Psychosocial interventions for emotion dysregulation across populations: a systematic review and network meta-analysis

Introduction Emotion dysregulation (ED) is a transdiagnostic construct associated with significant functional and clinical impairment across both clinical and non-clinical populations. It represents a core mechanism underlying a wide range of psychiatric conditions, including mood, anxiety, and personality disorders, as well as subclinical emotional difficulties in the general population. Despite the development of numerous psychosocial interventions targeting ED, their comparative efficacy remains unclear due to the heterogeneity of populations and interventions, and the lack of direct head-to-head comparisons. In this context, network meta-analysis (NMA) allows the integration of direct and indirect evidence to compare multiple interventions within a single analytical framework, providing a more comprehensive understanding of their relative efficacy across populations.

Aims This study aimed to compare the efficacy of psychosocial interventions for reducing ED across clinical and non-clinical populations using a NMA of randomized controlled trials (RCTs).

Methods A systematic review and NMA was conducted following PRISMA guidelines, based on a registered protocol. Electronic databases (PubMed, Scopus, PsycINFO) were searched from inception to April 2025. RCTs evaluating psychosocial interventions targeting ED were included. Study selection and data extraction were performed independently by two reviewers. The primary outcome was change in ED measured using the Difficulties in Emotion Regulation Scale (DERS). A random-effects NMA was conducted. Effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using τ² and I² statistics, and inconsistency was evaluated using the design-by-treatment interaction model.

Results To date, 12 RCTs including 742 participants have been included, covering 11 interventions. The network encompassed a wide range of populations, including individuals with borderline personality disorder, mood and anxiety disorders, trauma-related conditions, and non-clinical samples with elevated ED, supporting the transdiagnostic scope of the analysis. Preliminary NMA showed no evidence of heterogeneity or inconsistency (τ² = 0; I² = 0%; Q test = 0.84, p value = 0.36), suggesting a stable and coherent network structure. Compared with waitlist, dialectical behaviour therapy skills training was associated with a statistically significant reduction in ED (SMD = -1.03, 95% CI -1.98 to -0.09). Other interventions showed numerically favourable effects but with wide confidence intervals, indicating imprecision and limited statistical power in the current evidence base.

Conclusions Psychosocial interventions may reduce ED across a broad range of clinical and non-clinical populations, with preliminary evidence supporting dialectical behaviour therapy-based approaches. Notably, the absence of heterogeneity and inconsistency despite substantial clinical diversity supports the transdiagnostic validity of ED as a treatment target. These findings suggest that targeting ED may represent a unifying therapeutic strategy across diagnostic categories. However, the overall certainty of evidence remains limited by small sample sizes and imprecision. Further high-quality, adequately powered trials are needed to confirm comparative efficacy and better inform treatment selection in clinical practice.

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