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

Nature Human Behaviour volume 5, pages 1443–1457 (2021)Cite this article

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Abstract

Difficulties in applying emotional regulation (ER) skills are associated with depression and anxiety symptoms, and are common targets of treatment. This meta-analysis examined whether improvements in ER skills were associated with psychological treatment outcomes for depression and/or anxiety in youth. A multivariate, random-effects meta-analysis was run using metafor in R. Inclusion criteria included studies that were randomized controlled trials (RCTs) of a psychological intervention for depression and/or anxiety in patients aged 14–24, were peer reviewed, were written in English, measured depression and/or anxiety symptoms as an outcome and measured ER as an outcome. Medline, Embase, APA PsycInfo, CINAHL and The Cochrane Library were searched up to 26 June 2020. Risk of bias (ROB) was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool. The meta-analysis includes 385 effect sizes from 90 RCTs with total N = 11,652. Psychological treatments significantly reduced depression, anxiety, emotion dysregulation (k = 13, Hedges’ g = 0.54, P < 0.001, 95% confidence interval (CI) = 0.30–0.78) and disengagement ER (k = 83, g = 0.24, 95% CI = 0.15–0.32, P < 0.001); engagement ER also increased (k = 82, g = 0.26, 95% CI = 0.15–0.32, P < 0.001). Improvements in depression and anxiety were positively associated with improved engagement ER skills, reduced emotion dysregulation and reduced disengagement ER skills. Sensitivity considered study selection and publication bias. Longer treatments, group formats and cognitive-behavioural orientations produced larger positive associations between improved ER skills and reduced symptoms. ER skill improvement is linked to depression and anxiety across a broad range of interventions for youth. Limitations of the current study include reliance on self-report measures, content overlap between variables and inability to test the directionality of associations.

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Fig. 1: Three ways of measuring improvements in ER over the course of psychological treatment in the present synthesis.
Fig. 2: PRISMA figure depicting the flow of studies in the present synthesis using a comprehensive search strategy.
Fig. 3: Overall and domain-specific Risk of Bias ratings for each of the 90 RCTs included in the meta-analysis.

Data availability

The data that support the findings of this study are available through an OSF repository (https://osf.io/56fvu). Additional details are available from the corresponding author on request.

Code availability

The R script used to produce the statistics in this review can be provided on request from the corresponding author.

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Acknowledgements

This project was supported by funding from the Wellcome Trust. This project was developed in partnership with the Youth Engagement Initiative, supported by the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and the Child, Youth and Emerging Adult Program at CAMH. Funding by the Wellcome Trust was awarded to A.R.D., S.A.H. and L.C.Q. after a competitive request for proposals examining active ingredients in psychological treatments for youth depression and anxiety aged 14–24. More information about the initiative and the other teams funded can be found here (https://wellcome.org/what-we-do/our-work/mental-health-transforming-research-and-treatments).

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Authors and Affiliations

  1. Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada

    Alexander R. Daros, Sasha A. Haefner, Shayan Asadi, Sharifa Kazi & Lena C. Quilty

  2. Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada

    Sasha A. Haefner

  3. CAMH Library, Department of Education, Centre for Addiction and Mental Health, Toronto, Canada

    Terri Rodak

  4. Department of Psychiatry, University of Toronto, Toronto, Canada

    Lena C. Quilty

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Contributions

A.R.D., S.A.H. and L.C.Q. conceived, designed and obtained funding for the study. T.R. designed and executed the search strategy in consultation with A.R.D, S.A.H. and L.C.Q. T.R. managed the database of search results. A.R.D. and S.A. performed data analysis. A.R.D., S.A.H. and L.C.Q. organized and met with the youth advisory board. All authors (A.R.D., S.A.H., S.A., S.K., T.R. and L.C.Q.) contributed to study selection and screening procedures, as well as writing of the paper and additional supplementary materials.

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Correspondence to Alexander R. Daros.

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None of the authors have financial conflicts of interest to disclose or have a relationship that may pose a conflict of interest in relation to the content presented in the paper. The authors independently chose the active ingredient based on their expertise and the funding source did not play a role in the design of this review, data collection and analyses, or the decision to publish this paper. None of the authors have previously received funding from the funding source.

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Table of Contents, Supplementary Methods, Results and Discussion, Figs. 1 and 2, Tables 1–4, References and PRISMA Checklist Nature (43 pages total).

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Daros, A.R., Haefner, S.A., Asadi, S. et al. A meta-analysis of emotional regulation outcomes in psychological interventions for youth with depression and anxiety. Nat Hum Behav 5, 1443–1457 (2021). https://doi.org/10.1038/s41562-021-01191-9

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