Emotion regulation in social anxiety and depression: a systematic review of expressive suppression and cognitive reappraisal

Social anxiety disorder (SAD) and major depressive disorder (MDD) are highly comorbid, and together they
result in greater functional impairment and a poorer prognosis than either condition alone. Theoretical models
implicate impairments in emotion regulation in the development and maintenance of internalizing disorders, yet
there has been no systematic comparison of emotion regulation in social anxiety and depression. The current
review presents an in-depth examination of the literature on two widely-studied emotion regulation strategies,
expressive suppression (ES) and cognitive reappraisal (CR), in SAD and MDD. Our review indicated that SAD
is broadly characterized by an overreliance on ES, which is associated with negative social and emotional
consequences. SAD is also characterized by ineffective utilization of CR, which inhibits the potential positive
emotional benefits of this adaptive emotion regulation strategy. In contrast, MDD is broadly characterized by an
underutilization of CR, which may be particularly detrimental in stressful or uncontrollable situations. For both
SAD and MDD, treatment intervention appears to address deficits in CR but not ES. After reviewing the
literature, we propose multiple pathways by which impairments in ES and CR may increase risk for the cooccurrence
of SAD and MDD. Clinical implications and future research directions are also discussed.