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Emotion Regulation in Current and Remitted Depression: A Systematic Review and Meta-Analysis
Open accessAbstract
Background Major Depressive Disorder (MDD) is a highly prevalent, recurrent and potentially chronic disorder. Identifying risk factors and underlying mechanisms to inform preventive and therapeutic interventions is therefore imperative. Emotion regulation is a proposed factor in the development and maintenance of MDD. The aim of the present review was to summarize and synthesize research on self-reported emotion regulation strategy use and emotion regulation abilities in adults diagnosed with current and remitted MDD. Methods Seventy-two eligible studies were retrieved from databases through a systematic literature search. Group differences between individuals with current MDD, remitted MDD and healthy controls were calculated using meta-analytic procedures. Meta-regression analyses investigated potential moderator effects on emotion regulation difficulties. Results Results indicated that individuals with current MDD report higher maladaptive emotion regulation strategy use for avoidance (Hedges’ g = 1.3), rumination (g = 2.1) and suppression (g = 1.1) compared to healthy controls. Also, they reported lower adaptive emotion regulation strategy use for acceptance (g =-1.0), problem solving (g = -1.0) and reappraisal (g = -0.7). Individuals with current MDD reported limited general emotion regulation abilities, indicated by higher alexithymia (g =1.45), lower emotional awareness (g =-0.95), emotional clarity (g = -1.50) and emotional tolerance (g =-1.89). Similar results were found in individuals with remitted MDD for avoidance (g = 1.0), rumination (g = 1.1), suppression (g = 0.6) and general emotion regulation abilities. However, no difference was found between individuals with remitted MDD and healthy controls for adaptive emotion regulation strategies. Meta-regression analyses suggest that age of illness onset, comorbid anxiety and duration of remission influence emotion regulation. Conclusion The present review and meta-analysis indicates that individuals with current and remitted MDD have difficulties with emotion regulation compared to individuals who have never been depressed. Although depressive symptoms improve, emotion regulation difficulties may continue, and could be a contributing factor to relapse. Our findings inform future research on emotion regulation and psychotherapeutic interventions.
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“Difficulties in emotion regulation strategy use play a central role in the development, maintenance, and treatment of depression and anxiety disorders [27–29].”
From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [29]
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“The first pathway to mitigating anxiety and depression symptoms involves reducing perseverative and avoidant emotion regulation strategies, such as rumination, avoidance, and suppression, which are known to maintain and exacerbate internalizing psychopathology [29, 58–62].”
From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [29]
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In the citing paper
“The first pathway to mitigating anxiety and depression symptoms involves reducing perseverative and avoidant emotion regulation strategies, such as rumination, avoidance, and suppression, which are known to maintain and exacerbate internalizing psychopathology [29, 58–62].”
From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [29]
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The role of emotion regulation in the characterization, development and treatment of psychopathology
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BackgroundPsychiatric Aspects of Obesity: A Narrative Review of Pathophysiology and Psychopathology
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Mindfulness-based interventions for anxiety and depression
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Kovács, L. N., Jordan, G., Berglund, F., Holden, B., Niehoff, E., Pohl, F., Younssi, M., Zevallos, I., Ágoston, C., Varga, A., et al. (2024) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2024.102327 · Cited by 76
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“27 The fi nding in this study that children ’ s exposure to maternal depression is associated with problematic functioning in these 2 domains at as early as 5 years of age extends the literature and offers insight into the origins of these psychosocial dif fi culties.”
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“…disorders (e.g. Cai et al., 2018; Conner, White, et al., 2020), it is important to continue to expand the literature to include other significant associations that have been established in TD literature, including depression and ADHD (Bodalski et al., 2019; Uhl et al., 2019; Visted et al., 2018).”
The impact of traumatic childhood experiences on interoception: disregarding one’s own body
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“11,12”
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“Forms of affect regulation were also related to well-being (Koval et al., 2014; Visted et al., 2018).”
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“…as measured by the DERS have also been found to be associated with different kinds of psychopathology such as personality disorders, posttraumatic stress disorders, depression and anxiety (e.g., Gratz et al. 2006; Sloan et al. 2017; Tull and Roemer 2007; Villalta et al. 2018; Visted et al. 2018).”
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“Overall, difficulties in ER appears to be a contributing factor in both the onset and recurrence of depressive episodes (Visted et al., 2018).”
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Why Do People With Depression Use Faulty Emotion Regulation Strategies?
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“Emotional tension—which was primarily associated with affective pain perceptions—may similarly be addressed by applied emotion regulation interventions [93, 94, 95].”
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Neural basis of positive and negative emotion regulation in remitted depression
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“rumination and expressive suppression but lower use of cognitive reappraisal (Aldao et al., 2010; Joormann et al., 2007; Joormann and Michael, 2014; Visted et al., 2018).”
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“Given that depression is associated with alexithymia and deficits in emotional awareness or clarity (Visted et al., 2018), it is conceivable that daily emotion reporting contributed to improvements in these facets of emotion regulation.”
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“…recently published systematic review and meta-analysis concluded that patients with MDD use maladaptive emotion regulation strategies more often, use adaptive emotion regulation strategies less often, and have lower emotion regulation ability compared with healthy controls (Visted et al. 2018).”
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Difficulties in Emotion Regulation and Problematic Pornography Use: The Mediating Role of Loneliness
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“…as their implications for interpersonal relationships and the development of psychopathological symptoms (Aldao et al., 2016; Victor & Klonsky, 2016; Visted et al., 2018), future research could expand on our work to other mental health constructs (e.g., anxiety, depression, boredom, well-being).”
BackgroundThe role of emotion regulation in perinatal depression and anxiety: a systematic review
Verhelst, P., Sels, L., Lemmens, G. M. D., & Verhofstadt, L. (2024) · BMC Psychology · doi:10.1186/s40359-024-02033-9 · Cited by 37
“These findings are consistent with previous research in (non) perinatal samples [33, 35, 37, 56, 65–67].”
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“Studies have revealed that patients with depression exhibit abnormal emotions closely linked with emotion regulation, which are reflected in their facial expressions [9, 10].”
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“Difficulty in emotion regulation is a proposed factor in the development and maintenance of Major Depressive Disorder (Visted et al., 2018).”
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Suicidality in People With Obsessive-Compulsive Symptoms or Personality Traits
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“The recurring thoughts were also recorded verbatim (79).”
BackgroundValidation of an Emotion Regulation Training Program on Mental Well-Being
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“In addition, it has been suggested that decreased emotion-regulation ability, known to be associated with depressive symptoms [32], is a key component of individual academic well-being [33].”
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McKinnon, A., Kuyken, W., Hayes, R. A., Werner‐Seidler, A., Watson, P., Dalgleish, T., & Schweizer, S. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.06.061 · Cited by 27
Depressive symptoms in youth with ADHD: the role of impairments in cognitive emotion regulation
Mayer, J. S., Brandt, G. A., Medda, J. E., Basten, U., Grimm, O., Reif, A., & Freitag, C. M. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01382-z · Cited by 36
“This finding is consistent with the depression literature [40, 87].”
BackgroundResultInfluentialVarela, J. J., Hernández, C., Berger, C., de Souza, S. B., & Pacheco, E. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107268 · Cited by 23
Altaweel, N., Upthegrove, R., Surtees, A. D. R., Durdurak, B. B., & Marwaha, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1176355 · Cited by 24
“These studies, whilst limited in range and number, suggest emotional dysregulation deficits may be important in the genesis, manifestation (59) and outcomes of depression, such as relapse (60).”
BackgroundDirection of Dependence Between Specific Symptoms of Depression: A Non-Gaussian Approach
Velázquez, R. G., Jokela, M. M., & Rosenström, T. H. (2019) · Clinical Psychological Science · doi:10.1177/2167702619875410 · Cited by 24
Prefrontal-amygdala emotion regulation and depression in multiple sclerosis
Meyer‐Arndt, L., Kuchling, J., Brasanac, J., Hermann, A., Asseyer, S., Bellmann–Strobl, J., Paul, F., Gold, S. M., & Weygandt, M. (2022) · Brain Communications · doi:10.1093/braincomms/fcac152 · Cited by 24
“The clinical importance of emotion regulation was indicated by studies showing that persons with depression engage more frequently in less efficient strategies (such as rumination) and appear less able to use efficient ones (such as reinterpreting and distancing).(15,20,21) The clinical importance of PFC and amygdala…”
BackgroundThe power of emotion regulation: how managing sadness influences depression and anxiety?
Zaid, S. M., Hutagalung, F. D., Hamid, H. S. A., & Taresh, S. M. (2025) · BMC Psychology · doi:10.1186/s40359-025-02354-3 · Cited by 23
“These two disorders are accompanied by the persistence of negative emotions, such as sadness along with difficulties in regulating these emotions [27].”
Facial Emotion Recognition and Executive Functions in Insomnia Disorder: An Exploratory Study
de Almondes, K. M., Júnior, F. W. N. H., Leonardo, M. E. M., & Alves, N. T. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00502 · Cited by 23
Thompson, R. J., Bailen, N. H., & English, T. (2021) · Clinical Psychological Science · doi:10.1177/2167702621992082 · Cited by 36
Labella, M. H., Klein, N. D., Yeboah, G., Bailey, C., Doane, A. N., Kaminer, D., Bravo, A. J., & Cross‐Cultural Addictions Study Team (2023) · Aggressive Behavior · doi:10.1002/ab.22111 · Cited by 32
“…and depressive symptoms in young adulthood (e.g., Ttofi et al., 2011), as well as links between depression and emotion regulation (Hu et al., 2014; Visted et al., 2018), rumination (Olatunji et al., 2013; Zhou et al., 2020), and distress tolerance (Lass & Winer, 2020, Williams et al., 2013).”
Atta, M. H. R., El-Gueneidy, M., & Lachine, O. A. R. (2024) · BMC Psychology · doi:10.1186/s40359-024-01949-6 · Cited by 31
Emotion regulation in emerging adult gamblers and its mediating role with depressive symptomology
Marchica, L. A., Mills, D. J., Keough, M. T., Montreuil, T. C., & Derevensky, J. L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.078 · Cited by 22
Differential effects of stress-related and stress-unrelated humor in remitted depression
Braniecka, A., Wołkowicz, I., Orylska, A., Antosik-Wójcińska, A., Chrzczonowicz-Stępień, A., & Bolek, E. (2022) · Scientific Reports · doi:10.1038/s41598-022-11515-y · Cited by 7
Yaroslavsky, I., Bush, A. H., & France, C. M. (2020) · Development and Psychopathology · doi:10.1017/s095457942000098x · Cited by 25
Metacognitions and brooding predict depressive symptoms in a community adolescent sample
Pedersen, H., Grønnæss, I., Bendixen, M., Hagen, R., & Kennair, L. E. O. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03779-5 · Cited by 22
“Further, meta-analyses have shown that there is a robust positive association between rumination and depression [5, 51, 67].”
BackgroundMachine learning models for predicting depression in Korean young employees
Kim, S., Gil, M., & Min, E. J. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1201054 · Cited by 24
Mechanisms underpinning the mental health impact of arts engagement
Fancourt, D. E., Stringaris, A. K., & Sacco, P. L. (2026) · Nature Reviews Psychology · doi:10.1038/s44159-026-00545-2 · Cited by 23
Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework
Koenders, M. A., Dodd, A., Karl, A., Green, M. J., Elzinga, B. M., & Wright, K. A. (2020) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2020.100031 · Cited by 23
“There is some indication of greater self-reported ehavioural inhibition in those with BD compared to HC’s and MDD paients ( Meyer et al., 2001 ; Weinstock et al., 2018 ; Yechiam et al., 2008 ). hese studies examined self-reported passive avoidance of threat.”
BackgroundInfluentialEmotion regulation profiles and symptoms of depression and anxiety
Reichler, A. G., Preece, D. A., & Gross, J. J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119548 · Cited by 22
Gillespie, M. L., & Rao, U. (2022) · Journal of Child and Family Studies · doi:10.1007/s10826-022-02296-z · Cited by 25
“, perseveration) and subsequent EF deficits (Kavanaugh et al., 2019; Visted et al., 2018).”
BackgroundAssociating Flexible Regulation of Emotional Expression With Psychopathological Symptoms
González‐Escamilla, G., Dörfel, D., Becke, M., Trefz, J., Bonanno, G. A., & Groppa, S. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.924305 · Cited by 27
“…in patients with various psychiatric disorders, also pointing to dysregulation in neural emotion regulation networks (Taylor and Liberzon, 2007; Gaebler et al., 2014; Rabinak et al., 2014; Wackerhagen et al., 2017, 2018; Fitzgerald et al., 2019; Khodadadifar et al., 2022; Poon et al., 2022).”
BackgroundWeihs, K., McConnell, M. H., Wiley, J., Crespi, C. M., Sauer-Zavala, S., & Stanton, A. (2019) · Psycho-Oncology · doi:10.1002/pon.5037 · Cited by 18
“Preliminary evidence shows changes in ER and coping processes mediate the effects of psychotherapy for resolution of depression, but more rigorously designed studies are needed to establish causal priority.(22,25,26) To our knowledge, these mediating targets have not been tested in preventive interventions.”
BackgroundRohr, C. S., Bray, S., & Dewey, D. (2021) · Development and Psychopathology · doi:10.1017/s0954579421001449 · Cited by 21
“top-down modulation of visual processing and visual recognition especially in relationship to working 6 memory (67, 68) and conflict processing (50), and has been shown to be altered in major depressive 7 disorder (67), another condition in which issues with BR are readily apparent (69).”
BackgroundMechler, J., Lindqvist, K., Falkenström, F., Carlbring, P., Andersson, G., & Philips, B. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00671 · Cited by 19
A systematic review and meta-analysis of the effect of emotion regulation on cortisol
Mikkelsen, M. B., Tramm, G., Zachariae, R. H., Gravholt, C. H., & O’Toole, M. S. (2020) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2020.100020 · Cited by 24
Phillips, A., Halligan, S. L., Lavi, I., Macleod, J., Robinson, S., Wilkins, D., & Hiller, R. M. (2023) · Trauma Violence & Abuse · doi:10.1177/15248380231196107 · Cited by 21
“This corroborates findings within the general population, which indicates strong ties between maltreatment and emotion dysregulation, and mental health problems (e.g., Gruhn & Compas, 2020; Visted et al., 2018; Weiss et al., 2022).”
ResultRegli, J., Bahmani, D. S., Rigotti, V., Stanga, Z. G., Ülgür, I. I., Fichter, C., Lang, U. E., Brühl, A. B., & Brand, S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13154372 · Cited by 20
“Accordingly, Visted, et al. [105] speculated that poor emotion regulation and more limited social competencies might be latent risk factors for relapses of depressive episodes.”
BackgroundSanwald, S., Widenhorn‐Müller, K., Gahr, M., Kammer, T., Schönfeldt‐Lecuona, C., Montag, C., & Kiefer, M. (2022) · BMC Psychiatry · doi:10.1186/s12888-021-03677-2 · Cited by 20
“Previous studies suggest that two emotion regulation strategies, high suppression and low reappraisal, are associated with current (suppression and reappraisal) as well as remitted (only suppression) depression [41].”
BackgroundResultAlawadhi, Y. T., Smith, M. R., & King, K. M. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23458 · Cited by 20
Depression core network-based individualized targeting for transcranial magnetic stimulation
Raij, T. T., Komulainen, E., Aydogan, D. B., Pamilo, S., Isometsä, E. T., & Raij, T. (2023) · Brain stimulation · doi:10.1016/j.brs.2023.03.005 · Cited by 23
“Mood is a prevalent emotional state that is coupled to more fleeting emotions, linking the two fundamental MDD symptoms with emotion regulation, and accumulating evidence points to dysfunctional emotion regulation strategies in MDD [21].”
Patterns and Longitudinal Changes in Negative Emotions of People with Depression on Sina Weibo
Yao, X., Yu, G., Tian, X., & Tang, J. (2019) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2019.0108 · Cited by 19
Ruminative Inertia, Emotion Regulation, and Depression: A Daily-Diary Study
Bean, C. A. L., Heggeness, L. F., & Ciesla, J. A. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.04.004 · Cited by 25
Shi, X., Qi, H., Wang, S., Li, Z., Li, Z., & Fan, F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.748064 · Cited by 20
Cui, X., Ding, Q., Yu, S., Zhang, S., & Li, X. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102480 · Cited by 18
Letzen, J. E., Boissoneault, J., Sevel, L. S., & Robinson, M. E. (2019) · Brain Imaging and Behavior · doi:10.1007/s11682-019-00076-w · Cited by 17
Validity of retrospectively-reported depressive episodes
Birk, S. L., Olino, T. M., Klein, D. N., & Seeley, J. R. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.08.067 · Cited by 17
“Retrospective reports of depressive disorders assessed via diagnostic interviews are extensively used in studies of risk, course and outcome, epidemiology, and genetics (e.g., Bonde, 2008; Flemming & Offord, 1990; Hartman et al., 2019; Hölzel et al., 2011; Lewinsohn et al., 1994; Liu et al., 2019; Middeldorp et al., 2…”
MethodArrivillaga, C., Elhai, J. D., Rey, L., & Extremera, N. (2023) · Cyberpsychology Journal of Psychosocial Research on Cyberspace · doi:10.5817/cp2023-3-2 · Cited by 22
Feldmann, L., Zsigo, C., Mörtl, I., Bartling, J., Wachinger, C., Oort, F. J., Schulte‐Körne, G., & Greimel, E. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.08.087 · Cited by 19
Metadata
- Authors
- Visted, E., Vøllestad, J., Nielsen, M. B., & Schanche, E.
- Affiliations
- Haukeland University Hospital (NO)
- University of Bergen (NO)
- National Institute of Occupational Health (NO)
- Corresponding author
- Visted, Endre
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2018-05-18
- Volume
- 9
- Pages
- 756-756
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC5968125
- OpenAlex
- W2800418807
- Cited by
- 337
- References
- 122
- Citations by year
- 2026: 54 · 2025: 48 · 2024: 61 · 2023: 42 · 2022: 38 · 2021: 31 · 2020: 25 · 2019: 32 · 2018: 6
- FWCI
- 3.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Funders
- L. Meltzers Høyskolefond (7183, 16545)
- Universitetet i Bergen
- 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
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- emotion regulation, major depressive disorder, remitted depression, maladaptive emotion regulation, rumination, avoidance, emotional suppression, cognitive reappraisal, acceptance, alexithymia, emotional awareness, emotional clarity, emotional tolerance, relapse risk, anxiety comorbidity, remission duration
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