Emotion regulation strategies in bipolar disorder: A systematic and critical review

Alyson Dodd, Elizabeth Lockwood, Warren Mansell, Jasper Palmier-Claus

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Theoretical frameworks emphasise associations between interpretations and responses to affect and bipolar disorder (BD). This review (PROSPERO CRD42016043801) investigated which emotion regulation (ER) strategies have been applied to BD, are elevated in BD compared to clinical and non-clinical controls, and are associated with clinical and functional outcomes in BD


Search terms relating to emotion regulation, coping and bipolar disorder were entered into Embase, MedLine and PsycInfo. Quantitative studies investigating relationships between ER strategies and BD were eligible for this narrative synthesis


A large volume of research (n = 47) investigated specific ER strategies in BD. Maladaptive strategies such as rumination and dampening were elevated in BD compared to controls and these particular strategies had a detrimental impact on outcomes such as mood symptoms. BD had a similar profile of ER strategies to unipolar depression, but there was limited comparison to other clinical groups. People with BD did not generally have deficits in using adaptive strategies, as evidenced by comparisons with controls and experimental studies


Methodological heterogeneity and a lack of ecologically valid ER assessments


Empirical literature is critiqued in line with contemporary theories of BD and of emotion regulation more generally, in order to inform future research recommendations. This includes investigation of the importance of context in the impact of ER strategies, and discrepancies between trait and state use of ER strategies, particularly through experience sampling.
Original languageEnglish
Pages (from-to)262-284
JournalJournal of Affective Disorders
Early online date18 Dec 2018
Publication statusPublished - 1 Mar 2019


  • Bipolar disorder
  • Emotion regulation
  • Response styles
  • mania
  • rumination
  • depression


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