Emotion regulation in patients with somatic symptom and related disorders: A systematic review

BACKGROUND: Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. OBJECTIVES: This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. DATA SOURCES: PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. SEARCH TERMS: “emotion/al regulation” or “affect regulation” and various forms of SSD. STUDY ELIGIBILITY CRITERIA: Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. STUDY SYNTHESIS METHODS: A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). RESULTS: The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. LIMITATIONS: There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. CONCLUSIONS AND IMPLICATIONS: Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.