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

In the paper

“increasing the potential for mental health difficulties and suicidal behavior in adulthood if not treated.1,3–5”

What the sources say

• Not checked yetcites [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
• ?Could not verify

  The Discussion (p. 10) links youth depression and anxiety to disability during childhood and adolescence. The Sample section (p. 3) says the analysis includes only observations from ages 9–16; the passages found on treatment and adult outcomes do not address whether untreated depression or anxiety increases later mental-health problems or suicidal behavior. (LLM, conf=0.76)

  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). sourceExperimental — accuracy not yet measured
• Not checked yetcites [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 yetcites [5] Gould, M. S. et al. Psychopathology associated with suicidal ideation and attempts among children and adolescents. J. Am. Acad. Child Adolesc. Psychiatry 37, 915–923 (1998). source

In the paper

“supporting their earlier putative associations with psychopathology and models of their common structure.34,39”

What the sources say

• Not checked yetcites [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
• Supported

  The Introduction (‘Emotion regulation and psychopathology’; page not provided) describes associations between emotion regulation difficulties and several forms of psychopathology. The Introduction (‘Emotion regulation in interventions’; page not provided) also presents emotion regulation as a proposed transdiagnostic feature and describes frameworks in which disorders share underlying processes. These passages support the claim’s qualified reference to putative associations and models of common structure. (LLM, conf=0.86)

  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

In the paper

“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.”

In the paper

“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)”

In the paper

“psychological treatments for depression and anxiety tended to increase acceptance and problem solving, but not cognitive reappraisal”

In the paper

“disengagement ER skills (k=33, g=0.56, p<.001, 95% CI=0.32-0.60)”

In the paper

“they also produced small effect size increases in engagement ER skills (k=82, g=0.26, p<.001, 95% CI=0.15-0.32)”

In the paper

“Using the trim-and-fill procedure under random effects assumptions, seven studies were estimated as missing to the right of the mean for the anxiety outcome studies, with an adjusted random-effects Hedges’ g=0.42, p<.001, 95% CI=0.32-0.51, favoring larger intervention effects than estimated.”

In the paper

“Psychological treatments reduced anxiety, depression, disengagement ER skills, and emotion dysregulation, and improved engagement ER skills.”

In the paper

“consistent at the individual skill level, with the two engagement ER skills increasing, and three disengagement skills decreasing, over the course of treatments for anxiety and/or depression symptoms.”

In the paper

“we were unable to locate any studies that utilized interpersonal ER measures”

In the paper

“Longer treatments, group formats, and cognitive-behavioral orientations produced larger positive associations between improved ER skills and reduced symptoms.”

In the paper

“Moreover, improved engagement ER skills had positive associations with improved anxiety and depression symptoms across all studies.”

In the paper

“anxiety (k=44, g=0.53, p<.001, 95% CI=0.40-0.66)”

In the paper

“psychological treatments reduced avoidance, rumination, and suppression.”

In the paper

“psychological treatments for depression and anxiety tended to increase acceptance and problem solving, but not cognitive reappraisal”

In the paper

“with the two engagement ER skills increasing, and three disengagement skills decreasing, over the course of treatments for anxiety and/or depression symptoms.”

In the paper

“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.”

In the paper

“disengagement ER skills (k=83, g=0.24, p<.001, 95% CI=0.15-0.32)”

In the paper

“Similarly, positive associations between reduced disengagement ER skills and reduced depression and anxiety were observed with a decrease in the specific skill of rumination.”

In the paper

“Finally, decreased suppression was negatively associated with reduced anxiety and depressive symptoms (opposite to expectations).”

In the paper

“Correlational analyses indicated that reduced emotion dysregulation and reduced disengagement ER skills (note, decreases in these indices were coded positively) had positive associations with improved depression and anxiety symptoms overall”

In the paper

“Results from 186 effect size extractions across 55 non-RCT studies largely converged with the above.”

In the paper

“emotion dysregulation (k=10, g=0.83, p<.001, 95% CI=0.58-1.08)”

In the paper

“psychological treatments for depression and anxiety tended to increase acceptance and problem solving, but not cognitive reappraisal”

In the paper

“As seen in Figure 3, risk of bias ratings indicated that 85% of RCTs had low or some concerns.”

In the paper

“Longer treatments, group formats, and cognitive-behavioral orientations produced larger positive associations between improved ER skills and reduced symptoms.”

In the paper

“psychological treatments produced small-to-medium effect size decreases in depression symptoms (k=117, g=0.35, p<.001, 95% CI=0.24-0.46)”

In the paper

“anxiety symptoms (k=90, g=0.29, p<.001, 95% CI=0.12-0.40)”

In the paper

“Small-to-medium increases in engagement ER skills were also found pre-to-post treatment (k=44, g=0.48, p<.001, 95% CI=0.37-0.59).”

In the paper

“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.”

In the paper

“Longer treatments, group formats, and cognitive-behavioral orientations produced larger positive associations between improved ER skills and reduced symptoms.”

In the paper

“Psychological treatments reduced anxiety, depression, disengagement ER skills, and emotion dysregulation, and improved engagement ER skills.”

In the paper

“Psychological treatments reduced anxiety, depression, disengagement ER skills, and emotion dysregulation, and improved engagement ER skills.”

In the paper

“psychological treatments reduced avoidance, rumination, and suppression.”

In the paper

“Psychological treatments reduced anxiety, depression, disengagement ER skills, and emotion dysregulation, and improved engagement ER skills.”

In the paper

“with the two engagement ER skills increasing, and three disengagement skills decreasing, over the course of treatments for anxiety and/or depression symptoms.”

In the paper

“Correlational analyses indicated that reduced emotion dysregulation and reduced disengagement ER skills (note, decreases in these indices were coded positively) had positive associations with improved depression and anxiety symptoms overall”

In the paper

“emotion dysregulation (k=13, g=0.54, p<.001, 95% CI=0.30-0.78)”

In the paper

“psychological treatments reduced avoidance, rumination, and suppression.”

In the paper

“Psychological treatments reduced anxiety, depression, disengagement ER skills, and emotion dysregulation, and improved engagement ER skills.”

In the paper

“We also observed positive associations between engagement ER skills and reduced depression and anxiety extended to the specific skills of acceptance, problem-solving, and cognitive reappraisal (see Table 4, lower portion).”

In the paper

“the associations were more limited in some cases (i.e., emotion dysregulation) by the smaller number of studies included overall.”

In the paper

“Nevertheless, positive treatment outcomes were also positively associated with reduced disengagement ER skills and general emotion dysregulation.”

In the paper

“while avoidance was in the direction opposite to expectations for changes in the latter only.”

In the paper

“youth aged 18-21.9 exhibited positive, but smaller in magnitude, correlations between symptom reduction and improved ER skills versus two other age groups.”

In the paper

“Substantial differences between RCTs and non-RCTs that met criteria for inclusion suggested that our RCTs may be different than the broader sample of treatment studies at large.”

In the paper

“With respect to anxiety symptoms, positive treatment outcomes produced relatively larger positive associations with reduced disengagement (vs. improved engagement) ER skills during treatment.”

In the paper

“whereas positive associations in disengagement ER and emotion dysregulation were found regardless of treatment length.”

In the paper

“Improvements in all three engagement ER skills considered here were positively associated with anxiety and/or depression symptom reduction”

In the paper

“Positive outcomes for depression produced large positive associations with increased engagement ER skills.”

In the paper

“though problem-solving had the largest observed association.”

In the paper

“Alternatively, reductions in suppression and avoidance were not consistently associated with reductions in depression and or anxiety symptoms.”

In the paper

“In fact, reduced suppression was in the direction opposite to expectations for changes in anxiety and depression”

In the paper

“As a result, overall reductions in emotion dysregulation were also associated with large effect-size reductions in depression symptoms during treatment in a similar manner.”

In the paper

“Nevertheless, positive treatment outcomes were also positively associated with reduced disengagement ER skills and general emotion dysregulation.”

In the paper

“Reductions in anxiety and depression symptoms during treatment were not universally associated with reduced disengagement ER skills on an individual basis.”

In the paper

“Nevertheless, increases in engagement ER and reductions to emotion dysregulation were also associated with reduced anxiety symptoms during treatment.”

In the paper

“There is considerable moderator (i.e., outcome) heterogeneity for studies in this age group”

In the paper

“Nevertheless, increases in engagement ER and reductions to emotion dysregulation were also associated with reduced anxiety symptoms during treatment.”

In the paper

“We considered several assessment measures related to expert reviews of interpersonal ER19,20,27,68; however, we were unable to locate any intervention trials that utilized these measures.”

What the sources say

• Not checked yetcites [19] Williams, W. C., Morelli, S. A., Ong, D. C. & Zaki, J. Interpersonal emotion regulation: implications for affiliation, perceived support, relationships, and well-being. J. Pers. Soc. Psychol. 115, 224–254 (2018). source
• Not checked yetcites [20] Dixon-Gordon, K. L., Bernecker, S. L. & Christensen, K. Recent innovations in the field of interpersonal emotion regulation. Curr. Opin. Psychol. 3, 36–42 (2015). source
• Not checked yetcites [27] Hofmann, S. G., Carpenter, J. K. & Curtiss, J. Interpersonal emotion regulation questionnaire (IERQ): scale development and psychometric characteristics. Cogn. Ther. Res. 40, 341–356 (2016). source
• Not checked yetcites [68] Swerdlow, B. A., & Johnson, S. L. The Interpersonal Regulation Interaction Scale (IRIS): a multistudy investigation of receivers’ retrospective evaluations of interpersonal emotion regulation interactions. Emotion (in press).

In the paper

“Mindfulness-based interventions were also particularly effective in reducing disengagement ER skills.”

In the paper

“while Acceptance/ER-based interventions were successful in reducing emotion dysregulation.”

In the paper

“Reductions in symptoms during treatment were generally associated with improvements in ER skills, translating into the reduction of emotion dysregulation.”

In the paper

“Interventions with six or more sessions, cognitive-behavioral interventions, and a group format of delivery produced larger associations between improvements in ER and symptom reduction.”

In the paper

“Overall, there were mixed findings with respect to which interventions enhanced treatment outcomes for depression versus anxiety”

In the paper

“as findings for engagement and disengagement ER skills were generally in the expected direction”

In the paper

“There were relatively consistent effects regardless of sample type and age”

In the paper

“There were some differences depending on whether depression versus anxiety symptoms were targeted.”

In the paper

“which tended to align with the overall findings.”

In the paper

“Drawing inferences from the large body of evidence incorporated into the current study, we found that improvements in intrapersonal ER skills defined in three different ways (e.g., emotion dysregulation; disengagement ER; engagement ER) were associated with significant treatment gains for depression and anxiety in youth and young adults.”

In the paper

“As the assumed correlation between our dependent variables increased, the estimates for each outcome decreased”

In the paper

“individual differences in interpersonal ER skills, such as becoming dependent on others or social settings to regulate one’s own emotions (e.g., through excessive reassurance or advice seeking)20,26 have been shown to predict depressive and anxiety symptoms in adults.19,27”

What the sources say

• Not checked yetcites [19] Williams, W. C., Morelli, S. A., Ong, D. C. & Zaki, J. Interpersonal emotion regulation: implications for affiliation, perceived support, relationships, and well-being. J. Pers. Soc. Psychol. 115, 224–254 (2018). source
• Not checked yetcites [27] Hofmann, S. G., Carpenter, J. K. & Curtiss, J. Interpersonal emotion regulation questionnaire (IERQ): scale development and psychometric characteristics. Cogn. Ther. Res. 40, 341–356 (2016). source

In the paper

“dysfunctional patterns in intrapersonal ER skills in youth and young adults are positively associated with symptoms of depression and anxiety cross-sectionally,18,21–23”

What the sources say

• Not checked yetcites [18] Aldao, A., Gee, D. G., De Los Reyes, A. & Seager, I. Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: current and future directions. Dev. Psychopathol. 28, 927–946 (2016). source
• Not checked yetcites [21] Schäfer, J. Ö., Naumann, E., Holmes, E. A., Tuschen-Caffier, B. & Samson, A. C. Emotion regulation strategies in depressive and anxiety symptoms in youth: a meta-analytic review. J. Youth Adolesc. 46, 261–276 (2017). source
• Not checked yetcites [22] Garnefski, N. & Kraaij, V. Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety. Cogn. Emot. 32, 1401–1408 (2018). source
• Not checked yetcites [23] Keil, V., Asbrand, J., Tuschen-Caffier, B. & Schmitz, J. Children with social anxiety and other anxiety disorders show similar deficits in habitual emotional regulation: evidence for a transdiagnostic phenomenon. Eur. Child Adolesc. Psychiatry 26, 749–757 (2017). source

In the paper

“the experience of emotion dysregulation is also positively associated with depressive and anxiety symptom severity.31–33”

What the sources say

• Not checked yetcites [31] Abravanel, B. T. & Sinha, R. Emotion dysregulation mediates the relationship between lifetime cumulative adversity and depressive symptomatology. J. Psychiatr. Res. 61, 89–96 (2015). source
• Not checked yetcites [32] Roemer, L. et al. Mindfulness and emotion regulation difficulties in generalized anxiety disorder: preliminary evidence for independent and overlapping contributions. Behav. Ther. 40, 142–154 (2009). source
• Not checked yetcites [33] Tull, M. T., Stipelman, B. A., Salters-Pedneault, K. & Gratz, K. L. An examination of recent non-clinical panic attacks, panic disorder, anxiety sensitivity, and emotion regulation difficulties in the prediction of generalized anxiety disorder in an analogue sample. J. Anxiety Disord. 23, 275–282 (2009). source

In the paper

“Thus, accumulating evidence suggests that individual differences in the ability to engage in intrapersonal and interpersonal ER skills may have a transdiagnostic role in the development and course of depressive and anxiety disorder symptoms.”

In the paper

“they are typically said to be experiencing emotion dysregulation, which is common to depressive and anxiety disorders.28–30”

What the sources say

• Not checked yetcites [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 yetcites [29] Beauchaine, T. P. Future directions in emotion dysregulation and youth psychopathology. J. Clin. Child Adolesc. Psychol. 44, 875–896 (2015). source
• Not checked yetcites [30] Linehan, M. M. DBT Skills Training Manual 2nd edn (Guilford Publications, 2014).

In the paper

“Existing research suggests that individual differences in intrapersonal and interpersonal ER skills are transdiagnostic factors that underlie the development and course of depression and anxiety disorders.17–20”

What the sources say

• Not checked yetcites [17] Fernandez, K. C., Jazaieri, H. & Gross, J. J. Emotion regulation: a transdiagnostic perspective on a new RDoC domain. Cogn. Ther. Res. 40, 426–440 (2016). source
• Not checked yetcites [18] Aldao, A., Gee, D. G., De Los Reyes, A. & Seager, I. Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: current and future directions. Dev. Psychopathol. 28, 927–946 (2016). source
• Not checked yetcites [19] Williams, W. C., Morelli, S. A., Ong, D. C. & Zaki, J. Interpersonal emotion regulation: implications for affiliation, perceived support, relationships, and well-being. J. Pers. Soc. Psychol. 115, 224–254 (2018). source
• Not checked yetcites [20] Dixon-Gordon, K. L., Bernecker, S. L. & Christensen, K. Recent innovations in the field of interpersonal emotion regulation. Curr. Opin. Psychol. 3, 36–42 (2015). source

In the paper

“and prospectively predict anxiety and depressive symptoms over time.24,25”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“Improvements in intrapersonal ER skills may represent a common “active” ingredient across psychological interventions for young people, consistent with a substantial treatment literature in adult samples demonstrating a similar effect.42–48”

What the sources say

• Not checked yetcites [42] Slee, N., Spinhoven, P., Garnefski, N. & Arensman, E. Emotion regulation as mediator of treatment outcome in therapy for deliberate self‐harm. Clin. Psychol. Psychother. 15, 205–216 (2008). source
• Not checked yetcites [43] Neacsiu, A. D., Rizvi, S. L. & Linehan, M. M. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav. Res. Ther. 48, 832–839 (2010). source
• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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

In the paper

“Other research has demonstrated that improvements in ER skills during treatment are associated with positive treatment outcomes for a variety of evidence-based psychological treatments, including Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and Emotion Regulation Therapy, among others.42–48”

What the sources say

• Not checked yetcites [42] Slee, N., Spinhoven, P., Garnefski, N. & Arensman, E. Emotion regulation as mediator of treatment outcome in therapy for deliberate self‐harm. Clin. Psychol. Psychother. 15, 205–216 (2008). source
• Not checked yetcites [43] Neacsiu, A. D., Rizvi, S. L. & Linehan, M. M. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav. Res. Ther. 48, 832–839 (2010). source
• Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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

In the paper

“ER skill improvement is linked to depression and anxiety across a broad range of interventions for youth.”

In the paper

“Results for depression and anxiety were robust across almost all sensitivity analyses conducted”

In the paper

“Young people with anxiety are often explicitly taught to accept rather than suppress their feared thoughts or situations in treatments”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“Given pre-treatment relationships between intrapersonal skills and symptoms of depression and anxiety,18,21–25”

What the sources say

• Not checked yetcites [18] Aldao, A., Gee, D. G., De Los Reyes, A. & Seager, I. Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: current and future directions. Dev. Psychopathol. 28, 927–946 (2016). source
• Not checked yetcites [21] Schäfer, J. Ö., Naumann, E., Holmes, E. A., Tuschen-Caffier, B. & Samson, A. C. Emotion regulation strategies in depressive and anxiety symptoms in youth: a meta-analytic review. J. Youth Adolesc. 46, 261–276 (2017). source
• Not checked yetcites [22] Garnefski, N. & Kraaij, V. Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety. Cogn. Emot. 32, 1401–1408 (2018). source
• Not checked yetcites [23] Keil, V., Asbrand, J., Tuschen-Caffier, B. & Schmitz, J. Children with social anxiety and other anxiety disorders show similar deficits in habitual emotional regulation: evidence for a transdiagnostic phenomenon. Eur. Child Adolesc. Psychiatry 26, 749–757 (2017). source
• Not checked yetcites [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 yetcites [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

In the paper

“rumination can increase the risk of suicidal thoughts and behaviors,58”

What the sources say

• Not checked yetcites [58] Nolen-Hoeksema, S., Wisco, B. E. & Lyubomirsky, S. Rethinking rumination. Perspect. Psychol. Sci. 3, 400–424 (2008). source

In the paper

“Substantial differences between RCTs and non-RCTs that met criteria for inclusion suggested that our RCTs may be different than the broader sample of treatment studies at large.”

In the paper

“young people with depression appear to endorse rumination (or repetitive thinking) more strongly along with avoidance and suppression of their negative emotions.”

In the paper

“Although we largely confirmed our meta-analytic findings in non-RCTs”

In the paper

“Findings suggest that a common goal across psychological interventions for depression and anxiety symptoms in youth and young adults may be to increase and diversify the types of intrapersonal ER skills used to regulate emotions.”

In the paper

“Our risk of bias assessment for RCTs found less than 20% were at high risk for bias, even after we employed a conservative approach which automatically elevated some studies to high risk.”

In the paper

“which may have suppressed enhanced positive relationships (see Supplementary Table 3).”

In the paper

“Regardless of how one defines ER skills, it appears that helping to correct a bias in using disengagement over engagement ER skills is common to interventions for depression in youth and young adults.”

In the paper

“and so youth with depression may simply have more skills to gain from treatment to avoid negative mental health outcomes.”

In the paper

“While replication and more stringent mediation methods are necessary to understand these relationships, results suggest that it may not be necessary to completely reduce disengagement ER skills for positive anxiety and depression treatment outcomes.”

In the paper

“No study had two or more domains where high risk was identified.”

In the paper

“and elucidates the multiple possible pathways to recovery for youth with anxiety.”

In the paper

“Results from funnel plot examination and the trim-and-fill procedure indicated that findings with respect to interventions were underestimated due to our selection of a large range of studies that were variable in their reduction of depression and anxiety symptoms.”

In the paper

“which may facilitate a reduction in disengagement ER skills (i.e., avoidance, ruminative negative thinking, and suppression) that may have maintained their anxiety.56,57”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“Coupled with lower use of problem-solving and other engagement ER skills,34–36”

What the sources say

• Not checked yetcites [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 yetcites [35] Sloan, E. et al. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review. Clin. Psychol. Rev. 57, 141–163 (2017). source
• Not checked yetcites [36] Naragon-Gainey, K., McMahon, T. P. & Chacko, T. P. The structure of common emotion regulation strategies: a meta-analytic examination. Psychol. Bull. 143, 384–427 (2017). source

In the paper

“We excluded studies with primary diagnoses of obsessive-compulsive disorder and post-traumatic stress disorder because the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders now places them in a separate classification section from the depressive and anxiety disorders described above.72”

What the sources say

• Not checked yetcites [72] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edn (DSM-5) (American Psychiatric Association, 2013). source

In the paper

“Moreover, the results of our synthesis support continued distinction between the two groupings of skills utilized in this study”

In the paper

“Reductions in symptoms during treatment were generally associated with improvements in ER skills, translating into the reduction of emotion dysregulation.”

In the paper

“There were slight biases in how studies contributed to the meta-analysis”

In the paper

“Overall, we demonstrated more specificity of the ER constructs compared to past reviews37,38 by conducting separate analyses for more generalized measures of emotion dysregulation and specific ER skills.”

What the sources say

• Not checked yetcites [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 yetcites [38] Aldao, A., Sheppes, G. & Gross, J. J. Emotion regulation flexibility. Cogn. Ther. Res. 39, 263–278 (2015). source

In the paper

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

In the paper

“Hedges’ g was used because it can correct for small sample sizes”

What the sources say

• Not checked yetcites [75] Cohen, J. A power primer. Psychol. Bull. 112, 155–159 (1992). source

In the paper

“Thus, we argue that our findings remain unchanged even after considering potential study selection and publication bias.”

In the paper

“This age range was chosen based on epidemiological studies regarding the age-of-onset for depression and anxiety.1,2”

What the sources say

• Not checked yetcites [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 yetcites [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

In the paper

“Further, adults with higher levels of emotion dysregulation have more difficulty reporting on their emotional experiences,63,64”

What the sources say

• Not checked yetcites [63] Kashdan, T. B., Barrett, L. F. & McKnight, P. E. Unpacking emotion differentiation: transforming unpleasant experience by perceiving distinctions in negativity. Curr. Dir. Psychol. Sci. 24, 10–16 (2015). source
• Not checked yetcites [64] Daros, A. R. et al. Relationships between trait emotion dysregulation and emotional experiences in daily life: an experience sampling study. Cogn. Emot. 34, 743–755 (2020). source

In the paper

“These findings are consistent with the improvement of ER skills as a transdiagnostic active ingredient in the treatment of depression and anxiety in young people.”

In the paper

“this conceptual issue has been noted previously34–39 and may contribute to artificially inflated effects in the current synthesis.”

What the sources say

• Not checked yetcites [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 yetcites [35] Sloan, E. et al. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review. Clin. Psychol. Rev. 57, 141–163 (2017). source
• Not checked yetcites [36] Naragon-Gainey, K., McMahon, T. P. & Chacko, T. P. The structure of common emotion regulation strategies: a meta-analytic examination. Psychol. Bull. 143, 384–427 (2017). source
• Not checked yetcites [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 yetcites [38] Aldao, A., Sheppes, G. & Gross, J. J. Emotion regulation flexibility. Cogn. Ther. Res. 39, 263–278 (2015). source
• Not checked yetcites [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

In the paper

“cannot be tested using standard methods for traditional correlation coefficients (i.e., Pearson, Spearman).”

In the paper

“Given the stochastically dependent nature of our five outcome variables,76,77”

What the sources say

• Not checked yetcites [76] Hedges, L. V. in The Handbook of Research Synthesis and Meta-Analysis 3rd edn (eds Cooper, H. et al.) 281–298 (Russell Sage, 2019). source
• Not checked yetcites [77] Kalaian, H. A. & Raudenbush, S. W. A multivariate mixed linear model for meta-analysis. Psychol. Methods 1, 227–235 (1996). source