The extended process model of emotion regulation in managing negative affect in posttraumatic stress disorder: A systematic review.

Abstract

Gross’s (2015) extended process model (EPM) of emotion regulation (ER) provides a framework for conceptualizing ER deficits in posttraumatic stress disorder (PTSD). While ER in PTSD has been extensively studied, the manifestation of regulatory difficulties across EPM stages (identification, selection, and implementation) and potential interstage cascade effects remain unexamined. This review analyzes these stage-specific deficits and their propagating effects in the regulation of negative affect. A systematic review of ER in adults with PTSD was conducted following Preferred Reporting Project of the Systematic Review and Meta-Analysis guidelines. Literature through September 29, 2024, was searched across PubMed, PsycINFO, Scopus, and Web of Science. Quality was assessed via the Newcastle–Ottawa Scale. The review was registered with PROSPERO (CRD42024498531). Analysis of 21 studies (N = 2,105) revealed deficits across all EPM stages: impaired emotional clarity (identification, n = 6), preference for response modulation/attention deployment over cognitive reappraisal (selection, n = 10), and difficulties in regulation application (implementation, n = 5). Findings indicated that identification deficits cascaded into impaired strategy selection and implementation. While highlighting interconnected regulatory challenges in PTSD, monitoring processes remained unexamined. The review identified stage-specific regulatory impairments in PTSD across the EPM framework, with evidence of interstage cascade effects from identification through implementation. While revealing distinct patterns of impairment across stages, these findings are limited in generalizability due to methodological heterogeneity across studies, variability in trauma types, and predominant reliance on cross-sectional designs. This stage-based mapping of deficits, particularly in emotional awareness, and identification of key research gaps suggests directions for developing more targeted PTSD interventions. (PsycInfo Database Record (c) 2025 APA, all rights reserved)