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Riehle M, Straková A, Lincoln TM. Emotional Experience of People With Schizophrenia and People at Risk for Psychosis: A Meta-Analysis. JAMA Psychiatry 2024; 81:57-66. [PMID: 37755868 PMCID: PMC10535019 DOI: 10.1001/jamapsychiatry.2023.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 09/28/2023]
Abstract
Importance Psychotic symptoms are associated with subjective reports of aberrant emotion, such as excessive fear or anhedonia, but whether these aberrations reflect aberrant emotional experience of normative stimuli is uncertain both for individuals with schizophrenia and those at risk for psychosis. Objective To provide a meta-analysis of study samples of emotional experience in individuals with schizophrenia and those at risk for psychosis as assessed in laboratory-based emotion-induction studies. Data Sources MEDLINE and PsycINFO databases were searched for articles published from January 1986 and Google Scholar citations of a relevant earlier meta-analysis until August 2022. Reference lists were manually searched for additional studies. Study Selection Included studies measured positive or negative emotional experience in response to standardized emotionally evocative stimuli and compared participants diagnosed with schizophrenia or participants at risk for psychosis with healthy controls. Data Extraction and Synthesis The meta-analysis was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by 2 independent coders, and random-effects analyses were conducted. Main Outcomes and Measures Outcomes were 3 scales of emotional experience (unipolar positive emotion, unipolar negative emotion, bipolar valence), analyzed separately for pleasant, neutral, and unpleasant stimuli. A meta-analysis was conducted for differences between the 2 clinical groups combined and controls. Subgroup differences (schizophrenia vs at risk) and the influence of several other variables were tested in moderator analyses. Results This systematic review and meta-analysis included data from 111 studies and 6913 participants (schizophrenia: 2848 [41.2%]; at risk: 877 [12.7%]; healthy controls: 3188 [46.1%]). Compared with controls, people with schizophrenia and those at risk for psychosis experienced pleasant stimuli as less positive (unipolar positive: standardized mean difference [SMD] Hedges g = -0.19; P =.001; bipolar valence: SMD Hedges g = -0.28; P <.001) and more negative (Hedges g = 0.52; P <.001), neutral stimuli as more negative (Hedges g = 0.55; P <.001), and unpleasant stimuli as both more positive (unipolar positive: SMD Hedges g = 0.23; P =.005; bipolar valence: Hedges g = 0.12; P =.01) and more negative (Hedges g = 0.22; P <.001). Moderator analyses indicated a less aberrant emotional experience for odors than for visual stimuli (unipolar negative, pleasant z score = -2.97; P =.003; unipolar negative, neutral z score = -2.70; P =.007), an association between higher negative symptoms and diminished positive emotion for pleasant stimuli in schizophrenia (z score = -2.98; P =.003), and that subgroup differences were limited to neutral stimuli. Conclusions and Relevance Results suggest a pattern of aberrant emotional experience of normative stimuli in schizophrenia and that this already was observable before disorder onset. In particular, the aberrant experience of pleasant stimuli needs to be considered as an intervention target.
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Affiliation(s)
- Marcel Riehle
- Institute for Psychology, Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Alexandra Straková
- Department of Psychology, Comenius University in Bratislava, Bratislava, Slovakia
| | - Tania M. Lincoln
- Institute for Psychology, Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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Pishdadian S, Martins F, Milanovic M, Doell FK, Kidd SA, Grossman MJ. Emotion regulation relates to clinical characteristics and quality of life but not daily functioning in psychosis spectrum outpatients. J Psychiatr Res 2023; 161:289-297. [PMID: 36947960 DOI: 10.1016/j.jpsychires.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention.
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Affiliation(s)
- Sara Pishdadian
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 4700 Keele Street, York University, Toronto, ON, M3J 1P3, Canada
| | - Felicia Martins
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 1265, Military Trail, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada
| | - Melissa Milanovic
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Faye K Doell
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Sean A Kidd
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Michael J Grossman
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada.
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Igra L, Shilon S, Kivity Y, Atzil-Slonim D, Lavi-Rotenberg A, Hasson-Ohayon I. Examining the associations between difficulties in emotion regulation and symptomatic outcome measures among individuals with different mental disorders. Front Psychol 2023; 14:944457. [PMID: 36998365 PMCID: PMC10043222 DOI: 10.3389/fpsyg.2023.944457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundDifficulties in emotion regulation (ER) abilities have been found to play a central role in different psychiatric disorders. However, researchers rarely compare ER across different diagnostic groups. In the current study, we examined ER and its relation to functional and symptomatic outcome among three distinct diagnostic groups: people with schizophrenia (SCZ), people with emotional disorders (EDs; i.e., depression and/or anxiety), and individuals without any psychiatric diagnosis (controls).MethodsParticipants in this study comprised 108 adults who requested psychotherapy at a community clinic in the year 2015 and between 2017 and 2019. Clients were interviewed and filled out questionnaires measuring depression, distress, and difficulties in ER abilities.ResultsResults showed that individuals with psychiatric diagnoses reported higher levels of difficulties in ER abilities than did controls. Moreover, there were very few differences in levels of ER difficulty between SCZ and EDs. Further, the associations between maladaptive ER and psychological outcomes were significant in each diagnostic group, and especially for SCZ.ConclusionOur study indicates that difficulties in ER abilities partially have a transdiagnostic nature, and that these difficulties are associated with psychological outcomes among both clinical populations and controls. There were very few differences in levels of ER ability difficulties between SCZ and EDs, suggesting that the two groups share difficulties in relating and responding to emotional distress. The associations between difficulties in ER abilities and outcome were more robust and stronger among SCZ than the other groups, highlighting the potential contribution of targeting ER abilities in the treatment of schizophrenia.
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Pinpointing affective disturbances in psychosis: A comparison of temporal affect dynamics in individuals with psychotic disorders, individuals with attenuated psychotic symptoms, and clinical and healthy controls. J Psychiatr Res 2022; 153:260-268. [PMID: 35843067 DOI: 10.1016/j.jpsychires.2022.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 05/08/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022]
Abstract
Affective disturbances in psychosis are well-documented but our understanding of their phenotypic nature in everyday life remains limited. Filling this gap could advance mechanistic models of the affective pathway to psychosis and pave the ground for new research avenues. Therefore, this study focused on temporal affect dynamics in psychosis, i.e., the patterns with which affect fluctuates over time. We applied experience-sampling with nine assessments per day over one week in participants with psychotic disorders (PSY), participants with attenuated psychotic symptoms (AS), clinical controls with obsessive compulsive disorders (OCD) and healthy controls (HC; total N = 139) to assess whether in PSY and AS, dynamics in affective valence and arousal are characterized by higher instability (i.e., extreme and frequent moment-to-moment fluctuations of affect intensities), higher affective variability (i.e., larger range of affect intensities), or lower inertia (i.e., higher frequency of affective changes), compared to the clinical and healthy control samples. Mixed-model ANOVAs revealed higher instability in both PSY and OCD compared to HC, but no significant differences for variability and inertia. AS had an intermediate position and did not differ significantly from any other group. We found evidence for small to medium effect sizes for the influence of mean affect levels on the dynamic indicators. Our findings indicate that individuals with psychotic disorders have increased affective instability and that this could be a transdiagnostic phenomenon. Zooming in on the variability and inertia components did not confer additional benefits. Emotion-focused interventions for psychosis should focus on reducing frequent and extreme affective fluctuations.
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Schnabel K, Petzke TM, Witthöft M. The emotion regulation process in somatic symptom disorders and related conditions - A systematic narrative review. Clin Psychol Rev 2022; 97:102196. [DOI: 10.1016/j.cpr.2022.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/31/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022]
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Lawlor C, Vitoratou S, Duffy J, Cooper B, De Souza T, Le Boutillier C, Carter B, Hepworth C, Jolley S. Managing emotions in psychosis: Evaluation of a brief DBT-informed skill group for individuals with psychosis in routine community services. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:735-756. [PMID: 35130354 PMCID: PMC9543194 DOI: 10.1111/bjc.12359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/19/2022] [Indexed: 12/02/2022]
Abstract
Objectives Individuals with psychosis report that emotion regulation (ER) difficulties are treatment priorities, yet little is known about how targeted ER interventions may help. We evaluated a new eight‐session Dialectical Behavioural Therapy (DBT)–informed skills group specifically adapted for individuals with psychosis: the Managing Emotions Group (MEG) in diverse, inner‐city community services. Method A mixed‐method design was utilised to assess the feasibility (acceptability and potential clinical impact) of local delivery of MEG. Uptake, completion (≥50% of sessions), post‐session satisfaction ratings, and thematic analysis of qualitative feedback from 12 completers assessed acceptability. Pre–post‐intervention changes in psychological distress, self‐reported ER difficulties, and adaptive ER skill use assessed potential clinical impact. Results Forty‐eight individuals (81% of attenders) completed the intervention (Mage = 43, 54% female) of whom 39 completed pre‐ and post‐group measures. Participants reported high satisfaction and meaningful improvements in understanding and managing emotions, with positive impact on daily life. Self‐reported psychological distress, ER difficulties, and adaptive ER skill use significantly improved, with medium‐to‐large pre‐post effects (d = 0.5–0.7) except lack of emotional clarity (d = 0.3). Conclusions MEG was feasible and acceptable, and a future feasibility randomised controlled trial is warranted. Practitioner points Individuals with psychosis report that support with their emotions is a priority. Brief interventions for emotion regulation difficulties are acceptable to individuals with psychosis and can be feasibly delivered in a local outpatient service. Distress and emotion regulation difficulties and skills improved significantly from pre–post treatment for clients completing the managing emotions group. Further implementation and evaluation are needed to support continued refinement to meet the needs and priorities of individuals with psychosis.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Duffy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Cooper
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Clair Le Boutillier
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ben Carter
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Bahlinger K, Lincoln TM, Clamor A. Are Acute Increases and Variability in Emotion Regulation Strategies Related to Negative Affect and Paranoid Thoughts in Daily Life? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Negative affect reliably predicts paranoid thoughts. Previous studies point to the importance of emotion regulation for paranoid thoughts but have not yet focused on effects of acute increases and variability in strategy use.
Methods
We conducted an experience-sampling study for one week in a subclinical sample. Acute increases in the intensity of strategy use from one measurement point until the next, between-strategy variability (i.e., standard deviation between all strategies at one measurement point), and within-strategy variability (i.e., standard deviation of each strategy over one day) were analyzed for effects on negative affect and paranoid thoughts.
Results
Multi-level-models indicated that acute increases in acceptance and reappraisal are associated with less negative affect. Acute increases in acceptance, but not in reappraisal, were related to less paranoid thoughts. In contrast, acute increases in rumination and suppression were associated with more negative affect and paranoid thoughts. Between- and within-strategy variability were no significant predictors.
Conclusions
Acute increases in the intensity of but not variability in emotion regulation strategies are related to negative affect and paranoid thoughts in daily life. Future studies are needed to examine whether improving emotion regulation leads to sustainable reductions in symptoms.
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Popa CO, Predatu R, Lee WC, Blaga P, Sirbu E, Rus AV, Clark A, Cojocaru C, Schenk A, Vacaras V, Szasz S, Muresan S, Bredicean C. Thought Suppression in Primary Psychotic Disorders and Substance/Medication Induced Psychotic Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010116. [PMID: 33375300 PMCID: PMC7795668 DOI: 10.3390/ijerph18010116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Introduction: First episode-psychosis (FEP) represents a stressful/traumatic event for patients. To our knowledge, no study to date has investigated thought suppression involved in FEP in a Romanian population. Our objective was to investigate thought suppression occurring during FEP within primary psychotic disorders (PPD) and substance/medication induced psychotic disorders (SMIPD). Further, we examined the relationship between thought suppression and negative automatic thoughts within PPD and SMIPD. Methods: The study included 30 participants (17 females) with PPD and 25 participants (10 females) with SMIPD. Psychological scales were administered to assess psychotic symptoms and negative automatic thoughts, along a psychiatric clinical interview and a biochemical drug test. Results: Participants in the PPD group reported higher thought suppression compared to SMIPD group. For the PPD group, results showed a positive correlation between thought suppression and automatic thoughts. For the SMIPD group, results also showed a positive correlation between thought suppression and automatic thoughts. Conclusions: Patients with PPD rely more on thought suppression, as opposed to SMIPD patients. Thought suppression may be viewed as an unhealthy reaction to FEP, which is associated with the experience of negative automatic thoughts and might be especially problematic in patients with PPD. Cognitive behavioral therapy is recommended to decrease thought suppression and improve patients’ functioning.
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Affiliation(s)
- Cosmin O. Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania;
| | - Razvan Predatu
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania;
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, 400015 Cluj-Napoca, Romania
- Correspondence: (R.P.); (S.M.)
| | - Wesley C. Lee
- Department of Social and Behavioral Sciences, Southwestern Christian University, Bethany, OK 73008, USA; (W.C.L.); (A.V.R.)
| | - Petronela Blaga
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania;
- Doctoral School “Evidence-based Assessment and Psychological Interventions”, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania
| | - Eliza Sirbu
- Doctoral School of George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania; (E.S.); (C.C.); (A.S.)
| | - Adrian V. Rus
- Department of Social and Behavioral Sciences, Southwestern Christian University, Bethany, OK 73008, USA; (W.C.L.); (A.V.R.)
| | - Alexander Clark
- College of Education and Professional Studies, University of Central Oklahoma, Edmond, OK 73034, USA;
| | - Cristiana Cojocaru
- Doctoral School of George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania; (E.S.); (C.C.); (A.S.)
| | - Alina Schenk
- Doctoral School of George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania; (E.S.); (C.C.); (A.S.)
| | - Vitalie Vacaras
- Neurology Department, Cluj Emergency County Hospital, 400006 Cluj-Napoca, Romania;
| | - Simona Szasz
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania;
| | - Simona Muresan
- Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania
- Correspondence: (R.P.); (S.M.)
| | - Cristina Bredicean
- Department of Neuroscience, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania;
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Educational Response to a Student with Psychosis at the Secondary Level: A Non-Experimental Single-Case Study. Eur J Investig Health Psychol Educ 2020; 10:1080-1094. [PMID: 34542437 PMCID: PMC8314312 DOI: 10.3390/ejihpe10040076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Students with psychosis in school within the ordinary education system are a reality in the classroom. To study their correct adaptation at school, it is necessary to consider numerous factors such as the personal characteristics of the student, environmental variables, educational measures put in place as well as emotional and cognitive aspects. The aim of this research was to monitor the teaching-learning process of a student diagnosed with psychosis and enrolled in a public school at the secondary level in the ordinary modality with support during an academic year, with the usual resources provided by a guidance department to assess the impact of the educational measures and plans on his emotional and academic fields. This was a single case study in which both qualitative and quantitative information was collected (N = 1). The participant was a student with special needs at the secondary level. An analysis of the results of psychometric tests, plan for diversity, observational analysis, academic file, scholastic history, and multiple interviews were carried out. The findings show how the educational curriculum can be adapted to improve the competences of a student with psychosis by encouraging an increase in social abilities and potential cognitive abilities through the counseling department. The conclusions of this research can provide a guideline for comparison of different educational systems, paying greater attention to the development of emotional aspects, and opting for inclusive measures. In this line, this study shows that students with psychosis can share classrooms and studies with their peers, thus fulfilling the principle of educational inclusion.
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