Efficacy and acceptability of transdiagnostic emotion regulation-focused psychological interventions for adolescents: a systematic review with exploratory network meta-analysis of randomized controlled trials

Emotion regulation (ER) is a transdiagnostic process implicated across adolescent psychopathology and a candidate mechanism of change, but comparative evidence for ER-focused psychological interventions remains fragmented across intervention families. We searched PubMed, Embase, PsycINFO, and CENTRAL from inception to 24 December 2025 for randomized controlled trials (RCTs) evaluating ER-focused psychological interventions in adolescents aged 10–19 years. Twenty RCTs were included in the systematic review. Intervention nodes were treated as clinically recognizable program families—mindfulness-based interventions (MBI), Unified Protocol for Adolescents-based interventions (UP-A), and DBT-informed or equivalent ER-skills interventions (DBT/ER skills)—rather than as mutually exclusive mechanisms. Comparators were classified as inactive comparators or active comparators. The primary efficacy outcome was post-treatment ER/dysregulation, and all-cause study dropout was examined as a secondary pragmatic acceptability outcome. A change-from-baseline network analysis was conducted as a robustness analysis. Risk of bias was assessed using RoB 2, and certainty was evaluated using GRADE/CINeMA principles. Twenty RCTs ( N = 2,681) were included: 12 in the primary network, two additional studies in the broader-outcome sensitivity set, and six in narrative synthesis only. In the 12-study post-treatment network, UP-A (Hedges’ g = 1.11, 95% CI 0.72 to 1.50) and DBT/ER skills (g = 0.99, 95% CI 0.55 to 1.44) showed the largest estimates relative to inactive comparators; MBI was not statistically distinguishable from inactive comparators (g = 0.16, 95% CI -0.00 to 0.32). No intervention family differed significantly from inactive comparators in all-cause study dropout; all acceptability estimates were imprecise. Change-from-baseline analyses attenuated effect sizes but retained the same overall pattern. Eleven studies were judged at low overall risk of bias and nine had some concerns; none was judged at high risk. The exploratory network estimates suggest that UP-A and DBT/ER-skills program families may improve adolescent ER outcomes, whereas evidence for MBI on direct ER/dysregulation measures was inconclusive. The evidence does not establish ER as a mediator of symptom improvement, and all-cause study dropout should be interpreted only as a pragmatic acceptability proxy. Sparse comparisons, overlapping intervention content, cluster-trial limitations, and low-to-very-low certainty require cautious interpretation. Trial registration PROSPERO CRD420261287322.