Efficacy of emotion regulation strategy implementation in and across mental disorders: A systematic review and meta-analysis

Emotion regulation (ER) difficulties are an important transdiagnostic marker of mental disorders. This preregistered meta-analytic study aimed to quantify the effects of instructed ER versus control conditions during a controlled mood induction in participants with mental disorders in regard to experiential, behavioral, and physiological outcomes. Furthermore, it aimed to find diagnosis-, individual- and task-related moderators of ER efficacy and to address possible gaps in the literature. 109 studies fulfilled the inclusion criteria, of which 71 studies with 566 effect sizes were included in a multi-level meta-analysis. Results show a small, significant effect of ER on experiential outcomes (d = -0.37, CI[95%] = [-0.48; -0.25]), which was larger in healthy than in clinical samples. Moreover, this effect was larger for cognitive change compared to response modulation and attentional deployment strategies and for studies with a pre-regulation training and disorder relevant stimuli. The small, significant effect on physiological outcomes (d = -0.09, CI[95%] = [-0.17; -0.02]) was moderated by control strategy type. Notably, there were no significant effects on behavioral outcomes (d = -0.06, CI[95%] = [-0.25; 0.12]). This comprehensive meta-analysis expands on the theoretical basis of the process model of ER and its taxonomy, has a robust statistical analysis plan, but is limited to laboratory studies and there is a shortage of studies with behavioral outcomes. Although there was no strong evidence for publication bias, quality assessment shows risk of bias especially regarding non-validated outcome measures. Results suggest that ER strategies can be implemented across mental disorders. Future research should include adequate strategy trainings and employ disorder relevant stimuli and strategies.