Aldao, Nolen-Hoeksema, & Schweizer, 2010 PDF

This article appeared in a journal published by Elsevier.
The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
websites are prohibited.
In most cases authors are permitted to post their version of the
article (e.g. in Word or Tex form) to their personal website or
institutional repository. Authors requiring further information
regarding Elsevier’s archiving and manuscript policies are
encouraged to visit:
http://www.elsevier.com/copyright
Author's personal copy
Clinical Psychology Review 30 (2010) 217–237
Contents lists available at ScienceDirect
Clinical Psychology Review
Emotion-regulation strategies across psychopathology: A meta-analytic review

Amelia Aldao a,1, Susan Nolen-Hoeksema a,⁎, Susanne Schweizer b,2
a
Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06520, United States
b
MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, CB2 7EF, UK
a r t i c l e i n f o a b s t r a c t
Article history: We examined the relationships between six emotion-regulation strategies (acceptance, avoidance, problem
Received 29 August 2009 solving, reappraisal, rumination, and suppression) and symptoms of four psychopathologies (anxiety,
Received in revised form 12 November 2009 depression, eating, and substance-related disorders). We combined 241 effect sizes from 114 studies that
Accepted 13 November 2009
examined the relationships between dispositional emotion regulation and psychopathology. We focused on
dispositional emotion regulation in order to assess patterns of responding to emotion over time. First, we
Keywords:
Emotion regulation
examined the relationship between each regulatory strategy and psychopathology across the four disorders.
Emotion-regulation strategies We found a large effect size for rumination, medium to large for avoidance, problem solving, and
Meta-analysis suppression, and small to medium for reappraisal and acceptance. These results are surprising, given the
prominence of reappraisal and acceptance in treatment models, such as cognitive-behavioral therapy and
acceptance-based treatments, respectively. Second, we examined the relationship between each regulatory
strategy and each of the four psychopathology groups. We found that internalizing disorders were more
consistently associated with regulatory strategies than externalizing disorders. Lastly, many of our analyses
showed that whether the sample came from a clinical or normative population significantly moderated the
relationships. This finding underscores the importance of adopting a multi-sample approach to the study of
psychopathology.
© 2009 Elsevier B.V. All rights reserved.
Contents
1. Models of emotion regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

1.1. Adaptive and maladaptive emotion regulatory strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
2. Measuring emotion regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
3. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
3.1. Literature searches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
3.1.1. Inclusion/exclusion criteria for the study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
3.2. Coding procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
3.3. Effect size calculation and corrections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
3.4. Data analytic plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
3.4.1. Random-effect models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
3.4.2. Moderator analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
4. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
4.1. Regulation strategies across disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
4.2. Emotion-regulation strategies in each disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
4.3. Publication bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
5. Review of longitudinal studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
5.1. Rumination and depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
5.2. Rumination and other psychopathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
5.3. Avoidance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
⁎ Corresponding author. Tel.: +1 203 432 0699.

E-mail addresses: [email protected] (A. Aldao), [email protected] (S. Nolen-Hoeksema), [email protected] (S. Schweizer).
1
Tel.: +1 203 432 7352.
2
Tel.: +44 1223 355294.
0272-7358/$ – see front matter © 2009 Elsevier B.V. All rights reserved.
doi:10.1016/j.cpr.2009.11.004
218 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237
5.4. Suppression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

5.5. Problem solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
6.1. Moderators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
6.2. Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
6.3. Limitations of the literature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
6.4. Study limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Emotion regulation is increasingly being incorporated into models of anxiety disorder (SAD; Kashdan & Breen, 2008), eating disorders
psychopathology (Berenbaum, Raghavan, Le, Vernon, & Gomez, 2003; (Bydlowski et al., 2005; Clyne & Blampied, 2004; Fairburn et al., 1995;
Greenberg, 2002; Kring & Bachorowski, 1999; Mennin & Farach, 2007). McCarthy, 1990; Polivy & Herman, 2002), alcohol-related disorders
As “distress disorders” (Watson, 2005), depression and anxiety are (Sher & Grekin, 2007; Tice et al., 2001) and substance-related
widely viewed as the result of difficulties in regulating emotions disorders (Fox, Axelrod, Paliwal, Sleeper, & Sinha, 2007; Linehan
(Campbell-Sills & Barlow, 2007; Gross & Munoz, 1995; Mennin, et al., 2002; Sher & Grekin, 2007; Tice et al., 2001). Consequently,
Holoway, Fresco, Moore, & Heimberg, 2007). Several theorists argue various therapeutic approaches incorporate some form of emotion-
that individuals who cannot effectively manage their emotional regulation training, including dialectical behavioral therapy (Linehan,
responses to everyday events experience longer and more severe 1993), emotion focused therapy (Greenberg, 2002), acceptance- and
periods of distress that may evolve into diagnosable depression or mindfulness-based therapy (Hayes, Strosahl, & Wilson, 1999; Roemer,
anxiety (e.g., Mennin et al., 2007; Nolen-Hoeksema, Wisco, & Orsillo, & Salters-Pedneault, 2008; Segal, Williams, & Teasdale, 2002),
Lyubomirsky, 2008). In addition, models of eating disorders (Fairburn and emotion-regulation therapy (Mennin & Fresco, 2009).
et al., 1995; McCarthy, 1990; Polivy & Herman, 1998, 2002) and alcohol
abuse (Sher & Grekin, 2007; Tice, Bratslavsky, & Baumeister, 2001)
suggest that individuals with poorly regulated emotions often turn to 1.1. Adaptive and maladaptive emotion regulatory strategies
food or alcohol to escape from or down-regulate their emotions,
creating risk for diagnosable problems in relation to food or alcohol. Over the years, different theoretical models have highlighted
Several individual emotion-regulation strategies have been hypoth- different specific strategies as adaptive or maladaptive. Dating back to
esized to be risk factors for or protective factors against psychopathol- stress and coping theories (Billings & Moos, 1981; Carver, Scheier, &
ogy. In the meta-analysis presented here, we first review models of Weintraub, 1989; Folkman & Lazarus, 1986), and early cognitive-
emotion regulation that have linked specific regulatory strategies to behavioral approaches to psychopathology (Beck, 1976; Cooper, Russell,
psychopathology. Then, we evaluate the empirical support for the Skinner, Frone, & Mudar, 1992; D'Zurilla, 1988; Marlatt, Baer, Donovan,
relationships between symptoms of four psychopathologies and six & Kivlahan, 1988), two strategies thought to be adaptive across a variety
emotion-regulation strategies. We ask which emotion-regulation of contexts are reappraisal and problem solving. Reappraisal involves
strategies are most strongly associated with psychopathology. We also generating benign or positive interpretations or perspectives on a
ask if there is specificity in the relationship between certain emotion- stressful situation as a way of reducing distress (Gross, 1998).
regulation strategies and different psychopathologies. Maladaptive appraisal processes are thought to be at the core of
depression and anxiety according to several models (Beck, 1976; Clark,
1988; Salkovskis, 1998), and thus cognitive-behavioral therapies for
1. Models of emotion regulation depression and anxiety focus on teaching reappraisal skills (Beck, Rush,
Shaw, & Emery, 1979). More recently, Gross' (1998) influential model of
Emotion regulation has been conceptualized as processes through emotion regulation highlights reappraisal as a strategy that results in
which individuals modulate their emotions consciously and noncon- positive emotional and physical responses to emotion-eliciting stimuli.
sciously (Bargh & Williams, 2007; Rottenberg & Gross, 2003) to Problem-solving responses are conscious attempts to change a
appropriately respond to environmental demands (Campbell-Sills & stressful situation or contain its consequences. Problem solving is often
Barlow, 2007; Cole, Martin, & Dennis, 2004; Gratz & Roemer, 2004; assessed as an orientation or specific actions directed at solving
Gross, 1998; Gross & Munoz, 1995; Thompson, 1994). Individuals a problem (e.g., brainstorming solutions, planning a course of action).
deploy regulatory strategies to modify the magnitude and/or type of Although problem-solving responses are not direct attempts to regulate
their emotional experience or the emotion-eliciting event (Diamond & emotions, they can have beneficial effects on emotions by modifying
Aspinwall, 2003; Gross, 1998). The process of emotion regulation has or eliminating stressors. Low problem-solving orientation or poor
been conceptualized as distinct from the emotion generation process problem-solving skills have been theorized to lead to depression
(Cole et al., 2004; Gross & Thompson, 2007; Rottenberg & Gross, 2003) (Billings & Moos, 1981; D'Zurilla, Chang, Nottingham, & Faccinni,
although the distinction between these two processes still remains the 1998), anxiety (Chang, Downey, & Salata, 2004; Kant, D'Zurilla
source of debate (see Campos, Frankel, & Camras, 2004). & Maydeu-Olivares, 1997), substance use (Cooper et al., 1992), and
Theoretical models associate successful emotion regulation with eating disorders (VanBoven & Espelage, 2006). Training in problem-
good health outcomes, and improved relationships and academic and solving skills is a component of cognitive-behavioral therapies for all
work performance (Brackett & Salovey, 2004; John & Gross, 2004). these disorders (Beck et al., 1979; Fairburn et al., 1995; Marlatt et al.,
Conversely, difficulties with emotion regulation are associated with 1988).
mental disorders (Berenbaum et al., 2003; Greenberg, 2002; Kring & More recently, there has been an increased interest in the role of
Bachorowski, 1999; Mennin & Farach, 2007) and incorporated into mindfulness in adaptive emotion regulation (Gratz & Roemer, 2004).
several models of specific psychopathologies, including borderline Although the precise delineation of the components of mindfulness is
personality disorder (BPD; Linehan, 1993; Lynch, Trost, Salsman, & still the source of much debate (Baer, Smith, & Allen, 2004; Bishop
Linehan, 2007), major depressive disorder (Nolen-Hoeksema et al., et al., 2004) one component that most researchers tend to agree upon
2008; Rottenberg, Gross, & Gotlib, 2005), bipolar disorder (Johnson, is that of non-judgmental acceptance of emotions. Along these lines,
2005), generalized anxiety disorder (GAD; Mennin et al., 2007), social mindfulness has been conceptualized as non-elaborative, non-
A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 219
judgmental, present-centered awareness in which thoughts, feelings, find this state unpleasant and might try to regulate it by avoiding it,
and sensations are accepted as they are (Kabat-Zinn, 1990; Segal et al., that is, by using the substance they are abstaining from (Baker, Piper,
2002; Shapiro & Schwartz, 1999). Mindfulness-based therapies that McCarthy, Majeski, & Fiore, 2004).
emphasize taking a non-judgmental stance have been developed to Finally, instead of avoiding or suppressing negative thoughts and
treat a variety of disorders, including depression (Segal et al., 2002), moods, some individuals repetitively focus on their experience of the
anxiety (Roemer et al., 2008), eating disorders (Kristeller, Baer, & emotion and its causes and consequences (Nolen-Hoeksema et al.,
Quillian-Wolever, 2006), substance abuse (e.g., Breslin, Zack, & 2008; Trapnell & Campbell, 1999; Watkins, 2008). People often say they
McMain, 2002; Marlatt et al., 2004), and borderline personality engage in rumination because they want to understand and solve their
disorder (Linehan, 1993; Lynch et al., 2007). Research on acceptance problems (Papageorgiou & Wells, 2003), but rumination is negatively
as a regulatory strategy has suggested that using this strategy related to problem solving (Hong, 2007). Indeed, rumination in the
promotes good outcomes (Hayes et al., 1999; Heffner, Eifert, Parker, context of distress appears to interfere with good problem solving, and
Hernandez, & Sperry, 2003) whereas low levels of acceptance have may immobilize individuals in indecision (Ward, Lyubomirsky, Sousa, &
been shown in many disorders, including generalized anxiety Nolen-Hoeksema, 2003). Although rumination has been most frequent-
disorder (McLaughlin, Mennin, & Farach, 2007; Roemer et al., 2008), ly studied in relation to depression and anxiety, it has recently been
panic disorder (Tull & Roemer, 2007), heroin use (Tull, Schulzinger, studied in relation to substance use and eating disorders (e.g., Nolen-
Schmidt, Zvolensky, & Lejeuz, 2007), and borderline personality Hoeksema, Stice, Wade, & Bohon, 2007). Binge-drinking and binge
disorder (Gratz, Rosenthal, Tull, & Lejuez, 2006). eating may be attempts to escape from the aversive self-awareness
In contrast, suppression and avoidance have long been seen as maintained by rumination (Heatherton & Baumeister, 1991).
maladaptive responses to a variety of stressors, and risk factors for both Thus, three emotion-regulation strategies that have been widely
distress (i.e., depression and anxiety) and maladaptive behaviors theorized to be protective against psychopathology are reappraisal,
(particularly substance abuse; Carver et al., 1989; Folkman & Lazarus, problem solving, and acceptance. Three strategies that have consis-
1980). Various forms of suppression and avoidance have been implicated tently been argued to be risk factors for psychopathology are
in psychopathology. Gross' model (1998) focuses primarily on suppres- suppression (including both expressive suppression and thought
sion of emotional expression, and argues that although expressive suppression), avoidance (including both experiential avoidance and
suppression may reduce the outward expression of emotion and possibly behavioral avoidance), and rumination. However, a direct comparison
the subjective experience of emotion in the short term, it will be less of the degree to which they relate to psychopathology is needed.
effective in reducing emotion and physiological arousal over the long In this meta-analysis, we address two main questions. First, we are
term (Gross, 1998; Gross & Thompson, 2007; John & Gross, 2004). interested in the relationship between each of the six regulatory
Other theorists have focused on the suppression of unwanted strategies of interest and psychopathology. That is, we propose to
thoughts. Wenzlaff and Wegner (2000) have produced a large body of investigate the sensitivity of each emotion-regulation strategy in
research showing that attempts to voluntarily suppress thoughts result capturing variance in different types of psychopathology. Identification
in an increased accessibility of the suppressed thought (Wegner & Erber, of strategies that might have stronger relationships to specific
1992; Wegner, Schneider, Carter, & White, 1987) and increased psychopathologies can inform the improvement of existing treatments
emotional arousal, especially in the physiological domain, as evidenced and provide avenues for new interventions (Berking, Wupperman, Orth,
by increased electrodermal responses to emotional stimuli (e.g., Wegner, Meier, & Caspar, 2008). The second aim of the present investigation is to
Broome, & Blumberg, 1997). They have also suggested that chronic examine the specificity of each of these six regulatory strategies, that is,
suppression might prevent habituation to emotional stimuli, and as such are emotion-regulation strategies related to some forms of psychopa-
result in hypersensitivity to depression and anxiety-related thoughts thology but not others. Emotion-regulation strategies have been mostly
and symptoms (Wegner & Zanakos, 1994; Wenzlaff & Wegner, 2000). examined within the context of internalizing disorders, but as noted
Hayes et al. (1999) have been concerned with what they call earlier, recently emotion-regulation models have also been applied to
experiential avoidance: the suppression or avoidance of an array of externalizing disorders (e.g., Nolen-Hoeksema et al., 2008). We limited
psychological experiences, including thoughts, emotions, sensations, the psychopathologies we surveyed to four types that several theorists
memories, and urges. They have argued that experiential avoidance have claimed are linked to emotion-regulation deficits: depression
can lead to a variety of negative outcomes, ranging from problems (Gross & Munoz, 1995; Nolen-Hoeksema, 1991), anxiety (Campbell-
with mood to problems with substance use, because it paradoxically Sills & Barlow, 2007; Mennin et al., 2007), eating disorders (Bydlowski et
increases negative thoughts (i.e., Wenzlaff & Wegner, 2000) and al., 2005; Clyne & Blampied, 2004; Fairburn et al., 1995; McCarthy, 1990;
prevents individuals from taking necessary action (Hayes et al., Polivy & Herman, 2002), and substance-related disorders (Fox et al.,
2004). Similarly, emotion-regulation models of eating disorders 2007; Sher & Grekin, 2007; Tice et al., 2001).
suggest that avoidance of psychological experiences leads to binge
eating and then maladaptive compensatory behaviors (e.g., Heather-
ton & Baumeister, 1991; McCarthy, 1990; Polivy & Herman, 2002). 2. Measuring emotion regulation
Hayes et al. propose that acceptance is an adaptive alternative to
avoidance and they have developed a corresponding treatment: Along with the increased interest in individual differences in emotion
acceptance and commitment therapy (ACT; Hayes et al., 1999). regulation in recent years, there has been a proliferation of self-report
Avoidance has also been conceptualized in the behavioral domain. measures of emotion-regulation strategies (see Table 1). These measures
Mowrer's (1947) two-stage theory of fear proposes that: 1) fear is have advantages and disadvantages. On the one hand, because self-
acquired through classical conditioning and, 2) as individuals avoid report measures are easy and quick to administer, there is a sufficient
the feared stimulus, extinction cannot take place and thus the fear is body of research from which to draw data for this meta-analysis. In
maintained via operant conditioning. This model has been mostly addition, self-report scales typically measure dispositional tendencies
applied to anxiety disorders, such as panic disorder (Barlow, Craske, toward certain emotion-regulation strategies, and thus supposedly
Cerny, & Klosko, 1989; Lissek et al., 2009); posttraumatic stress assess what participants do across time and different contexts. This is in
disorder (Foa & Kozak, 1986); specific phobia (Merckelbach, de Jong, line with Campbell-Sills and Barlow's (2007) argument that in
Muris, & van den Hout, 1996); and agoraphobia (Rachman, 1993). conceptualizing emotion dysregulation and its relationship to psycho-
Interestingly, avoidance of other non-fear-based negative states, such pathology we need to take a “long view,” assessing patterns of
as withdrawal symptoms after substance use, has also been linked to responding to episodes of emotion over time that lead to the persistence
psychopathology. In this case, individuals going through withdrawal or recurrence of unwanted emotions over time.
220
Table 1
Study characteristics — cross-sectional and experimental designs.
Author name Sample details/moderators Design Psychopathology measures Emotion-regulation measures
Allan and Gilbert (2002) 197 college students Experimental CES-D STAXI: anger-in
Ball, Smolin, and Shekhar (2002) 12 adult patients with anxiety NOS, Cross-sectional ADIS for DSM-IV TCI: harm avoidance
45 patients with panic disorder,
13 patients with social anxiety,
12 patients with OCD, 21 patients
with depression, and 17 healthy controls
Borders, Barnwell, and Earleywine (2007) 285 college students Cross-sectional Alcohol consumed in the last 6 months; RRQ: rumination
alcohol-aggression expectancies;
alcohol-related aggression index;
alcohol-related hostility index
Britton (2004) 196 college students Cross-sectional Alcohol-related consequences; COPE: acceptance, positive reinterpretation
quantity frequency variability average
number of drinking days;
heavy drinks days
Burns, Bruehl, and Caceres (2004) 53 college students Experimental STAI AEI: anger-in
A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

Cheung, Gilbert, and Irons (2004) 125 college students Cross-sectional CES-D RRS
Ciesla and Roberts (2007) 263 college students Experimental BDI RRS
Connolly, Rieger, and Caterson (2007) 140 female college students Cross-sectional BES BARQ: avoidance, rumination; STAXI-2: anger-in
Conway, Mendelson, Giannopoulos, Csank, 201 college students Cross-sectional BDI ROS
and Holm (2004)
Cox, Stabb, and Hulgus (2000) 161 children/adolescents 5th–9th graders Cross-sectional CDI PAES-III: anger-in
Dennis (2007) 67 college students Cross-sectional BDI; STAI ERQ: reappraisal, suppression
Donaldson, Lam, and Mathews (2007) 36 adult patients with depression and 36 Experimental SCID for DSM-IV RRS
healthy controls
Egloffet al. (2006) 82 college students Cross-sectional STAI ERQ: reappraisal, suppression
Erskine, Kvavilashvili, and Kornbrot (2007) Sample 1: 84 college students; sample 2: 65 Cross-sectional BDI; STAI RI; WBSI
adult community
members
Felsten (1998) 240 college students Cross-sectional BDI CSI: avoidance, problem solving
Flett, Hewitt, Blankstein, Solnik, and 114 college students Cross-sectional BAI; CES-D SPSI: problem orientation, problem-solving skills, social
Van Brunschot (1996) problem solving
Flett, Madorsky, Hewitt, and Heisel (2002) 65 college students Cross-sectional MASQ: anhedonic depression, anxious RSQ 10 rumination items
arousal, general distress anxious
symptoms, general distress depressive
symptoms
Fresco et al. (2007) 61 college students Cross-sectional BDI; MASQ: anhedonic depression, AAQ; ERQ: reappraisal, suppression; RSQ: brooding
anxious arousal
Geller, Cockell, Hewitt, Goldner, and 21 adult female patients with anorexia nervosa Cross-sectional EDE STAXI-2 anger-in; STSS: silencing the self
Flett (2000) and 21 healthy controls
Goldman and Haaga (1996) 33 depressed adult patients and 41 healthy Cross-sectional Composite BDI + SCID for DSM-III STAXI: suppression target others, suppression target spouse
controls
Goldstein (2006) Sample 1: 57 female adult community members; Cross-sectional BDI; KAT RRS
sample 2: 51 male community members
Good, Heppner, Debord, and Fischer (2004) 260 male college students Cross-sectional BDI; STAI PSI
Gross and John (2003) 210 college students Cross-sectional BDI; CES-D; ZDS ERQ: reappraisal, suppression
Haaga, Fine, Terrill, Stewart, and Beck (1995) 115 college students Cross-sectional BAI; composite BDI + IDD SPSI
Hankin, Lakdawalla, Carter, Abela, Sample 1: 950 college students; sample 2: Cross-sectional BDI RRS brooding
and Adams (2007) 431 college students
Harrington and Blankenship (2002) 199 college students Cross-sectional BAI; BDI SMRI
Harris, Pepper, and Maack (2008) 96 college students Cross-sectional BDI RSQ: brooding
Haugh (2006) 245 college students Cross-sectional BAI; BDI SPSI-R: positive problem orientation
Hayes et al. (2004) Sample 1: 202 college students; sample 2: Cross-sectional ASI; BAI; BDI AAQ
304 college students; sample 3: 205 college
students
Hewitt et al. (2002) 114 children/adolescents; 10–15 years old Cross-sectional CDI; R-CMAS PAES-III: anger suppression
Table 1 (continued)
Joormann et al. (2006) 20 adult patients with social anxiety, 64 with Experimental SCID for DSM-IV RRS
depression, and 91 healthy controls
Joormann and Gotlib (2008) 23 adult patients with depression and 21 Experimental SCID for DSM-IV RRS brooding
healthy controls
Kant et al. (1997) Sample 1: 100 adult community members; Cross-sectional BDI; STAI SPSI-R
sample 2: 100 adult community members
Kashdan, Barrios, Forsyth, and 382 college students Cross-sectional ASI; BSQ; SFS; STAI AAQ; CSQ: avoidant, rational; ECQ
Steger (2006)
Kashdan and Breen (2007a,b) 144 college students Cross-sectional BDI; MASQ: anhedonic depression, AAQ; DERS: non-acceptance; EACQ: emotional expression
anxious arousal; SIAS
Kashdan and Breen (2007, 2008) 246 community members Cross-sectional ASI; MASQ: anhedonic depression, DERS; EACQ: emotional expression
anxious arousal
Knowles, Tai, Christensen, and 528 college students Cross-sectional BDI RSQ 23-item rumination scale; 4-item problem-solving
Bentall (2005) scale
Kocovski, Endler, Rector, and Flett (2005) 55 college students with social anxiety and Experimental EMAS — trait anxiety — social evaluation CHIP
57 healthy controls
Koff and Sangani (1997) 128 female college students Cross-sectional EAT CISS: avoidance
Kopper and Epperson (1996) 705 college students Cross-sectional BDI AES: suppression
Krause, Mendelson, and Lynch (2003) 127 adults from the community Experimental BAI; BDI CSQ: chronic avoidance, current avoidance; WBSI
Kuyken and Brewin (1994) 32 adult female patients with depression and Cross-sectional DSM-III criteria WCQ: escape-avoidance, planful problem solving, positive

32 healthy controls reappraisal
Kuyken, Watkins, Holden, and Cook (2006) 36 children/adolescents from the community Cross-sectional DSM-IV criteria RRS
with depression and 187 healthy controls;
14–18 years old
Lau, Christensen, Hawley, Gemar, and 32 adult patients with anxiety NOS, 43 adult Experimental SCID for DSM-IV RSQ
Segal (2007) patients with depression, and 36 healthy
controls
Londahl, Tverskoy, and D'Zurilla (2005) 123 college students Cross-sectional BAI; BDI SPSI-R: positive problem orientation
Luck, Waller, Meyer, Ussher, and 43 adult female patients with anorexia nervosa Cross-sectional DSM-IV criteria YRAI
Lacey (2006) restrictive type, 50 adult patients with bulimia
nervosa, 28 patients with anorexia nervosa
binge/purge type, and 345 healthy adult controls
Luxton, Ingram, and Wenzlaff (2006) 44 depressed college students and 178 healthy Cross-sectional Composite BDI + IDD WBSI
controls
Luxton and Wenzlaff (2005) 78 depressed college students and 121 healthy Cross-sectional Composite BDI + IDD WBSI
controls
Maltby and Day (2000) Sample 1: 188 female college students; sample 2: Cross-sectional BDI; STAI RWCC avoidance, problem focus
172 male college students
Martin and Dahlen (2005) 362 college students Cross-sectional DASS: anxiety, depression CERQ: acceptance, positive reappraisal, refocus on planning,
rumination
Mayhew and Edelmann (1989) 49 college students Cross-sectional EDI: bulimia, drive for thinness CI: avoidance coping, cognitive coping
McCabe, Blankstein, and Mills (1999) 207 college students Cross-sectional CES-D SPSI-R: positive problem orientation
McLean, Miller, and Hope (2007) 160 female college students Cross-sectional BDI; EAT; SIAS ERQ: reappraisal, suppression
Milligan and Waller (2000) 83 college students Cross-sectional BITE STAXI: suppression
Moulds, Kandris, Starr, and Wong (2007) 104 college students Cross-sectional BAI; BDI CBAS; RRS: brooding
Moulds, Kandris, and Williams (2007) 93 college students Experimental BAI; BDI RRS
Nezu (1986) Sample 1: 37 depressed college students and Cross-sectional BDI; SADS PSI: personal control, confidence, approach-avoidance
38 healthy controls; sample 2: 25 depressed
adult patients and 21 healthy controls
(continued on next page)

221
222
Table 1 (continued)

Nezu, Nezu, Saraydarian, Kalmar, 462 college students Cross-sectional BDI PSI
and Ronan (1986)
Papadakis, Prince, Jones, and Strauman 223 female children/adolescents; 7th–12th Cross-sectional CDI RSQ: brooding
(2006) graders
Paxton and Diggens (1997) 61 college students Cross-sectional DEBQ-R; BUILIT binge WCQ: emotional avoidance, problem solving, positive reappraisal
with eating restraint, 15 college students with
bulimia nervosa, and 73 healthy controls
Peirson and Heuchert (2001) 471 college students Cross-sectional BDI TCI: harm avoidance
Perini, Abbott, and Rapee (2006) 40 adult patients with social anxiety and 20 Experimental ADIS for DSM-IV RRS; WBSI
healthy controls
Piran and Cormier (2005) 394 female adult community members Cross-sectional EAT; EDI: bulimia, drive for thinness STAXI: anger-in
Rimes and Watkins (2005) 30 adult patients with depression and 30 Experimental SCID for DSM-IV RRS
healthy controls
Riso et al. (2003) 42 depressed adult patients and 24 healthy Cross-sectional SCID for DSM-IV RSQ: rumination
controls
Roberts et al. (1998) Sample 1: 13 depressed college students and Cross-sectional IDD RRS
19 healthy controls; sample 2: 8 depressed
college students and 175 healthy controls;
sample 3: 16 depressed college students and
181 healthy controls
Rude (2007) 232 college students Cross-sectional BDI; STAI; ZDS RRS: brooding
Rude, Wenzlaff, Gibbs, Vane, and Whitney 399 college students Experimental BDI; IDD WBSI
(2002)
Rudolph, Flett, and Hewitt (2007) 100 college students Cross-sectional CES-D CERQ: acceptance, positive reappraisal, refocus on planning, rumination
Rudolph, Hammen and Burge (1994) 57 children/adolescents from the community Experimental CDI IPSQ: hostile, passive, sociable
with depression and 61 healthy controls;
7–13 years old
Santanello and Gardner (2007) 125 college students Cross-sectional BDI AAQ
Schwarze, Oliver, and Handal (2003) 43 adult female patients with binge eating and Cross-sectional Q-EDD CISS: avoidance; WCQ: escape-avoidance
164 healthy controls
Siegle, Moore, and Thase (2004) 349 college students Cross-sectional BDI ROS; RRQ: rumination; SMRI: motivation
Sigmon et al. (2007) 17 adult patients with depression and 17 Experimental SCID for DSM-IV COPE: acceptance, problem focused
healthy controls
Soukup, Beiler, and Terrell (1990) 12 adult patients with anorexia nervosa, 33 Cross-sectional DSM-III criteria PSI
with bulimia nervosa, and 26 healthy controls
Sperberg and Stabb (1998) 234 female college students Cross-sectional BDI STAXI: anger-in
Stewart, Zvolensky, and Eifert (2002) 182 college students Cross-sectional ASI EAS
Tull and Gratz (2008) 53 depressed college students and 53 healthy Cross-sectional DASS: depression AAQ
controls
Table 1 (continued)
Verhaeghen, Joormann, and Khan (2005) 99 college students Cross-sectional CES-D RRS
Vickers and Vogeltanz-Holm (2003) 84 college students with depression and 86 Experimental BDI RRS
healthy controls
Waller et al. (2003) 20 adult female patients with anorexia nervosa Cross-sectional DSM-IV criteria STAXI: suppression
restrictive type, 68 with bulimia nervosa,
39 with anorexia nervosa binge purge type, 13
with binge eating disorder, and 50 healthy
controls
Watkins (2004) 140 college students Cross-sectional HADS: anxiety, depression RSQ
Watkins and Baracaia (2002) 32 adult patients with depression and 26 Experimental SCID for DSM-III RRS
healthy controls
Watkins and Brown (2002) 14 adult patients with depression and 14 Experimental DSM-III criteria RRS
healthy controls
Wegner and Zanakos (1994) Sample 1: 609 college students; sample 2: Cross-sectional ASI; BDI; MOCDI; STAI WBSI
405 college students; sample 3: 490 college
students; sample 4: 199 college students;
sample 5: 133 college students
Weinstock and Whisman (2007) 244 college students Cross-sectional BDI RRS
Wenzlaff, Rude, and West (2002) 22 college students with depression and 400 Cross-sectional DSM-IV; IDD-L; BDI WBSI
healthy controls

Wupperman and Neumann (2006) 589 college students Cross-sectional CES-D ROS; RRQ: rumination
Ziegert and Kistner (2002) 205 children/adolescents; 4th–5th graders Cross-sectional CDI CRSS: rumination
Notes: AAQ: Acceptance and Action Questionnaire; ADIS for DSM-IV: Anxiety Disorders Interview Schedule for DSM-IV; AEI: Anger Expression Inventory; AES: Anger Expression Scale; ASI: Anxiety Sensitivity Index; BAI: Beck Anxiety
Inventory; BARQ: Behavioral Anger Response Questionnaire; BDI: Beck Depression Inventory; BES: Binge Eating Scale; BITE: Bulimic Investigatory Test Edinburgh; BSQ: Body Sensations Questionnaire; BULIT: Bulimia Test; CBAS: Cognitive
Behavioral Avoidance Scale; CDI: Children Depression Inventory; CERQ: Cognitive Emotion Regulation Questionnaire; CES-D: Center for Epidemiologic Studies Depression Scale; CHIP: Coping with Health Injuries and Problems; CI: Coping
Index; CISS: Coping Inventory for Stressful Situations; COPE: Cope Inventory; CRSS: Children's Response Styles Scale; CSI: Coping Strategy Inventory; CSQ: Coping Styles Questionnaire; DASS: Depression and Anxiety Scales; DEBQ-R: Dutch
Eating Behaviour Questionnaire; DERS: Difficulties with Emotion Regulation Questionnaire; DSM: Diagnostic and Statistical Manual of Mental Disorders; EACQ: Emotional Approach Coping Questionnaire; EAS: Experiential Avoidance Scale;
EAT: Eating Attitudes Test; ECQ: Emotional Control Questionnaire; EDE: Eating Disorder Examination; EDI: Eating Disorders Inventory; EMAS: Endler Multidimensional Anxiety Scales; ERQ: Emotion Regulation Questionnaire; HADS: Hospital
Anxiety and Depression Scale; IDD: Inventory to Diagnose Depression; IPSQ: Interpersonal Problem Solving Questionnaire; KAT: Khavari alcohol test; MASQ: Mood and Anxiety Symptom Questionnaire; MOCDI: Maudsley Obsessive–
Compulsive Inventory; PAES-III: Pediatric Anger Expression Scale III; PSI: Problem-Solving Inventory; Q-EDD: Questionnaire for Eating Disorder Diagnoses; R-CMAS: Children's Manifest Anxiety Scale — Revised; RI: Rumination Inventory;
ROS: Rumination on Sadness; RRQ: Rumination Reflection Questionnaire; RRS: Ruminative Response Scale; RSQ: Response Styles Questionnaire; RWOCC: Revised Ways of Coping Checklist; SADS: Schedule for Affective Disorders and
Schizophrenia; SCID-IV: Structured Clinical Interview Diagnosis for DSM-IV; SCID-III-R: Structured Clinical Interview Diagnosis for DSM-III-R; SFS; Suffocation Fear Scale; SIAS: Social Interaction Anxiety Scale; SMRI: Scott–McIntosh
Rumination Index; SPSI: Social Problem-Solving Inventory; STAI: Spielberg State–Trait Anxiety Inventory; STAXI: State–Trait Anger Expression Inventory; STAXI-2: State–Trait Anger Expression Inventory 2; STSS: Silencing the Self Scale; TCI:
Temperament and Character Inventory; WBSI: White Bear Suppression Inventory; WCQ: Ways of Coping Questionnaire; YRAI: Young–Rygh Avoidance Inventory; ZDS: Zung Self-Rating Depression Scale.
223
224
Table 2

Study characteristics — longitudinal design.
Author name Sample details/moderators Psychopathology measures Emotion-regulation measures Duration of follow-up Summary of longitudinal results
Beevers and Meyer (2004) 144 college students MASQ: anhedonic depression, WBSI 7 weeks Among those with low life stress, high thought suppression
general distress depressive predicted lower depression over time.
symptoms
Blalock and Joiner (2000) 179 college students BAI, BDI CRI: cognitive avoidance 3 weeks Among those with higher life stress, higher cognitive
avoidance predicted increases in both depression and
anxiety for women only; no effects for behavioral avoidance.
Broderick and Korteland (2004) 70 children/adolescents CDI RSQ: 10 rumination items Once per year Rumination predicted increases in depression.
4–6th graders for 3 years
Burwell and Shirk (2007) 168 children/adolescents CDI; CDRS-R, MCC RRS adapted for children 1 year Brooding predicted increases in depression, but not any
8th graders other depression measures; reflection was not associated
with change in any depression scores.
Butler and Nolen-Hoeksema (1994) 199 college students BDI RRS:10 items 2 weeks Rumination predicted increases in depression,
controlling for distraction and gender.
Calmes and Roberts (2007) 543 college students BAI, BDI RRS 6–8 weeks Structural model showed significant paths from rumination
to anxiety (controlling for initial anxiety and worry) but not
to depression (controlling for initial depression and worry).
Ciarrochi and Scott (2006) 163 college students DASS: anxiety, depression ECQ: rumination; SPSI: 1 year Problem solving predicted increases in anxiety and
problem orientation depression.
Cooper et al. (2003) 1978 children/adolescents, BSI: anxiety, depression Avoidance composite 4.5 years Avoidance coping predicted increases in problem behavior
13 to 19 years old from AES and HDL composite, but not in substance use when considered
individually.
Engler et al. (2006) 26 female college students LHQ-R: binge eating WCQ: escape-avoidance 1 year Avoidance predicted binge eating over time.
who reported binge eating
and 199 who did not
Gerard and Buehler (2004) 5071 children/adolescents, CES-D Problem-solving orientation 1 year Problem-solving orientation did not predict changes in
11–18 years old assessed with 4 items depression scores, controlling for a number of other risk
variables.
Grabe et al. (2007) 299 children/adolescents, CDI; OBC-Y: body shame RSQ: 5 rumination items 2 years Rumination predicted increases in depression, controlling
11–13 years old for body shame and self-surveillance.
Hankin et al. (2005) 210 college students BDI RRS 35 days Rumination did not predict daily depressive symptoms.
Holahan et al. (2005) 1221 late–middle-aged HDL: depressive features, CRI: cognitive avoidance 10 years Avoidance coping at predicted increases in depressive
adult community member depressive mood symptoms.
Hong (2007) 241 college students MASQ: anhedonic depression, COPE: problem solving; 1 month Rumination predicted depression controlling for baseline
anxious arousal, general RRS: 10 items worry and anxiety, but did not predict anxiety when
distress anxious symptoms, controlling for baseline worry and depression.
general distress depressive
symptoms
Table 2 (continued)
Author name Sample details/moderators Psychopathology measures Emotion-regulation measures Duration of follow-up Summary of longitudinal results
Kashdan and Breen (2008) 148 college students BDI; SIAS ERQ: suppression 3 months Suppression at baseline predicted social anxiety symptoms
and lower level of positive emotions at follow-up.
Matheson and Anisman (2003) 177 college students BAI BDI SCOPE: cognitive restructuring, 6 months Increases in depression associated with low problem solving
emotional expression, problem and high emotional containment and rumination.
solving, rumination subscale
Nezu and Ronan (1988) 150 college students BDI PSI 3 months Low problem solving on both measures predicted increases
in depression.
Nolen-Hoeksema (2000) 1122 adult community BAI; composite BDI + HRSD RRS 1 year Rumination predicted increases in depression.
members
Nolen-Hoeksema and Harrell (2002) Sample 1: 599 female adult DSM-IV criteria RRS 1 year Rumination predicted increases in alcohol abuse problems
community members; in women but not men.
sample 2: 523 male adult
community members
Nolen-Hoeksema et al. (2007) 478 female children/ DSM-IV criteria, substance RRS: 6 items Measures taken each Lagged models showed rumination predicted increases in
adolescents, 14–17 years abuse items from Stice et al. year for 4 years depression, substance abuse, and eating disorder symptoms;
old at time 1 (1998); EDE: bulimic symptoms; girls with higher rumination were more likely to show onsets
SADS for school-aged children of MDE, and to meet diagnostic criteria for bulimia nervosa.
O'Connor et al. (2007) Sample 1: 224 adult CES-D; GHQ: anxiety, depression RRS:10 items 8 weeks Brooding predicted increases in depression after controlling
community members; for social perfectionism.
sample 2: 279 college

students
Priester and Clum (1993) 303 college students BDI PSI 1–2 weeks Low problem-solving confidence interacted with poor test
scores to predict increases in depression
Sarin et al. (2005) 86 college students MASQ: anhedonic depression, RRS Immediately after Rumination predicted increases in depression and mixed
anxious arousal, general distress exam, 4–8 h later, anxiety/depression at 4 days post-exam only; rumination
anxious symptoms, general and 4 days later predicted anxiety 4–8 h and 4 days after exam.
distress depressive symptoms
Segerstrom et al. (2000) 110 college students BDI; CCL: anxiety, depression GRS; RDS: rumination 1 week Full scale rumination predicted increases in depression but
modified: 11 items not anxiety when controlling for worry; short form of
rumination did not predict increases in depression or anxiety
when controlling for worry.
Wenzlaff and Luxton (2003) 225 college students BDI RS: 10 items; WBSI 10 weeks Suppression predicted increases in depression but rumination
did not.
Notes: AES: Anger Expression Scale; BAI: Beak Anxiety Inventory; BDI: Beck Depression Inventory; BSI: Brief Symptom Inventory; CCL: Cognitive Checklist; CDI: Children Depression Inventory; CDRS-R: Children's Depression Rating Scale —
Revised; CES-D: Center for Epidemiologic Studies Depression Scale; COPE: Cope Inventory; CRI: Cognitive Responses Inventory; DASS: Depression and Anxiety Scales; DSM: Diagnostic and Statistical Manual of Mental Disorders; ECQ:
Emotional Control Questionnaire; EDE: Eating Disorders Examination; ERQ: Emotion Regulation Questionnaire; GHQ: General Health Questionnaire; GRS: Global Rumination Scale; HDL: Health and Living Daily Form; HRSD: Hamilton Rating
Scale for Depression; LHQ-R: Life History Questionnaire — Revised; MASQ: Mood and Anxiety Symptoms Questionnaire; MCC: Mood and Conduct Checklist; OBC-Y: Objectified Body Consciousness Scale for Youth; PSI: Problem-Solving
Inventory; RDS: Responses to Depression Scale; RRS: Ruminative Responses Scale; RS: Rumination Scale; RSQ: Response Styles Questionnaire; SADS: Schedule for Affective Disorders and Schizophrenia; SCOPE: Survey of Coping Profile
Endorsement; SIAS: Social Interaction Anxiety Scale; SPSI: Social Problem-Solving Inventory; WBSI: White Bear Suppression Inventory; WCQ: Ways of Coping Questionnaire.
225
Fig. 1. Information flow on study selection.
On the other hand, the extent to which individuals can accurately self- and expressive suppression on emotion and physiology. Extensive
report on their emotion-regulation strategies can be questioned reviews and meta-analyses of experimental manipulations of rumi-
(Robinson & Clore, 2002). For example, such reports may require nation on depression or anxiety are provided by Mor and Winquist
more insight and meta-cognition than individuals are capable of. (2002) and Watkins (2008). Effects of experimental manipulations of
These reports may also be influenced by negative moods or self- thought suppression on subsequent thought frequency in clinical and
presentation biases. Self-reports of emotion regulation may confound non-clinical samples are reviewed narratively by Purdon (1999) and
the experience of emotion with its regulation (Cole et al., 2004). Rassin, Merckelbach, and Muris (2000) and in a meta-analysis by
Finally, some measures of emotion regulation may have substantial Abramowitz, Tolin, and Street (2001). Thus, the present meta-analysis
content overlap with psychopathology criterion measures (Treynor, will focus only on self-report measures of dispositional tendencies
Gonzalez, & Nolen-Hoeksema, 2003). We return to these measure- toward specific emotion-regulation strategies.
ment issues in the Discussion section.
Some researchers have used observational methods to study 3. Methods
emotion regulation, usually by instructing participants to engage in a
particular emotion-regulation strategy in response to an emotion- 3.1. Literature searches
eliciting stimulus and then observing the effects on participants'
subsequent emotions, cognitions, or physiological responding (e.g., We searched for studies that provided data on at least one of the
Gross, 1998; Gross & John, 2003; Nolen-Hoeksema et al., 2008). disorders and one of the regulatory strategies of interest, regardless of
Although these studies are invaluable in testing hypotheses about the whether the study of these constructs was a central focus of the study.
short-term effects of emotion-regulation strategies, they do not assess We conducted systematic searches for articles published between 1985
whether the tendency to engage in certain emotion-regulation and July 2008 using PsycInfo and Medline. We chose 1985 as a beginning
strategies is associated with clinically significant levels of psychopa- point because, with the exception of some studies of problem solving
thology. In this respect, recent evidence suggests that when some and avoidance coping, there was little work on what is now referred to
participants are instructed to use specific strategies, they have a hard as emotion regulation prior to the mid-1980s. Also, many of the
time doing so (Demaree, Robinson, Pu, & Allen, 2006). In addition, emotion-regulation measures that are widely used now did not exist
these studies have typically focused only on one or two emotion- prior to the mid-80s, and as the lists of studies in Tables 1 and 2 indicate,
regulation strategies at a time (usually either expressive or thought the vast majority of the work on emotion regulation has been done since
suppression, reappraisal, or rumination), and are highly heteroge- the mid-1990s. We searched with keywords for every combination of
neous in design and outcome variables, making it difficult to compare individual emotion-regulation strategy and type of psychopathology.
findings across them. Furthermore, reviews of these experimental Specifically, we searched for combinations of these terms across all
studies are available elsewhere: Gross and Thompson (2007) review fields (i.e., title, abstract, keywords): acceptance, avoidance, reapprais-
studies of the effects of experimental manipulations of reappraisal al, problem solving, rumination, suppression, emotion, regulation,
emotion regulation, mindfulness, depression, anxiety, eating, binge, populations: diagnosed with medical conditions (e.g., cancer, HIV,
anorexia, bulimia, alcohol, and substance. We searched for truncated cardiac problems), special groups (e.g., caregivers, bereaved indivi-
versions of these terms. In addition, we searched for authors who have duals, traumatized individuals) in order to increase the representa-
published substantially in the topics of interest. We supplemented our tiveness of the samples included in the meta-analysis. Fourth, for
searches by looking for articles in Google Scholar. In addition to the similar reasons, we excluded studies that preselected individuals
online databases, we checked reference sections of published articles, based on variables other than clinical diagnosis (e.g., cognitive
examined tables of contents of relevant journals, consulted with factors). Fifth, we excluded studies with clinical samples consisting
colleagues, and contacted authors in the field in order to obtain only of recovered patients (as opposed to patients with a current
information regarding the existence of studies we might have left out. diagnosis) because we wanted to maximize differences between
Two of the authors conducted independent searches that yielded those with and without psychopathology and because most emotion-
similar results. We organized these references and identified duplicates regulation theories do not make predictions about differences
using Endnote X1. Fig. 1 shows this search process in more detail. between recovered patients (who may have received psychotherapy
that changed their emotion-regulation strategies) and other groups.
3.1.1. Inclusion/exclusion criteria for the study Sixth, we excluded treatment studies because they did not have a
We included a study if it reported at least one cross-sectional healthy control group that would allow us to draw comparisons with
relationship between an emotion-regulation strategy and one of the the psychopathology groups. Seventh, we excluded the few studies
disorders of interest regardless of their specific aims. For example, we that only provided data on generalized anxiety disorder (GAD) in
included studies that focused on the experimental manipulation of order to minimize contamination between worry and rumination
emotional states (e.g., mood induction paradigms) or on scale (Watkins, Moulds, & Mackintosh, 2005). Eighth, we excluded studies
development as long as they provided baseline data for the that only provided data on Posttraumatic Stress Disorder (PTSD),
relationship between dispositional emotion regulation and psycho- which had a lot of variability in the type of trauma and the time
pathology. When studies measured psychopathology dichotomously elapsed from trauma until assessment. Ninth, we excluded the
either by using a diagnostic interview or cutoff in a continuous self- longitudinal portion of longitudinal studies since there was much
report measures, we only included the study if it provided an variability in the length of time that elapsed between assessments,
appropriate control group that would allow us to compute mean although we did use baseline data from these studies. Following the
difference effect sizes. In terms of populations, we included studies Results section, we provide a qualitative review of the longitudinal
recruiting adults and children, as well as from various demographic findings.
groups, such as college students, community residents, and clinical Applying these exclusion criteria resulted in 114 studies being
patients (in most cases, outpatients). retained (71 cross-sectional, 18 experimental, and 25 longitudinal). Of
Emotion regulation was assessed via self-report questionnaires the cross-sectional studies, 54 provided correlations and 17 provided
and psychopathology was assessed via self-report questionnaires or mean difference data. Of the experimental studies, 6 provided
diagnostic interviews. Most studies provided data on more than one correlational data and 12 provided mean differences data. Of the
relationship between regulation strategy and disorder. Additionally, longitudinal studies, 24 provided correlational data and 1 provided
for each relationship, studies tended to provide data from various mean difference data. The 114 included studies provided a total of 241
measures, thus resulting in several effect sizes per relationship per effect sizes (198 from correlations, and 43 from mean differences). For
sample. Because utilizing multiple effect sizes from a sample results in more information see Tables 1 and 2.
a violation of the assumption of independence of meta-analyses
(Lipsey & Wilson, 2001), we sought to correct for this problem. First, 3.2. Coding procedures
we defined each combination of emotion-regulation strategy and
disorder as a construct (see Augustine & Hemenover, 2008; Pole, The first author and two research assistants coded studies
2007; Thomas, Vartanian, & Brownell, 2009). Second, for each of these independently and achieved adequate levels of agreement, with
constructs, we calculated one effect size by averaging across the data kappa coefficients ranging from .83 to 1 (Landis & Koch, 1977). We
provided by that study on that construct (Rosenthal & DiMatteo, coded the following potential moderator variables: sample type
2001). We chose this approach over randomly selecting data in order (clinical or non-clinical) and sample age group (children/adolescents
to avoid losing information. versus adults). Children and adolescents were recruited from either
If a study did not report data that had been collected or presented schools or the community, so none of them was recruited from clinical
in a form that we could use, we contacted the authors. Twenty-four populations. In terms of dependent variables, we coded information
authors provided data for 11 studies. The remaining authors indicated on the emotion-regulation strategies measures (acceptance, avoid-
that too much time had elapsed since the time of data collection and ance, reappraisal, rumination, problem solving, and suppression) and
thus data were no longer available. the disorder measures (anxiety, depression, eating, or substance). If a
We utilized several exclusion criteria. First, we excluded disserta- study provided several subscales for a measure, we included all of
tions, master's theses, or conference presentations because restricting them and then averaged across all subscales for each combination of
our analyses to studies published in peer-reviewed journals increased strategy and disorder. When studies provided continuous data for a
the likelihood that studies would be of acceptable quality. Also, most combination of strategy and disorder, we extracted relevant data to
studies of interest included in this meta-analyses administered calculate effect sizes of the r-family. When necessary, we reversed
several measures and reported many correlations, including many coded correlation coefficients, so that positive scores would indicate a
non-significant ones, thus reducing the concern for file-drawer stronger use of the strategy. When studies provided dichotomous
effects. This decision is consistent with several recent meta-analytic data, such as scores for an emotion-regulation strategy in a clinical
reviews that have not included dissertations, master's theses, and control group, we extracted relevant data to calculate effect sizes
or conference presentations (e.g., Hagedoorn, Sanderman, Bolks, of the d-family (Lipsey & Wilson, 2001). If a study administered
Tuinstra, & Coyne, 2008; Kurtz & Mueser, 2008; Papadatou-Pastou, continuous measures and also used a cutoff to dichotomize the
Martin, Munafo, & Jones, 2008; Pole, 2007; Tarbox & Pogue-Geile, sample, we favored the continuous (i.e. correlational) over the
2008). Second, we excluded studies that recruited non-English dichotomized data, because splitting a variable into categories results
speaking populations because the validity of most translated in loss of information and might increase the probability of type II
measures of emotion regulation in other cultures has not been errors (Altman & Royston, 2006; Rosenthal & DiMatteo, 2001;
established. Third, we excluded studies that recruited the following Streiner, 2002).
Table 3
Emotion-regulation strategies across psychopathology groups.
Emotion-regulation strategy Mean 95% CI 95% CI p-value k Q-statistics p-value
Acceptance − .19 − .40 .05 ns 7 b.001

Avoidance .38 .33 .44 b .001 37 b.001
Problem solving − .31 − .36 −.25 b .001 42 b.001
Reappraisal − .14 − .20 −.07 b .001 15 b.001
Rumination .49 .45 .52 b .001 89 b.001
Suppression .34 .28 .39 b .001 51 b.001
3.4.2. Moderator analyses

3.3. Effect size calculation and corrections We were interested in the proportion of the variance in the
association between emotion-regulation strategy and psychopathology
Because the coded studies provided effect sizes of the r- and d- that is accounted for by sample type or age group among the reviewed
families, we put them in the same metric for the purposes of our studies. We focused on these two moderators because they can introduce
analyses. Rosenthal and DiMatteo (2001) suggest converging d's to r's substantial variability in assessments of psychopathology. First, we were
given that r's are more easily interpreted in terms of practical interested in evaluating sample type as a potential moderator, given that
importance. Additionally, converting continuous r into dichotomous d individuals from a clinical population would be expected to have higher
results in loss of information. Thus, when studies provided effect sizes levels of psychopathology than those from a non-clinical population. In
of the d-family, we first calculated Cohen's D standardized mean this respect, we were curious to see whether the relationship between
difference by subtracting the means of control group from those of the emotion regulation and psychopathology was greater when more
clinical group and then dividing this difference by the pooled variance clinically severe participants were included in the analyses.
(Cohen, 1988). Then, we transformed Cohen's D into an effect size of Second, emotion regulation is considered key to mental health in
the r-family, the correlation coefficient r (Rosenthal, & DiMatteo, children, but the ability to regulate emotions develops over childhood
2001). Once all the effect sizes were on the r-metric, we calculated and adolescence (Eisenberg, Spinrad, & Eggum, in press). Thus, the
the appropriate corrections. Correlation coefficients have a prob- relationships between emotion regulation and psychopathology may
lematic standard error formulation (Lipsey & Wilson, 2001), which be less strong in children than in adults. We evaluated whether age
can be solved by using the Fisher's Zr-transform (Hedges & Olkin, influenced the relationship between emotion-regulation strategies
1985; Lipsey & Wilson, 2001), so we applied this transformation. and psychopathology.
Given that larger samples are more precise, we also corrected for In order to examine moderators, we first calculated the Q statistics
sample size by multiplying the effect sizes by their inverse variances (Hedges & Olkin, 1985) to determine the degree of heterogeneity
(Hedges & Olkin, 1985; Hedges & Vevea, 1998; Lipsey & Wilson, among our effect sizes. However, many researchers find this metric to
2001). We then back transformed the Fisher's z coefficients to raw be problematic as it tends to be overly sensitive to detecting
correlation coefficients for ease of interpretation. We utilized Cohen's heterogeneity in larger samples (Hunter & Schmidt, 1990). In the
guidelines (1988) to interpret correlation effect sizes: above .40 as case of this investigation we ran the risk of not detecting significant
large, around .25 as medium, and below .10 as small. heterogeneity, given the small sample size of many of our combina-
tions of strategies and disorders. For this reason, in addition to
3.4. Data analytic plan calculating the Q statistics, we decided to follow the suggestions of
Rosenthal and DiMatteo (2001) to evaluate our moderators even in
3.4.1. Random-effect models the absence of a significant Q.3 We ran these analyses using SPSS
We assumed that the effect sizes included in the meta-analyses were version 13.0 for Mac (SPSS Inc, Chicago, Illinois, USA) and the macros
sampled from a universe of possible effect sizes, and as such we make written by Lipsey and Wilson (2001). Similarly to our approach with
unconditional inferences to generalize beyond them (Hedges & Vevea, the random-effect models, we ran mixed effects analyses in which
1998; Hunter & Schmidt, 1990). In order to model these unconditional there were at least 2 effect sizes per level.
inferences, we ran random-effect models, as they assume that effect
sizes differ from the population by sampling error plus random 4. Results
variability among the studies (Field, 2003; Lipsey & Wilson, 2001;
Rosenthal & DiMatteo, 2001). Another advantage of using random- 4.1. Regulation strategies across disorders
effect models is that because they model variability from both between-
and within-studies, they tend to produce larger standard errors, which We calculated the random-effect model of the correlation coeffi-
means they reduce the risk of type I errors and are thus more cients for each regulatory strategy collapsed across the disorder clusters
conservative (for a review of the risks resulting from failing to use (see Table 3). As predicted, the following strategies were positively
random-effect models when appropriate, see Field, 2003). associated with psychopathology: avoidance (r = .38; k = 37; 95% CI =
According to Hedges and Vevea (1998), using less than five [.33; .44]) and suppression (r = .34; k = 51; 95% CI= [.28; .39]), both
effect sizes might result in random-effect tests that can only be with magnitudes from medium to large, and rumination with a large
regarded as approximate. However, for many combinations of magnitude (r = .49; k = 89; 95% CI = [.45; .52]). Conversely, the
regulatory strategy and disorder less than five effect sizes were following strategies were negatively associated with psychopathology:
found in the literature. Our best solution to address this problem problem solving, with a medium to large effect size (r = −.31; k = 42;
was to still run the models with two, three, and four effect sizes. 95% CI = [−.36; −.25]), and reappraisal, with a small to medium effect
However, we do suggest caution in the interpretation of these effect size (r = −.14; k = 15; 95% CI= [−.20; −.07]). Surprisingly, accep-
sizes. Additionally, in order to address the low power in analyses tance was not significantly associated with psychopathology (r = −.19;
with such few observations, when evaluating our results we took k = 7; 95% CI = [−.40; .05]), although it is worth mentioning that this
two additional steps: we included relationships that were margin- effect is small to medium in magnitude and in the predicted direction.
ally significant (p b .10) and we pointed at the magnitude of their
effect sizes. 3
This was only the case for eating and avoidance and sample type as the moderator.
Table 4
Emotion-regulation strategies and psychopathology groups.
Emotion- Psychopathology Mean 95% 95% p-value k Q-statistics

regulation CI CI p-value
strategy
Acceptance Anxiety − .25 − .70 .35 .42 2 b.001

Acceptance Depression − .20 − .52 .16 .27 4 b.001
Acceptance Substance .00 1
Avoidance Anxiety .37 .26 .48 b .001 13 b.001
Avoidance Depression .48 .40 .55 b .001 16 b.001
Avoidance Eating .18 .13 .24 b .001 7 .91
Avoidance Substance .26 1
Problem Anxiety −.27 − .36 .16 b .001 14 b.001
solving
Problem Depression − .33 − .40 −.26 b .001 26 b.001
solving
Problem Eating − .29 −.53 −.01 b .05 2 .08
solving
Reappraisal Anxiety − .13 − .28 .02 .09 5 b.01
Reappraisal Depression −.17 − .29 −.06 b .05 7 b.01
Reappraisal Eating −.05 − .21 .1 .5 2 .56
Reappraisal Substance −.08 1
Rumination Anxiety .42 .37 .48 b .001 23 b.001 Fig. 2. Funnel plot of all effect sizes in this study.
Rumination Depression .55 .51 .59 b .001 56 b.001
Rumination Eating .26 .20 .32 b .001 3 .87
Rumination Substance .21 .11 .31 b .001 7 b.001
Suppression Anxiety .29 .19 .39 b .001 19 b.001 k = 13; 95% CI [.26, .48]), depression (r = .48; k = 16; 95% CI [.40, .55]),
Suppression Depression .36 .29 .43 b .001 26 b.001 and eating (r = .18; k = 7; 95% CI [.13, .24]); rumination was positively
Suppression Eating .36 .24 .47 b .001 6 b.05 associated with anxiety (r = .42; k = 23; 95% CI [.37, .48]), depression
(r=.55; k=56; 95% CI [.51, .59]), eating (r=.26; k=3; 95% CI [.20, .32]),
and substance (r=.21; k=7; 95% CI [.11, .31]); and suppression was
As Table 3 shows, all these effects but acceptance had significant Q positively associated with anxiety (r=.29; k=19; 95% CI [.19, .39]),
statistics, suggesting important variability. We then conducted moder- depression (r=.36; k=26; 95% CI [.29, .43]), and eating (r=.36; k=6;
ator analyses by running mixed models. In the first mixed model, we 95% CI [.24, .47]). Conversely, problem solving was negatively associated
evaluated the role of sample type in moderating avoidance, problem with anxiety (r=−.27; k=14; 95% CI [−.36, −.16]), depression (r=
solving, rumination, and suppression, since they all had at least two −.33; k=26; 95% CI [−.40, −.26]) and eating (r=−.29; k=2; 95% CI
effect sizes per level of this variable. Sample type significantly moderated [−.53, −.01]); and reappraisal was marginally negatively associated with
rumination (Q (1) = 24. 54, p b .001) with studies including clinical anxiety (r = −.13; k = 5; 95% CI [−.28, .02]; p = .09), negatively
participants showing larger effect sizes (r = .87; k = 11; 95% CI [.73, 1]) associated with depression (r=−.17; k=7; 95% CI [−.29, −.06]), and
than studies including only non-clinical participants (r = .49; k = 78; not associated with eating (r = −.05; k = 2; 95% CI [−.21; .10]).
95% CI [.44, .54]). It also moderated suppression (Q (1) = 6.76, p b .01), Acceptance was not significantly associated with anxiety (r=−.25;
with studies including clinical participants having larger effect sizes k=2; 95% CI [−.70, .35]) or depression (r=−.20; k=4; 95% CI [−.52,
(r = .68; k = 4; 95% CI [.42, .93]) than those without clinical participants .16]). Lastly, there was only one sample providing data to calculate effect
(r = .33; k = 47; 95% CI [.26, .40]). However, sample type was only a sizes for the following combinations of strategies and disorders:
marginally significant moderator of avoidance (Q (1) = 3.21, p = .07), acceptance and substance (Britton, 2004; r=0; n=196), avoidance and
with studies including clinical participants having larger effect sizes substance (Cooper et al., 2003; r=.26, n=1978), and reappraisal and
(r = .57; k = 6; 95% CI [.38; .76]) than those without clinical participants substance (Britton, 2004; r=−.08; n=196).
(r = .38; k = 31; 95% CI [.30; .46]) and problem solving (Q (1) = 2.94, We then conducted moderator analyses for the effect sizes with
p = .09), with studies including clinical participants having larger effect significant Q statistics (see Table 4). We examined age group in the
sizes (r = −.53; k = 4; 95% CI [−.78, −.28]) than those without clinical combinations of strategy and disorder that had at least two effect sizes
participants (r = −.31; k =38; 95% CI [−.38, −.24]). in each level of the moderator variable: problem solving, rumination +
In the second mixed model, we evaluated the role of age group as a depression, and suppression + depression. Age group was a significant
moderator of problem solving, rumination, and suppression, since moderator of problem solving + depression (Q (1) = 5.81, p b .05)
these were the only strategies with more than two effect sizes in each with adults showing larger effect sizes (r = −.38; k = 24; 95% CI
level of this variable. Age group did account for a significant portion [−.46, − .30]) than children/adolescents (r = −.04; k = 2; 95% CI
of the variability in problem solving (Q (1) = 4, p b .05) with adults [−.30, .23]) and of suppression + depression (Q (1) = .9.27, p b .01),
having a stronger relationship (r = − .34; k = 40; 95% CI [. −.41; with adults having larger effect sizes (r = .42; k = 24; 95% CI [.34, .50])
−.27]) than children/adolescents (r = −.03; k = 2; 95% CI [−.32; than children/adolescents (r = − .06; k = 2; 95% CI [− .36, .23]).
.26]) and of suppression (Q (1) = 11. 98, p b .001), with adults again However, age group was not a significant moderator of rumination+
having a stronger relationship (r = .38; k = 48; 95% CI = [.32; .44]) depression (Q (1) = .28, p = .60).
than children/adolescents (r = −.08; k = 3; 95% CI = [−.34, .17]). We then examined our second moderator variable, sample type, in
However, age group did not moderate the relationship between the combinations of strategy and disorder with at least two effect sizes
rumination and psychopathology (Q (1) = .83, p = .36). in each level of the moderator variable: avoidance + depression;
problem solving + depression; rumination + anxiety; rumination +
4.2. Emotion-regulation strategies in each disorder depression; and suppression + eating. Sample type was a significant
moderator of avoidance+ depression (Q (1) = 4.55, p b .05) with studies
We calculated the random-effect model of the correlation including clinical participants showing larger effect sizes (r = .77; k = 3;
coefficients for each combination of regulatory strategy and disorder 95% CI [.52, 1]) than those without clinical patients; rumination +
(e.g., avoidance + anxiety; rumination + depression). As Table 4 anxiety (Q (1) = 8.51, p b .01) with studies including clinical patients
shows, avoidance was positively associated with anxiety (r = .37; having a larger effect size (r = .70; k = 3; 95% CI [.52, .86]) than those
without clinical participants (r = .42; k = 20; 95% CI [.36, .48]); sample, we constructed a funnel plot, which is a scatterplot with an
rumination + depression (Q (1) = 16.60, p b .001), with studies includ- index of study size plotted against a measure of effect size (Rothstein,
ing clinical participants having a larger effect size (r = .92; k = 8; 95% CI 2007). Larger studies appear at the top and cluster around the mean,
[.77, 1.08]) than those without clinical participants (r = .57; k = 48; 95% whereas smaller studies appear at the bottom and show more
CI [.51, .63]); and suppression + eating, with studies including clinical dispersion around the mean. If the plot looks symmetric (i.e., a
participants having a larger effect size (r = .59; k = 2; 95% CI [.42, .77]) funnel), this indicates that effect sizes hone in on the true mean as the
than those without clinical participants (r = .30; k = 4; 95% CI [.23, .37]). sample size increases. Conversely, if the plot is asymmetric, this
However, sample type was not a significant moderator of problem suggests the presence of publication bias (Rothstein, 2007). As Fig. 2
solving + depression (Q (1) = 2.13, p = .15). Lastly, we examined shows, we plotted precision (1-SE; a measure of sample size) against
sample type in avoidance + eating, an effect size with non-significant effect size. Visual inspection indicates a funnel shape, and thus,
Q statistics. It was non-significant (Q (1) = 1.18, p = .28). suggests no publication bias. However, because of the subjective
It is also important to keep in mind that critics of measures of nature of visual inspections, we conducted a statistical analyses based
rumination such as the Response Styles Questionnaire (RSQ) have on the rank correlation (Kendall's tau) between precision and effect
argued that the items on this measure overlap substantially with size (Begg & Mazumdar, 1994, Rothstein, 2007). We found this
symptoms of distress, inflating correlations between rumination and correlation to be non-significant (τb = −.01, p = .77), thus providing
depression and anxiety (e.g., Roberts, Gilboa, & Gotlib, 1998; converging evidence to support the inferences made from the visual
Segerstrom, Tsao, Alden, & Craske, 2000). To address the item overlap inspection of the funnel plot.4
between the rumination scale of the RSQ and depression, Treynor et Despite their wide use, funnel plots have been the source of much
al. (2003) removed items from the rumination scale that most criticism (e.g., Lau, Ioannidis, Terrin, Schmidt & Olkin, 2006), we have
obviously overlapped with depression (e.g., “I think about my feelings also assessed publication bias by calculating Orwin's (1983) fail-safe N
of sadness”) and then submitted the remaining 10 items to a factor for each of the five regulatory strategies that showed significant
analysis to determine if these 10 items represented one scale or results across psychopathology with .10 as the absolute value
multiple subscales. This analysis yielded two subscales, brooding (e.g., (corresponding to small effect sizes according to Cohen and lower
“I think, ‘What am I doing to deserve this?’”) and pondering (e.g., “I than our lowest effect size −.14 which was significant). These
analyze my personality to try to understand why I am depressed.”). analyses indicate that the number of additional studies with effect
The brooding items did not include references to depressive sizes of 0 required to make our results non-significant would be: 3.9
symptoms, but did capture theorists' definitions of rumination as times as many for rumination (351 studies), 2.4 times as many for
abstract, self-evaluative self-focus (i.e., Nolen-Hoeksema, 1991; suppression (122 studies), 2.8 times as many for avoidance (104
Watkins, 2008), while the pondering items capture a less self- studies), twice as many for problem solving (88 studies), and half as
evaluative, more problem-solving form of self-reflection. Treynor et many for reappraisal (6 studies). Thus, this supports the notion that
al. (2003) found that the brooding subscale showed very similar publication bias was unlikely in this study.
relationships to depression cross-sectionally and longitudinally as did
the full rumination scale, whereas the pondering subscale was less
5. Review of longitudinal studies
reliably associated with depression (see also Joormann, Dkane, &
Gotlib, 2006).
As noted earlier, there was a great deal of heterogeneity in the
In this meta-analysis, we sought to address this issue empirically,
designs of longitudinal studies examining the relationships between
by showing that the correlation coefficients between rumination and
one of the emotion-regulation variables of interest and one of the
psychopathology were comparable regardless of whether we had
outcome variables of interest. Further, with the exception of
calculated them using only the brooding subscale from the RSQ, only
rumination, there was a small number of longitudinal studies of any
other rumination scales (i.e., non-RSQ), or all the scales available for
of the other emotion-regulation variables. We included the baseline
this meta-analysis. Indeed, this is what we found. We averaged 27
bivariate correlations between emotion-regulation variables and
effect sizes from scales other than the RSQ and found the following
psychopathology variables from these studies in the meta-analysis
relationships: medium to large for rumination and psychopathology
where possible. Below, we describe the longitudinal results of these
(r = .37; k = 27; 95% CI [.30; .45]), large for rumination and depression
studies. See Table 2 for details about the studies.
(r = .41; k = 15; 95% CI [.32; .49]), medium to large for rumination
and anxiety (r = .32; k = 10; 95% CI [.27; .36]), and medium for
rumination and eating (r = .23; k = 1) and rumination and substance 5.1. Rumination and depression
(r = .22; k = 1). We then averaged the 19 effect sizes from the
brooding subscale of the RSQ and the results paralleled those obtained In studies of adults, rumination, as measured with a version of the
using non-RSQ rumination scales and all the rumination scales Response Styles Questionnaire (RSQ; Treynor et al., 2003) predicted
combined. We found the following relationships: medium to large increases in self-reported depressive symptoms across periods of a few
for brooding and psychopathology (r = .39; k = 19; 95% CI [.33; .45]), days to weeks (Butler & Nolen-Hoeksema, 1994; Hong, 2007; O'Connor,
large for brooding and depression (r = .44; k = 11; 95% CI [.38; .50]), O'Connor & Marshall, 2007; Sarin, Abela & Auerbach, 2005; Segerstrom
medium to large for brooding and anxiety (r = .38; k = 5; 95% CI [.23; et al., 2000) to one year later (Nolen-Hoeksema, Larson, & Grayson,
.52]), medium for brooding and eating (r = .27; k = 2; 95% CI [.20; 1999). RSQ rumination also predicted onsets of major depression across
.33]) and brooding and substance (r = .2; k = 1). one year (Nolen-Hoeksema, 2000). A few studies found that RSQ
rumination did not predict increases in self-reported depression over
4.3. Publication bias periods of 5 to 10 weeks (Calmes & Roberts; 2007; Hankin, Fraley, &
Abela, 2005; Wenzlaff & Luxton, 2003). Matheson and Anisman (2003)
Meta-analyses are subject to the file-drawer problem (Rosenthal, found that a different measure of rumination (Survey of Coping Profile
1979). In the present study, however, because most effect sizes were Endorsement, SCOPE) predicted increases in self-reported depression
obtained from large tables examining correlations between several over 6 months. Ciarrochi and Scott (2006) used the rumination scale of
measures, it is likely that null results were actually reported. However, the Emotional Control Questionnaire (ECQ; Ciarrochi, Scott, Deane, &
it is also problematic that for some regulatory strategies (i.e.,
reappraisal and acceptance), the number of available effect sizes 4
We found similar results when doing visual inspection and calculating correlations
was much smaller. To address presence of publication bias in our for each of the six regulatory strategies.
Heaven, 2003) and found that it did not predict increases in depressive (Priester & Clum, 1993) to 3 months (Nezu & Ronan, 1988). Other
symptoms but did predict decreases in positive mood. measures of problem solving have also predicted changes in
In studies of children, rumination, as measured by the adult depressive symptoms over one month (COPE problem solving;
rumination scale (RSQ; Treynor et al., 2003), predicted increases in Hong, 2007), 6 months (SCOPE problem solving; Matheson & Anis-
self-reported depression across a span of three years (Broderick & man, 2003), and one year (SPSI; Ciarrochi & Scott, 2006) in college
Korteland, 2004). Among adolescents, rumination as measured by the students.
CRSQ or RSQ has been found to predict increases in self-reported In a study of adolescents, Gerard and Buehler (2004) found that a
depression one to four years (Burwell & Shirk, 2007; Grabe, Hyde, & 4-item measure of problem-solving orientation did not predict
Lindberg, 2007; Nolen-Hoeksema et al., 2007). Rumination predicted change in self-reported depressive symptoms over 1 year when
new onsets of major depression across four years as assessed by controlling for a number of other risk factors.
structured clinical interview in one study of 496 adolescents (Nolen-
Hoeksema et al., 2007), but did not predict clinician-rated or mother- 6. Discussion
rated depressive symptoms over one year in another study of 168
adolescents (Burwell & Shirk, 2007). In the present meta-analytic review, we evaluated the relationship
between six widely studied emotion-regulation strategies and four
5.2. Rumination and other psychopathology psychopathology groups. Each emotion-regulation strategy was
associated with overall psychopathology in the predicted direction:
Three studies of adults have found that RSQ rumination predicted maladaptive strategies (i.e., rumination, avoidance, suppression)
increases in self-reported anxiety symptoms (Calmes & Roberts, 2007; were associated with more psychopathology and adaptive strategies
Nolen-Hoeksema, 2000; Sarin et al., 2005) while two studies found that (i.e., acceptance, reappraisal, and problem solving) with less psycho-
it did not predict anxiety symptoms (Hong, 2007; Segerstrom et al., pathology. However, interesting patterns emerged when examining
2000, who controlled for worry in the same equation). RSQ rumination the magnitude of these relationships, suggesting that the relationship
predicted increases in alcohol abuse problems in women but not men between emotion-regulation strategies and psychopathology might
(Nolen-Hoeksema & Harrell, 2002). One study of adolescent females vary by strategy and type of psychopathology.
found that RSQ rumination predicted increases in substance abuse Some emotion-regulation strategies were more strongly related to
symptoms and eating disorder symptoms, and the onset of bulimia overall psychopathology (i.e., collapsing across symptom types) than
nervosa over a four-year period (Nolen-Hoeksema et al., 2007). others. We found that the effect size for rumination was large; the
effect sizes for avoidance, problem solving, and suppression were
5.3. Avoidance medium to large; and the effect sizes for reappraisal and acceptance
were small to medium (non-significant for the latter). Thus, in
Two studies of adults used the avoidance subscales of the Coping general, the maladaptive strategies were more strongly related to
Responses Inventory (CRI: Moos, 1993). Holahan, Moos, Holahan, psychopathology than the adaptive strategies. This may indicate that
Brennan, and Schutte (2005) found that a combination of the cognitive presence of a maladaptive emotion-regulation strategy is more
avoidance and emotional discharge scales predicted increases in deleterious than the relative absence of particularly adaptive
depressive symptoms over 10 years in a sample of late-to-middle emotion-regulation strategies. The exception may be problem
aged adults. Blalock and Joiner (2000) found that cognitive avoidance solving; not having a strong problem-solving orientation may have
predicted increases in both depressive and anxiety symptoms over wide-ranging negative effects on well-being, and open the door for
3 weeks in college students, but for women only; there were no the development of maladaptive emotion-regulation strategies such
significant effects for behavioral avoidance. Engler, Crowther, Dalton, as rumination, suppression, and avoidance (Nolen-Hoeksema et al.,
and Sanftner (2006) found significant differences for the Ways of Coping 2008; Zelazo & Cunningham, 2007).
escape-avoidance scale between chronic and recent-onset binge-eaters When we examined the relationships between each emotion-
versus non-binge-eaters over a one-year period of female college regulation strategy and each psychopathology separately, some
students. In a study of female adolescents, Cooper, Wood, Orcutt, and patterns emerged. The relationships between certain emotion-
Albino (2003) found that the CRI avoidance coping subscale predicted regulation strategies were stronger for depression and anxiety than
increases in a composite measure of problem behaviors, but not for substance use and eating disorders. Specifically, for rumination,
increases specifically in substance use. effect sizes were large for anxiety and depression and medium for
eating and substance. For avoidance, the effect size was large for
5.4. Suppression depression, medium to large for anxiety, and medium for eating and
substance. Lastly, for reappraisal, the effect sizes were small to
Scores on the White Bear Suppression Inventory (WBSI; Wegner & medium for depression and anxiety, and small for eating and
Zanakos, 1994) predicted increases in depressive symptoms over substance. These patterns suggest that, not surprisingly, mood-related
7 weeks among college students with low life stress (Beevers & disorders (i.e., depression and anxiety) are more closely related to
Meyer, 2004) and over 10 weeks in another sample of college students certain problems in emotion regulation than externalizing disorders
(Wenzlaff & Luxton, 2003). Scores on the emotional containment (i.e., substance use and eating disorders).
subscale of the SCOPE predicted increases in self-reported depression Emotion dysregulation, in the form of rumination, avoidance, and
across 6 months in college students (Matheson & Anisman, 2003). difficulties with reappraisal, may show a weaker association with
Similarly, a study examining expressive suppression with the Emotion substance use and eating disorders because these relationships might
Regulation Questionnaire (ERQ; Gross & John, 2003) found that low be more complex. Several potential explanations come to mind. For
emotional suppression and low social anxiety interacted to predict example, the relationship between these strategies and substance and
heightened positive affect three months later (Kashdan & Breen, 2008). eating disorders might be moderated by reward sensitivity. In this
respect, individuals with these emotion-regulation difficulties who
5.5. Problem solving also are high on reward sensitivity may be more likely to turn to
substances (alcohol, drugs, food) to ameliorate their unregulated
Two studies using the Problem-Solving Inventory (PSI; Heppner & distress, and thus, will be more prone to develop substance use
Petersosn, 1982) found that this scale predicted changes in self- disorders and/or eating disorders (Carver, Johnson, & Joormann,
reported depression across periods ranging from 1–2 weeks 2008). Evidence supporting this notion comes from studies showing
that higher reward sensitivity is correlated with earlier age of onset of between these strategies and psychopathology than studies without
drinking alcohol in young adults (Pardo, Aguilar, Molinuevo, & clinical participants. Thus, the relationship between dispositional
Torrubia, 2007), alcohol use and abuse in non-clinical samples emotion-regulation strategies and psychopathology may be stronger
(Loxton & Dawe, 2001), with craving and positive affect responses when more extreme groups are compared, suggesting that the
in response to alcohol cues in young adult hazardous drinkers strength of this relationship may be a function of clinical severity.
(Zisserson & Palfai, 2007). Similarly, some studies find that individuals This is consistent with research showing that emotion regulation
with symptoms of binge eating or eating disorders show elevated plays a central role in the etiology and maintenance of clinical levels of
levels of reward sensitivity (Davis, Strachan, & Berkson, 2004; Kane, psychopathology (Berenbaum et al., 2003; Greenberg, 2002; Kring &
Loxton, Staiger, & Dawe, 2004; Loxton & Dawe, 2001, 2007). Thus, Bachorowski, 1999; Mennin & Farach, 2007).
people high in reward sensitivity may be drawn toward the These findings underscore the importance of simultaneously
reinforcing properties of substances, such as alcohol and/or palatable studying both normative and clinical populations when conducting
foods (Davis et al., 2004; Dawe & Loxton, 2004). Emotional distress, research in psychopathology. Specifically, our results indicate that
which is chronically higher in people with emotion dysregulation, direct comparisons between normative and clinical populations can
appears to potentiate reward systems in the brain (Brady & Sinha, be critical in our endeavor to delineate how and when normative
2005), and this potentiation may be even greater in individuals high processes become pathological. However, it is worth keeping in mind
in reward sensitivity, increasing the chances they will turn to alcohol that only a minority of our effect sizes (27) came from studies that
or binge eating. Intake of alcohol or food will be reinforced both by the used a clinical sample and barely any studies used a multi-sample
satisfaction of high appetitive drives and by the reduction of negative method with a direct comparison of clinical and normative samples.
emotions these individuals otherwise cannot regulate. Thus, the Thus, we recommend that future studies of psychopathology-related
combination of emotional dysregulation and high reward sensitivity processes utilize a multi-sample approach.
should be a potent risk factor for the development and/or mainte- Age moderated the relationship between psychopathology and
nance of substance abuse and eating disorders. problem solving and suppression, with adults showing stronger
Alternately, some theories of eating and substance disorders propose relationships than children/adolescents. Conversely, age did not
that binge eating and substance use function as emotion-regulation moderate the relationship between psychopathology and rumination.
strategies in their own right (Macht, Haput, & Ellgring, 2005; Polivy & Children may be less able than adults to report on their use of problem
Herman, 2002; Sher & Grekin, 2007). Individuals regulating their solving and suppression because awareness of one's use of these
emotions by binge eating or substance use may be less likely to resort to strategies takes a greater degree of meta-cognition than children are
other forms of emotion-regulation strategies, because the binge eating capable of (Eisenberg et al., in press). Children may also be less likely
and substance use fill the individuals' emotion-regulation needs. This to use suppression or problem solving than adults because they
suggests that binge eating or substance use would be relatively weakly require a degree of executive control over emotional reactions that
associated with other emotion-regulation strategies, and indeed our children have not yet developed (Steinberg et al., 2006). In contrast,
meta-analysis showed they were less correlated with emotion- rumination may be a more primitive, automatic response to negative
regulation strategies than were depression or anxiety. Still, binge eating emotion than problem solving or suppression, which makes it easier
and substance use were correlated somewhat with emotion-regulation for children both to engage in and report on.
strategies. Perhaps binge eating and substance use tend to be part of a
cluster of maladaptive emotion-regulation strategies used by some 6.2. Implications
individuals. Future research is needed to determine if binge eating (and
other eating-related pathology) and substance use actually do serve to Our findings suggest that certain strategies (i.e., rumination, suppres-
down-regulate emotions in some individuals, and how they fit into sion, avoidance, problem solving) might be more strongly related to
possible clusters of maladaptive emotion-regulation strategies. mental health than others (acceptance and reappraisal). The relatively
Further, it should be noted that there were substantially more small relationships between psychopathology and acceptance and
studies of the relationships between rumination, avoidance, and reappraisal are surprising, given the prominent role of these constructs
reappraisal, on the one hand, and depression and anxiety, on the other in two major therapeutic approaches: acceptance-based treatments and
hand, than there were of the relationships between these emotion- cognitive-behavioral therapy, respectively (see Hofmann & Asmundson,
regulation strategies and substance use or eating disorders. Thus, 2008). First, we note that acceptance-based treatments promote
effect sizes for substance use and eating disorders may be less reliable acceptance in order to reduce experiential avoidance (Eifert & Forsyth,
than the effect sizes for depression and anxiety. 2005; Hayes et al., 1999). This meta-analysis showed that avoidance had a
In contrast, effect sizes for the relationships between problem medium size relationship to psychopathology, a finding in accordance
solving and suppression and depression, anxiety and eating disorders with the goals of acceptance-focused treatments. Second, in addition to
were all medium. Again, the number of studies of these emotion- reappraisal, another important regulatory strategy to CBT is problem
regulation strategies and eating disorders limits the reliability of our solving (Beck et al., 1979; D'Zurilla, 1988; Marlatt et al., 1988), which
findings, and no studies of the relationships between substance use showed moderate relationships to psychopathology. Thus, our findings
and suppression or problem solving met the inclusion criteria for this provide some support for the foci of CBT.
meta-analysis. If these findings hold up in future studies, however, Given the nature of a meta-analytic review, we examined strategies
they suggest that suppression and problem solving have similar independently of one another. Thus, we could not model the relation-
effects across at least two types of internalizing symptoms and one ships among strategies, which for example, might have helped clarify
type of externalizing symptom. the relationship between avoidance and acceptance. Utilizing multi-
variate structural models (i.e., structural equation modeling, SEM,
6.1. Moderators Arbuckle, 2007; Kline, 1998) would allow researchers to model the
relationship between dispositional strategies and psychopathology and
We evaluated sample age and type as moderators of the relation- to incorporate latent factors (e.g., personality traits, attentional factors)
ships between strategies and disorders. In many cases, we were not that might account for differential relationships between strategies and
able to conduct moderation analysis because of lack of sufficient disorders. Additionally, it will be important to examine strategies at the
studies in each cell. Sample type was a significant moderator of state level. In this respect, researchers could model the temporal course
avoidance, problem solving, rumination, and suppression, with of emotion-regulation strategies, since people may use different
studies including clinical participants showing stronger relationships strategies over the course of an emotional event. For example, it
might be possible that individuals with eating or substance use regulation strategies, and this skill is at least as important as the use of
disorders will try regulatory strategies for a short period of time before any one strategy in determining psychopathology.
using eating or substances to regulate their moods.
Another necessary step would be to examine the relationships 6.4. Study limitations
between emotion-regulation strategies and psychopathology simulta-
neously at the dispositional and state level. The importance of examining Our investigation had some limitations. First, we examined
both levels simultaneously is underscored by studies showing that emotion regulation with self-report data, which allowed us to assess
dispositional and state affect interact to produce different outcomes emotional experience in the subjective domain. Examining only one
(e.g., Egloff & Hock, 2001), that dispositional regulatory strategies (i.e., domain is problematic because biases specific to that domain might
avoidance) moderate the effects of instructed state suppression not be corrected. In the case of the subjective domain, the biases that
(Feldner, Zvolensky, Eifert, & Spira, 2003), and that regulatory strategies might have introduced include people's difficulties with reporting
interact with dispositional affective style to affect mood (Dennis, 2007). emotional phenomena (e.g., Koster, Soetens, Braet, & De Raedt, 2008;
In order to examine the interaction between dispositional and state Robinson & Clore, 2002), especially in the case of children (Eisenberg
level, we recommend the assessment of spontaneous emotion regula- et al., in press); confounding items that measure psychopathology
tion, since allowing people to regulate their emotions in whichever way with items that measure emotion, and confounding the assessment of
comes naturally to them will likely parallel assessment of emotion emotion generation with regulation (e.g., Cole et al., 2004).
regulation at the dispositional level (see Berkman & Liberman, 2009; Second, the relationship between emotion-regulation strategies
Egloff, Schmukle, Burns & Schwerdtfeger, 2006). Support for this notion and psychopathology might be inflated because of item overlap. For
comes from studies showing that when participants are instructed to use example, assessment of eating disorder symptomatology might be
specific strategies, they have a hard time doing so (Demaree et al., 2006) confounded by the presence affective items in measurement instru-
and work on automatic processes suggesting that people engage in ments of eating symptoms (Barker & Galambos, 2009), the assess-
automatic emotion regulation (Williams & Bargh, 2007). A few recent ment of emotion might be confounded by distress (Stanton, Dannof-
studies have examined spontaneous regulation in the lab (e.g., Egloff Burg, Cameron, & Ellis, 1994), or the assessment of rumination might
et al., 2006; Liverant, Brown, Barlow, & Roemer, 2008), but the extent of be confounded with depressive symptomatology (Nolen-Hoeksema
regulatory strategies examined and of modeling with dispositional et al., 2008). We addressed the latter issue by showing similar
levels of emotion regulation and affect has been limited, so we suggest a patterns of results when using measures of rumination that did not
more comprehensive pursue of this line of work. Additionally, we contain symptom overlap. Still, the possibility of item overlap
recommend the assessment of spontaneous emotion regulation in between self-reports of emotion regulation and psychopathology
ecologically valid contexts of assessment such as those that elicit calls for the use of other methods, including experimental methods, to
emotions in a social context. test the relationships between emotion-regulation strategies and
psychopathology symptoms. As noted earlier, experimental methods
6.3. Limitations of the literature have confirmed the relationships between some emotion-regulation
strategies and symptoms (e.g., rumination and depression), but most
When examining the literature on emotion-regulation strategies relationships remain untested.
and psychopathology, we found that, despite all the interest that In the present meta-analytic review, we evaluated the relationship
emotion regulation and strategies have received in the last decade, the between six widely studied emotion-regulation strategies and four
number of effect sizes for some combinations of strategies and psychopathology groups. We found that maladaptive strategies were
disorders was, indeed, small. Thus, the small size of some of our cells more strongly associated with psychopathology than adaptive strate-
might have limited the generalizability of our findings. However, by gies, and that rumination, avoidance, and difficulties with reappraisal
using random-effect models, we sought to maximize the generaliz- were more strongly associated with depression and anxiety than with
ability of our results. Additionally, it is worth keeping in mind that the eating and substance use disorders. Conducting an empirical review of
two strategies with the weakest relationship to psychopathology (i.e., this magnitude was possible because of the recent growth in interest in
acceptance and reappraisal) also had the smallest number of effect affective phenomena in psychopathology and the resulting flourishing
sizes, suggesting that more comprehensive assessment of these of research examining regulatory strategies. At the same time, this
strategies is necessary to better understand asymmetry. When review reflects critical omissions in the study of regulatory strategies in
examining the longitudinal data, most focused on rumination and psychopathology. Specifically, regulatory strategies should be compre-
not on other strategies or the interaction between strategies. In this hensively assessed transdiagnostically and modeled in relation to one
respect, we hope that in future years, the examination of specific another both at the state and dispositional level. We hope that future
emotion-regulation strategies in disorders becomes more systematic. work on emotion regulation in psychopathology follows a systematic
Finally, some theorists have argued that the adaptiveness of specific course that carefully addresses these issues.
emotion-regulation strategies depends on the context, for example,
problem solving may not be an adaptive strategy when facing an References
uncontrollable situation in which there is no problem to solve (e.g.,
Cheng, Hui, & Lam, 1999; Folkman & Lazarus, 1986). Similarly, some Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought
suppression: A meta-analysis of controlled studies. Clinical Psychology Review, 21,
theorists have argued that it is most adaptive to be able to flexibly move 683−703.
between coping strategies depending on the context of a situation Aldwin, C. (1994). Stress, coping, and development. New York: Guilford Press.
(Aldwin, 1994; Barrett & Gross, 2001; Bonanno, 2001; Cole et al., 2004; ⁎Allan, S., & Gilbert, P. (2002). Anger and anger expression in relation to perceptions of social
rank, entrapment, and depressive symptoms. Personality and Individual Differences, 32,
Compas, Malcarne, & Fondacaro, 1988; Thompson, 1994; Gratz & 551−565.
Roemer, 2004). Unfortunately, only a handful of studies have specifically Altman, D. G., & Royston, P. (2006). The cost of dichotomising continuous variables.
tested these context-specificity and flexibility hypotheses (e.g., British Medical Journal, 332, 1080.
Arbuckle, J. (2007). Amos user's guide. Chicago, Ill.: SPSS Inc.
Bonanno, Papa, Lalande, Westphal & Coifman, 2004; Cheng, 2001,
Augustine, A. A., & Hemenover, S. H. (2008). On the relative effectiveness of affect
2003). This will be an important focus for future work. We speculate that regulation strategies: A meta-analysis. Cognition and Emotion, 23, 1181−1220.
one reason that studies of non-clinical populations showed less of a Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report:
relationship between specific emotion-regulation strategies and psy- The Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191−206.
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeski, M. R., & Fiore, M. C. (2004). Addiction
chopathology than clinical populations is because the non-clinical motivation reformulated: An affective processing model of negative reinforcement.
populations are more likely to move flexibly between emotion- Psychological Review, 111, 33−51.
⁎Ball, S., Smolin, J., & Shekhar, A. (2002). A psychobiological approach to personality: Cheng, C. (2001). Accessing coping flexibility in real-life and laboratory settings:
Examination of anxious outpatients. Journal of Psychiatric Research, 36, 97−103. A multimethod approach. Journal of Personality and Social Psychology, 80,
Bargh, J. A., & Williams, L. E. (2007). On the nonconscious of emotion regulation. In J. Gross 814−833.
(Ed.), Handbook of emotion regulation (pp. 429−445). New York: Guilford Press. Cheng, C. (2003). Cognitive and motivational processes underlying coping: A dual-
Barker, E. R., & Galambos, N. L. (2009). Exploring criterion confounding in the process model. Journal of Personality and Social Psychology, 84, 425−438.
measurement of binge eating symptoms and negative affect. Journal of Psychopa- Cheng, C., Hui, W., & Lam, S. (1999). Coping style of individuals with functional
thology and Behavioral Assessment, 31, 43−50. dyspepsia. Psychosomatic Medicine, 61, 789−795.
Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of ⁎Cheung, M. S. P., Gilbert, P., Irons, C., Cheung, M. S. P., Gilbert, P., & Irons, C. (2004). An
panic disorder. Behavior Therapy, 20, 261−282. exploration of shame, social rank and rumination in relation to depression. Personality
Barrett, L. F., & Gross, J. J. (2001). Emotional intelligence: A process model of emotion and Individual Differences, 36, 1143−1153.
representation and regulation. In T. J. Mayne, & G. A. Bonanno (Eds.), Emotions: ⁎Ciarrochi, J., & Scott, G. (2006). The link between emotional competence and well-being:
Current issues and future directions (pp. 286−311). New York: Guilford Press. A longitudinal study. British Journal of Guidance and Counseling, 34, 231−243.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: Ciarrochi, J., Scott, G., Deane, F. O., & Heaven, P. C. L. (2003). Relations between social and
International Universities Press. emotional competence and mental health: A construct validation study. Personality
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. and Individual Differences, 35, 1947−1963.
New York: Guilford. ⁎Ciesla, J. A., & Roberts, J. E. (2007). Rumination, negative cognition, and their
⁎Beevers, C. G., & Meyer, B. (2004). Thought suppression and depression risk. Cognition interactive effects on depressed mood. Emotion, 7, 555−565.
and Emotion, 18, 859−867. Clark, D. M. (1988). A cognitive model of panic disorder. In S. Rachman, & J. D. Maser
Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation test (Eds.), Panic: Psychological perspectives (pp. 71−89). Hillsdale, NJ: Erlbaum.
for publication bias. Biometrics, 50, 1088−1101. Clyne, C., & Blampied, N. M. (2004). Training in emotion regulation as a treatment for
Berenbaum, H., Raghavan, C., Le, H. N., Vernon, L. L., & Gomez, J. J. (2003). A taxonomy of binge eating: A preliminary study. Behaviour Change, 21, 269−281.
emotional disturbances. Clinical Psychology: Science and Practice, 10, 206−226. Cohen, J. (1988). Statistical power analysis for the behavioral sciences, 2nd ed. Hillsdale,
Berking, M., Wupperman, P., Orth, U., Meier, L. L., & Caspar, F. (2008). Prospective effects NJ: Erlbaum.
of emotion-regulation skills on emotional adjustment. Journal of Counseling Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific
Psychology, 55, 485−494. construct: Methodological challenges and directions for child development
Berkman, E. T., & Liberman, M. D. (2009). Using neuroscience to broaden emotion research. Child Development, 75, 317−333.
regulation: Theoretical and methodological considerations. Social and Personality Compas, B. E., Malcarne, V. L., & Fondacaro, K. M. (1988). Coping with stressful events in
Psychology Compass, 3, 1−19. older children and young adolescents. Journal of Consulting and Clinical Psychology,
Billings, A. G., & Moos, R. H. (1981). The role of coping responses and social responses in 56, 241−258.
attenuating the stress of life events. Journal of Behavioral Medicine, 4, 139−157. ⁎Connolly, A. M., Rieger, E., & Caterson, I. (2007). Binge eating tendencies and anger
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). coping: Investigating the confound of trait neuroticism in a non-clinical sample.
Mindfulness: A proposed operational definition. Clinical Psychology: Science and European Eating Disorders Review, 15, 479−486.
Practice, 11, 230−241. ⁎Conway, M., Mendelson, M., Giannopoulos, C., Csank, P. A. R., & Holm, S. L. (2004).
Blalock, A., & Joiner, T. (2000). Interaction of cognitive avoidance coping and stress in Childhood and adult sexual abuse, rumination on sadness, and dysphoria. Child
predicting depression/anxiety. Cognitive Therapy and Research, 24, 47−65. Abuse and Neglect, 28, 393−410.
Bonanno, G. A. (2001). Emotion self-regulation. In T. J. Mayne, & G. A. Bonanno (Eds.), Cooper, M. L., Russell, M., Skinner, J. B., Frone, M. R., & Mudar, P. (1992). Stress and
Emotions: Current issues and future directions (pp. 251−285). New York: Guilford Press. alcohol use: Moderating effects of gender, coping, and alcohol expectancies. Journal
Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. (2004). The of Abnormal Psychology, 101, 139−152.
importance of being flexible: The ability to both enhance and suppress emotion ⁎Cooper, M. L., Wood, P. K., Orcutt, H. K., & Albino, A. (2003). Personality and
expression predicts long-term adjustment. Psychological Science, 15, 482−487. predisposition to engage in risky behaviors or problem behaviors during
Borders, A., Barnwell, S. S., & Earleywine, M. (2007). Alcohol-aggression expectancies adolescence. Journal of Personality and Social Psychology, 84, 390−410.
and dispositional rumination moderate the effect of alcohol consumption on ⁎Cox, D. L., Stabb, S. D., & Hulgus, J. F. (2000). Anger and depression in girls and boys.
alcohol-related aggression and hostility. Aggressive Behavior, 33, 327−338. Psychology of Women Quarterly, 24, 110−112.
Brackett, M. A., & Salovey, P. (2004). Measuring emotional intelligence as a mental ability with Davis, C., Strachan, S., & Berkson, M. (2004). Sensitivity to reward: Implications for
the Mayer–Salovey–Caruso Emotional Intelligence Test. In G. Geher (Ed.), Measurement overeating and overweight. Appetite, 42, 131−138.
of emotional intelligence (pp. 179−194). Hauppauge, NY: Nova Science Publishers. Dawe, S., & Loxton, N. J. (2004). The role of impulsivity in the development of substance
Brady, K. T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: use and eating disorders. Neuroscience and Biobehavioral Reviews, 28, 343−351.
The neurobiological effects of chronic stress. American Journal of Psychiatry, 162, Demaree, H. A., Robinson, J. L., Pu, J., & Allen, J. J. B. (2006). Strategies actually employed
1483−1493. during response-focused emotion regulation research: Affective and physiological
Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of consequences. Cognition and Emotion, 20, 1248−1260.
mindfulness: Implications for relapse prevention in the treatment of substance ⁎Dennis, T. A. (2007). Interactions between emotion regulation strategies and affective
abuse. Clinical Psychology: Science and Practice, 9, 275−299. style: Implications for trait anxiety versus depressed mood. Motivation and
⁎Britton, P. C. (2004). The relation of coping strategies to alcohol consumption and Emotion, 31, 200−207.
alcohol-related consequences in a college sample. Addiction Research & Theory, 12, Diamond, L. M., & Aspinwall, L. G. (2003). Emotion regulation across the life span: An
103−114. integrative perspective emphasizing self-regulation, positive affect, and dyadic
⁎Broderick, P. C., & Korteland, C. (2004). A prospective study of rumination and depression processes. Motivation and Emotion, 27, 125−156.
in early adolescence. Clinical Child Psychology and Psychiatry, 9, 383−394. ⁎Donaldson, C., Lam, D., & Mathews, A. (2007). Rumination and attention in major
⁎Burns, J. W., Bruehl, S., & Caceres, C. (2004). Anger management style, blood pressure depression. Behaviour Research and Therapy, 45, 2664−2678.
reactivity, and acute pain sensitivity: Evidence for “trait × situation” models. Annals D'Zurilla, T. J. (1988). Problem solving therapies. In K. S. Dobson (Ed.), Handbook of
of Behavioral Medicine, 27, 195−204. cognitive-behavioral therapies (pp. 85−135). New York: Guilford.
⁎Burwell, R. A., & Shirk, S. R. (2007). Subtypes of rumination in adolescence: D'Zurilla, T. J., Chang, E. C., Nottingham, E. J., IV, & Faccinni, L. (1998). Social problem-
Associations between brooding, reflection, depressive symptoms, and coping. Cli- solving deficits and hopelessness, depression, and suicidal risk in college students
nical Child and Adolescent Psychology, 36, 56−65. and psychiatric inpatients. Journal of Clinical Psychology, 54, 1091−1107.
⁎Butler, L. D., & Nolen-Hoeksema, S. (1994). Gender differences in responses to Egloff, B., & Hock, M. (2001). Interactive effects of state anxiety and trait anxiety on
depressed mood in a college sample. Sex Roles, 30, 331−346. emotional Stroop interference. Personality and Individual Differences, 31, 875−882.
Bydlowski, S., Corcos, M., Jeammet, P., Paterniti, S., Berthoz, S., Laurier, C., et al. (2005). ⁎Egloff, B., Schmukle, S. C., Burns, L. R., & Schwerdtfeger, A. (2006). Spontaneous
Emotional-processing deficits in eating disorders. International Journal of Eating emotion regulation during evaluated speaking tasks: Associations with negative
Disorders, 37, 321−329. affect, anxiety expression, memory, and physiological responding. Emotion, 6,
⁎Calmes, C. A., & Roberts, J. E. (2007). Repetitive thought and emotional distress: 356−366.
Rumination and worry as prospective predictors of depressive and anxious Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety
symptomatology. Cognitive Therapy and Research, 31, 343−356. disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-
Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into based behavior change strategies. Oakland, CA, US: New Harbinger Publications.
conceptualizations and treatments of anxiety and mood disorders. In J. J. Gross Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (in press). Emotion-related regulation and
(Ed.), Handbook of emotion regulation (pp. 542−559). New York: Guilford Press. its relation to children's maladjustment. Annual Review of Clinical Psychology.
Campos, J. J., Frankel, C. B., & Camras, L. (2004). On the nature of emotion regulation. ⁎Engler, P. A., Crowther, J. H., Dalton, G., & Sanftner, J. L. (2006). Predicting eating
Child Development, 75, 377−394. disorder group membership: An examination and extension of the sociocultural
Carver, D. S., Johnson, S. L., & Joormann, J. (2008). Serotonergic function, two-mode model. Behavior Therapy, 37, 69−79.
modes of self-regulation, and vulnerability to depression: What depression has in ⁎Erskine, J. A. K., Kvavilashvili, L., & Kornbrot, D. E. (2007). The predictors of thought
common with impulsive aggression. Psychological Bulletin, 134, 912−943. suppression in young and old adults: Effects of rumination, anxiety, and other
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A variables. Personality and Individual Differences, 42, 1047−1057.
theoretically based approach. Journal of Personality and Social Psychology, 56, 267−283. Fairburn, C. G., Norman, P. A., Welch, S. L., O'Connor, M. R., Doll, H. A., & Peveler, R. C. (1995).
Chang, E. C., Downey, C. A., & Salata, J. L. (2004). Social problem solving and positive A prospective study of outcome in bulimia nervosa and the long-term effects of three
psychological functioning: Looking at the positive side of problem solving. In E. C. psychological treatments. Archives of General Psychiatry, 52, 304−312.
Chang, T. J. D'Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, Feldner, M. T., Zvolensky, M. J., Eifert, G. H., & Spira, A. P. (2003). Emotional avoidance:
and training (pp. 99−116). Washington, DC: American Psychological Association An experiential test of individual differences and response suppression using a
Press. biological challenge. Behaviour Research and Therapy, 41, 403−411.
⁎Felsten, G. (1998). Gender and coping: Use of distinct strategies and associations with Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL:
stress and depression. Anxiety, Stress, and Coping, 11, 289−309. Academic Press.
Field, A. P. (2003). The problems in using fixed-effects models of meta analysis on real- Hedges, L. V., & Vevea, J. L. (1998). Fixed- and random-effects models in meta-analysis.
world data. Understanding Statistics, 2, 77−96. Psychological Methods, 3, 486−504.
⁎Flett, G. L., Hewitt, P. L., Blankstein, K. R., Solnik, M., & Van Brunschot, M. (1996). Heffner, M., Eifert, G. H., Parker, B. T., Hernandez, D. H., & Sperry, J. A. (2003). Valued
Perfectionism, social problem-solving ability, and psychological distress. Journal of directions: Acceptance and commitment therapy in the treatment of alcohol
Rational-Emotive & Cognitive-Behavior Therapy, 14, 245−274. dependence. Cognitive and Behavioral Practice, 10, 378−383.
⁎Flett, G. L., Madorsky, D., Hewitt, P. L., & Heisel, M. J. (2002). Perfectionism cognitions, Heppner, P. P., & Petersosn, C. H. (1982). The development and implications of a
rumination, and psychological distress. Journal of Rational-Emotive & Cognitive- personal problem solving inventory. Journal of Counseling Psychology, 29, 66−75.
Behavior Therapy, 20, 33−47. ⁎Hewitt, P. L., Caelian, C. F., Flett, G. L., Sherry, S. B., Collins, L., & Flynn, C. A. (2002).
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective Perfectionism in children: Associations with depression, anxiety, and anger. Personality
information. Psychological Bulletin, 99, 20−35. and Individual Differences, 32, 1049−1061.
Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based
sample. Journal of Health and Social Behavior, 21, 219−239. therapy: New wave or old hat? Clinical Psychology Review, 28, 1−16.
Folkman, S., & Lazarus, R. S. (1986). Stress processes and depressive symptomatology. ⁎Holahan, C. J., Moos, R. S., Holahan, C. K., Brennan, P. L., & Schutte, K. K. (2005). Stress
Journal of Abnormal Psychology, 95, 107−113. generation, avoidance coping, and depressive symptoms: A 10-year model. Journal
Fox, H. C., Axelrod, S. R., Paliwal, P., Sleeper, J., & Sinha, R. (2007). Difficulties in emotion of Consulting and Clinical Psychology, 73, 658−666.
regulation and impulse control during cocaine abstinence. Drug and Alcohol ⁎Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and
Dependence, 89, 298−301. depressive symptoms and coping behaviors. Behavior Research and Therapy, 45,
⁎Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., et al. 277−290.
(2007). Initial properties of the experiences questionnaire: Validation of a self-report Hunter, J. E., & Schmidt, F. L. (1990). Methods of meta-analysis: Correcting error and bias
measure of decentering. Behavior Therapy, 38, 234−246. in research findings. Newbury Park, CA: Sage.
⁎Geller, J., Cockell, S. J., Hewitt, P. L., Goldner, E. M., & Flett, G. L. (2000). Inhibited John, O. O., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality
expression of negative emotions and interpersonal orientation in anorexia nervosa. processes, individual differences, and life span development. Journal of Personality,
International Journal of Eating Disorders, 28, 8−19. 72, 1301−1334.
⁎Gerard, J. M., & Buehler, C. (2004). Cumulative environmental risk and youth Johnson, S. L. (2005). Mania and dysregulation in goal pursuit: A review. Clinical
maladjustment: The role of youth attributes. Child Development, 75, 1832−1849. Psychology Review, 25, 241−262.
⁎Goldman, L., & Haaga, D. A. F. (1996). Depression and the experience and expression of ⁎Joormann, J., & Gotlib, I. H. (2008). Updating the contents of working memory in
anger in marital and other relationships. Journal of Nervous and Mental Disease, 183, depression: Interference from irrelevant negative material. Journal of Abnormal
505−509. Psychology, 117, 182−192.
⁎Goldstein, B. I. (2006). Why do women get depressed and men get drunk? An ⁎Joormann, J., Dkane, M., & Gotlib, I. H. (2006). Adaptive and maladaptive components
examination of attributional style and coping style in response to negative life of rumination? Diagnostic specificity and relation to depressive biases. Behavior
events among Canadian young adults. Sex Roles, 54, 27−37. Therapy, 37, 269−280.
⁎Good, G. E., Heppner, P. P., Debord, K. A, & Fischer, A. R. (2004). Understanding men's Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to
psychological distress: Contributions of problem-solving appraisal and masculine face stress, pain, and illness. New York: Delacorte.
role conflict. Psychology of Men & Masculinity, 5, 168−177. Kane, T. A., Loxton, N. J., Staiger, P. K., & Dawe, S. (2004). Does the tendency to act
⁎Grabe, S., Hyde, J. S., & Lindberg, S. M. (2007). Body objectification and depression in impulsively underlie binge eating and alcohol use problems? An empirical
adolescents: The role of gender, shame, and rumination. Psychology of Women investigation. Personality and Individual Differences, 36, 83−94.
Quarterly, 31, 164−175. ⁎Kant, G. L., D'Zurilla, T. J., & Maydeu-Olivares, A. (1997). Social problem solving as a
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation mediator of stress-related depression and anxiety in middle-aged and elderly
and dysregulation: Development, factor structure, and initial validation of the community residents. Cognitive Therapy and Research, 21, 73−96.
difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral ⁎Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential
Assessment, 26, 41−54. avoidance as a generalized psychological vulnerability: Comparisons with
Gratz, K. L., Rosenthal, M. A., Tull, M. T., & Lejuez, C. W. (2006). An experimental coping and emotion regulation strategies. Behaviour Research and Therapy, 44,
investigation of emotion dysregulation in borderline personality disorder. Journal 1301−1320.
of Abnormal Psychology, 115, 850−855. ⁎Kashdan, T. B., & Breen, W. E. (2007). Materialism and diminished well-being:
Greenberg, L. S. (2002). Emotion-focused therapy: Coaching clients to work through their Experiential avoidance as a mediating mechanism. Journal of Social and Clinical
feelings. Washington, D.C.: APA. Psychology, 26, 521−539.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. ⁎Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: A
Review of General Psychology, 2, 271−299. prospective examination of a self-regulatory model with tendencies to suppress or
⁎Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation express emotions as a moderating variable. Behavior Therapy, 39, 1−12.
processes: Implications for affect, relationships, and well-being. Journal of ⁎Kashdan, T. B., Zvolensky, M. S., & McLeish, A. C. (2008). Anxiety sensitivity and affect
Personality and Social Psychology, 85, 348−362. regulatory strategies: Individual and interactive risk factors for anxiety-related
Gross, J. J., & Munoz, R. F. (1995). Emotion regulation and mental health. Clinical symptoms. Journal of Anxiety Disorders, 22, 429−440.
Psychology: Science and Practice, 2, 151−164. Kline, R. B. (1998). Principles and practice of structural equation modeling. New York:
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Guilford Press.
Gross (Ed.), Handbook of emotion regulation New York: Guilford Press. ⁎Knowles, R., Tai, S., Christensen, I., & Bentall, R. (2005). Coping with depression and
⁎Haaga, D. A. F., Fine, J. A., Terrill, D. R., Stewart, B. L., & Beck, A. T. (1995). Social vulnerability to mania: A factor analysis of the Nolen-Hoeksema (1991) Response
problem-solving deficits, dependency, and depressive symptoms. Cognitive Therapy Styles Questionnaire. British Journal of Clinical Psychology, 44, 99−112.
and Research, 19, 147−158. ⁎Kocovski, N. L., Endler, N. S., Rector, N. A., & Flett, G. L. (2005). Ruminative coping and
Hagedoorn, M., Sanderman, R., Bolks, H. N., Tuinstra, J., & Coyne, J. C. (2008). Distress in post-event processing in social anxiety. Behaviour Research and Therapy, 43,
couples coping with cancer: A meta-analysis and critical review of role and gender 971−984.
effects. Psychological Bulletin, 134, 1−30. ⁎Koff, E., & Sangani, P. (1997). Effects of coping style and negative body image on eating
⁎Hankin, B. L., Fraley, R. C., & Abela, J. R. (2005). Daily depression and cognitions about disturbance. International Journal of Eating Disorders, 22, 51−56.
stress: Evidence for a trait like depressogenic cognitive style and the prediction of ⁎Kopper, B. A., & Epperson, D. L. (1996). The experience and expression of anger:
depressive symptoms in a prospective daily diary study. Journal of Personality and Relationships with gender, gender role socialization, depression, and mental health
Social Psychology, 88, 673−685. functioning. Journal of Counseling Psychology, 43, 158−165.
⁎Hankin, B. L., Lakdawalla, Z., Carter, I. L., Abela, J. R. Z., & Adams, P. (2007). Are Koster, E. H. W., Soetens, B., Braet, C., & De Raedt, R. (2008). How to control a white
neuroticism, cognitive vulnerabilities and self-esteem overlapping or distinct risks bear? Individual differences involved in self-perceived and actual thought
for depression? Evidence from exploratory and confirmatory factor analyses. suppression ability. Cognition and Emotion, 22, 1068−1080.
Journal of Social and Clinical Psychology, 26, 29−63. ⁎Krause, E. D., Mendelson, T., & Lynch, T. R. (2003). Childhood emotional invalidation
⁎Harrington, J. A., & Blankenship, V. (2002). Ruminative thoughts and their relation to and adult psychological distress: The mediating role of emotional inhibition. Child
depression and anxiety. Journal of Applied Social Psychology, 32, 465−485. Abuse & Neglect, 27, 199−213.
⁎Harris, P. W., Pepper, C. M., & Maack, D. J. (2008). The relationship between Kring, A. M., & Bachorowski, J. A. (1999). Emotions and psychopathology. Cognition and
maladaptive perfectionism and depressive symptoms: The mediating role of Emotion, 13, 575−599.
rumination. Personality and Individual Differences, 44, 150−160. Kristeller, J. L, Baer, R. A, & Quillian-Wolever, R. (2006). Mindfulness-based approaches
⁎Haugh, J. A. (2006). Specificity and social problem-solving: Relation to depressive to eating disorders. In R. A Baer (Ed.), Mindfulness-based treatment approaches:
and anxious symptomatology. Journal of Social and Clinical Psychology, 25, Clinician's guide to evidence base and applications (pp. 75−91). San Diego, CA:
392−403. Elsevier Academic Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: Kurtz, M. M., & Mueser, K. T. (2008). A meta-analysis of controlled research on social
An experiential approach to behavior change. New York: Guilford Press. skills training for schizophrenia. Journal of Consulting and Clinical Psychology, 76,
⁎Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. 491−504.
(2004). Measuring experiential avoidance: A preliminary test of a working model. ⁎Kuyken, W., & Brewin, C. R. (1994). Stress and coping in depressed women. Cognitive
The Psychological Record, 54, 553−578. Therapy and Research, 18, 403−412.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self- ⁎Kuyken, W., Watkins, E., Holden, E, & Cook, W. (2006). Rumination in adolescents at
awareness. Psychological Bulletin, 110, 86−108. risk for depression. Journal of Affective Disorders, 96, 39−47.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for ⁎Moulds, M. L., Kandris, E., Starr, S., & Wong, A. C. M. (2007). The relationship between
categorical data. Biometrics, 33, 159−174. rumination, avoidance and depression in a non-clinical sample. Behaviour Research
⁎Lau, M. A., Christensen, B. K., Hawley, L. L., Gemar, M. S., & Segal, Z. V. (2007). and Therapy, 45, 251−261.
Inhibitory deficits for negative information in persons with major depressive ⁎Moulds, M. L., Kandris, E., & Williams, A. D. (2007). The impact of rumination on
disorder. Psychological Medicine, 37, 1249−1259. memory for self-referent material. Memory, 15, 814−821.
Lau, J., Ioannidis, J. P. A., Terrin, N., Schmidt, C. H., & Olkin, I. (2006). The case of the Mowrer, O. H. (1947). On the dual nature of learning: A re-interpretation of
misleading funnel plot. British Medical Journal, 333, 597−600. “conditioning” and “problem-solving”. Harvard Educational Review, 17, 102−148.
Linehan, M. M. (1993). Cognitive-behavioral treatment for borderline personality disorder. ⁎Nezu, A. M. (1986). Cognitive appraisal of problem solving effectiveness: Relation to
New York: Guilford Press. depression and depressive symptoms. Journal of Clinical Psychology, 42, 42−48.
Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., et al. ⁎Nezu, A. M., Nezu, C. M., Saraydarian, L., Kalmar, K., & Ronan, G. F. (1986). Social
(2002). Dialectical behavior therapy versus comprehensive validation therapy plus problem solving as a moderating variable between negative life stress and
12-step for the treatment of opioid dependent women meeting criteria for borderline depressive symptoms. Cognitive Therapy and Research, 10, 489−498.
personality disorder. Drug and Alcohol Dependence, 67, 13−26. ⁎Nezu, A. M., & Ronan, G. F. (1988). Social problem solving as a moderator of stress-
Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage. related depressive symptoms: A prospective analysis. Journal of Counseling
Lissek, S., Rabin, S. J., McDowell, D. J., Dvir, S., Bradford, D. E., Geraci, M., et al. (2009). Psychology, 35, 134−138.
Impaired discriminative fear-conditioning resulting from elevated fear responding Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration
to learned safety cues among individuals with panic disorder. Behaviour Research of depressive episodes. Journal of Abnormal Psychology, 100, 569−582.
and Therapy, 47, 111−118. ⁎Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed
Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L. (2008). Emotion regulation in anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504−511.
unipolar depression: The effects of acceptance and suppression of subjective ⁎Nolen-Hoeksema, S., & Harrell, Z. A. (2002). Rumination, depression, and alcohol use:
emotional experience on the intensity and duration of sadness and negative affect. Tests of gender differences. Journal of Cognitive Psychotherapy: An International
Behaviour Research and Therapy, 46, 1201−1209. Quarterly, 16, 391−403.
⁎Londahl, E. A., Tverskoy, A., & D'Zurilla, T. J. (2005). The relations of internalizing Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference
symptoms to conflict and interpersonal problem solving in close relationships. in depressive symptoms. Journal of Personality and Social Psychology, 77,
Cognitive Therapy and Research, 29, 445−462. 1061−1072.
Loxton, N. J., & Dawe, S. (2001). Alcohol abuse and dysfunctional eating in adolescent ⁎Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations
girls: The influence of individual differences in sensitivity to reward and between rumination and bulimic, substance abuse, and depressive symptoms in
punishment. International Journal of Eating Disorders, 29, 455−462. female adolescents. Journal of Abnormal Psychology, 116, 198−207.
Loxton, N. J., & Dawe, S. (2007). How do dysfunctional eating and hazardous drinking Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
women perform on behavioral measures of reward and punishment sensitivity? Perspectives on Psychological Science, 3, 400−424.
Personality and Individual Differences, 42, 1163−1172. ⁎O'Connor, D. B., O'Connor, R. C., & Marshall, R. (2007). Perfectionism and psychological
⁎Luck, A., Waller, G., Meyer, C., Ussher, M., & Lacey, H. (2006). The role of schema distress: Evidence of the mediating effects of rumination. European Journal of
processes in the eating disorders. Cognitive Therapy and Research, 29, 717−732. Personality, 21, 429−452.
⁎Luxton, D. D., & Wenzlaff, R. M. (2005). Self-esteem uncertainty and depression Orwin, R. G. (1983). A fail-safe N for effect size. Journal of Educational Statistics, 8,
vulnerability. Cognition and Emotion, 19, 611−622. 147−159.
⁎Luxton, D. D., Ingram, R. E., & Wenzlaff, R. M. (2006). Uncertain self-esteem and future ⁎Papadakis, A. A., Prince, R. P., Jones, N. P., & Strauman, T. J. (2006). Self-regulation,
thinking in depression vulnerability. Journal of Social and Clinical Psychology, 25, rumination, and vulnerability to depression in adolescent girls. Development and
840−854. Psychopathology, 18, 815−829.
Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical behavior therapy Papadatou-Pastou, M., Martin, M., Munafo, M. R., & Jones, G. V. (2008). Sex differences
for borderline personality disorder. Annual Review of Clinical Psychology, 3, 181−205. in left-handedness: A meta-analysis of 144 studies. Psychological Bulletin, 134,
Macht, M., Haput, C., & Ellgring, H. (2005). The perceived function of eating is changed 677−699.
during examination stress: A field study. Eating Behaviors, 6, 109−112. Papageorgiou, C., & Wells, A. (2003). An empirical test of a clinical metacognitive model
⁎Maltby, J., & Day, L. (2000). Depressive symptoms and religious orientation: Examining of rumination and depression. Cognitive Therapy and Research, 27, 261−273.
the relationship between religiosity and depression within the context of other Pardo, Y., Aguilar, R., Molinuevo, B., & Torrubia, R. (2007). Alcohol use as a behavioral
correlates of depression. Personality and Individual Differences, 28, 383−393. sign of disinhibition: Evidence from J. A. Gray's model of personality. Addictive
Marlatt, G. A., Baer, J. S., Donovan, D. M., & Kivlahan, D. R. (1988). Addictive behaviors: Behaviors, 32, 2398−2403.
Etiology and treatment. Annual Review of Psychology, 39, 223−252. ⁎Paxton, S. J., & Diggens, J. (1997). Avoidance coping, binge eating, and depression: An
Marlatt, G. A., Witkiewitz, K., Dillworth, T. M., Bowen, S. W., Parks, G. A, Macpherson, L. M., examination of the escape theory of binge eating. International Journal of Eating
Lonczak, H. S., Larimer, M. E., Simpson, T., Blume, A. W., & Crutcher, R. (2004). Disorders, 22, 83−87.
Vipassana Meditation as a treatment for alcohol and drug use disorders. In S. C. Hayes, ⁎Peirson, A. R., & Heuchert, J. W. (2001). The relationship between personality and
V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the mood: Comparison of the BDI and the TCI. Personality and Individual Differences, 30,
cognitive-behavioral tradition (pp. 261−287). New York: Guilford Press. 391−399.
⁎Martin, R. C., & Dahlen, E. R. (2005). Cognitive emotion regulation in the prediction of ⁎Perini, S. J., Abbott, M. J., & Rapee, R. M. (2006). Perception of performance as a
depression, anxiety, stress, and anger. Personality and Individual Differences, 39, mediator in the relationship between social anxiety and negative post-event
1249−1260. rumination. Cognitive Therapy and Research, 30, 645−659.
⁎Matheson, K., & Anisman, H. (2003). Systems of coping associated with dysphoria, anxiety ⁎Piran, N., & Cormier, H. C. (2005). The social construction of women and disordered
and depressive illness: A multivariate profile perspective. Stress, 6, 223−234. eating patterns. Journal of Counseling Psychology, 52, 549−558.
⁎Mayhew, R., & Edelmann, R. J. (1989). Self-esteem, irrational beliefs and coping Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-
strategies in relation to eating problems in a non-clinical population. Personality analysis. Psychological Bulletin, 133, 725−746.
and Individual Differences, 10, 581−584. Polivy, J., & Herman, C. P. (1998). Distress and eating: Why do dieters overeat? Inter-
⁎McCabe, R. E., Blankstein, K. R., & Mills, J. S. (1999). Interpersonal sensitivity and social national Journal of Eating Disorders, 26, 153−164.
problem-solving: Relations with academic and social self-esteem, depressive Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of
symptoms, and academic performance. Cognitive Therapy and Research, 23, 587−604. Psychology, 53, 18213.
McCarthy, M. (1990). The thin ideal, depression and eating disorders in women. Be- ⁎Priester, M. J., & Clum, G. A. (1993). Perceived problem-solving ability as a predictor of
haviour Research and Therapy, 28, 205−215. depression, hopelessness, and suicide ideation in a college population. Journal of
McLaughlin, K. A., Mennin, D. S., & Farach, F. J. (2007). The contributory role of worry in Counseling Psychology, 40, 79−85.
emotion generation and dysregulation in generalized anxiety disorder. Behaviour Purdon, C. (1999). Thought suppression and psychopathology. Behaviour Research and
Research and Therapy, 45, 1735−1752. Therapy, 37, 1029−1054.
⁎McLean, C. P., Miller, N. A., & Hope, D. A. (2007). Mediating social anxiety and Rachman, S. (1993). Obsessions, responsibility and guilt. Behaviour Research and
disordered eating: The role of expressive suppression. Eating Disorders, 15, 41−54. Therapy, 31, 149−154.
Mennin, D. S., & Farach, F. J. (2007). Emotion and evolving treatments for adult Rassin, E., Merckelbach, H., & Muris, P. (2000). Paradoxical and less paradoxical effects
psychopathology. Clinical Psychology: Science and Practice, 14, 329−352. of thought suppression: A critical review. Clinical Psychology Review, 20, 978−995.
Mennin, D. S., & Fresco, D. M. (2009). Emotion regulation as a framework for ⁎Rimes, K. A., & Watkins, E. (2005). The effects of self-focused rumination on global
understanding and treating anxiety pathology. In A. M. Kring, & D. M. Sloan (Eds.), negative self-judgments in depression. Behavior Research and Therapy, 43,
Emotion regulation in psychopathology New York: Guilford Press. 1673−1681.
Mennin, D. S., Holoway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). ⁎Riso, L. P., du Toit, P. L., Blandino, A., Penna, S., Dacey, S., Duin, J. S., et al. (2003). Cognitive
Delineating components of emotion and its dysregulation in anxiety and mood aspects of chronic depression. Journal of Abnormal Psychology, 112, 72−80.
psychopathology. Behavior Therapy, 38, 284−302. ⁎Roberts, J. E., Gilboa, E., & Gotlib, I. H. (1998). Ruminative response style and
Merckelbach, H., de Jong, P. J., Muris, P., & van den Hout, M. A. (1996). The etiology of vulnerability to episodes of dysphoria: Gender, neuroticism, and episode duration.
specific phobias: A review. Clinical Psychology Review, 16, 337−361. Cognitive Therapy and Research, 22, 401−423.
⁎Milligan, R. -J., & Waller, G. (2000). Anger and bulimic psychopathology among Robinson, M. D., & Clore, G. L. (2002). Episodic and semantic knowledge in emotional
nonclinical women. International Journal of Eating Disorders, 28, 446−450. self report: Evidence for two judgment processes. Journal of Personality and Social
Moos, R. H. (1993). Coping Responses Inventory: Adult form manual. Odessa, FL: Psychology, 83, 198−215.
Psychological Assessment Resources. Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based
Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta- behavior therapy for generalized anxiety disorder: Evaluation in a randomized
analysis. Psychological Bulletin, 128, 638−662. control trial. Journal of Counseling and Clinical Psychology, 76, 1083−1089.
Rosenthal, R. (1979). The “file drawer problem" and tolerance for null results. Psy- Tice, D. M., Bratslavsky, E., & Baumeister, R. F. (2001). Emotional distress regulation
chological Bulletin, 86, 638−641. takes precedence over impulse control: If you feel bad, do it! Journal of Personality
Rosenthal, R., & DiMatteo, M. R. (2001). Meta-analysis: Recent developments and Social Psychology, 80, 53−67.
in quantitative methods for literature reviews. Annual Review of Psychology, 52, Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor
59−82. model of personality: Distinguishing rumination from reflection. Journal of
Rothstein, H. R. (2007). Publication bias as a threat to the validity of meta-analytic Personality and Social Psychology, 76, 284−304.
results. Journal of Experimental Criminology, 4(61), 81. Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A
Rottenberg, J., & Gross, J. J. (2003). When emotion goes wrong: Realizing the promise of psychometric analysis. Cognitive Therapy and Research, 27, 248−259.
affective science. Clinical Psychology Science and Practice, 10, 227−232. ⁎Tull, M. T., & Gratz, K. L. (2008). Further examination of the relationship between
Rottenberg, J., Gross, J. J., & Gotlib, I. H. (2005). Emotion context insensitivity in major anxiety sensitivity and depression: The mediating role of experiential avoidance
depressive disorder. Journal of Abnormal Psychology, 114, 627−639. and difficulties engaging in goal-directed behavior when distressed. Journal of
⁎Rude, S. S. (2007). Paying attention to distress: What's wrong with rumination? Anxiety Disorders, 22, 199−210.
Cognition and Emotion, 21, 843−864. Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the
⁎Rude, S. S., Wenzlaff, R. M., Gibbs, B., Vane, J., & Whitney, T. (2002). Negative experience of uncued panic attacks: Evidence of experiential avoidance, emotional
processing biases predict subsequent depressive symptoms. Cognition and Emotion, nonacceptance, and decreased emotional clarity. Behavior Therapy, 38, 378−391.
16, 423−440. Tull, M. T., Schulzinger, D., Schmidt, N. B., Zvolensky, M. J., & Lejeuz, C. W. (2007).
⁎Rudolph, K. D., Hammen, C., & Burge, D. (1994). Interpersonal functioning and Development and initial examination of a brief intervention for heightened anxiety
depressive symptoms in childhood: Addressing the issue of specificity and sensitivity among heroin users. Behavior Modification, 31, 220−242.
comorbidity. Journal of Abnormal Child Psychology, 22, 355−371. VanBoven, A. M., & Espelage, D. L. (2006). Depressive symptoms, coping strategies, and
⁎Rudolph, S. G., Flett, G. L., & Hewitt, P. L. (2007). Perfectionism and deficits in cognitive disordered eating among college women. Journal of Counseling and Development,
emotion regulation. Journal of Rational-Emotive & Cognitive Behavioral Therapy, 25, 84, 341−348.
343−357. ⁎Verhaeghen, P., Joormann, J., & Khan, R. (2005). Why we sing the blues: The relation
Salkovskis, P. M. (1998). Psychological approaches to the understanding of obsessional between self-reflective rumination, mood, and creativity. Emotion, 5, 226−232.
problems. In R. Swinson (Ed.), Obsessive–compulsive disorder: Theory, research and ⁎Vickers, K. S., & Vogeltanz-Holm, N. D. (2003). The effects of rumination and
treatment (pp. 33−50). New York: Guilford Press. distraction tasks on psychophysiological responses and mood in dysphoric and
⁎Santanello, A. W., & Gardner, F. L. (2007). The role of experiential avoidance in the nondysphoric individuals. Cognitive Therapy and Research, 27, 331−348.
relationship between maladaptive perfectionism and worry. Cognitive Therapy and ⁎Waller, G., Babbs, M., Milligan, R., Meyer, C., Ohanian, V., & Leung, N. (2003). Anger and
Research, 30, 319−332. core beliefs in the eating disorders. International Journal of Eating Disorders, 34,
⁎Sarin, S., Abela, J., & Auerbach, R. (2005). The response styles theory of depression: A 118−124.
test of specificity and causal mediation. Cognition and Emotion, 19, 751−761. Ward, A., Lyubomirsky, L., Sousa, L., & Nolen-Hoeksema, S. (2003). Can't quite commit:
⁎Schwarze, N. J., Oliver, J. M., & Handal, P. J. (2003). Binge eating as related to negative Rumination and uncertainty. Personality and Social Psychology Bulletin, 29, 96−107.
self-awareness, depression, and avoidance coping in undergraduate. Journal of ⁎Watkins, E. (2004). Appraisals and strategies associated with rumination and worry.
College Student Development, 44, 644−652. Personality and Individual Differences, 37, 679−694.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological
for depression: A new approach to preventing relapse. New York: Guilford Press. Bulletin, 134, 163−206.
⁎Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000). Worry and ⁎Watkins, E., & Baracaia, S. (2002). Rumination and social-problem solving in
rumination: Repetitive thought as a concomitant and predictor of negative mood. depression. Behavior Research and Therapy, 40, 1179−1189.
Cognitive Therapy and Research, 24, 671−688. ⁎Watkins, E., & Brown, R. G. (2002). Rumination and executive function in depression:
Shapiro, S., & Schwartz, G. (1999). Intentional systemic mindfulness: An integrative An experimental study. Journal of Neurology, Neurosurgery and Psychiatry, 72,
model for self-regulation and health. Advances in Mind–Body Medicine, 15, 400−402.
128−134. Watkins, E., Moulds, M., & Mackintosh, B. (2005). Comparisons between rumination
Sher, K. J., & Grekin, E. R. (2007). Alcohol and affect regulation. In J. J. Gross (Ed.), and worry in a non-clinical population. Behaviour Research and Therapy, 43,
Handbook of emotion regulation (pp. 560−580). New York, NY: Guilford Press. 1577−1585.
⁎Siegle, G. J., Moore, P. M., & Thase, M. E. (2004). Rumination: One construct, many Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative
features in healthy individuals, depressed individuals, and individuals with lupus. hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522−536.
Cognitive Therapy and Research, 28, 645−668. Wegner, D. M., Broome, A., & Blumberg, S. J. (1997). Ironic effects of trying to relax
⁎Sigmon, S. T., Pells, J. J., Schartel, J. G., Hermann, B. A., Edenfield, T. M., LaMattina, S. M., under stress. Behaviour Research and Therapy, 35, 11−21.
et al. (2007). Stress reactivity and coping in seasonal and nonseasonal depression. Wegner, D. M., & Erber, R. (1992). The hyperaccessibility of suppressed thoughts.
Behaviour Research and Therapy, 45, 965−975. Journal of Personality and Social Psychology, 63, 903−912.
⁎Soukup, V. M., Beiler, M. E, & Terrell, F. (1990). Stress, cognitive style, and problem Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of
solving ability among eating-disordered inpatients. Journal of Clinical Psychology, thought suppression. Journal of Personality and Social Psychology, 53, 5−13.
46, 392−600. ⁎Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of
⁎Sperberg, E. D., & Stabb, S. D. (1998). Depression in women as related to anger and Personality, 62, 615−640.
mutuality in relationships. Psychology of Women Quarterly, 22, 223−238. ⁎Weinstock, L. M., & Whisman, M. A. (2007). Rumination and excessive reassurance-
Stanton, A. L., Dannof-Burg, S., Cameron, C. L., & Ellis, A. P. (1994). Coping through seeking in depression: A cognitive-interpersonal integration. Cognitive Therapy and
emotional approach: Problems of conceptualization and confounding. Journal of Research, 30, 333−342.
Personality and Social Psychology, 66, 350−362. ⁎Wenzlaff, R. M., & Luxton, D. D. (2003). The role of thought suppression in depressive
Steinberg, L., Dahl, R., Keating, D., Kupfer, D. J., Masten, A. S., & Pine, D. (2006). The study rumination. Cognitive Therapy and Research, 27, 293−308.
of developmental psychopathology in adolescence: Integrating affective neurosci- ⁎Wenzlaff, R. M., Rude, S. S., & West, L. M. (2002). Cognitive vulnerability to depression:
ence with the study of context. In D. Cicchetti, & D. Cohen (Eds.), Developmental The role of thought suppression and attitude certainty. Cognition and Emotion, 16,
psychopathology, Vol. 2: Developmental neuroscience (pp. 710−741). New York: 533−548.
Wiley. Wenzlaff, R. M., & Wegner, D. M. (2000). Thought suppression. Annual Review of
⁎Stewart, S. H., Zvolensky, M. J., & Eifert, G. H. (2002). The relations of anxiety Psychology, 51, 59−91.
sensitivity, experiential avoidance, and alexithymic coping to young adults' Williams, L. E., & Bargh, J. A. (2007). The nonconscious regulation of emotion. In J. J.
motivations for drinking. Behavior Modification, 26, 274−296. Gross (Ed.), Handbook of emotion regulation, (pp. 429−445). New York: Guilford
Stice, E., Barrera Jr, M., & Chassin, L. (1998). Prospective differential prediction of Press.
adolescent alcohol use and problem use: Examining mechanisms of effect. Journal ⁎Wupperman, P., & Neumann, C. S. (2006). Depressive symptoms as a function of sex-
of Abnormal Psychology, 107, 616−628. role, rumination, and neuroticism. Personality and Individual Differences, 40,
Streiner, D. L. (2002). Breaking up is hard to do: The heartbreak of dichotomizing 189−201.
continuous data. Canadian Journal of Psychiatry, 47, 262−266. Zelazo, P. D., & Cunningham, W. A. (2007). Executive function: Mechanisms
Tarbox, S. I., & Pogue-Geile, M. F. (2008). Development of social functioning in underlying emotion regulation. In James J. Gross (Ed.), Handbook of emotion
preschizophrenia children and adolescents: A systematic review. Psychological regulation (pp. 135−158). New York, NY, US: Guilford Press.
Bulletin, 34, 561−583. ⁎Ziegert, D. I., & Kistner, J. A. (2002). Response styles theory: Downward extension to
Thomas, J. J., Vartanian, L. R., & Brownell, K. D. (2009). The relationship between eating children. Journal of Clinical Child and Adolescent Psychology, 31, 325−334.
disorder not otherwise specified (EDNOS) and officially recognized eating Zisserson, R. N., & Palfai, T. P. (2007). Behavioral activation system (BAS) sensitivity and
disorders: Meta-analysis and implications for DSM. Psychological Bulletin, 135, reactivity to alcohol cues among hazardous drinkers. Addictive Behaviors, 32,
407−433. 2178−2186.
Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Mono-
graphs of the Society for Research in Child Development, 59, 25−52.

Aldao, Nolen-Hoeksema, & Schweizer, 2010 PDF

Uploaded by

Copyright:

Available Formats

Aldao, Nolen-Hoeksema, & Schweizer, 2010 PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Aldao, Nolen-Hoeksema, & Schweizer, 2010 PDF

Uploaded by

Copyright:

Available Formats

This article appeared in a journal published by Elsevier.

Clinical Psychology Review 30 (2010) 217–237

Contents lists available at ScienceDirect

Clinical Psychology Review

Emotion-regulation strategies across psychopathology: A meta-analytic review

1. Models of emotion regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

⁎ Corresponding author. Tel.: +1 203 432 0699.

218 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

5.4. Suppression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 219

Author name Sample details/moderators Design Psychopathology measures Emotion-regulation measures

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

(continued on next page)

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

226 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

Fig. 1. Information ﬂow on study selection.

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 227

228 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

Emotion-regulation strategy Mean 95% CI 95% CI p-value k Q-statistics p-value

Acceptance − .19 − .40 .05 ns 7 b.001

3.4.2. Moderator analyses

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 229

Emotion- Psychopathology Mean 95% 95% p-value k Q-statistics

Acceptance Anxiety − .25 − .70 .35 .42 2 b.001

230 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 231

232 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 233

234 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 235

236 A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237

A. Aldao et al. / Clinical Psychology Review 30 (2010) 217–237 237

You might also like