Emotion Regulation
Emotion regulation refers to the processes by which individuals influence which emotions they experience, when they experience them, and how they express them. Difficulty in emotion regulation is a transdiagnostic feature of many mental-health conditions and an important treatment target across modalities.
Overview
Emotion regulation is a foundational psychological construct describing the ways individuals manage their emotional experience. The most influential contemporary framework, developed by James Gross since 1998, identifies a sequence of regulation strategies — situation selection, situation modification, attentional deployment, cognitive change, and response modulation — that operate at different points in the emotional process.
Emotion regulation is not a discrete DSM-5-TR diagnosis. It is a transdiagnostic feature, meaning that difficulties in emotion regulation appear across many psychiatric conditions rather than being specific to one. The DSM-5-TR’s Disruptive Mood Dysregulation Disorder (DMDD) — a childhood diagnosis — is the closest formal recognition of regulation difficulty, but adult emotion regulation problems are addressed within other diagnostic categories or as a clinical focus in their own right.
Difficulty regulating emotions is implicated in borderline personality disorder, post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder, eating disorders, attention-deficit/hyperactivity disorder, substance use disorders, and intermittent explosive disorder, among others. Marsha Linehan’s biosocial theory of borderline personality disorder, which positioned emotion dysregulation as the central feature, helped establish the construct’s clinical importance and led to the development of dialectical behaviour therapy.
Emotion regulation difficulties typically present along two general patterns. Underregulation involves intense, reactive emotional experiences that are difficult to modulate — emotional flooding, rapid escalation, prolonged recovery time. Overregulation involves chronic suppression, avoidance, or numbing — reduced access to emotional experience, alexithymia (difficulty identifying emotions), and somatic expression of unprocessed feelings. Many individuals show both patterns at different times or across different emotion categories.
Emotion regulation is highly responsive to evidence-based treatment. Multiple modalities have demonstrated efficacy, with dialectical behaviour therapy holding the strongest evidence base for severe regulation difficulties.
Signs and symptoms
- Intense emotional reactions — Emotions that emerge quickly, peak high, and feel disproportionate to the triggering situation, often noticeable to others.
- Difficulty calming down — Prolonged time required to return to baseline after an emotional event, with continued physical and cognitive activation hours or days later.
- Avoiding emotional content — Pattern of steering away from situations, conversations, or activities that produce strong feelings, sometimes leading to functional restriction.
- Black-or-white emotional shifts — Rapid transitions between emotional states with little time spent in moderate or transitional zones.
- Substance use to manage emotions — Use of alcohol, cannabis, food, screens, or other substances primarily for emotional self-regulation rather than for the substance's direct effects.
- Emotional numbing — Reduced access to emotional experience, sense of feeling cut off from one's own feelings, or chronic blunted affect.
- Reactivity to perceived rejection — Intense emotional response to actual or perceived disapproval, dismissal, or interpersonal slights, sometimes called rejection sensitivity.
- Difficulty identifying emotions — Limited ability to name what one is feeling beyond global terms ("upset", "off"), often called alexithymia.
- Somatic expression — Physical symptoms — gastrointestinal, headache, muscle tension, fatigue — that track emotional state when the emotion itself is not consciously identified.
Diagnostic context
Emotion regulation difficulty is not a discrete DSM-5-TR diagnosis. It is a transdiagnostic feature assessed within the broader presenting concern.
The most widely used measure is the Difficulties in Emotion Regulation Scale (DERS), a 36-item self-report instrument developed by Gratz and Roemer in 2004. The DERS yields six subscales: nonacceptance of emotional responses, difficulty engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to emotion regulation strategies, and lack of emotional clarity. Other instruments include the Emotion Regulation Questionnaire (ERQ) for measuring specific strategy use and the Toronto Alexithymia Scale (TAS-20) for difficulty identifying emotions.
In clinical practice, emotion regulation is typically assessed alongside the primary diagnostic concern and serves as a treatment target rather than a standalone diagnosis. Treatment selection depends on the broader clinical picture: regulation difficulty in the context of borderline personality disorder is approached differently than regulation difficulty in the context of post-traumatic stress disorder or attention-deficit/hyperactivity disorder.
Causes and risk factors
Emotion regulation capacity develops over the life course through interaction of biology, attachment, and learned patterns.
Biological factors
Temperamental traits — particularly emotional reactivity and recovery time — have a moderate heritable component. Neurobiological research consistently identifies altered prefrontal-limbic connectivity in individuals with emotion regulation difficulties, with reduced top-down regulatory engagement from the prefrontal cortex over amygdala-driven emotional responses. Sleep disruption, hormonal factors, and traumatic brain injury can all affect regulation capacity acutely.
Developmental and attachment factors
Linehan’s biosocial theory emphasizes the role of “invalidating environments” — caregiving contexts where emotional experience is dismissed, punished, or treated as wrong — in producing later regulation difficulty. Children develop emotion regulation through co-regulation with attuned caregivers; when this scaffolding is unavailable or unreliable, the developing nervous system may not learn to modulate its own activation. Insecure attachment, particularly disorganized attachment, is robustly associated with later regulation difficulty.
Trauma
Both single-incident and complex developmental trauma significantly disrupt emotion regulation. The threat-detection systems that drive emotional response can become chronically dysregulated following trauma, producing either persistent over-reactivity, chronic numbing, or oscillation between the two. Complex trauma in childhood, in particular, is associated with severe and persistent regulation difficulty.
modelling and learning
Children learn regulation strategies through observation of caregivers and peers. Patterns including chronic suppression, avoidance, substance use, or explosive expression can be transmitted across generations through modelling. Cultural factors influence which emotional expressions are considered acceptable.
Substance and contextual factors
Alcohol, cannabis, stimulants, and several other substances acutely affect regulation capacity, often used initially as a regulation strategy and later contributing to regulation deterioration. Chronic stress, sleep deprivation, and hostile interpersonal environments degrade baseline regulation.
Typical treatments
Emotion regulation is responsive to several evidence-based therapeutic approaches. Selection depends on the broader clinical context.
Dialectical behaviour therapy (DBT). The strongest evidence base for severe emotion regulation difficulty, originally developed by Marsha Linehan for borderline personality disorder. DBT teaches four skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Standard DBT is delivered in a year-long format combining weekly individual therapy and weekly skills group; briefer DBT-skills-only formats have evidence for less severe regulation difficulty.
Cognitive behavioural therapy (CBT). Standard CBT addresses emotion regulation through cognitive reappraisal training (changing the meaning of emotional triggers) and behavioural strategies. The Affect Regulation Training (ART) protocol developed by Berking integrates emotion regulation skills explicitly into CBT-based treatment.
Acceptance and commitment therapy (ACT). ACT emphasizes acceptance of emotional experience rather than control or suppression, combined with values-based action. Particularly suited to individuals whose regulation difficulty involves chronic experiential avoidance.
Mindfulness-based interventions. Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) develop the capacity to notice emotional experience without immediate reaction, supporting regulation across a range of contexts.
Schema therapy. For regulation difficulties rooted in early developmental patterns, schema therapy targets the maladaptive coping modes (overcompensator, detached protector, vulnerable child) that organize regulatory responses.
Trauma-focused therapy. When emotion regulation difficulty is rooted in trauma history, evidence-based trauma therapies (EMDR, prolonged exposure, cognitive processing therapy, sensorimotor psychotherapy, somatic experiencing) address the underlying threat responses that drive dysregulation. Stabilization-phase work in complex trauma typically focuses on regulation skills before processing trauma content.
Pharmacotherapy. Medications are not specifically indicated for emotion regulation but may be used when comorbid conditions (depression, anxiety, post-traumatic stress disorder) warrant treatment. Mood stabilizers may be considered in specific bipolar-spectrum or severe regulation contexts.
When to seek help
Professional consultation is warranted when emotion regulation difficulties are causing measurable distress, contributing to relationship instability, occupational difficulty, substance use, self-harm, or impulsive behaviour, or when they co-occur with diagnosable conditions that warrant treatment.
Immediate help is indicated when regulation difficulty is accompanied by suicidal ideation, self-injury, acute substance use, or risk of harm to self or others.
In Canada, free 24-hour mental-health support is available through 9-8-8: Suicide Crisis Helpline (call or text 988) and Talk Suicide Canada (1-833-456-4566). A general practitioner is an appropriate first contact and can refer to clinicians with training in DBT, CBT, ACT, or trauma-focused therapy. Many DBT programs maintain dedicated intake processes; provincial colleges of psychology list qualified practitioners.
Frequently asked questions
Is emotion regulation a diagnosis?
What is the difference between emotion regulation and emotional control?
Is dialectical behaviour therapy the only treatment that works?
Can adults learn emotion regulation skills?
Does emotion regulation difficulty mean I have borderline personality disorder?
Why do I feel emotions so intensely?
References
- Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299.
- Linehan, M. M. (1993). Cognitive-behavioural Treatment of Borderline Personality Disorder.
- Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and behavioural Assessment, 26(1), 41-54.
- Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217-237.
- Berking, M., & Whitley, B. (2014). Affect Regulation Training: A Practitioners' Manual.
Find the pattern behind what's been feeling hard
A few simple questions to help surface the concerns that may fit best.
Find Your PatternFind a Therapist by City
Browse therapy availability by city to see local and virtual options, explore services, and connect with a clinician who can serve your area.
Find a Therapist by Province
Browse therapy options by province to see which clinicians are available to work with clients in your region.
Trusted by Leading Psychology & Mental Health Organizations Across Canada
ShiftGrit Psychology & Counselling is professionally regulated, certified, and recognized by leading psychology and mental-health organizations across Canada. These associations reflect our commitment to ethical practice, clinical standards, and evidence-informed therapy through Identity-Level Therapy and Reconditioning.
Trusted By Alberta’s Leading Psychology & Mental Health Organizations
ShiftGrit Psychology & Counselling is professionally regulated, certified, and recognized by leading psychology and mental-health organizations across Alberta and Canada. These associations reflect our commitment to ethical practice, clinical standards, and evidence-informed therapy through Identity-Level Therapy and Reconditioning.
Regulated and affiliated across Alberta’s leading psychology, counselling, and mental-health organizations.
Regulated and affiliated across Canada’s leading psychology, counselling, and mental-health organizations.
