Clinical Psychology and Psychotherapy
Clin. Psychol. Psychother. (2015)
Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/cpp.1947
Measuring Subtypes of Emotion Regulation: From
Broad Behavioural Skills to Idiosyncratic
Meaning-making
Antonio Pascual-Leone,* Nicole M. Gillespie, Emily S. Orr and Shawn J. Harrington
Department of Psychology, University of Windsor, Windsor, Canada
The current paper introduces the notion of clinically relevant subtypes of emotion regulation behaviours. A new measure of emotion regulation, the Complexity of Emotional Regulation Scale (CERS),
was established as psychometrically sound. It was positively correlated with a measure of emotional
awareness (r = 0.28, p < 0.001) and negatively correlated with measures of self-criticism (r = 0.28,
p < 0.001) and depression (r = 0.35, p = 0.025), among others. Participants were drawn from two samples: clients from a university counselling centre and a non-clinical student sample. Comparisons were
conducted between non-clinical and clinical samples to determine the effects of depression and other
symptoms of psychopathology on participant’s generation of strategies for emotion regulation. Participants in the clinical sample more often identified an intention to soothe but did not follow through as
compared with the non-clinical group, F(1, 198) = 4.662, p < 0.04. Furthermore, individuals in the
non-clinical sample were more likely to engage in specific, meaning-making strategies when compared
with the clinical group, F(1, 198) = 5.875, p < 0.02. Implications from the current studies suggest the possible applicability of the CERS to clinical settings using an interview rather than questionnaire format.
Copyright © 2015 John Wiley & Sons, Ltd.
Key Practitioner Message:
• Emotion regulation should be thought of as being on a continuum of complexity, where strategies range
from general (‘one size fits all’) action to specific (‘personal and idiosyncratic’) meaning. The best
emotion regulation strategy depends on a client’s presenting difficulty and level of distress.
Keywords: Emotion regulation, measurement, self-soothing, distress, experiential, behavioural
Emotional processing has been described as a broad mechanism of reducing distress across a number of psychotherapy orientations (e.g., Borkovec, Alcaine, & Behar, 2004;
Foa & Kozak, 1986; Fosha, 2000; Greenberg & PascualLeone, 2006). Similarly, in the fields of personality and
developmental psychology, a number of authors, using
the very broadest definition, have discussed all forms of
working with emotion as having a ‘regulatory’ purpose.
Indeed, emotion regulation has been described as ‘…the
processes by which individuals influence which emotions
they have, when they have them, and how they experience
and express these emotions’ (Gross, 1998, p. 271). From
this perspective, emotion regulation is how individuals
change their emotional experience to make it more
manageable. As Holodynski and Friedlmeier (2006)
explained, individuals do not simply have to accept the
*Correspondence to: Antonio Pascual-Leone, Department of Psychology, University of Windsor, 401 Sunset Ave., Windsor, Ontario N9B
3P4, Canada.
E-mail: [email protected]
Copyright © 2015 John Wiley & Sons, Ltd.
emotions they experience; instead, they can actively alter
the arousing emotion as a complex strategy for selfregulation. In contrast, a failure to successfully regulate
emotion has been posited as a mechanism of, for example,
depression in which people struggle with a limited ability
to regulate negative affect (Cole & Kaslow, 1988; Aldao,
Nolen-Hoeksema, & Schweizer, 2010). These authors
further suggest that well-adjusted adults possess an ability
to modify their affective experience to match differing
situations, thereby accessing a range of emotions and
modulating their intensity as a function of the situation.
While these observations are both valuable and incisive,
they also expand the definition of emotion regulation to
its broadest limits, which risks conflating several distinct
subtypes of emotion change that otherwise are both
conceptually and operationally distinct. For example,
‘problem-solving’ as an emotion regulation strategy is
much more complex and multifaceted than ‘avoidance’
as a strategy; nevertheless, they are sometimes grouped
together as comparable forms of ‘emotion regulation’
(see Aldao et al., 2010). On closer examination, however,
emotion regulation is variegated: sometimes, best thought
A. Pascual-Leone et al.
of as a process that applies immediately to coping with
arousal in a given moment (i.e., calming oneself down),
while at other times, it should be thought of as a more
involved process of self-development that elaborates
gradually over time (i.e., making personalized meaning).
Indeed, this conceptual distinction is supported by a
meta-analysis that concluded that aroused amygdale activity could be ‘inhibited either by voluntary suppression
or by co-occurring higher-level activity such as language’
(p. 66, Costafreda, Brammer, David, & Fu, 2008). Moreover, while in personality or developmental research, the
distinction between these methods of emotion regulation
may seem less important; in clinical work, the distinction
can be critical.
From a clinical perspective, emotion regulation in the
short-term describes gaining psychological distance from
distress, anxiety, hopelessness etc. (Linehan, 1993b;
Gendlin, 1996). The goal of emotion regulation in this
more immediate situation is ‘turning down the volume’
of affective experience (i.e., a more basic quantitative
change in the intensity of a given feeling). In their review
of the psychotherapy literature on emotional change, this
quantitative change in the short term is what Greenberg
and Pascual-Leone (2006) referred to in strict terms as
basic emotion regulation.
In contrast, emotion regulation in the longer term (and
in its broadest sense, c.f. Holodynski & Friedlmeier, 2006)
is achieved through a more complex, qualitative process
of emotional change (rather than simply changes in intensity). This type of emotional regulation can be considered more complex because, in addition to behavioural
strategies such as getting a distance from distressing
stimuli, it may also require cognitive and emotional
awareness and psychological mindedness in the differentiation of one’s emotional experiences. These forms of
modulating the quality of emotional experience, which
also eventually lead to improvements in regulated affect,
are what Greenberg and Pascual-Leone (2006) identified
as either reflection on emotion (e.g., narrative reframing)
or transformation of emotion (e.g., changing emotion with
emotion). Thus, if immediate reduction of arousal can
be described as ‘turning down the volume’, more complex strategies that also eventually contribute to regulating emotion can be thought of as efforts at ‘changing
the channel’. With this distinction in mind, it must be
emphasized that one strategy is not necessarily superior
to another. Rather, the purpose of this study is to highlight that the range of emotion regulation strategies
varies widely in practice (e.g., from basic self-distraction
to elaborate introspection and meaning-making), and
yet, this often goes unrecognized in the theoretical
literature. It follows that articulating a conceptual
framework that describes some continuum in these
subtypes of emotion regulation would be an important
contribution to the field.
Copyright © 2015 John Wiley & Sons, Ltd.
Behavioural Strategies for Regulating Emotional Intensity:
‘Turning Down the Volume’
Thus, particularly as they apply to change and emotional process in psychotherapy, Greenberg and
Pascual-Leone (2006) have defined emotion regulation
more narrowly, referring specifically to client’s concrete
efforts in reducing the quantitative intensity of an emotion
(i.e., emotion regulation as simply calming oneself
down). As a case in point, in reaction to a painful experience, a client may have an experience of global and
undifferentiated distress (Pascual-Leone & Greenberg,
2007; Stern, 1997). In a situation like this, the presenting
affective experience is immediate, aversive and of high
arousal. Intense emotional pain can be disorganizing
and often needs to be regulated to allow one to continue
functioning (Greenberg, 2002; Haas & Canli, 2008). Still,
the meaning or the object of distress may remain inarticulate and unexplored even when the pain is intense. As
Stern (1997) explains, ‘[one] has information about one’s
experience only to the extent that one has tended to
communicate it to another or thought about it in the
manner of communicative speech. Much of that which
is ordinarily said to be repressed is merely unformulated’ (p. 3). In a similar way, when clients express global
distress, they often do not know, at first, what they are
upset about and they have no sense of direction, only a
sense that something is wrong (Pascual-Leone &
Greenberg, 2007). This is most likely to occur in clinical
cases where individuals suffer from markedly underregulated emotion (Greenberg, 2002), and is particularly
apparent in cases of generalized anxiety, trauma and
borderline personality disorder (Haas & Canli, 2008;
Linehan, 1993).
In this manner, painful emotion not only remains undisclosed but also unexperienced in specific and idiosyncratic
detail. Nonetheless, as demonstrated, for example, by
skills training modules in dialectical behavioural therapy
(DBT; Linehan, 1993), painful emotion can be alleviated
through general skills and actions: e.g., listening to
soothing music, enjoying the smell of baking, slowly
sipping a hot beverage, putting an ice pack on the back
of one’s neck or attending to the sensation of rubbing
lotion on oneself. Interestingly, the effectiveness of such
an externally focused, behavioural approach to emotion
regulation suggests that articulate levels of emotional
awareness are not a necessary prerequisite for basic forms
of affective regulation and self-soothing (Lynch, Trost,
Salsman, & Linehan, 2007). We describe this as a ‘generic
behavioural strategy’ of emotion regulation, because it
involves evoking a behaviour response that does not necessarily involve the elaboration of either thoughts or feelings to be able to assuage the pain. We use the term
‘generic’ here, because a key characteristic of these strategies is that they have very broad, rather than particularly
Clin. Psychol. Psychother. (2015)
Emotion Regulation Subtypes
unique, conditions of applications. Consequently, this
skills-training approach to emotion regulation is one that
can be applied across distressing situations and largely
irrespective of individual differences (i.e., a ‘one size fits
all’ general strategy). Like the DBT approach to distress
tolerance (Linehan, 1993), other forms of behavioural
emotion regulation have been developed, such as
content-free mindfulness (Khoury et al., 2013) and stress
inoculation (Meichenbaum, 2007).
Meaning-making Strategies for Regulating Emotional
Experience: ‘Changing the Channel’
In practice, it stands to reason that treatments use a
variety of blended strategies to facilitate emotion regulation. However, a purely behavioural (skill-based) approach contrasts with experiential and meaning-making
strategies, which are arguably categorically different
methods of self-regulation. Thus, as authors have pointed
out (i.e., Gross, 1998; Holodynski & Friedlmeier, 2006;
among others), from a less immediate scope of analysis,
emotional arousal can ultimately also be regulated by
qualitatively changing the difficult emotion in question.
Here, painful emotion is alleviated through the exploration of memories and idiosyncratic meanings. This set of
specific and idiosyncratic strategies for ‘emotion regulation’ (broadly defined) are exemplified by Victor Frankl’s
(2006; orig. pub. 1946) description of coping with deep
physical and emotional suffering by way of the search
for higher meaning. In this unique process, painful emotion is soothed through articulating and directly attending
to an unmet existential need.
Experiential therapists have long argued that symbolizing bodily felt emotional experience can decrease emotional arousal (Paivio & Laurent, 2001). For example, a
study that encouraged girls to use emotion diaries found
that the simple practice of disclosing and tracking emotion
reduced anxiety symptoms particularly for girls who had
difficulty coping with emotion (Thomassin, Morelen, &
Suveg, 2012). Research from affective neuroscience has
corroborated these clinical and experimental observations:
Findings from a study using functional magnetic resonance
imaging demonstrated that when healthy participants were
presented with distressing images and then given the
opportunity to label their feelings with words, it reduced
the activity in their amygdala (Lieberman et al., 2007).
Unlike with the use of behavioural strategies for reducing arousal, regulating distress through the experiential
search for meaning is predicated on a modicum of emotional awareness and exploration (e.g., one must ‘find the
right words’). Indeed, some authors (i.e., Mayer & Salovey,
1997) have argued that emotional awareness is a prerequisite for sophisticated forms of emotion regulation. For example, a study by Dizén, Berenbaum, and Kerns (2005)
Copyright © 2015 John Wiley & Sons, Ltd.
found that individuals with a decreased capacity for emotional awareness, who were unable to acknowledge or
identify an explicit need, endured more variability in their
emotional reactions, which resulted in their having uncertainty about how they felt. Other research has similarly
shown a negative relationship between alexithymia and
regulated emotion (Pandey, Saxena, & Dubey, 2010;
Ogrodniczuk, Piper, & Joyce, 2011).
Certainly, from the perspective of interventions developed in experiential psychotherapy, emotional awareness
is required to engage in self-compassion and self-soothing
(Greenberg, 2002; Greenberg & Pascual-Leone, 2006). In
Pascual-Leone and Greenberg’s (2007) sequential model
of emotional processing, self-compassion and selfsoothing represent an advanced state of emotional processing. It follows then that in psychotherapy, emotional
arousal, awareness and engagement are seen as prerequisites for engaging in meaning-laden emotional processing
(Greenberg & Pascual-Leone, 2006; Carryer & Greenberg,
2010). Therefore, from this perspective, emotion regulation might be encouraged so as to modulate and maintain
(but not extinguish) an optimal level of arousal when
working through difficult experiences (Paivio & PascualLeone, 2010). From this viewpoint, the act of emotion
regulation is essentially a means to some other end: emotional regulation through self-soothing allows one to
tolerate painful emotion just enough to turn one’s focus
inward and complete a distressing but meaningful task
(e.g., overcoming an interpersonal rupture, exploring
and accepting painful material, or transforming maladaptive shame).
What Does Experimental Research Tell Us About Different
Emotion Regulation Strategies?
In an effort to synthesize the literature, Aldao et al. (2010)
conducted a meta-analysis of 114 experimental studies
that collectively examined the six most commonly studied
emotion-regulation strategies (acceptance, avoidance,
problem-solving, reappraisal, rumination and suppression) as related to symptoms of four psychopathologies
(anxiety, depression, disordered eating and substancerelated disorders). While a seminal contribution, one
might also observe that the six strategies identified by
Aldao and colleagues from the literature are not simply
operationally different but also embody the epistemologically different understandings of what dysregulated affect
is and conflate the essential meaning of the emotional
arousal they address.
In short, although the six identified strategies regulate
emotion and relate to mental health, they also vary widely
in their operational and conceptual complexity, and sideby-side comparisons overlook this critical difference. Rumination, for example, which had a large correlation with
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A. Pascual-Leone et al.
psychopathology (r = 0.49; Aldao et al., 2010), essentially
entails only an intention to regulate. Thus, while rumination and worry are subjectively reported by participants
as active processes, they are nonetheless ineffective and
even maladaptive (McEvoy, Watson, Watkins, & Nathan,
2013). Meanwhile, avoidance and suppression relate
moderately strongly with psychopathology (respective
r’s = 0.38 and 0.34; Aldao et al., 2010) but are active and
purposeful methods of regulating through the interruption of affect and experience. Depending on the exact nature of a strategy, suppression may also be achieved
through physical self-comforts (e.g., taking a hot bath
or drinking hot chocolate) rather than affective interruption alone (e.g., focusing on a distraction). Furthermore,
after acknowledging a debate in the literature, Aldao
et al., 2010 have referred to these strategies (rumination,
avoidance and suppression) as ‘maladaptive’ because of
their consistent relationship with increased levels of psychopathology. Although causal interpretations cannot be
made, the implication of this is that such strategies may
be inherently unproductive or inherently related to
psychopathology. The alternate view we propose is that
these are simply more general and less complex strategies:
i.e., ‘generic behavioural strategies’ (described earlier).
Furthermore, while they may not be suitable as long-term
solutions for dealing with clinical symptoms, avoidance
and suppression may nonetheless be helpful strategies in
critical situations where arousal is extremely high and
individuals are left dysregulated or disorganized.
Contrasting these more generic strategies with the remaining three examined by Aldao et al., 2010, the difference in operational and epistemologically complexity
comes to light. Reappraisal, which is negatively related
to psychopathology (r = 0.14; Aldao et al., 2010), is a
strategy that regulates emotion through meaning-making
about the context and outcome of an upsetting event.
Similarly, acceptance (r = 0.19; Aldao et al., 2010) also
connotes an overall shift in meaning and in experiential
attitude, which cannot be easily compared in behavioural
terms with, say, the strategy of avoidance. Finally,
problem-solving has a moderately negative relationship
with psychopathology (r = 0.31; Aldao et al., 2010) and
is arguably the most complex strategy, entailing the
execution of a series of specific operational steps and
likely the elaboration of personal and idiosyncratic meanings (i.e., as in the process of expressing self-compassion).
Even more so, when problem-solving is directed outwards, it arguably becomes the primary goal itself, while
affect regulation becomes a sort of secondary benefit.
While Aldao et al., 2010 surmise from the literature that
these latter strategies (reappraisal, acceptance and
problem-solving) may be ‘productive’ emotion regulation
strategies, we would argue that it is more appropriate to
conceptualize them as more ‘complex’: i.e., specific and
experiential meaning-making strategies.
Copyright © 2015 John Wiley & Sons, Ltd.
Few studies in the experimental literature are designed
to directly compare emotional regulation strategies
(Aldao, Nolen-Hoeksema, & Schweizer, 2010). An exception to this is a study by Joorman et al. (2007), which examined the ability of depressed individuals to engage in two
different kinds of emotion regulation, distraction versus
the recall of happy memories: strategies that parallel the
‘generic behavioural’ and ‘specific experiential meaningmaking’ subtypes we are proposing. Findings indicated
that non-depressed individuals were successful in regulating their emotion using both the distraction and recall of
happy memories. However, depressed individuals were
only able to regulate emotion using the distraction technique. Similarly, Garber, Braafladt, and Weiss (1995) found
that depressed individuals were more inclined than nondepressed individuals to use avoidance and irrelevant
strategies (e.g., distraction) as a means of regulating emotion. These observations suggest that depressed individuals are unable to alter and adapt their emotion
regulation strategies in light of differing circumstances.
In fact, a correlate of depression is top-down distortions
in processing (e.g. an a priori, ‘the glass is half empty’ perspective), which can lead to difficulty in regulating negative arousal (Davidson, Fox, & Kalin, 2007).
In summary, the ‘complexity’ of a given emotion regulation strategy is reflected by several elements, including (a)
the action tendency and the degree of effort it entails; (b)
the level of (dys)function being coped with; (c) level of
awareness regarding one’s personal needs; and (d) one’s
psychological mindedness in generating personal meaning for coping with distress. It seems that in moments of
high and dysregulating distress (panic, suicidality etc.), individuals are more likely to preferentially benefit from
behaviourally oriented strategies of emotion regulation
(see Linehan, 1993). These strategies allow one to disengage and immediately create psychological distance, so
that one can return to a functional range. It could be, however, that an individual who is depressed following the
death of a loved one might benefit more from a more involved and experientially based type of self-soothing
(see Neimeyer & Currier, 2009). Thus, while straight behavioural strategies to emotion regulation tend to be more
direct and less complex than meaning making strategies,
which require the symbolization of experience, this does
not suggest that the latter set of strategies is either more
sophisticated or more effective. Indeed, often individuals
will be best served by the simplest tool that accomplishes
the job. The emphasis in our conceptualization is more on
the fact that experiential versus behavioural strategies are
not easily interchangeable, because they accomplish different kinds of tasks. This supports the position of
Kashdan and Rottenberg’s (2010) review of ‘psychological
flexibility’ in which they conclude that the ability to adapt
one’s responses to match the situation is more important
than the specific strategies one deploys.
Clin. Psychol. Psychother. (2015)
Emotion Regulation Subtypes
Current Study: A Pilot Investigation
Objectives. The first purpose of the current paper was to
investigate the two different conceptualizations of emotional regulation (i.e., behavioural skills versus personal
meaning-making) and examine their relationships to
depressive symptomatology and psychopathology. In
order to study these relationships, a theoretically derived
measure, the Complexity of Emotional Regulation Scale
(CERS; Pascual-Leone & Gillespie, 2007), was created,
and a preliminary assessment of its psychometric properties was conducted. The CERS was originally constructed
as an interpretive–observational tool to explore what the
previous research has neglected, namely, to identify the
concrete criteria that articulate the subtypes of emotion
regulation strategies and behaviours. Previous studies
have employed clinical observation and behavioral measures only to study the simple process of distress tolerance, while the trend in recent research has been to
increasingly rely on self-report measures self-report measures (Lejeuz, Banducci, & Long, 2013). However, our
study expands upon this research by creating an in vivo,
empirically testable method of evaluating the complexity
of emotion regulation strategies.
The second purpose of this study was to examine the relationship between depressive symptomatology and emotional regulation strategies. Given the conclusion of Aldao
et al. (2010) that the clinical severity of samples seems to
produce larger effects in studies of emotion regulation,
the current study examined this capacity in both nonclinical and clinical samples.
Hypotheses. The present investigation was divided into two
studies with one examining a non-clinical, university sample
and the other examining a sample of clients from a
university-based psychotherapy clinic. The two groups were
studied in order to better evaluate the validity of the CERS
and to allow an exploratory comparison of the groups. For
each, the relationship between measures of depression,
emotional awareness and emotion regulation was examined.
Hypothesis 1: As an interpretive–observational measure, the
CERS will have adequate inter-rater reliability. Hypothesis 2:
CERS scores, which index the strategies of emotion regulation, will be negatively correlated with symptoms of psychopathology (i.e., depression, anxiety and general clinical
symptoms), therefore demonstrating convergent validity.
Hypothesis 3: CERS scores will be positively related to emotional awareness, indicating that being aware of emotion
and attending to it are related, further supporting convergent
validity. Hypothesis 4: The clinical sample will be more likely
to use maladaptive emotion regulation strategies (self-harm,
substance abuse, indiscriminant sexual intercourse etc.)
than the non-clinical sample; in keeping with studies
Copyright © 2015 John Wiley & Sons, Ltd.
that have found that depressed individuals engage in more
behaviourally based emotion regulation (e.g., Joorman et al.,
2007) and that some of these strategies are maladaptive.
Hypothesis 5:
CERS scores will be higher for the
non-clinical sample than for the clinical sample, thus
supporting criterion validity. Moreover, consistent with
the experimental literature (i.e., Aldao et al., 2010; Joorman
et al., 2007), we hypothesize that the increases in depressive
symptomatology will be related to more behavioural emotion regulation strategies.
STUDY #1: EMOTION REGULATION
SUBTYPES IN A STUDENT SAMPLE
Method
Participants
A sample of 160 undergraduate university students (90%
women) with mean age of 21.3 years (standard deviation
(SD) = 3.4) were drawn from a Southwestern Ontario university undergraduate participant pool. Participants were compensated with partial course credit for their involvement.
Measures
Beck Depression Inventory-II. The Beck Depression
Inventory-II (BDI-II; Beck, Steer & Brown, 1996) is a 21item self-report measure with forced-choice responses,
assessing depressive symptoms. The BDI-II has good internal consistency (α = 0.91) and is well validated using diagnostic criteria (Beck et al., 1996). It is considered the gold
standard for assessing depression symptomology among
various populations. O’Hara, Sprinkle, and Ricci (1998)
established the psychometric properties of the scale for
non-clinical and clinical university samples.
Depressive Experiences Questionnaire. The Depressive
Experiences Questionnaire (DEQ; Blatt, D’Afflitti, &
Quinlan, 1976) is a measure of an individual’s vulnerability to depression. The 66 items on the DEQ reflect a range
of experiences that are correlated with depression but are
not symptoms of depression (Zuroff, Moskowitz, Wielgus,
Powers, & Franko, 1983). Factor analysis of this questionnaire consistently indicates that there are three scales that
comprise this measure: self-criticism, dependency and
efficacy (Blatt et al., 1976). The dependency and self-criticism
scores have been found to have significant test–retest correlations (Zuroff et al., 1983), which is consistent with the
conceptualization of these constructs as personality-based.
Levels of Emotional Awareness Scale. The Levels of Emotional Awareness Scale (LEAS; Lane, Quinlan, Schwartz,
Walker, & Zeitlan, 1990) is a performance measure of
emotional awareness and consists of 10 short, fictional,
emotionally charged vignettes about situations involving
Clin. Psychol. Psychother. (2015)
A. Pascual-Leone et al.
the reader and another person. After reading the vignette,
the participant is asked to write a response to the following questions: ‘How would you feel?’ and ‘How would
[the other person] feel?’ Participant responses are coded
by raters in terms of the use of emotionally evocative
language. Responses were scored independently by three
trained raters following the five-point scale described in
the LEAS manual (Lane et al., 1990). The LEAS has good
internal consistency (α = 0.81) and good concurrent and
discriminant validity. The measure provides scores for emotional awareness from the perspective of the ‘self’ and from
the perceived perspective of the ‘other’ and a total score.
Instruments for the Measurement of Emotion Regulation
Strategies
Stimuli vignettes to solicit reports of emotion regulation. In the
current study, participants were presented with a subset
of six vignettes based on the LEAS (described above; Lane
et al., 1990) but on this second occasion to solicit reports of
emotion regulation. The specific subset of vignettes used
were selected, because they involved potentially
upsetting events. However, instructions were modified
to address emotion regulation behaviours. One vignette
states, for example, ‘You receive an unexpected longdistance phone call from a doctor informing you that your
mother has died. This situation leaves you feeling emotionally
upset in some way (i.e., afraid, ashamed, angry…). What would
you do to make yourself feel better?’ (Italics indicate modifications to the LEAS instructions). Thus, participants provided
open-ended written responses that were later scored by
trained raters. Each of the six vignettes was coded separately. This method is similar with that used by Reijntjes
et al. (2007) to study the regulation of negative affect in
response to vignettes depicting emotion-eliciting events.
Complexity of Emotional Regulation Scale. To assess the
complexity of strategies with which individuals regulate
emotion, the first two authors developed the CERS
(Pascual-Leone & Gillespie, 2007) based on a comprehensive review of the emotion-regulation and self-soothing
literatures. It was concluded that four dimensions are particularly relevant to coping with distress. These dimensions include the following: action tendency, expression,
adaptive need and meaning. Therefore, based on these dimensions, the CERS is intended as an ordinal scale that an
observer may use to appraise the complexity of strategies
from any personal accounts that describe an individual’s
emotion regulation. For the purposes of the current study,
the CERS was applied as a coding system to responses
solicited by six vignettes (described above). In the original
version of the CERS, the accounts from participants are
rated on an eight-point scale, ranging from 1 up to 6.
Appendix A presents each of the scoring categories,
describes responses within this category and provides
Copyright © 2015 John Wiley & Sons, Ltd.
examples of typical responses. Moreover, the scale is conceptualized as a qualitative continuum so that emotion
regulation strategies are organized in terms of their increasing complexity both operationally and conceptually.
In the current study, the rating scale was collapsed, from
eight points to four points, to best represent the nature of
data at hand (see Table 1). These scaled scores are conceptually congruent with the original measure and indicate
four distinct groups of emotion regulation strategies that
each has weighted scores: ( 1) Maladaptive strategies
reflect destructive approaches (e.g., avoidant substance
abuse and self-harm); (1) no action to soothe reflects a
general intention to regulate without mobilizing any
resources (e.g., passivity and rumination); (2) general
strategies entail behavioural interventions (e.g., avoidance,
suppression and pleasant distraction); and (3) specific
strategies reflect experiential meaning-making (e.g., reappraisal and problem solving). Finally, participants were
also assigned a score of 3 if they expressed both a general
strategy and a specific strategy.
The overall scaled scores for the CERS were calculated
beginning with the frequency with which an individual
used different emotion regulation strategies from each of
the four groups. These ‘raw score’ frequencies had a possible maximum of six, given the administration of six vignettes. Once a frequency was obtained for each of the
four scaled-score categories, it was multiplied by a corresponding weighting (i.e., 1, 1, 2, 3; see Table 1). Once calculated, the scaled scores were summed across the six
CERS vignettes. Thus, it is possible for participants’ scores
to range from 6 (indicating all maladaptive strategies) to
18 (indicating all specific meaning-making strategies). In
short, higher scaled scores reflect the frequency and complexity of emotion regulation strategies, such that scaled
scores represent an overall index.
Results
Inter-observer Reliability of the CERS and LEAS
The LEAS and CERS required scoring by trained raters,
and so, in order to establish inter-rater reliability, a random
subset of half the data (50% of the narrative responses)
were rescored. Inter-rater reliability between two raters
using the LEAS protocol was excellent (min. κ = 0.75; average κ = 0.87). Similarly, inter-rater reliability on the CERS
was calculated based on the original eight-point scoring.
The average inter-rater reliability for the CERS data was
κ = 0.79, which is considered an excellent level of agreement above chance (Fleiss, 1981); this is the first published
index of reliability for the CERS.
CERS Descriptive Data
The frequency with which participants used the various
categories of emotion regulation strategies (i.e., based on
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Emotion Regulation Subtypes
Table 1. Complexity of Emotion Regulation Scale: scaled scores and definitions
Original CERS
Raw Scores
Scaled scores
1
Definition
Maladaptive Strategies: self regulation strategies that may involve physical self-destruction,
reckless or impulsive behaviours or hateful meaning-making
No action to soothe: reflecting an intention to soothe but not engaging in active behaviours
in order to do so
General behavioural strategies: include specific activities or deliberate distractions, but without
the recognition that these behaviours are intended to relieve the negative affect
Specific meaning-making strategies: responses indicate at least one specific behaviour or
meaning-making cognition intended to relieve negative affect
1
0 and 1
1
2 and 3
2
4, 5 and 6
3
Note: See Appendix A for a more complete description of the original CERS.
CERS = Complexity of Emotional Regulation Scale.
Table 2. Occurrences of regulation strategies across six vignettes
—undergraduate sample
Frequency out
of six vignettes
0
1
2
3
4
5
6
Total
Maladaptive
No action
General
Specific
159
71
54
22
9
4
39
53
40
25
3
160
160
2
5
26
35
40
38
14
160
1
160
Note: Only one emotion regulation strategy was coded per participant, per vignette. When more than one strategy was present the higher code was used.
the scaled scores) is presented in Table 2. The mean
scaled scores are as follows: maladaptive strategies
mean = 0.019 (SD = 0.237); no action to soothe M = 0.88
(SD = 1.012); general behavioural strategies M = 2.75
(SD = 2.149); specific meaning-making strategies M = 11.18
(SD = 4.106); and the total CERS scaled M = 14.79
(SD = 2.409). Given our conceptualization of emotion
regulation, we do not regard the alpha coefficient as a
suitable index of internal consistency; however, for the
sake of completeness, it was calculated as 0.501.
Correlations
Bivariate correlations with other measures of clinical interest were calculated to investigate their relationship
with the CERS. The relationships between the data obtained from the CERS, LEAS, BDI-II and DEQ data are
presented in Table 3. The results suggest that the CERS
is significantly positively correlated with all three scores
of the LEAS and significantly negatively correlated with
the self-criticism scale of the DEQ (all |r|’s > 0.26;
p’s < 0.002). Thus, as the participants reported more
complex and specific strategies (i.e., meaning-making)
for emotion regulation, they also indicated higher scores
Copyright © 2015 John Wiley & Sons, Ltd.
of emotional awareness. Moreover, as the participants
used more general strategies (i.e., behavioural distraction),
they were also more likely to report a higher degree of
depressogenic self-critical style.
STUDY #2: EMOTION REGULATION
SUBTYPES IN A CLINICAL SAMPLE
Method
Participants
In the second study, a sample of 40 clients from the same
university’s outpatient mental healthcare centre were recruited. As before, these participants were students at a
university in Southwestern Ontario but were also seeking
treatment for psychological distress. The sample (80%
woman) had a mean age of 22.0 years (SD = 3.6 years). Client diagnoses differed but conformed with the psychological services centre’s mandate of providing treatment to
individuals with depression and anxiety and whose
primary presenting concern was neither a substance-use
problem, an eating disorder nor an immediate crisis
(i.e., imminent suicide risk). Participants in this study were
asked to fill out a screening battery prior to their first
Table 3. Correlations of scaled score with clinical measures—
undergraduate sample (n = 160)
Measure
BDI-II
LEAS-B Total
LEAS-B Self
LEAS-B Other
DEQ Self-Criticism
DEQ Dependency
DEQ Self-Efficacy
r
0.03
0.28
0.26
0.28
0.28
0.09
0.06
p
0.679
0.000*
0.001*
0.000*
0.000*
0.277
0.453
*p < 0.002.
BDI = Beck Depression Inventory. LEAS = Levels of Emotional Awareness
Scale. DEQ = Depressive Experiences Questionnaire.
Clin. Psychol. Psychother. (2015)
A. Pascual-Leone et al.
therapy session as part of the standard protocol of the
healthcare centre. Participants were anonymous to the
researchers and gave informed consent for their data to
also be used for this study.
Measures
The BDI-II and CERS were administered (as described
above) to treatment-seeking individuals as part of the centre’s standard intake battery. This battery also contained
the following measures of interest.
Symptom Check-List-90-Revised. The Symptom Check-List90-Revised (SCL-90R; Derogatis, 1977) is a widely used
measure of psychopathology consisting of 90 items. The
measures subscales reflect somatization, obsessive–
compulsive disorder, interpersonal sensitivity, depression,
anxiety, hostility, phobic anxiety, paranoid ideation and
psychoticism, as well as a global severity index (GSI). In
the present study, the GSI alone was used as a measure
of symptom distress. The SCL-90R has been shown to be
reliable and valid in a range of clinical populations, with
internal consistency coefficients ranging from 0.64 to 0.86
(Cohen, 2002).
State-Trait Anxiety Inventory. The State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970) is
a widely used clinical measure of anxiety, consisting of
self-report items on a Likert scale about experiences of
anxiety from 1 (not at all) to 4 (very much so). Separate subscales on the measure are used to represent state and trait
anxiety. Research indicates that the validity and reliability
of the STAI is adequate, with a reported Cronbach alpha
of 0.91 and 0.87 for the state and trait scales, respectively
(Evren, Sar, Evren, Semiz, Dalbudak & Cakmak, 2008).
Results
Inter-observer Reliability of the CERS
The CERS was scored according to the procedures
outlined in Study 1. Again, 50% of the narratives were
rescored independently by a second rater. The average
inter-rater reliability for CERS in the second study was
κ = 0.83, which is considered excellent (Fleiss, 1981).
CERS Descriptive Data
The frequency with which participants reported using
the various categories of emotion regulation strategies
(i.e., based on scaled scores) is presented in Table 4. The
mean scaled scores are as follows: maladaptive strategies
M = 0.125 (SD = 0.563); no action to soothe M = 1.28
(SD = 1.012); general behavioural strategies M = 2.95
(SD = 2.218); specific meaning-making strategies M = 9.38
(SD = 4.567); and total emotion regulation scaled M = 13.48
(SD = 3.105). Again, alpha coefficient is not considered
Copyright © 2015 John Wiley & Sons, Ltd.
Table 4. Occurrences of regulation strategies across six vignettes
—clinical sample
Frequency out
of six vignettes
0
1
2
3
4
5
6
Total
Maladaptive
No action
General
Specific
38
1
1
12
13
7
8
6
19
8
4
3
40
40
40
1
4
11
8
5
5
3
40
Note: Only one emotion regulation strategy was coded per participant, per vignette. When more than one strategy was present the higher code was used.
to be a suitable index for theoretical reasons but is, nonetheless, calculated to be 0.467.
Correlations
The CERS was correlated with the BDI-II, SCL-90 and
STAI; these data are presented in Table 5. The results suggest that the CERS is significantly negatively correlated
with all clinical measures (all r’s < 0.35; p’s < 0.04). Thus,
as the participants indicated more complex and specific
emotion regulation strategies (i.e., experiential meaningmaking), they evidenced lower scores on the measures of
depression symptoms, anxiety symptoms and general
psychological distress.
Analyses Comparing the Data in Study 1 with Study 2
The two studies present samples with similar demographics. Of the 160 students from the normal university
population, 80% were female, with an average age of
21.3 years. By comparison, among the 40 students from
the clinical setting, 90% were female, with an average
age of 22.0 years. That similarity permitted us to conduct
some comparisons across the samples.
The non-clinical sample had a mean score of 10.88
(SD = 8.481) on the BDI-II, which was a comparable score
to available norms of a non-depressed population, as
Table 5. Correlation of scaled score with clinical measures—
clinical sample (n = 40)
Measure
r
BDI-II
SCL-90 GSI Score
STAI State
STAI Trait
0.35
0.35
0.35
0.42
p
0.025*
0.027*
0.031*
0.008*
*p < 0.04
BDI = Beck Depression Inventory. SCL-90 GSI = Symptom Checklist-90
Global Severity Index. STAI = State-Trait Anxiety Inventory.
Clin. Psychol. Psychother. (2015)
Emotion Regulation Subtypes
outlined by Steer, Brown, Beck, and Sanderson (2001). The
clinical sample had a mean score of 21.85 (SD = 11.329) on
the BDI-II, which was indicative of a moderate level
of depression, according to Steer et al. (2001). As expected,
results indicated that the clinical sample was significantly
more depressed (t (198) = 6.813, p < 0.001).
In order to investigate the differences in emotion regulation, as indicated by the CERS, a one-way analysis of
variance was conducted in order to investigate the differences in mean scaled scores between the non-clinical sample of Study 1 and the clinical sample of Study 2. This
analysis revealed that there were some significant differences between the groups: no action to soothe, F(1, 198)
= 4.662, p < 0.04; use of specific meaning-making
strategies, F(1, 198) = 5.875, p < 0.02; and overall CERS
score, F(1, 198) = 8.404, p < 0.01. These results suggest that
the participants in the clinical sample were more likely to
report no action to either soothe or to regulate themselves
at times of distress. Related specifically to the differential
use of emotion regulation strategies, there was no
observed difference between the two groups in their use
of general behavioural strategies. However, there was a
difference between the groups in the use of specific
meaning-making strategies. Participants in the nonclinical sample were more likely to use experiential
meaning-making strategies. Thus, the non-clinical sample
seemed to use more complex strategies in addition to the
general behavioural strategies. In short, the non-clinical
sample reports a broader range of emotion regulation
strategies.
Discussion
The goal of this pilot study was to empirically investigate
a conceptualization of emotion regulation subtypes and
their relationship to depressive symptomatology and
psychopathology. Therefore, a further aim of the study
was an initial examination of the CERS’s psychometric
properties. Finally, this study sought to expand our understanding of emotion regulation by studying both clinical
and non-clinical population from within this theoretical
framework.
Key Findings
Reliability. Consistent with the hypothesis 1, the CERS
evidenced excellent inter-rater reliability when used with
either non-clinical or clinical samples (representing a combined sample of n = 200), with kappa ranging from 0.79 to
0.83. Moreover, this rater reliability was comparable
across all six vignettes in the CERS. As expected, however,
the CERS did not demonstrate high internal consistency
when considered across vignettes. This latter finding was
likely due to the fact that emotion regulation is a highly
context-specific process. For example, an individual is
Copyright © 2015 John Wiley & Sons, Ltd.
likely to use different types of strategies when one gets
news of one’s mother’s death, as compared with when
one twists an ankle during a running race (c.f. the
vignettes used). Given this observation, apart from
inter-rater reliability (as reported), test–retest reliability
showing stability for responses to a given vignettes could
be another suitable index.
Validity. As proposed by hypothesis 2, more complex
strategies for emotion regulation (i.e., higher CERS scores)
were consistently associated with fewer symptoms of
depression, anxiety and general psychological distress.
Furthermore, consistent with hypothesis 3, individuals
who reported more specific emotion regulation strategies
(i.e., specific meaning-making) were also found to be more
emotionally aware and less self-critical than those who engaged in emotion regulation strategies that were more
generic and behavioural. Taken together, these two findings suggest that the CERS demonstrates good convergent
validity.
Comparative findings. The non-clinical sample scored below the cutoff for depression, whereas the clinical sample
was found to be suffering from moderate depression.
However, contrary to hypothesis 4, individuals in the clinical group did not appear to be more likely to describe maladaptive emotion regulation strategies when responding
to distressing vignettes, as compared with those in the
non-clinical group. In examining hypothesis 5, we found
that those in the clinical group were, however, less likely
to engage in actions to soothe (i.e., they used more passive
responding, rumination), often expressing some intention
to soothe but a failure to actually engage in self-regulation.
Conceptualization of these strategies as passive and even
maladaptive (e.g., Aldao et al., 2010; McEvoy et al., 2013)
should not be confused with individuals’ internal process
in this regard. Rumination and worry are often subjectively experienced as active attempts to lessen distress.
Nonetheless, this finding is consistent with Aldao et al.
(2010) who showed rumination to have a strong positive
relationship with general psychopathology, and highest
specifically for depression (i.e., r = 0.55). Such a finding
may be accounted for by the anhedonic and decreased motivational features of depression. The general intention to
soothe, while still not taking action, might also be explained by the fact that depressed individuals tend to engage in passive avoidance that manifests as behavioural
and social withdrawal (Campbell-Sills & Barlow, 2007).
However, even more than the issue of passivity, this finding also opens the possible interpretation that depressed
individuals may not actually have a clear sense of what
they need to assuage their distress, further eroding their
sense of hope for feeling better.
Interestingly, when individuals in the clinical group
were presented with distressing situations, our findings
Clin. Psychol. Psychother. (2015)
A. Pascual-Leone et al.
did not show them to be significantly different from the
non-clinical group in the frequency with which they used
generic and behavioural strategies for emotion regulation
(i.e., active avoidance, distraction and physical comforts),
while, at first, this seems inconsistent with the robust finding of Aldao et al. (2010) that higher levels of psychopathology were also associated with the increased use of
avoidance and suppression. However, our inclusion of
‘using physical comforts or exercise’ into the broader
CERS’s conceptualization of behavioural strategies makes
side-by-side comparisons difficult. Furthermore, Aldao
et al. (2010) examined emotion regulation strategies as
isolated constructs (i.e., avoidance alone versus reappraisal alone), whereas the CERS treats these as hierarchically organized (i.e., on a continuum of complexity), such
that when general action strategies (e.g., self-distraction
by avoiding cues to a recent heartbreak) are combined
with specific meaning strategies (e.g., meaning-making
through the exploration of new romantic possibilities),
the overall effort in emotion regulation is considered a
nested and more complex set of strategies. We believe that
these differences in measurement explain the mixed
findings.
In contrast, the specific and more complex strategies described by the CERS (e.g., reappraisal, positive self-talk,
active self-nurturing and combined strategy sets) successfully differentiated the clinical and non-clinical groups.
The non-clinical controls were more likely to engage in
experiential meaning-making as a type of emotion regulation strategy. That is, they were more likely to use
meaning-making to mitigate their negative affect: a topdown processing that is known to go awry in depressed
individuals (Davidson, Fox, & Kalin, 2007). Moreover,
the sum effect of these differences was that the non-clinical
group also made use of a broader range of different
methods for emotion regulation, which varied along a
range of complexity.
clinical control sample coped with distress by using the
same behavioural strategies as did the clinical sample, as
well as additional meaning-making strategies, that were
unique to the non-clinical control group.
From this perspective, one type of regulation strategy
is not necessarily superior to another; it depends on the
context. It stands to reason that emotion regulation is an
ongoing process for all individuals, whether suffering
from clinical symptoms or not, but we might consider an
individual’s moment-by-moment level of distress as an
indicator of which skill set might be most suitable,
particularly given the tolerance for distress that is required to generate meaning in times of distress. For example, emotion that is overwhelming, highly aversive and
disorganizing is more suited to immediate and nonevocative forms of emotion regulation. Thus, the indicated
interventions (e.g., distraction, suppression of feeling and
generic self-comforting behaviours) do not rely on
meaning-making as such and avoid sustained engagement with intolerable distress. When overwhelming and
intolerable distress is typical for an individual, the longterm goal of facilitating emotion regulation is to help that
person develop a better repertoire of strategies for coping
with such intense feelings.
In a different scenario, the individual experiences
intense and painful emotion, but it remains bearable
nonetheless, at least for the time being. Distress that is
intense yet tolerable is better mitigated by reappraisal,
problem-solving and acceptance, which help facilitate
the articulation of idiosyncratic meanings and unmet
needs underlying ones emotional pain. The long-term
goal of this approach to regulation is to help one construct meaning, which makes distressing experience
more comprehensible and manageable (Greenberg &
Pascual-Leone, 2006).
Limitations and Future Research Directions
Clinical and Theoretical Implications
Together, these findings suggest a promising framework
for conceptualizing emotion regulation, not only in terms
of one or another strategy but also in terms of its complexity, as well as the overall range or repertoire of strategies that
an individual seems to make use of. While more development in both research and theory is needed, the CERS offers a preliminary conceptualization of emotion regulation
that considers the complexity of a given strategy in terms
of its general (‘one size fits all’) action versus specific
(‘personal and idiosyncratic’) meaning—or a combination
thereof. The study has also provided data to suggest that a
basic difference between our samples is that the clinical
group spontaneously reported a range of strategies that
entail passive responding and generic behavioural regulation. In contrast, the repertoire of participants in the nonCopyright © 2015 John Wiley & Sons, Ltd.
As mentioned, test–retest reliability would likely be a
useful additional index of reliability given the nature of
varying CERS vignettes. On one hand, the nature of emotion regulation is unique to both a particular situation and
the coping repertoire of a given individual. However, one
might explore the possibility of there being some kind of
stability in the strategies that a given person uses to regulate emotion across situations. Moreover, given that the
CERS has low to moderate correlations with the measure
of characterological features (i.e., trait anxiety, depressive
style and emotional awareness), it suggests that the construct might similarly be understood as some trait reflection of emotional competence. Future research should be
directed at establishing the consistency of emotion regulation strategies in the CERS over time while recognizing
the possibility of differential strategies based on the types
of situation presented.
Clin. Psychol. Psychother. (2015)
Emotion Regulation Subtypes
For pragmatic reasons, the current non-clinical and
clinical samples are also mostly limited to the representation of women (80–90% women, across the two studies).
The gender differences in emotional awareness and
expression are well known (Barrett, Lane, Sechrest, &
Schwartz, 2000). However, given that emotion regulation,
particularly behavioural forms of self-soothing, can be
tacit and outside of one’s awareness, it is difficult to know
what the impact of gender might be on this different kind
of emotional process. With an eye to this issue, future
studies should seek an equal representation of men and
women. The deliberate study of gender differences in
emotional regulation should be undertaken using the
CERS. Also, due to practical constraints, Study 2 was limited in its clinical sample size (n = 40), which is why its
findings are taken as pilot exploration of the issues at
hand. Although there is some potential to generalize the
study’s findings to broader clinical populations, it is also
important to note that these participants were recruited
at a university counselling centre. As such, this particular
clinical population of women in their early 20s was also
more likely to be of higher than average intelligence, have
more insight and be motivated for treatment. Therefore,
future studies using the CERS would benefit from using
a non-university sample to generalize the results and establish the usefulness of the measure.
In this study, vignettes were used to solicit participant
responses, and those responses were subsequently rated
on the CERS. However, the CERS as a rating scale is likely
to be useful even without the use of vignettes. Indeed, future researchers working on clinical difficulty, health psychology or psychotherapy case formulation may find it
useful to conduct the CERS rating within an interview
context, rather than using the standardized questionnaire
format. In doing so, one could use more spontaneous
questions, without the cues or prompts for regulating, that
were implicit in the instructions we presented with vignettes (i.e., ‘…What would you do to make yourself feel
better?’). In keeping with this effort to minimize cues or
prompts, careful attention must also be paid to ensuring
other measures in the study that do not inadvertently facilitate the emotion regulation process.
Furthermore, by using an interview, researchers
would be able to determine whether individuals can regulate emotion successfully based on a participant’s spontaneous account of what happened in the way of emotion
regulation, whether or not the action was within the participant’s emotional awareness. This would allow individuals to reveal their preferred emotion regulation strategies
indirectly, rather than being prompted through an explicit
inquiry about self-regulation. Additionally, clinical researchers could administer the CERS in a pre-post treatment format, perhaps from the client narratives or
observed accounts, as a measure of client progress and
treatment efficacy.
Copyright © 2015 John Wiley & Sons, Ltd.
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Clin. Psychol. Psychother. (2015)
Copyright © 2015 John Wiley & Sons, Ltd.
Mention of a need that
they have for healthy
functioning
Attention to unmet need
through positive selfevaluation and
experiential
problem-solving
Arousal is moderate to
high, possibly interfering
with functioning
If arousal present, it is
regulated
If arousal present, it is
regulated
Implementation of a
behaviour to create a
new sensory–motor
experience to reduce
negative feelings
Presence of self-directed
reappraisal for caring,
tenderness, soothing or
nurturing
Presence of self-directed
reappraisal and related
goal-directed action for
caring, tenderness,
soothing or nurturing
Presence of general AND
specific meaning-making
strategies
(3) General
distraction:
comforting
sensory
experience
(4) Specific
meaning:
generation
(5) Specific
meaning:
transformation
(6) Combined
regulation
strategies
If arousal present, it is
regulated
No mention of a need
that they have for
healthy functioning
Arousal is moderate to
high, possibly interfering
with functioning
Implementation of a
behaviour to interrupt,
distract, avoid or suppress
negative feeling
(2) General
distraction:
unrelated
interruption
Attention to unmet need
is adaptive and healthy
No mention of a need
that they have for
healthy functioning
Mention of a need to feel
differently
Arousal is moderate to
high, possibly interfering
with functioning
No deliberate action to
interrupt or act on
situation, rumination
No mention of any need
Need
(1) No action
to soothe
(despite any
general intention)
Arousal is moderate to
high, possibly interfering
with functioning
Level of functioning
No deliberate action to
interrupt or act on
situation
Action tendency
(0) No Response
Category ( 1 to 6)
Acknowledgment of
need for different
strategies or to
organize strategies
Detailed reflection,
imagery or associated
memories that
elaborate difficult
experience. Elaborated
reappraisals that lead
to problem-solving
though new meaning
Detailed reflection or
general reappraisal
of personal meaning
related to painful
experience
Negative feeling(s)
and a need to reduce
emotion arousal both
acknowledged
Negative feeling(s)
and a need to reduce
emotion arousal both
acknowledged
Negative feeling(s)
acknowledged
No acknowledgment
or reference to
negative feelings
Meaning
APPENDIX A
COMPLEXITY OF EMOTION REGULATION SCALE (CERS)
(Continues)
‘I would do nothing./I
don’t know, I would let
it pass./There isn’t anything
I could do’
‘I would remain calm, feel
the pain and do nothing.
/It isn’t my house on fire,
so I won’t get upset./Grit
my teeth until it goes away’
‘I would count backward
from 100./Run away, avoid.
/Distract by reading,
working./Watch TV, play
loud music’
‘I would sit at home and eat
ice cream or my favourite
food./Take a shower.
/Splash cold water on my
face./Go for a 5 km run.
/Smell flowers./Listen to
soft calming music.
/Relaxation meditation’
‘I would look on the bright
side’
‘Call my best friend and
catch up’
‘Remind myself that it isn’t
a life or death situation’
‘I would remember that
time when Mom held me
close when I was upset./
Imagine my partner
offering encouragement. He
understands me and would
know what to say./Count
my losses, then count my
blessings and make some
brave choices’
‘I would go for a run to
get out of the house. Then
maybe call my best friend
later to talk it out./I would
go home and take a long
Examples
Emotion Regulation Subtypes
Clin. Psychol. Psychother. (2015)
Copyright © 2015 John Wiley & Sons, Ltd.
Attempts are
self-destructive
or reckless
Action tendency
Arousal moderate to
high, often interfering
with functioning
Level of functioning
Need may or may not
be mentioned
Need
Action is selfdestructive, reckless
or hateful meaning
Meaning
bath. Then I would sit down
and probably write in my
journal’
‘I would cut myself to feel
better./Go to the bar and
find someone to sleep with.
/I would send him
hate-mail’
Examples
Note: Reader may contact the first author for the unabridged version of the measure’s coding criteria or go to http://www1.uwindsor.
ca/people/apl/29/research-tools.
(-1) Maladaptive
emotion
regulation
Category ( 1 to 6)
APPENDIX (Continued)
A. Pascual-Leone et al.
Clin. Psychol. Psychother. (2015)