Emotion Regulation as a Transdiagnostic Framework in Internalizing Disorders: Integrating Cognitive, Behavioral, and Neurobiological Pathways: Narrative review

This narrative review integrated data on difficulties in emotion regulation as transdiagnostic framework underlying internalizing disorders, specifically anxiety and depression.Integrating literature from 2000-2025 using various search engines PubMed, Google Scholar, Research Gate, PsycINFO.This review combines behavioral, psychological, cognitive and neural mechanisms to elaborate how maladaptive emotion regulation strategies such as rumination, suppression and avoidance and disturbance in cognitive appraisal led to psychopathology.Clear inclusion and exclusion criteria applied, and results reveal that studies from peer reviewed journals from 2000 and 2025 were included to monitor if they examined relationship between emotion regulation strategies and the internalization of disorder (e.g., anxiety and depression) in non-clinical and clinical human population.Qualitative and quantitative studies, including meta-analyses were considered.Exclusion criteria is applied on if they focus only on externalizing disorders, did not directly measure emotion regulation, not available in full text or lack scientific precision.Results indicate that adaptive ER strategies such as cognitive reappraisal and acceptance reduce the severity of symptoms and increase subjective well-being while on the other hand maladaptive ER strategy increases the symptoms severity, hinders subjective well-being, increases emotional reactivity and susceptibility to internalize symptoms.Neurobiological evidence highlights dysfunction in prefrontal cortex, increases activity of amygdala and HPA axis dysfunction play key role in emotion dysregulation.Comprehensively, emotion dysregulation rises as transdiagnostic framework which integrates developmental processes, ecological stressors, neurobiological vulnerabilities and affective factors across internalizing disorders.Future research should prioritize longitudinal and cross-cultural investigations to strengthen the generalizability of emotion regulation framework.Clinical practices should adopt transdiagnostic framework to counter maladaptive strategies such as suppression and rumination while promoting adapting strategies such as cognitive reappraisal and acceptance.Furthermore, integration of digital and neurobiological tools (e.g., real time monitoring) may enhance early identification and intervention of emotion dysregulation.