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Sandsten KE, Jensen MT, Saebye D, Null K, Northoff G, Parnas J. Altered cardiac autonomic functioning associates with self-disorders in schizophrenia. Schizophr Res 2024; 270:57-62. [PMID: 38865806 DOI: 10.1016/j.schres.2024.06.003] [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: 02/11/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
Elevated resting heart rate (RHR) and reduced heart rate variability (HRV) are signs of autonomic nervous system dysfunction identified in schizophrenia (SCZ). This dysfunction has been found to manifest prior to the onset of the clinical diagnosis. Yet whether such autonomic dysfunction is associated with vulnerability to schizophrenia remains unknown. This case-control study included recent onset SCZ patients (n = 35) and healthy controls (HC) (n = 33). Patients were scored for self-disorders (SD's) using the EASE manual and all participants underwent a 5-minute resting state electrocardiogram (ECG) recording. Patients were included from outpatient clinics in Denmark. The main measures comprised EASE total scores (SDs), RHR (beats per minute) and three standard HRV measures usually included in testing autonomic nervous system dysfunction: root mean squared of successive differences (RMSSD), standard deviation of normal-to-normal interval (SDNN) and high-frequency/ low frequency ratio (HF/LF). Pearson correlations and linear regression models adjusted for age, sex and medication were used in the SCZ group. The main finding was a positive moderate association between SDs and RHR (r = 0.463; p = 0.005) and a negative association between SDs and HRV (RMSSD) (r = -0.440; p = 0.008) in the SCZ group. Linear regression models found SDs to explain 22 % of the variance of RHR and 19 % in RMSSD. SDs correlated with LF/HF (r = 0.434; p = 0.009), but non-significantly with SDNN. The study provides evidence of an intriguing link between SDs as a susceptibility trait for schizophrenia spectrum disorders and altered cardiac autonomic functioning.
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Affiliation(s)
| | - Magnus T Jensen
- William Harvey Research Institute, NIHR Bart's Biomedical Research Centre, Queen Mary University of London, United Kingdom; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Denmark
| | - Ditte Saebye
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Kaylee Null
- Department of Psychology, University of California Los Angeles, United States of America
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, Ont., Canada
| | - Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, Denmark
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2
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Phalen P, Kimhy D, Jobes D, Bennett M. Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review. Eur Arch Psychiatry Clin Neurosci 2024; 274:955-961. [PMID: 37597022 DOI: 10.1007/s00406-023-01675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
There is a pressing need for effective treatments that address the high rate of suicide observed among people with psychosis. In this scoping review we highlight two suicidogenic treatment targets that have been relatively neglected in people with psychotic disorders: emotional distress and emotion dysregulation. We review the research on these constructs in psychosis and their relationship to suicide in this population, and then make clinical recommendations based on research findings. Emotional distress and emotional dysregulation may be promising treatment targets for suicide among people with psychosis.
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Affiliation(s)
- Peter Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA.
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA
- Education and Clinical Center, James J. Peters VA Medical Center, Mental Illness Research, New York, NY, USA
| | - David Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Melanie Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA
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3
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Bradley ER, Portanova J, Woolley JD, Buck B, Painter IS, Hankin M, Xu W, Cohen T. Quantifying abnormal emotion processing: A novel computational assessment method and application in schizophrenia. Psychiatry Res 2024; 336:115893. [PMID: 38657475 DOI: 10.1016/j.psychres.2024.115893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/31/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Abnormal emotion processing is a core feature of schizophrenia spectrum disorders (SSDs) that encompasses multiple operations. While deficits in some areas have been well-characterized, we understand less about abnormalities in the emotion processing that happens through language, which is highly relevant for social life. Here, we introduce a novel method using deep learning to estimate emotion processing rapidly from spoken language, testing this approach in male-identified patients with SSDs (n = 37) and healthy controls (n = 51). Using free responses to evocative stimuli, we derived a measure of appropriateness, or "emotional alignment" (EA). We examined psychometric characteristics of EA and its sensitivity to a single-dose challenge of oxytocin, a neuropeptide shown to enhance the salience of socioemotional information in SSDs. Patients showed impaired EA relative to controls, and impairment correlated with poorer social cognitive skill and more severe motivation and pleasure deficits. Adding EA to a logistic regression model with language-based measures of formal thought disorder (FTD) improved classification of patients versus controls. Lastly, oxytocin administration improved EA but not FTD among patients. While additional validation work is needed, these initial results suggest that an automated assay using spoken language may be a promising approach to assess emotion processing in SSDs.
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Affiliation(s)
- Ellen R Bradley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, CA, USA.
| | - Jake Portanova
- Department of Biomedical Informatics and Medical Education, University of Washington, WA, USA
| | - Josh D Woolley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, CA, USA
| | - Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Ian S Painter
- Department of Statistics, University of Washington, USA
| | | | - Weizhe Xu
- Department of Biomedical Informatics and Medical Education, University of Washington, WA, USA
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, WA, USA; Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
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4
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Lho SK, Kim T, Moon SY, Kim M, Kwon JS. Alteration in left frontoparietal connectivity correlates with impaired cognitive reappraisal in early psychosis. Schizophr Res 2024; 267:130-137. [PMID: 38531160 DOI: 10.1016/j.schres.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Impaired cognitive reappraisal is a notable symptom of early psychosis, but its neurobiological basis remains underexplored. We aimed to identify the underlying neurobiological mechanism of this impairment by using resting-state functional connectivity (FC) analyses focused on brain regions related to cognitive reappraisal. METHODS Resting-state functional magnetic resonance images were collected from 36 first-episode psychosis (FEP) patients, 32 clinical high-risk (CHR) individuals, and 48 healthy controls (HCs). Whole-brain FC maps using seed regions associated with cognitive reappraisal were generated and compared across the FEP, CHR and HC groups. We assessed the correlation between resting-state FC, reappraisal success ratio, positive symptom severity and social functioning controlling for covariates. RESULTS FEP patients showed higher FC between the left superior parietal lobe and left inferior frontal gyrus than HCs. Higher FC between the left superior parietal lobe and left inferior frontal gyrus negatively correlated with the reappraisal success ratio in the FEP group after controlling for covariates. Lower FC correlated with lower positive symptom severity and improved global functioning in the FEP group. CONCLUSIONS Alteration in left frontoparietal connectivity reflects impaired cognitive reappraisal in early psychosis, and such alteration correlates with increased positive symptoms and decreased global functioning. These findings offer a potential path for interventions targeting newly emerging symptoms in the early stages of psychosis.
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Affiliation(s)
- Silvia Kyungjin Lho
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sun-Young Moon
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Public Health Service, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jun Soo Kwon
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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5
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Moran EK, Shapiro M, Culbreth AJ, Nepal S, Ben-Zeev D, Campbell A, Barch DM. Loneliness in the Daily Lives of People With Mood and Psychotic Disorders. Schizophr Bull 2024; 50:557-566. [PMID: 38429937 PMCID: PMC11059807 DOI: 10.1093/schbul/sbae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND HYPOTHESIS Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning. STUDY DESIGN The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N = 59), bipolar disorder (N = 61), unipolar depression (N = 60), remitted unipolar depression (N = 51), and nonclinical comparisons (N = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life. STUDY RESULTS Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F(4,284) = 28.00, P < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = -0.44, t = 6.40, P < .001). Furthermore, passive sensing measures showed that greater movement (β = -0.56, t = -3.29, P = .02) and phone calls (β = -0.22, t = 12.79, P = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life. CONCLUSIONS These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness.
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Affiliation(s)
- Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Madelyn Shapiro
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, Baltimore, MD, USA
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Dror Ben-Zeev
- Department of Psychiatry, BRiTE Center, University of Washington, Seattle, WA, USA
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Romero-Ayuso DM, Toledano-González A, Pinilla-Cerezo M, Sánchez-Rodríguez Ó, García-Arenas JJ, Triviño-Juárez JM, Ortíz-Rubio A. Occupational Balance and Emotional Regulation in People With and Without Serious Mental Illness. Can J Occup Ther 2024; 91:100-109. [PMID: 37271981 DOI: 10.1177/00084174231178440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background. Serious mental illness affects daily functioning, including occupational balance. Purpose. This study aims to compare occupational balance and emotional regulation between people with serious mental illness and the healthy population and to examine the relationship between occupational balance and emotional regulation. Method. A cross-sectional study was performed. Occupational balance and emotional regulation were measured using the Occupational Balance Questionnaire and the Emotional Regulation Questionnaire, respectively. A multivariate analysis (analysis of covariance) was conducted. Findings. The sample consisted of 112 individuals, divided into two groups: the serious mental illness group (n = 55); and the healthy group (n = 57). People with serious mental illness reported lower occupational balance and lower cognitive reappraisal than the healthy population. Furthermore, the higher cognitive reappraisal, the higher the occupational balance, and the higher the expressive suppression, the lower the occupational balance. Conclusion. The results provide preliminary evidence of the relationship between occupational balance and emotional regulation.
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Nardelli C, Bonanno GA, Chen S, Bortolon C. Emotion regulation flexibility and psychosis: A longitudinal study disentangling components of flexibility in psychosis-proneness. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:54-72. [PMID: 37846929 DOI: 10.1111/bjc.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Flexibility in self-regulation has emerged as an important component of mental health. Previous findings found that deficits in two components of regulatory flexibility were linked cross-sectionally to psychosis-proneness. We aimed to replicate and extend these findings longitudinally. METHODS We measured psychosis-proneness and components of emotion regulation flexibility (i.e. context sensitivity, repertoire and feedback) at two time points with three months in between. RESULTS Two flexibility components predicted psychotic-like experiences. The ability to detect the absence of contextual cues was implicated in both positive and negative dimensions but through opposite pathways. Expressive suppression ability-a subcomponent of repertoire-predicted positive symptoms. None of the flexibility components predicted distress related to the symptoms. CONCLUSIONS The current study provides further evidence on the implication of emotion regulation flexibility in the longer-term maintenance of psychotic-like experiences. Future studies can advance this work further by evaluating possible bidirectional relationships between psychotic-like experiences and deficits in emotion regulation flexibility.
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Affiliation(s)
- Carla Nardelli
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | | | - Shuquan Chen
- Teachers College, Columbia University, New York, USA
| | - Catherine Bortolon
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France
- Institut Universitaire de France, Paris, France
- C3R - Réhabilitation psychosociale et remédiation cognitive, Centre Hospitalier Alpes Isère, Grenoble, France
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8
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Beals K, Torregrossa LJ, Smith R, Lane RD, Sheffield JM. Impaired emotional awareness is associated with childhood maltreatment exposure and positive symptoms in schizophrenia. Front Psychiatry 2024; 14:1325617. [PMID: 38283891 PMCID: PMC10811959 DOI: 10.3389/fpsyt.2023.1325617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives Evidence suggests that emotional awareness-the ability to identify and label emotions-may be impaired in schizophrenia and related to positive symptom severity. Exposure to childhood maltreatment is a risk factor for both low emotional awareness and positive symptoms. Methods The current investigation examines associations between a performance-based measure of emotional awareness, positive symptom severity, and childhood maltreatment exposure in 44 individuals with a schizophrenia-spectrum disorder and 48 healthy comparison participants using the electronic Levels of Emotional Awareness Scale (eLEAS), Positive and Negative Syndrome Scale (PANSS) and Childhood Trauma Questionnaire (CTQ). Results Patients demonstrated significant deficits in emotional awareness overall, which was true for both self and others. In patients, lower emotional awareness was significantly associated with more severe positive symptoms. Emotional awareness was significantly impaired in patients with schizophrenia with self-reported maltreatment exposure, relative to other groups. Severity of maltreatment was not significantly associated with emotional awareness or positive symptoms when looking continuously, and there was no significant indirect effect. Conclusion These data suggest that emotional awareness impairments observed in schizophrenia may be exacerbated by exposure to childhood maltreatment, possibly putting individuals at greater risk for experiencing positive symptoms of psychosis.
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Affiliation(s)
- Kendall Beals
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
- Social Cognition and Recovery in Schizophrenia Lab, Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, United States
| | - Lénie J. Torregrossa
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Richard David Lane
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Julia M. Sheffield
- Sheffield Lab, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Raugh IM, Strauss GP. Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome. Behav Ther 2024; 55:55-67. [PMID: 38216237 PMCID: PMC10787159 DOI: 10.1016/j.beth.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.
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10
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Jiang J, Ferguson MA, Grafman J, Cohen AL, Fox MD. A Lesion-Derived Brain Network for Emotion Regulation. Biol Psychiatry 2023; 94:640-649. [PMID: 36796601 DOI: 10.1016/j.biopsych.2023.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Emotion regulation has been linked to specific brain networks based on functional neuroimaging, but networks causally involved in emotion regulation remain unknown. METHODS We studied patients with focal brain damage (N = 167) who completed the managing emotion subscale of the Mayer-Salovey-Caruso Emotional Intelligence Test, a measure of emotion regulation. First, we tested whether patients with lesions to an a priori network derived from functional neuroimaging showed impaired emotion regulation. Next, we leveraged lesion network mapping to derive a de novo brain network for emotion regulation. Finally, we used an independent lesion database (N = 629) to test whether damage to this lesion-derived network would increase the risk of neuropsychiatric conditions associated with emotion regulation impairment. RESULTS First, patients with lesions intersecting the a priori emotion regulation network derived from functional neuroimaging showed impairments in the managing emotion subscale of the Mayer-Salovey-Caruso Emotional Intelligence Test. Next, our de novo brain network for emotion regulation derived from lesion data was defined by functional connectivity to the left ventrolateral prefrontal cortex. Finally, in the independent database, lesions associated with mania, criminality, and depression intersected this de novo brain network more than lesions associated with other disorders. CONCLUSIONS The findings suggest that emotion regulation maps to a connected brain network centered on the left ventrolateral prefrontal cortex. Lesion damage to part of this network is associated with reported difficulties in managing emotions and is related to increased likelihood of having one of several neuropsychiatric disorders.
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Affiliation(s)
- Jing Jiang
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa; Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, Massachusetts; Department of Neurology, Harvard Medical School, Boston, Massachusetts.
| | - Michael A Ferguson
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, Massachusetts; Department of Neurology, Harvard Medical School, Boston, Massachusetts; Center for the Study of World Religions, Harvard Divinity School, Cambridge, Massachusetts
| | - Jordan Grafman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Shirley Ryan Ability Laboratory, Chicago, Illinois
| | - Alexander L Cohen
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, Massachusetts; Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, Massachusetts; Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham & Women's Hospital, Boston, Massachusetts
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Raugh IM, Bartolomeo LA, Zhang L, James SH, Strauss GP. Deconstructing emotion regulation in schizophrenia: The nature of abnormalities at the selection and implementation stages. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:908-920. [PMID: 37668572 PMCID: PMC10592206 DOI: 10.1037/abn0000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Difficulties with emotion regulation are observed across psychiatric diagnoses, including psychotic disorders. Past studies using trait self-report indicate that people with schizophrenia (SZ) are less likely to use adaptive emotion regulation strategies and more likely to use maladaptive emotion regulation strategies than controls (CN). However, more recent evidence using ecological momentary assessment (EMA) indicates that regulation effectiveness and adaptiveness may vary across strategies. The present study aimed to systematically understand abnormalities in state-level emotion regulation strategy selection, effectiveness, and adaptiveness in SZ compared to CN using EMA. Participants (n = 50 SZ; n = 53 CN) completed 6 days of EMA surveys assessing emotional experience, emotion regulation, and symptoms. Results indicated that SZ selected interpersonal emotion regulation and avoidance more often than CN, while both groups selected reappraisal and distraction more often than avoidance and suppression. Overall, strategies were effective at reducing negative emotion and adaptive for reducing delusions over time. Reappraisal, avoidance, and suppression all significantly down-regulated delusions over time. Although some selection abnormalities were present in terms of rate of selection and effort exertion, people with SZ select strategies which are effective and adaptive in the short term. The present results have implications for how cognitive therapy for psychosis may target delusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia
| | | | - Luyu Zhang
- Department of Psychology, University of Georgia
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12
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Kimhy D, Ospina LH, Beck-Felts K, Lister A, Omene C, Bodenhausen G, Mittal V. Psychiatric and affective predictors of negative racial attitudes. Psychiatry Res 2023; 327:115376. [PMID: 37531817 DOI: 10.1016/j.psychres.2023.115376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
Negative Racial Attitudes (NRA) have been identified as major contributors to discrimination and inequalities. Previous studies of predictors of NRA have focused largely on socioeconomic, socialization, social attitudes, and personality characteristics. Yet, the potential links of psychiatric and affective indicators to NRA have received little scientific inquiry. Three-hundred-and-two participants completed measures of explicit, covert, and implicit NRA, along with indices of psychotic-like experiences (PLEs), mood symptoms, affective processing, social attitudes, and personality characteristics. Explicit and covert NRA were significantly correlated with difficulty identifying and describing feelings, use of suppression to regulate emotion, and the PLEs domains of perceptual abnormalities, bizarre experiences, and persecutory ideation, along with social attitudes and personality characteristics. Implicit NRA was not associated with any indicators. Next, employing hierarchical multiple linear regression analyses, the affective and psychiatric indicators accounted 5.2% and 10.4% of the explicit and covert NRA variance, respectively, controlling for previously identified predictors including demographics, social attitudes, and personality characteristics. Our results point to newly identified predictors of NRA including difficulties identifying and describing emotions, use of suppression to regulate emotions, as well as PLEs, specifically perceptual abnormalities. We discuss the implications of the findings to the development and adaptation of anti-racism interventions.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; MIRECC, The James J. Peters VA Medical Center, Bronx, NY, United States.
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Amanda Lister
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Coral Omene
- Rutgers Cancer Institute of New Jersey, Rutgers - The State University of New Jersey, New Brunswick, NJ, United States
| | - Galen Bodenhausen
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Vijay Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
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13
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Raugh IM, Spilka M, Luther L, Suveg CM, Strauss GP. Ecological Momentary Assessment Of State Fluctuations In Mindfulness And Symptoms In Psychotic Disorders. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 29:219-229. [PMID: 37720056 PMCID: PMC10501155 DOI: 10.1016/j.jcbs.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; n = 49) and healthy controls (CN; n = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.
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Affiliation(s)
- Ian M. Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Michael Spilka
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Cynthia M. Suveg
- Department of Psychology, University of Georgia, Athens, GA, USA
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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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15
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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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16
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Berglund AM, James SH, Raugh IM, Strauss GP. Beliefs About the Uncontrollability and Usefulness of Emotion in the Schizophrenia-Spectrum: Links to Emotion Regulation and Negative Symptoms. COGNITIVE THERAPY AND RESEARCH 2023; 47:282-294. [PMID: 36779179 PMCID: PMC9894745 DOI: 10.1007/s10608-023-10357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
Background Beliefs about the usefulness and controllability of emotions are associated with emotion regulation and psychological distress in the general population. Although individuals with schizophrenia-spectrum disorders evidence emotion regulation abnormalities, it is unclear whether emotional beliefs contribute to these difficulties and their associated poor clinical outcomes. Methods Participants included 72 individuals with schizophrenia-spectrum diagnoses (outpatients with schizophrenia n = 38; youth at clinical high-risk for psychosis, n = 34) and healthy controls (CN: n = 61) who completed the Emotional Beliefs Questionnaire, Emotion Regulation Questionnaire, and measures of clinical symptom severity. Results Those with schizophrenia-spectrum diagnoses reported believing that emotions were less controllable than CN; however, groups did not differ regarding beliefs about the usefulness of emotion. Greater beliefs of the uncontrollability of emotion were associated with greater use of suppression, less use of reappraisal, and increased negative symptoms. Emotion regulation partially mediated the association between emotional beliefs and negative symptoms. Conclusions Individuals in the schizophrenia-spectrum display superordinate beliefs that emotions are uncontrollable. These beliefs may influence emotion regulation strategy selection and success, which contributes to negative symptoms. Findings suggest that beliefs of emotional uncontrollability reflect a novel process related to both emotion regulation and negative symptoms that could be targeted in psychosocial treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10357-w.
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Affiliation(s)
- Alysia M. Berglund
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Sydney H. James
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
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17
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Dysregulated affective arousal regulates reward-based decision making in patients with schizophrenia: an integrated study. SCHIZOPHRENIA 2022; 8:26. [PMID: 35314840 PMCID: PMC8938557 DOI: 10.1038/s41537-022-00234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/10/2022] [Indexed: 11/08/2022]
Abstract
Schizophrenia is a chronic and severe mental disorder. Dysregulated decision-making and affective processing have been implicated in patients with schizophrenia (SZ) and have significant impacts on their cognitive and social functions. However, little is known about how affective arousal influences reward-based decision-making in SZ. Taking advantage of a two-choice probabilistic gambling task and utilizing three facial expressions as affective primes (i.e., neutral, angry, and happy conditions) in each trial, we investigated how affective arousal influences reward-related choice based on behavioral, model fitting, and feedback-related negativity (FRN) data in 38 SZ and 26 healthy controls (CTRL). We also correlated our measurements with patients’ symptom severity. Compared with the CTRL group, SZ expressed blunted responses to angry facial primes. They had lower total game scores and displayed more maladaptive choice strategies (i.e., less win-stay and more lose-shift) and errors in monitoring rewards. Model fitting results revealed that the SZ group had a higher learning rate and lower choice consistency, especially in the happy condition. Brain activity data further indicated that SZ had smaller amplitudes of FRN than their controls in the angry and happy conditions. Importantly, the SZ group exhibited attenuated affective influence on decision-making, and their impairments in decision-making were only correlated with their clinical symptoms in the angry condition. Our findings imply the affective processing is dysregulated in SZ and it is selectively involved in the regulation of choice strategies, choice behaviors, and FRN in SZ, which lead to impairments in reward-related decision-making, especially in the angry condition.
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18
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Igra L, Sened H, Lavi-Rotenberg A, Pijnenborg M, Lysaker PH, Hasson-Ohayon I. Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy. J Psychiatr Res 2022; 156:460-466. [PMID: 36335836 DOI: 10.1016/j.jpsychires.2022.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/18/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests that in-session emotional experiences in psychotherapy promote both session and treatment outcomes across different clinical samples and treatment approaches. However, little is known about how this notion applies to clients with schizophrenia, who experience particular deficits related to emotional experience. To explore this question, we investigated the association between clients' emotional experience and their session outcome evaluations and metacognitive growth in a metacognitively-oriented treatment, Metacognitive Reflection and Insight Therapy (MERIT). MERIT is a recovery-oriented treatment approach for psychosis that focuses on recapturing a coherent sense of self and personal agency by enhancing metacognitive capacity. METHOD Five-hundred-and-sixty-three sessions of 37 clients with schizophrenia who took part in an ongoing MERIT trial were analyzed. The Emotional Experience Self-Report (EE-SR) and Outcome Rating Scale (ORS) were collected on a session-by-session basis. Levels of metacognition ware assessed pre- and post-treatment using the Metacognitive Assessment Scale-Abbreviated (MAS-A) coding system. We used multilevel modeling to test our session-level predictions, and linear regression analysis for treatment-level predictions. RESULTS Greater emotional experience, expression, and regulation within a session were associated with better session outcome. Regarding treatment level, greater emotional experience was associated with improvement in metacognitive mastery. CONCLUSIONS Our findings reveal that experiencing emotions in MERIT has significant implications for clients' subjective well-being during therapy sessions and for their ability to respond to psychological challenges using metacognitive knowledge. These findings lend weight to the idea that emotional experience is a key mechanism of change in metacognitive therapy for schizophrenia.
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Affiliation(s)
- Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
| | - Haran Sened
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | - Marieke Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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19
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Relationships among inflammation, social cognition, and social functioning in schizophrenia. Schizophr Res 2022; 248:366-367. [PMID: 34561146 DOI: 10.1016/j.schres.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 11/24/2022]
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20
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Sood M, Carnelley KB, Newman‐Taylor K. Do emotion regulation strategies mediate the attachment-paranoia association? An experimental study of repeated attachment imagery priming and stress buffering. Psychol Psychother 2022; 95:781-806. [PMID: 35570714 PMCID: PMC9543866 DOI: 10.1111/papt.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Paranoia describes unfounded interpersonal threat beliefs. Secure attachment imagery attenuates paranoia, but limited research examines mechanisms of change and no studies examine how secure imagery may be implemented most effectively in clinical practice. In this study, we tested: (a) the causal impact of secure, anxious, and avoidant attachment imagery on paranoia and anxiety, (b) whether emotion regulation strategies mediate these relationships, and (c) whether secure imagery buffers against social stress. DESIGN We utilized a longitudinal, experimental design. METHOD A general population sample with high non-clinical paranoia (N = 265) completed measures of paranoia, anxiety, and emotion regulation strategies. Participants were randomly allocated to secure, anxious, or avoidant conditions and repeated an imagery prime for four days prior to a social stress task. RESULTS Relative to anxious and avoidant imagery, secure imagery decreased state paranoia and anxiety. These associations were not mediated by state emotion regulation strategies, and secure imagery did not buffer against stress. Exploratory analyses on trait variables revealed that: (a) hyperactivating strategies mediated the association between attachment anxiety and paranoia, and (b) suppression mediated the association between attachment avoidance and paranoia. CONCLUSIONS Secure attachment imagery reduces state paranoia and anxiety and could be incorporated into psychotherapies to attenuate clinical paranoia. Measurement of state emotion regulation was problematic. Attachment imagery does not buffer stress; further research is required to test whether secure imagery facilitates recovery from stress. Attachment style is likely to account for trait paranoia via attachment-congruent emotion regulation strategies. Research is now needed to determine if these strategies can be targeted to alleviate paranoia in clinical populations.
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Affiliation(s)
- Monica Sood
- School of PsychologyUniversity of SouthamptonSouthamptonUK
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21
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Raugh IM, Strauss GP. Deconstructing emotion regulation in schizophrenia: the nature and consequences of abnormalities at the identification stage. Eur Arch Psychiatry Clin Neurosci 2022; 272:1061-1071. [PMID: 34716486 DOI: 10.1007/s00406-021-01350-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
Existing evidence suggests that emotion regulation is abnormal in schizophrenia and associated with undesirable clinical outcomes. However, this literature is based predominantly on trait self-report and does not indicate which stages of emotion regulation (identification, selection, implementation) are impaired. The current study focused on determining the nature of abnormalities at the identification stage using ecological momentary assessment (EMA). Participants included clinically stable outpatients with schizophrenia (SZ; n = 48) and healthy controls (CN; n = 52) who completed 6 days of EMA. The EMA surveys assessed emotional experience, emotion regulation, and symptoms. Results indicated that SZ identified the need to regulate at a higher rate than CN. Specifically, SZ displayed an inefficient threshold for identifying the need to regulate, such that they regulated too much when negative affect was low and too little when negative affect was high. Emotion regulation effort exertion was also inefficient, such that effort was too high at low levels of negative affect and too low at high levels of negative affect in SZ. These identification stage abnormalities also demonstrated differential associations with positive and negative symptoms. Findings suggest that identification stage abnormalities may create a bottleneck that feeds forward and impacts subsequent stages of emotion regulation in SZ that are critically related to symptoms. Targeting the psychological processes underlying these identification stage abnormalities might offer a novel means of treating positive and negative symptoms in schizophrenia.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA, 30602, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA, 30602, USA.
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22
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Vines L, Bridgwater M, Bachman P, Hayes R, Catalano S, Jalbrzikowski M. Elevated emotion reactivity and emotion regulation in individuals at clinical high risk for developing psychosis and those diagnosed with a psychotic disorder. Early Interv Psychiatry 2022; 16:724-735. [PMID: 34528404 DOI: 10.1111/eip.13212] [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: 01/25/2021] [Revised: 06/29/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022]
Abstract
AIMS Disrupted affective processes are core features of psychosis; yet emotion reactivity and emotion regulation impairments have not been fully characterized in individuals at clinical high-risk for developing psychosis (CHR) or adolescents diagnosed with a psychotic disorder (AOP). Characterizing these impairments may provide a fuller understanding of factors contributing to psychosis risk and psychosis onset. Using cross-sectional and longitudinal data, we evaluated (1) group-level effects of emotion reactivity and regulation, (2) stability of group-level effects over time and age, (3) relationships between emotion reactivity and regulation, and (4) associations between these measures and psychosocial functioning and clinical symptomatology. METHODS Eighty-seven participants (CHR = 32, TD = 42, AOP = 13; 12-25 years, 1-5 visits) completed the Emotion Reactivity Scale, Difficulties in Emotion Regulation Scale, and Emotion Regulation Questionnaire. We assessed psychotic symptoms with the Structured Interview for Prodromal Syndromes and measured real-world functioning with the Global Functioning: Social and Role Scales. We used analysis of variance to assess Aim 1 and linear mixed models to address Aims 2-4. RESULTS CHR and AOP endorsed experiencing heightened levels of emotion reactivity and greater difficulty utilizing emotion regulation strategies compared to TD. These impairments were stable across time and adolescent development. Greater levels of emotion reactivity were associated with greater emotion regulation impairments. Greater impairments in emotion regulation were associated with lower social functioning and greater negative symptom severity. CONCLUSION Therapeutic interventions designed to reduce emotion reactivity and improve one's ability to utilize emotion regulation strategies may be effective in reducing clinical symptomatology and improving real-world functioning in CHR and AOP.
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Affiliation(s)
- Leah Vines
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miranda Bridgwater
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA
| | - Peter Bachman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Hayes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sabrina Catalano
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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23
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Uzun G, Lok N. Effect of emotional awareness skills training on emotional awareness and communication skills in patients with schizophrenia: A Randomized Controlled Trial. Arch Psychiatr Nurs 2022; 38:14-20. [PMID: 35461642 DOI: 10.1016/j.apnu.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/08/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was conducted to examine the effect of emotional awareness skills training on emotional awareness and communication skills in patients with schizophrenia. METHODS This randomized controlled trial was conducted with 44 patients with schizophrenia (22 in the intervention group and 22 in the control group) registered at a community mental health center. The personal information form, Toronto Alexithymia Scale (TAS-20), and communication skills scale-adult form were used to collect patient data. The emotional awareness skills training was implemented once a week for 8 weeks. RESULTS After the training, the mean scores of the "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" subscales of TAS-20 decreased and the mean scores of the communication skills scale-adult form increased in the intervention group; the difference between the groups was statistically significant. While there was no difference between the groups in the initial measurements, a significant difference was found between the mean scores of "Difficulty Identifying Feelings" and "Difficulty Describing Feelings" in the intervention group and a significant difference was found in both groups between the subscales of "Basic Skills and Personal (Self) Expression", "Willingness to Communicate", "Caring Communication" and "Active Listening and Non-Verbal Communication" and the total mean score after the intervention. CONCLUSION Based on the study results, it can be concluded that emotional awareness skills training is an effective psychiatric nursing intervention that improves emotional awareness and communication skills. NCT05038927.
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Affiliation(s)
- Gülten Uzun
- Selcuk University, Health Sciences Institute, Department of Nursing, 42130 Konya, Turkey.
| | - Neslihan Lok
- Selcuk University, Nursing Faculty, Department of Mental Health and Psychiatric Nursing, 42130 Konya, Turkey.
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24
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Phalen P, Grossmann J, Bruder T, Jeong JY, Calmes C, McGrath K, Malouf E, James A, Romero E, Bennett M. Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System. EVALUATION AND PROGRAM PLANNING 2022; 92:102098. [PMID: 35525095 DOI: 10.1016/j.evalprogplan.2022.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/30/2021] [Accepted: 04/17/2022] [Indexed: 06/14/2023]
Abstract
A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6-8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.
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Affiliation(s)
- Peter Phalen
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States.
| | | | | | - Jae Yeon Jeong
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
| | | | | | | | | | - Erin Romero
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
| | - Melanie Bennett
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
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25
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Weiss EM, Deisenhammer EA, Fink A, Marksteiner J, Canazei M, Papousek I. Disorder-Specific Profiles of Self-Perceived Emotional Abilities in Schizophrenia and Major Depressive Disorder. Brain Sci 2022; 12:brainsci12030356. [PMID: 35326312 PMCID: PMC8945907 DOI: 10.3390/brainsci12030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Deficits in social cognition are a core feature of neuropsychiatric disorders. The purpose of this study was to compare profiles of self-perceived abilities across the core domains of emotional functioning between patients with schizophrenia (n = 22), major depressive disorder (n = 31) and healthy participants (n = 43) with the Self-report Emotional Ability Scale (SEAS). Profile analyses were used to explore group differences in the overall level of self-perceived effectiveness of emotional functioning and in the patterns in which the four functions of emotion perception and regulation in the intra- and inter-personal domains are arranged to each other. Both patient groups showed significantly lower overall levels of self-perceived emotional functioning compared to healthy controls. Most importantly, we found significant differences between patient groups in their profile patterns. Patients with schizophrenia indicated experiencing difficulties in all investigated domains, but the profile pattern largely matched that of healthy individuals. Instead, the profile of patients with depression was much more accentuated, showing lower perceived effectiveness of emotion perception and regulation in the intra-personal domain compared to inter-personal functions. Our results of disorder-specific emotional deficits may have profound implications for early screening and identification of at-risk populations as well as recovery-oriented interventions.
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Affiliation(s)
- Elisabeth M. Weiss
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
- Correspondence:
| | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Andreas Fink
- Department of Psychology, University of Graz, 8010 Graz, Austria; (A.F.); (I.P.)
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria;
| | - Markus Canazei
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Ilona Papousek
- Department of Psychology, University of Graz, 8010 Graz, Austria; (A.F.); (I.P.)
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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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Bartolomeo LA, Raugh IM, Strauss GP. Deconstructing emotion regulation in schizophrenia: The nature and consequences of abnormalities in monitoring dynamics. Schizophr Res 2022; 240:135-142. [PMID: 35026598 PMCID: PMC8917994 DOI: 10.1016/j.schres.2021.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/09/2021] [Accepted: 12/25/2021] [Indexed: 02/03/2023]
Abstract
Prior studies implicate abnormalities at the identification, selection, and implementation stages of Gross' extended process model of emotion regulation in schizophrenia. However, it is unclear whether monitoring dynamics (i.e., emotion regulation maintenance, switching, and stopping), another critical component of the model, are also abnormal or what predicts those abnormalities. The current study evaluated switching (i.e., switching to a different emotion regulation strategy because the initial strategy was not effective) and stopping dynamics (i.e., terminating the implementation of an emotion regulation strategy) and their associated mechanisms using 6 days of ecological momentary assessment in 47 outpatients with schizophrenia or schizoaffective disorder (SZ) and 52 healthy controls (CN). Results indicated that individuals with SZ exhibited excessive switching between emotion regulation strategies and delayed stopping compared to CN, self-efficacy moderated group differences in stopping abnormalities, and switching and stopping abnormalities were associated with different patterns of state-level positive and negative symptoms in SZ. Findings may inform psychosocial emotion regulation therapies for SZ that could incorporate elements for monitoring dynamics and associated mechanisms.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, United States
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28
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Pathways from insecure attachment to paranoia: the mediating role of emotion regulation. Behav Cogn Psychother 2022; 50:404-417. [DOI: 10.1017/s1352465822000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism.
Aims:
This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia.
Method:
Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point.
Results:
As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia.
Conclusion:
Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.
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29
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Damme KSF, Gupta T, Haase CM, Mittal VA. Responses to positive affect and unique resting-state connectivity in individuals at clinical high-risk for psychosis. Neuroimage Clin 2022; 33:102946. [PMID: 35091254 PMCID: PMC8800133 DOI: 10.1016/j.nicl.2022.102946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
Individuals at clinical high-risk for psychosis (CHR) report dampened positive affect, while this deficit appears to be an important clinical marker, our current understanding of underlying causes is limited. Dysfunctional regulatory strategies (i.e., abnormal use of dampening, self-focused, or emotion-focused strategies) may account for dampening affect but has not yet been examined. Participants (57 CHR and 56 healthy controls) completed the Response to Positive Affect Scale, clinical interviews, and resting-state scan examining nucleus accumbens (NAcc) connectivity. Individuals at CHR for psychosis showed greater dampening (but no differences in self/emotion-focus) in self-reported response to positive affect compared to healthy controls. In individuals at CHR, higher levels of dampening and lower levels of self-focus were associated with higher positive and lower negative symptoms. Dampening responses were related to decreased dorsal and rostral anterior cingulate cortex-NAcc resting-state connectivity in the CHR group but increased dorsal and rostral anterior cingulate cortex-NAcc resting-state connectivity in the healthy control group. Self-focused responses were related to increased dorsolateral prefrontal cortex-NAcc resting-state connectivity in the CHR group but decreased resting-state connectivity in the healthy control group. Self-reported dampening of positive affect was elevated in individuals at CHR for psychosis. Dampening and self-focused responses were associated with distinct resting-state connectivity compared to peers, suggesting unique mechanisms underlying these emotion regulation strategies. Responses to positive affect may be a useful target for cognitive treatment, but individuals at CHR show distinct neurocorrelates and may require a tailored approach.
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Affiliation(s)
- Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA.
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
| | - Claudia M Haase
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA; Human Development and Social Policy, Northwestern University, Evanston, IL, USA; Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA; Human Development and Social Policy, Northwestern University, Evanston, IL, USA; Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA; Department of Psychiatry, Northwestern University, Chicago, IL, USA; Medical Social Sciences, Northwestern University, Chicago, IL, USA
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30
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von Hardenberg L, Leopold K, Stenzel N, Kallenbach M, Aliakbari N, Bechdolf A, Mehl S. Feasibility and efficacy of an acceptance and mindfulness-based group intervention for young people with early psychosis (Feel-Good group). Front Psychiatry 2022; 13:943488. [PMID: 36186856 PMCID: PMC9522968 DOI: 10.3389/fpsyt.2022.943488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over the last decade, researchers have sought for alternative interventions that have better treatment effects than Cognitive Behavioral Therapy (CBT) when treating psychotic symptoms. Mindfulness-based interventions have been a proposed alternative to CBT, yet research regarding its feasibility, acceptance and effectiveness is lacking when treating individuals with early psychosis in inpatient settings. OBJECTIVE Before conducting a large-scale randomized-controlled trial (RCT), this pilot study evaluated the feasibility and the potential efficacy of a mindfulness-based inpatient group intervention that targets emotion regulation in patients with early psychosis, and thus indirectly improving psychotic symptoms. METHODS A pre-post study was performed. Thirty-six patients with early psychosis treated at the specialized inpatient treatment "Frühinterventions- und Therapiezentrum; FRITZ" (early intervention and therapy center) received eight group therapy sessions. Assessments were performed at baseline, after 8 weeks post treatment and at follow-up after 16 weeks. RESULTS Rates of patients who participated in the study suggests that a mindfulness-based group therapy is highly accepted and feasible for patients with early psychosis being treated in an inpatient ward. Friedman analyses revealed significant changes in the primary outcomes of emotional goal attainment (Goal 1: W = 0.79; Goal 2: W = 0.71) and psychotic symptoms (PANSS-T: W = 0.74). Significant, albeit small, effect sizes were found in patients' self-perception of emotion regulation skills (ERSQ: W = 0.23). DISCUSSION We found favorable findings regarding the feasibility and acceptance of the Feel-Good mindfulness-based intervention. Results of the study provide a basis for an estimation of an adequate sample size for a fully powered RCT that needs to be conducted to test whether Feel-Good is effective in the inpatient treatment of psychotic symptoms for individuals with early psychosis. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT04592042], identifier [NCT04592042].
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Affiliation(s)
- Laura von Hardenberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nikola Stenzel
- Department of Psychology, Psychologische Hochschule Berlin (PHB), Berlin, Germany
| | - Michèle Kallenbach
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Navid Aliakbari
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Mehl
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior, Philipps-University Marburg, Marburg, Germany.,Department of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt, Germany
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31
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Maaßen E, Büttner M, Bröcker AL, Stuke F, Bayer S, Hadzibegovic J, Just SA, Bertram G, Rau R, von Haebler D, Lempa G, Montag C. Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders. Front Psychol 2021; 12:725787. [PMID: 34858263 PMCID: PMC8632138 DOI: 10.3389/fpsyg.2021.725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
The ability to mentalize (i.e., to form representations of mental states and processes of oneself and others) is often impaired in people with schizophrenia spectrum disorders. Emotional awareness (EA) represents one aspect of affective mentalizing and can be assessed with the Levels of Emotional Awareness Scale (LEAS), but findings regarding individuals with schizophrenia spectrum disorders are inconsistent. The present study aimed at examining the usability and convergent validity of the LEAS in a sample of N = 130 stabilized outpatients with schizophrenia or schizoaffective disorders. An adequacy rating was added to the conventional LEAS rating to account for distortions of content due to, for example, delusional thinking. Scores of the patient group were compared with those of a matched healthy control sample. Correlation with symptom clusters, a self-report measure of EA, a measure of synthetic metacognition (MAS-A-G), and an expert rating capturing EA from the psychodynamic perspective of psychic structure (OPD-LSIA) were examined. Regarding self-related emotional awareness, patients did not score lower than controls neither in terms of conventional LEAS nor in terms of adequacy. Regarding other-related emotional awareness, however, patients showed a reduced level of adequacy compared to controls whereas no such difference was found for conventional LEAS scores. Higher conventional LEAS scores were associated with fewer negative symptoms, and higher structural integration of self-perceptions measured by the OPD-LSIA. Higher adequacy of responses correlated with fewer symptoms of disorganization as well as excitement, higher scores of self-reflection on the MAS-A-G as well as self- and object-perception and internal and external communication as measured by the subscales of the OPD-LSIA. Findings suggest that the LEAS might not be sensitive enough to detect differences between mildly symptomatic patients with schizophrenia or schizoaffective disorders and healthy controls. However, LEAS ratings are still suitable to track intraindividual changes in EA over time. Observing the adequacy of patients’ responses when using the LEAS may be a promising way to increase diagnostical utility and to identify patterns of formal and content-related alterations of mentalizing in this patient group. Methodological indications for future studies are discussed.
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Affiliation(s)
- Eva Maaßen
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marielle Büttner
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Samuel Bayer
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Psychoanalytic University Berlin, Berlin, Germany
| | - Jasmina Hadzibegovic
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sandra Anna Just
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Richard Rau
- Department of Psychology, University of Münster, Münster, Germany
| | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Psychoanalytic University Berlin, Berlin, Germany
| | | | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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32
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Barbato M, Arora T, Al Hemeiri S, AlJassmi MA. Looking within: Interoceptive sensibility in young adults with psychotic-like experiences. Early Interv Psychiatry 2021; 15:1705-1712. [PMID: 33442933 DOI: 10.1111/eip.13117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/13/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
AIM Interoception is the ability to sense internal bodily changes and research indicates that it may play a role in the development of mental illness. In recent years, preliminary evidence has shown that interoception is impaired in people with psychosis. Interoceptive sensibility, a meta-cognitive aspect of interoception, has never been studied across the psychosis continuum. The present study aimed at assessing interoceptive sensibility in youth with psychotic-like experiences. METHOD We invited a sample of young adults (N = 609; age 19-21 years) to complete an online survey that included a measure of interoceptive sensibility (the Multidimensional Assessment of Interoceptive Awareness-2) and the Community Assessment of Psychotic Experiences-Positive Scale -15 (CAPE-P15). Using the recommended cutoff for the CAPE-P15, the overall sample was divided into two groups (high/low risk for psychosis). RESULTS Significant group differences were observed in several dimensions of interoceptive sensibility. A logistic regression analysis indicated that scores in the subscales of Not-Distracting, Not-Worrying, Attention-Regulation, Emotional Awareness, Body Listening, and Trusting significantly predicted increased risk for psychosis. CONCLUSION Abnormal interoceptive sensibility may be a vulnerability marker for psychosis. These results, however, await further validation from additional comprehensive, longitudinal studies. Enhanced interoceptive sensibility has been reported following contemplative training, thus creating opportunities for future interventions to delay or prevent psychotic illness.
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Affiliation(s)
- Mariapaola Barbato
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Teresa Arora
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | | | - Maryam A AlJassmi
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
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33
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Lawlor C, Vitoratou S, Hepworth C, Jolley S. Self-reported emotion regulation difficulties in psychosis: Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS-16). J Clin Psychol 2021; 77:2323-2340. [PMID: 33971018 DOI: 10.1002/jclp.23164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Individuals with psychosis self-report difficulties in understanding, relating, and responding to emotions as treatment priorities, yet we lack comprehensive, reliable, and valid assessments for routine clinical use. METHODS The psychometric properties of a brief version of the Difficulties in Emotion Regulation Scale-16 (DERS-16) were examined using anonymized data from a sample of 150 outpatients with psychosis. RESULTS Confirmatory factor analysis supported the five-factor structure of the DERS-16. The model fit was further improved by omitting two items. Measurement invariance was shown with respect to age and gender. The DERS-16 demonstrated good internal consistency, well comparable to the original DERS. Evidence toward convergent validity is also presented. CONCLUSION Findings suggest that the DERS-16 is a reliable and valid measure of self-reported emotion regulation difficulties in individuals with psychosis. Further research on the clinical utility of the DERS-16 is needed, including examination of its test-retest reliability and predictive validity in response to targeted interventions.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,North Lambeth Promoting Recovery Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Hepworth
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Suzanne Jolley
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,North Lambeth Promoting Recovery Team, South London and Maudsley NHS Foundation Trust, London, UK
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Jáni M, Kikinis Z, Lošák J, Pasternak O, Szczepankiewicz F, Heller C, Swago S, Silva A, Bouix S, Kubicki M, Ustohal L, Kudlička P, Vojtíšek L, Westin CF, Kašpárek T. Emotional Awareness in Schizophrenia Is Associated With Gray Matter Volume of Right Precuneus. Front Psychiatry 2021; 12:601742. [PMID: 33868042 PMCID: PMC8046932 DOI: 10.3389/fpsyt.2021.601742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: We assessed the relationship between emotional awareness (e.g., the ability to identify and differentiate our own feelings and feelings of others) and regional brain volumes in healthy and in schizophrenia groups. Methods: Magnetic resonance images of 29 subjects with schizophrenia and 33 matched healthy controls were acquired. Brain gray matter was parcellated using FreeSurfer and 28 regions of interest associated with emotional awareness were analyzed. All participants were assessed using the Levels of Emotional Awareness Scale (LEAS) of Self and of Other. LEAS scores were correlated with gray matter volume for each hemisphere on the 14 brain regions of the emotional awareness network. Results: Individuals with schizophrenia showed decreased emotional awareness on both LEAS Self and LEAS Other compared to healthy controls. There were no statistically significant between-group differences in gray matter volumes of the emotional awareness network. The performance on LEAS Other correlated negatively with right precuneus gray matter volume only in the schizophrenia group. Conclusion: Our findings suggest a relationship between gray matter volume of the right precuneus and deficits in understanding of emotional states of others in schizophrenia.
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Affiliation(s)
- Martin Jáni
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
- Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Zora Kikinis
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jan Lošák
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Filip Szczepankiewicz
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Carina Heller
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sophia Swago
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Annelise Silva
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sylvain Bouix
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
- VA Boston Healthcare System, Brockton Division, Brockton, MA, United States
| | - Libor Ustohal
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
| | - Petr Kudlička
- Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Lubomír Vojtíšek
- Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Carl-Frederik Westin
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czechia
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35
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Edwards ER, Rose NLJ, Gromatsky M, Feinberg A, Kimhy D, Doucette JT, Goodman M, McClure MM, Perez-Rodriguez MM, New AS, Hazlett EA. Alexithymia, Affective Lability, Impulsivity, and Childhood Adversity in Borderline Personality Disorder. J Pers Disord 2021; 35:114-131. [PMID: 33650890 DOI: 10.1521/pedi_2021_35_513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Long-standing theories of borderline personality disorder (BPD) suggest that symptoms develop at least in part from childhood adversity. Emotion dysregulation may meaningfully mediate these effects. The current study examined three factors related to emotion dysregulation-alexithymia, affective lability, and impulsivity-as potential mediators of the relation between childhood adversity and BPD diagnosis in 101 individuals with BPD and 95 healthy controls. Path analysis compared three distinct models informed by the literature. Results supported a complex mediation model wherein (a) alexithymia partially mediated the relation of childhood adversity to affective lability and impulsivity; (b) affective lability mediated the relation of childhood adversity to BPD diagnosis; and (c) affective lability and impulsivity mediated the relation of alexithymia to BPD diagnosis. Findings suggest that affective lability and alexithymia are key to understanding the relationship between childhood adversity and BPD. Interventions specifically targeting affective lability, impulsivity, and alexithymia may be particularly useful for this population.
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Affiliation(s)
- Emily R Edwards
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York
| | - Nina L J Rose
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Molly Gromatsky
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York
| | - Abigail Feinberg
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Kimhy
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John T Doucette
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai
| | - Marianne Goodman
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret M McClure
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychology, Fairfield University, Fairfield, Connecticut
| | | | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin A Hazlett
- Mental Health Research, Education, and Clinical Center (MIRECC VISN-2), James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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Scheerer NE, Boucher TQ, Iarocci G. Alexithymia is related to poor social competence in autistic and nonautistic children. Autism Res 2021; 14:1252-1259. [PMID: 33616273 DOI: 10.1002/aur.2485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/21/2021] [Indexed: 11/11/2022]
Abstract
Alexithymia is characterized by difficulties identifying and describing one's own emotions and the emotions of others. These challenges with understanding emotions in people with alexithymia may give rise to difficulties with social interactions. Given that alexithymia frequently co-occurs with autism spectrum disorder (ASD), and that both populations have difficulties with social interactions, it is of interest to determine whether alexithymia can help to parse some of the heterogeneity in social competence in autistic and nonautistic individuals. The caregivers of 241 children (6-14 years old), including 120 autistic, and 121 nonautistic, rated their child's social competence using the Multidimensional Social Competence Scale (MSCS), autism traits using the Autism Spectrum Quotient (AQ), and alexithymia traits using the Children's Alexithymia Measure (CAM). Regression analyses indicated that age, IQ, sex, AQ, and CAM scores accounted for 40.2% of the variance in autistic children's, and 68.2% of the variance in nonautistic children's, parent-reported social competence. Importantly, after controlling for age, IQ, sex, and AQ scores, CAM scores alone accounted for an additional 16.2% of the variance in autistic children's, and 17.4% of the variance in nonautistic children's social competence. These results indicate that higher alexithymia traits predict lower levels of social competence, suggesting that increased difficulty in identifying and describing one's own emotions and the emotions of others is associated with poorer social competence. Furthermore, CAM scores were found to partially mediate the relationship between autistic traits and social competence, suggesting that comorbid alexithymia traits may be partially responsible for poor social competence in individuals with high autistic traits. This research contributes to the understanding of the factors associated with the development of social competence and highlights alexithymia as a potential target for identification and intervention to improve social competence. LAY SUMMARY: Alexithymia is a condition where people find it hard to think and talk about their (and others') feelings. About 50% of autistic people have alexithymia. This might be why they have social and emotional difficulties. Parents answered questions about alexithymia and social difficulties their children have. Children with more alexithymia problems had poorer social skills. Thus, alexithymia may be related to social problems faced by autistic and nonautistic children.
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Affiliation(s)
- Nichole E Scheerer
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,The Brain and Mind Institute, Western Interdisciplinary Research Building, University of Western Ontario, London, Ontario, Canada
| | - Troy Q Boucher
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Grace Iarocci
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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Enhancement of aerobic fitness improves social functioning in individuals with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:367-376. [PMID: 33389108 PMCID: PMC7778707 DOI: 10.1007/s00406-020-01220-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
Individuals with schizophrenia display substantial deficits in social functioning (SF), characterized by chronic, lifelong presentations. Yet, at present there are few effective interventions to enhance SF in this population. Emerging evidence from studies of clinical populations that display similar SF deficits suggests that aerobic exercise (AE) may improve social skills. However, this putative impact has not been investigated in schizophrenia. Employing a single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive 12 weeks of Treatment-As-Usual (TAU; n = 17) or TAU + AE (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed an evaluation of aerobic fitness (VO2max) as well as self-, informant-, and clinician-reported SF measures at baseline and after 12 weeks. Twenty-six participants completed the study (79%; TAU = 13; AE = 13). At follow-up, the AE participants improved their VO2max by 18.0% versus - 0.5% in the controls (group x time interaction, F1,24 = 12.88; p = .002). Hierarchical stepwise regression analyses indicated improvements in VO2max significantly predicted enhancement in SF as indexed by self-, informant-, and clinician-reported measures, predicting 47%, 33%, and 25% of the variance, respectively (controlling for baseline demographics, medications, mood symptoms, and social networks). Compared to the TAU group, AE participants reported significant improvement in SF (23.0% vs. - 4.2%; group × time interaction, F1,24 = 7.48, p = .012). The results indicate that VO2max enhancement leads to improvements in SF in people with schizophrenia. Furthermore, low VO2max represents a modifiable risk factor of SF in people with schizophrenia, for which AE training offers a safe, non-stigmatizing, and nearly side-effect-free intervention.
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An Analysis of the Pattern of Adaptive Emotion Regulation Associated with Low Paranoid Ideation in Healthy and Clinical Samples. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10173-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background
Research on emotion regulation and paranoid ideation has mostly focused on isolated regulation strategies and has remained largely inconclusive. According to the emotion regulation model by Berking and Whitley (in: Affect Regulation Training, Springer, New York 2014) successful modification or acceptance/tolerance of emotions requires an adequate comprehension (awareness, clarity, understanding) of emotions and adequate self-support.
Method
Building on this model, we investigated whether comprehension and self-support strengthen the negative association between modification and acceptance/tolerance and paranoid ideation. In study 1, we examined the hypotheses cross-sectionally based on questionnaire data from a combined sample (N = 125) consisting of people with a psychotic disorder, people at risk of developing psychosis, and healthy controls. In study 2, we examined the same hypotheses longitudinally by employing the experience sampling method in people with clinically relevant psychopathology below diagnostic threshold (N = 138).
Results
In study 1, the association between modification and paranoid ideation was not moderated by comprehension or self-support. However, comprehension and self-support moderated the association between acceptance/tolerance and paranoid ideation. In study 2, the interaction effect between comprehension and acceptance/tolerance on paranoid ideation was confirmed.
Conclusion
The results indicate that comprehending and accepting/tolerating emotions could be protective against paranoid ideation.
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Targeting affect leads to reduced paranoia in people with psychosis: a single case series. Behav Cogn Psychother 2020; 49:302-313. [PMID: 33070795 DOI: 10.1017/s1352465820000788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Current psychological interventions for psychosis focus primarily on cognitive and behavioural management of delusions and hallucinations, with modest outcomes. Emotions are not usually targeted directly, despite evidence that people with psychosis have difficulty identifying, accepting and modifying affective states. AIMS This study assessed the impact of emotion regulation skills practice on affect and paranoia in seven people who met criteria for a diagnosis of schizophrenia or schizoaffective disorder. METHOD The study utilised a single case ABA design and measured emotion regulation skills, affect and paranoia over baseline, intervention and withdrawal of intervention phases. We predicted that eight sessions of skills rehearsal would lead to improved emotion regulation, reduced negative affect, increased positive affect, and reduced paranoia. RESULTS Most participants were able to learn to regulate their emotions, and reported reduced negative affect and paranoia. There was no clear pattern of change for positive affect. CONCLUSIONS These findings suggest that emotion can be targeted in psychosis, and is associated with reduced paranoia. Emotion regulation may constitute a key treatment target in cognitive behavioural therapy for psychosis.
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Abstract
Emotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.
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Kim M, Hwang WJ, Park J, Kim T, Oh S, Kwon JS. Neurophysiological Correlate of Emotion Regulation by Cognitive Reappraisal and Its Association With Psychotic Symptoms in Early Psychosis. Schizophr Bull 2020; 47:87-96. [PMID: 32609340 PMCID: PMC7825098 DOI: 10.1093/schbul/sbaa080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Emotion dysregulation is crucial to both poor social functioning and psychotic symptom formation in patients with schizophrenia. The efficient use of emotion regulation strategies, such as cognitive reappraisal, has been less frequently observed in the early phases of psychotic disorder. It is unknown whether neurophysiological responses related to emotion regulation by cognitive reappraisal are altered in early psychosis. METHODS Fifty-four patients with first-episode psychosis (FEP), 34 subjects at clinical high risk (CHR) for psychosis, and 30 healthy controls (HCs) participated in event-related potential recordings during a validated emotion regulation paradigm to measure the effect of cognitive reappraisal on emotion regulation. Late positive potentials (LPPs), which reflect emotional arousal, were compared across the groups and the 3 conditions (negative, cognitive reappraisal, and neutral). The relationship among LPP modulation by cognitive reappraisal and social/role functioning and severity of psychotic symptoms was investigated in the early psychosis group. RESULTS The FEP and CHR participants showed comparably larger LPP amplitudes in the negative and cognitive reappraisal conditions than in the neutral condition, whereas the HCs presented larger LPPs in the negative condition than in the cognitive reappraisal and neutral conditions. LPP modulation by cognitive reappraisal was negatively correlated with positive symptom severity in the FEP patients and with disorganization severity in the CHR subjects. CONCLUSIONS Inefficient use of cognitive reappraisal may be related to the impaired emotion regulation and psychotic symptoms from the very beginning of psychotic disorder. This study provides the first neurophysiological evidence regarding current concepts of emotion regulation in early psychosis.
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Affiliation(s)
- Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Jihye Park
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea,To whom correspondence should be addressed; Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, Republic of Korea, 03080; tel: +82-2-2072-2972, fax: +82-2-747-9063, e-mail:
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42
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Emotion dysregulation mediates the relationship between nightmares and psychotic experiences: results from a student population. NPJ SCHIZOPHRENIA 2020; 6:15. [PMID: 32483140 PMCID: PMC7264199 DOI: 10.1038/s41537-020-0103-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/17/2020] [Indexed: 11/09/2022]
Abstract
Sleep disruption is commonly associated with psychotic experiences. While sparse, the literature to date highlights nightmares and related distress as prominent risk factors for psychosis in students. We aimed to further explore the relationship between specific nightmare symptoms and psychotic experiences in university students while examining the mediating role of emotion dysregulation. A sample (N = 1273) of student respondents from UK universities completed measures of psychotic experiences, nightmare disorder symptomology and emotion dysregulation. Psychotic experiences were significantly more prevalent in students reporting nightmares (n = 757) relative to those who did not (n = 516). Hierarchical linear regression analysis showed that psychotic experiences were significantly associated (Adjusted R2 = 32.4%) with perceived nightmare intensity, consequences and resulting awakenings, and with emotion regulation difficulties. Furthermore, multiple mediation analysis showed that the association between psychotic experiences and nightmare factors was mediated by emotion regulation difficulties. Adaptive regulation of dream content during rapid eye-movement sleep has previously been demonstrated to attenuate surges in affective arousal by controlling the intensity and variability of emotional content. Difficulties in emotion regulation may partially explain the experience of more intense and disruptive nightmares among individuals with psychotic experiences. Emotion regulation may represent an important control mechanism that safeguards dream content and sleep quality.
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Liu J, Subramaniam M, Chong SA, Mahendran R. Maladaptive cognitive emotion regulation strategies and positive symptoms in schizophrenia spectrum disorders: The mediating role of global emotion dysregulation. Clin Psychol Psychother 2020; 27:826-836. [PMID: 32358913 DOI: 10.1002/cpp.2466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022]
Abstract
Previous studies have identified a positive association between maladaptive cognitive emotion regulation strategies and positive symptoms (e.g., hallucinations and delusions) among patients with schizophrenia spectrum disorders. However, translating this finding to clinical practice is challenging. Some patients are reported to experience difficulties in correcting the use of maladaptive cognitive emotion regulation strategies in psychological therapy, which may be due to an underlying effect of global emotion dysregulation. Therefore, the present study aimed to determine the mediating or moderating role of global emotion dysregulation in the relationship between maladaptive cognitive emotion regulation strategies and positive symptoms. A total of 123 newly diagnosed patients with schizophrenia spectrum disorders completed self-report measures of maladaptive cognitive emotion regulation strategies (rumination, catastrophic thinking, self-blame, other-blame) and global emotion dysregulation. The severity of positive symptoms was rated on the Brief Psychiatric Rating Scale-Expanded. Mediation and moderation analyses were performed to test the hypothesized models. Mediation analysis revealed that global emotion dysregulation mediated the relationship between maladaptive cognitive emotion regulation strategies and positive symptoms after controlling for age, gender, ethnicity, duration of untreated psychosis, medication dosage, psychiatric comorbidities, and family history of mental illness (R2 = 23.3%, moderate effect size = 0.30). There was no moderating effect of global emotion dysregulation. The present study presents preliminary evidence on the mediating role of global emotion dysregulation in the relationship between maladaptive cognitive emotion regulation strategies and positive symptoms in schizophrenia spectrum disorders. This finding adds to our current understanding on emotion regulation phenomena in schizophrenia spectrum disorders.
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Affiliation(s)
- Jianlin Liu
- Research Division, Institute of Mental Health, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore.,Academic Development Department, Duke-NUS Medical School, Singapore
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Ifrah C, Ospina LH, Shagalow S, Beck-Felts K, Kimhy D. Cognitive insight and autonomic regulation during daily functioning in individuals with schizophrenia. Schizophr Res 2020; 218:300-301. [PMID: 32178930 DOI: 10.1016/j.schres.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Chloe Ifrah
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shaina Shagalow
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie Beck-Felts
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
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Pan DN, Hoid D, Wang ZH, Wang Y, Li X. Using questionnaires and task-related EEG signals to reveal hindered reappraisal and biased suppression in individuals with high schizotypal traits. Sci Rep 2020; 10:5529. [PMID: 32218454 PMCID: PMC7099017 DOI: 10.1038/s41598-020-62283-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022] Open
Abstract
Although impaired ability to regulate emotion is commonly reported in schizophrenic patients, the exact pattern of regulation of negative emotions in high-risk individuals remains unclear. In the current study, 26 high-schizotypy individuals paired with 26 controls completed an emotion regulation questionnaire (ERQ) and a laboratory emotion regulation task with electroencephalogram (EEG) recording. Two emotion regulation strategies, namely, reappraisal and expression suppression, were concurrently examined. The late positive potential (LPP) and frontal alpha asymmetry (FAA) were selected as two independent neural indicators of the emotion regulation effect. In the ERQ questionnaire, individuals in the high schizotypy group reported higher habitual use of suppression than the controls. During the emotion regulation task, the high schizotypy group showed no early LPP reduction in reappraisal compared with the control group and exhibited a general negative FAA pattern (left-biased alpha). In conclusion, we found that individuals with high schizotypy exhibited maladaptive regulation of negative emotions, manifested in hindered reappraisal and biased suppression; this may exacerbate the negative affect of such emotions and further serve as a risk factor for psychosis conversion. Early interventions targeting the regulation of negative emotions may be beneficial for individuals with high schizotypal traits.
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Affiliation(s)
- Dong-Ni Pan
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Delhii Hoid
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Zhen-Hao Wang
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Yi Wang
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China
| | - Xuebing Li
- Key laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 10049, China.
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Kimhy D, Lister A, Liu Y, Vakhrusheva J, Delespaul P, Malaspina D, Ospina LH, Mittal VA, Gross JJ, Wang Y. The impact of emotion awareness and regulation on psychotic symptoms during daily functioning. NPJ SCHIZOPHRENIA 2020; 6:7. [PMID: 32210232 PMCID: PMC7093537 DOI: 10.1038/s41537-020-0096-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
Emotion regulation (ER) difficulties are ubiquitous among individuals with schizophrenia and have been hypothesized to contribute to stress sensitivity and exacerbation of psychotic symptoms in this population. However, the evidence supporting this link is equivocal, potentially due to previous studies' reliance on retrospective assessments of ER and psychosis, as well as lack of consideration of putative moderators such as emotion awareness. To address these limitations, we employed experience sampling method using mobile electronic devices to investigate the links between momentary in vivo use of ER strategies (mER), emotion awareness, and psychotic symptoms during daily functioning. Fifty-four individuals with schizophrenia completed assessment of mER and psychotic symptoms, along with traditional retrospective measures of ER and symptoms. Use of mER suppression predicted significant increases in momentary experiences of thought insertion, mind reading, auditory and visual hallucinations. Use of mER reappraisal predicted significant increases in momentary experiences of suspiciousness, thought insertion, and mind reading. Emotion awareness, driven primarily by difficulties identifying feelings, moderated the impact of ER on psychotic symptoms. There were no associations between retrospective measures of ER and symptoms. Our results indicate that, among individuals with schizophrenia, emotion awareness significantly impacts the relationship between use of ER and exacerbations in psychotic symptoms during the course of daily functioning. Our results highlight the need to incorporate emotion awareness and regulation difficulties into the development of treatment models and interventions for psychosis. In addition, our results underscore the need to employ in vivo, high time-resolution assessment methods to study dynamic clinical phenomena such as ER and psychotic symptoms.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Amanda Lister
- New York State Psychiatric Institute, New York, NY, USA
| | - Ying Liu
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Chicago, IL, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University, New York, NY, USA
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Childhood trauma and psychotic experiences in a general population sample: A prospective study on the mediating role of emotion regulation. Eur Psychiatry 2020; 42:111-119. [DOI: 10.1016/j.eurpsy.2016.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 11/24/2022] Open
Abstract
AbstractBackgroundThe causal role of childhood trauma for psychosis is well established, but the mechanisms that link trauma to psychosis are largely unknown. Since childhood trauma is known to cause difficulties in emotion regulation (ER) and patients with psychosis show impaired ER, we hypothesize that impaired ER explains why people with a background of trauma are prone to psychotic experiences.MethodsThe study used a longitudinal cohort design based on a community sample (N = 562) from Germany, Indonesia, and the United States. Childhood trauma was assessed at baseline. ER and psychotic experiences (defined as positive symptom frequency and related distress) were measured repeatedly at a 4-, 8-, and 12-month follow-up. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the predictive value of ER on psychotic experiences and its mediating role in the association of childhood trauma and psychotic experiences.ResultsThe cross-lagged paths from impaired ER to symptom distress (but not frequency) were significant. However, there was also evidence for the reverse causation from symptom frequency and distress to impaired ER. ER partially mediated the significant prospective paths from childhood trauma to symptom distress.ConclusionThe findings demonstrate that ER plays a role in translating childhood trauma into distressing psychotic experiences in later life. Moreover, the findings point to a maintenance mechanism in which difficulties in ER and symptom distress exacerbate each other. Thus, ER could be a promising target for interventions aimed at prevention of psychosis.
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48
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Chavez-Baldini U, Wichers M, Reininghaus U, Wigman JTW. Expressive suppression in psychosis: The association with social context. PLoS One 2020; 15:e0230102. [PMID: 32160235 PMCID: PMC7065744 DOI: 10.1371/journal.pone.0230102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/21/2020] [Indexed: 01/10/2023] Open
Abstract
As emotion regulation deficits have been implicated in psychotic disorders, it is imperative to investigate not only the effect of regulation strategies but also how they are used. One such strategy is expressive suppression, the inhibition of emotion-expressive behavior, which may be influenced by social context. Therefore, this study aimed to investigate whether the use of expressive suppression was associated with social context and affect in daily life and if this differed between patients with psychosis and controls. Multilevel models using experience sampling method (ESM) data of 34 patients with psychotic disorders and 53 controls from the Genetic Risk and Outcome in Psychosis (GROUP) project were conducted. Expressive suppression and social context were assessed once a day for six days and daily affect was averaged per participant per day. Social context was significantly associated with the use of expressive suppression in daily life, so that the use of expressive suppression differed when in the presence of familiar versus non-familiar company when receiving negative feedback. This finding did not differ between patients and controls. This demonstrates that taking the situation into account when studying expressive suppression, and emotion regulation in general, may improve our understanding of how regulation takes place.
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Affiliation(s)
- UnYoung Chavez-Baldini
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen (UMCG), University Center Psychiatry (UCP), Groningen, The Netherlands
- * E-mail:
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen (UMCG), University Center Psychiatry (UCP), Groningen, The Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, England, United Kingdom
| | - Johanna T. W. Wigman
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen (UMCG), University Center Psychiatry (UCP), Groningen, The Netherlands
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Kolavarambath R, Sudhir PM, Prathyusha PV, Thirthalli J. Emotion Recognition, Emotion Awareness, Metacognition, and Social Functioning in Persons with Schizophrenia. Indian J Psychol Med 2020; 42:147-154. [PMID: 32346256 PMCID: PMC7173650 DOI: 10.4103/ijpsym.ijpsym_149_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/05/2019] [Accepted: 12/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emotion processing has received significant research attention in persons with schizophrenia. However, some aspects of this construct, such as emotion awareness, are less researched. In addition, there is limited work on metacognitive awareness and social functioning in persons with schizophrenia. METHODS Our sample comprised of 27 participants with schizophrenia- and 26 nonclinical controls. The clinical group was assessed on Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Tool for Recognition of Emotions in Neuropsychiatric Disorders, Toronto Alexithymia Scale, Metacognitive Assessment Scale, self-reflectiveness subscale of Beck's Cognitive Insight Scale, Scale S and Scale U subscales of the Metacognitive Assessment Scale, and Groningen's Social Dysfunction Scale. RESULTS AND CONCLUSION Participants with schizophrenia had greater deficits in emotion recognition than nonclinical controls (P = 0.05, df = 51). There was no significant correlation between emotion recognition and metacognition in the clinical group. The presence of negative symptoms was significantly associated with social functioning in persons with schizophrenia. KEY MESSAGES Clinical symptoms, in particular negative symptoms, play an important role in social functioning in persons with schizophrenia and it is necessary to address these along with social cognition in order to improve functioning.
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Affiliation(s)
- Radhika Kolavarambath
- Department of Psychology, Montfort College, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - P V Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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50
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Pinho LG, Pereira A, Chaves C, Sequeira C, Sampaio F, Correia T, Gonçalves A, Ferré‐Grau C. Affectivity in schizophrenia: Its relations with functioning, quality of life, and social support satisfaction. J Clin Psychol 2020; 76:1408-1417. [DOI: 10.1002/jclp.22943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lara G. Pinho
- Escola Superior de Enfermagem São João de Deus Universidade de Évora Évora Portugal
- Escola Superior de Saúde do Instituto Politécnico de Portalegre Portalegre Portugal
- Comprehensive Health Research Centre (CHRC) Évora Portugal
- Universitat Rovira i Virgili Tarragona Spain
| | | | - Cláudia Chaves
- Instituto de Ciências Biomédicas Abel Salazar/SIGMA – Phi Xi Chapter Porto Portugal
- CI&DETS/Politécnico de Viseu Viseu Portugal
| | - Carlos Sequeira
- Escola Superior de Enfermagem do Porto, NURSID: CINTESIS Porto Portugal
| | - Francisco Sampaio
- Faculdade de Ciências da Saúde da Universidade Fernando Pessoa, Porto/NURSID: CINTESIS Porto Portugal
| | - Tânia Correia
- Instituto de Ciências Biomédicas Abel Salazar Porto Portugal
- NURSID: CINTESIS Porto Portugal
| | - Amadeu Gonçalves
- Politécnico de Viseu Viseu Portugal
- NURSID: CINTESIS/CI&DETS Porto Portugal
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