Impaired emotion regulation in schizophrenia: evidence from event-related potentials

Neuroleptic-free youth at ultrahigh risk for psychosis evidence diminished emotion reactivity that is predicted by depression and anxiety

Although abnormalities in emotional response have long been considered a core feature of the chronic phase of schizophrenia, few investigations have examined emotional response in individuals at ultrahigh-risk (UHR) for psychosis. We investigated whether neuroleptic-free UHR (n=29) and healthy control (n=32) participants differed in emotional reactivity and emotion regulation on a laboratory-based task that required reporting levels of positive and negative affect to pleasant, unpleasant, and neutral stimuli. Results indicated that the UHR group evidenced reduced emotional reactivity, including decreased positive emotion to pleasant stimuli and decreased negative emotion to unpleasant stimuli. Furthermore, within the UHR group, attenuated positive emotion to pleasant stimuli was associated with greater severity of depression and anxiety. There were no group differences in self-reported emotion regulation effectiveness to unpleasant or pleasant stimuli. Findings suggest that UHR youth display a profile of emotional experience abnormalities that differs from the chronic phase of illness, which can be characterized as reduced positive emotion reactivity to pleasant stimuli (i.e., anhedonia) that may be driven by mood and anxiety symptoms.

Self-Report and Brain Indicators of Impaired Emotion Regulation in the Broad Autism Spectrum

Although not used as a diagnostic criterion, impaired emotion regulation is frequently observed in autism. The present study examined self-reported use of emotion regulation strategies in individuals scoring low or high on autistic traits. In addition, the late positive potential, which is sensitive to emotional arousal, was used to examine the effect of one strategy, reappraisal. Reporting more autistic traits was related to using more maladaptive and fewer adaptive emotion regulation strategies. Across both groups, no attenuation of the late positive potential during downregulation of unpleasant pictures was found, possibly because of the used valence-changing reappraisal operationalisation. Hence, although self-report indicated impaired emotion regulation in individuals high on autistic traits, electrophysiological findings could not confirm this.

Electrophysiological evidence for detrimental impact of a reappraisal emotion regulation strategy on subsequent cognitive control in schizophrenia

In healthy individuals, there is evidence that effective implementation of an emotion regulation strategy has beneficial effects on temporally proximal cognitive control task performance. This effect occurs because both of these processes rely heavily on the prefrontal cortex. Individuals with schizophrenia (SZ) have impairments in both emotion regulation and cognitive control that are driven by structural and functional abnormalities of the prefrontal cortex; however, it is unknown whether emotion regulation attempts fail to benefit subsequently performed cognitive control tasks in people with SZ. The present study examined whether attempts to increase or decrease negative emotion via reappraisal have differential effects on subsequent cognitive control in a sample of outpatients diagnosed with SZ (n = 30) and demographically matched healthy controls (CN; n = 29). Participants completed a combined emotion regulation and cognitive control task in which numerical Stroop trials were presented immediately after unpleasant or neutral images that were either increased via reappraisal, decreased via reappraisal, or passively viewed. The electroencephalogram was recorded while participants performed the reappraisal-Stroop task and event related potentials (ERPs) were used to index emotion regulation effectiveness (late positive potential: LPP) and cognitive control (sustained potential: SP). Both CN and SZ evidenced higher LPP amplitude for unpleasant than neutral stimuli consistent with robust neural response to unpleasant stimuli. Although CN demonstrated neurophysiological evidence of effective use of reappraisal to increase and decrease negative emotion, SZ only showed an effective ability to increase negative emotion via reappraisal. CN displayed enhanced cognitive control following increase trials and impaired cognitive control following decrease trials, as indicated by modulation of SP amplitude. In SZ, increase instructions impaired cognitive control and decrease instructions had no effect on cognitive control. Findings suggest that emotion regulation abnormalities may play an underrecognized role in general cognitive control deficits that occur in SZ. (PsycINFO Database Record

Do cognitive deficits predict negative emotionality and aggression in schizophrenia?

Schizophrenia is associated with an elevated risk of aggression. Cognitive deficits have been associated with inpatient aggression and future violence. The relationship between cognitive deficits and violent behavior has however been inconsistent across studies. In addition, studies have failed to inform how cognitive deficits may contribute to aggression in schizophrenia. The current study examined the association of cognitive deficits with schizophrenia-related aggression and violent offending. It also explored the putative mediating role of negative emotionality on the impact of cognitive deficits on aggression. People with schizophrenia and schizoaffective disorder (N = 78) were recruited from a state hospital. Participants were classified based on their history of violent offending. Participants completed measures of cognition, symptoms, and aggression. Deficits in working memory, reasoning/problem-solving, and verbal learning were the most prioritized for the prediction of violent offender status. Violent offenders demonstrated greater impairments in most cognitive domains especially working memory and verbal learning. Offenders also demonstrated greater negative emotionality, excitement/agitation, and incidents of verbal and physical aggression. Negative emotionality and excitement/agitation fully transmitted the effect of cognitive deficits on impulsive aggression in meditational models. Cognitive deficits increase the risk of impulsive aggression in schizophrenia via inefficient regulation of negative affective states.

Diminished Hedonic response in neuroleptic-free youth at ultra high-risk for psychosis

Hedonic response is preserved in schizophrenia. However, it is unclear whether this is also true in individuals meeting criteria for “prodromal” psychosis, who are considered to be at symptomatic high risk for developing the disorder. In this study, we examined neurophysiological and self-reported response to emotional stimuli in UHR (n = 23) and healthy control (CN: n = 30) participants who passively viewed pleasant, unpleasant, and neutral images for 500 ms while the electroencephalogram was recorded and then provided self-reports of valence and arousal to the stimuli. The Late Positive Potential (LPP) event related potential (ERP) component was used as a neurophysiological marker of emotional reactivity. Results indicated that CN participants had higher LPP amplitude for pleasant and unpleasant compared to neutral stimuli; however, UHR youth displayed no differences in LPP amplitude among pleasant, unpleasant, and neutral stimuli. Self-report data mirrored neurophysiological data, as UHR youth had lower reports of positive emotion to pleasant stimuli and negative emotion to unpleasant stimuli compared to CN participants. Furthermore, the presence of a mood disorder diagnosis predicted reduced neurophysiological emotional reactivity in UHR youth.

Findings suggest that youth at UHR for psychosis display diminished subjective and neurophysiological reactivity to emotional stimuli, and that symptoms of depression may result in diminished emotional reactivity.

Is Schizophrenia a Disorder of Consciousness? Experimental and Phenomenological Support for Anomalous Unconscious Processing

Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients' conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and conscious level. We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness.

The sound and the fury: Late positive potential is sensitive to sound affect

Emotion is an emergent construct of multiple distinct neural processes. EEG is uniquely sensitive to real-time neural computations, and thus is a promising tool to study the construction of emotion. This series of studies aimed to probe the mechanistic contribution of the late positive potential (LPP) to multimodal emotion perception. Experiment 1 revealed that LPP amplitudes for visual images, sounds, and visual images paired with sounds were larger for negatively rated stimuli than for neutrally rated stimuli. Experiment 2 manipulated this audiovisual enhancement by altering the valence pairings with congruent (e.g., positive audio + positive visual) or conflicting emotional pairs (e.g., positive audio + negative visual). Negative visual stimuli evoked larger early LPP amplitudes than positive visual stimuli, regardless of sound pairing. However, time frequency analyses revealed significant midfrontal theta-band power differences for conflicting over congruent stimuli pairs, suggesting very early (∼500 ms) realization of thematic fidelity violations. Interestingly, late LPP modulations were reflective of the opposite pattern of congruency, whereby congruent over conflicting pairs had larger LPP amplitudes. Together, these findings suggest that enhanced parietal activity for affective valence is modality independent and sensitive to complex affective processes. Furthermore, these findings suggest that altered neural activities for affective visual stimuli are enhanced by concurrent affective sounds, paving the way toward an understanding of the construction of multimodal affective experience.

Autonomic Regulation and Auditory Hallucinations in Individuals With Schizophrenia: An Experience Sampling Study

Auditory Hallucinations (AH) cause substantial suffering and dysfunction, yet remain poorly understood and modeled. Previous reports have linked AH to increases in negative emotions, suggesting a role for the autonomic nervous system (ANS) in underlying this link. Employing an Experience Sampling Method (ESM) approach, 40 individuals with schizophrenia completed a 36-hour ambulatory assessment of AH and cardiac autonomic regulation. Participants carried mobile electronic devices that prompted them to report 10 times/d the severity of their momentary AH, along with a Holter monitor that continuously recorded their cardiac autonomic regulation. The clocks of the devices and monitors were synchronized, allowing for high time-resolution temporal linking of the AH and concurrent autonomic data. Power spectral analysis was used to determine the relative vagal (parasympathetic) contribution to autonomic regulation during 5 minutes prior to each experience sample. The participants also completed interview-based measures of AH (SAPS; PSYRATS). The ESM-measured severity of AH was significantly correlated with the overall SAPS-indexed AH severity, along with the PSYRATS-indexed AH frequency, duration, loudness, degree of negative content, and associated distress. A mixed-effect regression model indicated that momentary increases in autonomic arousal, characterized by decreases in vagal input, significantly predicted increases in ESM-measured AH severity. Vagal input averaged over the 36-hour assessment displayed a small but significant inverse correlation with the SAPS-indexed AH. The results provide preliminary support for a link between ANS regulation and AH. The findings also underscore the highly dynamic nature of AH and the need to utilize high time-resolution methodologies to investigate AH.

Do people with schizophrenia experience more negative emotion and less positive emotion in their daily lives? A meta-analysis of experience sampling studies

Research on emotion experience in response to valenced stimuli has consistently shown that people with schizophrenia have the capacity to experience emotion. Specifically, people with schizophrenia report similar experiences to both positive and negative emotion-eliciting stimuli as individuals without the disorder. However, it is less clear if people with schizophrenia experience similar levels of positive emotion and negative emotion outside of standardized laboratory contexts, as in their daily lives. One reliable method for assessing emotion experience in schizophrenia has been the Experience Sampling Method (ESM), or Ecological Momentary Assessment (EMA). Using the PRISMA guidelines for meta-analysis, we reviewed the literature for all studies that included people with and without schizophrenia, and that included a positive or negative emotion assessment during participants' daily lives. The current study is a meta-analysis of 12 EMA studies of emotion experience, which included a total of 619 people with schizophrenia and 730 healthy controls. Results indicate that people with schizophrenia consistently report more negative and less positive emotion than healthy control participants. These findings differ from laboratory-based studies, which may be due to several factors, including environmental differences, effects of the disorder that appear more clearly in daily life, or additional concerns, such as depression, which has been shown to be related to negative emotion in schizophrenia. Importantly, these findings are in line with questionnaire-based measures of emotion experience, lending some support for their use in research and clinical settings.

The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis

BACKGROUND

Social functioning (SF) difficulties are ubiquitous among individuals at clinical high risk for psychosis (CHR), but it is not yet clear why. One possibility is suggested by the observation that effective SF requires adaptive emotion awareness and regulation. Previous reports have documented deficits in emotion awareness and regulation in individuals with schizophrenia, and have shown that such deficits predicted SF. However, it is unknown whether these deficits are present prior to the onset of psychosis or whether they are linked to SF in CHR individuals.

METHOD

We conducted a cross-sectional comparison of emotion awareness and regulation in 54 individuals at CHR, 87 with schizophrenia and 50 healthy controls (HC). Then, within the CHR group, we examined links between emotion awareness, emotion regulation and SF as indexed by the Global Functioning Scale: Social (Cornblatt et al. 2007).

RESULTS

Group comparisons indicated significant differences between HC and the two clinical groups in their ability to identify and describe feelings, as well as the use of suppression and reappraisal emotion-regulation strategies. Specifically, the CHR and schizophrenia groups displayed comparable deficits in all domains of emotion awareness and emotion regulation. A hierarchical multiple regression analysis indicated that difficulties describing feelings accounted for 23.2% of the SF variance.

CONCLUSIONS

The results indicate that CHR individuals display substantial emotion awareness and emotion-regulation deficits, at severity comparable with those observed in individuals with schizophrenia. Such deficits, in particular difficulties describing feelings, predate the onset of psychosis and contribute significantly to poor SF in this population.

Deficits in attentional processing of fearful facial expressions in schizophrenic patients

Impaired attentional processing of negative facial expressions is prominent in schizophrenia and has been shown to be associated with patients’ social dysfunctions. However, little is known about when and which specific attention deficits influence social functions. Given the dynamic feature of attention, it is necessary to investigate the attention deficits in negative emotional processing unfolding in time. The current study used event-related potentials (ERPs) to investigate the temporal dynamics of attention deficits in emotion perception and their potential relationship with emotional/social impairments in neuroleptic naive schizophrenic patients. Two specific attention deficits were identified and were found to be associated with emotional/social impairments. More specifically, the deficit in orienting attention (evidenced with the reduced P1 amplitude) was correlated with expressive deficits, while the deficit in executive control of attention (evidenced with the reduced P3 amplitude) was correlated with avolition/asociality. Together, these findings may provide novel insights into the core pathophysiological processes and offer objective biomarkers for specific emotional/social impairments in schizophrenia. It is also hoped that this study helps to bridge the gap between basic cognitive deficits and relative high-level social dysfunctions in schizophrenic patients.

A Review of Anticipatory Pleasure in Schizophrenia

PURPOSE OF REVIEW

Anhedonia, traditionally defined as a diminished capacity to experience pleasure, has long been considered a core symptom of schizophrenia. However, recent research calls into question whether individuals with schizophrenia are truly anhedonic, suggesting intact subjective and neurophysiological response to rewarding stimuli in-the-moment. Despite a presumably intact capacity to experience pleasure, people with schizophrenia still engage in fewer reward-seeking behaviors. This discrepancy has been explained as a dissociation between "liking" and "wanting", with dopaminergic and prefrontal influences on incentive salience leading hedonic responses to not effectively translate into motivated behavior. In the current review, the literature on a key aspect of the wanting deficit is reviewed, anticipatory pleasure.

RECENT FINDINGS

Results provide consistent evidence for impairment in some aspects of anticipatory pleasure (e.g., prospection, associative learning between reward predictive cues and outcomes), and inconsistent evidence for others (e.g., anticipatory affect and affective forecasting).

SUMMARY

Mechanisms underlying anticipatory pleasure abnormalities in schizophrenia are discussed and a new model of anticipatory pleasure deficits is proposed. Findings suggest that anticipatory pleasure may be a critical component of impairments in wanting that impact motivated behavior in schizophrenia.

Neurophysiological responses to unpleasant stimuli (acute electrical stimulations and emotional pictures) are increased in patients with schizophrenia

Patients with schizophrenia have often been described as insensitive to nociceptive signals, but objective evidence is sparse. We address this question by combining subjective behavioral and objective neurochemical and neurophysiological measures. The present study involved 21 stabilized and mildly symptomatic patients with schizophrenia and 21 control subjects. We applied electrical stimulations below the pain threshold and assessed sensations of pain and unpleasantness with rating scales, and Somatosensory Evoked Potentials (SEPs/EEG). We also measured attention, two neurochemical stress indices (ACTH/cortisol), and subjective VEPs/EEG responses to visual emotional stimuli. Our results revealed that, subjectively, patients’ evaluations do not differ from controls. However, the amplitude of EEG evoked potentials was greater in patients than controls as early as 50 ms after electrical stimulations and beyond one second after visual processing of emotional pictures. Such responses could not be linked to the stress induced by the stimulations, since stress hormone levels were stable. Nor was there a difference between patients and controls in respect of attention performance and tactile sensitivity. Taken together, all indices measured in patients in our study were either heightened or equivalent relative to healthy volunteers.

Distinct patterns of dysfunctional appetitive and aversive motivation in bipolar disorder versus schizophrenia: An event-related potential study

Schizophrenia and bipolar disorder are associated with different clinical profiles of disturbances in motivation, yet few studies have compared the neurophysiological correlates of such disturbances. Outpatients with schizophrenia (n = 34), or bipolar disorder I (n = 33), and healthy controls (n = 31) completed a task in which the late positive potential (LPP), an index of motivated attention, was assessed along motivational gradients determined by apparent distance from potential rewards or punishments. Sequences of cues signaling possible monetary gains or losses appeared to loom progressively closer to the viewer; a reaction time (RT) task after the final cue determined the outcome. Controls showed the expected pattern with LPPs for appetitive and aversive cues that were initially elevated, smaller during intermediate positions, and escalated just prior to the RT task. The clinical groups showed different patterns in the final positions just prior to the RT task: the bipolar group's LPPs to both types of cues peaked relatively early during looming sequences and subsequently decreased, whereas the schizophrenia group showed relatively small LPP escalations, particularly for aversive cues. These distinct patterns suggest that the temporal unfolding of attentional resource allocation for motivationally significant events may qualitatively differ between these disorders. (PsycINFO Database Record

Pain empathy in schizophrenia: an fMRI study

Although it has been proposed that schizophrenia is characterized by impaired empathy, several recent studies found intact neural responses on tasks measuring the affective subdomain of empathy. This study further examined affective empathy in 21 schizophrenia outpatients and 21 healthy controls using a validated pain empathy paradigm with two components: (i) observing videos of people described as medical patients who were receiving a painful sound stimulation treatment; (ii) listening to the painful sounds (to create regions of interest). The observing videos component incorporated experimental manipulations of perspective taking (instructions to imagine 'Self' vs 'Other' experiencing pain) and cognitive appraisal (information about whether treatment was 'Effective' vs 'Not Effective'). When considering activation across experimental conditions, both groups showed similar dorsal anterior cingulate cortex (dACC) and anterior insula (AI) activation while merely observing others in pain. However, there were group differences associated with perspective taking: controls showed relatively greater dACC and AI activation for the Self vs Other contrast whereas patients showed relatively greater activation in these and additional regions for the Other vs Self contrast. Although patients demonstrated grossly intact neural activity while observing others in pain, they showed more subtle abnormalities when required to toggle between imagining themselves vs others experiencing pain.

Electrophysiological Correlates of Aberrant Motivated Attention and Salience Processing in Unaffected Relatives of Schizophrenia Patients

Patients with schizophrenia (SCZ) exhibit debilitating deficits in attention and affective processing, which are often resistant to treatment and associated with poor functional outcomes. Impaired orientation to task-relevant target information has been indexed by diminished P3b event-related potentials in patients, as well as their unaffected first-degree relatives, suggesting that P3b may be a vulnerability marker for schizophrenia. Despite intact affective valence processing, patients are unable to employ cognitive change strategies to reduce electrophysiological responses to aversive stimuli. Less is known about the attentional processing of emotionally salient task-irrelevant information in patients and unaffected first-degree relatives. The goal of the present study was to examine the neural correlates of salience processing, as indexed by the late positive potential (LPP), during the processing of emotionally salient distractor stimuli in 31 patients with SCZ, 28 first-degree relatives, and 47 control participants using an oddball paradigm. Results indicated that despite intact novelty detection (P3a), both SCZ and first-degree relatives demonstrated deficiencies in attentional processing, reflected in attenuated target-P3b, and aberrant motivated attention, with reduced early-LPP amplitudes for aversive stimuli relative to controls. First-degree relatives revealed a unique enhancement of the late-LPP response, possibly underlying an exaggerated evaluation of salient information and a compensatory engagement of neural circuitry. Furthermore, reduced early-LPP and target-P3b amplitudes were associated with enhanced symptom severity. These findings suggest that, in addition to P3b, LPP may be useful for monitoring clinical state. Future studies will explore the value of P3 and LPP responses as vulnerability markers for early detection and prediction of psychopathology.

Social cognition in schizophrenia

Individuals with schizophrenia exhibit impaired social cognition, which manifests as difficulties in identifying emotions, feeing connected to others, inferring people's thoughts and reacting emotionally to others. These social cognitive impairments interfere with social connections and are strong determinants of the degree of impaired daily functioning in such individuals. Here, we review recent findings from the fields of social cognition and social neuroscience and identify the social processes that are impaired in schizophrenia. We also consider empathy as an example of a complex social cognitive function that integrates several social processes and is impaired in schizophrenia. This information may guide interventions to improve social cognition in patients with this disorder.

A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia

Cognitive remediation has proven efficacy for improving neurocognition in people with schizophrenia. The current study evaluated the benefits of cognitive remediation on neurocognition, functioning, psychotic symptoms, and aggression in a sample of forensic and mental health patients. Care recipients with schizophrenia or schizoaffective disorder (N = 78) receiving services in the forensic and mental health units of a state hospital were randomized to participate in cognitive remediation versus computer games control activities. Participants' neurocognition, functional capacity, experiential recovery, psychotic symptoms, and aggression incidents were assessed at baseline and posttreatment. Cognitive remediation was associated with improvements in several neurocognitive domains and circumscribed domains of functional capacity. People assigned to cognitive remediation experiences greater reductions in negative symptoms, agitation/excitement, and verbal and physical aggression. In addition to improving neurocognition in long-term hospitalized forensic and mental health patients, cognitive remediation may enhance efforts at reducing negative symptoms, emotion dysregulation, and aggression incidents. Forensic settings may represent a new frontier for the clinical dissemination of cognitive remediation.

Prevention of homicidal behaviour in men with psychiatric disorders

OBJECTIVES

Homicide is overwhelmingly committed by men compared to women. Conservative estimates suggest that more than a third of these individuals have a treatable psychiatric disorder. These data present an opportunity to mental health clinicians to assist in the prevention of homicide by improving men's mental health.

METHODS

We review the current literature on men's mental health with a focus on assessing and reducing homicide risk in men with psychiatric conditions.

RESULTS

Bipolar disorder and schizophrenia appear to share a neural endophenotype that is a risk factor for homicide. Dual disorders, or the presence of a substance use disorder with other major mental illness, are a major risk factor for homicide in males. Dual diagnosis disorders, personality disorders and pathological traits and male depression share emotion dysregulation, irritability, and reactive aggression. Promoting physician education, addressing firearm safety, reducing the reluctance of men relative to women to engage in help-seeking behaviour, and using targeted risk interviews which integrate these data are all currently recommended.

CONCLUSIONS

The main focus in prevention of homicidal behaviour in males with psychiatric disorders should be to identify high risk groups, to provide adequate treatment, and to facilitate compliance with long-term treatment while considering male specific problems and needs.

Perceived emotional intelligence is impaired and associated with poor community functioning in schizophrenia and bipolar disorder

Schizophrenia and bipolar disorder have been associated with shared and distinct emotion processing abnormalities. Initial findings indicate that these disorders differ with respect to the domain of emotional intelligence (EI). Individuals with schizophrenia display deficits on performance measures of EI, whereas those with bipolar disorder do not. However, no research has examined patients' subjective beliefs about their own EI (referred to as "perceived EI"). This study examined perceived EI, assessed with the Trait Meta-Mood Scale (TMMS), and its clinical and functional correlates in outpatients with schizophrenia (n=35) or bipolar disorder I (n=38) and matched healthy controls (n=35). The TMMS includes three subscales that assess beliefs about one's ability to attend to (Attention to Feelings), understand (Clarity of Feelings), and repair emotions (Mood Repair). Participants in the clinical groups also completed community functioning and symptom assessments. Both clinical groups reported significantly lower perceived EI than controls, but did not differ from each other. Higher total TMMS correlated with higher levels of independent living in the schizophrenia group (r=.36) and better social functioning in the bipolar group (r=.61). In addition, although higher Attention to Feelings scores correlated with greater psychiatric symptoms in the schizophrenia group, higher scores across all subscales correlated with less manic symptoms in the bipolar group. The findings suggest that perceived EI is impaired and related to community functioning in both disorders.

Structure and correlates of self-reported empathy in schizophrenia

Research on empathy in schizophrenia has relied on dated self-report scales that do not conform to contemporary social neuroscience models of empathy. The current study evaluated the structure and correlates of the recently-developed Questionnaire of Cognitive and Affective Empathy (QCAE) in schizophrenia. This measure, whose structure and validity was established in healthy individuals, includes separate scales to assess the two main components of empathy: Cognitive Empathy (assessed by two subscales) and Affective Empathy (assessed by three subscales). Stable outpatients with schizophrenia (n = 145) and healthy individuals (n = 45) completed the QCAE, alternative measures of empathy, and assessments of clinical symptoms, neurocognition, and functional outcome. Exploratory and confirmatory factor analyses provided consistent support for a two-factor solution in the schizophrenia group, justifying the use of separate cognitive and affective empathy scales in this population. However, one of the three Affective Empathy subscales was not psychometrically sound and was excluded from further analyses. Patients reported significantly lower Cognitive Empathy but higher Affective Empathy than controls. Among patients, the QCAE scales showed significant correlations with an alternative self-report empathy scale, but not with performance on an empathic accuracy task. The QCAE Cognitive Empathy subscales also showed significant, though modest, correlations with negative symptoms and functional outcome. These findings indicate that structure of self-reported empathy is similar in people with schizophrenia and healthy subjects, and can be meaningfully compared between groups. They also contribute to emerging evidence that some aspects of empathy may be intact or hyper-responsive in schizophrenia.

Daily life evidence of environment-incongruent emotion in schizophrenia

Researchers have recently hypothesized that negative emotion in positive situations may be one mechanism for understanding emotion dysfunction in schizophrenia. Using ecological momentary assessment, we examined the relationship between emotion experience and environmental context in the daily lives of participants with and without schizophrenia. Participants with (n=47) and without schizophrenia (n=41) were provided a cellular telephone and called four times a day for one week. During each call participants rated their emotion experiences, described their current activities, and rated enjoyment from those activities. In line with previous research, participants with schizophrenia reported higher negative emotion overall relative to participants without schizophrenia, but equivalent levels of positive emotion and activity enjoyment. In line with the environment-incongruent negative emotion hypothesis, participants with schizophrenia evidenced a weaker relationship between reported enjoyment of current activities and current negative emotion compared to participants without schizophrenia. In addition, lower neurocognition predicted this weak relationship between negative emotion and context in the schizophrenia group. These findings provide ecologically valid support for environment-incongruent negative emotion in schizophrenia, and suggest that people with schizophrenia with more impaired neurocognition may have more difficulties regulating negative emotion.

Emotion regulation abnormalities in schizophrenia: Directed attention strategies fail to decrease the neurophysiological response to unpleasant stimuli

Previous research provides evidence that individuals with schizophrenia (SZ) have emotion regulation abnormalities, particularly when attempting to use reappraisal to decrease negative emotion. The current study extended this literature by examining the effectiveness of a different form of emotion regulation, directed attention, which has been shown to be effective at reducing negative emotion in healthy individuals. Participants included outpatients with SZ (n = 28) and healthy controls (CN: n = 25), who viewed unpleasant and neutral images during separate event-related potential and eye-movement tasks. Trials included both passive viewing and directed attention segments. During directed attention, gaze was directed toward highly arousing aspects of an unpleasant image, less arousing aspects of an unpleasant image, or a nonarousing aspect of a neutral image. The late positive potential (LPP) event-related potential component indexed emotion regulation success. Directing attention to nonarousing aspects of unpleasant images decreased the LPP in CN; however, SZ showed similar LPP amplitude when attention was directed toward more or less arousing aspects of unpleasant scenes. Eye tracking indicated that SZ were more likely than CN to attend to arousing portions of unpleasant scenes when attention was directed toward less arousing scene regions. Furthermore, pupilary data suggested that SZ patients failed to engage effortful cognitive processes needed to inhibit the prepotent response of attending to arousing aspects of unpleasant scenes when attention was directed toward nonarousing scene regions. Findings add to the growing literature indicating that individuals with SZ display emotion regulation abnormalities and provide novel evidence that dysfunctional emotion-attention interactions and generalized cognitive control deficits are associated with ineffective use of directed attention strategies to regulate negative emotion. (PsycINFO Database Record

Approach and withdrawal motivation in schizophrenia: an examination of frontal brain asymmetric activity

Although motivational disturbances are common in schizophrenia, their neurophysiological and psychological basis is poorly understood. This electroencephalography (EEG) study examined the well-established motivational direction model of asymmetric frontal brain activity in schizophrenia. According to this model, relative left frontal activity in the resting EEG reflects enhanced approach motivation tendencies, whereas relative right frontal activity reflects enhanced withdrawal motivation tendencies. Twenty-five schizophrenia outpatients and 25 healthy controls completed resting EEG assessments of frontal asymmetry in the alpha frequency band (8-12 Hz), as well as a self-report measure of behavioral activation and inhibition system (BIS/BAS) sensitivity. Patients showed an atypical pattern of differences from controls. On the EEG measure patients failed to show the left lateralized activity that was present in controls, suggesting diminished approach motivation. On the self-report measure, patients reported higher BIS sensitivity than controls, which is typically interpreted as heightened withdrawal motivation. EEG asymmetry scores did not significantly correlate with BIS/BAS scores or with clinical symptom ratings among patients. The overall pattern suggests a motivational disturbance in schizophrenia characterized by elements of both diminished approach and elevated withdrawal tendencies.

Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy

Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n=52) and healthy comparison (n=37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocognition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocognition and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed.

Increasing stimulus duration can normalize late-positive event related potentials in people with schizophrenia: Possible implications for understanding cognitive deficits

This study determined whether increasing stimulus duration for patients with schizophrenia normalized late Event Related Potentials (ERPs) associated with modulation of response to emotion-evoking stimuli. These ERPs are decreased in patients versus healthy controls when both view stimuli of the same duration. Subjects viewed pictures of hands and judged whether the events depicted were painful or non-painful. Pictures were presented to patients for 500 or 800 ms and to healthy controls for 200 or 500 ms. Participants were 19 adult outpatients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder and 18 healthy controls, as assessed by the Structured Clinical Interview. ERPs to neutral stimuli during a 350-900 ms window following stimulus onset were subtracted from ERPs during this same response window to pain stimuli. The area under this difference wave reflected the degree of pain-related positivity and was the dependent measure for analysis. Patient late-positive ERP responses following 500 and 800 ms stimuli were highly similar to responses in healthy controls following 200 and 500 ms stimuli respectively. Patients and controls differed significantly when responses to 500 ms stimuli were compared. People with schizophrenia are known to process information more slowly than healthy people. Our results indicate that slowed early processing of sensory input may limit engagement of higher cognitive and regulatory processes in patients with schizophrenia. This may be one reason that self-regulation is compromised in patients, and may help explain why measures of slowed information processing account for so much variance in other cognitive deficits in schizophrenia.

Emotion self-regulation and empathy depend upon longer stimulus exposure

Observation of others in pain induces positive elevation (pain effect) in late event-related potentials (ERP). This effect is associated with top-down attention regulating processes. It has previously been shown that stimulus exposure duration can affect top-down attentional modulation of response to threat-related stimuli. We investigated the effect of exposure duration on ERP response to others in pain. Two late ERP components, P3 and late positive potentials (LPP), from 18 healthy people were measured while they viewed pictures of hands in painful or neutral situations for either 200 or 500 ms, during two task conditions (pain judgment and counting hands). P3 and LPP pain effects during the pain judgment condition were significantly greater with 500 ms than 200 ms stimulus presentation. Ours is the first study to suggest that engagement of empathy-related self-regulatory processes reflected in late potentials requires longer exposure to the pain-related stimulus. Although this is important information about the relationship between early sensory and subsequent brain processing, and about engagement of self-regulatory processes, the neural basis of this time-dependence remains unclear. It might be important to investigate the relationship between stimulus duration and empathic response in clinical populations where issues of self-regulation, empathic response and speed of information processing exist.