Relation between Emotion Regulation, Psychological Inflexibility, Dispositional Mindfulness, and Emotional Symptoms in a Portuguese Sample

Authors

  • Ana Meireles Health Sciences Faculty, University of Beira Interior, Covilhã; USF Caminhos do Cértoma, ULS de Coimbra, Portugal
  • Ricardo João Teixeira REACH – Mental Health Clinic, Porto, Portugal; CINEICC, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal https://orcid.org/0000-0003-3820-1660
  • Paulo Vitória RISE-Health, Department of Psychology and Education, Faculty of Human and Social Sciences, University of Beira Interior, Covilhã, Portugal
  • Célia Nunes Department of Mathematics and Center of Mathematics and Applications, University of Beira Interior, Covilhã, Portugal
  • Teresa Magalhães Health Sciences Faculty, University of Beira Interior, Covilhã, Portugal; USF Anadia Saúde, ULS da Região de Aveiro, Portugal
  • Frederica Carvalho Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Institute of Psychological Medicine, University of Coimbra, Coimbra, Portugal
  • Maria Matos Gabinete de Psicologia, Psintonia, Coimbra; University of Coimbra, Coimbra, Portugal
  • Mariana Vaz Marques Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Institute of Psychological Medicine, University of Coimbra, Coimbra, Portugal; Gabinete de Psicologia, Psintonia, Coimbra, Portugal
  • Tânia Brandão William James Center for Research, Ispa – Instituto Universitário, Lisboa, Portugal

DOI:

https://doi.org/10.13129/2282-1619/mjcp-5430

Abstract

Background: Mental health is a central component of an individual´s holistic health status. Various factors affect mental health, leading to different emotional symptoms. This study aimed to explore the relationship between emotional symptoms and emotion regulation, psychological inflexibility, and dispositional mindfulness, as well as age, sex, marital status, education, and professional situation.

Methods: A total of 390 clinical patients (Mage=34.33, SD=9.99, 66.4% female) filled in the Philadelphia Mindfulness Scale (PHLMS), the Emotion Regulation of Others and Self (EROS) scale, the Acceptance and Action Questionnaire II (AAQ-II) and the Brief Symptom Inventory (BSI).

Results: We found a significant relationship between emotional symptoms and sex (women reporting more symptoms), and a trend toward a negative relationship between emotional symptoms and age (older participants reporting fewer symptoms). Emotional symptoms showed a significant negative association with mindfulness (PHLMS total score and Acceptance subscale), and with emotion regulation (EROS Intrinsic affect-improving subscale). Conversely, higher scores on the EROS Extrinsic affect-worsening and Intrinsic affect-worsening subscales, as well as greater psychological inflexibility, were associated with more emotional symptoms.

Conclusions: Mindfulness and emotion regulation appear to act as protective factors against emotional symptoms, whereas psychological inflexibility is associated with greater vulnerability to such symptoms.

References

1. Albert, P. R. (2015). Why is depression more prevalent in women?. Journal of Psychiatry & Neuroscience : JPN, 40(4), 219–221. https://doi.org/10.1503/jpn.150205

2. Apóstolo, J., Ventura, Â., Caetano, C., & Costa, S. (2008). Depressão, ansiedade e stresse em utentes de cuidados de saúde primários [Depression, anxiety and stress in primary health care users]. Revista de Enfermagem, 2(8), 45-49. https://www.redalyc.org/pdf/3882/388239955004.pdf

3. Aslan, I. H., Dorey, L., Grant, J. E., & Chamberlain, S. R. (2024). Emotion regulation across psychiatric disorders. CNS spectrums, 29(3), 215–220. https://doi.org/10.1017/S1092852924000270

4. Beauchaine, T. P., & Cicchetti, D. (2019). Emotion dysregulation and emerging psychopathology: A transdiagnostic, transdisciplinary perspective. Development and Psychopathology, 31(3), 799–804.

https://doi.org/10.1017/S0954579419000671

5. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077

6. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688.

https://doi.org/10.1016/j.beth.2011.03.007

7. Brandão, T., Teixeira, R. J., & Pereira, A. (2023). The Portuguese version of the Emotion Regulation of Others and Self (EROS) in a clinical sample: psychometric properties and measurement invariance across sex. Current Psychology, 42(34), 30020-30028. https://doi.org/10.1007/s12144-022-04021-x

8. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822. https://doi.org/10.1037/0022-3514.84.4.822

9. Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211-237. https://doi.org/10.1080/10478400701598298

10. Canavarro, M. C. (1999). Inventário de Sintomas Psicopatológicos: BSI [Psychopathological Symptom Inventory: BSI]. In M. R. Simões, M. Gonçalves, & L. S. Almeida (Eds.), Testes e provas psicológicas em Portugal [Psychological tests and exams in Portugal] (vol. II, pp. 87-109). Braga, Portugal: SHO/APPORT.

11. Canavarro, M. C. (2007). Inventário de Sintomas Psicopatológicos: Uma revisão crítica dos estudos realizados em Portugal [Psychopathological Symptom Inventory: A critical review of studies carried out in Portugal]. In M. Simões, C. Machado, M. Gonçalves, & L. Almeida (Eds.), Avaliação psicológica: Instrumentos validados para a população Portuguesa [Psychological assessment: Instruments validated for the Portuguese population] (vol. III, pp. 305-331). Coimbra, Portugal: Quarteto Editora.

12. Carvalho, A. (2017). Depressão e outras perturbações mentais comuns - Enquadramento Global e Nacional e referência de Recurso em Casos Emergentes [Depression and other common mental disorders - Global and National Framework and Resource Reference in Emerging Cases]. Lisboa, Portugal: Direção Geral Saúde.

13. Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: The Philadelphia Mindfulness Scale. Assessment, 15(2), 204-223.

https://doi.org/10.1177/1073191107311467

14. Clamor, A., Lincoln, T. M., & Schulze, L. (2026). Emotion regulation in mental disorders: A systematic review and multilevel meta-analysis of transdiagnostic and disorder-specific impairments. Psychological Bulletin, 152(2), 157–200. https://doi.org/10.1037/bul0000512

15. Cohen, J. (2013). Statistical power analysis for the behavioral sciences (2nd ed.). Routledge.

16. Coutinho, J., Ribeiro, E., Ferreirinha, R., & Dias, P. (2010). Versão portuguesa da Escala de Dificuldades de Regulação Emocional e sua relação com sintomas psicopatológicos [Portuguese version of the Emotion Regulation Difficulties Scale and its relationship with psychopathological symptoms]. Archives of Clinical Psychiatry, 37, 145-151. https://doi.org/10.1590/S0101-60832010000400001

17. Derogatis, L. R., & Fitzpatrick, M. (2004). The SCL-90-R, the Brief Symptom Inventory (BSI), and the BSI-18. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (3rd ed., pp. 1-41). Lawrence Erlbaum Associates Publishers.

18. Direção-Geral de Saúde. (2016). Porque se fala em saúde mental? [Why do we talk about mental health?] [cited in 2020 jan 15].

https://www.dgs.pt/paginas-de-sistema/saude-de-a-a-z/programa-nacional-para-a-saude-mental/perguntas-e-respostas.aspx

19. Direção-Geral de Saúde. (2017). Programa Nacional para a Saúde Mental [National Mental Health Program]. [cited in 2020 jan 15].

https://www.dgs.pt/programa-nacional-para-a-promocao-da-atvidade-fisica/perguntas-e-respostas.aspx

20. Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363-389. https://doi.org/10.1146/annurev.clinpsy.032408.153621

21. Gilbert, K. E., Tonge, N. A., & Thompson, R. J. (2019). Associations between depression, anxious arousal and manifestations of psychological inflexibility. Journal of Behavior Therapy and Experimental Psychiatry, 62, 88-96. https://doi.org/10.1016/j.jbtep.2018.09.006

22. Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60. https://doi.org/10.1016/j.cpr.2017.10.011

23. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.

https://doi.org/10.1016/j.brat.2005.06.006

24. Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001

25. Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041-1056. https://doi.org/10.1016/j.cpr.2011.04.006

26. Kotsou, I., Leys, C., & Fossion, P. (2018). Acceptance alone is a better predictor of psychopathology and well-being than emotional competence, emotion regulation and mindfulness. Journal of Affective Disorders, 226, 142–145. https://doi.org/10.1016/j.jad.2017.09.047

27. Kuehner, C. (2017). Why is depression more common among women than among men?. The Lancet. Psychiatry, 4(2), 146–158. https://doi.org/10.1016/S2215-0366(16)30263-2

28. Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., Segal, Z., Speckens, A., Teasdale, J. D., Van Heeringen, K., Williams, M., Byford, S., Byng, R., & Dalgleish, T. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials. JAMA Psychiatry, 73(6), 565–574.

https://doi.org/10.1001/jamapsychiatry.2016.0076

29. Maas genannt Bermpohl, F., Hülsmann, L., & Martin, A. (2023). Efficacy of mindfulness- and acceptance-based cognitive-behavioral therapies for bodily distress in adults: a meta-analysis. Frontiers in Psychiatry, 14, 1160908. https://doi.org/10.3389/fpsyt.2023.1160908

30. Magalhães, T., Teixeira, R. J., Vitória, P., Nunes, C., Meireles, A., Vaz Marques, M., Carvalho, F., & Brandão, T. (2023). Interference of difficulties in mindful acceptance and emotional intelligence, added to perseverative negative thinking, in emotional balance: A study with a low/high emotional symptomatology clinical sample. Mediterranean Journal of Clinical Psychology, 11(3). https://doi.org/10.13129/2282-1619/mjcp-3862

31. Moreno-Agostino, D., Khan, N., De Rubeis, V., Jacob, C. M., Banati, P., Sadana, R., & Prina, M. (2026). An umbrella review of psychological capacity and mental health trajectories across the life course. Nature Mental Health, 4, 451–468. https://doi.org/10.1038/s44220-026-00592-x

32. Niven, K., Totterdell, P., Stride, C. B., & Holman, D. (2011). Emotion Regulation of Others and Self (EROS): The development and validation of a new individual difference measure. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues, 30(1), 53–73. https://doi.org/10.1007/s12144-011-9099-9

33. Nolen-Hoeksema, S. (1987). Sex differences in unipolar depression: evidence and theory. Psychological Bulletin, 101(2), 259. https://doi.org/10.1037/0033-2909.101.2.259

34. Nolen-Hoeksema, S., & Aldao, A. (2011). Gender and age differences in emotion regulation strategies and their relationship to depressive symptoms. Personality and Individual Differences, 51(6), 704-708.

https://doi.org/10.1016/j.paid.2011.06.012

35. Patuleia, N., Rosa, E., & Pinto, A. R. (2016). Portal da Saúde Mental - A saúde mental [Mental Health Portal - Mental health]. [cited in 2020 may 1].

https://www.portaldasaudemental.pt/a-saude-mental/

36. Pinto-Gouveia, J., Gregório, S., Dinis, A., & Xavier, A. (2012). Experiential avoidance in clinical and non-clinical samples: AAQ-II Portuguese version. International Journal of Psychology and Psychological Therapy, 12(2), 139-156. http://www.redalyc.org/articulo.oa?id=56023336002

37. Riegner, G., Dean, J., Wager, T. D., & Zeidan, F. (2025). Mindfulness meditation and placebo modulate distinct multivariate neural signatures to reduce pain. Biological Psychiatry, 97(1), 81–88.

https://doi.org/10.1016/j.biopsych.2024.08.023

38. Riggs, N. R., Black, D. S., & Ritt-Olson, A. (2015). Associations between dispositional mindfulness and executive function in early adolescence. Journal of Child and Family Studies, 24, 2745-2751.

https://doi.org/10.1007/s10826-014-0077-3

39. Saccaro, L. F., Giff, A., De Rossi, M. M., & Piguet, C. (2024). Interventions targeting emotion regulation: A systematic umbrella review. Journal of psychiatric research, 174, 263–274.

https://doi.org/10.1016/j.jpsychires.2024.04.025

40. Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020). Mindfulness and Behavior Change. Harvard Review of Psychiatry, 28(6), 371–394. https://doi.org/10.1097/HRP.0000000000000277

41. Sheppes, G., Suri, G., & Gross, J. J. (2015). Emotion regulation and psychopathology. Annual Review of Clinical Psychology, 11, 379-405. https://doi.org/10.1146/annurev-clinpsy-032814-112739

42. Sloan, M. E., Stellern, J., Xiao, K. B., Germeyer, A., Gill, K., Laputsina, V., Mulsant, B. H., Ngoy, A., Nguyen, M., Tang, V. M., Sanches, M., & Gowin, J. L. (2026). Emotion regulation impairment across psychiatric disorders: a systematic review and meta-analysis. Translational Psychiatry, 16(1), 386.

https://doi.org/10.1038/s41398-026-04119-x

43. Spinhoven, P., Hoogerwerf, E., van Giezen, A., & Greeven, A. (2022). Mindfulness-based cognitive group therapy for treatment-refractory anxiety disorder: A pragmatic randomized controlled trial. Journal of Anxiety Disorders, 90, 102599. https://doi.org/10.1016/j.janxdis.2022.102599

44. Stange, J. P., Alloy, L. B., & Fresco, D. M. (2017). Inflexibility as a vulnerability to depression: A systematic qualitative review. Clinical Psychology: Science and Practice, 24(3), 245. https://doi.org/10.1037/h0101744

45. Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PLOS ONE, 9(4), e96110. https://doi.org/10.1371/journal.pone.0096110

46. Teixeira, R. J., Ferreira, G., & Pereira, M.G. (2017). Portuguese validation of the cognitive and affective mindfulness scale-revised and the Philadelphia Mindfulness Scale. Mindfulness & Compassion, 2(1), 3-8.

https://doi.org/10.1016/j.mincom.2017.03.001

47. Wielgosz, J., Kral, T. R. A., Perlman, D. M., Mumford, J. A., Wager, T. D., Lutz, A., & Davidson, R. J. (2022). Neural signatures of pain modulation in short-term and long-term mindfulness training: A randomized active-control trial. The American Journal of Psychiatry, 179(10), 758–767.

https://doi.org/10.1176/appi.ajp.21020145

48. World Health Organization. (2018). Mental health: strengthening our response [cited in 2020 May 1].

https://www.who.int/en/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Downloads

Published

15-08-2026

Issue

Vol. 14 No. 2 (2026)

Section

Clinical Psychology

License

Creative Commons License Articles and conference papers published in Mediterranean Journal of Clinical Psychology are distributed under the terms and conditions of a Creative Commons Attribution 4.0 International License. Correspondingly, authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

 

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

 

  1. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).