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.

背景
躯体症状及相关障碍（Somatic symptoms and related disorders, SSD）是医疗保健系统中极为常见的临床现象。罹患SSD的患者常伴随情绪调节（emotion regulation, ER）障碍。

目的
本综述旨在通过系统分析现有实证研究，探究SSD的特征性情绪调节过程。

数据来源
检索1985年1月至2018年6月期间发表于PsycINFO与PubMed数据库的相关文献。

检索词
“情绪调节”或“情感调节”，以及各类躯体症状及相关障碍的表述。

研究纳入标准
纳入满足以下两项条件的实证研究：a) 基于临床诊断标准，纳入患有SSD的青少年或成年患者；b) 探究情绪调节与SSD之间的关联。

研究合成方法
根据研究特征、研究质量、变量设置与研究结果，对纳入文献进行表格化总结。随后依据文献中采用的情绪调节变量与SSD诊断类型梳理研究结果，并进一步将其归总至情绪调节的三大核心维度：注意、躯体感知与认知知识。

结果
共纳入64项研究，其结果基本证实SSD与情绪调节障碍之间存在显著关联，且该障碍在不同SSD诊断亚型中普遍存在。研究结果显示，患者对情绪相关认知内容的加工投入度显著降低；反之，情绪调节的躯体维度则呈现过度反应模式。此外，患者在灵活将（自发）注意从情绪性刺激中脱离方面往往存在明显困难。

局限性
现有研究缺乏纵向设计、随机对照试验、实验研究与日记研究，难以探究情绪调节与SSD之间的短期及长期因果关系；同时SSD的症状表现与情绪调节的评估工具均存在异质性。

结论与启示
对情绪调节过程的评估，有助于深入理解SSD的发病机制并指导临床治疗方案的制定。此外，同时探究情绪调节各维度间的动态交互作用，有望为进一步阐明情绪调节在SSD的发生、发展与维持过程中的核心作用提供全新的研究视角。