A narrative review of the major evidence concerning the relationship between emotional regulation and depression was conducted. The literature demonstrates a mediating role of emotional regulation in the development of depression and physical illness. Literature suggests in fact that the employment of adaptive emotional regulation strategies (e.g., reappraisal) causes a reduction of stress-elicited emotions leading to physical disorders. Conversely, dysfunctional emotional regulation strategies and, in particular, rumination and emotion suppression appear to be influential in the pathogenesis of depression and physiological disease. More specifically, the evidence suggests that depression and rumination affect both cognitive (e.g., impaired ability to process negative information) and neurobiological mechanisms (e.g., hypothalamic pituitary adrenal axis overactivation and higher rates of cortisol production). Understanding the factors that govern the variety of health outcomes that different people experience following exposure to stress has important implications for the development of effective emotion-regulation interventional approaches (e.g., mindfulness-based therapy, emotion-focused therapy, and emotion regulation therapy). 1. Introduction Exposure to stress has generally been associated with a wide range of negative outcomes, including decreased well-being and increased incidence of psychological disorders such as posttraumatic stress disorder, generalized anxiety disorder, and major depression [1, 2]. However, some individuals do not develop psychological disorders even when exposed to high levels of stress. It appears, therefore, that when faced with the same stressor, certain individuals demonstrate impaired functionality, while others show remarkable resilience. Stressful events typically elicit significant emotional responses [3, 4]. Accordingly, emotional regulation capacity has been proposed as a mediator of stress adjustment [5, 6]. According to this model, exposure to stress leads to the dysregulation of emotions, which in turn elicits negative psychological and physiological health outcomes (e.g., depression and stress-induced cardiomyopathy) (see Figure 1). Figure 1: The mediating role of emotional regulation in the relationship between stress and emotions. Whilst emotional regulation capacity has been proposed as a mediator in the link between emotion and psychosomatic health, a review of the empirical and theoretical literature that specifically reports on the mediating role of emotional regulation in the development of depression
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