The empirical status of implicit emotion regulation in mood and anxiety disorders: a meta-analytic review

Strategies to successfully regulate negative emotions may be hindered by maladaptive implicit emotion processing tendencies. And while implicit emotion regulation is known to be impaired in many psychiatric disorders, contradictory findings exist within the empirical literature. Therefore, a meta-analysis of implicit emotion regulation in mood and anxiety disorders (major depressive disorder [MDD], bipolar disorder, generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder and post-traumatic stress disorder [PTSD]) was performed.

Systematic literature searches were conducted in Web of Science, PubMed/MEDLINE, Scopus, and Brain Map for articles published between 2011 and 2024, and inclusion criteria included internationally recognised diagnostic measures (i.e., DSM-5). A total of 23 clinical studies were identified, and using the Newcastle-Ottawa Scale, 21 studies were of excellent quality. Small to medium effect sizes were reported in patients across measures of accuracy (patients [n = 428] vs. controls [n = 412], standardised mean difference [SMD] -0.39, 95% CI [−0.57 to −0.21], p < .0001) and response latency (patients [n = 477] vs. controls [n = 428], SMD 0.38, 95% CI [0.22 to 0.54], p < .0001). 

The pooled effects of reduced accuracy and longer reaction times in patients were confirmed by separate sub-group analyses for mood and anxiety disorders, with MDD and PTSD reporting the largest effects. Regarding publication bias, Egger's regression test did not indicate funnel plot asymmetry.

Recommendations for future research include investigation of dysfunctional implicit emotion regulation as a transdiagnostic characteristic of psychiatric disorders within the Research Domain Criteria (RDoC) framework.