{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:04:37Z","timestamp":1785409477875,"version":"3.56.0"},"reference-count":119,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["10960102310035"],"award-info":[{"award-number":["10960102310035"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"award":["10960102310035"],"award-info":[{"award-number":["10960102310035"]}],"id":[{"id":"https:\/\/ror.org\/01yaj9a77","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Existential, spiritual, and religious themes often evoke strong emotions in therapy, yet little is known about how clients\u2019 emotion regulation relates to these aspects. Spiritual psychotherapy for inpatient residential and intensive treatment (SPIRIT) integrates meaning in life within a cognitive-behavioral treatment (CBT) framework in acute and intensive mental health care and provides an appropriate context for examining this. This qualitative study explores: (1) clients\u2019 beliefs about expressing, managing, or suppressing emotions related to meaning in life, spirituality, or religion (MSR); (2) how emotion regulation strategies (e.g., reappraisal, acceptance, and distress tolerance) are influenced by addressing MSR in therapy; and (3) whether engaging with MSR activates emotion regulation mechanisms for clients\u2019 experienced distress. We analyzed 118 client evaluation forms and 19 semi-structured client interviews using a thematic approach informed by emotion regulation theory. SPIRIT-CBT made implicit beliefs about (MSR-related) emotion regulation explicit, and group interactions sometimes led to changes. Clients showed various regulation strategies, for example: MSR-based reappraisal, connectedness, reflection, and positive refocusing. However, emotional tension and suppression were also reported. Particularly from the interviews, it emerged that the therapy facilitated regulation mechanisms, including narrative processing, perspective shifting, sense-making, and social belonging. Focusing on MSR and existential themes addresses an important gap in mental health care and may contribute to supporting clients\u2019 emotional recovery and overall well-being.<\/jats:p>","DOI":"10.3390\/bs16050685","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:32:21Z","timestamp":1777555941000},"page":"685","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cSo Much Comes Up\u201d: Emotion Regulation in Psychotherapy Addressing Existential, Spiritual and Religious Themes"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7584-3211","authenticated-orcid":false,"given":"Joke C.","family":"van Nieuw Amerongen","sequence":"first","affiliation":[{"name":"School of Religion and Theology, Faculty of Social Sciences and Humanities, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands"},{"name":"Center for Research and Innovation in Christian Mental Health Care, 3871 MR Hoevelaken, The Netherlands"},{"name":"Eleos Mental Health Care, 3871 MR Hoevelaken, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolien","family":"van Stam","sequence":"additional","affiliation":[{"name":"Eleos Mental Health Care, 3871 MR Hoevelaken, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Mieke","family":"Romkes-Bart","sequence":"additional","affiliation":[{"name":"Eleos Mental Health Care, 3871 MR Hoevelaken, The Netherlands"},{"name":"Dimence Mental Health Care, 8043 RR Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1460-6201","authenticated-orcid":false,"given":"Arjan W.","family":"Braam","sequence":"additional","affiliation":[{"name":"Department of Acute Psychiatry, Altrecht Mental Health Care, 3512 PG Utrecht, The Netherlands"},{"name":"Department of Humanist Chaplaincy Studies, University of Humanistic Studies, 3512 HD Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke","family":"Schaap-Jonker","sequence":"additional","affiliation":[{"name":"School of Religion and Theology, Faculty of Social Sciences and Humanities, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands"},{"name":"Center for Research and Innovation in Christian Mental Health Care, 3871 MR Hoevelaken, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8405-2198","authenticated-orcid":false,"given":"Bart","family":"van den Brink","sequence":"additional","affiliation":[{"name":"GGz Centraal, 3818 EW Amersfoort, The Netherlands"},{"name":"Department of Practical Theology, Theological University Apeldoorn, 7316 BT Apeldoorn, The Netherlands"},{"name":"University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","unstructured":"Akwa GGz (2023). 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