Emotion regulation strategies and depression

Today, I look at emotion regulation and depression in three studies. First, Liu, Springstein, Tuck, English & Thompson (2023) published “Everyday Emotion Regulation Goals, Motives, and Strategies in Current and Remitted Major Depressive Disorder: An experience sampling study” in Journal of Psychopathology and Clinical Science. Here are the edited abstract and impact statements:

People with major depressive disorder (MDD) report difficulties with emotion regulation (ER), particularly in habitual strategy use. We examined ER strategy use and other aspects of ER—desired emotional states (emotion goals) and reasons for ER (ER motives)—in current and remitted MDD. In a 2-week experience sampling study, adults with current MDD (n = 48), remitted MDD (n = 80), and healthy controls (n = 87) reported their negative affect (NA) and positive affect (PA), emotion goals (frequency, direction), ER motives (hedonic, instrumental), and ER strategy use (social sharing, acceptance, savoring, reappraisal, suppression, distraction). Compared to the remitted MDD and control groups, the current MDD group regulated emotion more frequently in general but showed weakened associations between initiating regulation and momentary affect and reported different emotion goal directions. Although all groups mostly reported emotion goals to regulate prohedonically (decrease NA [negative affect], increase or maintain PA [positive affect]), the current MDD group was the most likely to try to amplify NA and PA simultaneously. Current MDD and remitted MDD groups endorsed hedonic motives more than controls, but the three groups did not differ in instrumental motives. The only group difference in ER strategy use was that the current MDD group used distraction more than controls. Most group differences in ER were between the current MDD group and controls, with the remitted MDD group and controls being quite similar. ER in current MDD is characterized by frequent regulation, weakened association between initiating regulation and momentary affect, increased hedonic-focused ER motives, and a greater use of distraction. 

Most group differences were found between the current MDD group and the control group, suggesting that those with current MDD had more frequent goals to regulate their emotions, showed a weaker link between how they felt and initiating regulation, more frequently regulated their emotions because of how emotions would make them feel, and more frequently used distraction as an ER strategy. 

I like this study because of its three groups. I’ve seen previous research suggesting that people with MDD use distraction more than others. Here, we see some of the challenges MDD clients face. Two of the previous authors produced this next study, which uses the same sample. Liu, Strube & Thompson (2023) published “Do Emotion Regulation Difficulties in Depression Extend to Social Context? Everyday interpersonal emotion regulation in current and remitted major depressive disorder” in Journal of Psychopathology and Clinical Science. Abstract and Impact Statement

Individuals with major depressive disorder (MDD) have difficulties regulating emotion on their own. As people also use social resources to regulate emotion (i.e., interpersonal emotion regulation [IER]), we examined whether these difficulties extend to IER in current and remitted MDD compared to those with no psychiatric disorders (i.e., controls). Adults with current MDD (n = 48), remitted MDD (n = 80), and controls (n = 87) assessed via diagnostic interviewing completed 2-week experience sampling, reporting on how frequently (IER frequency), from whom (sharing partners), and why (IER goals) they sought IER; how the sharing partners responded (sharing partner’s extrinsic IER strategies and warmth); and how their feelings about the problem and the sharing partner changed following IER (IER outcomes). Using multilevel modeling, the current-MDD group did not differ from controls in IER frequency and sharing partners, but the current-MDD group demonstrated a more mixed (albeit generally adaptive) profile of received IER strategies and benefited similarly or more from certain IER strategies than the other two groups, suggesting that IER may be a promising avenue for effective emotion regulation in current MDD. The remitted-MDD group sought IER most frequently and demonstrated the most adaptive profile of received IER strategies, and they and the current-MDD group reported seeking more types of IER goals than controls. People with remitted MDD seem highly motivated to pursue IER support and their pursuit takes place in particularly supportive social contexts. Research is needed to examine mechanisms driving these group differences and how IER predicts the course of MDD.

In efforts to investigate whether emotion regulation (ER) difficulties in major depressive disorder (MDD) extend to social context, this study examined everyday interpersonal emotion regulation (IER) among adults with current MDD, those whose MDD was in remission, and a healthy control group using the experience sampling method. Although groups showed many similarities in IER processes, they differed in several aspects of IER, including intrinsic IER frequency and goals, extrinsic IER strategies received from others, and IER outcomes following certain IER strategies. This research represents initial efforts to elucidate the characteristics and utility of everyday IER at different stages of MDD and provides preliminary evidence that IER may be a promising avenue for effective ER in MDD.

Here, I found the data from the remitted MDD group most interesting. They provide a healthy model for current MDD clients to emulate. The final study looks at adolescents. Zsigo et al. (2023) published “Emotion Regulation Training for Adolescents with Major Depression: Results from a randomized controlled trial” in Emotion. Here’s the edited abstract:

Difficulties in emotion regulation (ER) are thought to contribute to the development and maintenance of major depression (MD) in adolescents. In healthy adults, a task-based training of ER has previously proven effective to reduce stress, but no such studies are available for MD. It is also unclear whether findings can be generalized onto adolescent populations. The final sample consisted of n = 70 adolescents with MD, who were randomized to a task-based ER training (n = 36) or a control training (n = 34). Across four sessions, the ER group was trained to downregulate negative affect to negative images via reappraisal, while the control group was instructed to attend the images. Rumination, stress-, and affect-related measures were assessed as primary outcomes, behavioral and neurophysiological responses (late positive potential, LPP), as secondary outcomes. The trial was preregistered at clinicaltrials.gov (NCT03957850). While there was no significant differential effect of the ER training on primary outcomes, we found small to moderate effects on rumination in the ER group, but not the control group. During reappraisal (compared to attend), the ER group showed an unexpected increase of the LPP during the first, but not during later training sessions. Although replication in large, multicenter trials is needed, our findings on effect sizes suggest that ER training might be promising to decrease rumination in adolescent MD. The LPP increase at the first session may represent cognitive effort, which was successfully reduced over the sessions. Future studies should research whether training effects transfer to daily life and are durable over a longer time period. 

While these authors take a different approach, I find the notions of decreasing rumination and seeing the LPP increase as a sign of cognitive effort potentially helpful. Taken together, these studies illustrate the power of emotion regulation strategies in assisting people presenting with MDD.