Are attitudes towards emotions associated with depression? A Conceptual and meta-analytic review

Objectives: We performed a conceptual and meta-analytic review of the relationship between negative cognitive and affective evaluations of negative emotional experiences (negative ATE) and depression. We examined the negative ATE-depression relationship in terms of three ATE constructs: fear of emotion, non-acceptance of emotion, and distress intolerance. We also explored whether the negative ATE-depression relationship differs as a function of specific emotions. Methods: Seventy articles with a total sample of 19950 adults were included in the general analysis, and 10 studies with a total sample of 1726 were included in the emotion-specific analysis. Results: In the general analysis, negative ATE was associated with depression with a medium to large effect. Notably, this effect size was stronger than previously observed associations between emotion regulation strategies and depression (Aldao et al., 2010). In the emotion-specific analysis, negative attitudes towards depressive affect had a particularly strong association with depression. Limitations: Limitations include heterogeneity in effect sizes and a small number of samples for the emotion-specific analyses. Conclusions: The present review is the first to establish a systematic relationship between negative ATE and depression. We close with suggestions for future work designed to understand why negative ATE is related to depression, which can lead to understanding of depression's etiology and ways to refine interventions to alter ATE.