Mental health disorders are on the rise in adolescents and young adults in the United Kingdom. Depression and anxiety disorders are the most common mental health disorders diagnosed in young people, with a substantial increase in overall incidence in recent years (Cybulski L. et al, 2021).
In this context, an increasing number of young people are seeking psychological treatment (Cybulski L. et al, 2021). Recent studies have identified different psychological interventions that help to reduce clinical symptoms (Das J.K. et al, 2016). These interventions can target skills that are often affected in depressive and anxiety disorders, such as emotion regulation (Schäfer J.O. et al, 2017).
Emotion regulation skills are defined as a set of strategies aimed at influencing emotions in ourselves and others (McRae K. et al, 2020). These can be separated into ‘engagement emotion regulation skills’, which involve engagement with an emotional experience (e.g., acceptance), and ‘disengagement emotion regulation skills’, which involve disengagement with an emotional experience and include strategies such as avoidance (Daros A.R. et al, 2021). Emotion dysregulation is characterised by difficulties responding to and managing emotions, which can aggravate mental health disorders (Paulus F.W. et al, 2021).
Recent studies have shown a positive effect of treatments for depression and anxiety in emotion regulation skills (Sloan E. et al, 2017). However, this association has been less studied in adolescents and young adults and for different constructs of emotion regulation separately. The aim of the present study (Daros et al. 2021), funded by the Wellcome Trust as one of their Active Ingredients projects, was to explore the effect of psychological interventions for depression and/or anxiety in adolescents and young adults in different emotion regulation skills.
The authors of this study ran a random-effects meta-analysis. They searched for studies published up until June 2020 using different databases (Medline, Embase, APA PsycInfo, CINAHL, The Cochrane Library). To be included in their review, studies needed to be randomised controlled trials testing the effects of a psychological intervention for depression and/or anxiety in adolescents and young adults aged 14 to 24 years old. Included studies measured depression and/or anxiety symptoms and emotion regulation skills as an outcome. Selected studies were peer-reviewed and written in English. Members of the National Youth Action Council at the Centre for Addiction and Mental Health in Canada were recruited as a youth advisory board and were involved in the design of the study and the interpretation and dissemination of the findings.
This meta-analysis included 385 effect sizes from 90 randomised controlled trials with a total sample size of 11,652 participants. Selected studies included different psychological interventions, with Cognitive Behavioural-, Mindfulness-, Cognitive Training- and Acceptance/Emotion Regulation-based interventions being the most frequently studied. This meta-analysis focused on intrapersonal rather than interpersonal emotion regulation skills.
Main findings showed:
- Psychological interventions reduced depression and anxiety symptoms, emotion dysregulation and disengagement emotion regulation skills, and increased engagement emotion regulation skills.
- Cognitive training interventions did not significantly reduce depression and anxiety symptoms or improve engagement emotion regulation skills.
- Acceptance/Emotion Regulation based interventions did not improve disengagement emotion regulation skills.
- Reduced emotion dysregulation and disengagement emotion regulation skills and improved emotion regulation skills were associated with improvements in depression and anxiety symptoms.
- The association between emotion regulation skills and depression and anxiety symptoms varied depending on intervention characteristics. Overall, group intervention formats, longer treatments and cognitive behavioural interventions produced larger positive associations between improved emotion regulation skills and reduced depression and anxiety symptoms.
- Psychological interventions increased acceptance and problem-solving and reduced avoidance, rumination and suppression.
- The specific emotion regulation skills of acceptance, problem-solving and cognitive reappraisal were positively associated with reduced depression and anxiety symptoms.
- A decrease in rumination (disengagement emotion regulation) was positively associated with reduced depression and anxiety symptoms.
- This meta-analysis showed that psychological interventions for depression and anxiety in adolescents and young adults reduced depression and anxiety symptoms, disengagement emotion regulation skills and emotion dysregulation, and improved engagement emotion regulation skills.
- Additionally, reductions in depression and anxiety symptoms were positively associated with reductions in emotion dysregulation and disengagement emotion regulation skills and increases in engagement emotion regulation skills.
- Overall, larger associations were found for longer treatments, group format and cognitive behavioural interventions.
- The authors concluded that psychological interventions that focus on decreasing disengagement emotion regulation skills and emotion dysregulation and improving engagement regulation skills may be particularly effective for reducing depression and anxiety symptoms.
Strengths and limitations
The current meta-analysis explored the effect of psychological interventions for depression and/or anxiety in emotion regulation skills, with a focus on young people and considering different emotion regulation skills for enhanced specificity. One of the strengths of this study is that it included a panel of youths who participated in all the stages of the research, promoting the engagement of youth in mental health research and practice, but also raising awareness of this issue.
The findings of this study should be interpreted in the light of some limitations, that were acknowledged by the authors in the study. In addition, it is important to note that, although selected studies included outcome measures of depression and/or anxiety symptoms, patients with other mental health disorders were also recruited, increasing the heterogeneity of the sample. Finally, the age of the sample ranged between 14 and 24 years old based on the age of onset for depression and anxiety. However, further studies are needed to clarify whether emotion regulation training in younger children could prevent the appearance of depression and anxiety symptoms.
Implications for practice
Psychological interventions for depression/anxiety should target more and more diverse intrapersonal emotion regulation skills. More specifically, therapies focusing on improving engagement emotion regulation skills and reducing disengagement emotion regulation skills and emotion dysregulation seem particularly impactful. Additionally, long treatments with six or more sessions, cognitive behavioural therapies and group interventions should be favoured.
Based on the youth advisory board recommendations, there is a need for an increased awareness of the relationships between emotion regulation skills and depression and anxiety symptoms, to reduce the stigma associated with these disorders but also in order to understand how improvements in emotion regulation skills may contribute to positive treatment outcomes. In this context, informing young people about emotion regulation and its different types is recommended to make informed treatment decisions but also, emotion regulation training could be incorporated in school curriculums as a preventive strategy.
Statement of interests
The author declares no conflicts of interest.
Daros AR, Haefner SA, Asadi S. et al (2021) A meta-analysis of emotional regulation outcomes in psychological interventions for youth with depression and anxiety. Nature Human Behaviour 2021 5 1443–1457.
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Schäfer JÖ, Naumann E, Holmes EA. et al (2017) Emotion Regulation Strategies in Depressive and Anxiety Symptoms in Youth: A Meta-Analytic Review. Journal of Youth and Adolescence 2017 46 261–76.
Sloan E, Halla K, Moulding R. et al (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review 57 2017 141–163.
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