SIS J. Proj. Psy. & Ment.

Health (2011) 18 : 147-155

Role of Emotion Regulation Difficulties in Predicting Mental Health and Well-being

Prachi Saxena, Akanksha Dubey and Rakesh Pandey

The present study reports the relationship of emotion regulation difficulties and alexithymia with
mental health and subjective wellbeing of an individual. Two hundred and eighty eight participants
(218 males and 70 females) in the age range of 16 to 38 years (Mean age =20.78, SD= 2.95 years)
were assessed on a measure of alexithymia, difficulties in emotion regulation, general mental health,
and subjective well-being (assessed by Positive Negative Affect Schedule and Satisfaction with Life
Scale). The results of the bi-variate correlation analysis revealed that difficulties in understanding
and communicating as well as regulating emotions, in general, have a negative influence on health
and wellbeing. However, the findings of step-wise multiple regression analysis indicated that some
specific types of emotional deficits such as difficulties in identifying feelings, lack of emotional clarity
and limited access to emotion regulation strategies were relatively more important in predicting the
health status and well-being of an individual as compared to other emotional difficulties. Overall
the findings imply that emotion regulation difficulties and alexithymia in general is associated with
impaired mental health and lower level of happiness and life satisfaction, i.e., subjective well-being.
The observed findings have been discussed in the light of the available empirical evidences.

The role of emotions and emotional experiences
in determining the health status of an individual,
though, has been focus of psychological inquiry
since long the last few decades have witnessed
an invigorated interest in this area (see review by
Pandey and Choubey, 2010). While emotions
can be adaptive in many ways, emotions can
also be maladaptive (Amstadter, 2008). For
example, researchers have noted that while
positive emotional experiences and emotional
intelligence have a positive effect on mental
health, suppression of emotions, inability or
difficultly in understanding and communicating
emotions (e.g. alexithymia), disposition to
exaggerate emotional experiences may have
health impairing effect (Pandey and Choubey,
2010). The functional role of emotions in mental
health and subjective well being has been
highlighted by several researchers (Quoidbach
et al, 2010). The manner in which individuals are
able to manage their emotional experiences to
confirm adaptively to a given context appears
to be important in mental health (Gross 1995).,
there are various affect related deficits, such
as difficulties in understanding, communicating
and regulating emotions that may adversely
affect the mental health and subjective well
being of an individual (Gross and Munoz, 1995;
Taylor, 2004). The present paper deals with
the role of emotion regulation difficulties and
alexithymia in understanding the mental health
status and well-being of an individual.
Alexithymia is a cognitive-affective deficit in
understanding and communicating emotions
and has been conceptualized as a personality
trait relating to inabilities or severe reductions
in identifying, describing, and communicating
feelings; difficulties in differentiating feelings
from bodily sensations; and diminished affect-
related fantasy (Sher and Grekin, 2007). Initially
alexithymia was, though, linked with only
psychosomatic disorders; subsequent studies
reported its association with a variety of other
types of mental health problems (Taylor, 2004),
such as depression (Bamonti et al., 2010),

Prachi Saxena and Akanksha Dubey, Research Scholar, and Rakesh Pandey, Ph.D., FSIS, Professor,
Dept of Psychology, Banaras Hindu University,Varanasi-221005(India),(Correspondence to Rakesh Pandey,
Email:rpan_in@yahoo.com)
Key Words: Emotion regulation, alexithymia, positive/negative affect, life satisfaction, Mental Health and
Well-being
148 Saxena, Dubey and Pandey
anxiety disorders (Zeitlin and Mcnally, 1993),
sleep disorders (Lundh and Broman, 2006),
eating disorders (Speranza et al., 2005) and
various interpersonal problems (Vanheule et al,
2007) and has been reported as significant risk
factor for developing mental health problems
(Taylor, 2004).
Another emotion related deficit having some
conceptual overlap but independent of
alexithymia is difficulties in emotion regulation.
Different researchers have defined emotion
regulation in different ways. The present paper
is based on the operational model proposed by
Gratz and Roemer (2004) according to whom
emotion regulation includes (a) awareness and
understanding of emotions, (b) acceptance
of emotions, (c) ability to control impulsive
behaviours and behave in accordance with
desired goals when experiencing negative
emotions, (d) ability to use situational
appropriate emotion regulation strategies
flexibly to modulate emotional responses as
desired in order to meet individual goals and
situational demands.
Difficulties in emotion regulation or emotional
deregulation has been found to be associated
with a number of mental health problems,
such as depression(Gross and Munoz, 1995),
anxiety disorders (Campbell-Sills et al, 2006),
post traumatic stress disorder (McDermott et al,
2009), and social dysfunction (Gross and
Munoz, 1995). Difficulties in emotion regulation
have also been linked with high negative
affect and lower level of positive affect and
satisfaction with life (Quoidbach et al., 2010).
As the preponderance of positive emotional
experiences, relative absence of negative
affect and satisfaction with life are indicator of
subjective well-being, the aforesaid findings
imply that emotion regulation difficulties would
be associated with lower level of subjective
well-being.
From the preceding review it is evident that
ability to understand and communicate
emotions (i.e., lower level of alexithymia)
and enhanced capacity to regulate emotions
is likely to be associated with sound mental
health and higher levels of subjective well
being. Contrary to it, the alexithymic tendency
(i.e., the difficulties in emotional understanding
and communication emotion) and emotion
regulation difficulties may result in a variety of
mental health related problems and reduced
happiness and satisfaction in one’s life.
However, a closer review of the aforesaid
empirical evidences bring to fore the fact that
most of the aforementioned studies have
examined only a few aspects of the multifaceted
construct of alexithymia and emotional
deregulation. Thus, it would be interesting and
theoretically meaningful to examine the relative
significance of different aspects of alexithymia
and emotion regulation difficulties in predicting
an individual’s level of mental health and
subjective wellbeing. The present paper makes
an attempt in this direction and examines not
only the relationship of various dimensions of
alexithymia and emotion regulation difficulties
with various aspects of mental health and well-
being but also explores the relative importance
of these affective variables in predicting health
and well-being.
Materials and Methods:
Sample:
Two hundred and eighty-eight individuals (218
males and 70 females) in the age range of 16 to
38 years (Mean age =20.78, SD= 2.95 years)
participated in the present study. The age
range of female participants was 16 to 35 years
(Mean age = 20.60 years, SD = 2.77 years)
whereas that of male participants was 18 to
38 years (Mean age = 21.32 years, SD = 3.41
years). None of the participants reported any
present or prior history of medical or psychiatric
illness in a semi-structured interview conducted
before the administration of the tools for the
present study.
Tools:
The Hindi version of 20 item Toronto Alexithymia
Scale (TAS-20-H)(Pandey, Mandal, Taylor, and
Parker, 1996) was used to assess the level of

alexithymia of the participants. The TAS-20-H
consists of 20 items rated on five-point scale of
agreement and measures the three dimensions
of alexithymia- difficulties in identifying feelings,
difficulties in describing feelings, and externally
oriented thinking.
Emotion regulation difficulties were assessed
using the Hindi adaptation of the Difficulties in
Emotion Regulation Scale (DERS)(Pandey et
al, 2010). The DERS is a 36 item measure that
assesses an individual’s difficulties in regulating
emotions across six domains. The Hindi
version of the DERS was developed using the
contemporary method of translations and back-
translation. The initial psychometric evaluation
of the Hindi version of DERS (the DERS-H)
revealed that the scale is psychometrically
sound and reliable and the has a factor
structure similar to the original DERS (Pandey
et al., 2010).
The 28 item version of the General Health
Questionnaire (GHQ-28)(Goldberg and Hillier,
1979) was used to assess four dimensions of
mental health, viz., somatic complains, anxiety &
insomnia, depression and social dysfunction.
The subjective well-being was gauged by two
scales- one measuring positive/negative affect
and the other life satisfaction. To assess the
level of positive and negative the Hindi version
of Positive Affect and Negative Affect Schedule
(PANAS; (Pandey and Shrivastava, 2008) was
used. It consists of 20 mood related adjectives
(10 positive and 10 negative) that assesses
two global dimensions of affect: positive and
negative (Watson et al, 1988). Respondents are
required to mark the level to which these moods
were experienced by them during a specified
period on a 5-point scale. The Satisfaction with
Life Scale (SWLS; Diener, et al (1985) was
used to assess the general life satisfaction. It is
five item scale rated on 7-point scale.
Procedure:
The participants of the present study were
Emotion Regulation Difficulties and Mental Health 149
contacted either individually or in small
groups consisting of 3 to 4 persons. Before
the administration of the questionnaires the
participants were briefed about the purpose
of the study and their task. After getting the
consent of the participants the aforesaid
questionnaires were administered as per the
standard instructions of each questionnaire.
All participants were requested to ensure that
they have responded to each items of every
questionnaire/scale.
Results:
To ascertain the relationship various affect
related deficits (alexithymia and difficulties in
regulating emotions) with various domains
of mental health and subjective well-being
(positive/negative affect and satisfaction with
life) bi-variate correlation coefficients were
computed. The obtained results have been
displayed in Table 1. It is evident from the
Table-1 that two dimensions of alexithymia
(difficulties in identifying feelings and
difficulties in describing feelings) are correlated
significantly with all the dimensions of mental
health and subjective well being. Further, the
direction of correlation is positive will all the
dimensions of mental health and well-being
except positive affect and life satisfaction.
However, the third dimension of alexithymia,
externally oriented thinking (EOT), showed
significant correlations with some dimensions
but not with others. For example, it failed to
correlate significantly with somatic complaints,
anxiety, negative affect and life satisfaction.
Here it is important to mention that higher score
on various dimensions of GHQ indicate greater
mental health complaints. Thus, the observed
pattern of correlation suggests that the affective
domain of alexithymia (difficulty in identifying
and describing feelings) have significant and
negative influence on all the dimensions
of mental health and well-being whereas
the cognitive component of alexithymia is
associated with selected aspects of mental
health such as social dysfunction, depression
and reduced positive emotional experiences.
150 Saxena, Dubey and Pandey

Table1
Correlations of Various Dimensions of Alexithymia with Dimensions of Mental
Health & Well Being

Difficulties in Difficulties in Externally Alexithymia

identifying describing oriented think- total
feelings feelings ing
Somatic complains 0.386** 0.350** 0.087 0.373**
Anxiety and Insomnia 0.456** 0.385** 0.082 0.423**
Social Dysfunction 0.271** 0.276** 0.149* 0.311**
Depression 0.430** 0.330** 0.139* 0.412**
GHQ total 0.498** 0.427** 0.140* 0.485**
Positive Affect -0.241** -0.220** -0.154** -0.272**
Negative Affect 0.463** 0.311** 0.129 0.425**
Life satisfaction -0.155** -0.155** -0.007 -0.147*

A similar pattern of correlations was also
obtained between various dimensions of
difficulties in regulating emotions one hand and
mental health and subjective well being on the
other (Table-2). All the dimensions of difficulties
in emotion regulation except lack of emotional
awareness correlated significantly with all
dimensions of mental health and subjective
well being. The lack of emotional awareness
correlated significant with only one dimension
of mental health and well being respectively,
i.e., social dysfunction and positive affect.

Table 2
Correlations of Dimensions of Difficulties in Emotion Regulation with
Mental Health & Well Being
Non Difficulty Impulse Lack of Limited Lack of DERS
acceptance engaging control emotional access to emotional total
of in goal difficulties awareness emotion clarity
emotional directed regulation
resonses behaviour strategies
somatic Complains 0.270** 0.245** 0.251** 0.097 0.325** 0.344** 0.384**
Anxiety & Insomnia 0.445 **
0.278 **
0.369 **
0.082 0.457 **
0.387 **
0.514**
Social Dysfunction 0.282** 0.211** 0.185** 0.135* 0.255** 0.314** 0.342**
Depression 0.403 **
0.202 **
0.387 **
0.027 0.413 **
0.369 **
0.468**
GHQ Total 0.451** 0.299** 0.393** 0.096 0.480** 0.448** 0.550**
Positive affect -0.251 **
-0.253 **
-0.294 **
-0.259 **
-0.272 **
-0.316 **
-0.407**
Negative affect 0.435 **
0.231 **
0.338 **
0.061 0.490 **
0.334 **
0.490**
Satisfaction with life scale -0.161** -0.258** -0.232** -0.031 -0.255** -0.156** -0.280**

This pattern of findings suggests that various the findings of correlations are encouraging
types of difficulties in regulating one’s emotion and show that alexithymia and difficulties in
negatively influence the mental health and emotion regulation are related to mental health
subjective well-being of an individual. Although and subjective well being, it does not show
 Emotion Regulation Difficulties and Mental Health 151

the relative significance of various domains of of step wise multiple regression analyses
alexithymia and emotion regulation difficulties was conducted using various dimensions of
in predicting mental health problems and well- alexithymia as predictor variables and various
being. Thus, to address this objective, a series dimensions of mental health and subjective
Table 3
Results of Step wise Multiple Regression Analysis using Dimensions of Alexithymia as
Predictor Variables and Dimensions of Mental Health & Well Being as Criterion
Predictors R R2 R2 change F change Sig of F Beta t sig
change
Dependent Variable : Somatic Complalns
Difficulties in identifying .386 .149 .149 49.336 .000 0.274 3.981 .000
feelings
Difficulties in identifying .412 .169 .021 6.951 .009 0.182 2.637 .009
feelings
Dependent Variable: Anxiety & Insomnia
Difficulties in identifying .456 .208 .208 73.860 .000 0.351 5.282 .000
feelings
Difficulties in describing .475 .225 .018 6.496 .011 0.170 2.549 .011
feelings
Dependent Variable: Social Dysfunction
Difficulties in describing .276 .076 .076 23.176 .000 0.175 2.432 .016
feelings
Difficulties in identifying .304 .093 .017 5.159 .024 0.164 2.271 0.24
feelings
Dependent Variable: Depression
Difficulties in identifying .430 .185 .185 63.916 .000 0.430 7.995 .000
feelings
Dependent Variable: Positive Affect
Difficulties in identifying .241 .058 .058 17.284 .000 -0.241 -4.157 .000
feelings
Dependent Variable: Negative Affect
Difficulties in identifying .463 .215 .215 76.852 .000 0.463 8.767 .000
feelings
Dependent Variable: Satisfaction With Life Scale
Difficulties in describing .155 .024 .024 6.917 .009 -0.155 -2.630 .009
feeling

well being as criterion. The obtained results
have been summarized in Table 3 and 4
The results of stepwise regression analysis
using various dimensions of alexithymia as
predictor and dimensions of health and well-
being as criterion (Table-3) revealed that
difficulties in identifying feelings emerged as
the best predictor of all dimensions of mental
health and subjective wellbeing except social
dysfunction and satisfaction with life, explaining
a total variance of approximately 5% to 22% of
the various domains of health. Difficulties in
describing feelings were the single best predictor
of social dysfunction and negative affect
and for some other dimensions of health the
second best predictor (e.g., somatic complaints
and anxiety). This pattern of findings suggests
that the mental health status and well-being
of an individual can be best predicted by the
affective component of alexithymia, particularly
152 Saxena, Dubey and Pandey

by difficulties in identifying feelings. Thus, it main deficit associated with various mental
is evident that difficulty in identify feelings or health symptoms and an inadequate level of
being unable to understand feelings is the subjective wellbeing.
Table 4
Results of step wise Multiple Regression Analysis using Dimensions of Emotion Regulation
as Predictor Variables and various Dimensions of Mental Health and well being as Criterion
Predictors R R2 R2 change F change Sig of F Beta t sig
change
Dependent Variable: Somatic Complains
Lack of Emotional Clarity .344 .118 .118 38.310 .000 0.261 4.294 .000
Difficulty in engaging in goal .396 .157 .039 13.021 .000 .136 2.166 .031
directed behaviour
Limited access to emotion .410 .168 .012 3.954 .048 .139 1.988 .048
regulation strategies
Dependent Variable: Anxiety & Insomnia
Limited access to emotion .457 .209 .209 75.563 .000 .234 3.449 .001
regulation strategies
Lack of Emotional Clarity .500 .250 .041 15.702 .000 .192 3.330 .001
Non acceptance of emotional .526 .277 .026 10.401 .001 .215 3.225 .001
responses
Dependent Variable: Social Dysfunction
Lack of Emotional Clarity .314 .099 .099 31.339 .000 .240 3.952 .000
Difficulty in engaging in goal .356 .127 .028 9.063 .003 .124 2.087 .038
directed behaviour
Non acceptance of emotional .374 .140 .013 4.293 .039 .134 2.072 .039
responses
Dependent Variable: Depression
Limited access to emotion .413 .186 .186 65.368 .000 .235 3.385 .001
regulation strategies
Difficulty in engaging in goal .474 .225 .039 14.170 .000 .191 3.239 .001
directed behaviour
Non acceptance of emotional .492 .242 .017 6.447 .012 .174 2.539 .012
responses
Dependent Variable: Positive Affect
Lack of Emotional Clarity .316 .100 .100 31.665 .000 -.226 -4.019 .000
Difficulty in engaging in goal .379 .144 .044 14.519 .000 -.235 .4.306 .000
directed behaviour
Lack of Emotional Aware- .432 .187 .043 15.04 .000 -.216 -3.880 .000
ness
Dependent Variable: Negative Affect
Limited access to emotion .490 .240 .240 90.155 .000 .320 4.720 .0004
regulation strategies
Non acceptance of emotional .516 .266 .025 9.858 .002 .179 2.678 .008
responses
Lack of Emotional Clarity .517 .278 .012 4.884 .028 .127 2.210 .028
Dependent Variable: Satisfaction With Life Scale
Difficulty in engaging in goal .258 .067 .067 20.471 .000 -0.174 -2.662 .008
directed behaviour feeling
Limited access to emotion .296 .088 .021 6.447 .011 -.167 -2.545 .011
regulation strategies

A similar set of step wise multiple regression
analysis was conducted using dimensions of
difficulties in regulating emotions as predictors
and various dimensions of mental health
and well being as criterion. The findings are
reported in Table 4. The findings revealed
that lack of emotional clarity emerged as the
best predictor of somatic complains, social
dysfunction and positive affect whereas
limited access to emotion regulation strategies
emerged as the best predictor of anxiety and
insomnia, depression and negative affect.
Limited access to emotion regulation strategies
also emerged as the second best predictor of
satisfaction with life that was best predicted by
difficulties engaging in goal directed behaviour.
Other dimensions of emotion regulation
difficulties that were found to be the significant
predictors included difficulties engaging in goal
directed behaviour and non acceptance of
emotional responses. These findings suggest
that, though, various dimensions of emotion
regulation difficulties are associated with one’s
mental health and well-being (as indicated by
bi-variate correlation), only a few of them are
relatively more important for understanding
the health status of an individual. Overall, the
findings suggest that individuals who are not
clear about their emotional experiences and
do not have adequate skills to regulate their
emotions are more prone to have mental health
problems and lower level of subjective well
being.
Taken together, the findings of the present
study suggest that the affective component of
alexithymia (particularly difficulty in identifying
feelings) and certain specific types of emotion
regulation difficulties such as lack of emotional
clarity, limited access to emotion regulation
strategies, difficulties engaging in goal directed
behaviour and non acceptance of emotional
responses are relatively more detrimental to
one’s mental health and subjective well-being
as compared to other domains of alexithymia
and emotion regulation difficulties.
Discussion:
The findings of the present study empirically
support the notion that difficulties in
understanding, communicating and regulating
Emotion Regulation Difficulties and Mental Health 153
emotions are related to the mental health
and subjective well being of an individual.
However, certain specific types of emotional
deficits such as difficulties in identifying and
describing feelings lack of emotional clarity,
limited access to emotion regulation strategies,
difficulties engaging in goal directed behaviour
and non acceptance of emotional responses
are relatively more detrimental to one’s mental
health and subjective well-being as compared
to other types of emotional difficulties.
The finding that individuals with higher level of
difficulties in identifying and describing feelings
is related to various mental health problems
such as depression, anxiety, insomnia, somatic
complains, social dysfunction is supported
by a number of earlier studies. For example,
in a recent study the depressive symptom
severity was found to be strongly associated
with alexithymia particularly with the two
dimensions –difficulty in identifying feelings
and difficulty in describing feelings (Bamonti
et al., 2010). Similarly, difficulties in identifying
and describing feelings has been found to be
related to high negative affect and lower level
of positive affect and subjective well being
(Yelsma, 2007). Lundh and Broman (2006) have
argued that the difficultly in identifying feelings
and difficulty in describing feelings index
alexithymia via the person’s self assessment
of his or her abilities, which is likely to be
influenced by positive and negative affect. The
externally oriented thinking, on the other hand,
indexes alexithymia more indirectly, by asking
for aspects of people’s experience (awareness
of external facts vs. internal experiences) and
therefore is less likely to emerge as a predictor
of the positive/negative effect.
The findings of the present study that lack of
emotional clarity and limited access to emotion
regulation strategies play a more significant
role in predicting mental health problems
and subjective well being of an individual
is supported by some indirect empirical
evidences. For example, studies report that
patients with panic attack show reduced
emotional clarity and difficultly to distinguish
between bodily sensations and emotional
states, resulting in internal states being
154 Saxena, Dubey and Pandey
perceived as ambiguous and unpredictable.
Similarly, in a recent Meta analytic review
Aldao and associates (2010) have noted that
various types of psychopathology and mental
health problems can be viewed as a result of
limited access to emotion regulation strategies.
Depressive individuals have been found to use
dysfunctional strategies such as rumination
and catastrophising and less frequently use
positive strategies in regulating their emotions
(McMurrich and Johnson, 2008) and as a result
experience heightened intensity and duration
of negative emotions (Liverant et al, 2008).
To sum up, the findings of the current study
adds to the existing literature demonstrating the
role of specific types of emotional deficits such
as difficulties in understanding, communicating
and regulating emotions in determining the
mental health and subjective well being of an
individual.
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