Assessment of Cognitive Emotion Regulation in Gambling Disorder: A Systematic Review of the Literature

TL;DR

This review explores how poor emotion regulation is linked to gambling disorder and highlights the need for better research and targeted therapies.

Contribution

The study systematically evaluates the role of cognitive emotion regulation in gambling disorder using specific questionnaires.

Findings

Individuals with gambling disorder show reduced cognitive reappraisal and increased maladaptive strategies like rumination.

Emotion dysregulation and impulsivity are significant predictors of gambling severity.

Neuroimaging suggests altered frontal region activation during negative emotion regulation in gambling disorder.

Abstract

Background/Objectives: Gambling disorder (GD) is a behavioral addiction characterized by persistent and repetitive gambling behaviors that cause significant psychological distress and functional impairment. Increasing evidence indicates that difficulties in emotion regulation are a key factor in the development and persistence of GD. This systematic review aimed to summarize and critically evaluate the existing literature on the relationship between emotion regulation strategies and gambling disorder, with a specific focus on studies using the Emotion Regulation Questionnaire (ERQ) and the Cognitive Emotion Regulation Questionnaire (CERQ). Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Systematic searches were performed in PubMed and Scopus databases for studies published between 25 October 2015 and 25 October 2025. The methodological quality and risk of bias of the included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and JBI Checklist for Randomized Controlled Trials. Data extraction and synthesis were performed manually by two independent reviewers. Eligible studies included adult participants (≥18 years) diagnosed with gambling disorder or pathological gambling and using the ERQ or CERQ to assess emotion regulation. Results: Nine studies met the inclusion criteria, comprising a total of 607 patients with GD. Across studies, individuals with GD consistently showed reduced cognitive reappraisal, greater expressive suppression, and higher use of maladaptive cognitive strategies such as rumination, catastrophizing, and self-blame. All studies identified impulsivity, emotion dysregulation, alexithymia, or gambling-related cognitive distortions as significant predictors of gambling severity. Neuroimaging evidence from one study further revealed altered activation of frontal regions during negative emotion regulation. Conclusions: This review highlights the central role of emotion regulation in GD. However, the limited available ERQ/CERQ studies in GD were mostly cross-sectional, limiting causal inferences. Second, samples were predominantly male, reducing generalizability to women. Finally, only one study used neurobiological measures, hindering integration of self-report and neural data. These findings emphasize the importance of integrating emotion regulation-based interventions within therapeutic programs for gambling disorder, with ERQ and CERQ being useful tools to assess the pathology.

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