Towards an Integrative Framework of Self-Regulation: A Scoping Review on the Interplay Between Emotion Regulation, Executive Functions and Decision-Making in Clinical Populations.

Background/Objective: Emotion regulation (ER) is closely linked to decision-making (DM). Although executive functions (EF) are often suggested as a key mechanism underlying this relationship, evidence from different clinical conditions remains fragmented. This scoping review aims to map the literature on the relationship between ER and DM in clinical populations, with a specific focus on the interaction between EF and ER in shaping adaptive DM processes, particularly in populations characterised by cognitive impairment and emotional dysregulation. Methods: A search of electronic databases was conducted to identify empirical studies examining ER, EF and DM in clinical populations. Sixteen studies involving patients with dementia, traumatic brain injury, autism spectrum disorder, substance and behavioural addictions were included. Results: Difficulties in ER were associated with altered DM. EF, particularly inhibitory control, working memory, and cognitive flexibility, were found to be key processes linking emotional states to decision outcomes. Clinical groups consistently showed a tendency to prefer immediate rewards despite potential long-term negative consequences and experienced difficulties integrating emotional and cognitive information. Conclusions: This scoping review emphasises the importance of moving beyond reductionist explanations of DM and to adopt an integrative approach. ER and EF should be conceptualised as interacting components of a broader self-regulatory system shaping decision behaviour. Developing this framework will be crucial to enable targeted clinical and neurorehabilitation interventions for individuals experiencing impaired DM.