012). source

      Not checked in the free run.

    • cites [46] Renna, M. E., Quintero, J. M., Fresco, D. M. & Mennin, D. S. Emotion regulation therapy: a mechanism-targeted treatment for disorders of distress. Front Psychol. 8, 98 (2017). source

      Not checked in the free run.

    • cites [47] Barlow, D. H., Bullis, J. R., Comer, J. S. & Ametaj, A. A. Evidence-based psychological treatments: an update and a way forward. Annu Rev. Clin. Psychol. 9, 1–27 (2013). source

      Not checked in the free run.

    • cites [48] Gratz, K. L., Weiss, N. H. & Tull, M. T. Examining emotion regulation as an outcome, mechanism, or target of psychological treatments. Curr. Opin. Psychol. 3, 85–90 (2015). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The youth advisory board felt it valuable to increase awareness of ER-symptom relationships to broader youth.

    “they felt that it would be valuable to increase awareness of the relationships between ER skills and depression/anxiety symptoms to the broader youth audience.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Studies with larger positive associations tended to have interventions longer than 6 sessions, group format, and CBT-based.

    “Overall, studies that produced larger positive associations tended to have interventions that were longer (>6 sessions), delivered in group format, and were CBT-based.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Subtle differences between the two skill groupings remained and played an important role in identifying treatment factors for depression versus anxiety.

    “However, subtle differences between the two skills groupings also remained and played an important role in identifying key factors involved in the treatment of depression versus anxiety.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    RCTs had small-to-medium effect size reductions in symptoms compared to large effect sizes in non-RCTs.

    “This is also indicated by the small-to-medium effect size reduction in symptoms for RCTs compared to the large effect sizes seen in the relatively more uncontrolled nature of non-RCTs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Shorter interventions and individual formats were also effective at times for depression symptoms and produced positive associations with ER skill improvements.

    “In addition to the above findings, shorter interventions and individual formats were also effective approaches at times for depression symptoms and produced positive associations with improvements in ER skills.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    CBT-based interventions more consistently improved engagement and reduced disengagement ER skills.

    “Nevertheless, CBT-based interventions more consistently improved engagement (and reduced disengagement) ER skills”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Results were relatively insensitive to small differences when ρ > 0, with all estimates remaining significant.

    “results were relatively insensitive to small differences when ρ > 0, with all estimates remaining significant”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    This synthesis grouped emotion regulation skills into two broad categories that correspond to a two-factor structure previously used to relate them to psychopathology.

    “We organized these ER skills into two broad classes which align closely to a two-factor structure used to evaluate their relationship with psychopathology.34,39”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Aldao, A., Nolen-Hoeksema, S. & Schweizer, S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30, 217–237 (2010). source

      Not checked in the free run.

    • cites [39] Moltrecht, B., Deighton, J., Patalay, P., & Edbrooke-Childs, J. Effectiveness of current psychological interventions to improve emotion regulation in youth: a meta-analysis. Eur. Child. Adolesc. Psych. https://doi.org/10.1007/s00787-020-01498-4 (2020). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Anxiety and depressive disorders typically first appear during adolescence or early adulthood, before age 24.

    “Depressive and anxiety disorders most often begin in adolescence and young adulthood, before the age of 24.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Kessler, R. C., Berglund, P., Demler, O., Jin, R. & Walters, E. E. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry 62, 593–602 (2005). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Depression and anxiety are frequently occurring, impairing conditions that often appear together.

    “Depression and anxiety are common and disabling conditions that often co-occur,2–4”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Wittchen, H. U., Nelson, C. B. & Lachner, G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol. Med. 28, 109–126 (1998). source

      Not checked in the free run.

    • cites [3] Ezpeleta, L., Keeler, G., Erkanli, A., Costello, E. J. & Angold, A. Epidemiology of psychiatric disability in childhood and adolescence. J. Child Psychol. Psychiat. 42, 901–914 (2001). source

      Not checked in the free run.

    • cites [4] Melton, T. H., Croarkin, P. E., Strawn, J. R. & Mcclintock, S. M. Comorbid anxiety and depressive symptoms in children and adolescents: a systematic review and analysis. J. Psychiatr. Pr. 22, 84–98 (2016).

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The process model framework holds that depression and anxiety disorders result from ineffective selection and implementation of emotion regulation strategies.

    “Using the process model framework,7 mental disorders such as depression and anxiety are said to arise from failures to select and implement ER skills effectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Gross, J. J. & Jazaieri, H. Emotion, emotion regulation, and psychopathology: an affective science perspective. Clin. Psychol. Sci. 2, 387–401 (2014). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Cochrane Collaboration Risk of Bias 2.0 tool was used to assess risk of bias.

    “Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The larger treatment effects in non-randomized studies compared with randomized controlled trials are attributable to the absence of control arms and support the earlier underestimation of treatment effects.

    “The larger effects of treatment found for non-RCTs compared to RCTs relates to the lack of control arm data and supports our underestimation of treatment effect above.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This study adds to prior reviews by focusing on dimensional depression and anxiety symptoms in youth aged 14-24, including emotion regulation skills, and involving a youth advisory panel.

    “The current study extends other reviews37,38 by focusing on dimensional depressive and anxiety symptoms in young persons aged 14-24, incorporating ER skills to broaden previous reviews, and involving a panel of youths with lived experience to support study design and knowledge dissemination.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Bonanno, G. A. & Burton, C. L. Regulatory flexibility: an individual differences perspective on coping and emotion regulation. Perspect. Psychol. Sci. 8, 591–612 (2013). source

      Not checked in the free run.

    • cites [38] Aldao, A., Sheppes, G. & Gross, J. J. Emotion regulation flexibility. Cogn. Ther. Res. 39, 263–278 (2015). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These findings suggest that different psychological treatments can yield meaningful changes in intrapersonal emotion regulation skills, and such changes may act as a core process across psychological disorders when targeted in treatment.

    “These results suggest that distinct psychological treatments can produce meaningful changes in intrapersonal ER skills, and that these changes may represent a core process across psychological disorders likely to produce change when targeted in treatment.49”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Fowler, J. C. et al. Emotion dysregulation as a cross-cutting target for inpatient psychiatric intervention. J. Affect. Disord. 206, 224–231 (2016). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A study limitation is the inability to test the directionality of associations.

    “Limitations of the current study include reliance on self-report measures, content overlap between variables, and inability to test the directionality of associations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Youth with lived experience contributed to the research questions and methods, and their input shaped the synthesis.

    “Notably, these research questions and methodology were informed by youth with lived experience, whose recommendations meaningfully shaped this synthesis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The main findings were compared with 55 non-randomized studies (N=3,224) that met inclusion criteria but were analyzed separately.

    “Primary findings were compared to 55 non-RCTs (N=3,224) that met criteria for inclusion but were analyzed separately.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A study limitation is content overlap between variables.

    “Limitations of the current study include reliance on self-report measures, content overlap between variables, and inability to test the directionality of associations.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Multiple reviews have concluded that diverse psychological treatments with different theoretical orientations enhance intrapersonal emotion regulation skills in youth and adults with varied clinical presentations.

    “Several reviews have argued that a range of psychological treatments with varied theoretical orientations improve intrapersonal ER skills in youth and adults with heterogeneous clinical presentations.37,38”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Bonanno, G. A. & Burton, C. L. Regulatory flexibility: an individual differences perspective on coping and emotion regulation. Perspect. Psychol. Sci. 8, 591–612 (2013). source

      Not checked in the free run.

    • cites [38] Aldao, A., Sheppes, G. & Gross, J. J. Emotion regulation flexibility. Cogn. Ther. Res. 39, 263–278 (2015). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The youth advisory shaped the interpretation of results and the commentary.

    “Our youth advisory informed the interpretation of the results and commentary outlined below.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The most comprehensive review to date reported that 95% of studies found marked reductions in disengagement emotion regulation skills and overall emotion dysregulation, independent of treatment protocol, emotion regulation construct, or target disorder.

    “In the most comprehensive review of the literature to date, 95% of studies (which largely focused on adult samples) found substantial decreases in disengagement ER skills and overall emotion dysregulation, regardless of the specific treatment protocol, the construct of ER examined, or the disorder targeted.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Aldao, A., Sheppes, G. & Gross, J. J. Emotion regulation flexibility. Cogn. Ther. Res. 39, 263–278 (2015). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Engagement emotion regulation skills are defined as those involving active contact with an emotional experience or stimulus, and habitual use is negatively linked with psychopathology.

    “We define “engagement ER skills” as those that involve active engagement with an emotional experience or stimulus (e.g., acceptance, cognitive reappraisal, and problem-solving) and are negatively associated with psychopathology if used habitually.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Aldao, A., Nolen-Hoeksema, S. & Schweizer, S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30, 217–237 (2010). source

      Not checked in the free run.

    • cites [39] Moltrecht, B., Deighton, J., Patalay, P., & Edbrooke-Childs, J. Effectiveness of current psychological interventions to improve emotion regulation in youth: a meta-analysis. Eur. Child. Adolesc. Psych. https://doi.org/10.1007/s00787-020-01498-4 (2020). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Disengagement emotion regulation skills are defined as those involving withdrawal from an emotional experience or stimulus through avoidance, inhibition, or repetitive thinking, and habitual use is positively linked with psychopathology.

    “Alternatively, “disengagement ER skills” are those involving disengagement from an emotional experience or stimulus through avoidance, inhibition of thoughts or overt expression, or the use of repetitive thinking (e.g., avoidance, suppression, and rumination) and are positively associated with psychopathology if used habitually.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Aldao, A., Nolen-Hoeksema, S. & Schweizer, S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30, 217–237 (2010). source

      Not checked in the free run.

    • cites [39] Moltrecht, B., Deighton, J., Patalay, P., & Edbrooke-Childs, J. Effectiveness of current psychological interventions to improve emotion regulation in youth: a meta-analysis. Eur. Child. Adolesc. Psych. https://doi.org/10.1007/s00787-020-01498-4 (2020). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A study limitation is reliance on self-report measures.

    “Limitations of the current study include reliance on self-report measures, content overlap between variables, and inability to test the directionality of associations.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The present study quantitatively assessed specific ER skills and focused on depression and anxiety symptoms in youth and young adults.

    “However, the present study quantitatively assessed specific ER skills and focused on depression and anxiety symptoms in youth and young adults”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    These study characteristics may have led to the unexpected findings.

    “which may have led to these unexpected findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    A possible explanation for the larger association with reduced disengagement ER skills in anxiety is that exposures and cognitive restructuring across several intervention approaches centrally reduce experiential avoidance and anxious arousal.

    “One possible explanation for this finding is the central role in reducing the experiential avoidance and anxious arousal common in anxiety through exposures and cognitive restructuring across several intervention approaches.56,57”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [56] Liu, D. Y. & Thompson, R. J. Selection and implementation of emotion regulation strategies in major depressive disorder: an integrative review. Clin. Psychol. Rev. 57, 183–194 (2017). source

      Not checked in the free run.

    • cites [57] Daros, A. R. & Williams, G. E. A meta-analysis and systematic review of emotion-regulation strategies in borderline personality disorder. Harv. Rev. Psychiatry 27, 217–232 (2019). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Over the long term, disengagement and engagement ER skills are respectively associated with higher and lower levels of psychopathology.

    “which over the long-term are respectively associated with higher and lower levels of psychopathology,24,25,34”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [24] McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S. & Nolen-Hoeksema, S. Emotion dysregulation and adolescent psychopathology: a prospective study. Behav. Res. Ther. 49, 544–554 (2011). source

      Not checked in the free run.

    • cites [25] Berking, M., Wirtz, C. M., Svaldi, J. & Hofmann, S. G. Emotion regulation predicts symptoms of depression over five years. Behav. Res. Ther. 57, 13–20 (2014). source

      Not checked in the free run.

    • cites [34] Aldao, A., Nolen-Hoeksema, S. & Schweizer, S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30, 217–237 (2010). source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Studies with Acceptance/ER-based interventions appeared smaller in sample size and had more risk of bias concerns on average.

    “In addition, studies incorporating Acceptance/ER-based interventions appeared to be smaller in sample size and had more risk of bias concerns on average”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Interventions focusing on improving engagement ER skills, decreasing disengagement ER skills, and decreasing emotion dysregulation may be particularly impactful for anxiety and depression symptom reduction.

    “As a result, interventions that focus on improving engagement ER skills, and decreasing disengagement ER skills and emotion dysregulation, may all be particularly impactful for anxiety and depression symptom reduction.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Findings for blended/online and Acceptance/ER-based interventions should be interpreted with caution due to lower number of studies.

    “Our findings related to blended/online and Acceptance/ER-based interventions should be interpreted with caution due to the lower number of studies contributing to these analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This focus could potentially explain the difference from previous reviews.

    “which could potentially explain the difference in findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Longer treatments may be necessary for youth with anxiety and depression to build engagement ER skills.

    “It is possible that longer treatments are necessary for youth anxiety and depression to build engagement ER skills (perhaps related to exposure protocols)”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The multidimensional investigation allowed nuanced examination of three ER skill constructs with treatment outcomes.

    “Collectively, our multidimensional investigation permitted a nuanced investigation of these three different ER skills constructs with treatment outcomes”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Context is increasingly important for determining effectiveness and mental health outcomes.

    “a factor found to be increasingly important to determine effectiveness and mental health outcomes,40,41”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Berking, M., Ebert, D., Cuijpers, P. & Hofmann, S. G. Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. Psychother. Psychosom. 82, 234–245 (2013). source

      Not checked in the free run.

    • cites [41] Radkovsky, A., McArdle, J. J., Bockting, C. L. & Berking, M. Successful emotion regulation skills application predicts subsequent reduction of symptom severity during treatment of major depressive disorder. J. Consult Clin. Psychol. 82, 248–262 (2014). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The decreases may reflect a shared repetitive negative thinking construct underlying psychopathology.

    “a potential reflection of the shared repetitive negative thinking construct that underlies psychopathology.59”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Ehring, T. & Watkins, E. R. Repetitive negative thinking as a transdiagnostic process. Int J. Cogn. Ther. 1, 192–205 (2008). source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous reviews found decreases in all disengagement ER skills following psychological treatment.

    “Previous reviews37,38 found decreases in all disengagement ER skills (rumination, avoidance, and suppression) following psychological treatment”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [37] Bonanno, G. A. & Burton, C. L. Regulatory flexibility: an individual differences perspective on coping and emotion regulation. Perspect. Psychol. Sci. 8, 591–612 (2013). source

      Not checked in the free run.

    • cites [38] Aldao, A., Sheppes, G. & Gross, J. J. Emotion regulation flexibility. Cogn. Ther. Res. 39, 263–278 (2015). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The two-factor grouping of ER skills fails to consider the context in which skills are used.

    “Nevertheless, our two-factor grouping of ER skills fails to consider the context in which those skills are used”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two youth facilitators and three council members with lived experience advised design, implementation, and dissemination.

    “Two youth facilitators and three members of the council with lived experience about psychological treatments for depressive and/or anxiety symptoms advised the design and implementation of the current review, and associated knowledge dissemination activities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Quality ratings were completed by SAH and SA and discussed with ARD for final consensus.

    “Quality ratings were completed by SAH and SA and all ratings were discussed through consultation meetings with ARD for final consensus.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool version 2.0.

    “Quality and risk of bias was assessed using the Cochrane Collaboration Risk of Bias (ROB) tool (version 2.0).74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Sterne, J. A. C. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Brit. Med. J. 366, l4898 (2019). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Studies focused on severe medical issues, brain/body trauma, neurodevelopmental disorders, intellectual disabilities, or severe psychiatric conditions were excluded.

    “At each stage, the team carefully excluded studies that focused on severe medical issues (e.g., cancer, HIV, heart/liver diseases), brain or body trauma (e.g., traumatic brain/spinal cord injuries, stroke), neurodevelopmental disorders (e.g., fetal alcohol spectrum and autism spectrum disorders), intellectual disabilities or impairments, and psychiatric conditions that would supersede a diagnosis”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The review used PRISMA guidelines, AMSTAR recommendations, and Cochrane Handbook procedures.

    “We used established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the AMSTAR recommendations to conduct this review.69 We also followed procedures outlined by the Cochrane Handbook for Systematic Reviews.70”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] Shea, B. J. et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. Brit. Med. J. 358, j4008 (2017). source

      Not checked in the free run.

    • cites [70] Higgins, J. P. T. et al. Cochrane Handbook for Systematic Reviews of Interventions v.6.0 (Cochrane, 2019); www.training.cochrane.org/handbook source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Reference lists of chosen articles were hand-searched.

    “Reference lists of chosen articles were also hand-searched to identify any relevant resources not captured by the systematic searches.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Hedges' g effect size magnitudes are similar to Cohen's d.

    “the magnitudes for effect sizes are similar to Cohen’s d”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Cohen, J. A power primer. Psychol. Bull. 112, 155–159 (1992). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    RCTs with Mindfulness-based interventions more often assessed engagement ER skills, while Acceptance/ER-based and cognitive training trials more often assessed disengagement ER skills.

    “for example, RCTs with Mindfulness-based interventions more often assessed engagement ER skills (e.g., acceptance) whereas trials of Acceptance/ER-based and cognitive training interventions more often assessed disengagement ER skills (e.g., rumination).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Advisory meetings provided input on study questions, design, results interpretation, and knowledge dissemination.

    “Advisory meetings provided input on the study questions and design, results interpretation, and recommendations for knowledge dissemination materials and knowledge mobilization from a youth perspective.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    This was likely related to difficulty dividing studies into distinct therapeutic orientation categories.

    “and this was likely related to a difficulty in dividing the studies into distinct categories based on therapeutic orientation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Youth may introduce substantial variability in subjective responses.

    “which suggests that youth may introduce substantial variability in subjective responses as well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The synthesis was unable to examine whether interpersonal ER skills improve in relation to depression/anxiety symptom reduction over treatment in youth.

    “Despite an attempt, this synthesis was not able to examine or incorporate analyses related to whether interpersonal ER skills improve in relation to depression and anxiety symptom reduction over treatment in youth.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Studies were included only if written in English, reported primary cohort data in a peer-reviewed source, had participants with mean age 14.0-24.9, contained a psychological intervention, had a dimensional depression/anxiety outcome, and had an ER measure.

    “a) Written in English.b) Primary cohort data in peer-reviewed source. Secondary sources, case studies, dissertations, and published abstracts were excluded.c) Young people with a mean age between 14.0 and 24.9 received an intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Sensitivity analyses and consideration of non-RCTs were used to mitigate concerns.

    “however, we attempted to mitigate concerns by conducting sensitivity analyses, and considering other non-RCTs which met the criteria for inclusion”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These issues make it difficult to determine whether changes in depression/anxiety are caused by ER changes or vice versa, or whether they are overlapping constructs.

    “These issues can make it difficult to understand whether changes in depression and anxiety are caused by changes in ER skills or the opposite, or whether they simply represent overlapping constructs.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Psychoeducational-only, pharmacological, and neurostimulation interventions were excluded.

    “We excluded interventions that were psychoeducational only (e.g., provided pamphlet, online resource), pharmacological, or neurostimulation-based.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The meta-analysis limited selection to English-language studies.

    “Additional limitations of the present meta-analysis, include limiting the selection of studies to only those written in English”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The meta-analysis relied almost entirely on self-report measures, which can be susceptible to recall bias.

    “and relying almost entirely on data from self-report measures, which can be susceptible to recall bias.61”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Robinson, M. D. & Clore, G. L. Episodic and semantic knowledge in emotional self-report: evidence for two judgment processes. J. Pers. Soc. Psychol. 83, 198–215 (2002). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Low risk studies had either all Low ratings across the five domains or only one Some Concerns rating.

    “low risk studies had either all “Low” risk ratings across the five domains or only one “Some Concerns” rating.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Full-text articles were reviewed by two team members with conflicts resolved by consensus (96% agreement; κ=.82).

    “Here, each full-text article was similarly reviewed by two team members with conflicts resolved by team consensus (96% average agreement; κ = .82).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Results support affective science perspectives on mental disorders and theoretical models of emotion dysregulation.

    “Results also serve to support affective science perspectives on mental disorders and theoretical models of emotion dysregulation.7,28–30”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [7] Gross, J. J. & Jazaieri, H. Emotion, emotion regulation, and psychopathology: an affective science perspective. Clin. Psychol. Sci. 2, 387–401 (2014). source

      Not checked in the free run.

    • cites [28] Hofmann, S. G., Sawyer, A. T., Fang, A. & Asnaani, A. Emotion dysregulation model of mood and anxiety disorders. Depress. Anxiety 29, 409–416 (2012). source

      Not checked in the free run.

    • cites [29] Beauchaine, T. P. Future directions in emotion dysregulation and youth psychopathology. J. Clin. Child Adolesc. Psychol. 44, 875–896 (2015). source

      Not checked in the free run.

    • cites [30] Linehan, M. M. DBT Skills Training Manual 2nd edn (Guilford Publications, 2014).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Risk of bias ratings were not completed for non-randomized studies.

    “we did not complete ROB ratings for these studies.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The design of non-randomized studies automatically introduces multiple concerns with respect to randomization and participant allocation.

  • May combine two claims.

    Study design and conductown data

    There was some indication of publication bias and significant heterogeneity between individual RCTs.

    “There was some indication of publication bias and significant heterogeneity between individual RCTs treating depression and anxiety symptoms”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A youth advisory was recruited from the National Youth Action Council at CAMH and involved in all stages of the research.

    “A youth advisory was recruited from members of the National Youth Action Council at the Centre for Addiction and Mental Health were involved in all stages of the current research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Most youth with depression and anxiety symptoms can benefit from interventions that yield ER skill improvements, especially those under 18.

    “suggesting that most youth with depression and anxiety symptoms can benefit from interventions that yield ER skill improvements and especially those under 18.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies with more general measures of coping were excluded unless a subscale overlapped substantially with a specific ER skill.

    “We excluded studies with more general measures of coping, unless the study utilized a subscale that overlapped substantially with one of the above specific ER skills.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Titles and abstracts were screened by two independent team members with conflicts resolved by consensus (81% agreement; κ=.51).

    “At the first stage, all titles and abstracts were screened for inclusion by two independent team members and conflicts were resolved by team consensus (81% average agreement; κ = .51).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Studies with more general measures of psychopathology or well-being were excluded.

    “We excluded studies with more general measures of psychopathology (e.g., internalizing symptoms) and well-being (e.g., quality of life)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The provided algorithm was followed to assess individual domains, with two minor modifications to improve consistency of the overall bias rating.

    “We followed the provided algorithm to assess individual domains, with two minor modifications to improve the consistency of the overall bias rating.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Studies with at least one High risk rating or four or more Some Concerns ratings automatically received a High overall rating.

    “any study with least one “High” risk rating or ≥4 “Some Concerns” ratings automatically received a “High” overall rating”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The multivariate meta-analysis method allowed conducting one large meta-analysis followed by sensitivity analyses, simplifying the output.

    “This method allowed us to conduct one large meta-analysis followed by sensitivity analyses, simplifying the output.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Depression and anxiety symptoms are strongly correlated but not completely overlapping, with a correlation between .60 and .80.

    “depression and anxiety symptoms are strongly correlated but not completely overlapping (i.e., between .60 and .80).79”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Cole, D. A. et al. A longitudinal look at the relation between depression and anxiety in children and adolescents. J. Consult Clin. Psychol. 66, 451–460 (1998). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Previous meta-analyses found medium effect size correlations between anxiety/depression symptoms and disengagement ER strategies (≤0.56), with smaller correlations for engagement ER strategies.

    “previous meta-analyses found medium effect size correlations between anxiety/depression symptoms and disengagement ER strategies (e.g., ≤0.56), with smaller effect size correlations for engagement ER strategies,34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Aldao, A., Nolen-Hoeksema, S. & Schweizer, S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30, 217–237 (2010). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    I2 indicates the percentage of variation across studies due to heterogeneity rather than chance, with 0% none, 25% low, 50% moderate, and 75% substantial.

    “I 2 is an intuitive and simple expression of the inconsistency of studies’ results and indicates the percentage (0% indicating none; 25% low; 50% moderate; and 75% substantial heterogeneity) of variation across studies that is due to heterogeneity rather than chance.80”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] Higgins, J. P., Thompson, S. G., Deeks, J. J. & Altman, D. G. Measuring inconsistency in meta-analyses. Brit. Med. J. 327, 557–560 (2003). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We do not present tests to support significant differences between the correlations themselves.

    “we do not present tests to support significant differences between the correlations themselves.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Publication bias was assessed by funnel plot inspection, Egger's test for asymmetry, and Duval and Tweedie's trim-and-fill procedure.

    “publication bias for the treatment of depression and anxiety symptoms was assessed by funnel plot inspection, Egger’s test for asymmetry, and Duval and Tweedie’s trim-and-fill procedure;81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Duval, S. & Tweedie, R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics 56, 455–463 (2000). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Duval and Tweedie's trim-and-fill procedure yields an estimate of the effect size after publication bias has been considered with an imputation of missing studies.

    “the latter yields an estimate of the effect size after publication bias has been considered with an imputation of missing studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Duval, S. & Tweedie, R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics 56, 455–463 (2000). source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    We lacked prior knowledge of the covariance structure between the dependent effect sizes.

    “As we lacked prior knowledge of the covariance structure between the dependent effect sizes”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Intent-to-treat sample size and treatment data were prioritized (71%), otherwise completer data was used (29%).

    “We prioritized intent-to-treat sample size and treatment data (71%); otherwise, completer data was used (29%).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Effect sizes were calculated only from reliable and validated self-report and observer-rated questionnaires, excluding single-item assessments.

    “Effect sizes were calculated only from reliable and validated self-report and observer-rated questionnaires (i.e., no single item assessments).”
    Quote in the paperSubstantial claim
87 of 87

  • The paper relies on this without support.

    A gap exists because few studies or reviews have examined multiple emotion regulation indices for specificity, and systematic reviews and meta-analyses have rarely tested whether emotion regulation skill gains relate to depression and anxiety treatment outcomes in young people.

    “While ER skills training may be a key factor to consider in treatment outcomes for depressive and anxiety disorders, few of these studies or reviews have considered multiple indices of ER for enhanced specificity. Moreover, systematic reviews and meta-analyses have less often examined whether improvement in ER skills are associated with depression and anxiety treatment outcomes in young persons.”

  • The paper relies on this without support.

    Contextual emotion regulation use is harder to measure than habitual emotion regulation use.

    “However, contextual use of ER skills remains difficult to measure versus habitual ER skill use.”

  • The paper relies on this without support.

    The included studies' measures of depression, anxiety, and ER skills validly and comparably capture the constructs they are intended to measure.

    “relying almost entirely on data from self-report measures, which can be susceptible to recall bias.61”
    “We included studies that incorporated a general measure of emotion dysregulation (e.g., ER skills deficits) and/or a specific measure of ER skills, based on previous expert reviews”

  • The paper relies on this without support.

    The psychological interventions included are sufficiently similar in their ER-related mechanisms to be pooled in a meta-analysis.

    “We defined a psychological intervention as any evidence-based intervention that was grounded in psychological principles to reduce symptoms of anxiety and/or depression.”
    “difficulty in dividing the studies into distinct categories based on therapeutic orientation.”

  • The paper relies on this without support.

    The observed associations between ER skill improvements and symptom reductions reflect treatment-related change rather than reverse causation or overlapping constructs.

    “we were unable to examine more causal relationships”
    “whether changes in depression and anxiety are caused by changes in ER skills or the opposite”

  • The paper relies on this without support.

    Cognitive training interventions are usually delivered as brief single-session treatments.

    “cognitive training interventions are usually delivered as brief treatments (i.e., single-session)”

  • The paper relies on this without support.

    The youth advisory board's perspectives are relevant to the broader youth population.

    “Our youth advisory board highlighted the utility of framing depression and anxiety as problems with ER to reduce the stigma regarding the disorders”

  • The paper relies on this without support.

    Randomized controlled trials have a rigorous study design.

    “primary analyses were conducted on data from randomized controlled trials (RCTs) due to their rigorous study design”

  • The paper relies on this without support.

    The design of non-randomized studies automatically introduces multiple concerns with respect to randomization and participant allocation.

    “Because the design of non-RCTs would automatically introduce multiple concerns with respect to randomization and participant allocation”

  • The authors state this as an assumption.

    Included studies are from populations of studies that differ from each other systematically.

    “Random-effects models were used, which assume that included studies are from populations of studies that differ from each other systematically.”

  • The authors state this as an assumption.

    The random effects follow a multivariate normal distribution.

    “These computed correlations represent the estimated restricted maximum likelihood relationship between two random effects, which are assumed to follow a multivariate normal distribution.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Interventions that target emotion regulation have proved effective for mood and anxiety disorders.

    “as interventions that target emotion regulation have proved effective for mood and anxiety disorders [93].”

    From Emotion regulation in substance use disorders: a systematic review and meta-analysis (2023) · cites this paper as [93]

    The Results section (page unavailable) reports that psychological treatments reduced depression and anxiety symptoms and improved emotion-regulation measures in young people. The Introduction and Discussion (pages unavailable) frame the evidence around ages 14–24 and symptom changes associated with emotion-regulation improvements. They do not establish that interventions specifically targeting emotion regulation have proved effective for mood and anxiety disorders generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: χ2(1)=10.54, p = .012

    Minor

    The paper reports p = .012 here; recomputing from the test statistic and its degrees of freedom gives p = .001. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .012 · recomputed p = .001

  • Inconsistent p-value: χ2(1)=13.05, p = .003

    Minor

    The paper reports p = .003 here; recomputing from the test statistic and its degrees of freedom gives p < .001. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .003 · recomputed p < .001

2 of 2

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upχ²(1) = 10.54reported p = .012 · recomputed p = .001

    “χ2(1)=10.54, p = .012”

  • Doesn’t add upχ²(1) = 13.05reported p = .003 · recomputed p < .001

    “χ2(1)=13.05, p = .003”

  • Consistentχ²(1) = 20.92reported p < .001 · recomputed p < .001

    “χ2(1)=20.92, p < .001”

  • Consistentχ²(1) = 35.96reported p < .001 · recomputed p < .001

    “χ2(1)=35.96, p < .001”

  • Consistentχ²(1) = 8.5reported p = .004 · recomputed p = .004

    “χ2(1)=8.50, p = .004”

  • Consistentχ²(1) = 20.29reported p < .001 · recomputed p < .001

    “χ2(1)=20.29, p < .001”

  • Consistentχ²(6) = 53.96reported p < .001 · recomputed p < .001

    “χ2(6)=53.96, p < .001”

  • Consistentt(65) = 4.25reported p < .001 · recomputed p < .001

    “t(65)=4.25, p < .001”

  • Consistentt(78) = 4.79reported p < .001 · recomputed p < .001

    “t(78)=4.79, p < .001”

  • Consistentχ²(1) = 5.48reported p = .019 · recomputed p = .019

    “χ2(1)=5.48, p = .019”

  • Consistentχ²(1) = 9.39reported p = .002 · recomputed p = .002

    “χ2(1)=9.39, p = .002”

  • Consistentχ²(1) = 31.13reported p < .001 · recomputed p < .001

    “χ2(1)=31.13, p < .001”

  • Consistentχ²(1) = 22.29reported p < .001 · recomputed p < .001

    “χ2(1)=22.29, p < .001”

  • Consistentχ²(1) < 0.1reported p > .99 · recomputed p = .752

    “χ2(1)<0.1, p > .99”

  • Consistentχ²(1) = 2.33reported p = .13 · recomputed p = .127

    “χ2(1)=2.33, p = .13”

  • Consistentχ²(6) = 40.6reported p < .001 · recomputed p < .001

    “χ2(6)=40.60, p < .001”

16 of 16

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Non-RCT disengagement estimate conflicts with its confidence interval

    Minor

    The stated interval is centered at 0.46 rather than the reported Hedges' g of 0.56.

    Reported 0.56 · recomputed 0.46

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Zelazo, P. D. & Cunningham, W. A. in Handbook of Emotion Regulation (ed. Gross, J. J.) 135–158 (Guilford Press, 2007).
  2. Thompson, R. A. & Waters, S. F. in The Oxford Handbook of Emotion Dysregulation (eds Beauchaine, T. P. & Crowell, S. E.) 99–114 (Oxford Univ. Press, 2020).

Cited by

Sorted by citations

Related

Authors
Daros, A. R., Haefner, S. A., Asadi, S., Kazi, S., Rodak, T., & Quilty, L. C.
Affiliations
Centre for Addiction and Mental Health (CA)
Corresponding author
Daros, Alexander R.
ORCID
Venue
Nature Human Behaviour
Publisher
Springer Science and Business Media LLC
Published
2021-09-20
Volume
5
Issue
10
Pages
1443-1457
ISSN
2397-3374 (ISSN-L)
DOI
10.1038/s41562-021-01191-9
PMC
PMC7611874
OpenAlex
W3198995769
Semantic Scholar
7fc46b769c7f3b4ca4233709447a9556f5777618
Cited by
136
References
86
Citations by year
2026: 34 · 2025: 41 · 2024: 32 · 2023: 16 · 2022: 11 · 2021: 2
FWCI
2.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature Human Behaviour (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • RePEc: Research Papers in Economics (acceptedVersion)
  • OSF Preprints (OSF Preprints) (submittedVersion)
Funders
Wellcome Trust (Active Ingredients 2020)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
emotion regulation, adolescent depression, youth anxiety, psychological intervention, emotional dysregulation, disengagement, engagement, treatment outcomes, cognitive behavioral therapy, group therapy, treatment duration
MeSH terms
Emotional Regulation, Adaptation, Psychological, Adolescent, Anxiety, Depression, Humans, Psychological Techniques, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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