Emotion Regulation in Bipolar Disorder: A Meta-Analytic Review

Bipolar disorder (BD) is a serious mental illness characterized by dramatically differing mood states and marked costs for the individual and society, making it important to find factors associated with the condition. Deficits in emotion regulation have been found across a wide range of mental health disorders and may represent an important risk factor for BD. Literature in this area has large methodological inconsistencies and many conclusions are mixed. Therefore, the current study sought to conduct a meta-analytic review of literature related to emotion regulation in BD. Results suggest that people with BD broadly report more frequent use of maladaptive emotion regulation strategies and less frequent use of adaptive emotion regulation strategies than healthy controls. Of these strategies, the largest effect sizes were found for risk-taking, rumination, impulsivity, catastrophizing, and self-blame. Comparisons to other clinical groups suggest that emotion regulation in BD is largely similar to major depressive disorder and less severely impaired than borderline personality disorder. Moderator analyses of BD samples in different mood states suggest mood state plays a limited role in emotion regulation strategy usage, although some maladaptive strategies may be more common in samples with depressive symptoms. Among emotion regulation strategies, increased positive rumination and suppression may be uniquely characteristic of BD. Findings of this review support the importance of targeting emotion regulation in assessment and treatment of BD. Notably, psychotherapeutic interventions focused on emotion regulation, such as cognitive therapies, may be a key factor in reducing BD risk and episode recurrence.