A review by Anne Ramos Giquel
Introduction
Recently, literature has considerably grown up around the theme of transdiagnostic process as a new approach of psychopathology to better understand psychological disorders. This article written by Barbara Cludius (researcher at the Ludwig Maximilian University of Munich), Thomas Ehring (Professor at the Ludwig Maximilian University of Munich) and Douglas Mennin (Professor at the Columbia University), specialized in emotion regulation process, takes interest in the emotion regulation as a transdiagnostic process by looking for scientific papers sustaining their problematic in the existing literature.
Content of the article
Following the definition of Harvey and al. (2004), the authors describe a transdiagnostic processes as a procedure by which psychological factors can have an important influence on several different disorders, whether by increasing or decreasing their severity or by promoting their outbreak. According to Harvey and al. (2004) two conditions are necessary to be considered as a transdiagnostic process, that is to say are being “present across a range of different disorders” and contribute as a cause to the maintenance and development of these disorders.
Thus, the goal of this study is to evaluate emotion regulation as a potential transdiagnostic process. More precisely, the authors decided to examine the following three existing emotion regulation strategies : cognitive reappraisal (the capacity to reinterpret a situation to modify its emotional impact), negative rumination (the fact of ruminating on negative emotions, their causes, consequences and meanings), and positive rumination (akin to negative rumination albeit for positive emotions). They attempted at establishing if, according to the existing literature, these three strategies meet the necessary conditions to be considered as transdiagnostic processes.
Thereby, the authors noticed that several articles show that cognitive reappraisal is impaired across various disorders, such as depression or generalized anxiety disorder. But also, that a low effect of the disorder on the individual could be observed when this emotion regulation strategy was used. However, for the second criteria, it is difficult to assess with certitude if cognitive reappraisal is a risk or a maintaining factor of these disorders. Indeed, some researchers found that cognitive reappraisal predicted lower psychopathology, as it is shown by Brewer and al. (2016) in their article in which cognitive reappraisal predicted fewer symptoms of anxiety and depression in college students, when others did not, either regarding the disorder or population. Some articles also show that cognitive reappraisal had more of a moderator role regarding the variables reviewed. In the end, this emotion regulation strategy could be considered as a risk factor when reduced for some disorders, such as anxiety and depression, when for other disorders, such as psychosis, it is considered more as an epiphenomenon. Nevertheless, the evidence of a relationship between its effectiveness and psychopathology in literature is still scarcely found.
Regarding rumination, the authors show that depending on the fact, whether rumination is negative or positive, different outcomes are found in literature. For example, positive rumination can be both a protective factor and a maladaptive strategy regarding the disorders (e.g. positive rumination has been found to be positively correlated with symptoms of (hypo)mania in several studies, when in other articles it could almost be considered as an adaptive strategy to cope with negative emotions). However, for the authors the fact that this strategy seems more prominent in one type of disorder (bipolar disorder) compared to other disorders would mean that it would be more of a maladaptive process rather than a transdiagnostic process. Compared to positive rumination, negative rumination may be found in many different disorders (depression, posttraumatic stress disorders, eating disorders, etc.) and has a significant impact/influence in their maintenance and development, that is to say, more likely to be a transdiagnostic process.
Despite their findings, the authors quickly realized the difficulties to conclude since the existing literature is scattered across various outcomes. Indeed, some of the emotion regulation strategies are subject to a consensus, like the negative rumination regarding its presence in several disorders, which mean its thus meets the first criterion of a transdiagnostic process. Whereas positive rumination gives mixed results in the literature regarding the disorders, the population and the limits of each research. The second criterion is even more challenging to meet because it is difficult to confirm with certitude if the emotion regulation strategy used is the cause or the consequence of the disorder. That is why, for the authors, the study is limited by the lack of information on emotion regulation and its strategies, hence the need for more research and models on the subject.
Critical evaluation
In this article, a key aspect of the transdiagnostic process approach is that it meets the limits of the disorder-specific approach which categorizes the psychopathology disorders without taking into account the possible comorbidities, the overlaps of some symptoms or the fact that several risk factors are multifinal and so could thus lead to different disorders. Hence, this new approach is interesting as it does not only consider disorders and their symptomatology but also the different factors which could explain and/or influence them as a process in itself. More precisely, it could help clinicians to target these processes in interventions with the goal to reduce clinical symptomatology. Emotion regulation seems then like an interesting factor to examine as a transdiagnostic process in disorders, because it is a complex process which leads individuals to react to their different emotions and to choose which strategies they can use to deal with them. Therefore, knowing the importance of emotions in a human’s life and their impact, dysregulation, or ubiquity in some disorders, the emotion regulation seems all the more interesting to study.
However, this article also shows the limits of the actual literature and the fact that still little is known about emotion regulation and its process. More exactly, researchers yet cannot find a consensus concerning its definition or the possible strategies which could be used in emotion regulation, and it seems extremely difficult to have a clear view of this process. Thus, as it is explained by the authors, a theoretical refinement and more investigations of emotion regulation across disorders are necessary to understand its process. Furthermore, it seems interesting to propose for future research more longitudinal studies in order to better assess the causality of emotion regulation strategies on disorders. Consequently, the study shows the need for further investigations and the difficulty to answer properly their problematic for now.
Notwithstanding these limitations pointed out by Cludius and al. (2020), one major drawback in the article in itself is the fact that to assess emotion regulation as a transdiagnostic process the authors decided to research only three emotion regulation strategies, while there are many more emotion regulation strategies in literature. Therefore, it seems simplistic to evaluate emotion regulation as a transdiagnostic process based only on three emotion regulation strategies.
Conclusion
Finally, even if the authors were not able to answer with certainty their problematic, they offer a different and interesting point of view on emotion regulation. Personally, I was drawn to this article because of its subject on emotion regulation, which is also the subject of my thesis. Emotion regulation is from my point of view an important factor because emotions can play a fundamental role in an individual’s life and in some disorders, such as excessive sadness in depression ; it seems therefore necessary to be interested in its treatment process and how it can influence the development of some of these disorders. Moreover, as a clinician, this new perspective could be a fulcrum* to help patients and to orient intervention towards better care. It is therefore from my perspective, a process which deserves more investigations.
*fulcrum : un point d’appui
Words I have learned:
- ubiquity : Omniprésence
- the implementation phase : La phase de mise en oeuvre
- beyond the scope of this article : au-delà du champ d’application de cet article
- there is ample evidence : il y a des nombreuses preuves
- too broad : trop large
References:
Brewer, S. K., Zahniser, E., & Conley, C. S. (2016). Longitudinal impacts of emotion regulation on emerging adults : Variable- and person-centered approaches. Journal of Applied Developmental Psychology, 47, 1-12. http://dx.doi.org/10.1016/j.appdev.2016.09.002
Cludius, B., Mennin, D., & Ehring, T. (2020). Emotion regulation as a transdiagnostic process. Emotion, 20(1), 37‑42. https://doi.org/10.1037/emo0000646
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive Behavioural Processes across Psychological Disorders : A transdiagnostic approach to research and treatment. Oxford, New York: Oxford University Press. http://dx.doi.org/10.1093/med:psych/9780198528883.001.0001