Nefise DEMİR, Zuhal KOÇ APAYDIN, Dilanur CINKAVUK, Melisa ATASEVEN, Rıfat TARHAN
Cyprus Journal of Medical Sciences - 2026;11(4):273-281
BACKGROUND/AIMS: Depression and anxiety are conditions that often accompany each other, and multiple factors have been implicated in their development. The present research investigates the interplay between emotion regulation (ER) deficits, cognitive flexibility, and the manifestation of neurotic symptoms. MATERIALS AND METHODS: Patients meeting diagnostic and statistical manual of mental disorders, fifth edition diagnostic criteria for anxiety disorders (n=79) and depression (n=72), as well as a healthy control group (n=82). All groups completed a socio-demographic data form, the difficulties in ER scale-16, and the cognitive flexibility inventory (CFI). In addition, the patient groups completed the hamilton depression rating scale and the hamilton anxiety rating scale. Descriptive, mediation, and regression analyses were conducted using SPSS. RESULTS: Scores on the CFI control subscale (p<0.001) and the CFI total score (p=0.002) differed significantly across groups. Post-hoc analyses indicated superior performance in the control group compared with both clinical groups across all measures, with no statistically significant difference between the anxiety and depression groups. Scores on the difficulties in ER scale also differed significantly among groups (p<0.001), with the control group showing lower scores than both clinical groups. Moreover, no significant difference was observed between the anxiety and depression groups. As cognitive flexibility increased, capacity for ER and levels of anxiety and depression decreased. Mediation analyses showed that ER ability mediated the association between cognitive flexibility and depressive symptoms, but did not mediate the association between cognitive flexibility and anxiety. CONCLUSION: Cultivating ER strategies could mitigate the adverse effects of cognitive rigidity on depressive symptoms. Interventions aimed at improving cognitive flexibility may be considered a therapeutic option for anxiety by promoting greater internal control over anxiety symptoms. These findings are important for understanding how cognitive flexibility and ER contribute to depression and anxiety. In psychotherapy programs, these characteristics should be assessed and taken into account.
