The concept of emotion regulation (ER) is receiving considerable attention in research on psychiatric disorders and their treatment. The popularity of the concept is largely rooted in its premise that deficits in adaptive responses toward undesired affective states contribute to the development and maintenance of most forms of psychopathology.

This appears obvious when considering psychiatric disorders that are primarily defined by an excess of undesired affective states (e.g., anxiety and mood disorders). For these conditions, it follows almost by definition that the perpetuation or escalation of undesired affective states results from the individual's inability to regulate them.

However, given that many behavioral and cognitive symptoms of other psychiatric disorders can also be conceptualized as dysfunctional ER strategies, the scope of this paradigm extends much further. Consider, for example, when avoidance is used to reduce anxiety, when alcohol is consumed to numb loneliness, when binge eating serves to distract from emotional anguish, or when appraising a situation as uncontrollable and hopeless is used to reduce the pressure to solve one's problems or to shield oneself from further disappointment. In all these scenarios, behavioral or cognitive strategies yield short-lived relief from undesired affective states. Since the immediate ameliorating effects of these maladaptive strategies reinforce their usage, individuals tend to progressively increase their adoption until criteria for an anxiety, alcohol use, eating or mood disorder, etc. are met.

Importantly, this trajectory is preventable if the individual realizes the negative mid- and long-term consequences of maladaptive strategies, and pivots to more adaptive ways of coping with undesired affective states. However, any such shift will fail to the extent that the individual lacks effective ER skills. Since all psychiatric disorders are arguably maintained by behaviors and cognitions that initially reduce negative affect, and since a distressed individual is more likely to utilize those strategies in the absence of more adaptive alternatives, it can be hypothesized that all psychiatric disorders are, to a significant degree, perpetuated by insufficient ER skills.

Drawing on this framework, it can be deduced that patients with psychiatric disorders should benefit from treatments that systematically enhance effective ER skills. Evidence-based ER frameworks, such as the Adaptive Coping with Emotions Model¹, posit that such treatments should foster the ability to modify the intensity and duration of undesired affective states, as well as the ability to accept and tolerate such states when modification is not possible.

Additionally, these treatments should foster so-called preparatory ER skills that facilitate the successful utilization of modification- and acceptance-focused ER skills. Examples of such preparatory skills include the ability to become aware of one's feelings, to adequately identify and label one's feelings, and to develop a mental model explaining how one's present feelings are maintained, preferably in a manner that validates and destigmatizes one's experience, while also proposing concrete tools to promote successful change/acceptance.

Finally, it is noteworthy that all adaptive ER strategies reviewed so far may initially increase negative affect^{1, 2}. Thus, treatments focusing on ER should also strengthen self-support skills that enable patients to persistently commit to adaptive strategies, despite their likely initial exacerbation of negative affect.

Regarding empirical evidence for these theoretical premises, salient deficits in ER skills have been reported for various psychiatric disorders³. Moreover, a significant number of longitudinal and experimental studies suggest that this association results from ER deficits impacting mental health, and not (exclusively) vice versa³. Regarding the importance of specific ER skills, substantial evidence supports the efficacy of reappraisal, acceptance, and self-compassion^{4, 5}.

Further studies yield evidence that treatments explicitly focusing on enhancing ER skills (e.g., dialectical behavioral therapy) are effective in treating a wide range of psychiatric disorders. More specific evidence in the literature shows that interventions exclusively focusing on enhancing ER skills (e.g., affect regulation training, emotion regulation therapy) are effective treatments for several disorders^{2, 6}. Finally, significant mediation effects observed across these studies suggest that ER skill improvement is the main driver of symptom severity reduction^{7, 8}.

While these findings are encouraging, ER research in the context of psychopathology remains fraught with several challenges. First of all, conceptual definition of key terms lacks sufficient clarity, beginning with the term emotion, which is ubiquitously used for various affective states even though more specific definitions have been proposed (i.e., emotion refers to a rather short-lived experience that has an identifiable trigger; mood is comparably more protracted, often with a vague trigger; stress is an unspecific response to threats thwarting attainment of one's goals; urges are motivational impulses; feelings are the subjective experience of affective states; and affect is an umbrella term for all of the above).

Further ambiguity plagues the term regulation, which implies that actions must be undertaken to change an affective state. However, in some instances, a conscious decision not to regulate an emotion, but rather simply observe it and allow it to run its course, could be the most adaptive response. Thus, terms such as adaptive/maladaptive response toward an undesired affective state could represent useful alternatives to regulation when conceptual clarity is deemed crucial.

Another challenge arises when researchers try to identify the most effective ER strategies. Obviously, there is no silver bullet for successfully regulating all undesired affective states under all circumstances. The number of variables moderating the efficacy of a particular ER strategy in a specific situation is too large to allow for a systematic comparison of the efficacy of multiple ER strategies for all possible constellations of potential moderators. Nevertheless, research should develop and validate rules of thumb that take significant moderators into account (e.g., “use acceptance if your chances of modifying the emotion are slim”, or “use exposure to cope with fear, but distraction to cope with anger”).

A related challenge results from the likelihood that combinations of ER strategies are more effective than any single ER strategy. For example, it has been shown that encouraging patients to practice self-compassion prior to engaging in reappraisal augments the potency of the latter⁹. Thus, future studies should elucidate effective combinations of ER strategies.

Moreover, it is evident that present research tends to focus on comparatively broad skill categories. For instance, many studies demonstrate the efficacy of the general ER skill represented by reappraisal. However, there are many ways by which an individual can reappraise a salient problem, and these different approaches may differ significantly in their effects on undesired emotions. Thus, future research should also compare the efficacy of different ways of applying ER strategies from the same ER skill domain.

Regarding intervention studies, treatments focusing exclusively on ER skill enhancement have previously only been evaluated for a relatively limited set of mental disorders. Thus, future research should evaluate the efficacy of such ER-focused interventions for a broader range of psychiatric conditions. Since, according to preliminary evidence, ER interventions may, at best, match the effect sizes of disorder-specific treatments, researchers might choose to prioritize the evaluation of treatment formats that capitalize on the unique practical and economic advantages of ER-focused treatments – particularly their transdiagnostic applicability.

More specifically, investigators might examine the incremental effects to be achieved when disorder-specific individual therapy is augmented with transdiagnostic group-based interventions focusing exclusively on ER skill promotion. Such combinations would ensure the crucial targeting of disorder-specific maintaining factors, while also exploiting the increased ease of organizing group therapy sessions for diagnostically diverse patients.

情绪调节（ER）的概念在精神疾病及其治疗的研究中受到广泛关注。这一概念的流行很大程度上源于它的前提：对不良情感状态的适应性反应的缺陷有助于大多数形式的精神病理学的发展和维持。

当考虑主要由过度不良情感状态（例如焦虑和情绪障碍）定义的精神疾病时，这一点显得很明显。对于这些情况，几乎从定义上就可以看出，不良情感状态的持续或升级是由于个人无法调节它们造成的。

然而，考虑到其他精神疾病的许多行为和认知症状也可以被概念化为功能失调的 ER 策略，这种范式的范围延伸得更远。例如，考虑一下何时使用回避来减少焦虑，何时通过饮酒来麻木孤独感，何时通过暴饮暴食来分散情绪痛苦，或者何时将情况评估为无法控制和无望来减少解决问题的压力或者保护自己免受进一步的失望。在所有这些情况下，行为或认知策略都能短暂缓解不良情绪状态。由于这些适应不良策略的直接改善效果加强了它们的使用，个人倾向于逐渐增加它们的采用，直到满足焦虑、饮酒、饮食或情绪障碍等标准。

重要的是，如果个人认识到适应不良策略的负面中长期后果，并转向更具适应性的方式来应对不良情感状态，这种轨迹是可以预防的。然而，如果个人缺乏有效的急诊室技能，任何此类转变都会失败。由于所有精神疾病都可以说是通过最初减少负面影响的行为和认知来维持的，并且由于在没有更具适应性的替代方案的情况下，痛苦的个体更有可能利用这些策略，因此可以假设所有精神疾病在很大程度上都是由行为和认知来维持的。学位，但因急诊技能不足而长期存在。

根据这个框架，可以推断，精神疾病患者应该受益于系统性增强有效急诊技能的治疗。基于证据的 ER 框架，例如适应性情绪应对模型¹ ，认为此类治疗应培养改变不良情感状态的强度和持续时间的能力，以及在不改变不良情绪时接受和容忍此类状态的能力。可能的。

此外，这些治疗应培养所谓的准备性 ER 技能，以促进成功利用以修改和接受为中心的 ER 技能。这种准备技能的例子包括意识到自己的感受、充分识别和标记自己的感受的能力，以及开发一种心理模型来解释如何维持当前的感受，最好以验证和消除其经历的方式来维持，同时也提出促进成功变革/接受的具体工具。

最后，值得注意的是，迄今为止审查的所有适应性 ER 策略最初都可能会增加负面影响^{1, 2} 。因此，针对 ER 的治疗还应该加强自我支持技能，使患者能够坚持不懈地采取适应性策略，尽管最初可能会加剧负面影响。

关于这些理论前提的经验证据，据报道，各种精神疾病的急诊技能存在显着缺陷³ 。此外，大量的纵向和实验研究表明，这种关联是由于 ER 缺陷影响心理健康造成的，而不是（完全）反之亦然³ 。关于特定 ER 技能的重要性，大量证据支持重新评估、接受和自我同情的功效^{4, 5} 。

进一步的研究证据表明，明确注重增强 ER 技能的治疗（例如辩证行为疗法）可有效治疗多种精神疾病。文献中更具体的证据表明，专注于增强 ER 技能的干预措施（例如，情感调节训练、情绪调节治疗）是多种疾病的有效治疗方法^{2, 6} 。最后，这些研究中观察到的显着中介效应表明，ER 技能的提高是症状严重程度减轻的主要驱动力^{7, 8} 。

尽管这些发现令人鼓舞，但精神病理学背景下的急诊室研究仍然充满了一些挑战。首先，关键术语的概念定义缺乏足够的清晰度，从术语“情感”开始，尽管已经提出了更具体的定义，但它普遍用于各种情感状态（即，情感是指一种相当短暂的体验，它具有可识别的触发因素；情绪是相对更持久的，通常具有模糊的触发因素；压力是对阻碍实现目标的威胁的非具体反应；冲动是情感状态的主观体验；上述所有的）。

进一步的模糊性困扰着“监管”一词，它意味着必须采取行动来改变情感状态。然而，在某些情况下，有意识地决定不调节情绪，而是简单地观察它并让它自然发展，可能是最具适应性的反应。因此，当概念清晰度被认为至关重要时，诸如对不良情感状态的适应性/适应不良反应之类的术语可以代表监管的有用替代方案。

当研究人员试图确定最有效的急诊策略时，另一个挑战出现了。显然，没有灵丹妙药可以在所有情况下成功调节所有不良情感状态。在特定情况下调节特定 ER 策略功效的变量数量太大，无法系统比较多种 ER 策略对所有可能的潜在调节因素的功效。尽管如此，研究应该制定和验证经验法则，将重要的调节因素考虑在内（例如，“如果改变情绪的机会很小，则使用接受”，或“使用暴露来应对恐惧，但使用分心来应对愤怒”） 。

一个相关的挑战来自于 ER 策略的组合比任何单一 ER 策略更有效的可能性。例如，研究表明，鼓励患者在进行重新评估之前进行自我同情可以增强后者的效力⁹ 。因此，未来的研究应该阐明 ER 策略的有效组合。

此外，很明显，目前的研究倾向于关注相对广泛的技能类别。例如，许多研究证明了以重新评估为代表的一般 ER 技能的有效性。然而，个人可以通过多种方式重新评估突出问题，并且这些不同的方法对不良情绪的影响可能存在显着差异。因此，未来的研究还应该比较同一 ER 技能领域应用 ER 策略的不同方法的有效性。

关于干预研究，以前仅针对相对有限的一组精神障碍评估了专门针对 ER 技能增强的治疗方法。因此，未来的研究应该评估这种以急诊室为重点的干预措施对更广泛的精神疾病的有效性。根据初步证据，由于 ER 干预措施充其量只能与特定疾病治疗的效果大小相匹配，因此研究人员可能会选择优先评估利用以 ER 为中心的治疗的独特实用和经济优势的治疗形式，特别是它们的跨诊断适用性。

更具体地说，研究人员可能会检查当特定疾病的个体治疗与专门关注急诊室技能提升的基于跨诊断小组的干预措施相结合时所要达到的增量效果。这种组合将确保针对疾病特异性维持因子的关键目标，同时还可以更轻松地为诊断多样化的患者组织团体治疗课程。