Lost in Emotion Regulation? A Network Analysis of Strategies and Internalizing Symptoms in a Transdiagnostic Sample

This project examines how emotion regulation (ER) processes are organized and how they relate to psychopathology at both transdiagnostic and disorder-specific levels. Although ER difficulties are considered core mechanisms in internalizing disorders—particularly depression, anxiety disorders, and obsessive–compulsive disorder (OCD)—it remains unclear which ER components act as shared vulnerability or protective factors across disorders and which show disorder-specific relevance. Using a network analytic framework, this study aims to clarify these relationships. Data are drawn from a large naturalistic psychotherapy cohort of approximately 585 adult patients with primary diagnoses of depressive disorders, anxiety disorders (including social anxiety disorder, panic disorder, and generalized anxiety disorder), and OCD. Emotion regulation is operationalized by four to five latent ER factors derived from a separate exploratory factor analysis conducted in a preparatory study; these factors serve as nodes in all network models. The analyses follow a two-stage design. First, a transdiagnostic network is estimated in the full sample, integrating ER factors with depressive symptoms (BDI-II), anxiety symptoms (ASI-3), and global psychological distress (BSI-GSI), thereby capturing the joint structure of emotion regulation and core internalizing symptom domains. Second, we estimate networks within each diagnostic subgroup. These networks include the ER factors and a disorder-specific interview-based symptom severity node: MADRS for depression, HAM-A for anxiety disorders, and Y-BOCS for OCD. Centrality metrics are used to identify influential ER components, and network stability and accuracy are evaluated via bootstrapping. Disorder-specific networks are formally compared using Network Comparison Tests to assess differences in global connectivity and network structure. The results contribute to a more nuanced description of how different ER strategies relate to symptom dimensions across mental disorders, and these associations may vary by diagnostic group.