Emotional Regulation and Depression: A Potential Mediator between Heart and Mind

Abstract

A narrative review of the major evidence concerning the relationship between emotional regulation and depression was conducted. The literature demonstrates a mediating role of emotional regulation in the development of depression and physical illness. Literature suggests in fact that the employment of adaptive emotional regulation strategies (e.g., reappraisal) causes a reduction of stress-elicited emotions leading to physical disorders. Conversely, dysfunctional emotional regulation strategies and, in particular, rumination and emotion suppression appear to be influential in the pathogenesis of depression and physiological disease. More specifically, the evidence suggests that depression and rumination affect both cognitive (e.g., impaired ability to process negative information) and neurobiological mechanisms (e.g., hypothalamic pituitary adrenal axis overactivation and higher rates of cortisol production). Understanding the factors that govern the variety of health outcomes that different people experience following exposure to stress has important implications for the development of effective emotion-regulation interventional approaches (e.g., mindfulness-based therapy, emotion-focused therapy, and emotion regulation therapy).

Figure 1

The mediating role of emotional regulation in the relationship between stress and emotions.

Figure 2

Functioning aspects involved in cognitive emotion regulation.

Figure 3

Amygdala-frontal circuit of emotion regulation. Prefrontal cortex seems to be involved in the modulation of the amygdala reactivity, a critical structure for the generation of negative emotions. During reappraisal, enhanced activation in medial prefrontal cortex (MPFC) is associated with attenuation of amygdala activation and with a reduction of negative affect intensity. Orbitofrontal cortex (OFC) coordinates the interactions between these areas.