Why people with anxiety and other mood disorders struggle to manage their emotions

Regulating our emotions is something we all do, every day of our lives. This psychological process means that we can manage how we feel and express emotions in the face of whatever situation may arise. But some people cannot regulate their emotions effectively, and so experience difficult and intense feelings, often partaking in behaviours such as self-harm, using alcohol, and over-eating to try to escape them.

There are several strategies that we use to regulate emotions – for example, reappraisal (changing how you feel about something) and attentional deployment (redirecting your attention away from something). Underlying neural systems in the brain’s prefrontal cortex are responsible for these strategies. However, dysfunction of these neural mechanisms can mean that a person is unable to manage their emotions effectively.

Emotion dysregulation does not simply occur when the brain neglects to use regulation strategies. It includes unsuccessful attempts by the brain to reduce unwanted emotions, as well as the counterproductive use of strategies that have a cost that outweighs the short term benefits of easing an intense emotion. For example, avoiding anxiety by not opening bills might make someone feel better in the short term, but comes with the long-term cost of ever increasing charges.

These unsuccessful attempts at regulation and counterproductive use of strategies are a core feature of many mental health conditions, including anxiety and mood disorders. But there is not one simple pathway that causes the dysregulation in these conditions. In fact research has found several causes.

1. Dysfunctional neural systems

In anxiety disorders, dysfunction of the brain’s emotional systems is related to emotional responses being of a much higher intensity than usual, along with an increased perception of threat and a negative view of the world. These characteristics influence how effective emotion regulation strategies are, and result in an over-reliance on maladaptive strategies like avoiding or trying to suppress emotions.

In the brains of those with anxiety disorders, the system supporting the reappraisal does not work as effectively. Parts of the prefrontal cortex show less activation when this strategy is used, compared to non-anxious people. In fact, the higher the levels of anxiety symptoms, the less activation is seen in these brain areas. This means that the more intense the symptoms, the less they are able to reappraise.

Similarly, those with major depressive disorder (MDD) – the inability to regulate or repair emotions, resulting in prolonged episodes of low mood – struggle to use cognitive control to manage negative emotions and decrease emotional intensity. This is due to neurobiological differences, such as decreased density of grey matter, and reduced volume in the brain’s prefrontal cortex. During emotion regulation tasks, people who have depression show less brain activation and metabolism in this area.


People with MDD sometimes show less effective function in the brain’s motivation systems – a network of neural connections from the ventral striatum, located in the middle of the brain, and prefrontal cortex – too. This might explain their difficulty in regulating positive emotions (known as anhedonia) leading to a lack of pleasure and motivation for life.

2. Less effective strategies

There is little doubt that people have different abilities in using different regulation strategies. But for some they simply don’t work as well. It’s possible that people with anxiety disorders find reappraisal a less effective strategy because their attentional bias means they involuntarily pay more attention towards negative and threatening information. This can stop them from being able to come up with more positive meanings for a situation – a key aspect of reappraisal.

It’s possible that reappraisal doesn’t work as well for people with mood disorders either. Cognitive biases can lead people with MDD to interpret situations as being more negative, and make it difficult to think more positive thoughts.

3. Maladaptive strategies

Although maladaptive strategies might make people feel better in the short term they come with long term costs of maintaining anxiety and mood disorders. Anxious people rely more on maladaptive strategies like suppression (trying to inhibit or hide emotional responses), and less on adaptive strategies like reappraisal. Though research into this is ongoing, it’s thought that during intense emotional experiences these people find it very difficult to disengage – a necessary first step in reappraisal – so they turn to maladaptaive suppression instead.

The use of maladaptive strategies like suppression and rumination (where people have repetitive negative and self-depreciating thoughts) is also a common feature of MDD. These, together with difficulties using adaptive strategies like reappraisal, prolong and exacerbate depressed mood. It means that people who have MDD are even less able to use reappraisal during a depressed episode.

It’s important to note that mood disorders don’t just come from neural abnormalities. The research suggests that a combination of brain physiology, psychological and environmental factors are what contributes to the disorders, and their maintenance.

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