The Relationship Between Emotion Regulation and Sexual Function and Satisfaction: A Scoping Review

Introduction: Sexual problems are characterized by dif ﬁ culties in the ability to respond sexually or to obtain sexual pleasure. Their etiology is assumed to be multifactorial, demanding a biopsychosocial treatment approach. Positive sexual experiences involve the dynamic interplay between cognitive, emotional, and motivational factors. Dif ﬁ culties in emotion identi ﬁ cation or impairment in emotion regulation may thus play a pivotal role in the development and maintenance of sexual problems. Objectives: To conduct a scoping review of the literature on the effects of emotion regulation on sexual function and satisfaction. Methods: We conducted a scoping review using Cinahl, Lilacs, Scielo, Scopus, PsycInfo and Pubmed electronic databases using search terms related to emotion regulation and sexual function and satisfaction. Results: 27 articles met the inclusion criteria and were further analyzed. Overall, emotion regulation dif ﬁ culties were associated with poorer sexual health outcomes, dif ﬁ culties in the sexual response cycle and overall lower sexual satisfaction. Laboratory studies and intervention trials found positive effects of promoting emotion regulation change on sexual function and satisfaction. Conclusions: Despite the methodological diversity of studies, it can be concluded from this review that dif ﬁ cul-ties in emotion regulation are related to sexual dif ﬁ culties and sexual dissatisfaction. Future research should consider emotion regulation-focused interventions to mitigate sexual health problems. Fischer VJ, Andersson G, Billieux J, et al. The Relationship Between Emotion Regulation and Sexual Function and Satisfaction: A Scoping Review. Sex Med Rev 2022;10:195 − 208. Copyright


INTRODUCTION
Sexual health is "a central aspect of overall health and encompasses physical, emotional, mental and social well-being in relation to sexuality, and not only the absence of disease, dysfunction or infirmity". 1 Sexual health "requires a positive approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences.Sexual health cannot be understood without taking into consideration the definition of sexuality, which underlies important elements of sexual health, such as the experience and expression of thoughts, fantasies, desires, beliefs, attitudes, values, behaviors and practices". 2 In contrast to sexual health, sexual disorders are characterized by difficulties in the ability to respond sexually or to obtain sexual pleasure. 3Their etiology is assumed to be multifactorial, encompassing physiological, affective, interpersonal, and psychological, context-dependent-factors. 4 Epidemiological data suggests that approx.About 40-45% of adult women and 20-30% of adult men in the general population fulfil the criteria for at least one sexual dysfunction during their lives. 5e recommendations for a high standard of sexological care and research recognize that sexual health should be assessed using a biopsychosocial approach, considering not only biological aspects but also psychological factors, partner-related factors, the social context, environmental factors and life stressors (daily hassles, critical life events).These factors are assumed to play a crucial role in rendering individuals susceptible to developing sexual difficulties, in triggering the onset of a sexual problem, and in maintaining sexual dysfunction in the long term. 6shared element of these factors is emotion regulation (ER).ER refers to the way in which emotions are generated, experienced, and modulated.Such processes include emotional awareness (attention, differentiation, and labeling of emotions), their expression (suppression versus expression of emotions), and their experience (accessing and reflecting on one's emotions and their consequences). 7−10 Among the most influential model is Gross' extended process model of emotion regulation. 8This model defines the process through which individuals regulate their emotions at different points in the process of emotion generation (eg, situation selection, situation modification, attentional deployment, cognitive change, and response modulation).In this model, the type and timing of the emotion regulation strategy used by an individual impact what emotion one has and how it is expressed. 8This model has several elements in common with other ER models which place special importance on the strategies used by individuals to regulate the process via which emotions are generated and enacted in behavior. 11,12Considering sexual health, it is plausible that the ability to use ER strategies that are situation and context adequate (i.e.adaptive in terms of downregulating negative emotions), are beneficial for both sexual function and satisfaction.For example, unsatisfactory sexual encounters may be better dealt with reappraisal of the negative emotions and not with avoidance of future situations.
Functional components of efficient ER, includes: (i) awareness and understanding of emotions; (ii) acceptance of emotions; (iii) the ability to control impulsive behaviors and to behave in accordance with desired goals when experiencing both negative and positive emotions; and (iv) the ability to use situationally appropriate ER strategies to achieve personal goals and meet situational demands. 9,13ER strategies are not intrinsically adaptive or maladaptive.Instead, this depends on whether they enable social functioning, and what is appropriate in a given environment and context. 9,14Consequently, emotion dysregulation corresponds to the difficulty or inability to process emotions adequately, which has been associated with unhealthy coping strategies, 15 and is often regarded as a transdiagnostic factor for psychopathology. 16R can be assessed in different ways.The majority of studies use self-report measures, which offer important information on emotion regulation and dysregulation.Nevertheless, self-report measures are subject to bias and may reflect people's beliefs about their ER strategies (sensu meta-cognitive beliefs) rather than their actual ER behavior.Useful and complementary assessment methods are, therefore, experimental paradigms to assess behavioral, psychophysiological and neurological indices of ER. 17 Emotions, as well as sexual problems, normally arise in the context of an interpersonal encounter and are often shared and regulated within the relationship experience. 18Emotions affect sexual behavior either by strengthening or weakening feelings of sexual arousal and sexual desire. 19For instance, experiencing positive emotions and feelings such as high satisfaction with current sexual relationships and affection is associated with strong sexual desire, 20 while shame (eg, related to low performance or self-perceived attractiveness), fear (of genital pain), performance anxiety, or disgust (associated with signals of contamination threat) may hinder sexual arousal and desire. 21xual problems are commonly observed in complex relational environments, with relationship processes being involved not only in the generation and experience of sexual emotions, but also in their regulation. 22Sexual experience can be understood as an ER strategy that involves the dynamic interplay between cognitive, affective, and motivational responses.It is likely that partner variables, relationship processes, and the socio-relational context interact with these individual responses and eventually shape how sexual emotions are generated and regulated. 23As a result, the dysregulation of sexual emotions most likely constitutes a vulnerability factor for developing sexual problems. 24,25−29 In contrast, the relationship between ER and sexual function and satisfaction has received much less attention in research.
The present scoping review 30 addresses this gap in research.We chose the format of a scoping review for this review as this approach offers the possibility to provide a broad synthesis of the current state of the art rather than a critique of methodological issues or strength of the evidence.A more quantitative systematic review attempting to assess the quality of the available evidence may be premature at this time, given the heterogeneity in research designs and reporting standards in this field. 30 this review we investigated the relationship between ER and sexual function and satisfaction.Our aim was to identify and explore studies published to date, which have investigated the associations between ER and sexual health.The current review summarizes the current state-of-the-art of the literature regarding the associations between ER, and sexual functioning, disorders and satisfaction.We also provide an account of the methodology of ER research with respect to sexual health.

METHODS Inclusion and Exclusion Criteria
To be included in the scoping review, studies were required to fulfill the following criteria: (i) original empirical study; (ii) psychological and/or physiological assessment of emotion regulation; (iii) psychological or physiological assessment of sexual function and/or sexual satisfaction; (iv) participants aged 18 years or older, and (v) study published in English, Spanish, French, German or Portuguese (ie, the languages known by at least one of the authors).
The papers matching the inclusion criteria based on their title and abstract were then screened based on the following exclusion criteria: (i) studies not relating emotion regulation to sexual function or satisfaction and (ii) studies aiming at developing assessment instruments.

Databases Examined and Search Strategy
Studies were identified through searches in Cinahl, Lilacs, Scielo, Scopus, PsycInfo and Pubmed electronic databases.All searches were run in April 2021.An intersection of the search terms of the following groups was performed in all databases, group 1: emotion or emotion regulation and group 2: sexual function terms.No publication date limit was used.The search terms applied were: ("emotion regulation" (OR) "emotion") (AND) ("sexuality") OR ("sexual health")) OR ("sexual disorder") OR ("sexual dysfunction") OR "sexual problem" OR "sexual satisfaction").

Data Collection Process and Data Items
Articles were screened by title and abstract applying the eligibility criteria for inclusion.After excluding duplicate articles, exclusion criteria were applied reading the full-text of the remaining articles.Data extracted included the following: (i) first author and year of publication, (ii) study participant characteristics (sample size, mean age, gender, groups, clinical status), (iii) study design, (iv) methods of assessment of emotional state or ER, (v) clinical status, (vi) method of assessment of sexual function or sexual satisfaction, (vii) statistical analyses performed, and (viii) results.
See Figure 1 for the flow-chart summarizing the article inclusion process.

RESULTS
Twenty-seven articles matched the inclusion criteria and were included in the review.In terms of research design, 21 articles (77.7%) were observational, while six studies used an experimental and/or intervention design.Regarding the sample characteristics, nine studies were conducted with non-clinical participants, seven with participants with mental disorders, four with non-sexual clinical conditions, four with sexual disorders and three with victims of violence.Table 1 summarizes the information from the included articles.

Observational Studies
Non-Clinical Samples.Nine studies addressed the role of ER in non-clinical samples.With regards to effects on sexual distress in women, ER was found to mediate the relationship between anxiety sensitivity and psychological distress, with the mediation accounting for a large amount of the variance in psychological distress (51.3%), and anxiety sensitivity explaining a smaller proportion of the variance in ER (30.4%). 31Similarly, ER difficulties were associated with increased sexual dissatisfaction in women; however, such difficulties did not affect intimacy and affection expression. 32With regards to effects on sexual desire and arousal in men, a range of effects emerged.Anxiety sensitivity predicted sexual desire and was related to higher psychological distress. 33th in couples and single individuals, ER mediated the association between positive sexual outcomes and dispositional mindfulness -a quality of non-judgmental and present-focused awareness. 34,35Also, both men and women tended to accurately perceive their partners' sexual satisfaction, with emotion recognition being particularly important in cases where sexual communication was poor. 36Difficulties in identifying bodily sensations and labelling the emotional experience correlated with sexual difficulties in the sexual response cycle of both men and women (arousal, lubrication, orgasm, pain, erection and ejaculation). 37 summary, in non-clinical samples, difficulties in regulating emotions are associated with worse sexual health outcomes.These results hold for men and women, and across relationship status.
Sexual Disorders.Three studies examined the role of ER for sexual health in samples with various sexual disorders.One of the cross-sectional studies was conducted with a sample of women with different marital status 38 while the other included heterosexual couples. 39sconcellos et al. 38 assessed how self-compassion related to difficulties in ER and with self-reported sexual dysfunction.Women with self-reported sexual dysfunction, especially women with selfreported sexual pain showed lower self-compassion and more difficulties in ER than women without sexual problems.Dub e et al. 39 assessed ER strategies (emotional suppression and reappraisal) in heterosexual couples in which the women were diagnosed with female sexual interest and/or arousal disorder.In women greater emotional suppression was associated with greater depression and anxiety, and lower relationship satisfaction.In contrast, emotional reappraisal was associated with lower depression and anxiety, and fewer dyadic conflicts with their partners.Similarly, in men reporting greater emotional suppression, this was associated with increased depression, lower relationship satisfaction, and lower levels of sexual desire.In contrast, higher self-reports of emotional reappraisal were related to lower depression and anxiety, higher relationship satisfaction, fewer dyadic conflicts, and higher levels of sexual desire.The female partners of these men reported higher relationship satisfaction and fewer dyadic conflicts. 39 conclusion, for both genders, difficulties in ER and the predominant use of emotion suppression negatively impacted on sexual health.
Non-Sexual Clinical Conditions.Four studies analyzed the role of ER for sexual health in groups with a range of non-sexual clinical conditions (i.e., no sexual disorders).Two studies assessed women with vulvodynia, two studies with oncological samples.
With respect to studies including oncological patients or husbands of survivors, ER and communication difficulties cooccurred with sexual health difficulties.In a sample of prostate cancer participants, Wooten et al. 42 found that emotion-focused coping and threat appraisal mediated the relationship between sexual difficulties and mood disturbance.Emotion-focused coping to handle sexual distress resulted in poor psychological adjustment.Another study focusing on husbands of breast cancer survivors, showed that lower caregiving burden, higher marital satisfaction, and lower harm and/or threat appraisals were associated with better sexual quality of life.Importantly, ambivalence over emotional expression moderated the association between protective buffering and sexual quality of life. 43n summary, despite the range and specificities of the conditions included in these studies, overall negative emotions during sexual interactions, emotion-based rumination, emotion-focused coping and emotion dysregulation had a negative impact on sexual health and satisfaction.In contrast, emotion expression was positively related to sexual function and satisfaction both in oncological and in vulvovaginal patients.
Mental Conditions.Out of the 7 studies with participants with mental conditions, 2 were conducted with participants with anxiety or depressive disorders, 2 with post-traumatic stress disorder, 2 with a diagnosis of schizophrenia, and 1 with participants with eating disorders.Regarding medication-induced sexual dysfunction, and in accordance with the literature on side effects of selective serotonin reuptake inhibitors, there was an association between SSRI-induced sexual dysfunction and the blunting of emotions. 44In another study including anxious and depressive participants, a trans-diagnostic ER intervention showed improvements in quality of life, anxiety and depression symptomatology as well as improvements in sexual functioning. 45Opposed to these results are findings from a study with individuals presenting with comorbid post-traumatic stress disorder and tobacco use disorders, in which emotion dysregulation was not related to sexual function but negatively associated with sexual satisfaction.Emotional dysregulation independently explained sexual dissatisfaction even when controlling for anxiety sensitivity, negative affectivity, posttraumatic stress symptom severity, trauma type and daily smoking rate. 46 patients with a diagnosis of schizophrenia, Westheide et al. 47 assessed sexual impairment and emotion regulation in patients treated with quetiapine and risperidone.Participants on quetiapine reported less severe sexual impairment and better emotion regulation.Similarly, another study found that individual sexual activity and desire was associated with better emotional reactivity, cognitive functioning, motivation, psychomotricity and sensory perception. 48garding eating disorders, as compared with healthy controls, both clinical subgroups (anorexia nervosa and bulimia nervosa) reported higher scores in symptom severity, impulsiveness and emotion dysregulation.Comparing both clinical subgroups, and compared with the restricting subgroup, the binge-purging subgroup reported higher levels of emotion dysregulation than the restricting subgroup.When compared to the control group, eating disordered patients reported lower functioning in each Female Sexual Function Index subscale, with substantially lower levels of sexual functioning in the restricting as compared with the binge-purging group. 49 summary, ER difficulties are associated with impaired sexual health in groups with a range of mental disorders, either in terms of sexual function or sexual satisfaction.

Victims of Violence. Three studies addressed ER in victims
of violence (with a majority of women in these samples).Two studies included victims of childhood sexual abuse, while one study was conducted with spousal victims of intimate partner violence.With reference to childhood sexual abuse, victims may differ in their self-reported responses regarding the violence experienced, and their self-perception and sexuality in adulthood. 50urvivors of childhood sexual abuse involving touching only were at greater risk of reporting more negative sexual self-concept such as experiencing negative feelings during sex than were nonabused participants.Depending on the preferred ER strategies, the impact on psychological and sexual well-being also varies.Emotion-oriented coping strategies, ie, strategies aimed at managing negative emotional responses, have been shown to mediate outcomes related to a negative sexual self-concept (experience of negative feelings during sex.)Low levels of optimism, ie, the way individuals think and feel about their future, 51 mediated outcomes related to both, more negative sexual self-concept and high-risk sexual behaviors.Low levels of optimism may lead to a more negative sexual self-concept and greater engagement in risky sexual behaviors. 52Sexual satisfaction is positively correlated with emotion regulation abilities. 51nally, spousal victims of intimate partner violence showed more ER difficulties and sexual dissatisfaction than nonvictims. 53 conclusion, difficulties in ER were associated with impaired sexual health and lower satisfaction in victims of violence, with the degree of difficulties in psychological adaptation and with sexual health depending on the ER strategies used.
Experimental Studies.Six of the included studies used an experimental design.Four of these were laboratory experimental studies, 54−57 while two were group intervention experiments. 45,58nters et al. 54 conducted an experiment investigating factors affecting the ability to regulate sexual arousal (emotion reappraisal) while watching erotic and humorous videoclips.Sexual excitation, inhibition, and desire correlated with sexual arousal regulation success.Increased sexual excitation and desire were associated with poorer regulatory performance, whereas a propensity for sexual inhibition due to fear of performance consequences was related to regulatory success.Another study investigated the regulation of sexual arousal by means of attentional focus in healthy, sexually functional men and women.The findings showed an attenuation of sexual feelings by attentional focus, with stronger sexual feelings under the hot focus (emotion information) condition than under the cool focus (cognitive) condition.
Sarin et al 55 compared 3 groups (hypoactive sexual disorder, erectile dysfunction, healthy controls) on genital and selfreported arousal after watching a 15 minute film clip with neutral and erotic content.The healthy control group showed higher genital arousal than both clinical groups.Moreover, erectile dysfunction and hypoactive sexual disorder participants showed lower agreement between self-reported arousal and genital arousal compared with healthy control participants.The 2 clinical groups also differed from healthy control group participants in terms of lower sexual excitation and sexual attitudes, and higher body image self-consciousness and alexithymia.
Van Overveld and Borg 56 examined the effects of a brief ER training designed to enhance arousal levels during the presentation of sexual stimuli.Participants were trained in the up-regulation of affect using either a sexual arousal film (ie, femalefriendly erotic movie) or a threat arousal film clip (ie, horror movie), while control groups viewed the movie-clips without training instructions.Mood up-regulation enhanced arousal, suggesting that an ER training (increasing positive affect) may help with the management of affect-related sexual disorders.
With the aim to up-regulate sexual arousal and/or down-regulate disgust while watching pornography, a study 57 attempted to experimentally enhance sexual responses using instructions.As a result, up-regulation successfully enhanced feelings of sexual arousal, but this increase was not paralleled by reductions in feelings of disgust.Similarly, instructions to down-regulate successfully decreased disgust; however, this decrease was not paralleled by increases in sexual arousal.
Studies investigating the effects of multiple treatment sessions used a variety of intervention approaches and designs.A randomized intervention trial was conducted to enhance quality of life and sexual functioning in individuals with unipolar depressive disorder or anxiety disorder. 45The psychological intervention was based on the Unified Protocol (UP), a transdiagnostic treatment approach targeting symptoms associated with a range of emotional disorders. 59The UP was initially developed in response to high levels of comorbidity and the phenotypic overlap between emotional disorders while targeting the personality trait of neuroticism, ie, the tendency to experience frequent and intense negative affect, coupled with a perception of inadequate coping. 59,60he UP's main aims are to promote acceptance and a willingness attitude toward the experience of strong emotions to counter the processes that cause and maintain emotional disorders. 59,60Both intervention groups (UP group intervention + pharmacological treatment, and pharmacological treatment only group) showed significant improvements in quality of life, anxiety and depression.There were also improvements in sexual functioning with larger effects in the non-depressed group (d = 2.62) than in the depressed group (d = 1.04).Classen et al. 58 conducted a non-controlled trial to investigate the effects of a complex trauma intervention, consisting of an 8-week program using a multimodal treatment approach (inter-personal, psychodynamic, psycho-educational, cognitive-behavioral, creative arts, and somatically oriented groups) in a group of women with complex trauma.They found significant changes in posttraumatic stress disorder symptoms, dissociation, ER, interpersonal problems, sexual problems, alexithymia, and posttraumatic growth. 53 summary, the research on ER using experimental designs, applied to sexual health suggests that ER interventions, both using single experimental treatments as well as multiple session designs (8 and 14 weeks) resulted in positive outcomes, in participants with mental and sexual disorders.Participants with better use of ER strategies, and better sexual and mental health, showed better sexual response identification and more adaptive behaviors towards sexual function and satisfaction.

SUMMARY OF FINDINGS AND DISCUSSION
The present scoping review aimed at providing a better understanding of the relationship between ER and sexual function and satisfaction, and at identifying the mechanisms underlying such an association.The articles included in this review cover a heterogeneous spectrum of research designs and participants, including both clinical and non-clinical samples.
Overall, and independent of the clinical status of the samples, difficulties in ER were related to negative outcomes, both regarding functionality and satisfaction.Emotion dysregulation was associated with poorer sexual health outcomes both with respect to function 28 and sexual satisfaction. 46 this context, attention must be paid to the question of the direction of causality as it is likely that ER may causally contribute to sexual function and satisfaction, but the reverse may also be true.ER difficulties may be related to other variables contributing to sexual problems.For instance, emotion dysregulation can negatively affect the interpersonal connection with partners, 61,62 but this also applies to depression (affecting interpersonal relationships). 63In addition, and as can be seen from the variety of populations included in the reviewed studies (see the column diagnostic and/or symptomatology in the table), ER and emotion dysregulation do not exist in isolation and can be associated with a diversity of other factors (eg, health, relationship, communication).Importantly, and despite the heterogeneity of populations and variables investigated in previous research, a consistent pattern of poor ER associated with poorer sexual outcomes seems to emerge.
Among the articles that applied a mediation analysis, ER was found to mediate the relationship between dispositional mindfulness, and sexual health outcomes, 35 anxiety sensitivity, and psychological distress. 31rtners' emotion recognition abilities and negative emotions manifestations were important for dyadic adjustment, relational uncertainty and communication problems.This was found in patients with a diverse range of conditions as well as in non-clinical samples. 36,41,42 Tese results are in line with the literature, suggesting that relational elements in addition to individual processes have to be taken into account when working with individuals with sexual problems. 22garding mental health comorbidities, previous results from intervention studies have shown improvements in quality of life, Both men and women tended to be accurate in perceiving their partners' levels of sexual satisfaction.One sample t-tests indicated that men's perceptions of their partners' sexual satisfaction were biased such that they slightly underestimated their partners' levels of sexual satisfaction whereas women neither over-nor underestimated their partners' sexual satisfaction.However, the gender difference was not significant.Bias was attenuated by quality of sexual communication, which interacted with emotion recognition ability such that when sexual communication was good, there was no significant association between emotion recognition ability and bias, but when sexual communication was poor, better emotion recognition ability was associated with less bias.

ANOVA, Pearson correlations
Genital temperature increased for all groups during the erotic condition, yet men with ED and ED/ HSDD showed less GA than men without erectile difficulties.All groups increased in SA during the erotic condition, yet ED/HSDD men reported less SA than controls or ED men.SA and GA were highly correlated for controls, and less strongly correlated for clinical groups; men with ED showed low agreement between SA and GA.Groups also differed on body image, sexual inhibition/excitation, sexual attitudes and (continued)  sexual functioning, decreased anxiety, depression and post-traumatic stress disorder. 45,58 his is supported by the notion that couples' sexual problems should be addressed focusing on the emotional life of the couple and on the ER abilities of each individual, supporting the notion that ER training may help in the management of affect-related sexual disorders. 56,64 uch ER management may facilitate sexual activity, and as observed during the COVID-19 pandemic, sexual activity may help to prevent or alleviate psychological distress and have a positive effect on relational and sexual health. 65deed, the findings from the experimental studies support the application of current ER models (eg, Gross' model) to sexual health.−57 Based on this review we suggest that new intervention studies should be conducted applying existing, adjusted or newly designed emotion regulation-based interventions for sexual health difficulties.It stands to reason that particularly ER interventions should be investigated further, which have already shown promise in the treatment of the mental health comorbidities associated with sexual dysfunctions. 15,59,66 Tate, and despite the few randomized controlled trials of ER interventions for sexual health, studies like the de Ornelas Maia 45 show promising results for the use of trans-diagnostic approaches, for instance the Unified Protocol, which encompasses psychoeducational components of emotions as well as strategies to cope with them.In addition, a recent systematic review on mindfulness meditation-based interventions for sexual dysfunctions 67 suggests positive effects, despite methodological weaknesses of the studies included in the review (eg, patient selection, small sample sizes, complex interventions and lack of homework assessment.In line with this finding, mindfulnessbased and acceptance interventions have been proposed for prostate cancer survivors. 68Mindfulness-based approaches may enhance ER capacity, as they reinforce being in the present moment and to not suppress any emotion or intrusive and/or uncontrollable thoughts.
As this scoping review shows, research on ER and sexual health has developed in the past few years with the vast majority of included studies being published since 2012.
Considering the application of the biopsychosocial model to the area of sexual health, and the necessity for trans-diagnostic approaches, we would expect the number of well-designed studies in this area to grow further in the next few years.These studies should include constructs not considered in the present review, which partially overlap with ER, such as alexithymia and emotion-related impulsivity traits (ie, urgency, see Billieux, 2017). 13ile broad in scope the present review provides a first summary of the state of the art regarding the role and importance of ER for sexual function and satisfaction.As previously suggested, more research is needed to investigate how the regulation of emotion is associated with sexual (dys-)function and distress. 22We feel it is important to acknowledge (i) the need for more research on the role of ER in the development and maintenance of sexual disorders and (ii) the need for randomized controlled trials investigating the efficacy of sex therapy interventions including emotion regulation-based interventions in the management of sexual health problems.

Table 1 .
Summary of included articles ordered by year of publication.