What emotional regulation is and is not, the five families of strategies, how emotion dysregulation shows up across psychiatric conditions, what the latest research says, and practical skills that can be practised daily, with a clear view of their limits.
In this article 14
- "I either feel everything at full volume, or I switch off completely."
- Where we can step in, along the emotion's path
- Six areas that make regulation harder
- A thread through many conditions
- Which skills help, and for whom
- Naming an emotion can calm it
- Temperament, learning and the world around us
- Five steps to steer, not switch off
- Distress tolerance for the hardest moments
- When skills are not enough, get professional help
- Bring this to your next appointment
- Frequently Asked Questions
- References
- About this article
Opening
"I either feel everything at full volume, or I switch off completely."
Sana was twenty-two, a nursing student in Patna. She described her emotions as "a radio that only has two settings": loud, or silent. A bad shift, a sharp word from a senior, or a message she misread could leave her sobbing for hours, then flat and numb the next day. At home she snapped at her younger brother over small things and then felt so guilty that she stayed in her room. When she came to see me, she was not asking for her feelings to disappear. She wanted to be able to feel things and still be herself afterwards.
Composite illustration · for education only · not a real person
Details are blended and altered so that no individual can be identified.
Emotional regulation is the set of processes by which we influence which emotions we have, when we have them, and how we experience and express them. It is not the same as suppressing feelings, and it is not the same as feeling calm all the time. Healthy regulation allows emotions to rise, be understood, and then pass, or be acted on wisely. When this process is strained, emotions can become too intense, too long-lasting, or too difficult to steer. That pattern, called emotion dysregulation, sits at the heart of many psychiatric conditions.
Five families of strategies
Where we can step in, along the emotion's path
James Gross's process model describes emotion as unfolding over time.1 At each point there is a family of strategies that can change its course. Not all are equally helpful, which is the most important practical point.
1Situation selection
Choosing where and with whom you spend time
Evidence: mixed2Situation modification
Changing the situation to reduce its impact
Evidence: generally helpful3Attention deployment
Shifting focus, distraction, grounding
Evidence: helpful short term4Cognitive change
Reappraisal: reinterpreting what it means
Evidence: consistently helpful5Response modulation
Suppressing expressed feeling
Evidence: often costlyThe key distinction
Reappraisal changes the meaning of an event early, so the emotion itself changes. Suppression tries to hide the emotion after it has already risen. Research on expressive suppression links it with higher physiological stress and poorer memory for social interactions, while reappraisal is generally associated with better wellbeing.2
What dysregulation looks like
Six areas that make regulation harder
The Difficulties in Emotion Regulation Scale (DERS), developed by Gratz and Roemer, is one of the most used tools in research.3 It describes emotion regulation through six areas. Most people have difficulty in one or two; when several are strained together, daily life becomes markedly harder.
Non-acceptanceNon-acceptance of emotional responses
Feeling ashamed of them
GoalsDifficulty engaging in goal-directed behaviour
When upset
ImpulseImpulse control difficulties
Acting on feelings before thinking
AwarenessLack of emotional awareness
Noticing feelings late or not at all
StrategiesLimited access to strategies
Feeling there is nothing that helps
ClarityLack of emotional clarity
Not knowing exactly what you feel
Acting on a feeling before thinking is the area most people notice in themselves when anger takes over; our guide to anger management, its signs, triggers and treatment looks at that pattern in detail.
The latest evidence
A thread through many conditions
A 2026 systematic review and multilevel meta-analysis examined 619 studies comparing adults with mental disorders and non-clinical controls on self-reported emotion regulation. It included over 41,000 clinical participants.6 The pattern was consistent: difficulties in regulation were large, and the use of helpful strategies was reduced, while the use of unhelpful strategies was increased. Similar patterns are reported by a 2026 meta-analysis in Translational Psychiatry, which found reduced reappraisal and increased suppression across most psychiatric disorders.5
Rumination, the habit of replaying the same distressing thought, stands out in this research; practical ways to interrupt it are in our guide on how to stop rumination and repetitive thoughts.
Why this matters for treatment
Because the same regulation difficulties appear across diagnoses, transdiagnostic approaches that target regulation may help many people at once. Research also points to disorder-specific profiles, which is why targeted treatment still matters.
What research shows about skills
Which skills help, and for whom
| Approach | What the research suggests | Caution |
|---|---|---|
| Cognitive reappraisal | Consistently linked with better wellbeing and lower distress; trainable in group and individual settings | Not a way to argue yourself out of real pain or injustice |
| Mindfulness-based approaches | A 2024-2026 systematic review found mindfulness programmes improve reappraisal and reduce emotion dysregulation across mental health conditions7 | Effects on suppression were not significant in that review |
| Dialectical behaviour therapy (DBT) skills | Skills for distress tolerance, emotion regulation and interpersonal effectiveness; pilot trials show benefit for transdiagnostic dysregulation | Best delivered with trained facilitators, especially in crisis |
| Acceptance and commitment therapy (ACT) | Builds willingness to feel difficult emotions in service of values | Acceptance is not resignation; it supports action |
| Expressive suppression | Often increases physiological stress and can harm relationships, although effects vary by person | Sometimes necessary in professional settings, but costly as a habit |
| Rumination and avoidance | Strongly linked with depression and anxiety in the research | Often feel protective in the short term |
Naming an emotion can calm it
Matthew Lieberman and colleagues showed in 2007 that putting feelings into words, a process called affect labelling, reduced activity in the amygdala, a brain region involved in emotional alarm.4 The effect is modest and varies, but it gives a simple, low-cost starting point: say what you feel, as precisely as you can, before deciding what to do.
How it develops
Temperament, learning and the world around us
Some people are born with more intense emotional reactions. Others learn regulation through the adults who helped them through childhood distress. Regulation is shaped further by sleep, stress, trauma, substances and the expectations of family and culture.
Temperament
Sensitivity to stimulation and intensity of reactions varies between people and is partly inherited.
Early validation
Children learn regulation when adults name their feelings, stay calm, and help them recover. Harsh punishment or ignoring distress can make regulation harder.
Adversity
Trauma, neglect, bereavement and chronic stress can lock the nervous system into alarm, making regulation effortful.
Sleep and body
Poor sleep, hunger, pain, illness and caffeine all lower the threshold for overwhelm.
Substances
Alcohol and cannabis may reduce distress briefly but tend to destabilise regulation over time.
Culture
In many Indian families, expressing sadness or anger may be discouraged, and "keeping quiet" is taught as respect. That can build suppression as a default. Learning to express feelings with care is not disrespect.
A practical framework
Five steps to steer, not switch off
This simple sequence brings together the research above. It is not a research-validated protocol on its own, but each step draws on a skill with evidence behind it. Practise it when you are calm, then use it when you are not.
- PPause
Notice the first signal, in your body or breath, before reacting.
- AAutomatically name it
"I feel embarrassed." Naming it can reduce its intensity.
- UUnderstand the message
What is this feeling telling me? What matters here?
- SShift the meaning
Is there a more accurate, workable way to see this?
- EExplore a response
Choose one action that fits your values, then take it.
Distress tolerance for the hardest moments
Cool the body
Cold water on the face, or a slow exhale that is longer than the inhale. Brief, practical and quick to use.
Shift attention
Name five things you can see, or count backwards in threes. This moves attention without fighting the feeling.
Step out
Leave the room, take a walk, or move to another task for ten minutes, then return to the issue.
Reach out
Tell one trusted person how you feel, without needing them to solve it.
More calming tools, sorted by the time you have, are collected in how to relax your mind from stress.
Limits and treatment
When skills are not enough, get professional help
Self-help skills are valuable for everyday emotional stress. But if your emotions are frequently overwhelming, if they damage relationships or work, or if you find yourself using harmful ways to cope, a clinician can help. Treatment may combine several approaches:
Transdiagnostic CBT
Targets worry, rumination, negative metacognition and suppression. Has supportive trial evidence in primary care populations.8 Our explainer on what CBT is and how it works describes the sessions.
DBT
Skills-focused, well suited to intense emotion, self-harm and impulsivity. Usually delivered with structured sessions.9 At the clinic it is offered through the behaviour therapies service, including DBT.
Medicines
No medicine treats emotional regulation directly. Medicines may help co-existing depression, anxiety, mood instability or sleep problems.
Family and school support
Adults who validate feelings and model calm repair help children and teenagers build regulation. See our child and adolescent guidance service.
Seek urgent help if
you have thoughts of harming yourself or others, you lose control of your behaviour, or your emotions feel unmanageable and you cannot keep yourself safe. Call 112 or contact Tele-MANAS (14416).
Before your appointment
Bring this to your next appointment
- Two weeks of emotion notes: what, how strong, what I did
- Situations where emotions felt impossible to manage
- Coping methods you use, including alcohol or self-harm
- Sleep, medicines and any substance use
- Relationship and work or study difficulties
- Your goals: what you want to feel more able to do
Appointments are available in person in Patna and online; you can book a consultation or read about psychology and counselling at the clinic.
Your questions
Frequently Asked Questions
What is emotional regulation?
The processes by which we influence which emotions we have, when, and how we experience and express them. It is a normal skill that varies from person to person and day to day.
Is it the same as suppressing feelings?
No. Suppression holds back expression after the emotion has risen. Good regulation can include feeling, naming and expressing emotions with care, as well as calming them.
Is emotional dysregulation a diagnosis?
It is a transdiagnostic feature rather than a single diagnosis. It appears in depression, anxiety, borderline personality disorder, ADHD and others. A clinician assesses it within the wider picture.
Can I learn to regulate my emotions?
Yes. Reappraisal, mindfulness and DBT-style skills can be learned and practised, and research supports benefits for many people.
Why do I feel things so intensely?
Temperament, past experiences, sleep, stress and health all play a part. Intensity is not a character flaw, and often improves with practice and treatment.
Is it bad to cry or show anger?
Not in itself. The aim is to express feelings in ways that protect you and others. Occasional tears or frustration are part of healthy emotional life.
Can medicine fix emotional regulation?
No medicine targets regulation directly. Medicines can help co-existing conditions, and therapy builds the skills. Medicines should only be started, changed or stopped with a doctor.
How long does it take to notice a change?
Many people notice small changes within a few weeks of daily practice. Lasting change usually takes months, and is strongest with guided therapy.
References
The studies and guidance named in the text, in the order of the original edition's source list.
- Gross JJ. The emerging field of emotion regulation: an integrative review. Review of General Psychology. 1998;2(3):271-299.
- Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology. 2003;85(2):348-362.
- Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment. 2004;26(1):41-54.
- Lieberman MD, Eisenberger NI, Crockett MJ, Tom SM, Pfeifer JH, Way BM. Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science. 2007;18(5):421-428.
- Sloan ME, Stellern J, Xiao KB, et al. Emotion regulation impairment across psychiatric disorders: a systematic review and meta-analysis. Translational Psychiatry. 2026;16:386. doi:10.1038/s41398-026-04119-x
- Clamor A, Lincoln TM, Schulze L. Emotion regulation in mental disorders: a systematic review and multilevel meta-analysis of transdiagnostic and disorder-specific impairments. Psychological Bulletin. 2026;152(2):157-200. doi:10.1037/bul0000512
- Easdale-Cheele T, Nash G, Filobokova V, Westbury C, Bellato A. The effects of mindfulness-based interventions on emotion regulation/dysregulation in people with mental health conditions: a systematic review and meta-analysis. JCPP Advances. 2026. doi:10.1002/jcv2.70103
- Moriana E, Carpallo González JA, Ventura M, et al. Emotion regulation as a moderator of outcomes of transdiagnostic group cognitive-behavioral therapy for emotional disorders. Behavior Therapy. 2022;53(4):628-641.
- Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford; 1993.
- Government of India. The Mental Healthcare Act, 2017.
About this article
Written and medically reviewed by
- MD (Psychiatry) AIIMS New Delhi
- Associate Professor & HOD, Dept. of Psychiatry, RDJM Medical College, Muzaffarpur
- Ex-Assistant Professor, PMCH Patna
- Consultant, Healthy Minds India, Patna
- Published
- 13 October 2026
- Format
- Patient guide
- Focus
- Emotional regulation and mental health
- Sources
- 10 references
- The process model is from James Gross; the Difficulties in Emotion Regulation Scale from Kim Gratz and Lizabeth Roemer; affect labelling from Matthew Lieberman and colleagues; DBT from Marsha Linehan; ACT from Steven Hayes.
- Sana's story is composite and illustrative only. Figures are original schematic illustrations created for Healthy Minds India, and several recent references are summarised from their abstracts.
- Written for general education. It does not replace an individual assessment by a qualified clinician and does not diagnose any condition. Diagrams are original illustrations prepared for this article.
© 2026 Healthy Minds India, Patna · Blog edition 2.0, October 2026 (revised from the awareness-library article)
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For general education; not a substitute for a personal consultation. If you or someone close to you is in distress, please speak to a qualified mental health professional.
Medically reviewed by Dr. Saurabh Kumar, Consultant Neuropsychiatrist, Healthy Minds India, Patna. This article is for general education and is not a substitute for a personal consultation. To discuss your situation, book an appointment or contact the clinic.
Disclaimer: all characters and events depicted in this blog are entirely fictional. Any resemblance to actual persons, living or dead, is purely coincidental. The content is intended for informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional for medical concerns.
